Elevated circulating free fatty acids (FFA) cause hepatic insulin resistance; however, the mechanisms for this process are incompletely understood. The objective of the studies in the thesis was to examine whether protein kinase C (PKC)-delta (d), oxidative stress, and the serine kinase IkBa kinase (IKK) B are causally involved in FFA-induced hepatic insulin resistance. To test this, we infused rats with lipid with or without inhibitors of the aforementioned factors for 7h, during the last 2h of which a hyperinsulinemic-euglycemic clamp was performed. In Study 1, inhibition of hepatic PKC-d using antisense oligonucleotide prevented FFA-induced membrane translocation of PKC-d, which is a marker of its activation, in parallel with prevention of lipid-induced hepatic insulin resistance, without affecting lipid-induced peripheral insulin resistance. These results implicate PKC-d as a causal mediator of FFA-induced hepatic insulin resistance. In Study 2, the antioxidant N-acetyl-L-cysteine (NAC) prevented lipid-induced hepatic insulin resistance in conjunction with reversal of lipid-induced increase in markers of IKKB and c-Jun NH2-terminal kinase 1 (JNK1) activation, and of impairment of insulin signaling, without affecting PKC-d membrane translocation and increase in phosphorylated p38 mitogen-activated protein kinase (MAPK) induced by lipid infusion. These findings suggested that oxidative stress is a causal mediator of lipid-induced hepatic insulin resistance upstream of IKKB and JNK1, and potentially downstream of PKC-d and p38 MAPK. In Study 3, sodium salicylate, an IKKB inhibitor, prevented FFA-induced hepatic insulin resistance via restoration of hepatic insulin signaling, thus implicating IKKB as a causal factor in the process. Together, the results from these studies demonstrate that PKC-d, oxidative stress, and IKKB are causally involved in FFA-induced hepatic insulin resistance and suggest that the sequence for the process is: FFA -> PKC-d -> oxidative stress -> IKKB -> impaired hepatic insulin signaling.

Glucagon-like peptide-1 (GLP-1) is secreted from the enteroendocrine L cell following nutrient ingestion. Although GLP-1 regulates several aspects of nutrient homeostasis, one important function is to enhance glucose-dependent insulin secretion. In type 2 diabetes, post-prandial GLP-1 secretion is impaired. Insulin resistance, which is required for the pathogenesis of type 2 diabetes, is also associated with impaired GLP-1 secretion. I, therefore, hypothesized that insulin modulates GLP-1 secretion from the intestinal L cell and, furthermore, insulin resistance directly impairs the function of the endocrine L cell. In well-characterized L cell models, I established that insulin stimulates GLP-1 secretion through the MEK1/2-ERK1/2 pathway, and induction of insulin resistance in vitro attenuated insulin- and heterologous secretagogue-induced GLP-1 release. Furthermore, glucose-stimulated GLP-1 secretion was decreased in hyperinsulinemic-insulin resistant MKR mice, demonstrating that insulin resistance is associated with impaired L cell function. I next examined the role of the actin cytoskeleton in insulin-stimulated GLP-1 secretion. Insulin treatment transiently induced actin depolymerization, and depolymerization of the actin cytoskeleton potentiated insulin-stimulated GLP-1 release from the L cell, demonstrating that the cytoskeleton functions as a permissive barrier. Central to insulin’s effects on actin dynamics is the Rho GTPase, Cdc42, as siRNA-mediated knockdown and over-expression of a dominant-negative mutant, prevented insulin-stimulated actin remodeling and GLP-1 release. Insulin also promoted activation of PAK1, the downstream kinase of Cdc42, and over-expression of a kinase-dead PAK1 mutant attenuated insulin-stimulated GLP-1 release. In cells that expressed dominant-negative Cdc42 or kinase-dead PAK1, activation of ERK1/2 following insulin treatment was attenuated, demonstrating that the Cdc42-PAK1 axis regulates the activity of the canonical ERK1/2 pathway. In summary, this thesis demonstrates, for the first time, that insulin is a GLP-1 secretagogue, and this effect of insulin is mediated through the canonical ERK1/2 pathway and the Cdc42-PAK1 axis. Insulin resistance in the L cell impairs the responsiveness of the L cell to heterologous secretagogues. Collectively, these findings suggest that an alternative approach to treat type 2 diabetes and/or insulin resistance may be to directly improve the function of the L cell, thereby enhancing endogenous GLP-1 release.

<p>Insulin resistance has shown to be a precursor to a number of lifestylerelated chronic diseases and abnormalities in adults and is affected by a number of factors including genetics, age, physical activity and acute exercise, diet, obesity, body fat distribution and medication. Physical activity has shown to have marked effects on improving sensitivity to insulin though various physiological mechanisms, and numerous correlation studies have identified a relationship between these two variables, suggesting the beneficial role of exercise on insulin resistance.&nbsp / This study aimed to identify a relationship between current levels of physical activity, physical fitness and insulin resistance in adults between the ages of 35 and 65 years of age residing in a northern suburb community in Cape Town. A total of 186 volunteers participated in this study ranging from healthy individuals to those with diagnosed chronic conditions. Insulin resistance (determined by the homeostasis model assessment of insulin resistance), physical activity (measured by the Global Physical Activity Questionnaire) and five health-related physical fitness tests were measured. The five components included body composition, determined by body mass index and waist circumference, the 3-minute cardiorespiratory step test, the handgrip&nbsp / muscle strength test, one-minute crunches for muscle endurance and the sit-and-reach flexibility test. Spearman correlation was used to identify the relationships between the homeostasis model assessment of insulin resistance, age, body composition and physical activity and fitness.Results showed that body mass index and waist circumference were the only two variables which produced significant correlations with the homeostasis model assessment of insulin resistance (p &lt / 0.019). No physical activity or fitness data produced significant scores with the homeostasis model assessment of insulin resistance. Body mass index in men was the only significant predictor of HOMA-IR and explained 37% of the variance in insulin resistance, whereas in women, only waist circumference was related to HOMA-IR, but explained less than 16% of the variance. Associations between reported MET-minutes from the Global Physical Activity Questionnaire and the four fitness tests indicated significance with handgrip strength (&rho / = 0.17 / p =0.039), one-minute crunches (&rho / = 0.18 / p = 0.024) and sit-and-reach flexibility (&rho / = 0.17 / 0.034). This study has shown that body composition is an important component in influencing insulin resistance therefore physical activity interventions should be targeted at increasing physical activity levels and reducing body weight.</p>

Elevated circulating free fatty acids (FFA) cause hepatic insulin resistance; however, the mechanisms for this process are incompletely understood. The objective of the studies in the thesis was to examine whether protein kinase C (PKC)-delta (d), oxidative stress, and the serine kinase IkBa kinase (IKK) B are causally involved in FFA-induced hepatic insulin resistance. To test this, we infused rats with lipid with or without inhibitors of the aforementioned factors for 7h, during the last 2h of which a hyperinsulinemic-euglycemic clamp was performed. In Study 1, inhibition of hepatic PKC-d using antisense oligonucleotide prevented FFA-induced membrane translocation of PKC-d, which is a marker of its activation, in parallel with prevention of lipid-induced hepatic insulin resistance, without affecting lipid-induced peripheral insulin resistance. These results implicate PKC-d as a causal mediator of FFA-induced hepatic insulin resistance. In Study 2, the antioxidant N-acetyl-L-cysteine (NAC) prevented lipid-induced hepatic insulin resistance in conjunction with reversal of lipid-induced increase in markers of IKKB and c-Jun NH2-terminal kinase 1 (JNK1) activation, and of impairment of insulin signaling, without affecting PKC-d membrane translocation and increase in phosphorylated p38 mitogen-activated protein kinase (MAPK) induced by lipid infusion. These findings suggested that oxidative stress is a causal mediator of lipid-induced hepatic insulin resistance upstream of IKKB and JNK1, and potentially downstream of PKC-d and p38 MAPK. In Study 3, sodium salicylate, an IKKB inhibitor, prevented FFA-induced hepatic insulin resistance via restoration of hepatic insulin signaling, thus implicating IKKB as a causal factor in the process. Together, the results from these studies demonstrate that PKC-d, oxidative stress, and IKKB are causally involved in FFA-induced hepatic insulin resistance and suggest that the sequence for the process is: FFA -> PKC-d -> oxidative stress -> IKKB -> impaired hepatic insulin signaling.

Glucagon-like peptide-1 (GLP-1) is secreted from the enteroendocrine L cell following nutrient ingestion. Although GLP-1 regulates several aspects of nutrient homeostasis, one important function is to enhance glucose-dependent insulin secretion. In type 2 diabetes, post-prandial GLP-1 secretion is impaired. Insulin resistance, which is required for the pathogenesis of type 2 diabetes, is also associated with impaired GLP-1 secretion. I, therefore, hypothesized that insulin modulates GLP-1 secretion from the intestinal L cell and, furthermore, insulin resistance directly impairs the function of the endocrine L cell. In well-characterized L cell models, I established that insulin stimulates GLP-1 secretion through the MEK1/2-ERK1/2 pathway, and induction of insulin resistance in vitro attenuated insulin- and heterologous secretagogue-induced GLP-1 release. Furthermore, glucose-stimulated GLP-1 secretion was decreased in hyperinsulinemic-insulin resistant MKR mice, demonstrating that insulin resistance is associated with impaired L cell function. I next examined the role of the actin cytoskeleton in insulin-stimulated GLP-1 secretion. Insulin treatment transiently induced actin depolymerization, and depolymerization of the actin cytoskeleton potentiated insulin-stimulated GLP-1 release from the L cell, demonstrating that the cytoskeleton functions as a permissive barrier. Central to insulin’s effects on actin dynamics is the Rho GTPase, Cdc42, as siRNA-mediated knockdown and over-expression of a dominant-negative mutant, prevented insulin-stimulated actin remodeling and GLP-1 release. Insulin also promoted activation of PAK1, the downstream kinase of Cdc42, and over-expression of a kinase-dead PAK1 mutant attenuated insulin-stimulated GLP-1 release. In cells that expressed dominant-negative Cdc42 or kinase-dead PAK1, activation of ERK1/2 following insulin treatment was attenuated, demonstrating that the Cdc42-PAK1 axis regulates the activity of the canonical ERK1/2 pathway. In summary, this thesis demonstrates, for the first time, that insulin is a GLP-1 secretagogue, and this effect of insulin is mediated through the canonical ERK1/2 pathway and the Cdc42-PAK1 axis. Insulin resistance in the L cell impairs the responsiveness of the L cell to heterologous secretagogues. Collectively, these findings suggest that an alternative approach to treat type 2 diabetes and/or insulin resistance may be to directly improve the function of the L cell, thereby enhancing endogenous GLP-1 release.

Proopiomelanocortin (POMC) is a polypeptide precursor with 241 amino acid residues which undergoes extensive post-translational modification to yield a range of smaller, biological active peptides including £\-, £] -, £^-melanocyte-stimulating hormone (£\-MSH, £]-MSH, £^-MSH )¡A£]-endorphin (£]-EP) and adrenocorticotrophic hormone (ACTH). POMC-derived peptides play important roles in appetite and energy homeostasis. Recently, the peripheral POMC system is under active investigation to delineate their pathogenic roles in metabolic diseases such as Cushing¡¦s syndrome and obesity. In the present study, we utilized adenovirus gene delivery system to achieve systemic POMC overexpression in adult C57/BL6 mice for at least 30 days. Subsequently, the plasma and abdominal adipose tissue of mice were collected and analyzed by biochemical assays and weight determination respectively. POMC overexpression did not increase in the food uptake and body weight. These results imply that local POMC gene delivery induced the visceral fat accumulation and altered the metabolism in mice. It was observed that systemic POMC overexpression significantly elevated the triglyceride and the cholesterol levels in mice. However, POMC gene delivery also induced elevated plasma glucose concentration at weeks 1-4 and evoked glucose tolerance in mice at week 4. Interestingly, insulin resistance was readily detected in POMC-transduced in mice at as early as week 1. Besides, Micro-CT scanning and histological studies demonstrated that the visceral fat was significantly increased in POMC over-expressing mice compared with control animals. These data indicate that hepatic POMC gene delivery causes systemic ACTH rise and insulin resistance, which recapitulates the clinical features of Cushing¡¦s syndrome. In summary, POMC gene delivery induces systemic POMC overexpression and results in visceral fat accumulation and insulin resistance, which may facilitates a mice model for Cushing¡¦s-like metabolic syndrome.

No description available.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成23年3月25日 村松崇氏の博士論文として提出された

The prevalence of insulin resistance and type 2 diabetes mellitus (T2DM) in obese children and adolescents is growing at an alarming rate, especially in ethnic minorities. It is not clear whether young people of different ethnic backgrounds vary in their metabolic response to excessive adiposity. Differences in lipid partitioning in the abdominal fat compartments have been observed among different ethnic groups. The aim of this study was to evaluate whether there are ethnic differences in intramyocellular lipid (IMCL) levels that are related to differences in insulin sensitivity. Eighty-two obese children and adolescents underwent 1) 1H nuclear magnetic resonance (NMR) spectroscopy to non-invasively quantify IMCL levels in their soleus muscle, 2) an oral glucose tolerance test and (in a subset of subjects) a euglycemic-hyperinsulinemic clamp to assess insulin sensitivity, 3) a dual-energy X-ray absorptiometry (DEXA) scan to measure total percent body fat, and 4) magnetic resonance imaging to measure abdominal fat distribution. IMCL levels in Hispanic children and adolescents (1.50 ± 0.64%) were significantly greater than in their Caucasian (1.19 ± 0.40%) and African-American (1.09 ± 0.49%) peers. Visceral fat was significantly lower in African Americans (42.7 ± 18.8cm2) and were similar in Caucasians (70.9 ± 27.5cm2) and Hispanics (77.3 ± 41.9cm2). The three groups were not different with respect to insulin sensitivity. For the entire cohort, IMCL levels were inversely related to insulin sensitivity. There was a significant correlation between visceral fat and insulin resistance in Hispanics and Caucasians but not in African Americans. In conclusion, these data suggest that there are significant ethnic differences in lipid partitioning in both the muscle and abdominal compartment. These findings may explain ethnic differences in insulin sensitivity and further the understanding of the pathogenesis of insulin resistance and T2DM.

Das Equine metabolische Syndrom, das Equine Cushing Syndrom und die häufig daraus resultierende Hufrehe stellen den behandelnden Tierarzt noch immer vor Probleme bezüglich Diagnostik und Therapie. Grund hierfür sind fehlende einheitliche endokrinologische Parameter, die eine Einschätzung des Krankheitszustandes des jeweiligen Tieres ermöglichen. Für Ponys fehlt es gänzlich an statistisch validen Referenzbereichen für die, an den Krankheiten beteiligten Hormonen. In der vorliegenden Arbeit wurde die Aktivität von Insulin, sowie die Konzentration von Insulinwachstumsfaktor-1 (IGF-1) und adrenocorticotropem Hormon (ACTH) im Blut von 130 klinisch gesunden, erwachsenen Ponys bestimmt. Damit liegen erstmals Ergebnisse vor, welche auf einer für die Erstellung von Referenzwerten ausreichend großen Fallzahl basieren. Die Analyse fand mittels eines immunometrischen Chemielumineszenz-Assays an drei aufeinander folgenden Tagen statt. Anhand einer Dreifachuntersuchung am ersten Untersuchungstag wurde für jedes Hormon der 95 %-Referenzbereich bestimmt. Für Insulin konnte ein Referenzbereich von 2,0 - 34,3 µU/ml ermittelt werden. Damit liegen die Werte unterhalb den für Großpferde veröffentlichen Werten, wobei ein direkter Vergleich nur bedingt möglich ist. Für Insulinwachstumsfaktor-1 wurden für Pferde noch keine Werte erhoben. Somit ist ein Vergleich zwischen Großpferden und Ponys diesbezüglich noch nicht möglich. Für Ponys liegt der hier ermittelte Referenzbereich zwischen 48,3 und 382,6 ng/ml. Für die Konzentration von adrenocorticotropem Hormon gibt es in der Literatur unterschiedliche Angaben sowohl für Ponys als auch für Großpferde. Mit dieser Studie wurde der 95 %-Referenzbereich für Ponys bei 6,5 bis 23,3 pg/ml ermittelt. Es konnte ein Zusammenhang zwischen dem Alter der Tiere und der ACTH-Konzentration nachgewiesen werden. Der Referenzbereich der Gruppe B (13 bis 32 Jahre) reicht von 7,1 pg/ml bis 27,7 pg/ml und unterscheidet sich damit signifikant von dem Referenzbereich der Gruppe A (drei bis 12 Jahre), welcher zwischen 5,9 pg/ml und 22,2 pg/ml ermittelt wurde. Durch die Bestimmung der Hormonkonzentration an drei aufeinander folgenden Tagen konnte die Empfindlichkeit der Hormone gegenüber enzymatischem Abbau überprüft werden. Die Proben wurden an Tag 1 aufgetaut und anschließend bei 4°C gelagert. Lediglich für adrenocorticotropes Hormon konnte eine signifikante Reduzierung (p< 0,001) der Werte um 5,4 % an Tag 3 im Vergleich zu Tag 1 festgestellt werden. Das Chemielumineszens-Assay-Testverfahren mit den Geräten der IMMULITE 2000-Reihe wurde hinsichtlich seiner Präzisionen überprüft, indem der Variationskoeffizient für die Intra-Assay-Untersuchung und die Inter-Assay-Untersuchung berechnet wurde. Für das Verfahren konnte eine ausreichende (Variationskoeffizienten ACTH: 5,2 % bzw. 5,4%), für die Untersuchung von Insulin und IGF-1 sogar eine hervorragende (Variationskoeffizienten Insulin: 3,9 % bzw. 4,7 %; Variationskoeffizienten IGF-1: 2,6 % bzw.2,9 %) Testgenauigkeit nachgewiesen werden.