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| EDITORIAL |
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| Year : 2013 | Volume
: 18
| Issue : 2 | Page : 89-90 |
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Betatrophin in type 2 diabetes mellitus
Omprakash Gupta
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| Date of Web Publication | 6-Sep-2013 |
Correspondence Address:
Omprakash Gupta
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9903.117786
How to cite this article:
Gupta O. Betatrophin in type 2 diabetes mellitus. J Mahatma Gandhi Inst Med Sci 2013;18:89-90 |
Type 2 diabetes mellitus is world's largest growing problem, reaching almost epidemic level in our country numbering 50.8 million according to International Diabetes Federation (IDF, 2009). The World Health Organization has termed India as diabetes capital. Disease is likely to affect many more and also to cause a significant dent in the country's economy.
Type 2 diabetes accounts for 95% cases of diabetes. In the initial stages there is even hyperinsulinemia; but because of insulin resistance induced by multiple factors, hyperglycemia persists. However, various oral hypoglycemic drugs acting through different mechanisms can maintain euglycemia. A stage comes when the pancreatic beta cells get exhausted and can no more keep up with the increasing demand of insulin. Naturally, there is no alternative but to depend on insulin to maintain normal blood glucose levels. Multiple shots of insulin need to be taken every day to keep blood glucose levels under control and to prevent the life threatening complications. It not only involves higher cost of treatment but also burden of multiple injections and the pain of pricks. Is it possible to reduce the number of pricks or to totally break free from that regimen? The newer insulin analogue like insulin degludec which is an ultra-long acting basal insulin (duration of action about 40 h), can be give thrice a week (see page no 9-14 in this issue of the journal), thus reducing the number of pricks significantly.
The replication of pancreatic beta cells in mice and human being is quite rapid in embryonal and neonatal period, but in adulthood it is markedly reduced. Recently co-director and researcher at Harvard Stem Cell Institute Doug Melton and Peng Yi [1] while investigating 'what happens when animals do not make enough insulin' noted that by some process pancreas is induced to make more insulin. By using S961 protein in mice, they blocked insulin signaling (by blocking insulin pathway in the mice liver), and induced glucose intolerance. The level of betatrophin hormone markedly increased after S961 with significant increase in insulin secreting beta cells proliferation, almost 17-30 times in mice. With DNA microarray analysis they could find a single gene with 198 amino acids, expressed in liver and fat of the mice (in human being it is expressed in liver only). The betatrophin hormone so discovered is specific and works only on beta cells and at the same time it is highly potent and without any adverse effects. Betatrophin has also been found in human liver. The human gene for Betatrophin has already been cloned providing great hopes to diabetics for possible therapy and better management in future. [2] However, production of betatrophin in sufficient amount even for clinical trials will take quite some time. The researchers think that by injecting betatrophin once a month or perhaps once a year it may be possible to maintain beta cell activity and availability of insulin almost similar to daily multiple insulin shots in type 2 diabetes mellitus. [3]
What about type 1 diabetes where majority of beta cells are destroyed due to immune process? They can possibly be helped in earlier stage when all the beta cells are not wiped out. Researchers are also trying to find if betatrophin is produced in excess amount during pregnancy, when the requirement of insulin is generally increased. Its safety and efficacy in human being is still to be worked out. Can this open up new avenue for the research workers to explore the possibilities of making new beta cells in those who do not have enough to regulate normal metabolism? [4]
This study sets the stage for developing clinically useful cells by reprogramming adult cells without using stem cells. If clinical trials succeed in proving the safety and efficacy of betatrophin in near future, we can not only hope to slow the progression of life threatening complications of diabetes but it may be possible even to prevent diabetes particularly in those who are predisposed. [5]
| References | |  |
| 1. | Peng Yi, Ji-Sun Park, Melton D. Cell. vol 153. 2013. p. 747-58. Available from: http://www.cell.com/abstract/S0092-8674(13)00449-2 [Last accessed date on 2013 May 20]. 
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| 2. | Palmer C. Nature magazine. Available from: http://www.scientificamerican.com/article.cfm?id=liver-hormone-offers-hope-for-diabetes-treatment [2013 Apr 27] [Last accessed on 2013 May 20].
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| 3. | Palmer R. Available from: http://www.ibtimes.com/diabetes-breakthrough-newly-discovered-hormone-Betatrophin-could-eliminate-insulin-injections [2013 Apr 25] [Last accessed on 2013 May 20].
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| 4. | Collins F. Available from: http://directorsblog.nih.gov/more-beta-cells-more-insulin-less-diabetes [2013 May 7].
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| 5. | Knox R. Available from: http://news.harvard.edu/gazette/tag/betatrophin/ [2013 May 17] [Last accessed on 2013 May 22].
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