Whole genome expression profiling associates activation of unfolded protein response with impaired production and release of epinephrine after recurrent hypoglycemia

• Published in: PloS one Vol. 12; no. 2; p. e0172789
• Main Authors: Kim, Juhye Lena, La Gamma, Edmund F, Estabrook, Todd, Kudrick, Necla, Nankova, Bistra B
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.02.2017; Public Library of Science (PLoS)
• Subjects: Adrenal medulla; Animals; Apoptosis; Autonomic nervous system; Autonomic Nervous System Diseases - physiopathology; Biochemistry; Bioinformatics; Biology and Life Sciences; Blood Glucose; Calcium homeostasis; Calcium ions; Care and treatment; Deprivation; Diabetes; Diabetes mellitus; Diabetes Mellitus - genetics; Diabetes Mellitus - metabolism; Diabetes Mellitus - physiopathology; Diagnosis; Endoplasmic reticulum; Enzymes; Epinephrine; Epinephrine - genetics; Epinephrine - metabolism; Exocytosis; Experiments; Galanin; Gene expression; Gene Expression Profiling - methods; Gene Expression Regulation - genetics; Genes; Genetic aspects; Genome; Genomes; Glucose; Glucose - metabolism; Homeostasis; Hospitals; Humans; Hypoglycemia; Hypoglycemia - genetics; Hypoglycemia - pathology; Insulin; Insulin - metabolism; Insulin receptors; Insulin resistance; Kinases; Laboratory animals; Medicine and Health Sciences; Molecular biology; Molecular modelling; Neuropeptide Y; Organs; Pediatrics; Physical Sciences; Physiological aspects; Proenkephalin; Protein folding; Proteins; Public health; Rats; Regulation; Rodents; Secretion; Secretory vesicles; Signal transduction; Signaling; Splanchnic nerve; Unfolded Protein Response - genetics; New York; United States > US; Indianapolis Indiana
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172789

Recurrent hypoglycemia can occur as a major complication of insulin replacement therapy, limiting the long-term health benefits of intense glycemic control in type 1 and advanced type 2 diabetic patients. It impairs the normal counter-regulatory hormonal and behavioral responses to glucose deprivation, a phenomenon known as hypoglycemia associated autonomic failure (HAAF). The molecular mechanisms leading to defective counter-regulation are not completely understood. We hypothesized that both neuronal (excessive cholinergic signaling between the splanchnic nerve fibers and the adrenal medulla) and humoral factors contribute to the impaired epinephrine production and release in HAAF. To gain further insight into the molecular mechanism(s) mediating the blunted epinephrine responses following recurrent hypoglycemia, we utilized a global gene expression profiling approach. We characterized the transcriptomes during recurrent (defective counter-regulation model) and acute hypoglycemia (normal counter-regulation group) in the adrenal medulla of normal Sprague-Dawley rats. Based on comparison analysis of differentially expressed genes, a set of unique genes that are activated only at specific time points after recurrent hypoglycemia were revealed. A complementary bioinformatics analysis of the functional category, pathway, and integrated network indicated activation of the unfolded protein response. Furthermore, at least three additional pathways/interaction networks altered in the adrenal medulla following recurrent hypoglycemia were identified, which may contribute to the impaired epinephrine secretion in HAAF: greatly increased neuropeptide signaling (proenkephalin, neuropeptide Y, galanin); altered ion homeostasis (Na+, K+, Ca2+) and downregulation of genes involved in Ca2+-dependent exocytosis of secretory vesicles. Given the pleiotropic effects of the unfolded protein response in different organs, involved in maintaining glucose homeostasis, these findings uncover broader general mechanisms that arise following recurrent hypoglycemia which may afford clinicians an opportunity to modulate the magnitude of HAAF syndrome.