The mammalian insulin gene is exclusively expressed in the beta cells of the endocrine pancreas. Two decades of intensive
physiological and biochemical studies have led to the identification of regulatory sequence motifs along the insulin promoter
and to the isolation of transcription factors which interact to activate gene transcription. The majority of the islet-restricted
(BETA2, PDX-1, RIP3b1-Act/C1) and ubiquitous (E2A, HEB) insulin-binding proteins have been characterized. Transcriptional
regulation results not only from specific combinations of these activators through DNA-protein and protein-protein interactions,
but also from their relative nuclear concentrations, generating a cooperativity and transcriptional synergism unique to the
insulin gene. Their DNA binding activity and their transactivating potency can be modified in response to nutrients (glucose,
NEFA) or hormonal stimuli (insulin, leptin, glucagon like peptide-1, growth hormone, prolactin) through kinase-dependent signalling
pathways (PI3-K, p38MAPK, PKA, CaMK) modulating their affinities for DNA and/or for each other. From the overview of the research
presented, it is clear that much more study is required to fully comprehend the mechanisms involved in the regulated-expression
of the insulin gene in the beta cell to prevent its impairment in diabetes. [Diabetologia (2002) 45: 309–326]
Keywords Insulin gene - beta cell - transcription factor - promoter - PDX-1 - glucose - diabetes - NEFA - leptin - GLP-1.
Received: 23 May 2001 and in revised form: 15 November 2001