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September 2013 | Vol 18| Issue 2 Journal of Mahatma Gandhi Institute of Medical Sciences

Editorial

Betatrophin in type 2 diabetes mellitus

Type 2 diabetes mellitus is worlds 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

signicant dent in the countrys 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 signicantly.

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 proteinin 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 signicant increase in insulin

secreting beta cells proliferation, almost 17-30 times in

mice. With DNA microarray analysis they could nd

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

specic 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, productionof betatrophin in sufcient 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

nd if betatrophin is produced in excess amount duringpregnancy, when the requirement of insulin is generally

increased. Its safety and efcacy 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 efcacy 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]

Omprakash Gupta

Department of Medicine, Mahatma Gandhi Institute of

Medical Sciences, Sevagram, Wardha, Maharashtra, India

E-mail: gupta_op@hotmail.com

Access this article online

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DOI:10.4103/0971-9903.117786

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Gupta: Betatrophin in T2DM90

Journal of Mahatma Gandhi Institute of Medical Sciences September 2013 | Vol 18| Issue 2

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].

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].

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].

4. Collins F. Available from: http://directorsblog.nih.gov/more-

beta-cells-more-insulin-less-diabetes [2013 May 7].

5. Knox R. Available from: http://news.harvard.edu/gazette/tag/

betatrophin/ [2013 May 17] [Last accessed on 2013 May 22].

How to cite this article:Gupta O. Betatrophin in type 2 diabetes

mellitus. J Mahatma Gandhi Inst Med Sci 2013;18:89-90.

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