Diabetic osteoporosis is increasingly recognized as a significant comorbidity of type 1 diabetes mellitus. In contrast, type 2 diabetes mellitus is more commonly associated with modest increases in bone mineral density for age. Despite this dichotomy, clinical, in vivo, and in vitro data uniformly support the concept that new bone formation as well as bone microarchitectural integrity are altered in the diabetic state, leading to an increased risk for fragility fracture and inadequate bone regeneration following injury. In this review, we examine the contribution that insulin, as a potential anabolic agent in bone, may make to the pathophysiology of diabetic bone disease. Specifically, we have assimilated human and animal data examining the effects of endogenous insulin production, exogenous insulin administration, insulin sensitivity, and insulin signaling on bone. In so doing, we present evidence that insulin, acting as an anabolic agent in bone, can preserve and increase bone density and bone strength, presumably through direct and/or indirect effects on bone formation.

Subcellular targeting and the activity of facilitative glucose transporters are likely to be regulated by interactions with cellular proteins. This report describes the identification and characterization of a protein, GLUT1 C-terminal binding protein (GLUT1CBP), that binds via a PDZ domain to the C terminus of GLUT1. The interaction requires the C-terminal four amino acids of GLUT1 and is isoform specific because GLUT1CBP does not interact with the C terminus of GLUT3 or GLUT4. Most rat tissues examined contain both GLUT1CBP and GLUT1 mRNA, whereas only small intestine lacked detectable GLUT1CBP protein. GLUT1CBP is also expressed in primary cultures of neurons and astrocytes, as well as in Chinese hamster ovary, 3T3-L1, Madin-Darby canine kidney, Caco-2, and pheochromocytoma-12 cell lines. GLUT1CBP is able to bind to native GLUT1 extracted from cell membranes, self-associate, or interact with the cytoskeletal proteins myosin VI, ␣-actinin-1, and the kinesin superfamily protein KIF-1B. The presence of a PDZ domain places GLUT1CBP among a growing family of structural and regulatory proteins, many of which are localized to areas of membrane specialization. This and its ability to interact with GLUT1 and cytoskeletal proteins implicate GLUT1CBP in cellular mechanisms for targeting GLUT1 to specific subcellular sites either by tethering the transporter to cytoskeletal motor proteins or by anchoring the transporter to the actin cytoskeleton.

The effects of type 1 diabetes on de novo bone formation during tibial distraction osteogenesis (DO) and on intact trabecular and cortical bone were studied using nonobese diabetic (NOD) mice and comparably aged nondiabetic NOD mice. Diabetic mice received treatment with insulin, vehicle, or no treatment during a 14-day DO procedure. Distracted tibiae were analyzed radiographically, histologically, and by microcomputed tomography (CT). Contralateral tibiae were analyzed using CT. Serum levels of insulin, osteocalcin, and cross-linked C-telopeptide of type I collagen were measured. Total new bone in the DO gap was reduced histologically (P < 0.001) and radiographically (P < 0.05) in diabetic mice compared with nondiabetic mice but preserved by insulin treatment. Serum osteocalcin concentrations were also reduced in diabetic mice (P < 0.001) and normalized with insulin treatment. Evaluation of the contralateral tibiae by CT and mechanical testing demonstrated reductions in trabecular bone volume and thickness, cortical thickness, cortical strength, and an increase in endosteal perimeter in diabetic animals, which were prevented by insulin treatment. These studies demonstrate that bone formation during DO is impaired in a model of type 1 diabetes and preserved by systemic insulin administration. Diabetes 54:2875-2881, 2005 T ype 1 diabetes is associated with several disorders of skeletal health, including decreased bone density, an increased risk for osteoporosis (1-6), and fragility fracture (7-9), as well as poor bone healing and regeneration characteristics (10), conditions which all rely, in part, upon an intramembranous component to bone formation. Increasing evidence suggests that skeletal abnormalities in type 1 diabetes may, in part, result from the detrimental effects of type 1 diabetes on bone formation. For example, decreased expression of transcription factors that regulate osteoblast differentiation have been demonstrated in animal models of type 1 diabetes (11). Numerous reports of bone histology in diabetic animals demonstrate decreased osteoblast number, osteoid volume, and mineral apposition rates (rev. in 12). In diabetic rats, plasma osteocalcin concentrations, a marker of osteoblast activity, acutely decline beginning on the 1st day of glucosuria (13). Similarly, serum concentrations of osteocalcin in children with newly diagnosed type 1 diabetes are significantly lower at the onset of disease (14). Serum markers correlated with bone formation (IGF-I, alkaline phosphatase, and osteocalcin) also are significantly lower in diabetic patients with osteopenia compared with those without osteopenia (2), and studies have demonstrated that lower bone mineral density (BMD) in type 1 diabetes is correlated with decreased markers of bone formation and more exaggerated dysregulation of the IGF system (15).The present study was designed to test the hypothesis that type 1 diabetes specifically impedes intramembranous bone formation by using a model of tibial distraction osteogenesis uniquely modified for use ...

Matrix metalloproteinases (MMPs), a family of proteinases including collagenases, gelatinases, stromely-sins, matrilysins, and membrane-type MMPs, affect the breakdown and turnover of extracellular matrix (ECM).Moreover, they are major physiologic determinants of ECM degradation and turnover in the glomerulus. Renal hypertrophy and abnormal ECM deposition are hallmarks of diabetic nephropathy (DN), suggesting that altered MMP expression or activation contributes to renal injury in DN. Herein, we review and summarize recent information supporting a role for MMPs in the pathogenesis of DN. Specifically, studies describing dysregulated activity of MMPs and/or their tissue inhibitors in various experimental models of diabetes, including animal models of type 1 or type 2 diabetes, clinical investigations of human type 1 or type 2 diabetes, and kidney cell culture studies are reviewed. KeywordsGelatinase; Podocyte; Extracellular matrix; Proteinases; Proteinuria Diabetic nephropathy-general overviewDiabetic nephropathy is stated to be the most common cause of end-stage renal disease in the United States [1]. Between 20% and 30% of patients with type 1 diabetes mellitus (DM) or type 2 DM will develop nephropathy [1], and among patients with type 1 DM, diabetic nephropathy develops in 40-50% of patients with a 20-year history of disease [2]. Among those individuals who develop renal dysfunction, several risk factors for the development of renal disease have been identified, including duration of diabetes, age at diagnosis, race, systemic or glomerular hypertension, poor glycemic control, genetic predisposition to kidney disease, and dietary composition [1][2][3]. However, the precise pathogenic mechanisms involved in the initiation and progression of diabetic nephropathy remain incompletely understood.The development of diabetic nephropathy has been described as a five-stage process, progressing from glomerular hyperfiltration and nephromegaly (Stage 1), to glomerular basement membrane thickening and mesangial expansion (Stage 2), to microalbuminuria and eventual decline in glomerular filtration rate (Stage 3), to frank proteinuria with severe hypertension and sequelae of moderate to severe renal insufficiency (Stage 4), to eventual endstage renal disease (Stage 5) [4,5]. It has been hypothesized that the early changes in glomerular basement membrane thickness and content ultimately affect filtration properties of the © Humana Press Inc. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript glomerular basement membrane, leading first to increased urinary albumin excretion and eventually to proteinuria. Similar histological findings are also seen in many rodent models of diabetic nephropathy. Because enlargement of the kidney mesangium due to extracellular matrix over-accumulation is a major characteristic of diabetic nephropathy, and because MMPs produced by the mesangial cell account for up to 70% of extracellular matrix degradation and turnover in the kidney during normal matrix remodeling,...