lives. Medical Relevance Historically, the focus of many insulin related metabolic diseases has focused on mature insulin. However, in recent years the importance of studying the structure and function of proinsulin or proinsulin:insulin ratio in relation to these diseases has become increasingly clear. Diabetes Mellitus Increased levels of proinsulin in the circulatory system relative to mature insulin concentrations can indicate impending insulin resistance and the development of type 2 diabetes. Additional problems with proinsulin that can lead to diabetes include mutations in the number of cysteines present, which could affect correct folding. If the mutation causes only a mild change it could simply stress the endoplasmic reticulum’s ability to properly fold the protein. This stress, after a while, would lead to a decrease in the number of β-cells producing mature insulin, and would then lead to diabetes mellitus. Neonatal Diabetes Mellitus Postnatal proinsulin is crucial for metabolic regulation. However, proinsulin in neonates is important for normal development of the nerves of the eye, development of the heart, and general survival of embryonic cells. Regulation of the concentration of proinsulin during embryonic development is crucial, as too much or too little of the peptide can cause defects and death of the fetus. Thus far in the study of neonatal diabetes mellitus, only amino acid change mutations found in the B domain lead to the disease. See also insulin preproinsulin signal peptide signal peptide peptidase proprotein convertase 1 (PC1) proprotein convertase 2 (PC2) References Peptides Diabetes