Pasireotide is a new-generation somatostatin analog used for the treatment of acromegaly, Cushing’s disease and neuroendocrine tumors. However, due to its high affinity for somatostatin receptors (SSTR) 2 and 5, highly expressed in enteroendocrine- and pancreatic β-cells, it can reduce insulin, GLP-1 and GIP release and increase glucagonemia, causing marked hyperglycemia in some patients. The diabetogenic effects of pasireotide are significantly reduced in vivo by the co-administration of liraglutide or vildagliptin. The aim of this study was to evaluate the effects of pasireotide on β-cell survival and function, and the ability of molecules with known beneficial action on β-cells (incretin-based drugs and irisin, a myokine with β-cellular trophic properties) to prevent these effects. In INS-1E cells, both acute and chronic administration of pasireotide 10-50 nM reduced glucose-induced insulin secretion by 30% and 50% respectively and proinsulin mRNA levels by 20%, without altering cellular insulin content. Furthermore, pasireotide induced apoptosis in INS-1E cells and human pancreatic islets. Pretreatment with both incretin-based drugs (exendin-4, lixisenatide, liraglutide, saxagliptin) and irisin prevented pasireotide-induced apoptosis in INS-1E cells. In addition, pasireotide increased the protein levels of SSTR2 (2-fold) but not of SSTR5. Among the protective molecules examined, only irisin was able to prevent this increase.

In conclusion, pasireotide can induce hyperglycemia and diabetes via direct effects on β-cells, resulting in reduced insulin secretory capacity and survival. Both GLP-1 receptor agonists and DPP-4 inhibitors and irisin can reduce the proapoptotic effects of pasireotide, acting through partially different molecular mechanisms. These results demonstrate for the first time a functional antagonism between SSTR2/5 activation and incretin-based drugs or irisin in pancreatic β-cells.


A. Natalicchio: Consultant; Self; AstraZeneca, Novo Nordisk Inc., Sanofi-Aventis. G. Biondi: None. N. Marrano: None. L. Vincenti: None. A. Cignarelli: None. S. Perrini: None. L. Laviola: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk Inc., Roche Diabetes Care, Sanofi-Aventis. Speaker’s Bureau; Self; Abbott, Medtronic. F. Giorgino: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk Inc., Roche Diabetes Care, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., MedImmune, Merck Sharp & Dohme Corp., Roche Diabetes Care, Sanofi. Research Support; Self; Eli Lilly and Company, LifeScan, Inc., Takeda Development Centre Europe Ltd.



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