The Role for Endoplasmic Reticulum Stress in Diabetes Mellitus

Accumulating evidence suggests that endoplasmic reticulum (ER) stress plays a role in the pathogenesis of diabetes, contributing to pancreatic -cell loss and insulin resistance. Components of the unfolded protein response (UPR) play a dual role in -cells, acting as beneficial regulators under physiological conditions or as triggers of -cell dysfunction and apoptosis under situations of chronic stress. Novel findings suggest that "what makes a -cell a -cell", i.e., its enormous capacity to synthesize and secrete insulin, is also its Achilles heel, rendering it vulnerable to chronic high glucose and fatty acid exposure, agents that contribute to -cell failure in type 2 diabetes. In this review, we address the transition from physiology to pathology, namely how and why the physiological UPR evolves to a proapoptotic ER stress response and which defenses are triggered by -cells against these challenges. ER stress may also link obesity and insulin resistance in type 2 diabetes. High fat feeding and obesity induce ER stress in liver, which suppresses insulin signaling via c-Jun N-terminal kinase activation. In vitro data suggest that ER stress may also contribute to cytokine-induced -cell death. Thus, the cytokines IL-1 and interferon-, putative mediators of -cell loss in type 1 diabetes, induce severe ER stress through, respectively, NO-mediated depletion of ER calcium and inhibition of ER chaperones, thus hampering -cell defenses and amplifying the proapoptotic pathways. A better understanding of the pathways regulating ER stress in -cells may be instrumental for the design of novel therapies to prevent -cell loss in diabetes. (Endocrine Reviews 29: 42-61, 2008) I. Introduction II. Endoplasmic Reticulum (ER) Stress and the Unfolded Protein Response (UPR) A. The dialogue between the ER and the nucleus B. ER stress and apoptosis III. The UPR and -Cell Adaptation to Physiological Demand IV. ER Stress and -Cell Death in Monogenic and Type 2 Diabetes A. ER stress and human diabetes B. Animal models of ER stress and diabetes C. Lipotoxicity and glucotoxicity as triggers of ER stress-when physiology turns into pathology V. ER Stress and -Cell Death in Type 1 Diabetes-the Role of Cytokines and Nitric Oxide (NO) VI. -Cell Recovery from ER Stress VII. ER Stress as a Putative Link between Obesity and Insulin Resistance A. Liver B. Adipose tissue VIII. Future Areas of Research