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Department of 1 Endocrinology and Metabolism M, and 2 Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, 8000 Aarhus C, Denmark; 3 Department of Medicine and National Science Foundation Center for Biological Timing, University of Virginia, Charlottesville, Virginia 22908; and 4 Department of Hepatology, Freiburg University Hospital, Freiburg, Germany
Insulin is secreted as a series of
punctuated secretory bursts superimposed on variable basal insulin
release. The contribution of these secretory bursts to overall insulin
secretion has been estimated on the basis of peripheral vein sampling
in humans to encompass
75% of overall insulin release. A similar
contribution of the pulsatile mode of release was inferred in a canine
model by use of portal vein sampling. The primary regulation of insulin secretion is through perturbation of the mass and frequency of these
secretory bursts. The mode of delivery of insulin into the circulation
seems important for insulin action; therefore, physiological conditions
that alter the pattern of insulin release may affect insulin action
through this mechanism. Transhepatic intraportal shunt in humans may
provide access to portal vein samples, thus potentially improving the
sensitivity of detecting and quantitating the frequency, mass, and
amplitude of secretory bursts along with basal release and the
regularity of these variables. To establish the insulin-secretory
mechanism in nondiabetic humans by the use of portal vein sampling, we
here assessed the mass, frequency, amplitude, and overall contribution
of pulsatile insulin secretion by deconvolution analysis of portal vein
insulin profiles. We find that, in nondiabetic humans fasted overnight,
the portal vein insulin concentration oscillates at a periodicity of
4.1 ± 0.2 min/pulse and with secretory peak amplitudes averaging
660% of basal (interpulse) release. The frequency was confirmed by spectral and autocorrelation analyses. The punctuated insulin-secretory bursts partially overlap and are responsible for the majority (70 ± 4%) of insulin release. After ingestion of a mixed meal, the
insulin release was increased through amplification of the secretory
burst mass (507 ± 104 vs. 1,343 ± 211 pmol · l
1 · min
1,
P < 0.001), whereas frequency (4.4 ± 0.2 vs.
4.3 ± 0.2, P = 0.86) and basal secretion (62 ± 14 vs. 91 ± 22 pmol · l
1 · min
1,
P = 0.33) were unaffected. One subject with diabetes
and cirrhosis had a similar insulin-secretory pattern, whereas a
subject with insulin-dependent diabetes mellitus and minimal insulin
release had preserved pulsatile release. A single subject was entrained to show agreement between entrained frequency and portal vein insulin
oscillations. We conclude that insulin release in the human portal vein
occurs at a mean periodicity of 4.4 ± 0.2 min with a high
signal-to-noise ratio (pulse amplitude 660% of basal). The impact of
noise on the detected high frequency cannot be excluded.
C-peptide; oscillations; cirrhosis; secretion; diabetes
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