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학위논문
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C-peptide는 당뇨병 합병증에서 방어 역할을 하는 bioactive peptide이다. 그러나 C-peptide의 심혈관 손상에 대한 방어 기작은 아직 불분명하다. 고혈당으로 유도된 내피세포의 손상은 당뇨병 혈관 병리학에서 1차 적인 원인이다. 따라서 우리는 혈관내피세포와 당뇨병 쥐를 이용하여 고혈당으로 유도된 세포사멸에 대한 C-peptide의 잠재적 역할을 조사하였다. 내피세포에서 고혈당에 의해 유도된 apoptotic 세포 사멸은 Transglutaminase 2(TG2)의 연속적인 활성과 세포 내 Ca2+, ROS 의 연속적인 증가로 인하여 일어난다. C-peptide는 Protein kinase C 와 NADPH 산화효소 의존적인 세포 내 ROS 생성 의 억제와 세포 내 Ca2+ 양의 영향 없이 고혈당에 의해 유도는 TG2 활성을 없애 버림으로 써 내피 세포의 사멸을 막는다. 따라서 당뇨병 쥐의 대동맥에서 고혈당이 유도한 transamidating 활성과 내피 세포의 사멸을 Osmotic pump 를 이용한 C-peptide 대체 요법으로 막을 수 있다. 게다가 c-peptide는 당뇨병 쥐의 신장 피질과 심장에서 일어나는 고혈당이 유도한 transamidating 활성과 세포사멸을 막을 수 있다. 비록 고혈당증에서 ROS 생성 과정은 미토콘드리아와 세포기질 (cytosol) 에서 생성된다고 보고 되었지만, 우리는 세포기질성 (Cytosolic) NADPH 산화효소 의존성 superoxide (초과산화물) 이 미토콘드리아의 superoxide 생성을 증가시키고 따라서 미토콘드리아의 분열이 야기된다고 제시하였다. 미토콘드리아의 ROS 증가와 함께 일어나는 미토콘드리아 분열 기작은 순환과정에서 ROS의 증폭을 가능하게 하고 이러한 현상은 내피 세포의 세포사멸을 유도한다. 이것과 관련하여 우리는 5` AMP-activated protein kinase (AMPK) 활성을 통한 ROS 증폭을 막는 새로운 C-peptide 기작에 관하여 실험하였다. C-peptide 신호전달에 관련된 이 기작은 고혈당에 의해 유도된 미토콘드리아 dynamics 와 막전위의 변화를 회복시키고 내피세포의 사멸을 막는다. 따라서, C-peptide는 AMPK를 활성화시켜 ROS cycle과 미토콘드리아의 변화를 조절함으로 써 고혈당으로 인한 손상으로 발생하는 내피 세포의 사멸을 막아 당뇨성 혈관병증을 막는다.

목차

  1. I. INTRODUCTION 12
    1. Human C-peptide 12
    2. C-peptide deficiency in Diabetes mellitus 14
    3. Diabetic complications 15
    4. Benificial role of C-peptide in diabetes diabetic complications 16
    II. LITERATURE REVIEW 18
    1. Pathophysiology of cardiovascular disease 18
    2. Endothelial cell apoptosis and vascular pathology 19
    3. Transglutaminase 2 and Diabetes complications 20
    4. Amplification of ROS and mitochondrial fission 20
    5. AMPK activation as a potential therapeutic approach 22
    6. Clinical potential of C-peptide replacement therapy in diabetes 23
    III. MATERIAL AND METHODS 26
    1. Chemicals and reagents 26
    2. Cell culture 27
    3. Cell death assay 27
    4. Live-cell imaging for intracellular and mitochondrial ROS measurement 29
    5. Measurement of intracellular Ca2+ levels 29
    6. Measurement of in situ transamidating activity in HUVECs 30
    7. Mitochondrial staining and analysis of mitochondrial fission 31
    8. Measurement of mitochondrial membrane potential 31
    9. Transfection of small interfering RNA 32
    10. Western blot analysis 33
    11. Generation of diabetes mouse model and C-peptide treatment using osmotic pumps 34
    12. Tissue collection 35
    13. Measurement of transamidating activity in tissues 35
    14. Tissue TUNEL assay 36
    15. Measurement of ROS generation and mitochondrial fission in aortic endothelium of mice 37
    16. Western blot for mice aortic tissue homogenate 38
    17. Statistics 38
    IV. RESULT 39
    1. C-peptide inhibits high glucose-induced apoptosis 39
    2. Roles of intracellular ROS and Ca2+ and TG2 in high glucose-induced cell death 40
    3. Prevention of high glucose-induced generation of Intracellular ROS 42
    4. Intracellular Ca2+ acts upstream of intracellular ROS and is unaffected by C-peptide 44
    5. C-peptide regulates TG2 activity by inhibiting high glucose-induced ROS generation 46
    6. Ex vivo treatment of C-peptide in aortic segments of streptozotocin diabetic mice inhibits hyperglycemia-stimulated transamidating activity 49
    7. C-peptide replacement therapy inhibits hyperglycemia-induced activation of transamidating activity and prevents apoptosis in aortic endothelium of streptozotocin diabetic mice 51
    8. C-peptide prevents hyperglycemia-induced activation of transamidating activity and apoptosis in heart and renal cortex of streptozotocin diabetic mice 54
    9. High glucose-induced cytosolic reactive oxygen species (ROS) facilitates mitochondrial ROS increase 57
    10. High glucose-induced mitochondrial ROS also enables cytosolic ROS increase 59
    11. High glucose-induced cytosolic and mitochondrial ROS mediates mitochondrial fission 61
    12. High glucose-induced ROS mediates mitochondrial membrane potential collapse 64
    13. C-peptide inhibition of high glucose-induced ROS regulates mitochondrial fission and mitochondrial membrane potential collapse 66
    14. AMPKα activation is essential for C-peptide action on attenuation of high glucose-induced ROS 69
    15. C-peptide activation of AMPKα regulates high glucose-induced mitochondrial fission and mitochondrial membrane potential collapse 72
    16. AICAR and metformin showed C-peptide mimetic regulation of high glucose-induced endothelial damage 74
    17. C-peptide activation of AMPKα and subsequent inhibition of ROS-mediated mitochondrial fission regulates high glucose-induced endothelial cell apoptosis 77
    18. C-peptide replacement therapy promotes AMPKα activation instreptozotocin diabetic mice aorta 81
    V. DISCUSSION 86
    VI. REFERENCES 96
    VII. ABSTRACT (in Korean) 108
    VIII. ACKNOWLEDGEMENT 110
    LIST OF TABLES
    Table 1. In vivo clinical data from streptozotocin diabetic mice, C-peptide-supplemented diabetic mice, and age-matched non-diabetic mice 52
    LIST OF FIGURES
    Fig. 1. Human C-peptide, 31-amino acid sequence in intact pre-proinsulin 13
    Fig. 2. Consequences of hyperglycemia-induced activation of PKC 19
    Fig. 3. C-peptide and inhibitors of intracellular ROS, Ca2+ and TG 2 inhibit high glucose-induced apoptotic cell death in HUVECs 39
    Fig. 4. TG2 siRNA prevents high glucose-induced apoptotic cell death 41
    Fig. 5. High glucose-induced generation of intracellular ROS is prevented by various inhibitors 43
    Fig. 6. C-peptide inhibits high glucose-induced ROS generation but has no effect on intracellular Ca2+ 45
    Fig. 7. High glucose-induced activation of TG2 is inhibited by various inhibitors or C-peptide 48
    Fig. 8. C-peptide inhibits hyperglycemia-induced stimulation of transamidating activity and apoptosis in mice aortic segments 50
    Fig. 9. C-peptide inhibits hyperglycemia-induced stimulation of transamidating activity and apoptosis in mice aortic segments 53
    Fig. 10. C-peptide inhibits hyperglycemia-induced stimulation of transamidating activity and apoptosis in heart and renal cortex 55
    Fig. 11. Proposed mechanism for C-peptide prevention of hyperglycemia-induced endothelial apoptosis via inhibition of ROS-mediated TG2 activation 56
    Fig. 12. Blocking cytosolic mitochondrial ROS generation attenuates high glucose-induced cellular ROS amplification 58
    Fig. 13. Blocking mitochondrial ROS generation attenuates high glucose-induced cellular ROS amplification 61
    Fig. 14. Essential role of cytosolic and mitochondrial ROS in high glucose (HG)-induced mitochondrial fission and mitochondrial membrane potential collapse in HUVECs 63
    Fig. 15. Role of cytosolic and mitochondrial ROS in high glucose (HG)-induced mitochondrial membrane potential collapse in HUVECs 65
    Fig. 16. C-peptide regulation of high glucose-induced cellular ROS amplification prevents mitochondrial fission and mitochondrial membrane potential collapse 68
    Fig. 17. Activation of AMPKα is essential for C-peptide regulation of high glucose-induced cellular ROS accumulation in endothelial cells 71
    Fig. 18. Activation of AMPKα is also essential for C-peptide regulation of high glucose-induced, mitochondrial fission and mitochondrial membrane potential collapse in endothelial cells 73
    Fig. 19. AMPK activator AICAR and metformin inhibits high glucose (HG)-induced ROS amplification, mitochondrial fission and mitochondrial membrane potential collapse 75
    Fig. 20. AMPK activator AICAR and metformin showed C-peptide mimetic inhibition of high glucose (HG)-induced apoptosis 80
    Fig. 21. C-peptide replacement therapy activates AMPKα in aorta of diabetic mice 83
    Fig. 22. Schematic modfel of C-peptides rle in regulating hyperglycemia-induced vasculpathy through AMPK-dependent mechanism 85

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