20Background: Intercellular communication mediated by cationic fluxes through the Connexin-family 21 of gap-junctions regulates glucose-stimulated insulin-secretion and beta-cell defense against 22 inflammatory stress. Rotigaptide (RG, ZP123) is a peptide analog that increases intercellular 23 conductance in cardiac muscle-cells by prevention of dephosphorylation and thereby uncoupling of 24 Connexin-43 (Cx43), possibly via action on unidentified protein phosphatases. For this reason, it is 25 being studied in human arrhythmias. It is unknown if RG protects beta-cell function and viability 26 against inflammatory or metabolic stress, a question of considerable translational interest for the 27 treatment of beta-cell failure in diabetes.
28Methods: Apoptosis was measured in human islets known to express Cx43, treated with RG or the 29 control peptide ZP119 and exposed to glucolipotoxicity or IL-1b + IFNg. INS-1 cells shown to lack 30 Cx43 were used to verify if RG protected human islet-cells via Cx43-coupling. To study mechanisms 31 of action of Cx43-independent effects of RG, NO, IkBa degradation, mitochondrial activity, ROS and 32 insulin mRNA levels were determined.
33Results: RG reduced cytokine-induced apoptosis ~40% in human islets. In Cx43-deficient INS-1 cells 34 this protective effect was markedly blunted as expected, but unexpectedly RG still modestly reduced 35 apoptosis, and improved mitochondrial function, insulin-2 gene levels and accumulated insulin release.
36RG reduced NO production in Cx43-deficient INS-1 cells associated with reduced iNOS-expression, 37 suggesting that RG blunts cytokine-induced NF-kB signaling in insulin-producing cells in a Cx43-38 independent manner.39 Conclusion: RG reduces cytokine-induced cell-death in human islets. The protective action in Cx43-40 deficient INS-1 cells suggests a novel inhibitory mechanism of action of RG on NF-kB signaling.3 41 Highlights: 43 Rotigaptide (RG) counteracts cytokine-induced apoptosis in human islets 44 RG reduces cytokine-induced apoptosis in INS-1 cells independently of Cx43 45 Introduction: 46 By inducing beta-cell endoplasmic reticulum stress and apoptosis via the intrinsic mitochondrial 47 pathway, proinflammatory cytokines have been implicated as mediators of beta-cell failure and 48 destruction causing type 1 diabetes (T1D) and type 2 diabetes (T2D) (1). Antagonism of the action of 49 the prototypic proinflammatory cytokine interleukin-1 (IL-1) improves beta-cell function in T2D 50 patients (2), an effect sustained 39 weeks beyond cessation of the antagonism in responders (3).
51Despite a strong preclinical rationale (4) anti-IL-1 monotherapy was ineffective overall in recent-onset 52 T1D. However, IL-1 antagonism did moderate inflammation and caused a 2,5-fold higher secretory 53 function in T1D patients with intermediary beta-cell function at baseline (5, 6). Since IL-1 induced 54 beta-cell apoptosis is potentiated by other proinflammatory cytokines such as TNF, IFNg and IL-6, and 55 since anti-TNF therapy improved beta-ce...