The Na⁺/Ca²⁺ exchanger and the Plasma Membrane Ca²⁺-ATPase in β-cell function and diabetes

The rat pancreatic β-cell expresses 6 splice variants of the Plasma Membrane Ca²⁺-ATPase (PMCA) and two splice variants of the Na⁺/Ca²⁺ exchanger 1 (NCX1). In the β-cell Na⁺/Ca²⁺ exchange displays a high capacity, contributes to both Ca²⁺ outflow and influx and participates to the control of insulin release. Gain of function studies show that overexpression of PMCA2 or NCX1 leads to endoplasmic reticulum (ER) Ca²⁺ depletion with subsequent ER stress, decrease in β-cell proliferation and β-cell death by apoptosis. Loss of function studies show, on the contrary, that heterozygous inactivation of NCX1 (Ncx1^+/-) leads to an increase in β-cell function and a 5 fold increase in both β-cell mass and proliferation. The mutation also increases β-cell resistance to hypoxia, and Ncx1^+/- islets show a 2-4 times higher rate of diabetes cure than Ncx1^+/+ islets when transplanted in diabetic animals. Thus, down-regulation of the Na⁺/Ca²⁺ exchanger leads to various changes in β-cell function that are opposite to the major abnormalities seen in diabetes. In addition, the β-cell includes the mutually exclusive exon B in the alternative splicing region of NCX1, which confers a high sensitivity of its NCX splice variants (NCX1.3 & 1.7) to the inhibitory action of compounds like KBR-7943. Heterozygous inactivation of PMCA2 leads to apparented, though not completely similar results.These provide 2 unique models for the prevention and treatment of β-cell dysfunction in diabetes and following islet transplantation.