L39 - Biochemical basis of Diabetes Mellitus I Flashcards

1
Q

Describe function of signal peptide and post-translational modification of preproinsulin?

A

Signal peptide guides translocation into lumen of ER

ER:
- Disulphide bond formation + Proteolytic cleavage of signal peptide

Golgi:

  • Further proteolytic cleavage
  • Secretory vesicle
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2
Q

Describe the secretion of insulin in B cells?

A

Glucose enters β cells through GLUT-2

> > glycolysis and TCA cycle (oxidative phosphorylation) in mitochondria to generate ATP

> > inactivates K+ channel protein

> > membrane depolarization

> > opens Ca2+ channel, influx of Ca2+ cause insulin vesicle exocytosis

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3
Q

Define the locus and variability of HLA genes.

A

MHC/HLA locus = Chromosome 6

Highly polymorphic

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4
Q

Describe how HLA haplotypes can influence the risk of Type 1 DM?

A

MHC haplotype divided into:
1) Susceptibility alleles = increase occurrence of Type 1 DM

2) Neutral alleles = no difference in occurrence of Type 1 DM
3) Protective alleles = Lower risk of Type 1 DM

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5
Q

Which region of the MHC molecule is most affected by polymorphism?

A

Antigen binding site

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6
Q

Describe the role of MHC in T cell development?

A

1) Positive selection: Immature T cells that can bind to self-peptide/ MHC complex on thymic epithelial cells are selected
2) Negative selection in thymus medulla: MHC-restricted T cells binding to self-antigen/ MHC with very high affinity selected against

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7
Q

Describe how the MHC molecules can lead to release of autoreactive T cells to periphery? **

A

1) MHC-II polymorphism = change peptide binding region = faulty selection of T cells = failure to eliminate T cells that bind to self-antigen close to affinity threshold
» Maturation of autoreactive T cells

2) Faulty selection of Treg in thymus = compromise peripheral tolerance/ anergy of autoreactive T cells

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8
Q

Which gene related to glucose homeostasis is used for T cell selection and maturation?

A

Proinsulin gene

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9
Q

Describe how Proinsulin gene expression influences T cell selection?

A

Proinsulin gene has VNTR (variable number of tandem repeats) segment in promoter region

  • If mostly class 1 VNTR is expressed in thymus medullary epithelial cells

> > Less proinsulin gene expressed

> > Less insulin made for use as self-antigen to educate T cells

> > Faulty selection of autoreactive T cells and Treg

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10
Q

Describe the VNTR of proinsulin expressed in pancreas?

A
Pancreas:
Express equal amount of Proinsulin with class I and III VNTR
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11
Q

Compare the effects of Class I and III VNTR in proinsulin gene?

A

Class I = under-expression of insulin = faulty selection of Treg and T cells = increase risk of IDDM

Class III = Increase expression of insulin for T cell selection = Protective against IDDM

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12
Q

List 3 genes apart from proinsulin gene that are implicated in Type 1 DM development?

A

PTPN22 (protein phosphotyrosine-specific phosphatase)

AIRE (autoimmune regulator)

MODY

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13
Q

Describe the function of AIRE in T cell selection?

A

AIRE = transcription factor:

regulate expression of peripheral self-antigens in thymic epithelial cells for deleting autoreactive T-cells

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14
Q

Describe how virus can cause beta cell death in type 1 DM?

A

Virus infect Beta cell
» express protein similar to self-reactive peptide (autoantigen)
» Beta cell express viral antigen on MHC-II and MHC-I:

a) activate autoreactive CD4 T cells&raquo_space; Activate B cells to make anti-B cell antibodies
b) Activate CD8+ T cell

> > Beta cell elimination

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15
Q

Describe how damage to Beta cells (e.g. due to diet, trauma, toxins) can lead to beta cell depletion in Type 1 DM?

A

Stimuli damage Beta cells

> > damaged beta cells release beta cell proteins (autoantigens)

> > APC acquire and present beta cell autoantigens on MHC-II

> > Activation of autoreactive CD4+ T cell:

  • Secretion of TNFα, IFNγ&raquo_space; activates macrophages (secrete IL-1)
  • Activation of CD8+ T-cells
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16
Q

Explain the physiological role of MODY2?

A

Code for Glucokinase:

  • Used for rate limiting reaction: Glucose&raquo_space; G 6-P
  • Act as threshold and determine level of glucose to trigger insulin release
17
Q

Explain how MODY2 mutation leads to Type 1 DM?

A

Inactivate glucokinase

> > loss of regulation on intracellular glucose level

> > loss of regulation on insulin secretion

18
Q

Explain how MODY3: HNF-1α, MODY1: HNF-4α, MODY5: HNF-1β mutations can lead to Type 1 DM?

A

Mutation = faulty expression of genes encoding for protein component in TCA-cycle

> > Decrease ATP synthesis, glucose transport

> > Unable to trigger Insulin release

19
Q

Explain how MIDD mutation causes Type 1 DM?

A

Maternally Inherited Diabetes with Deafness (MIDD):

mutation of mitochondrial genome = cannot respond glucose, make ATP

No ATP = cannot trigger insulin release

20
Q

Explain how PNDM mutation causes type 1 DM?

A

Mutation of Permanent Neonatal Diabetes Mellitus (PNDM):

> > permanent activation of K-ATP channel
cannot depolarize beta cell
. cannot release insulin

21
Q

Explain how type 1 DM causes weight loss?

A

Insulin = suppress proteolysis and gluconeogenesis

Depletion of insulin = unopposed increased proteolysis and gluconeogensis

> > Elevated blood glucose not used or uptake by cells (low insulin-dependent glucose transport)

> > weight loss

22
Q

Explain how Type 1 DM leads to ketoacidosis? ***

A

Low insulin:
- Loss of inhibition on Hormone Sensitive Lipase (HSL) = Increase conversion of TAG in adipocytes to FA in circulation

  • Less Acetyl-CoA converted to Malonyl CoA = loss of inhibition on FA translocation into mitochondria = Increase FA into cell mitochondria

> > Increase B-oxidation&raquo_space; ketone body production more than elimination by TCA cycle&raquo_space; Ketoacidosis

23
Q

Explain how Type 1 DM leads to dehydration?

A

Increased blood glucose: Increase osmolarity in serum:

a) increase movement of water from tissue into serum
b) decrease water reabsorption in kidney

> > Polysuria

> > dehydration

24
Q

List effects of IDDM on brain?

A

microangiopathy, cerebral vascular infarcts, hemorrhage

25
Q

List effects of IDDM on eyes?

A

retinopathy, cataracts, glaucoma

26
Q

List effects of IDDM on CVS?

A

atherosclerosis, peripheral vascular atherosclerosis (gangrene, infections), MI

27
Q

List effects of IDDM on Kidney?

A

nephrosclerosis (glomerulosclerosis, arteriosclerosis, pyelonephritis)