[Amylin/IAPP (islet amyloid polypeptide)--physiology and clinical significance]

Amylin or islet amyloid polypeptide (IAPP) is the protein component of amyloid deposits commonly seen in pancreatic islets of patients with type 2 diabetes mellitus. In in vitro and in animal studies amylin has been shown to decrease insulin secretion and induce insulin resistance. Amylin is stored in the beta-cells and released together with insulin. Circulating amylin is increased in obesity, hypertension and pregnancy, while it is absent in type 1 diabetes mellitus. In type 2 diabetes mellitus the secretion of amylin is impaired prior to that of insulin. Infusion of amylin in man in doses leading to pharmacological levels did not cause any decrease of insulin sensitivity but an impairment of insulin secretion occurred. The recent availability of an amylin antagonist confirmed the effect of amylin on the decrease of insulin secretion in man. The kinetic pattern of amylin, which is presumably excreted by the kidneys, closely resembles that of C-peptide. Subcutaneous administration of the amylin agonist, pramlintide, delays gastric emptying in patients with type 1 diabetes mellitus and, thus, reduces postprandial hyperglycemia. In summary, there is evidence that amylin is able to regulate insulin secretion and gastric emptying in man, but further proof is required.