Lecture 16 - 22 Flashcards
What is diabetes mellitus?
The inability to regulate blood glucose
What is the normal levels of glucose and what is the diabetic level of glucose?
Normal = 5mM
Diabetes = 7mM+
What is the pathogenesis for type I diabetes?
- caused by a failure of insulin secretion
- character sized by low insulin and high glucose levels
- has sudden onsets
- caused by the destruction of beta cells
What is the pathogenesis of type II diabetes?
- caused by insulin resistance in tissues
- insulin present in circulation but glucose remains elevated
- has gradual onset
How does insulin-dependent diabetes mellitus (type I occur)?
Beta cells of pancreas are destroyed by cytotoxic CD8 T cells reactive against peptides of insulin and other specific proteins which are complexed with MHC molecules and recognized by cytotoxic T lymphocytes
What are the symptoms of hyperglycemia?
- increased fluid osmolarity in tubules
- more water is secreted from cells into the proximal convoluted tubule
- causes increased urine floe (dieresis)
- water reabsorption is reduced
- dehydration, excessive urine production and thirst
What is hyperglycemia?
When high glucose concentrations enter glomerular filtrate and overwhelms the glucose absorbing capacity of the proximal convoluted tubule
What are the forms of insulin used for therapy?
- animal insulin (porcine/bovine)
- human insulin
- human insulin analogue
What are the types of human insulin and what are their characteristics?
- Soluble insulin
- rapid and short lived
- used intravenously in emergency treatment of hyperglycemic. - Isophane insulin
- tends to form precipitates = intermediate acting - Insulin zinc suspension
- tends to form precipitates = long acting
What are the three insulin analogues and what are their characteristics?
- Insulin Lispro
- modified insulin obtained by switching a Lys28 and Pro29
- very rapid and very short lived.. usually taken before a meal - Insulin glaring
- modified insulin obtained by mutating Asn21 in Gly and by adding 2 Arg at the end of the beta chain - Insulin detemir
- modified insulin obtained by mutating Thr 30 (deletion)
How does type 2 diabetes occur?
Beta cells try to compensate for peripheral resistance = beta cells become exhausted and cannot keep up with the peripheral demand of insulin = failure of insulin secretion
Which cell is responsible for the autoimmune reaction that destroys the beta cells of pancreas in type 1 diabetes?
CD8 cytotoxic T cells
Which of the following is NOT a feature of type 1 diabetes?
A. Sudden on-set
B. Develops early in life
C. Rare
D. Caused by failure of insulin secretion
E. Caused by peripheral insulin resistance
E. Caused by peripheral insulin resistance
Which of the following combinations of insulin forms would be normally used to control glycaemia?
A. Lispro + soluble insulin
B. Zinc suspension + Glargine
C. Soluble insulin + glargine
D. Lispro + detemir
C & D: Soluble insulin + glargine, Lispro + detemir
Has to be a short acting + intermediate long acting
What are the order of events in type 2 diabetes?
- Obesity/ sedentary life style
- Hyperinsulinemia
- Beta cells failure
- Hyperglycemia
- Retinopathy
What molecules can lead to insulin resistance in type 2 diabetes?
IL-1 & DAG
Which of the following drugs work by improving insulin secretion from the beta cells of the pancreas?
A. Pioglitazone
B. Beta-3 receptor agonists
C. Gliclazide
D. Metaformin
E. Insulin
C. Gliclazide
What is the role of free fatty acids in insulin resistance?
- lead to insulin resistance in muscle and liver
- when in excess they are transformed into secondary messenger DAG
- DAG activates PKC which phosphorylate IRS-1 = attenuates insulin receptor signal
What is the role of Adipokines in insulin resistance?
- released by Adipocytes
- adiponectin is anti-hyperglycemic = improves insulin sensitivity by activating AMPK = promoting lipolysis in liver and muscle
What is the role of inflammation in insulin resistance?
- adipocytes produce IL-6 and IL-1 which attract macrophages to fat deposits
- experimental reduction of cytokines improve insulin sensitivity
What is the role of PPARgamma in insulin resistance?
- promotes secretion of anti-hyperglycemic adipokines
- mutations can cause diabetes
What is the role of Thiazolidinediones (Pioglitazone)?
- Agonist of nuclear receptor PPAR-gamma
- promotes expression ad secretion of anti-hyperglycemic adipokines = increases lipolysis
- reduce insulin resistance in liver and their peripheral tissues
What is the role of Metformin?
- suppress glucose release from liver
- activate AMPK
- increase lipolysis in liver and muscles = improve insulin receptor signaling
- suppress glucose release from liver
What is the role of Sulphonylureas (Gliclazide)?
- bind to sulhponylurea receptors expressed on membranes of beta cells
- block ATP sensitive K+ channels in Beta cells
- K+ accumulates inside cells = beta cells depolarize
- Ca2+ channels open = allow insulin secretion by exocitosis
What are the 2 types of drugs for type 2 diabetes?
- Alpha2 adrenoreceptor antagonist
- increase insulin secretion - Selective beta3 agonists
- beta3 adrenoreceptors control lipolysis in fat cells
What are the long term consequences of diabetes?
- ROS = high levels of glucose in our blood cause oxidation in long term excess of glucose = reactive oxygen species
- AGEs generation = binds to receptor and induces the production of reactive oxygen species that damage blood vessels
How is NF-kappaB activated in the canonical/classical pathway?
- formed by a dimer of p50 and RelA
- pathway activated by the binding of a ligand to the receptor which activates a complex of IkB kinases
- kinases complex will phosphorylate IkB causing IkB ubiquitination and then IkB is degraded
- p50 and RelA are free to enter the nucleus and cause the transcription of specific target genes
How is NF-kappaB activated in the non-canonical pathway/alternative signalling pathway?
- activation of kinases NIK phosphorylate IKKAlpha which phosphorylate p100
- processing of p100 via proteosome to form p52 = associates with RelB to cause transcription of the genes in the nucleus
What is the role of Rel Homology Domain (RHD)?
encodes the DNA binding and dimerisation functions of NF-kappaB
What is the role of p100 and p105?
contain ankyrin repeats in their C-termini that allow them to function as IkB inhibitors
What are TA1/TA2, TAD, SD1, SDII?
non-conserved transcriptional activation domains
What are the subunits in the canonical pathway?
- p50
- RelA
- c-Rel
What are the subunits in the alternative pathway?
- RelB
- p52
What are the inhibitors of NF-kappaB?
IKBA, IKBB, IKBE and Bcl-3
What do the IKB proteins contain?
contain ankyrin repeat motifs (ANK) in their C termini. PEST, domain rich in proline (P), glutamate (E), serine (S) and threonine (T).
What does Bcl-3 contain?
nuclear coactivator for the p52 NF-κB subunit (and other transcription factors)
How does NF-kappaB cause cancer?
control of NF-kappaB is lost = NF-kappaB in cytoplasm causes the transcription of genes = uncontrolled proliferation of cells
What is the structure of p53?
- N-terminal domain contains a sub-transactivation domain and a proline-rich domain which is involved in regulation of apoptosis.
- Core domain bind to specific DNA sequences
- C-terminal domain contains the tetramerization domain
What is the p53 signalling pathway?
- p53 binds to an inhibitor HDM2
- stimuli activates p53 and is recognised as an oncosurpressor
- when activated p53 the inhibitors are degraded so p53 is free
- p53 can repair DNA or induce apoptosis if the DNA cannot be repaired
What is the difference between NF-kappaB and p53?
NF-kappaB = tumor-promoting functions
p53 = tumour suppressing functions
What needs to happen to carry out a cell cycle?
- chromosomes need to be duplicated
- other organelles need to be copied
- cells need to grow
- chromosomes need to be segregated accurately
- cell needs to physically divide
What drives the cell cycle?
cyclin-dependent kinases (Cdks)
What are Cdks?
protein kinase that transfer a phosphate onto their substrates = act as master regulators
What makes cyclin levels oscillate?
Mechanisms controlling synthesis = changes in transcription and translation rate
What is the role of the APC/C signal?
signals degradation of M-cyclin to end mitosis and initiate cell division
What is the role of the SCF signal?
signals degradation of CKIs to promote G1-S transition
How is cell cycle fidelity maintained?
- cyclin oscillations provide timing for the successive phases of the cell cycle = checkpoints monitoring the cell cycle to make sure everything is in place
How do checkpoints in the cell cycle work?
act by promoting Cdk activation or inactivation
What are mitogens and their role in the cell cycle?
proteins that signal the cell to proliferate = promotes G1/S synthesis
What is the role of DNA damage in the cell cycle?
inhibits M phase cyclin activity by phosphoregulation or CKI
What is the role of unattached chromosomes in the cell cycle?
prevents M phase cyclin destruction = cell stays in M phase until chromosomes are attached
What does the G1 checkpoint check?
- if nutritional conditions are stable
- if the cell is receiving proliferation signals
- if damaged DNA has been repaired
What does the G2 checkpoint check?
- if damaged DNA has been repaired
- if DNA replication is complete
- if the cell is big enough
What does the mitotic/spindle assembly checkpoint check?
- of the chromosomes are properly attached to the spindle