pH-dependent trapping of cationic amphiphilic drugs perturbs insulin granule homeostasis

Pancreatic β-cells store insulin in acidic secretory granules (SGs), specialized organelles that also contain monoamine neurotransmitters such as serotonin. Many neuroactive drugs with monoaminergic activity are cationic amphiphilic drugs (CADs) that accumulate in acidic compartments by pH-dependent trapping. Yet, whether insulin SGs represent a site of CAD accumulation and if this affects their properties such as monoamine storage and pH remain unclear. Here, we show that Slc18a1/VMAT1 is required for vesicular monoamine uptake and maintenance of cellular serotonin levels in insulinoma INS-1 cells. In contrast, neuroactive CADs accumulate via pH-dependent trapping at luminal pH values characteristic of insulin SGs. CADs inhibit VMAT-mediated uptake of the fluorescent monoamine probe FFN206 and induce its efflux to the extracellular space without detectable changes in SG luminal pH. Conversely, natural VMAT substrates such as serotonin and dopamine increase SG pH in a VMAT-dependent manner. These findings identify insulin SGs as acidic organelles susceptible to CAD accumulation and uncover distinct mechanisms regulating secretory granule homeostasis.