https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/5 Sat, 23 Jul 2016 08:59:19 +0000 Address for Correspondence: Prof. KM Fariduddin, Department of Physiology, Ibrahim Medical College, 122 Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000 Historical Perspectives “They’ll find I’ th’ physiognomiesO’ th’ planets, all men’s destinies They’ll feel the pulses of the stars To find out agues, cough, catarrhs; And tell what crisis does divine”.                                     Butler, Hudibra, I. Throughout the annals of time, men even the prehistoric ones have been fascinated by the ever-existing rhythmic processes in living systems. However, this idea wasn’t completely in the open till 1797 when Hufeland proposed rhythmic events of life in relation to 24 hours or solar day as a prime unit of functional chronology1. In Florida, nose and throat surgeons found that hemorrhages in throat operation were 82% higher during the second quarter of the cycle of the moon than at other times2. Similarly, insulin sensitivity index was found to be lower during winter than summer in Swedish population3. Seasonal variations of HbA1C in diabetic subjects and glycemic variations in healthy subjects have also been   reported4-6.Thus, it seems that periodic biological events are intimately related to the non-biological cycles, whether terrestrial, astronomical, physical, electrical or others. But certainly it has been realized by the early scientists that the universe is rhythmic and displays incessant movement in the form of periodicity. The capacity to follow them, to oscillate, would enhance the survival potential of a species, including we, the human beings. In 1843, nearly half a century after Hufeland’s Publication, Chossat presented his report of 20 years of study on the changes in cloacal temperature of pigeons under various experimental conditions as to environmental temperature and nutrition1. Further analyses on biological rhythms revealed that ‘a close study of these rhythms should yield vital information concerning the construction of various biochemical reactions in the body, especially if cybernetic and thermodynamic principles are applied’. Many enthusiastic scientists and clinicians then devoted themselves for basic understanding of the fundamentals of biological rhythms. In the 30’s of the twentieth century, the periodic behavior of the normal blood glucose was characterized. In this case small meals were given regularly throughout the day and generally each meal produced a variable, transient increase. However, it was found that the glucose concentration often tended to drop somewhat at about 2 to 3 p.m. even if food was given7. The essential feature of this periodic behavior is that the blood glucose level is relatively stable, varying between 4.4 and 6.6 mM/L. It was discovered later, that under physiological conditions the blood glucose level is kept at around 5 mM/L in fasting mammals, including humans due to the pulsatile release of the glucostatic hormone insulin.  Pancreatic β-Cells and Calcium Insulin is secreted from the pancreatic β-cells in a highly regulated fashion. Among the factors affecting insulin release, glucose is the most important physiological stimulant and is considered as the primary regulatory signal. The exact sequence of biochemical events involved in glucose stimulated insulin secretion (GSIS) has not yet been identified. Nevertheless, it is well documented that GSIS is manifested due to a rise of cytosolic Ca2+ ([Ca2+]i), which acts as the primary intracellular messenger that couples physiological or pharmacological insulin secretegogues to insulin release from stored granules8. A characteristic feature of the [Ca2+]i response to glucose is its oscillatory nature observed both in individual pancreatic β-cells and in intact pancreatic islets9-12. Recent experiments have shown that the [Ca2+]i oscillations correspond to pulsatile insulin secretion and electrical activity of β-cells and thus it has been suggested that the [Ca2+]i oscillations may have important role in maintaining pulsatile release of insulin13-18. Pancreatic β-cell’s response to glucose is oscillatory. When glucose enters the b-cells through high capacity glucose transporters, its metabolism through glycolysis and Kreb’s cycle causes changes in the ATP/ADP ratio in the cytoplasm resulting in closure of the ATP-sensitive K+ channels and thereby trigger membrane depolarization19,20. This leads to the opening of voltage dependent calcium channels (VDCCs), Ca2+ influx and to subsequent rise in [Ca2+]i that promotes insulin secretion (Fig 1). Apart from the voltage-sensitive  Ca2+ influx from extracellular space, another major source of [Ca2+]i rise is mobilization of Ca2+ from intracellular stores21-23. Recent studies also suggest the existence of store operated Ca2+ entry in pancreatic b-cells24-26. However, once the [Ca2+]i is elevated, to restore it to its basal level, the b-cells drive Ca2+ actively either out of the cell across the plasma membrane through calcium pump and Na/Ca exchanger or to various intracellular stores27-29. We can simply postulate that the upstroke of the oscillation is due to Ca2+ influx and/or the release and the descending phase involves stimulation of outward Ca2+ transport and/or intracellular sequestration. And oscillations are generated and maintained via dynamic interplay of discrete signaling cascades which provides complex feedback, as well enhances co-ordination that critically maintains the fine tuning of [Ca2+]i fluctuations during different phases of the oscillation.   Figure 1. Schematic representation of ionic events in ‘glucose stimulated insulin secretion’ from pancreatic B-cells. IC = intracellular compartments.   Properties of [Ca2+]i Oscillations Oscillations in [Ca2+]i are of different fundamental types, involving different mechanisms. However, in secretory cells two major kinds of [Ca2+]i oscillations are seen – baseline transients or spikes and sinusoidal oscillations30,31. Spikes are characterized by transient increase in [Ca2+]i that rise rapidly from a baseline of [Ca2+]i. The shape of transients may vary depending on agonist-type: they may be symmetrical or may have a relatively rapid rising phase with a slower falling phase (Fig 2). Sinusoidal oscillations generally appear as symmetrical oscillations superimposed on a sustained level of [Ca2+]i usually above the pre-stimulus baseline level. They resemble more closely to true sine waves. These oscillations are generally considered insensitive to variations in agonist concentrations and may simply reflect how certain cells respond to a maintained elevation of calcium30. A less common [Ca2+]i oscillatory pattern that seems to be distinct from the spiking and sinusoidal patterns has been described by Rooney and Thomas32. The oscillations are highly asymmetric, consisting of a rapid increase in [Ca2+]i followed by a slow decline during which the next asymmetric oscillation is initiated. Such a pattern is extremely prominent in adrenal glomerulosa cells, in neutrophils and in mucosal mast cells33.   Figure 2. Different patterns of calcium oscillations. (A) Transient oscillations or spikes. Symmetrical transients (left) and transients  with slower recovery phase (right). (B) Sinusoidal oscillations. (C) Asymmetric oscillations.   In pancreatic islets, stimulatory glucose concentrations (>7mM) induce two types of [Ca2+]i oscillations – fast and slow. Fast oscillations are transient spikes in which the [Ca2+]i level rises sharply and then subsequently decreases along an exponential-like time course10. They oscillate at a frequency ranging from 2 to 5/min with duration of 3-11s (Fig 3). They are the direct consequence of β-cell bursting electrical activity, their duration depends on glucose concentration, and they are synchronous throughout the islet34. In contrast, slow oscillations are characterized by smooth rising and falling phase with duration of 1-3 min and frequency of 0.2-1/min. A mixed pattern of fast oscillations superimposed on the slow pattern is also a common observation. Both the slow and fast oscillations of [Ca2+]i in pancreatic islets depend on periodic entry of Ca2+.However, the fast ones somehow depend also on mobilization of Ca2+ from intracellular stores35.   Figure 3. Traces showing different oscillatory patterns of (Ca2+), in pancreatic islets. Stimulation of pancreatic islets with 11 mM glucose can produce fast (upper trace), slow (middle trace) or mixed (lower trace) patterns of (Ca2), oscillations.   Individual pancreatic b-cells exhibit different types of [Ca2+]i oscillations36. Type a or slow [Ca2+]i oscillations are sinusoidal which usually appear at glucose concentration of 7-20 mM with different thresholds for the individual cells (Fig 4). These oscillations have typical frequencies of 0.05-0.5/min, starting from the basal level with amplitudes of 300-500 nM37,38. The initial response of individual β-cells to glucose is characterized by a transient initial lowering of [Ca2+]i,due to sequestration of Ca2+ into intracellular compartments39-41, followed by a sharp rise of Ca2+ (Fig 5). The slow [Ca2+]i oscillations are strictly dependent on extracellular Ca2+ and disappear in the presence of the voltage-dependent Ca2+ channels (VDCC) blockers42. The slow [Ca2+]i oscillatory response is elicited not only by glucose as well leucine43, isoleucine44, ±-ketoisocaproate45 and tolbutamide46. Various mechanisms have been proposed to explain the generation of this [Ca2+]i fluctuations at single cell level including oscillations in glucose metabolism47-51, fluctuations of inositol 1,4,5 trisphosphate production52, oscillations of Ca2+ in the endoplasmic reticulum53, periodic Ca2+ influx during bursting electrical activity42,54 and cyclical periods of Ca2+ induced Ca2+ release55. But still it is an ongoing problem and no definitive conclusion has been reached so far.   Figure 4. (Ca2+)1 oscillations in individual pancreatic β -cell. Differentt types have been reffered to as a-d. (Reproduced with permission from Elsevier Science Publishers. Hellman B. Gylfe E, Grapengiesser E, Lund PE, Berts A. Cytoplasmic Ca2+ oscillations in pancreatic B-cells. Biochem Biophys Acta 1992, 1113:295-305).   Type b or fast [Ca2+]i oscillations usually appear as superimposed on the slow oscillations or on a sustained level of elevated [Ca2+]i. They occur at a frequency of 2-8/min with a duration of approximately 10s and amplitudes of 70-250 nM (Fig 4). The proportion of b-cells responding to glucose with the type b oscillations is higher in cells analyzed shortly after isolation than in those kept in culture for 1-2 days36. A critical cAMP concentration may be required for the appearance of these type b oscillations38,56.   Figure 5. Effect of raising glucose concentration from 3 to 11 mM on (Ca2+), of a single pancreatic β-cell. The horizontal bar indicates the period with the higher glucose concentration.   Type c oscillations are irregular [Ca2+]i transients with a duration of <10s and sometimes observed during glucose stimulation alone but becomes more frequent when cells are exposed to high concentrations of glucagon or when the adenylate cyclase activity has been stimulated with forskolin. The [Ca2+]i transients are independent of voltage dependent Ca2+ influx and disappear after addition of sarco-endoplasmic reticulum Ca2+-ATPase (SERCA) blocker, thapsigargin, indicating that the mobilization of Ca2+ from intracellular stores is responsible for their generation57. Type d oscillations are seen when b-cells, stimulated with glucose, are exposed to extracellular ATP or charbachol, which results in a series of [Ca2+]i transients of decreasing amplitude and increasing duration (Fig 4). It reflects mobilization of Ca2+ from intracellular stores mediated by activation of inositol 1,4,5-trisphosphate receptors and/or ryanodine receptors. These transients exhibit characteristic patterns, making it possible to identify individual b-cells by their [Ca2+]i ‘fingerprints’58. Significance of oscillatory [Ca2+]i signals In pancreatic b-cells, Ca2+ is the ‘naturally selected’ second messenger59,60 that decodes signals from different stimuli and relays messages to the biochemical machinery within the cell. But why does [Ca2+]i oscillate? Does it really need to oscillate for proper signal transduction in pancreatic β-cells? Although results of some experiments intriguingly suggest that [Ca2+]i oscillations are no more effective in insulin release than a sustained signal in pancreatic β-cell61-63, certainly [Ca2+]i oscillations confer positive functional advantages. In the following sections we will focus on the functional significance of oscillatory [Ca2+]I signals in the pancreatic β-cells. Regulation of insulin secretion. Oscillations in [Ca2+]i permit a finer control of secretion than a sustained elevation of [Ca2+]i as prolonged stimulation of cellular processes can cause desensitization64,65. It is anticipated that the various steps involved in exocytosis are also sensitive to distinct aspects of [Ca2+]i signals, eg, kinetics, multiple spikes, amplitude, and localization66. In pancreatic β-cells, KCl alone induces a sustained [Ca2+]i increase but causes transient insulin secretion67. In contrast, when glucose concentration is raised from basal to stimulatory, it induces [Ca2+]i oscillations and a continuous oscillatory insulin release from intact islets and individual β-cells16,17,68. Regulation of gene expression. Kinetics of oscillatory [Ca2+]i signaling exhibit significant variation in patterns and mechanisms of recognition69,70. It has been suggested that calcium spiking behavior permits information to be encoded and detected over a much broader range of signaling levels than with sustained [Ca2+]i increases31. Thus, oscillations of [Ca2+]i might regulate cellular processes other than insulin secretion, eg, gene expression. Glucose increases insulin gene expression both at transcriptional and translational levels71. The glucose induction of insulin transcription was inhibited by VDCC blocker suggesting that the stimulatory effect observed is mediated by Ca2+. Thus, glucose-induced oscillatory [Ca2+]i signal acts as a common pathway for effectively stimulating both the synthesis and release of insulin. Experimental results have clearly shown that [Ca2+]i oscillations and their frequencies are specific for gene activation, both in terms of efficiency and selectivity72. Li et a1.73 and Dolmetsch et a1.74 provided ample evidence for oscillatory [Ca2+]i signals to be more effective to activate Ca2+-dependent transcription factors than a single, prolonged increase. Regulation of metabolism. Oscillations in [Ca2+]i are also integrated at the level of the metabolic response. In hepatocytes, vasopressin-induced [Ca2+]i oscillation with the frequency of 0.5/min induces mitochondrial redox responses that were effectively maintained close to the peak response75. By contrast, sustained [Ca2+]i increases induced by maximal vasopressin doses were associated with only a single transient increase of NADH. Thus, a Ca2+ response system, in this case mitochondrial energy metabolism, can be tuned to the oscillatory change of [Ca2+]i signaling and actually tuned out by sustained [Ca2+]i signal31. In pancreatic b-cells, KCl induced a sustained [Ca2+]i increase and transient [Ca2+]m increase, while glucose induced [Ca2+]i oscillations and an oscillatory [Ca2+]m increase, suggesting that repetitive transients of [Ca2+]m associated with [Ca2+]i oscillations are necessary for continuous stimulation of mitochondrial metabolism and thereby continuous secretion of insulin76,77. It is also possible that oscillations prevent mitochondrial calcium overload and damage in chronically stimulated cells60,78. The Na+-dependent carriers, which discharge Ca2+ from mitochondrial matrix, are inhibited by increasing the extra-mitochondrial Ca2+ concentration within the physiological range79. Thus, the sustained increase in [Ca2+]i induced by KCl may attenuate the movement of Ca2+ from the mitochondrial matrix and consequently prolong the time course of the [Ca2+]m decline77. Regulation of apoptosis. Long-lasting sustained elevations of [Ca2+]i activates Ca2+-dependent degradative enzymes, e.g., protein kinases, endonucleases, proteases, and phospholipases,80,81 whose prolonged activation can result in extensive catabolism of cellular constituents and lethal injury. Oscillatory [Ca2+]i signals prevent these potentially damaging effects of Ca2+-dependent enzymes. McCormack et a1.82 have shown that induction of thymocytes apoptosis by glucocorticoid hormones are dependent on an early, receptor-mediated, sustained increase in [Ca2+]i concentrations. In hepatoma 1c1c7 cells low ATP concentrations (1-10 µM) stimulate a transient, receptor mediated Ca2+ response whereas high concentrations of ATP (mM) can also cause a sustained increase in the [Ca2+]i80,83. It appeared that treatment of the hepatoma cells with high levels of ATP could activate Ca2+-dependent, enzymatic DNA cleavage and contribute to cell killing80, Uncontrolled steady-state rise of [Ca2+]i can also induce Ca2+-dependent activation of several genes that characterize many types of acute lethal injury. These genes can be induced within 15 min or less, as in the case of c-fos66 and c-jun, to trigger additional events, such as the ced 3/ICE protease family members, which appear to be close to the final phase of cell death81. In pancreatic β-cells, increased cell death has been reported at elevated glucose concentrations when intracellular Ca2+ is not oscillating84.Recently, Iwakura et al.85 have shown that sustained enhancement of Ca2+ influx induced by continuous exposure to glibenclamide caused apoptotic cell death in rat insulinoma cell line (RINm5F cells). These results are consistent with the concept that oscillatory [Ca2+]i signals in pancreatic β-cells prevent cellular damage. In pancreatic β-cells, increased cell death has been observed at elevated glucose concentrations when [Ca2+]i is not exhibiting oscillations84.Recently, it has been shown that sustained enhancement of Ca2+ influx induced by continuous exposure to glibenclamide caused apoptotic cell death in rat insulinoma cell line, RINm5F cells85.These results are consistent with the idea that oscillatory Ca2+ signals in pancreatic β-cells prevent cellular damage. Role in energy homeostasis. Oscillations are less costly for maintenance of cell homeostasis65 considering that elevation of [Ca2+]i activates energy-consuming processes for extrusion of the ion33,60,while shortening of the time with a raised [Ca2+]i will conserve energy64.As an example of the efficiency of oscillatory system in conserving energy, the calculated results suggest that the dissipation of free energy is reduced by 5-10% in oscillatory glycolysis86. Synchronization of cellular processes. Oscillations can be integrated in single cell or tissue level. [Ca2+]i oscillations that result in asynchronous pulsatile responses in individual cells or groups of cells will be integrated into a smooth and continuous response in the total output of the tissue31. For example, response of single β-cell to glucose is heterogeneous – some cells display [Ca2+]i oscillations, others show a sustained rise, whereas a small proportion appear unresponsive87-89. However, a consistent oscillatory [Ca2+]i response is observed in clusters of 5-8 mouse pancreatic b-cells stimulated with 15 mM Glucose37,65. The heterogeneous response of isolated cells to glucose is masked when they are organized in the whole islets as a result of a very efficient coupling mechanism, which leads to synchronous glucose-induced oscillations of [Ca2+]i34,35. Analysis of [Ca2+]i oscillations in different regions of a single glucose-stimulated islet also showed that they may be of variable amplitude but are always synchronous. Simultaneous measurements of [Ca2+]i and insulin secretion in single mouse islets show that each [Ca2+]i oscillation is accompanied by an oscillation of secretion90. This synchrony persists when the frequency of [Ca2+]i oscillations is modified by a change in glucose concentration9l. Thus, pulsatile insulin secretion, triggered by highly integrated [Ca2+]i oscillations, from each islet is ultimately responsible for integrated pulsatile secretion by the whole pancreas and the generation of plasma insulin oscillations which are important for optimal action of the hormone65. Temporal control of cellular activity. In the biological targets the [Ca2+]i signal responds to the frequency of [Ca2+]i spikes rather than to the amplitude of [Ca2+]i change. This has given rise to the concept of frequency-modulated [Ca2+]i signaling78,86. However, it has also been reported that Ca2+ oscillations can be modulated both in frequency and amplitude92-94. Frequency encoding results in enhanced precision of control; it is particularly resistant to distortion by background noise86. Frequency dependent control systems also succeed in environments where amplitude dependent controls fail. If the [Ca2+]i is to be used as an amplitude-dependent signal, in which case its level would have to be maintained at a higher concentration for prolonged periods, it would cause calcium toxicity95. In pancreatic β-cell the frequencies of the [Ca2+]i oscillations vary as a function of agonist concentration58. For example, 25 µM carbamylcholine produced transients approximately every 15s, while at 200 µM transients occurred at ~10s intervals. Furthermore, Gilon et a1.91 explicitly demonstrated that when the concentration of glucose is raised, the peak of [Ca2+]i oscillations did not change significantly, but the frequency of [Ca2+]i oscillations clearly increased. This may result from glucose capacity to increase the efficacy with which frequency-encoded Ca2+ signals activates the exocytotic process and increases insulin release. Spatial control of cellular activity. Oscillations of [Ca2+]i show spatial order, which has indeed functional advantage for periodicity in biological control86. A distinctive attribute of biological system is to do the right thing at the right time in the right place. In heart, the temporal entrainment sequence (SA-node to Purkinje fibers to the ventricles) ensures the correct spatial sequence. Failures in this entrainment process can result in some of the clinically observed cardiac arrhythmias. Thus, Durham96 has speculated, “it is more plausible that every region (of the organism) can potentially oscillate at some frequency. Those parts with the highest inherent frequency will establish a phase lead and drive other regions. Waves will, therefore, move along membranes down gradients of inherent frequency”. Another crucial biological process in which precise spatial control is of central importance is the development of multicellular organisms from a single fertilized egg cell97. The events are particularly ordered in time and in space. However, the spatial organization of Ca2+ oscillations in pancreatic β-cell is not yet convincing. With digital imaging of the Ca2+-dependent fluorescence signal it has been demonstrated that [Ca2+]i varies substantially within the cell98a. [Ca2+]i first increases in a rim close to the plasma membrane. As the duration of the depolarization is increased, the [Ca2+]i-transient extends progressively deeper into the cell. However, at least during the first 350ms, [Ca2+]i remains highest in the vicinity of the plasma membrane. It is of interest, that the increase in [Ca2+]i is particularly rapid and pronounced in the upper right part of the cell whereas other parts of the cell remain relatively unaffected98a. The observation, that the [Ca2+]i-increase is more pronounced in certain parts of the cell may indicate an uneven distribution of Ca2+-channels in the β-cell membrane. It is tempting to speculate that regions of the plasma membrane with a high Ca2+-channel density correspond to ‘hot spots’ of exocytosis. Thus the spatial organization of oscillatory Ca2+ signal could lead to a provision of high Ca2+ concentration needed at the exocytotic sites while lower [Ca2+]i may be sufficient to activate other essential processes, such as the movement of insulin granules from storage to release sites98b. Discrimination between signal and noise. Calcium signal is digitized in the form of oscillations95,99 and a digitally encoded signal with the all or none property has favorable ‘signal-to-noise’ ratios70,100. By relying on large, discrete digital events, e.g. calcium oscillations, cells can readily distinguish an “intentional” calcium signal from potentially spurious wanderings of the steady-state, cytoplasmic calcium concentration. Indeed, in the brain, bursts of electrical activity are more readily perceived as signals than are action potentials that arrive singly.   Conclusion The periodic changes of [Ca2+]i is of great physiological and pathological importance since [Ca2+]i oscillates in synchrony with electrical activity and oscillations in [Ca2+]i correspond to pulsatile insulin release13-17. It has also been proposed that oscillatory insulin secretion is important in terms of insulin action on target organs, perhaps because of reducing down-regulation of receptors and thereby enhancing hormone action101. Several studies have demonstrated a greater hypoglycemic effect of insulin infused in a pulsatile manner and an enhancement of glucose disposal102-104. The greater potency of pulsatile insulin administration has also been demonstrated in perifused liver and in humans with IDDM105,106. 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