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Erschienen in: Diabetologia 9/2011

01.09.2011 | Article

Deletion of Ia-2 and/or Ia-2β in mice decreases insulin secretion by reducing the number of dense core vesicles

verfasst von: T. Cai, H. Hirai, G. Zhang, M. Zhang, N. Takahashi, H. Kasai, L. S. Satin, R. D. Leapman, A. L. Notkins

Erschienen in: Diabetologia | Ausgabe 9/2011

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Abstract

Aims/hypothesis

Islet antigen 2 (IA-2) and IA-2β are dense core vesicle (DCV) transmembrane proteins and major autoantigens in type 1 diabetes. The present experiments were initiated to test the hypothesis that the knockout of the genes encoding these proteins impairs the secretion of insulin by reducing the number of DCV.

Methods

Insulin secretion, content and DCV number were evaluated in islets from single knockout (Ia-2 [also known as Ptprn] KO, Ia-2β [also known as Ptprn2] KO) and double knockout (DKO) mice by a variety of techniques including electron and two-photon microscopy, membrane capacitance, Ca2+ currents, DCV half-life, lysosome number and size and autophagy.

Results

Islets from single and DKO mice all showed a significant decrease in insulin content, insulin secretion and the number and half-life of DCV (p < 0.05 to 0.001). Exocytosis as evaluated by two-photon microscopy, membrane capacitance and Ca2+ currents supports these findings. Electron microscopy of islets from KO mice revealed a marked increase (p < 0.05 to 0.001) in the number and size of lysosomes and enzymatic studies showed an increase in cathepsin D activity (p < 0.01). LC3 protein, an indicator of autophagy, also was increased in islets of KO compared with wild-type mice (p < 0.05 to 0.01) suggesting that autophagy might be involved in the deletion of DCV.

Conclusions/interpretation

We conclude that the decrease in insulin content and secretion, resulting from the deletion of Ia-2 and/or Ia-2β, is due to a decrease in the number of DCV.
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Literatur
1.
Zurück zum Zitat Lan MS, Lu J, Goto Y, Notkins AL (1994) Molecular cloning and identification of a receptor-type protein tyrosine phosphatase, IA-2, from human insulinoma. DNA Cell Biol 13:505–514PubMedCrossRef Lan MS, Lu J, Goto Y, Notkins AL (1994) Molecular cloning and identification of a receptor-type protein tyrosine phosphatase, IA-2, from human insulinoma. DNA Cell Biol 13:505–514PubMedCrossRef
2.
Zurück zum Zitat Lu J, Li Q, Xie H et al (1996) Identification of a second transmembrane protein tyrosine phosphatase, IA-2beta, as an autoantigen in insulin-dependent diabetes mellitus: precursor of the 37-kDa tryptic fragment. Proc Natl Acad Sci USA 93:2307–2311PubMedCrossRef Lu J, Li Q, Xie H et al (1996) Identification of a second transmembrane protein tyrosine phosphatase, IA-2beta, as an autoantigen in insulin-dependent diabetes mellitus: precursor of the 37-kDa tryptic fragment. Proc Natl Acad Sci USA 93:2307–2311PubMedCrossRef
3.
Zurück zum Zitat Notkins AL, Lernmark A (2001) Autoimmune type 1 diabetes: resolved and unresolved issues. J Clin Invest 108:1247–1252PubMed Notkins AL, Lernmark A (2001) Autoimmune type 1 diabetes: resolved and unresolved issues. J Clin Invest 108:1247–1252PubMed
4.
Zurück zum Zitat Verge CF, Gianani R, Kawasaki E et al (1996) Prediction of type I diabetes in first-degree relatives using a combination of insulin, GAD, and ICA512bdc/IA-2 autoantibodies. Diabetes 45:926–933PubMedCrossRef Verge CF, Gianani R, Kawasaki E et al (1996) Prediction of type I diabetes in first-degree relatives using a combination of insulin, GAD, and ICA512bdc/IA-2 autoantibodies. Diabetes 45:926–933PubMedCrossRef
5.
6.
Zurück zum Zitat Kulmala P, Savola K, Petersen JS et al (1998) Prediction of insulin-dependent diabetes mellitus in siblings of children with diabetes. A population-based study. The Childhood Diabetes in Finland Study Group. J Clin Invest 101:327–336PubMedCrossRef Kulmala P, Savola K, Petersen JS et al (1998) Prediction of insulin-dependent diabetes mellitus in siblings of children with diabetes. A population-based study. The Childhood Diabetes in Finland Study Group. J Clin Invest 101:327–336PubMedCrossRef
7.
Zurück zum Zitat Solimena M, Dirkx R Jr, Hermel JM et al (1996) ICA 512, an autoantigen of type I diabetes, is an intrinsic membrane protein of neurosecretory granules. EMBO J 15:2102–2114PubMed Solimena M, Dirkx R Jr, Hermel JM et al (1996) ICA 512, an autoantigen of type I diabetes, is an intrinsic membrane protein of neurosecretory granules. EMBO J 15:2102–2114PubMed
8.
Zurück zum Zitat Nishimura T, Kubosaki A, Ito Y, Notkins AL (2009) Disturbances in the secretion of neurotransmitters in IA-2/IA-2beta null mice: changes in behavior, learning and lifespan. Neuroscience 159:427–437PubMedCrossRef Nishimura T, Kubosaki A, Ito Y, Notkins AL (2009) Disturbances in the secretion of neurotransmitters in IA-2/IA-2beta null mice: changes in behavior, learning and lifespan. Neuroscience 159:427–437PubMedCrossRef
9.
Zurück zum Zitat Caromile LA, Oganesian A, Coats SA, Seifert RA, Bowen-Pope DF (2010) The neurosecretory vesicle protein phogrin functions as a phosphatidylinositol phosphatase to regulate insulin secretion. J Biol Chem 285:10487–10496PubMedCrossRef Caromile LA, Oganesian A, Coats SA, Seifert RA, Bowen-Pope DF (2010) The neurosecretory vesicle protein phogrin functions as a phosphatidylinositol phosphatase to regulate insulin secretion. J Biol Chem 285:10487–10496PubMedCrossRef
10.
Zurück zum Zitat Cai T, Krause MW, Odenwald WF, Toyama R, Notkins AL (2001) The IA-2 gene family: homologs in Caenorhabditis elegans, Drosophila and zebrafish. Diabetologia 44:81–88PubMedCrossRef Cai T, Krause MW, Odenwald WF, Toyama R, Notkins AL (2001) The IA-2 gene family: homologs in Caenorhabditis elegans, Drosophila and zebrafish. Diabetologia 44:81–88PubMedCrossRef
11.
Zurück zum Zitat Saeki K, Zhu M, Kubosaki A, Xie J, Lan MS, Notkins AL (2002) Targeted disruption of the protein tyrosine phosphatase-like molecule IA-2 results in alterations in glucose tolerance tests and insulin secretion. Diabetes 51:1842–1850PubMedCrossRef Saeki K, Zhu M, Kubosaki A, Xie J, Lan MS, Notkins AL (2002) Targeted disruption of the protein tyrosine phosphatase-like molecule IA-2 results in alterations in glucose tolerance tests and insulin secretion. Diabetes 51:1842–1850PubMedCrossRef
12.
Zurück zum Zitat Kubosaki A, Gross S, Miura J et al (2004) Targeted disruption of the IA-2beta gene causes glucose intolerance and impairs insulin secretion but does not prevent the development of diabetes in NOD mice. Diabetes 53:1684–1691PubMedCrossRef Kubosaki A, Gross S, Miura J et al (2004) Targeted disruption of the IA-2beta gene causes glucose intolerance and impairs insulin secretion but does not prevent the development of diabetes in NOD mice. Diabetes 53:1684–1691PubMedCrossRef
13.
Zurück zum Zitat Kubosaki A, Nakamura S, Notkins AL (2005) Dense core vesicle proteins IA-2 and IA-2beta: metabolic alterations in double knockout mice. Diabetes 54(Suppl 2):S46–S51PubMedCrossRef Kubosaki A, Nakamura S, Notkins AL (2005) Dense core vesicle proteins IA-2 and IA-2beta: metabolic alterations in double knockout mice. Diabetes 54(Suppl 2):S46–S51PubMedCrossRef
14.
Zurück zum Zitat Kubosaki A, Nakamura S, Clark A, Morris JF, Notkins AL (2006) Disruption of the transmembrane dense core vesicle proteins IA-2 and IA-2beta causes female infertility. Endocrinology 147:811–815PubMedCrossRef Kubosaki A, Nakamura S, Clark A, Morris JF, Notkins AL (2006) Disruption of the transmembrane dense core vesicle proteins IA-2 and IA-2beta causes female infertility. Endocrinology 147:811–815PubMedCrossRef
15.
Zurück zum Zitat Kim SM, Power A, Brown TM et al (2009) Deletion of the secretory vesicle proteins IA-2 and IA-2beta disrupts circadian rhythms of cardiovascular and physical activity. FASEB J 23:3226–3232PubMedCrossRef Kim SM, Power A, Brown TM et al (2009) Deletion of the secretory vesicle proteins IA-2 and IA-2beta disrupts circadian rhythms of cardiovascular and physical activity. FASEB J 23:3226–3232PubMedCrossRef
16.
Zurück zum Zitat Harashima S, Clark A, Christie MR, Notkins AL (2005) The dense core transmembrane vesicle protein IA-2 is a regulator of vesicle number and insulin secretion. Proc Natl Acad Sci USA 102:8704–8709PubMedCrossRef Harashima S, Clark A, Christie MR, Notkins AL (2005) The dense core transmembrane vesicle protein IA-2 is a regulator of vesicle number and insulin secretion. Proc Natl Acad Sci USA 102:8704–8709PubMedCrossRef
17.
Zurück zum Zitat Gotoh M, Maki T, Kiyoizumi T, Satomi S, Monaco AP (1985) An improved method for isolation of mouse pancreatic islets. Transplantation 40:437–438PubMedCrossRef Gotoh M, Maki T, Kiyoizumi T, Satomi S, Monaco AP (1985) An improved method for isolation of mouse pancreatic islets. Transplantation 40:437–438PubMedCrossRef
18.
Zurück zum Zitat Zhang G, Hirai H, Cai T et al (2007) RESP18, a homolog of the luminal domain IA-2, is found in dense core vesicles in pancreatic islet cells and is induced by high glucose. J Endocrinol 195:313–321PubMedCrossRef Zhang G, Hirai H, Cai T et al (2007) RESP18, a homolog of the luminal domain IA-2, is found in dense core vesicles in pancreatic islet cells and is induced by high glucose. J Endocrinol 195:313–321PubMedCrossRef
19.
Zurück zum Zitat Goping G, Pollard HB, Srivastava M, Leapman R (2003) Mapping protein expression in mouse pancreatic islets by immunolabeling and electron energy loss spectrum-imaging. Microsc Res Tech 61:448–456PubMedCrossRef Goping G, Pollard HB, Srivastava M, Leapman R (2003) Mapping protein expression in mouse pancreatic islets by immunolabeling and electron energy loss spectrum-imaging. Microsc Res Tech 61:448–456PubMedCrossRef
20.
Zurück zum Zitat Takahashi N, Kishimoto T, Nemoto T, Kadowaki T, Kasai H (2002) Fusion pore dynamics and insulin granule exocytosis in the pancreatic islet. Science 297:1349–1352PubMedCrossRef Takahashi N, Kishimoto T, Nemoto T, Kadowaki T, Kasai H (2002) Fusion pore dynamics and insulin granule exocytosis in the pancreatic islet. Science 297:1349–1352PubMedCrossRef
21.
Zurück zum Zitat Takahashi N, Hatakeyama H, Okado H et al (2004) Sequential exocytosis of insulin granules is associated with redistribution of SNAP25. J Cell Biol 165:255–262PubMedCrossRef Takahashi N, Hatakeyama H, Okado H et al (2004) Sequential exocytosis of insulin granules is associated with redistribution of SNAP25. J Cell Biol 165:255–262PubMedCrossRef
22.
Zurück zum Zitat Zhang M, Goforth P, Bertram R, Sherman A, Satin L (2003) The Ca2+ dynamics of isolated mouse beta-cells and islets: implications for mathematical models. Biophys J 84:2852–2870PubMedCrossRef Zhang M, Goforth P, Bertram R, Sherman A, Satin L (2003) The Ca2+ dynamics of isolated mouse beta-cells and islets: implications for mathematical models. Biophys J 84:2852–2870PubMedCrossRef
23.
Zurück zum Zitat Kinard TA, Satin LS (1996) Temperature modulates the Ca2+ current of HIT-T15 and mouse pancreatic beta-cells. Cell Calcium 20:475–482PubMedCrossRef Kinard TA, Satin LS (1996) Temperature modulates the Ca2+ current of HIT-T15 and mouse pancreatic beta-cells. Cell Calcium 20:475–482PubMedCrossRef
24.
Zurück zum Zitat Horrigan FT, Bookman RJ (1994) Releasable pools and the kinetics of exocytosis in adrenal chromaffin cells. Neuron 13:1119–1129PubMedCrossRef Horrigan FT, Bookman RJ (1994) Releasable pools and the kinetics of exocytosis in adrenal chromaffin cells. Neuron 13:1119–1129PubMedCrossRef
25.
Zurück zum Zitat Henquin JC, Nenquin M, Szollosi A, Kubosaki A, Louis Notkins A (2008) Insulin secretion in islets from mice with a double knockout for the dense core vesicle proteins islet antigen-2 (IA-2) and IA-2{beta}. J Endocrinol 196:573–581PubMedCrossRef Henquin JC, Nenquin M, Szollosi A, Kubosaki A, Louis Notkins A (2008) Insulin secretion in islets from mice with a double knockout for the dense core vesicle proteins islet antigen-2 (IA-2) and IA-2{beta}. J Endocrinol 196:573–581PubMedCrossRef
26.
Zurück zum Zitat Yang SN, Berggren PO (2006) The role of voltage-gated calcium channels in pancreatic beta-cell physiology and pathophysiology. Endocr Rev 27:621–676PubMedCrossRef Yang SN, Berggren PO (2006) The role of voltage-gated calcium channels in pancreatic beta-cell physiology and pathophysiology. Endocr Rev 27:621–676PubMedCrossRef
27.
Zurück zum Zitat Tian Y, Corkey RF, Yaney GC, Goforth PB, Satin LS, Moitoso de Vargas L (2008) Differential modulation of L-type calcium channel subunits by oleate. Am J Physiol Endocrinol Metab 294:E1178–E1186PubMedCrossRef Tian Y, Corkey RF, Yaney GC, Goforth PB, Satin LS, Moitoso de Vargas L (2008) Differential modulation of L-type calcium channel subunits by oleate. Am J Physiol Endocrinol Metab 294:E1178–E1186PubMedCrossRef
28.
Zurück zum Zitat Mears D (2004) Regulation of insulin secretion in islets of Langerhans by Ca(2+)channels. J Membr Biol 200:57–66PubMedCrossRef Mears D (2004) Regulation of insulin secretion in islets of Langerhans by Ca(2+)channels. J Membr Biol 200:57–66PubMedCrossRef
29.
Zurück zum Zitat Mizushima N, Levine B, Cuervo AM, Klionsky DJ (2008) Autophagy fights disease through cellular self-digestion. Nature 451:1069–1075PubMedCrossRef Mizushima N, Levine B, Cuervo AM, Klionsky DJ (2008) Autophagy fights disease through cellular self-digestion. Nature 451:1069–1075PubMedCrossRef
30.
Zurück zum Zitat Marsh BJ, Soden C, Alarcon C et al (2007) Regulated autophagy controls hormone content in secretory-deficient pancreatic endocrine beta-cells. Mol Endocrinol 21:2255–2269PubMedCrossRef Marsh BJ, Soden C, Alarcon C et al (2007) Regulated autophagy controls hormone content in secretory-deficient pancreatic endocrine beta-cells. Mol Endocrinol 21:2255–2269PubMedCrossRef
31.
Zurück zum Zitat Speidel D, Salehi A, Obermueller S et al (2008) CAPS1 and CAPS2 regulate stability and recruitment of insulin granules in mouse pancreatic beta cells. Cell Metab 7:57–67PubMedCrossRef Speidel D, Salehi A, Obermueller S et al (2008) CAPS1 and CAPS2 regulate stability and recruitment of insulin granules in mouse pancreatic beta cells. Cell Metab 7:57–67PubMedCrossRef
32.
Zurück zum Zitat Wiser O, Trus M, Hernandez A et al (1999) The voltage sensitive Lc-type Ca2+ channel is functionally coupled to the exocytotic machinery. Proc Natl Acad Sci USA 96:248–253PubMedCrossRef Wiser O, Trus M, Hernandez A et al (1999) The voltage sensitive Lc-type Ca2+ channel is functionally coupled to the exocytotic machinery. Proc Natl Acad Sci USA 96:248–253PubMedCrossRef
33.
Zurück zum Zitat Ji J, Muinuddin A, Kang Y, Diamant NE, Gaisano HY (2003) SNAP-25 inhibits L-type Ca2+ channels in feline esophagus smooth muscle cells. Biochem Biophys Res Commun 306:298–302PubMedCrossRef Ji J, Muinuddin A, Kang Y, Diamant NE, Gaisano HY (2003) SNAP-25 inhibits L-type Ca2+ channels in feline esophagus smooth muscle cells. Biochem Biophys Res Commun 306:298–302PubMedCrossRef
34.
Zurück zum Zitat Nunemaker CS, Bertram R, Sherman A, Tsaneva-Atanasova K, Daniel CR, Satin LS (2006) Glucose modulates [Ca2+]i oscillations in pancreatic islets via ionic and glycolytic mechanisms. Biophys J 91:2082–2096PubMedCrossRef Nunemaker CS, Bertram R, Sherman A, Tsaneva-Atanasova K, Daniel CR, Satin LS (2006) Glucose modulates [Ca2+]i oscillations in pancreatic islets via ionic and glycolytic mechanisms. Biophys J 91:2082–2096PubMedCrossRef
35.
Zurück zum Zitat Trus M, Corkey RF, Nesher R et al (2007) The L-type voltage-gated Ca2+ channel is the Ca2+ sensor protein of stimulus-secretion coupling in pancreatic beta cells. Biochemistry 46:14461–14467PubMedCrossRef Trus M, Corkey RF, Nesher R et al (2007) The L-type voltage-gated Ca2+ channel is the Ca2+ sensor protein of stimulus-secretion coupling in pancreatic beta cells. Biochemistry 46:14461–14467PubMedCrossRef
36.
Zurück zum Zitat Cai T, Hirai H, Fukushige T et al (2009) Loss of the transcriptional repressor PAG-3/Gfi-1 results in enhanced neurosecretion that is dependent on the dense-core vesicle membrane protein IDA-1/IA-2. PLoS Genet 5:e1000447PubMedCrossRef Cai T, Hirai H, Fukushige T et al (2009) Loss of the transcriptional repressor PAG-3/Gfi-1 results in enhanced neurosecretion that is dependent on the dense-core vesicle membrane protein IDA-1/IA-2. PLoS Genet 5:e1000447PubMedCrossRef
37.
Zurück zum Zitat Mziaut H, Trajkovski M, Kersting S et al (2006) Synergy of glucose and growth hormone signalling in islet cells through ICA512 and STAT5. Nat Cell Biol 8:435–445PubMedCrossRef Mziaut H, Trajkovski M, Kersting S et al (2006) Synergy of glucose and growth hormone signalling in islet cells through ICA512 and STAT5. Nat Cell Biol 8:435–445PubMedCrossRef
38.
Zurück zum Zitat Brunner Y, Coute Y, Iezzi M et al (2007) Proteomics analysis of insulin secretory granules. Mol Cell Proteomics 6:1007–1017PubMedCrossRef Brunner Y, Coute Y, Iezzi M et al (2007) Proteomics analysis of insulin secretory granules. Mol Cell Proteomics 6:1007–1017PubMedCrossRef
39.
Zurück zum Zitat Chernysheva A, Tsitlidze NM, Savost'ianov KV et al (2008) Association of the chromosomal region 2q35 with type 1 diabetes mellitus in the Russian patients from Moscow. Genetika 44:232–235PubMed Chernysheva A, Tsitlidze NM, Savost'ianov KV et al (2008) Association of the chromosomal region 2q35 with type 1 diabetes mellitus in the Russian patients from Moscow. Genetika 44:232–235PubMed
40.
Zurück zum Zitat Yang JH, Downes K, Howson JM et al (2011) Evidence of association with type 1 diabetes in the SLC11A1 gene region. BMC Med Genet 12:59PubMedCrossRef Yang JH, Downes K, Howson JM et al (2011) Evidence of association with type 1 diabetes in the SLC11A1 gene region. BMC Med Genet 12:59PubMedCrossRef
41.
Zurück zum Zitat An P, Freedman BI, Hanis CL et al (2005) Genome-wide linkage scans for fasting glucose, insulin, and insulin resistance in the National Heart, Lung, and Blood Institute Family Blood Pressure Program: evidence of linkages to chromosome 7q36 and 19q13 from meta-analysis. Diabetes 54:909–914PubMedCrossRef An P, Freedman BI, Hanis CL et al (2005) Genome-wide linkage scans for fasting glucose, insulin, and insulin resistance in the National Heart, Lung, and Blood Institute Family Blood Pressure Program: evidence of linkages to chromosome 7q36 and 19q13 from meta-analysis. Diabetes 54:909–914PubMedCrossRef
42.
Zurück zum Zitat Schelling JR, Abboud HE, Nicholas SB et al (2008) Genome-wide scan for estimated glomerular filtration rate in multi-ethnic diabetic populations: the Family Investigation of Nephropathy and Diabetes (FIND). Diabetes 57:235–243PubMedCrossRef Schelling JR, Abboud HE, Nicholas SB et al (2008) Genome-wide scan for estimated glomerular filtration rate in multi-ethnic diabetic populations: the Family Investigation of Nephropathy and Diabetes (FIND). Diabetes 57:235–243PubMedCrossRef
43.
Zurück zum Zitat Menasche G, Pastural E, Feldmann J et al (2000) Mutations in RAB27A cause Griscelli syndrome associated with haemophagocytic syndrome. Nat Genet 25:173–176PubMedCrossRef Menasche G, Pastural E, Feldmann J et al (2000) Mutations in RAB27A cause Griscelli syndrome associated with haemophagocytic syndrome. Nat Genet 25:173–176PubMedCrossRef
Metadaten
Titel
Deletion of Ia-2 and/or Ia-2β in mice decreases insulin secretion by reducing the number of dense core vesicles
verfasst von
T. Cai
H. Hirai
G. Zhang
M. Zhang
N. Takahashi
H. Kasai
L. S. Satin
R. D. Leapman
A. L. Notkins
Publikationsdatum
01.09.2011
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 9/2011
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-011-2221-6

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