Cooperation between brain and islet in glucose homeostasis and diabetes

Although a prominent role for the brain in glucose homeostasis was proposed by scientists in the nineteenth century, research throughout most of the twentieth century focused on evidence that the function of pancreatic islets is both necessary and sufficient to explain glucose homeostasis, and that...

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Bibliographic Details
Published in:Nature (London) 2013-11, Vol.503 (7474), p.59-66
Main Authors: Schwartz, Michael W, Seeley, Randy J, Tschöp, Matthias H, Woods, Stephen C, Morton, Gregory J, Myers, Martin G, D'Alessio, David
Format: Article
Language:English
Subjects:
Animals
Blood Glucose - metabolism
Brain - metabolism
Brain research
Dextrose
Diabetes
Diabetes Mellitus - metabolism
Glucose
Glucose - metabolism
Homeostasis
Humans
Insulin
Insulin - metabolism
Islands of Langerhans
Islets of Langerhans - metabolism
Pancreas
Physiological aspects
Properties
Rodents
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Summary:Although a prominent role for the brain in glucose homeostasis was proposed by scientists in the nineteenth century, research throughout most of the twentieth century focused on evidence that the function of pancreatic islets is both necessary and sufficient to explain glucose homeostasis, and that diabetes results from defects of insulin secretion, action or both. However, insulin-independent mechanisms, referred to as 'glucose effectiveness', account for roughly 50% of overall glucose disposal, and reduced glucose effectiveness also contributes importantly to diabetes pathogenesis. Although mechanisms underlying glucose effectiveness are poorly understood, growing evidence suggests that the brain can dynamically regulate this process in ways that improve or even normalize glycaemia in rodent models of diabetes. Here we present evidence of a brain-centred glucoregulatory system (BCGS) that can lower blood glucose levels via both insulin-dependent and -independent mechanisms, and propose a model in which complex and highly coordinated interactions between the BCGS and pancreatic islets promote normal glucose homeostasis. Because activation of either regulatory system can compensate for failure of the other, defects in both may be required for diabetes to develop. Consequently, therapies that target the BCGS in addition to conventional approaches based on enhancing insulin effects may have the potential to induce diabetes remission, whereas targeting just one typically does not.
ISSN:0028-0836
1476-4687
DOI:10.1038/nature12709