Alpha cell dysfunction in early type 1 diabetes

Multiple islet autoantibodies (AAb) predict type 1 diabetes (T1D) and hyperglycemia within 10 years. By contrast, T1D develops in just ~15% of single AAb+ (generally against glutamic acid decarboxylase, GADA+) individuals; hence the single GADA+ state may represent an early stage of T1D amenable to interventions. Here, we functionally, histologically, and molecularly phenotype human islets from non-diabetic, GADA+ and T1D donors. Similar to the few remaining beta cells in T1D islets, GADA+ donor islets demonstrated a preserved insulin secretory response. By contrast, alpha cell glucagon secretion was dysregulated in both T1D and GADA+ islets with impaired glucose suppression of glucagon secretion. Single cell RNA sequencing (scRNASeq) of GADA+ alpha cells revealed distinct abnormalities in glycolysis and oxidative phosphorylation pathways and a marked downregulation of PKIB, providing a molecular basis for the loss of glucose suppression and the increased effect of IBMX observed in GADA+ donor islets. The striking observation of a distinct early defect in alpha cell function that precedes beta cell loss in T1D suggests that not only overt disease, but also the progression to T1D itself, is bihormonal in nature.

Pathways of Glucagon Secretion and Trafficking in the Pancreatic Alpha Cell: Novel Pathways, Proteins, and Targets for Hyperglucagonemia

Patients with diabetes mellitus exhibit hyperglucagonemia, or excess glucagon secretion, which may be the underlying cause of the hyperglycemia of diabetes. Defective alpha cell secretory responses to glucose and paracrine effectors in both Type 1 and Type 2 diabetes may drive the development of hyperglucagonemia. Therefore, uncovering the mechanisms that regulate glucagon secretion from the pancreatic alpha cell is critical for developing improved treatments for diabetes. In this review, we focus on aspects of alpha cell biology for possible mechanisms for alpha cell dysfunction in diabetes: proglucagon processing, intrinsic and paracrine control of glucagon secretion, secretory granule dynamics, and alterations in intracellular trafficking. We explore possible clues gleaned from these studies in how inhibition of glucagon secretion can be targeted as a treatment for diabetes mellitus.

The liver-alpha-cell axis after a mixed meal and during weight loss in type 2 diabetes

Objective: Glucagon and amino acids may be regulated in a feedback loop called the liver-alpha-cell axis with alanine or glutamine as suggested signal molecules. We assessed this concept in individuals with type 2 diabetes in the fasting state, after ingestion of a protein rich meal and during weight loss. Moreover, we investigated if postprandial glucagon secretion and hepatic insulin sensitivity were related. Methods: This is a secondary analysis of a 12-week weight loss trial (Paleolithic diet ± exercise) in 29 individuals with type 2 diabetes. Before and after the intervention, plasma glucagon and amino acids were measured in the fasting state and during 180 min after a protein-rich mixed meal. Hepatic insulin sensitivity was measured using the hyperinsulinemic euglycemic clamp with [6,6-2H2]glucose as tracer. Results: The postprandial increase of plasma glucagon was associated with the postprandial increase of alanine and several other amino acids but not glutamine. In the fasted state and after the meal, glucagon levels were negatively correlated with hepatic insulin sensitivity (rS = -0.51 / r = -0.58 respectively; both P<0.05). Improved hepatic insulin sensitivity with weight loss was correlated with decreased postprandial glucagon response (r = -0.78; P<0.001). Conclusions: Several amino acids, notably alanine, but not glutamine could be key signals to the alpha cell to increase glucagon secretion. Amino acids may be part of a feedback mechanism as glucagon increases endogenous glucose production and ureagenesis in the liver. Moreover, postprandial glucagon secretion seems to be tightly related to hepatic insulin sensitivity.

A local insulin reservoir ensures developmental progression in condition of nutrient shortage in Drosophila

Insulin/IGF signalling (IIS) controls many aspects of development and physiology. In Drosophila, a conserved family of insulin-like peptides (Ilp) is produced by brain neurosecretory cells and exerts systemic functions. Here, we describe the local uptake and storage of Ilps in the Corpora Cardiaca (CC), a group of alpha cell homolog that produces the glucagon-like hormone AKH. Dilp uptake relies on the expression of Impl2, an IGF-BP that accumulates in the CCs. During nutrient shortage, this specific reserve of Ilps is released and activates IIS in a paracrine manner in the prothoracic gland, securing accelerated entry into pupal development through the production of the steroid hormone ecdysone. We therefore uncover a sparing mechanism whereby local Ilp storage and release activates the production of steroids and ensures early developmental progression in adverse food conditions.

Functional Heterogeneity Among Pancreatic Alpha Cells

Historically, endocrine cells in the pancreatic islets have been assumed to function as relatively homogenous populations largely because we lacked the ability to measure individual cell activity with sufficient throughput to reliably detect heterogeneity within each population. The glucagon-secreting alpha cells play a vital role in regulating glycemia, but the mechanisms that control alpha cell activity and whether the alpha cells behave as a single unit or heterogeneously remain incompletely understood. To overcome the limitations in throughput that have to date prevented the study of alpha cells at the population level, we used genetically-encoded fluorescent indicators selectively expressed in alpha cells. Imaging intact mouse islets with these indicators in 3D responding to treatments in real time yields hundreds of individual alpha cell recordings per experiment. Calcium imaging showed reproducible heterogeneous responses to a panel of known physiological potentiators of glucagon secretion such as arginine vasopressin, epinephrine, and amino acids. Separate dose response experiments revealed that the proportion of alpha cells responding to each signal plateaus at different proportions of alpha cells. The calcium data correlate both with direct glucagon secretion levels as well as cAMP measurement. Our findings highlight previously unappreciated levels of functional heterogeneity among alpha cells and demonstrate that alpha cells are not a single uniform unit. Our observations suggest that dose-dependent increases in glucagon secretion in response to different physiological cues may be the result of mobilizing progressively larger proportions of the total alpha cell mass. We hypothesize that this functional heterogeneity is a built-in mechanism through which different physiological cues elicit graded glucagon responses from the alpha cells.