Triggering and augmentation mechanisms, granule pools, and biphasic insulin secretion.

The insulin secretory response by pancreatic beta-cells to an acute "square wave" stimulation by glucose is characterized by a first phase that occurs promptly after exposure to glucose, followed by a decrease to a nadir, and a prolonged second phase. The first phase of release is due to the ATP-sensitive K(+) (K(ATP)) channel-dependent (triggering) pathway that increases [Ca(2+)](i) and has been thought to discharge the granules from a "readily releasable pool." It follows that the second phase entails the preparation of granules for release, perhaps including translocation and priming for fusion competency before exocytosis. The pathways responsible for the second phase include the K(ATP) channel-dependent pathway because of the need for elevated [Ca(2+)](i) and additional signals from K(ATP) channel-independent pathways. The mechanisms underlying these additional signals are unknown. Current hypotheses include increased cytosolic long-chain acyl-CoA, the pyruvate-malate shuttle, glutamate export from mitochondria, and an increased ATP/ADP ratio. In mouse islets, the beta-cell contains some 13,000 granules, of which approximately 100 are in a "readily releasable" pool. Rates of granule release are slow, e.g., one every 3 s, even at the peak of the first phase of glucose-stimulated release. As both phases of glucose-stimulated insulin secretion can be enhanced by agents such as glucagon-like peptide 1, which increases cyclic AMP levels and protein kinase A activity, or acetylcholine, which increases diacylglycerol levels and protein kinase C activity, a single "readily releasable pool" hypothesis is an inadequate explanation for insulin secretion. Multiple pools available for rapid release or rapid conversion of granules to a rapidly releasable state are required.