DIABETES MELLITUS can be described as a collection of metabolic diseases characterized by fasting hyperglycemia. Although the most prevalent forms of diabetes mellitus are the polygenic forms that result in -cell destruction or dysfunction, there exist monogenic forms that are diagnosed within the first six months of life, termed neonatal diabetes mellitus. This is a rare condition, occurring in one out of every 400,000 to 500,000 births, and can be either transient or permanent. Through numerous genetic studies, the cause of permanent neonatal diabetes mellitus (PNDM) can be traced to mutations in genes encoding for a number of -cell functions, including pancreatic and islet development, the insulin-secretory response to glucose, and insulin biosynthesis (1). Such studies have resulted in elegant examples of "bedside-to-bench-to-bedside" science, in which genetic mutations are first identified in human populations, examined for their molecular and cellular effects on -cell function, and the results applied to developing personalized approaches to disease management. For example, mutations in the K ATP channel components Kir6.2 (KCNJ11) and SUR1 (ABCC8) have been identified as the major cause of PNDM (6). These mutations were found to result in a gain-offunction, which, when expressed in transgenic mice, recapitulated PNDM by impairing glucose-stimulated insulin secretion. As a result, patients harboring mutations in K ATP channels are treated with sulfonuylurea drugs instead of insulin. Additionally, as novel mutations in K ATP channels are identified, the molecular mechanism of the disease can be studied on a case-by-case basis both for new treatments and to reveal novel aspects of K ATP function (2).A similar story appears to be emerging with the discovery of mutations in the proinsulin gene (INS) in patients with PNDM. Ten heterozygous mutations in the human INS gene have been recently identified through linkage analysis of a group of patients in Chicago (8). Interestingly, the mutations occurred at biologically critical sites within the proinsulin molecule: the site of signal peptide cleavage, residues involved in disulfide bond formation, and at the C-peptide-A chain junction, a site for posttranslational processing. The sites of these mutations led to the hypothesis that the type of PNDM associated with mutations in the INS gene could result from the improper folding and/or processing of proinsulin.In this issue, Rajan et al. (5) have addressed this hypothesis by examining the subcellular processing, trafficking, and secretion of the mutant proinsulins found in the Chicago probands. However, instead of simply generating the mutations within human proinsulin and following trafficking patterns with traditional secretion assays and immunocytochemistry, they made use of an "all-in-one" construct with which they could follow subcellular trafficking in live cells, detect proinsulin processing, and directly measure glucose-stimulated insulin secretion. The construct design incorporated green fluorescent protei...