C-peptide: New findings and therapeutic possibilities

Abstract Much new information on C-peptidephysiology has appeared during the past 20 years. It has been shown that C-peptidebinds specifically to cell membranes, elicits intracellular signaling via G-protein and Ca 2+ -dependent pathways, resulting in activation and increased expression of endothelial nitric oxide synthase, Na + , K + -ATPase and several transcription factors of importance for anti-inflammatory, anti-oxidant and cell protective mechanisms. Studies in animal models of diabetes and early clinical trials in patients with type 1 diabetesdemonstrate that C-peptidein replacement doses elicits beneficial effects on early stages of diabetes-induced functional and structural abnormalities of the peripheral nerves, the kidneys and the retina. Much remains to be learned about C-peptide's mechanism of action and long-term clinical trials in type 1 diabetessubjects will be required to determine C-peptide's clinical utility. Nevertheless, even a cautious evaluation of the available evidence presents the picture of a bioactive endogenous peptide with therapeutic potential