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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2015; 6(1): 145-150
Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.145
Pathological consequences of C-peptide deficiency in insulin-dependent diabetes mellitus
Ahmad Ghorbani, Reza Shafiee-Nick
Ahmad Ghorbani, Reza Shafiee-Nick, Pharmacological Research Center of Medicinal Plants, School of Medicine, Mashhad University of Medical Sciences, 91375-3316 Mashhad, Iran
Reza Shafiee-Nick, Department of Pharmacology, School of Medicine, Mashhad University of Medical Sciences, 91375-3316 Mashhad, Iran
Author contributions: Ghorbani A wrote the first draft; both authors contributed to the work, reviewed and edited the manuscript and approved the final version.
Supported by Mashhad University of Medical Sciences.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Reza Shafiee-Nick, Pharm D, PhD, Department of Pharmacology, School of Medicine, Mashhad University of Medical Sciences, Pardis Campus, Azadi Square, 91375-3316 Mashhad, Iran. shafieer@mums.ac.ir
Telephone: +98-51-38002256 Fax: +98-51-38828567
Received: September 9, 2014
Peer-review started: September 9, 2014
First decision: October 14, 2014
Revised: November 3, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 15, 2015
Abstract

Diabetes is associated with several complications such as retinopathy, nephropathy, neuropathy and cardiovascular diseases. Currently, insulin is the main used medication for management of insulin-dependent diabetes mellitus (type-1 diabetes). In this metabolic syndrome, in addition to decrease of endogenous insulin, the plasma level of connecting peptide (C-peptide) is also reduced due to beta cell destruction. Studies in the past decade have shown that C-peptide is much more than a byproduct of insulin biosynthesis and possess different biological activities. Therefore, it may be possible that C-peptide deficiency be involved, at least in part, in the development of different complications of diabetes. It has been shown that a small level of remaining C-peptide is associated with significant metabolic benefit. The purpose of this review is to describe beneficial effects of C-peptide replacement on pathological features associated with insulin-dependent diabetes. Also, experimental and clinical findings on the effects of C-peptide on whole-body glucose utilization, adipose tissue metabolism and tissues blood flow are summarized and discussed. The hypoglycemic, antilipolytic and vasodilator effects of C-peptide suggest that it may contribute to fine-tuning of the tissues metabolism under different physiologic or pathologic conditions. Therefore, C-peptide replacement together with the classic insulin therapy may prevent, retard, or ameliorate diabetic complications in patients with type-1 diabetes.

Keywords: C-peptide, Diabetes, Insulin, Nephropathy, Neuropathy

Core tip: In type-1 diabetes, in addition to decrease of endogenous insulin, the plasma level of connecting peptide (C-peptide) is also reduced due to beta cell destruction. Therefore, it may be possible that C-peptide deficiency be involved in the development of diabetic complications such as retinopathy, nephropathy, neuropathy and cardiovascular diseases. In this paper, beneficial effects of C-peptide replacement on pathological features associated with type-1 diabetes are described. Also, experimental and clinical findings that support the hypoglycemic, antilipolytic and vasodilator effects of C-peptide are discussed.