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World Journal of Biological Chemistry World Journal of W J B C Biological Chemistry Submit a Manuscript: http://www.wjgnet.com/esps/ World J Biol Chem 2015 August 26; 6(3): 95-109 Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx ISSN 1949-8454 (online) DOI: 10.4331/wjbc.v6.i3.95 © 2015 Baishideng Publishing Group Inc. All rights reserved. REVIEW Role of ZAC1 in transient neonatal diabetes mellitus and glucose metabolism Anke Hoffmann, Dietmar Spengler Anke Hoffmann, Dietmar Spengler, Max Planck Institute of half year and adolescent relapse with type 2 diabetes in Psychiatry, Translational Research, 80804 Munich, Germany half of the patients. Genetic defects in TNDM1 comprise uniparental isodisomy of chromosome 6, duplication Author contributions: Hoffmann A and Spengler D jointly of the minimal TNDM1 locus at 6q24, or relaxation contributed to this work. of genomically imprinted ZAC1 /HYMAI . Whereas the function of HYMAI, a non-coding mRNA, is still Supported by Max Planck Institute of Psychiatry. unidentified, biochemical and molecular studies show Conflict-of-interest statement: The authors declare no conflict that zinc finger protein 1 regulating apoptosis and cell of interest. cycle arrest (ZAC1) behaves as a factor with versatile transcriptional functions dependent on binding to specific Open-Access: This article is an open-access article which was GC-rich DNA motives and interconnected regulation of selected by an in-house editor and fully peer-reviewed by external recruited coactivator activities. Genome-wide expression reviewers. It is distributed in accordance with the Creative profiling enabled the isolation of a number of Zac1 Commons Attribution Non Commercial (CC BY-NC 4.0) license, target genes known to regulate different aspects of which permits others to distribute, remix, adapt, build upon this β-cell function and peripheral insulin sensitivity. Among work non-commercially, and license their derivative works on these, upregulation of Pparγ and Tcf4 impairs insulin- different terms, provided the original work is properly cited and secretion and β-cell proliferation. Similarly, Zac1- the use is non-commercial. See: http://creativecommons.org/ mediated upregulation of Socs3 may attenuate β-cell licenses/by-nc/4.0/ proliferation and survival by inhibition of growth factor Correspondence to: Dietmar Spengler, MD, Max Planck signalling. Additionally, Zac1 directly represses Pac1 Institute of Psychiatry, Translational Research, Kraepelinstrasse and Rasgrf1 with roles in insulin secretion and β-cell 2-10, 80804 Munich, Germany. [email protected] proliferation. Collectively, concerted dysregulation of Telephone: +49-89-30622587 these target genes could contribute to the onset and Fax: +49-89-30622605 course of TNDM1. Interestingly, Zac1 overexpression in β-cells spares the effects of stimulatory G-protein Received: April 20, 2015 signaling on insulin secretion and raises the prospect for Peer-review started: April 24, 2015 tailored treatments in relapsed TNDM1 patients. Overall, First decision: June 3, 2015 these results suggest that progress on the molecular Revised: June 19, 2015 and cellular foundations of monogenetic forms of Accepted: July 11, 2015 diabetes can advance personalized therapy in addition Article in press: July 14, 2015 Published online: August 26, 2015 to deepening the understanding of insulin and glucose metabolism in general. Key words: Diabetes mellitus; ZAC1; Transient neonatal diabetes mellitus 1; Genomic imprinting; Insulin; Glucose; Abstract Target genes; Tailored therapy Transient neonatal diabetes mellitus 1 (TNDM1) is a rare genetic disorder representing with severe neonatal © The Author(s) 2015. Published by Baishideng Publishing hyperglycaemia followed by remission within one and a Group Inc. All rights reserved. WJBC|www.wjgnet.com 95 August 26, 2015|Volume 6|Issue 3| Hoffmann A et al . ZAC1 and TNDM1 functions[5]. Insulin resistance typically evolves during Core tip: Accidents of nature leading to rare genetic diseases can provide important insights into the molecular the course of T2D as result of a diminished sensitivity and cellular foundations of related common diseases. to insulin’s metabolic regulatory functions in several Various genetic anomalies at chromosome 6q24 manifest peripheral tissues (fat, muscle, and liver) aggravated by with life-threatening transient neonatal diabetes mellitus reduced exercise, aging, and obesity. T2D represents a (TNDM1). All of these genetic defects share overexpress- relative, rather than an absolute insulin deficiency, as a ion of the maternally imprinted transcriptional regulator result of a progressive malfunction of β­cells to secrete ZAC1 . Genome-wide expression profiling identified a sufficient amounts of insulin for sustaining efficient [6] number of downstream target genes sharing a critical carbohydrate and lipid homeostasis . Conclusively, role in insulin secretion, β-cell proliferation, and survival. refined insight into the pathways that underlie β­cell Importantly, Zac1 overexpression in β-cells spares the dysfunction at a physiological and molecular scale effects of G-protein signaling on insulin secretion opening remains desirable to advance personalized treatment of the prospect for tailored therapy in TNDM1 patients. T2D. How can we examine human β­cells when these are barely accessible? Single gene defects encoding severe Hoffmann A, Spengler D. Role of ZAC1 in transient neonatal β­cell dysfunction with manifest diabetes provide diabetes mellitus and glucose metabolism. World J Biol unique inroads to disease mechanisms if the causative Chem 2015; 6(3): 95-109 Available from: URL: http://www. gene can be isolated. In this regard, positional cloning wjgnet.com/1949-8454/full/v6/i3/95.htm DOI: http://dx.doi. enabled the identification of heterozygous mutations org/10.4331/wjbc.v6.i3.95 in the hepatic transcription factors HNF1A and HNF4A as the cause of early­onset diabetes[7,8]. This important discovery drove forth the subsequent discovery of a transcription factor network underpinning normal INTRODUCTION β­cell development[9] as well as susceptibility to [10,11] The individual, societal, and economic burden of T2D . Hence, monogenetic diseases can guide the diabetes epidemic has raised steadily over the biological studies aimed to unlock the cellular and last decades despite continuous refinements in die­ molecular basis of the specific condition under study, tary and pharmacological therapies[1]. On current but may have also important implications for related trends, at least one in 10 people alive today are at multifactorial diseases. risk to suffer from diabetes at some stage during Based on this perspective, we will discuss in this their lifespan. At the same time, the total number review recent progress in the molecular genetics of individuals being at risk to develop diabetes is of transient neonatal diabetes mellitus (TNDM) and predicted to double in a generation from 150 million how these new findings advance insight into β­cell in 2000 to 300 million by 2025. Existing medical development and physiology. Specifically, we will focus treatments frequently ameliorate diabetic conditions on the transcriptional regulator ZAC1 (zinc­finger without reinstating normal metabolism and thus protein 1 regulating apoptosis and cell cycle arrest), leave many patients exposed to debilitating, or which is encoded by a genomically imprinted gene at even life­threatening, impairments[2]. In conjunction 6q24 in human. TNDM is characterized by a unique with genetic predisposition (particularly in some clinical course manifesting prenatally with T1D and an ethnicities) the epidemic derives mainly from type increased risk for T2D in adolescence. Importantly, 2 diabetes (T2D) and associated conditions termed the identification of various target genes over the last “diabesity” and “metabolic syndrome”. These states years eventually enabled insight into ZAC1’s role in encompass various risk factors such as obesity, overly pancreatic β­cell development and maturation and rich nutrition, and a sedentary lifestyle[3]. Although potential pharmacological treatments of newborns lifestyle modifications (balanced diet, more exercise, suffering from TNDM. and weight reduction) are well­recognized to delay, or even prevent, T2D in persons at risk, such cautionary measures are notoriously hard to sustain[4]. NEONATAL DIABETES MELLITUS A large number of epidemiological and experimental Neonatal diabetes mellitus (NDM), also recognized as studies have aimed to detect the genetic and en­ “early­onset” diabetes mellitus, manifests unregulated vironmental factors underlying the onset, progression, hyperglycemia during the first 6 mo of life and is a rare and treatment response of diabetes over the last disorder developing uniformly in all races and ethnic decades. Contrary to the well­established damage of groups. Typically, NDM presents with intrauterine insulin­producing β­cells by autoimmune processes in growth retardation (IUGR), reduced subcutaneous fat, type 1 diabetes (T1D), the pathophysiological basis failure to thrive, and low or undetectable C­peptide of T2D is still incompletely understood and involves levels (a peptide of 31 amino acids connecting the multiple cellular and physiological systems influencing A­chain and the B­chain of proinsulin)[12]. NDM com­ each other’s set points, thresholds, and metabolic monly arises from mutations in genes that play a WJBC|www.wjgnet.com 96 August 26, 2015|Volume 6|Issue 3| Hoffmann A et al . ZAC1 and TNDM1 crucial role in pancreas
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