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SIRT2 puts the brakes on human β cell proliferation: therapeutic opportunities and next challenges
Liora S. Katz, … , Donald K. Scott, Andrew F. Stewart
Liora S. Katz, … , Donald K. Scott, Andrew F. Stewart
Published October 1, 2025
Citation Information: J Clin Invest. 2025;135(19):e197142. https://doi.org/10.1172/JCI197142.
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Commentary

SIRT2 puts the brakes on human β cell proliferation: therapeutic opportunities and next challenges

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Abstract

The numbers of insulin-producing β cells in the pancreas are reduced in people with type 1 or type 2 diabetes, prompting efforts to replace these missing or lost β cells through transplant or regenerative medicine approaches. In this issue of the JCI, Wortham et al. describe a function for the deacetylase enzyme sirtuin 2 (SIRT2) in a novel pathway that acts as a brake on β cell proliferation. They show that inhibiting SIRT2 through pharmacologic or genetic approaches can induce human and mouse β cells to reenter a proliferative cell cycle. A surprising observation that remains unexplained is that the main targets of SIRT2 are mitochondrial oxidative phosphorylation (OxPhos) enzymes. It also remains unknown if and how these unanticipated acetylated OxPhos targets lead to cell-cycle entry. SIRT2 inhibitors will be a welcome addition to the growing repertoire of human β cell–regenerative drugs.

Authors

Liora S. Katz, Donald K. Scott, Andrew F. Stewart

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Figure 1

A glucose-driven, SIRT2-dependent metabolic switch regulates β cell proliferation.

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A glucose-driven, SIRT2-dependent metabolic switch regulates β cell prol...
(A) Under basal glucose conditions, high NAD+ levels maintain active SIRT2 deacetylase activity. SIRT2 targets and deacetylates genes encoding multiple metabolic enzymes that support baseline glycolytic and OxPhos activity, including glycolytic enzymes (e.g., GAPDH and PKM), fatty acid β oxidation enzymes (e.g., ACAA2 and HADH), and TCA enzymes (e.g., ACO2 and SDHA), a milieu that is associated with low β cell proliferation. (B) In contrast, elevated glucose or pharmacological inhibition of SIRT2 increases glycolytic flux, elevates NADH, and depletes NAD+, leading to SIRT2 inhibition. This results in hyperacetylation of metabolic enzymes and enhanced metabolic flux through glycolysis and OxPhos and promotes adaptive β cell proliferation. Systemically in mice, SIRT2 inhibitors increase the potential for acetylation, activation of metabolism, and adaptive proliferation without losing the braking effect of a return to low glucose and the restoration of deacetylating SIRT2 activity. Ac, acetylation; PKM, pyruvate kinase M1/2; ACAA2, acetyl-coenzyme A acyltransferase 2; HADH, hydroxyacyl coenzyme A dehydrogenase; ACO2, aconitase 2; SDHA, succinate dehydrogenase subunit A.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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