Tacrolimus-Induced BMP/SMAD Signaling Associates with Metabolic Stress-Activated FOXO1 to Trigger β-Cell Failure

Javier Triñanes, Peter Ten Dijke, Nathalie Groen, Maaike Hanegraaf, Esteban Porrini, Ana E Rodriguez-Rodriguez, Cinthia Drachenberg, Ton J Rabelink, Eelco de Koning, Françoise Carlotti, Aiko P J de Vries

Research output: Contribution to journal/periodicalArticleScientificpeer-review


Active maintenance of β-cell identity through fine-tuned regulation of key transcription factors ensures β-cell function. Tacrolimus, a widely used immunosuppressant, accelerates onset of diabetes after organ transplantation but underlying molecular mechanisms are unclear. Here we show that tacrolimus induces loss of human β-cell maturity and β-cell failure through activation of the BMP/SMAD signaling pathway when administered under mild metabolic stress conditions. Tacrolimus-induced phospho-SMAD1/5 acts in synergy with metabolic stress-activated FOXO1 through formation of a complex. This interaction is associated with reduced expression of the key β-cell transcription factor MAFA and abolished insulin secretion, both in vitro in primary human islets, and in vivo in human islets transplanted into high-fat diet fed mice. Pharmacological inhibition of BMP signaling protects human β-cells from tacrolimus-induced β-cell dysfunction in vitro Furthermore, we confirm that BMP/SMAD signaling is activated in protocol pancreas allograft biopsies from recipients on tacrolimus. To conclude, we propose a novel mechanism underlying the diabetogenicity of tacrolimus in primary human β-cells. This insight could lead to new treatment strategies for new-onset diabetes, and may have implications for other forms of diabetes.

Original languageEnglish
Publication statusPublished - Feb 2020


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