G lucagon-like peptide 1 (GLP-1) is an intestinal hormone that exerts profound effects in the regulation of glycemia, stimulating glucose-dependent insulin secretion, proinsulin gene expression, and -cell proliferative and anti-apoptotic pathways, as well as inhibiting glucagon release, gastric emptying, and food intake (1). The demonstrated success of GLP-1 to lower glycemia has led to approval of the GLP-1 receptor agonist exendin-4 (Byetta) for the treatment of patients with type 2 diabetes (2). Studies using GLP-1 receptor antagonists as well as GLP-1 receptor null mice have demonstrated that GLP-1 makes an essential contribution to the "incretin" effect after a meal (3,4). However, GLP-1 secretion is reduced in patients with type 2 diabetes (5-7), and this may contribute in part to the reduced incretin effect and the hyperglycemia that is observed in these individuals (8). Thus, interest has now focused on the factors that regulate the release of this peptide after nutrient ingestion. Many different GLP-1 secretagogues have been described in the literature over the past few decades, including nutrients, neurotransmitters, neuropeptides, and peripheral hormones (rev. in 9,10). However, the specific receptors, ion channels, and intracellular signaling proteins expressed by the GLP-1-producing intestinal L-cell have only recently begun to be characterized. The purpose of this review is to integrate the literature regarding the signal transduction pathways used by the major GLP-1 secretagogues. An improved understanding of the mechanisms regulating GLP-1 secretion may lead to novel approaches to enhance GLP-1 levels in vivo, thereby providing an alternative approach to the use of this peptide in the treatment of patients with type 2 diabetes.
SYNTHESIS AND DEGRADATION OF GLP-1Although the proglucagon gene is expressed in enteroendocrine L-cells and pancreatic ␣-cells (11), GLP-1 is synthesized by posttranslational processing of proglucagon only in the intestine. The L-cells are predominantly located in the ileum and colon and have been identified as open-type epithelial cells that are in direct contact with nutrients in the intestinal lumen (12). Furthermore, L-cells are located in close proximity to both neurons and the microvasculature of the intestine (13,14), which allows the L-cell to be affected by both neural and hormonal signals. In fetal rat intestinal L-cell cultures and immortalized murine L-cells, proglucagon gene expression is enhanced by activation of the protein kinase A (PKA) pathway (15,16). Although originally thought to be mediated through CREB binding to the cAMP response element in the proglucagon gene, recent studies have demonstrated that cAMP-dependent proglucagon gene expression in the L-cell occurs via -catenin-mediated activation of the bipartite transcription factor, TCF4 (17). Interestingly, a very recent report has linked variants of TCF4 to the risk for development of type 2 diabetes (18), implicating GLP-1 in the etiology of this disease.Tissue-specific expression of prohormone...