Pulsatile secretion is an inherent property of hormone-releasing pancreatic islet cells. This secretory pattern is physiologically important and compromised in diabetes. Neurotransmitters released from islet cells may shape the pulses in auto/paracrine feedback loops. Within islets, glucose-stimulated β-cells couple via gap junctions to generate synchronized insulin pulses. In contrast, α-and δ-cells lack gap junctions, and glucagon release from islets stimulated by lack of glucose is non-pulsatile. Increasing glucose concentrations gradually inhibit glucagon secretion by α-cell-intrinsic mechanism/s. Further glucose elevation will stimulate pulsatile insulin release and co-secretion of neurotransmitters. Excitatory ATP may synchronize β-cells with δ-cells to generate coinciding pulses of insulin and somatostatin. Inhibitory neurotransmitters from β-and δ-cells can then generate antiphase pulses of glucagon release. Neurotransmitters released from intrapancreatic ganglia are required to synchronize β-cells between islets to coordinate insulin pulsatility from the entire pancreas, whereas paracrine intra-islet effects still suffice to explain coordinated pulsatile release of glucagon and somatostatin. The present review discusses how neurotransmitters contribute to the pulsatility at different levels of integration. Keywords: glucagon, insulin, neurotransmitters, oscillations, pulsatile secretion, somatostatin
Date submitted 28 March 2014; date of final acceptance 15 April 2014
IntroductionInsulin is the major blood glucose-lowering hormone, and glucagon is most important for blood glucose elevation. The release of these hormones from the islets of Langerhans is therefore essential for normal glucose homeostasis, and secretion disturbances underlie development of type 2 diabetes (T2D), which is increasing worldwide in an almost epidemic manner. It has long been known that the concentration of circulating insulin shows regular oscillations in normal human subjects, and that this pattern does not reflect variations in blood glucose but is determined by a pancreatic pacemaker [1]. Studies in normal subjects and diabetic patients have shown that less insulin is required to maintain normoglycaemia if the hormone is infused in an oscillatory manner compared to a constant rate [2], which may reflect higher expression of insulin receptors. The oscillatory insulin pattern is early deteriorated in patients with T2D [1]. Loss of insulin oscillations may therefore contribute to insulin resistance and the resulting increased insulin demand may exhaust the β-cells and cause overt T2D in susceptible individuals.Although insufficient secretion of insulin is the generally accepted cause of diabetes, it was recently proposed that 'glucagon excess, rather than insulin deficiency, is the sine qua non of diabetes ' [3]. Also, circulating glucagon is oscillating due to pulsatile release of the hormone with insulin and glucagon in opposite phase [4]. Indeed, prediabetes is associated Correspondence to: E. Gylfe, Department of Medical C...