Sequence of human galanin and its inhibition of glucose-stimulated insulin secretion from RIN cells.

Human progalanin cDNA was cloned with polymerase chain reaction techniques. The cDNA sequence predicts that the human form of galanin has a substitution of the glycine residue found at position 30 in other species and thus is likely to retain this residue during posttranslational processing and not be amidated at the COOH terminus. Furthermore, the cDNA sequence predicts three additional amino acid substitutions compared with known galanins. Human galanin was synthesized, and its bioactivity was compared with porcine and rat galanin based on inhibition of insulin release from a glucose-responsive rat insulinoma (RIN) cell line. Human galanin inhibited glucose-stimulated insulin secretion in a dose-dependent manner in RIN cells. Human, porcine, and rat galanin exhibited similar activity with ED50 less than 1 nM.

Major species variation in the expression of galanin messenger ribonucleic acid in mammalian celiac ganglion.

To determine whether galanin may be a sympathetic neurotransmitter in the pancreas of primates and rats as well as dogs, the expression of the galanin gene was examined in the celiac ganglion of these species by in situ hybridization and RIA. Intense hybridization signal for galanin messenger RNA (mRNA) was observed in every neuronal cell body of the dog celiac ganglion. However, significant hybridization signal for galanin mRNA was seen in only 24 +/- 5% of celiac ganglion cell bodies in monkeys and was absent in rats. RIA of celiac ganglion extracts confirmed this species variation; galanin-like immunoreactivity was highest in dog celiac ganglion (158 +/- 13 pmol/g), present in monkeys (34 +/- 7 pmol/g), and undetectable in rats (< 0.8 pmol/g). In contrast, the celiac ganglia of all three species showed intense hybridization signal for neuropeptide-Y (NPY) mRNA in the majority of neuronal cell bodies (dog, 82 +/- 4%; monkey, 92 +/- 2%; rat, 91 +/- 3%), and the celiac ganglion NPY immunoreactivity content was high in all three species (dog, 1064 +/- 155 pmol/g; monkey, 3180 +/- 745 pmol/g; rat, 3412 +/- 347 pmol/g). Thus, there is a marked species variation in the expression of the galanin, but not the NPY, gene in the celiac ganglion of dogs, monkeys, and rats. These data suggest that galanin is an important sympathetic neurotransmitter in the pancreatic islets of dogs, but not those of primates or rats.

Disproportionately elevated proinsulin in Pima Indians with noninsulin-dependent diabetes mellitus.

Fasting serum total immunoreactive insulin (IRI), true insulin, and true proinsulin (PI) were measured in 169 Pima Indians. The relationship of these variables to glucose tolerance, obesity, and parental diabetes was studied. Seventy-seven subjects had normal glucose tolerance, 46 had impaired glucose tolerance (IGT), and 46 had noninsulin-dependent diabetes mellitus (NIDDM) by WHO criteria. In subjects with normal glucose tolerance, the geometric mean ratio of PI to IRI (PI/IRI) was 10.8% (arithmetic mean, 12.5%), similar to that reported in other ethnic groups with lower prevalence rates of NIDDM. Parental diabetes had no effect on PI/IRI. Obese persons (body mass index, greater than or equal to 27 kg/m2) with normal glucose tolerance had PI/IRI of 9.3% compared with 16.3% for the nonobese (P less than 0.001), and PI/IRI was negatively correlated with body mass index (r = -0.34; P = 0.002). Proinsulin was disproportionately elevated in NIDDM (geometric mean PI/IRI, 19.9%; arithmetic mean, 23.6%), and the degree of elevation was related to the severity of hyperglycemia, but not the duration of diabetes. Subjects with IGT were more obese and had higher fasting plasma glucose (5.7 vs. 5.2 mmol/L; P = 0.025), true insulin (250 vs. 125 pmol/L; P less than 0.001), and PI concentrations (26 vs. 15 pmol/L; P less than 0.001) than those with normal glucose tolerance but similar mean PI/IRI (9.4 vs. 10.8%; P = 0.4). These findings indicate that Pima Indians with NIDDM have a disproportionate elevation of PI consistent with the hypothesis that beta-cell dysfunction associated with hyperglycemia leads to the release of proinsulin-rich immature granules.

Neuroglycopenic and other symptoms in patients with insulinomas.

PURPOSE: To characterize neuroglycopenic symptoms in the clinical presentation of patients with insulinomas. SUBJECTS AND METHODS: Patients with histologically confirmed islet cell adenomas or carcinomas were identified at a single institution. Patient symptoms and clinical features of the insulinomas were obtained by retrospective medical record review with special attention to neuroglycopenic and autonomic symptoms. RESULTS: Of the 59 patients, 51% were female. Patients' ages ranged from 17 to 79 years (median 55) at the time of surgery. The interval from the onset of symptoms to diagnosis ranged from 1 month to 30 years (median 24 months). Most patients were diagnosed within 1 to 5 years (53%). Prior diagnoses included neurologic disorders (64%), especially seizure disorders (39%); 7 (12%) patients were treated with antiseizure medications. All patients had neuroglycopenic symptoms including confusion (83%) and personality change or bizarre behavior (64%). Amnesia for hypoglycemia was common (41%). Autonomic symptoms (83%) were usually diaphoresis (69%) or tremulousness (24%). Food ingestion relieved symptoms in 71% of patients; 39% reported weight gain. CONCLUSIONS: Despite improving diagnostic techniques, the diagnosis of an insulinoma is often delayed. Careful inquiry about neuroglycopenic symptoms from patients and persons who know them well is necessary whenever hypoglycemia due to endogenous hyperinsulinemia is a clinical consideration. A history of neuroglycopenic symptoms should suggest the diagnosis of hypoglycemia associated with a hyperinsulinemic state.

Evidence that galanin is a parasympathetic, rather than a sympathetic, neurotransmitter in the baboon pancreas.

To determine whether galanin is a pancreatic sympathetic neurotransmitter regulating insulin secretion in the baboon, as it is in the dog, we evaluated galanin for inhibitory effects on insulin secretion in conscious baboons, determined if baboon pancreatic islets are innervated by galaninergic fibers using immunohistochemistry, and measured galanin content in the major sympathetic ganglion supplying the pancreas. Surprisingly, infusion of galanin (1 microgram/kg per min) had no effect on arginine-stimulated secretion of either insulin (71 +/- 14 vs. 88 +/- 17 microU/ml; P = NS) or glucagon (104 +/- 12 vs. 94 +/- 9 pg/ml; P = NS). By contrast, growth hormone secretion was markedly increased during galanin infusion. In the baboon celiac ganglion, no galanin immunoreactivity was detectable in sympathetic neuronal cell bodies by immunostaining and their content of galanin-like immunoreactivity, determined by radioimmunoassay, was only 3% of that in dog celiac ganglion (5.2 +/- 0.8 vs. 158 +/- 13 pmol/g; P < 0.001). By contrast, galanin immunoreactivity was observed in many nerve fibers in the baboon exocrine pancreas and occasionally in baboon pancreatic islets. Moreover, galanin content of the baboon pancreas was similar to that of dog (8.7 +/- 1.5 vs. 5.5 +/- 1.2 pmol/g; P = NS). The finding of galanin immunoreactivity in many neuronal cell bodies in baboon intrapancreatic ganglia suggests a parasympathetic source for these galaninergic fibers in the baboon. Together these data demonstrate that galanin is likely to be a parasympathetic neurotransmitter in the baboon pancreas, without major effects on insulin or glucagon secretion.

Selection and performance of medical students and residents with type 1 diabetes mellitus.

The preliminary study reported here indicates that a number of medical students and residents are identified Type 1 diabetics (although the actual number is probably greater) and that they perform well. Most programs and schools have no formal or informal policy regarding the acceptance of diabetic candidates; indeed, most consider the disease irrelevant and treat the diabetic candidates the same as nondiabetic candidates in the selection process.

Liver releases galanin during sympathetic nerve stimulation.

To determine whether the gut or liver releases galanin during sympathetic neural activation, we performed bilateral thoracic splanchnic nerve stimulation (BTSNS) in halothane-anesthetized dogs. Using experimentally determined galanin extraction rates of 60% for gut and no extraction by liver, calculations demonstrated a minor increase in gut spillover during BTSNS (delta = +4.8 +/- 1.8 pmol/min), whereas liver spillover of galanin-like immunoreactivity (GLIR) increased markedly (delta = +27.9 +/- 9.5 pmol/min). To confirm the finding of liver galanin release, GLIR was measured in femoral artery, portal vein, and hepatic vein during hepatic nerve stimulation (HNS). GLIR spillover from gut was not increased by HNS (delta = +1.9 +/- 6.3 pmol/min). In contrast, liver GLIR spillover was greatly increased during HNS (delta = +53.3 +/- 16.4 pmol/min). Extracts of canine liver contained 2.7 +/- 0.4 pmol GLIR/g tissue. We conclude that, despite the known significant galanin content of the gut, little galanin is released from this organ during sympathetic activation. In contrast, the liver, heretofore not described to contain galanin, contains and releases significant amounts of the peptide during sympathetic activation.

Galanin is co-localized with noradrenaline and neuropeptide Y in dog pancreas and celiac ganglion.

To visualize the localization and potential co-localization of noradrenaline and the putative pancreatic sympathetic neurotransmitters, galanin and neuropeptide Y (NPY), immunofluorescent staining for galanin, NPY and tyrosine hydroxylase (TH) was performed on sections of canine pancreas and celiac ganglion. In the pancreas, galanin-immuno-fluorescent nerve fibers were confirmed as densely and preferentially innervating the islets, whereas numerous NPY-positive nerve fibers were found in the exocrine parenchyma, the surrounding of the blood vessels and within the islets. Double-staining for the peptides and TH indicated that most galanin-positive nerve fibers were adrenergic, most NPY-positive nerve fibers were adrenergic, and many islet nerves contained both galanin and NPY, although some galanin-positive nerve fibers appeared to lack NPY. In the celiac ganglion, virtually all cell bodies were positive for both galanin and TH; a large subpopulation of these cells were also positive for NPY. Radioimmunoassay (RIA) of galanin in extracts of dog celiac ganglion revealed a very high content (256 +/- 33 pmol/g wet weight) of galanin-like immunoreactivity (GLIR), consistent with the dense staining observed. This GLIR behaved in a similar manner to synthetic porcine galanin in the RIA. In addition, the majority of the GLIR in ganglion extracts co-eluted with the synthetic peptide upon gel filtration, although a minor peak of a larger apparent molecular weight was also observed, observations consistent with the presence of a precursor peptide. These findings suggest that galanin is a sympathetic post-ganglionic neurotransmitter in the canine endocrine pancreas and that NPY might serve a similar function.

Canine liver releases neuropeptide Y during sympathetic nerve stimulation.

To determine whether the liver or gut releases neuropeptide Y (NPY) from their sympathetic nerves, we performed bilateral thoracic sympathetic nerve stimulation (BTSNS) in halothane-anesthetized dogs and calculated gut and liver NPY spillover. BTSNS markedly increased hepatic NPY spillover (delta = +32 +/- 8 ng/min) and arterial NPY concentration (delta = +220 +/- 56 pg/ml), despite no effect on gut NPY spillover (delta = +8 +/- 7 ng/min). To determine the liver's contribution to this increase of circulating NPY, hepatic nerves were selectively stimulated (HNS). Liver NPY spillover increased markedly (delta = +114 +/- 42 ng/min, P < 0.025) during HNS, causing a large increase of arterial NPY (delta = +586 +/- 237 pg/ml, P < 0.025). Using this ratio of liver spillover to arterial increments of NPY, we calculated that the liver makes a major contribution (70%) to circulating NPY levels during BTSNS. The predominant form of canine NPY coeluted with synthetic [Met17]NPY and the minor form of canine NPY coeluted with the oxidized form of [Met17]NPY on high-performance liquid chromatography. We therefore conclude that dog NPY is likely [Met17]NPY and that the liver, rather than the gut, is a major source of circulating NPY during sympathetic nerve stimulation and perhaps stress.

Galanin is localized in sympathetic neurons of the dog liver.

Stimulation of canine hepatic nerves releases the neuropeptide galanin from the liver; therefore, galanin may be a sympathetic neurotransmitter in the dog liver. To test this hypothesis, we used immunocytochemistry to determine if galanin is localized in hepatic sympathetic nerves and we used hepatic sympathetic denervation to verify such localization. Liver sections from dogs were immunostained for both galanin and the sympathetic enzyme marker tyrosine hydroxylase (TH). Galanin-like immunoreactivity (GALIR) was colocalized with TH in many axons of nerve trunks as well as individual nerve fibers located both in the stroma of hepatic blood vessels and in the liver parenchyma. Neither galanin- nor TH-positive cell bodies were observed. Intraportal 6-hydroxydopamine (6-OHDA) infusion, a treatment that selectively destroys hepatic adrenergic nerve terminals, abolished the GALIR staining in parenchymal neurons but only moderately diminished the GALIR staining in the nerve fibers around blood vessels. To confirm that 6-OHDA pretreatment proportionally depleted galanin and norepinephrine in the liver, we measured both the liver content and the hepatic nerve-stimulated spillover of galanin and norepinephrine from the liver. Pretreatment with 6-OHDA reduced the content and spillover of both galanin and norepinephrine by > 90%. Together, these results indicate that galanin in dog liver is primarily colocalized with norepinephrine in sympathetic nerves and may therefore function as a hepatic sympathetic neurotransmitter.

The canine sympathetic neuropeptide galanin: a neurotransmitter in pancreas, a neuromodulator in liver.

Our laboratory has investigated the role of the neuropeptide galanin in the sympathetic neural control of both the canine endocrine pancreas and liver. Galanin mRNA and peptide were found in the neuronal cell bodies of the celiac ganglion, which projects fibers to both organs. Galanin fibers formed dense networks around the islets. Galanin was released from these nerves and the amount released appeared sufficient to markedly inhibit basal insulin secretion. We therefore propose that galanin is a sympathetic neurotransmitter in canine endocrine pancreas. Galanin was also found in hepatic nerves usually co-localized with tyrosine hydroxylase, a sympathetic marker. Further, intraportal administration of the sympathetic neurotoxin, 6-hydroxydopamine, abolished galanin staining in the hepatic parenchyma. We evaluated the role of galanin in mediating the actions of sympathetic nerves to increase hepatic glucose production and decrease hepatic arterial conductance. Local infusion of synthetic galanin had little effect by itself, but it did potentiate the action of norepinephrine to stimulate hepatic glucose production, demonstrating a neuromodulatory action. In contrast, galanin had no effect on hepatic arterial blood flow. We therefore propose that in the liver galanin functions as a neuromodulator of norepinephrine's metabolic action.