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.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24200号 / 医博第4894号 / 新制||医||1061(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 中本 裕士, 教授 江木 盛時 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

O peptídeo-1 semelhante ao glucagon (GLP-1) é um hormônio incretina secretado pelas células L do trato gastrointestinal e liberado imediatamente após a ingestão de alimento. O GLP-1 estimula a secreção de insulina pós-prandial moderando a elevação precoce da glicose no sangue. Embora primariamente envolvido na homeostase da glicose, o GLP-1 é capaz de induzir a diurese e natriurese, quando administrado em doses farmacológicas em humanos e em roedores. Estudos prévios do nosso laboratório demonstraram que o mecanismo de ação renal do GLP-1, bem como de agonistas sintéticos do receptor GLP-1R, envolve o aumento do fluxo plasmático renal (FPR) e do ritmo de filtração glomerular (RFG) bem como a diminuição da reabsorção de sódio dependente da isoforma 3 do trocador Na?/H? (NHE3) em túbulo proximal renal. Entretanto, até o momento, nenhum estudo investigou se o GLP-1 endógeno exerce efeitos sobre o manuseio renal de sal e água, nem o seu papel fisiológico sobre a regulação da atividade do NHE3. Portanto, o objetivo deste estudo foi testar a hipótese que o GLP-1 endógeno modula a função renal de ratos, ao menos em parte, via inibição da atividade do NHE3 em túbulo renal. Para este fim, ratos Wistar (2-3 meses de idade) foram devidamente anestesiados, submetidos à traqueostomia e tiveram a veia jugular e a bexiga canuladas para infusão de uma solução contendo 100 ug/kg/min do antagonista do receptor GLP-1R exendin-9 (Ex-9, 40 uL/min) por um período de 30 minutos e para a coleta de urina, respectivamente. A infusão sistêmica de Ex-9 diminuiu a concentração de AMPc urinário e atividade da PKA cortical renal consistente com o bloqueio da sinalização deflagrada pela interação GLP-1/GLP-1R no rim. Além disso, a administração sistêmica de Ex-9 reduziu a diurese, natriurese, RFG, FPR, clearance de lítio e pH urinário. Em experimentos de microperfusão estacionária in vivo, não foram observadas diferenças no fluxo de bicarbonato dependente de NHE3 entre os túbulos proximais perfundidos com exendin-9 (2 uM) e os túbulos perfundidos com solução controle. No entanto, a perfusão tubular proximal com Ex-9 foi capaz de bloquear completamente as ações inibitórias do GLP-1 (20 nM) sobre a atividade do NHE3. Por outro lado, a infusão sistêmica do Ex-9 reduziu os níveis de fosforilação da serina 552, sítio consenso para a fosforilação por PKA localizado na região C-terminal do NHE3, e que está associado à inibição da atividade de troca Na+/H+ mediada por este transportador. Baseando-se nos achados que a infusão sistêmica do Ex-9 aumenta a reabsorção de sódio e secreção de H?, reduz o clearance do lítio e os diminui os níveis de fosforilação do NHE3 na serina 552 são consistentes com um aumento na atividade deste transportador na ausência/redução da sinalização mediada pela interação do GLP-1 endógeno com seu receptor no rim. Por sua vez, o fato do Ex-9 não afetar a atividade do NHE3 sob as condições experimentais da microperfusão estacionária in vivo é condizente com o fato do GLP-1 não ser sintetizado no néfron e sugere fortemente que é o GLP-1 filtrado que se liga ao seu receptor no túbulo proximal renal resultando na diminuição da reabsorção de bicarbonato de sódio mediada pelo NHE3. Em conjunto, estes resultados sugerem que o GLP-1 endógeno exerce efeito tônico sobre o manuseio renal de sódio e água, mediando portanto, uma relação funcional entre a homeostase glicêmica e volêmica / The glucagon like peptide-1 (GLP-1) is an incretin hormone secreted by the L-cells of the gastrointestinal tract and released immediately after ingestion of food. GLP-1 stimulates postprandial insulin secretion moderating early increase in blood glucose. Although primarily involved in glucose homeostasis, GLP-1 is capable of inducing diuresis and natriuresis when administered in pharmacologic doses in humans and rodents. Previous studies from our laboratory have shown that the renal mechanism of action of GLP-1 and synthetic agonists of GLP-1R receptor, involves an increase of renal plasma flow (RPF) and glomerular filtration rate (GFR) as well a decrease in reabsorption of sodium mediated by the Na? / H? exchanger (NHE3) isoform 3 in the renal proximal tubule. However, to date, no study has investigated whether endogenous GLP-1 exerts effects on the renal handling of salt and water, or its physiological role in the regulation of the activity of NHE3. Therefore, the aim of this study was to test the hypothesis that endogenous GLP-1 modulates renal function in rats, at least in part, via inhibition of the NHE3 in renal tubule. To this end, male Wistar rats (2-3 months old) were properly anesthetized, tracheostomized and the jugular vein and the bladder were cannulated to the infusion of a solution containing 100 ug / kg / min GLP-1R antagonist receiver exendin-9 (Ex-9, 40 uL/min) for a period of 30 minutes and to collect urine, respectively. Systemic infusion of Ex-9 reduced the urinary concentration of cAMP and the renal cortical PKA activity, consistent with the blockage of the signal triggered by the interaction of GLP-1 / GLP-1R in the kidney. Furthermore, systemic administration of ex-9 reduced diuresis, natriuresis, GFR, RPF, lithium clearance and urinary pH. In experiments of in vivo stationary microperfusion, no differences were observed in the NHE3-mediated net bicarbonate flow between proximal tubules perfused with exendin-9 (2 mM) and perfused tubules with control solution. However, the tubular proximal perfusion with Ex-9 was able to completely block the inhibitory actions of GLP-1 (20 nM) on the activity of NHE3. On the other hand, systemic infusion of Ex-9 reduced phosphorylation levels of serine 552, a consensus site for phosphorylation by PKA located in the C-terminal region of NHE3, which is associated with inhibition of exchange activity of Na+/H+ mediated by this transporter. Collectively, the findings that systemic infusion of Ex-9 increases sodium reabsorption and secretion of H+, reduces the lithium clearance and decreases the NHE3 phosphorylation at serine 552 levels are consistent with the idea that NHE3 activity is upregulated in the absence/reduction of the signaling cascade mediated by the interaction of the endogenous GLP-1 with its receptor in the kidney. In turn, the fact Ex-9 does not affect the activity of NHE3 under the experimental conditions of stationary microperfusion in vivo is consistent with the fact that GLP-1 is not synthesized in the nephron. Besides, it strongly suggests that is the filtrated GLP-1 that binds to its receptor in renal proximal tubule, resulting in a decrease in NHE3-mediated sodium bicarbonate reabsorption. Taken together, these results suggest that endogenous GLP-1 exerts a tonic effect on renal sodium and water handling, mediating therefore a functional relationship between volume and glucose homeostasis

O peptídeo-1 semelhante ao glucagon (GLP-1) é um hormônio incretina secretado pelas células L do trato gastrointestinal e liberado imediatamente após a ingestão de alimento. O GLP-1 estimula a secreção de insulina pós-prandial moderando a elevação precoce da glicose no sangue. Embora primariamente envolvido na homeostase da glicose, o GLP-1 é capaz de induzir a diurese e natriurese, quando administrado em doses farmacológicas em humanos e em roedores. Estudos prévios do nosso laboratório demonstraram que o mecanismo de ação renal do GLP-1, bem como de agonistas sintéticos do receptor GLP-1R, envolve o aumento do fluxo plasmático renal (FPR) e do ritmo de filtração glomerular (RFG) bem como a diminuição da reabsorção de sódio dependente da isoforma 3 do trocador Na?/H? (NHE3) em túbulo proximal renal. Entretanto, até o momento, nenhum estudo investigou se o GLP-1 endógeno exerce efeitos sobre o manuseio renal de sal e água, nem o seu papel fisiológico sobre a regulação da atividade do NHE3. Portanto, o objetivo deste estudo foi testar a hipótese que o GLP-1 endógeno modula a função renal de ratos, ao menos em parte, via inibição da atividade do NHE3 em túbulo renal. Para este fim, ratos Wistar (2-3 meses de idade) foram devidamente anestesiados, submetidos à traqueostomia e tiveram a veia jugular e a bexiga canuladas para infusão de uma solução contendo 100 ug/kg/min do antagonista do receptor GLP-1R exendin-9 (Ex-9, 40 uL/min) por um período de 30 minutos e para a coleta de urina, respectivamente. A infusão sistêmica de Ex-9 diminuiu a concentração de AMPc urinário e atividade da PKA cortical renal consistente com o bloqueio da sinalização deflagrada pela interação GLP-1/GLP-1R no rim. Além disso, a administração sistêmica de Ex-9 reduziu a diurese, natriurese, RFG, FPR, clearance de lítio e pH urinário. Em experimentos de microperfusão estacionária in vivo, não foram observadas diferenças no fluxo de bicarbonato dependente de NHE3 entre os túbulos proximais perfundidos com exendin-9 (2 uM) e os túbulos perfundidos com solução controle. No entanto, a perfusão tubular proximal com Ex-9 foi capaz de bloquear completamente as ações inibitórias do GLP-1 (20 nM) sobre a atividade do NHE3. Por outro lado, a infusão sistêmica do Ex-9 reduziu os níveis de fosforilação da serina 552, sítio consenso para a fosforilação por PKA localizado na região C-terminal do NHE3, e que está associado à inibição da atividade de troca Na+/H+ mediada por este transportador. Baseando-se nos achados que a infusão sistêmica do Ex-9 aumenta a reabsorção de sódio e secreção de H?, reduz o clearance do lítio e os diminui os níveis de fosforilação do NHE3 na serina 552 são consistentes com um aumento na atividade deste transportador na ausência/redução da sinalização mediada pela interação do GLP-1 endógeno com seu receptor no rim. Por sua vez, o fato do Ex-9 não afetar a atividade do NHE3 sob as condições experimentais da microperfusão estacionária in vivo é condizente com o fato do GLP-1 não ser sintetizado no néfron e sugere fortemente que é o GLP-1 filtrado que se liga ao seu receptor no túbulo proximal renal resultando na diminuição da reabsorção de bicarbonato de sódio mediada pelo NHE3. Em conjunto, estes resultados sugerem que o GLP-1 endógeno exerce efeito tônico sobre o manuseio renal de sódio e água, mediando portanto, uma relação funcional entre a homeostase glicêmica e volêmica / The glucagon like peptide-1 (GLP-1) is an incretin hormone secreted by the L-cells of the gastrointestinal tract and released immediately after ingestion of food. GLP-1 stimulates postprandial insulin secretion moderating early increase in blood glucose. Although primarily involved in glucose homeostasis, GLP-1 is capable of inducing diuresis and natriuresis when administered in pharmacologic doses in humans and rodents. Previous studies from our laboratory have shown that the renal mechanism of action of GLP-1 and synthetic agonists of GLP-1R receptor, involves an increase of renal plasma flow (RPF) and glomerular filtration rate (GFR) as well a decrease in reabsorption of sodium mediated by the Na? / H? exchanger (NHE3) isoform 3 in the renal proximal tubule. However, to date, no study has investigated whether endogenous GLP-1 exerts effects on the renal handling of salt and water, or its physiological role in the regulation of the activity of NHE3. Therefore, the aim of this study was to test the hypothesis that endogenous GLP-1 modulates renal function in rats, at least in part, via inhibition of the NHE3 in renal tubule. To this end, male Wistar rats (2-3 months old) were properly anesthetized, tracheostomized and the jugular vein and the bladder were cannulated to the infusion of a solution containing 100 ug / kg / min GLP-1R antagonist receiver exendin-9 (Ex-9, 40 uL/min) for a period of 30 minutes and to collect urine, respectively. Systemic infusion of Ex-9 reduced the urinary concentration of cAMP and the renal cortical PKA activity, consistent with the blockage of the signal triggered by the interaction of GLP-1 / GLP-1R in the kidney. Furthermore, systemic administration of ex-9 reduced diuresis, natriuresis, GFR, RPF, lithium clearance and urinary pH. In experiments of in vivo stationary microperfusion, no differences were observed in the NHE3-mediated net bicarbonate flow between proximal tubules perfused with exendin-9 (2 mM) and perfused tubules with control solution. However, the tubular proximal perfusion with Ex-9 was able to completely block the inhibitory actions of GLP-1 (20 nM) on the activity of NHE3. On the other hand, systemic infusion of Ex-9 reduced phosphorylation levels of serine 552, a consensus site for phosphorylation by PKA located in the C-terminal region of NHE3, which is associated with inhibition of exchange activity of Na+/H+ mediated by this transporter. Collectively, the findings that systemic infusion of Ex-9 increases sodium reabsorption and secretion of H+, reduces the lithium clearance and decreases the NHE3 phosphorylation at serine 552 levels are consistent with the idea that NHE3 activity is upregulated in the absence/reduction of the signaling cascade mediated by the interaction of the endogenous GLP-1 with its receptor in the kidney. In turn, the fact Ex-9 does not affect the activity of NHE3 under the experimental conditions of stationary microperfusion in vivo is consistent with the fact that GLP-1 is not synthesized in the nephron. Besides, it strongly suggests that is the filtrated GLP-1 that binds to its receptor in renal proximal tubule, resulting in a decrease in NHE3-mediated sodium bicarbonate reabsorption. Taken together, these results suggest that endogenous GLP-1 exerts a tonic effect on renal sodium and water handling, mediating therefore a functional relationship between volume and glucose homeostasis

<p>The delivery of therapeutic peptides and proteins is often challenged by a short circulation half-life, necessitating frequent injections that limit efficacy, reduce patient compliance and increase treatment cost. The covalent conjugation of therapeutic peptides and proteins, and more recently oligonucleotide-based drugs, with the “stealth” polymer poly(ethylene glycol) (PEG), termed PEGylation, is one of the most commonly used approaches to increase the in vivo half-life and reduce the immunogenicity of these therapeutic biomolecules. However, after several decades of research and clinical use, the limitations of PEGylation have begun to emerge.</p><p>Conventional methods for synthesizing peptide/protein-polymer conjugates have drawbacks including low yield, non-trivial separation of conjugates from reactants, and lack of control over site and stoichiometry of conjugation, which results in heterogeneous products with significantly compromised biological activity. Additionally, anti-PEG antibodies have been induced in patients treated with PEGylated drugs and have been shown to correlate with rapid clearance of these drugs. High levels of pre-existing anti-PEG antibodies have also been found in individuals naïve to PEGylated agents, which are associated with serious first-exposure allergic reactions.</p><p>To address the synthetic limitations of PEGylation, a general approach for the high-yield synthesis of site-specific (C-terminal) and stoichiometric (1:1) peptide/protein-polymer conjugates, named sortase-catalyzed polymer conjugation, was developed. Demonstrating proof-of-concept of the approach with green fluorescent protein (GFP) as a model protein, sortase A from Staphylococcus aureus was used to site-specifically attach an initiator solely at the C-terminus of GFP, followed by in situ growth of the PEG-based brush polymer, poly(oligo(ethylene glycol) methyl ether methacrylate) (POEGMA) from the protein macroinitiator by atom transfer radical polymerization (ATRP). Sortase-catalyzed initiator attachment proceeded with high specificity and near-complete (~ 95%) product conversion. Subsequent in situ ATRP in aqueous buffer produced 1:1 stoichiometric conjugates with > 90% yield, tunable MW, low dispersity, and no denaturation of the protein. The extraordinarily high yield compares favorably to order of magnitude losses typically seen in conventional PEGylation processes.</p><p>Next, the therapeutic potential of POEGMAlation, or the conjugation of POEGMA to a peptide or protein, was demonstrated by implementing the developed sortase-catalyzed polymer conjugation strategy with exendin-4 (exendin), a therapeutic peptide for treating type 2 diabetes, to synthesize exendin-C-POEGMA conjugates with a wide and tunable range of molecular weights (MWs) and low dispersity. A single subcutaneous injection of exendin-C-POEGMA conjugates lowered blood glucose for up to 120 h in a diabetic mouse model. Most intriguingly, we showed that appending PEG as oligomeric side-chains on the conjugated POEGMA and tuning the side-chain length completely eliminated the reactivity of exendin-C-POEGMA conjugates toward patient-derived anti-PEG antibodies without compromising in vivo efficacy. Clinically, the lack of anti-PEG antigenicity of POEGMA conjugates is expected to completely eliminate serious first-exposure allergic reactions and the accelerated blood clearance of POEGMA-drug conjugates due to pre-existing anti-PEG antibodies in patients.</p><p>Collectively, these results establish POEGMAlation as a next-generation PEGylation technology that is highly useful for improving the pharmacological performance of therapeutic biomolecules while providing a timely solution to the increasing levels of pre-existing anti-PEG antibodies in patients that are seriously hindering the safety and efficacy of traditional PEGylated drugs.</p> / Dissertation

<p><strong><p>Abstract</p><em><p>Background and aim:</p>Diabetes mellitus (DM) is a chronic and progressive illness that affects all type of populations and ages. According to World health organization (WHO) by 2030 it will be 366 million people effected world wild. Many new drugs are Glucagon-like peptide-1 (GLP-1) based therapy for treatment of type 2diabetes. GLP-1 is released from the intestinal L-cells, and is a potent stimulator of glucose-dependent insulin secretion. The aim of this study was to investigate the effect of GLP-1 and its stable analogs on cell proliferation of GLP-1 secreting GLUTag cells. <em><p>Material and methods:</p>GluTag cells were incubated for 48h in DMEM medium containing (0.5% fetal bovine serum and 100 IU/ml penicillin and 100 μg/ml streptomycin and 3mM glucose concentration) in the present or absence of the agents. DNA synthesis was measured using 3H- thymidine incorporation and Ki67 antigen staining. Western blot were performed to investigate the present of GLP-1 receptor in GLUTag cells. <em><p>Results/conclusions:</p><p>These results suggest that GLP-1 regulates proliferation of the GLP-1-secreting cell through a feedback mechanism via its receptor. Since serum GLP-1 levels are decreased in type 2 diabetic patients, the effect of GLP-1 on the GLP-1-secreting cell proliferation suggested here provides a novel beneficial long-term effect of the incretin-based drugs in clinical practice i.e. through increase of the GLP-1-secreting cell mass, augmenting the incretin effect. In addition, the feedback mechanism action of GLP-1 reveals a new insight in regulation manner of the L-cell proliferation.</p>GLP-1(7-36) increased cell proliferation in GLUTag cells, an effect which was blocked by the GLP-1 receptor antagonist exendin(9-39). The GLP-1 receptor was expressed in GluTag cells. <em><p>Keywords:</p>Incretin hormone<em>, GLP-1, GLP-1 receptor, Exendin-4, Diabetes </em></em></em></em></em></strong></p>

Transplantation of pancreatic islets is a potential treatment of type 1 diabetes that aims to restore normal blood glucose control. By encapsulating the islets in alginate, they can be protected from rejection. The aim of this thesis was to study the biology of encapsulated islets and to use the technique of microencapsulation to study the effect of transplantation in a system that is separated from direct contact with the vascular system and the host tissue at the transplantation site. Encapsulated islets can effectively reverse hyperglycaemia after transplantation into the peritoneal cavity of diabetic mice. A period of culture before encapsulation and transplantation did not affect their insulin release or curative capability. Pre-culture with exendin-4 improved insulin secretion, but not to the extent that the long term outcome in our transplantation model was improved. Despite being able to reach and retain normoglycaemia, microencapsulated islets transplanted intraperitoneally decreased in size. More specifically the number of beta cells in each individual islet was decreased. However, in contrast to previous studies using non-encapsulated islets, the alpha cell number was maintained, and thus the capsule seems to protect these peripherally located and otherwise exposed cells. As the capsule also prevents revascularisation of the islets, the model was used to study the importance of vascular supply for islet amyloid formation. Islet amyloid is a possible reason for the long-term failure of transplanted islets. It is likely that their low vascular density causes a disturbed local clearance of IAPP and insulin that starts the aggregation of IAPP. Indeed, encapsulated islets had an accelerated amyloid formation compared to normal islets, and might serve as a model for further studies of this process. In conclusion, although revascularisation is not a prerequisite for islet graft function, it plays an important role for islet transplantation outcome.

Abstract Background and aim: Diabetes mellitus (DM) is a chronic and progressive illness that affects all type of populations and ages. According to World health organization (WHO) by 2030 it will be 366 million people effected world wild. Many new drugs are Glucagon-like peptide-1 (GLP-1) based therapy for treatment of type 2diabetes. GLP-1 is released from the intestinal L-cells, and is a potent stimulator of glucose-dependent insulin secretion. The aim of this study was to investigate the effect of GLP-1 and its stable analogs on cell proliferation of GLP-1 secreting GLUTag cells. Material and methods: GluTag cells were incubated for 48h in DMEM medium containing (0.5% fetal bovine serum and 100 IU/ml penicillin and 100 μg/ml streptomycin and 3mM glucose concentration) in the present or absence of the agents. DNA synthesis was measured using 3H- thymidine incorporation and Ki67 antigen staining. Western blot were performed to investigate the present of GLP-1 receptor in GLUTag cells. Results/conclusions: These results suggest that GLP-1 regulates proliferation of the GLP-1-secreting cell through a feedback mechanism via its receptor. Since serum GLP-1 levels are decreased in type 2 diabetic patients, the effect of GLP-1 on the GLP-1-secreting cell proliferation suggested here provides a novel beneficial long-term effect of the incretin-based drugs in clinical practice i.e. through increase of the GLP-1-secreting cell mass, augmenting the incretin effect. In addition, the feedback mechanism action of GLP-1 reveals a new insight in regulation manner of the L-cell proliferation. GLP-1(7-36) increased cell proliferation in GLUTag cells, an effect which was blocked by the GLP-1 receptor antagonist exendin(9-39). The GLP-1 receptor was expressed in GluTag cells. Keywords: Incretin hormone, GLP-1, GLP-1 receptor, Exendin-4, Diabetes

Introduction: Stroke is caused from the occlusion of any cerebral artery leading to cerebral ischemia, brain damage and consequent neurological impairments and disability. The primary causes of mortality in western populations is stroke. Diabetes type 2 is a high risk factor for stroke. Stroke leads to an observable increase of neural stem cell proliferation in the subventricular zone and enhances neurogenesis in the adult rodent and human brain which suggest a mechanism contributing to stroke recovery. Neurogenesis in type 2 diabetes patients is impaired. However, whether stroke-induced neurogenesis is impaired in diabetes has not been studied. Exendin-4 is a drug for clinical treatment of type 2 diabetes which has been shown to have neuroprotective properties in animal studies. However whether Exendine-4 leads to increased neurogenesis after  stroke in the diabetic brain has not been previously studied.  Aims: The specific aims of this project were to determine whether stroke-induced stem cell proliferation is impacted by diabetes in the mouse, and if Exendine-4 regulates stroke-induced stem cell proliferation in normal and diabetic mice. Material and Methods: Aged obese/type 2 diabetic mice were subjected to stroke. The Exendin-4 treatment was started 1.5 hours thereafter. Treatment was continued for one week before animals were sacrificed. Brains were isolated and the neurons were immunostained using the specific proliferation marker Ki67. Neural stem cell proliferation was quantified by counting Ki67+ cells in the ipsilateral (subventricular zone in stroke hemisphere).The estimation was assessed by stereological counts of proliferating stem cell in the subventricular zone.  Results: The number of proliferating stem cell after stroke was statistically significantly higher in the normal mice versus diabetic mice. The effect was present in both sides (control and stroke) of the subventricular zone. Exendine-4 treatment induced statistically significant increased of  stem cell proliferation in normal mice but not in diabetic mice.   Conclusions: The result of this study shows that type 2 diabetes decreased the proliferation of neural stem cell in the subventricular zone and that Exendin-4 enhanced the subventricular proliferation in a preclinical model of clinical relevance. The data suggest that the Exendin-4 treatment could be administered to normal patients suffering from stroke in the ambulance or in the emergency room although more studies are needed.