A protein in the brain may link smoking and diabetes
Nicotine overrides the communication pathway between the brain and pancreas, causing high glucose levels in rats
by Megha Satyanarayana
OCTOBER 16, 2019 | APPEARED IN VOLUME 97, ISSUE 41
Smokers develop type 2 diabetes 30–40% more often than nonsmokers, and new research suggests that nicotine’s actions in the brain may be to blame.
Experiments in rats suggest that nicotine may needlessly turn on part of the body’s fight-or-flight mechanism, flooding it with useless glucose that would otherwise get used to run, punch, or kick. Over years of cigarette or vape-pen use, those useless glucose bumps wear out the insulin-signaling pathways in cells and eventually lead to diabetes, says Paul J. Kenny, the neuroscientist at the Icahn School of Medicine at Mount Sinai who led the study (Nature 2019, DOI: 10. 1038/s41586-019-1653-x).
Kenny’s team found that the main player in this signaling short circuit is a protein called TCF7L2, which influences two things: the motivation to take nicotine and a conversation between the brain and pancreas.
“It all converges on this one factor, ” Kenny says. “Ultimately, a disease like diabetes may be originating in the brain or may reflect dysregulated brain-body interactions, and I think that’s absolutely fascinating and absolutely terrifying. ” He wonders if other diseases have brain-body connections that can get similarly disrupted.
His team studies a part of the brain called the habenula, which is involved in our stress response and is chock full of nicotinic acetylcholine receptors, which nicotine binds to and activates, giving people a buzz when they smoke. Kenny’s group had previously reported that mutations that seem to lead to nicotine addiction in humans were often found in nicotinic acetylcholine receptors in the habenula.
Credit: Wikipedia/Emw
TCF7L2 is a transcription factor active in the brain and pancreas.
The habenula is also full of TCF7L2, which is a transcription factor that acts as an on-off switch for several genes. Rats missing this transcription factor “consume absolutely horrendous amounts of nicotine, ” Kenny says.
But TCF7L2 is also expressed elsewhere in the body and is associated with type 2 diabetes. People with certain gene sequences for TCF7L2 tend to get diabetes more often than people with other sequences. Kenny says his team thought TCF7L2 might be doing something in both the brain and pancreas to influence the role of nicotine in diabetes. The researchers found that after nicotine exposure, the nicotinic acetylcholine receptors in rats without TCF7L2 were less sensitive than those of normal rats. Under normal conditions, when nicotine or other molecules turn on the receptors, the proteins eventually enter a sleepy state in which the receptors can’t turn back on for some time. In rats without TCF7L2, the receptors couldn’t bounce back from this state as quickly as ones in rats with TCF7L2. Basically, their brains weren’t responding in quite the same way, Kenny says. And in an experiment that traced the path of neurons, the team found that neurons in the pancreas led to the habenula.
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Looking at different genes in the habenula that TCF7L2 is predicted to control, the team found that many were involved in the regulation of glucose metabolism. Given that nicotine is known to cause increases inblood-glucose levels, the team wondered if TCF7L2 might influence this action of nicotine. Lowering levels of TCF7L2 reduced nicotine’s ability to boost blood sugar. And after treating rats for 21 days with nicotine, the team found that the rats missing TCF7L2 had lower blood-sugar levels, suggesting that the transcription factor mediates some diabetes-like symptoms.
Kenny doesn’t think that high blood-glucose levels lead to nicotine addiction. Instead, it’s more likely that all the extra glucose is tamping down the activity of nicotinic acetylcholine receptors, making each puff less effective and leading people to take more puffs. He says one of the next big questions is whether the habenula is playing a role in normal glucose metabolism.
Kenny thinks the link between the stress-response function of the habenula and the nicotine override might lead to diabetes. In an actual fight-or-flight situation, “you’re stressed or you’re frightened, and you need to respond to that, ” he says. “You need to access energy reserves, and this stress affects the pancreas. ” Over time, this regular stress to the pancreas leads to diabetes. TCF7L2 helps regulate all that.
The team is now looking at drugs that modulate TCF7L2 activity directly or indirectly. One is sitagliptin, sold as Januvia. It’s a diabetes drug that prevents the breakdown of a protein called GLP-1, which is associated with TCF7L2. Mice given the drug tend to consume less nicotine, and Kenny says there are some anecdotal data that people taking Januvia stop smoking (Nat. Neurosci. 2017, DOI: 10. 1038/nn. 4540). There are several other drugs in this class, and Kenny thinks these drugs might make an excellent one-two punch in people who have diabetes and may want to stop smoking.
Marina Picciotto, a neuroscientist at Yale School of Medicine who was not involved in the research, says these experiments not only define a new way that the brain communicates with the body and vice versa but also help pinpoint how nicotine and smoking affect metabolism by overtaking this conversation.
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Rats are a fairly reliable model for nicotine use and overuse, she says, but it remains to be seen if the same things are happening in humans. Kenny’s team is looking at large databases of human genetics, searching for people who might have mutations in TCF7L2 and seeing whether they smoke and if they ever developed diabetes.
There are “all sorts of interactions between [TCF7L2], smoking, and diabetes from human genetics data, ” he says. “Nicotine is a major driver of both brain and body diseases. It’s a very problematic drug. ”
A protein in the  
brain
 may link  
smoking
 and diabetes
Nicotine overrides the communication pathway between the  
brain
 and pancreas, causing high glucose  
levels
 in rats
by  
Megha
  Satyanarayana
OCTOBER 16, 2019 | APPEARED IN VOLUME 97, ISSUE 41
Smokers develop type 2 diabetes 30–40% more  
often
 than nonsmokers, and new research suggests that nicotine’s actions in the  
brain
 may be to blame.
Experiments in rats suggest that nicotine may  
needlessly
 turn on part of the  
body’s
 fight-or-flight mechanism, flooding it with useless glucose that would  
otherwise
  get
  used
 to run, punch, or kick. Over years of cigarette or vape-pen  
use
, those useless glucose bumps wear out the insulin-signaling pathways in cells and  
eventually
  lead
 to diabetes,  
says
 Paul J. Kenny, the neuroscientist at the Icahn School of Medicine at Mount Sinai  
who
 led the study (Nature 2019, DOI: 10. 1038/s41586-019-1653-x).
Kenny’s  
team
  found
 that the main player in this signaling short circuit is a protein called TCF7L2, which influences two things: the motivation to take nicotine and a conversation between the  
brain
 and pancreas.
“It all converges on this one  
factor
,  
” 
Kenny  
says
. “ 
Ultimately
, a disease like diabetes may be originating in the  
brain
 or may reflect  
dysregulated
 brain-body interactions, and I  
think
 that’s  
absolutely
 fascinating and  
absolutely
 terrifying. ” He wonders if  
other
 diseases have brain-body connections that can  
get
  similarly
 disrupted.
His  
team
 studies a part of the  
brain
 called the  
habenula
, which  
is involved
 in our  
stress
 response and is  
chock full
 of  
nicotinic
 acetylcholine receptors, which nicotine binds to and activates, giving  
people
 a buzz when they smoke. Kenny’s group had previously reported that mutations that seem to  
lead
 to nicotine addiction in  
humans
 were  
often
  found
 in  
nicotinic
 acetylcholine receptors in the  
habenula
.
Credit: Wikipedia/ 
Emw
TCF7L2 is a  
transcription
  factor
 active in the  
brain
 and pancreas.
The  
habenula
 is  
also
 full of TCF7L2, which is a  
transcription
  factor
 that acts as an on-off switch for several genes. Rats missing this  
transcription
  factor
 “consume  
absolutely
 horrendous amounts of nicotine,  
” 
Kenny says. 
But
 TCF7L2 is  
also
 expressed elsewhere in the  
body
 and  
is associated
 with type 2 diabetes.  
People
 with certain gene sequences for TCF7L2 tend to  
get
 diabetes more  
often
 than  
people
 with  
other
 sequences. Kenny  
says
 his  
team
  thought
 TCF7L2  
might
 be doing something in both the  
brain
 and pancreas to influence the role of nicotine in diabetes. The researchers  
found
 that after nicotine exposure, the  
nicotinic
 acetylcholine receptors in rats without TCF7L2 were less sensitive than those of normal rats. Under normal conditions, when nicotine or  
other
 molecules turn on the receptors, the proteins  
eventually
 enter a sleepy state in which the receptors can’t turn back on for  
some
 time. In rats without TCF7L2, the receptors couldn’t bounce back from this state as  
quickly
 as  
ones
 in rats with TCF7L2.  
Basically
, their  
brains
 weren’t responding in quite the same way, Kenny  
says
. And in an experiment that traced the path of neurons, the  
team
  found
 that neurons in the pancreas led to the  
habenula
.
ADVERTISEMENT
SCROLL TO CONTINUE WITH CONTENT
Looking at  
different
 genes in the  
habenula
 that TCF7L2  
is predicted
 to control, the  
team
  found
 that  
many
  were involved
 in the regulation of glucose metabolism.  
Given
 that nicotine  
is known
 to cause increases  
inblood-glucose
  levels
, the  
team
 wondered if TCF7L2  
might
 influence this action of nicotine. Lowering  
levels
 of TCF7L2  
reduced
 nicotine’s ability to boost blood sugar. And after treating rats for 21 days with nicotine, the  
team
  found
 that the rats missing TCF7L2 had lower blood-sugar  
levels
, suggesting that the  
transcription
  factor
 mediates  
some
 diabetes-like symptoms.
Kenny doesn’t  
think
 that high blood-glucose  
levels
  lead
 to nicotine addiction.  
Instead
, it’s more likely that all the extra glucose is tamping down the activity of  
nicotinic
 acetylcholine receptors, making each puff less effective and leading  
people
 to take more puffs. He  
says
 one of the  
next
  big
 questions is whether the  
habenula
 is playing a role in normal glucose metabolism.
Kenny  
thinks
 the link between the  
stress
-response function of the  
habenula
 and the nicotine override  
might
  lead
 to diabetes. In an actual fight-or-flight situation, “you’re  
stressed
 or you’re frightened, and you need to respond to that,  
” 
he  
says
. “You need to access energy reserves, and this  
stress
 affects the pancreas. ” Over time, this regular  
stress
 to the pancreas leads to diabetes. TCF7L2  
helps
 regulate all that.
The  
team
 is  
now
 looking at  
drugs
 that modulate TCF7L2 activity  
directly
 or  
indirectly
. One is  
sitagliptin
, sold as  
Januvia
. It’s a diabetes  
drug
 that  
prevents
 the breakdown of a protein called GLP-1, which  
is associated
 with TCF7L2. Mice  
given
 the  
drug
 tend to consume less nicotine, and Kenny  
says
 there are  
some
 anecdotal data that  
people
 taking  
Januvia
  stop
  smoking
 (Nat.  
Neurosci
. 2017, DOI: 10. 1038/ 
nn
. 4540). There are several  
other
  drugs
 in this  
class
, and Kenny  
thinks
 these  
drugs
  might
  make
 an excellent one-two punch in  
people
  who
 have diabetes and may want to  
stop
 smoking.
Marina  
Picciotto
, a neuroscientist at Yale School of Medicine  
who
 was not involved in the research,  
says
 these experiments not  
only
 define a new way that the  
brain
 communicates with the  
body
 and vice versa  
but
  also
  help
 pinpoint how nicotine and  
smoking
 affect metabolism by overtaking this conversation.
SPONSORED CONTENT
New, Safer Automated Analysis of Ethylene Oxide
by  
Metrohm
Rats are a  
fairly
 reliable model for nicotine  
use
 and overuse, she  
says
,  
but
 it remains to be  
seen
 if the same things are happening in  
humans
. Kenny’s  
team
 is looking at large databases of  
human
 genetics, searching for  
people
  who
  might
 have mutations in TCF7L2 and seeing whether they smoke and if they ever developed diabetes.
There are “all sorts of interactions between [TCF7L2],  
smoking
, and diabetes from  
human
 genetics data,  
” 
he  
says
. “Nicotine is a major driver of both  
brain
 and  
body
 diseases. It’s a  
very
 problematic  
drug
. ”