2. Flow of presentation
Background of islet amyloid, IAPP and type 2 diabetes
Role of iapp
Processing and secretion of IAPP
Possible mechanisms for amyloid formation
Islet amyloid and β-cell toxicity
Techniques used to monitor aggregation
Therapeutic approaches
2
3. Islet amyloid
Eugene Opie (1900’s) described the occurrence of
‘hyaline degeneration of the islets of Langerhans’ in
patients with hyperglycemia
In 1987, Westermark and Cooper with separate
groups identified peptide aggregates in β-cells of
pancreas in type 2 diabetes and named it as IAPP &
AMYLIN
IAPP is 37 AA’ peptide hormone co-secreted with
insulin and forms amyloid fibrils in type 2 diabetes that
disrupts the cell membrane and is responsible for β-
cells death
Present in ≥90% of type 2 diabetic subjects
3
4. Type 2 diabetes
Non-insulin dependant diabetes mellitus
Long term metabolic disorder characterized by high
blood glucose levels, decreased insulin sensitivity
Body’s inability to utilize the insulin present
complications: CVD, blindness, kidney failure,
cognitive dysfunction
4
6. Figure. Sequence of aminoacids in IAPP and the amyloidogenic region from 20-29
6
7. IAPP or AMYLIN
Amylin, or islet amyloid polypeptide (IAPP), is a
37-residue peptide hormone
Disulfide bond between 2nd & 7th position between
two Cysteine aminoacids
It is cosecreted with insulin from the pancreatic β-cells
in the ratio of approximately 100:1 (insulin:amylin)
contributes to glycemic control
7
8. Role of IAPP
8
Debbie L et al., Amylin: Pharmacology, Physiology, and Clinical Potential
Pharmacological Reviews July 2015, 67 (3) 564-600
9. Processing and secretion of IAPP
derived from larger molecule proIAPP and processed
by two enzymes called prohormone convertases
(PC) – PC 1/3 and PC2
9https://en.wikipedia.org/wiki/Amylin
10. 10
Jing Wang et al., The Prohormone Convertase Enzyme 2 (PC2) Is Essential for Processing Pro-Islet Amyloid
Polypeptide at the NH2-Terminal Cleavage Site. Diabetes 2001 Mar; 50(3): 534-539
11. 11
Figure. Alignment of sequence of IAPP in different species
•Rodent IAPP is non amyloidogenic, proline in the
region of 24-29 prevents fibrillization
•8-20; 20-29; 30-37 regions have tendency to form β-
sheets can form fibrils
Hye Rin Jeong et al., 2015 Causative factors for formation of toxic islet amyloid polypeptide oligomer in type 2 diabetes
mellitus, Clinical Interventions in Aging
12. Possible mechanisms for amyloid
formation
Mutations in pro IAPP gene leads to misfolding of
IAPP, misfolded IAPP form fibrils and tend to attract
other IAPP monomer
Increased production of IAPP with increased demand
for insulin (hyperglycemia & hyperlipidemia)
Impaired precursor IAPP processing NH2 terminus
elimination
Unprocessed IAPP binding with heparan sulfate
proteoglycans
Presence of fibril seeds
12
13. 13
Figure. List of genetic mutations of IAPP determined from in silico studies,
and naturally occurring (eg, S20G) mutations.
Karen Pillay et al., 2013 amylin
uncovered. biomed research
international.
14. Figure. proposed mechanism of N-terminal of pro-Amylin binding with
perlecan heparan sulfate proteoglycan at basement membrane of β-cell.
Marzban l et al., 2013 Islet amyloid polypeptide and type 2 diabetes 2, experimental
gerontology 14
15. β-cell toxicity by Islet amyloid
Cell membrane disruption and disrupts the
intracellular homeostasis
Causes oxidative stress by ROS generation
Deposits of IAPP in β-cell causes apoptotic cell death
15
16. Figure. Apoptosis in β-cell by islet amyloid aggregation
16
Karen Pillay et al., 2013 amylin uncovered. biomed research international.
17. Techniques used to monitor
aggregation and toxicity
Dyes : Congo red, Thioflavin T
Microscopic techniques:
Transmission electron microscopy
Atomic force microscopy
Spectroscopic techniques:
Circular dichromism
FT-IR spectroscopy
17
18. Drugs reported
NSAIDS have shown to decrease the association between β-
sheets
EPIGALLOCATECHIN decreases many peptides aggregation
polyphenol RESVERATROL has been shown to inhibit
amyloid formation
ASCORBIC ACID, LIPOIC ACID have shown to interact with
amylin and inhibit early stages of aggregation process
Tannic acid, curcumin, myricetin have also been reported
for their activity in inhibiting aggregation
Rifampicin invivo studies has shown to inhibit the
aggregation and preformed aggregates
18
19. Therapeutic approaches
Target or intended effect Drug therapy or approach
1. Direct inhibition of gene
transcription
Drugs inhibiting the activity
of the IAPP gene promoter
2. Direct inhibition of
translation of mRNA
3. Reduction in the demand
for endogenous insulin
Insulin therapy in T2DM
4. Reduction in hepatic
glucose production &
increase in insulin sensitivity
conventional antidiabetic
drugs like metformin,
sulfonyl ureas etc..
19
A. Production of hIAPP
20. Target or intended effect Drug therapy or approach
1. Inhibition of fibril
formation, stabilization,
protection.
Drugs that inhibit binding of
serum amyloid p with
developing fibril
2. Inhibition of fibril
formation
Drugs inhibiting the
interaction between perlecan
and fibril forming protein.
3. Removal of deposits invivo Phagocytosis or increase
solubility of fibril
4. Inhibition of fibril
formation and dissociation
with existing fibrils
Disrupt the aggregation of β-
pleated sheets
20
B. Fibrillization