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  • University of Birmingham

    Glucocorticoids reprogram beta cell signaling to preserve insulin secretion Fine, Nicholas; Doig, Craig; Elhassan, Yasir; Vierra, Nicholas; Marchetti, Piero; Bugliani, Marco; Nano, Rita; Piemonti, Lorenzo; Rutter, Guy; Jacobson, David A; Lavery, Gareth; Hodson, David DOI: 10.2337/db16-1356

    License: None: All rights reserved

    Document Version Peer reviewed version

    Citation for published version (Harvard): Fine, N, Doig, C, Elhassan, Y, Vierra, N, Marchetti, P, Bugliani, M, Nano, R, Piemonti, L, Rutter, G, Jacobson, DA, Lavery, G & Hodson, D 2017, 'Glucocorticoids reprogram beta cell signaling to preserve insulin secretion', Diabetes.

    Link to publication on Research at Birmingham portal

    Publisher Rights Statement: Accepted for publication in Diabetes, Nicholas H.F. Fine, Craig L. Doig, Yasir S. Elhassan, Nicholas C. Vierra, Piero Marchetti, Marco Bugliani, Rita Nano, Lorenzo Piemonti, Guy A. Rutter, David A. Jacobson, Gareth G. Lavery and David J. Hodson, Diabetes 2017 Dec; db161356. © 2017 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at

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    Download date: 29. Oct. 2020

  • Glucocorticoids reprogram beta cell signaling to preserve

    insulin secretion

    Journal: Diabetes

    Manuscript ID DB16-1356.R4

    Manuscript Type: Original Article: Islet Studies

    Date Submitted by the Author: 27-Oct-2017

    Complete List of Authors: Fine, Nicholas; University of Birmingham, Endocrinology, Diabetes and Metabolism Doig, Craig; University of Birmingham, Endocrinology, Diabetes and Metabolism Elhassan, Yasir; University of Birmingham, Endocrinology, Diabetes and Metabolism

    Vierra, Nicholas; Vanderbilt University, Molecular Physiology Marchetti, Piero; Metabolic Unit, Endocrinology & Metabolism Bugliani, Marco; University of Pisa, Dept. Clinical and Experimental Medicine Nano, Rita; IRCCS San Raffaele Scientific Institute, San Raffaele Diabetes Research Institute Piemonti, Lorenzo; IRCCS San Raffaele Scientific Institute, San Raffaele Diabetes Research Institute Rutter, Guy; Imperial College London, Cell Biology, Division of Medicine; Jacobson, David; Vanderbilt University, Molecular Physiology Lavery, Gareth; University of Birmingham, Division of Medicine Hodson, David; University of Birmingham, Institute of Metabolism and

    Systems Research

    For Peer Review Only


  • 1

    Glucocorticoids reprogram beta cell signaling to preserve insulin secretion 1

    Nicholas H.F. Fine1,2, Craig L. Doig1,2, Yasir S. Elhassan1,2, Nicholas C. Vierra3, Piero 2 Marchetti4, Marco Bugliani4, Rita Nano5, Lorenzo Piemonti5, Guy A. Rutter6, David A. 3

    Jacobson3, Gareth G. Lavery1,2 and David J. Hodson1,2,7* 4

    1Institute of Metabolism and Systems Research (IMSR), University of Birmingham, 5 Edgbaston, B15 2TT, UK. 2Centre for Endocrinology, Diabetes and Metabolism, 6

    Birmingham Health Partners, Birmingham, B15 2TH, UK. 3Department of Molecular 7 Physiology and Biophysics, Vanderbilt University, Nashville, TN. 4Department of Clinical 8

    and Experimental Medicine, University of Pisa, Pisa, Italy. 5Diabetes Research Institute, San 9 Raffaele Scientific Institute, Milan, Italy. 6Section of Cell Biology and Functional Genomics, 10 Department of Medicine, Imperial College London, W12 0NN, UK. 7COMPARE University 11

    of Birmingham and University of Nottingham Midlands, UK. 12 13 14

    Running title: glucocorticoids reprogram beta cell signaling to preserve insulin secretion 15 16

    Key words: islet, insulin, incretin, steroid, glucocorticoid, 11β-hydroxysteroid dehydrogenase 17 type 1, adenylate cyclase, cAMP 18

    19 Word count (main body): 4,000 20

    21 22

    *Correspondence to: 23 David J. Hodson, 24

    Office 227, IBR Tower, 25 Institute of Metabolism and Systems Research, 26

    University of Birmingham, 27 Edgbaston, B15 2TT, UK 28

    +44(0)121 414 6896 29 30




    Page 1 of 52

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  • 2


    Excessive glucocorticoid exposure has been shown to be deleterious for pancreatic beta cell 2

    function and insulin release. However, glucocorticoids at physiological levels are essential 3

    for many homeostatic processes, including glycemic control. Here, we show that 4

    corticosterone and cortisol and their less active precursors, 11-dehydrocorticosterone (11-5

    DHC) and cortisone, suppress voltage-dependent Ca2+ channel function and Ca2+ fluxes in 6

    rodent as well as human beta cells. However, insulin secretion, maximal ATP/ADP responses 7

    to glucose and beta cell identity were all unaffected. Further examination revealed the 8

    upregulation of parallel amplifying cAMP signals, and an increase in the number of 9

    membrane-docked insulin secretory granules. Effects of 11-DHC could be prevented by 10

    lipotoxicity and were associated with paracrine regulation of glucocorticoid activity, since 11

    global deletion of 11β-hydroxysteroid dehydrogenase type 1 normalized Ca2+ and cAMP 12

    responses. Thus, we have identified an enzymatically-amplified feedback loop whereby 13

    glucocorticoids boost cAMP to maintain insulin secretion in the face of perturbed ionic 14

    signals. Failure of this protective mechanism may contribute to diabetes in states of 15

    glucocorticoid excess such as Cushing’s syndrome, which are associated with frank 16

    dyslipidemia. 17


    Page 2 of 52

    For Peer Review Only


  • 3


    Circulating glucocorticoids exert potent metabolic effects including lipolysis, hepatic 2

    gluconeogenesis, amino acid mobilization and reduced skeletal muscle glucose uptake (1). 3

    This is facilitated by the enzyme 11β-hydroxysteroid dehydrogenase type 1 (HSD11B1), 4

    which (re)activates glucocorticoid in a tissue-specific manner to determine bioavailability (2). 5

    As such, states of excess glucocorticoids (e.g. Cushing’s syndrome) are pro-diabetic, since 6

    they cause profound glucose intolerance and insulin resistance. 7

    While systemic administration of glucocorticoids induces a compensatory increase in 8

    beta cell mass, and eventually insulin secretory failure due to insulin resistance (3), effects 9

    directly on beta cell function are less well understood. Suggesting an important link between 10

    glucocorticoids and insulin release, beta cell-specific glucocorticoid receptor (GR) 11

    overexpression reduces glucose tolerance (4). However, in vitro studies using isolated islets 12

    have shown inhibitory or no effect of glucocorticoids on glucose-stimulated insulin secretion 13

    depending on the steroid potency, concentratio