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Animal Models |






From the Department of Physiology and Pharmacology,*
College of Veterinary Medicine, University of Georgia, Athens,
Georgia; and the Departments of Veterinary Diagnostic
Medicine,
Veterinary
Pathobiology,
and Small Animal Clinical
Sciences,§
College of Veterinary Medicine,
University of Minnesota, St. Paul, Minnesota
| Abstract |
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| Introduction |
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The study of the pathogenesis of IAPP-derived islet amyloidosis has been hampered by the lack of animal models whereby the various factors in islet amyloidogenesis can be studied sequentially. Therefore, the goal of the present study was to develop an inducible model of islet amyloidosis in a species (feline) that can also develop spontaneous IAPP-derived islet amyloidosis. Although transgenic mouse models involving overexpression of human IAPP are also useful for these purposes, they have the disadvantage of having ß cells that are further removed from being physiologically normal due to the presence of several transgenes, and are complicated by the concurrent synthesis and secretion of murine IAPP. The present study used, in sequence, partial pancreatectomy, induction of insulin resistance with corticosteroid and growth hormone treatment, and stimulation of IAPP/insulin secretion after induction of diabetes with glipizide, a sulfonylurea drug, to successfully induce islet amyloidosis in domestic cats.
| Research Design and Methods |
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Eight castrated male purpose-bred domestic shorthair cats weighing 4.22 to 5.6 kg (4.7 ± 0.6 kg; mean ± SD) were used in this study. The cats ranged in age from 24 to 29 months at the beginning of the study. All cats had normal complete blood counts, blood biochemical analyses, and urinalyses before study. The cats were housed individually in stainless steel cages. Commercially available cat food was fed twice daily (35 kcal/kg b.i.d.) and water was available ad libitum. A partial pancreatectomy, which entailed removal of the splenic lobe, was performed under general anesthesia in all cats. Sections of pancreas were saved for light and electron microscopic examination (see below).
After a 2-month recovery period, diabetes was induced by daily subcutaneous administration of 1 mg bovine growth hormone (a donation of Monsanto, St. Louis, MO) and oral administration of 1.5 mg dexamethasone. All cats were diabetics after 4 months on this treatment regimen. Stable diabetes was indicated by the fact that the cats remained hyperglycemic after discontinuation of the growth hormone and dexamethasone treatment. The cats had a 3-week period during which they were hyperglycemic but were not yet treated with antihyperglycemic agents. Four of the cats then received Humulin N (Eli Lilly Corp., Indianapolis, IN) subcutaneously twice daily. The average insulin dose given twice daily was 1.5 units/kg. Four cats received 5 mg glipizide (Glucotrol, Pfizer) 2 to 3 times daily. The cats were treated for 18 months with either glipizide or insulin. They were then euthanized with an overdose of pentobarbital. A complete necropsy was performed, and sections of pancreas were fixed for light microscopic examination (see below).
Blood glucose concentrations were measured weekly during the diabetes induction after an overnight fast. In addition, before and 2 months after pancreatectomy, every 4 weeks during diabetes induction, and every 8 weeks during the treatment with insulin or glipizide, glycosylated hemoglobin (gHb) concentrations were measured and intravenous glucose tolerance tests (IVGTT) were performed as described.23,24 Treatment with either insulin or glipizide was withheld on the evening before the glucose tolerance tests were performed. The IVGTT were performed as follows: 50% dextrose (w/v) was injected into a cephalic vein at 1 g/kg body weight. Blood samples for glucose determinations were taken at 5, 10, 15, 30, 45, 60, 90, and 120 minutes. At times 0 and 15, blood samples were also taken for the measurement of IAPP. Because of the large amount of blood that was necessary for the IAPP measurements, only these two time points were chosen for analysis. Blood samples for glucose determinations were kept at room temperature for 30 minutes and then centrifuged for 10 minutes at 500 x g (Beckman GPR, Palo Alto, CA). The serum was then collected and frozen at -20°C until assayed. Glucose measurements were performed using a colorimetric glucose oxidase method (glucose trinder kit; Sigma, St. Louis, MO). Serum insulin concentrations were measured as described using a charcoal method.23 The intra-assay coefficient of variation (CV) was 2.7%; the interassay CV was 3.9%.
Light Microscopy
Pieces of pancreas to be examined by light microscopy were fixed in 10% neutral buffered formalin for 6 hours and then transferred to 70% ethanol solution until processed. Tissues were then routinely dehydrated and paraffin-embedded, sectioned at 4 µm, and stained with hematoxylin and eosin (H&E) and Congo red. Immunohistochemistry was performed on a Dako Autostainer (Dako, Carpenteria, CA) using rabbit anti-human IAPP (1:1000, Peninsula Laboratories, Belmont, CA), and a labeled streptavidin kit (LSAB2 Detection Kit with AEC chromogen, Dako). Positive control tissue (normal cat pancreas) exhibited strong IAPP immunoreactivity in islet ß cells, whereas omission of the primary antibody eliminated all staining. Tissue sections were examined by brightfield microscopy and, in addition, Congo red-stained sections were examined with cross-polarized light for the presence of green birefringence, typical of amyloid. The severity of islet amyloidosis was semiquantitatively scored in each pancreas on a 0 to 4 scale: 0 = no lesion, 1 = minimal (<10% of islets affected and amyloid comprising <10% of islet), 2 = mild (1024% of islets affected and amyloid comprising <25% of islet), 3 = moderate (2549% of islets affected and amyloid comprising up to 50% of islet), 4 = severe (>50% of islets affected and amyloid comprising >50% of most islets). To further assess the degree of islet amyloidosis, all islets in each of 3 sections of pancreas from each cat were counted in the Congo red-stained sections along with the number of islets in which there was detectable islet amyloid (IA). Results were expressed as percentage of islets with IA.
IAPP Radioimmunoassay
Samples were collected into chilled tubes containing EDTA and
trasylol (400 kIU) and were then centrifuged for 10 minutes at 500
x g (Beckman GPR). Plasma IAPP concentrations were measured
essentially as described with modifications for feline
IAPP.25
Plasma was extracted using Sep-Pak C18 cartridges
(Waters, Marlborough, MA) with solvent flow controlled by a Harvard
pump (Harvard Apparatus, South Natick, MA). Cartridges were activated
with 5 ml of 100% acetonitrile/0.1% TFA and then washed with 10 ml of
H2O/0.1% TFA. Three milliliters of plasma were
then loaded onto each column, followed by a wash with 10 ml of
H2O/0.1% TFA. Columns were then eluted with 3 ml
of 70% acetonitrile/0.1% TFA and plasma extracts lyophilized.
Radioimmunoassays were performed at 4°C in polypropylene tubes. A
feline IAPP standard curve (1100 fmol/tube, cat. no. 7290, Peninsula
Laboratories, Belmont, CA) was prepared in Sorensons assay buffer
(0.6 mol/L phosphate, pH 7.4). Lyophilized plasma extracts were
reconstituted in 700 µl radioimmunoassay buffer. For the
assay, duplicate 300 µl samples were incubated at 4°C for 7 days
with 100 µl anti-human IAPP antiserum (cat. no. RAS7321, Peninsula
Laboratories) and 100 µl 125I-labeled IAPP
(Amersham). After incubation, separation of free and bound peptide was
done by addition of 100 µl of bovine
globulin (10 mg/ml in water,
Sigma) and 1 ml 20% polyethylene glycol (Sigma) to samples
followed by centrifugation at 2500 rpm for 30 minutes at 4°C. The
supernatant was aspirated and 125I radioactivity
of the pellet assayed on a
counter (Compugamma, LKB Wallac,
Gaithersburg, MD). Tracer recovery after extraction was 77%.
Minimum detectable peptide was 2.5 fmol/tube. Intra-assay CV was 8.3%;
interassay CV was 16%. The CV for parallelism (3 concentrations) was
10.1%.
The data were analyzed using Data Desk software for Macintosh computers. The data are expressed as means ± SD, unless stated otherwise. The significance of differences of means between groups was assessed by Students t-test for paired samples. A P value <0.05 was considered statistically significant.
| Results |
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All cats had normal glucose tolerance at the beginning of the
study (Figure 1)
. The IAPP concentrations
were similar in all cats at the beginning of the study (3.1 ± 0.2
at time 0, and 4.8 ± 1.0 at time 15 of the IVGTT). During the
growth hormone and dexamethasone treatment period, glucose intolerance
developed, as indicated by changes in the insulin secretion pattern, an
increase in fasting blood glucose, increased gHb, and decreased glucose
disposal rate during IVGTT (K value). The results of changes in blood
glucose, gHb, and K value have been described
previously.19
The insulin release pattern was the first to
change. First phase insulin release became delayed and smaller, whereas
second phase became more exaggerated (Figure 2, a and b)
. The fasting blood glucose
did not become abnormal until first phase insulin secretion had almost
completely disappeared and the amount of insulin secreted during the
2-hour test had dropped about fivefold (see Figure 2c
). The area under
curve for insulin in the cats before diabetes induction was 25.6
± 3.8 nmoles/l*120 minutes, whereas it was 5.0 ± 2.9
nmoles/l*120 minutes when the fasting blood glucose increased above the
normal range (ie, >120 mg/dl).
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Although the gHb concentrations during the 18 months of diabetes
treatment were similar in both groups (2.6 ± 0.2% in the
glipizide- and 2.4 ± 0.2 in the insulin-treated group), the IAPP
concentrations were significantly higher in the glipizide-treated group
than in the insulin-treated group. The average baseline IAPP
concentrations (time 0 of the IVGTT) for the glipizide group were
9.8 ± 1.9 pmol/l and were 2.9 ± 0.2 pmol/l for the
insulin-treated group; the IAPP concentrations after stimulation (time
15 of the IVGTT) were 10.9 ± 1.9 pmol/l for the glipizide group
and 2.1 ± 0.6 pmol/l for the insulin-treated group
(P < 0.001 for both). The average IAPP
concentration in response to the IVGTT during the insulin and glipizide
treatment period is shown in Figure 3
.
The area under curve for insulin in response to the IVGTT was greater
for the insulin-treated cats than for the glipizide-treated cats
(6.7 ± 4.1 versus 4.4 ± 1.0 nmol/120 minutes,
mean ± SD), this was statistically not significant
(P = 0.051).
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Light microscopic examination of pretreatment pancreatic biopsies
failed to demonstrate any endocrine or exocrine lesions. No evidence of
islet amyloidosis was found on H&E or Congo red-stained sections. Light
microscopic examination of post-treatment (necropsy) pancreatic tissues
from insulin-treated cats revealed that 1 of 4 cats had detectable IA.
The single cat with IA had16% of islets exhibiting deposits (Figure 4)
. All 4 cats in this group had islet
cell vacuolar change, which was moderate or severe in 3 cats and
minimal in 1 cat.
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| Discussion |
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An interesting finding in this study was the positive association between glipizide treatment and development of islet amyloidosis, or conversely, a negative association between insulin treatment and the development of islet amyloidosis. It appears likely that relatively increased IAPP secretion played a role in this difference since the glipizide-treated cats had a 3x higher basal and 5x higher glucose-stimulated IAPP secretion than insulin-treated cats. These differences in fasting and glucose-stimulated secretion were most likely due to a combination of increased IAPP secretion in the glipizide-treated cats and reduced IAPP secretion in the insulin-treated cats. Similarly, insulin has been shown previously to suppress IAPP secretion in human patients with non-insulin-dependent diabetes mellitus.29 Our findings are also consistent with data from van Jaarsveld and coworkers, who compared 27 patients treated with oral hypoglycemics to 6 insulin-treated diabetics and 18 nondiabetic patients. The fasting IAPP concentration in the insulin-treated group was approximately 50% of the concentration of the sulfonylurea-treated group.30 No difference in the fasting IAPP concentration was seen in a recent study between sulfonylurea-treated and diet-treated type 2 diabetic patients, whereas a decrease was seen in insulin-treated patients. Sulfonylurea treatment, however, increased the postprandial IAPP concentration more than either diet alone or insulin, which supports the notion that sulfonylureas have differential effects on IAPP and insulin secretion.31 Our data also suggested that glipizide preferentially stimulates IAPP secretion, because the glipizide-treated cats had a lower glucose-stimulated insulin secretion. The insulin secretion pattern was abnormal in both groups but in the insulin-treated group, ß cells were able to respond to the glucose load much earlier (at 30 minutes) than in the glipizide-treated group (at 90 minutes). Differences in the occurrence of islet amyloid in the two groups were not due to differences in regulation of blood glucose concentrations, since gHb levels in the two groups were not significantly different.
The above findings support the concept that islet amyloidosis occurs as a result of prolonged stimulation of ß cells to secrete (the "overworking" hypothesis). This theory postulates that since insulin resistance increases both insulin and IAPP secretion, prolonging or exaggerating this condition (as in long-term obesity) may promote conditions suitable for IAPP fibrillogenesis. It has been speculated that constant overstimulation of ß cells due to insulin resistance may lead to amyloid formation through the depletion of factors necessary for the normal processing and secretion of IAPP.32 This hypothesis is supported by previous observations that cats with impaired glucose tolerance have increased ß-cell IAPP immunoreactivity.8,33 Likewise, in the current study, the ß cells in glipizide-treated cats showed exaggerated IAPP immunoreactivity and loss of normal staining polarity. In addition, the fact that insulinomas (in which there is dysregulation of insulin and IAPP secretion) also contain IAPP-derived amyloid deposits lends further support to this hypothesis.34
The present study raises the intriguing question of whether the long-term use of drugs that increase IAPP (and insulin) secretion, such as sulfonylureas, may induce or accelerate the development of IAPP-derived islet amyloid deposits. Such effects would be predicted to contribute to the progression of diabetes toward insulin dependence. The fact that each year approximately 5% of human patients taking oral hypoglycemic drugs progress to insulin dependence supports this possibility.35 The striking degree of islet amyloidosis that developed primarily in the glipizide-treated cats in the present study occurred over the course of 18 months of treatment and indicates the rapidity with which this pathological change may occur. It is also possible, however, that glipizide was not so much a promoter of IAPP-derived islet amyloidosis as insulin treatment was an inhibitor of this process. It may be that pathological processes that lead to islet amyloidosis are initiated by the diabetes induction methods used in this study and that insulin treatment inhibits further development of islet amyloid. The facts that islet amyloidosis was found (albeit in trace amounts) in one of the insulin-treated cats, and that islet amyloidosis may be induced by corticosteroid and growth hormone treatment in mice transgenic for human IAPP,19 also support this latter possibility. The present experiment was not designed to assess these potential mechanisms and elucidation of the precise pathogenesis will require further study.
| Acknowledgements |
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| Footnotes |
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Supported by the Morris Animal Foundation.
Accepted for publication September 12, 2000.
| References |
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