Type 2 diabetes is generally perceived as a polygenic disorder, with disease development being influenced by both hereditary and environmental factors. However, despite intensive investigations, little progress has been made in identifying the genes that impart susceptibility to the common late-onset forms of the disease. E23K, a common single nucleotide polymorphism in K IR 6.2, the pore-forming subunit of pancreatic -cell ATP-sensitive K ؉ (K ATP ) channels, significantly enhances the spontaneous open probability of these channels, and thus modulates sensitivities toward inhibitory and activatory adenine nucleotides. Based on previous association studies, we present evidence that with an estimated attributable proportion of 15% in Caucasians, E23K in K IR 6.2 appears to be the most important genetic risk factor for type 2 diabetes yet identified. Diabetes 51 (Suppl. 3):S358 -S362, 2002
ROLE OF K ATP CHANNELS IN INSULIN SECRETIONPlasma insulin concentrations are normally determined by a feedback system that is controlled mainly by the level of plasma glucose (1). The overall activity of the pancreatic -cell is set by the sensitivity of peripheral tissues to the action of insulin, with insulin-resistant subjects having increased plasma insulin levels and secretion rates. Insulin secretion is also elicited in response to amino and fatty acids; the extent of this response is modified by neural (e.g., autonomic tone) and hormonal (e.g., glucagon, glucagon-like peptide) factors. Glucose, however, is the dominating factor in controlling insulin secretion.Glucose enters the -cell by facilitated diffusion, and its phosphorylation by glucokinase to glucose-6-phosphate determines the rate of glycolysis and the rate of pyruvate generation ( Fig. 1) (2,3). Thus the rate of glycolysis will increase with blood glucose. In -cells, pyruvate is the main product of glycolysis (4) and, compared to other cell types, an unusually high proportion of glucose-derived pyruvate enters the mitochondrial tricarboxylic acid (TCA) cycle (2).Subsequent oxidative metabolism generates the trigger for insulin secretion (5). Electron transfer from the TCA cycle to the respiratory chain by NADH and reduced flavin adenine dinucleotide (FADH 2 ) initiates the production of ATP, which is delivered to the cytosol. Here the rise of the ATP-to-ADP ratio causes a reduction in plasma membrane K ϩ conductance, resulting in depolarization of the membrane (6). Hence voltage-sensitive Ca 2ϩ channels are opened that are similar to those expressed in other excitable cells. This is the critical step by which glucose stimulates insulin secretion, as the increase in cytosolic Ca 2ϩ is the main trigger for exocytosis (6,7). The decrease in K ϩ conductance results from closure of the ATP-sensitive potassium (K ATP ) channels (6). These channels dominate the resting membrane potential in -cells and act as transducers of glucose-induced metabolic changes into electrical activity. Their central role in the stimulation of insulin secretion can easily be demonstrat...