Indiana University-Purdue University Indianapolis (IUPUI) / Insulin-stimulated glucose uptake into skeletal muscle cells requires translocation of the glucose transporter-4 (GLUT4) from the cell interior to the plasma membrane. Insulin-stimulated GLUT4 vesicle translocation is dysregulated in Type 2 diabetes (T2D). The Group I p21–activated kinase (PAK1) is a required element in insulin-stimulated GLUT4 vesicle translocation in mouse skeletal muscle in vivo, although its placement and function(s) in the canonical insulin signaling cascade in skeletal muscle cells, remain undetermined. Therefore, the objective of my project is to determine the molecular mechanism(s) underlying the requirement for PAK1 in the process of insulin-stimulated GLUT4 vesicle translocation and subsequent glucose uptake by skeletal muscle cells. Toward this, my studies demonstrate that the pharmacological inhibition of PAK1 activation blunts insulin-stimulated GLUT4 translocation and subsequent glucose uptake into L6-GLUT4myc skeletal myotubes. Inhibition of PAK1 activation also ablates insulin-stimulated F-actin cytoskeletal remodeling, a process known to be required for mobilizing GLUT4 vesicles to the plasma membrane. Consistent with this mechanism, PAK1 activation was also required for the activation of cofilin, another protein implicated in F-actin remodeling. Interestingly, my studies reveal a novel molecular mechanism involving PAK1 signaling to p41-ARC, a regulatory subunit of the cytoskeletal Arp2/3 complex, and its interactions with another cytoskeletal factor, N-WASP, to elicit the insulin-stimulated F-actin remodeling in skeletal muscle cells. Pharmacological inactivation of N-WASP fully abrogated insulin-stimulated GLUT4 vesicle translocation to the cell surface, coordinate with blunted F-actin remodeling. Furthermore, my studies revealed new insulin-induced interactions amongst N WASP, actin, p41-ARC and PAK1; inactivation of PAK1 signaling blocked these dynamic interactions. Taken together, the above studies demonstrate the significance of PAK1 and its downstream signaling to F-actin remodeling in insulin-stimulated GLUT4 vesicle translocation and glucose uptake, revealing new signaling elements that may prove to be promising targets for future therapeutic design.

京都大学 / 0048 / 新制・論文博士 / 博士(人間健康科学) / 乙第13064号 / 論人健博第3号 / 新制||人健||3(附属図書館) / (主査)教授 高桑 徹也, 教授 三谷 章, 教授 横出 正之 / 学位規則第4条第2項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Background: Modifying the gut microbiota through the administration of probiotics during high fat feeding has been shown to attenuate weight gain and body fat accretion while improving insulin sensitivity in animal models. Objective: Our objective was to determine the effects of the probiotic VSL#3 on body weightand composition, skeletal muscle substrate oxidation, and insulin sensitivity and during 4 weeks of high-fat, hypercaloric feeding. We hypothesized that the probiotic would attenuate the body weight and fat gain and adverse changes in insulin sensitivity and substrate oxidation following high fat, hypercaloric feeding in young, non-obese males. Methods: Twenty non-obese males (18-30 y) volunteered to participate in the present study. Following a 2-week eucaloric control diet, subjects underwent a dual x-ray absorptiometry (DXA) to determine body composition, an intravenous glucose tolerance test (IVGTT) to determine insulin sensitivity, a skeletal muscle biopsy for measurement of substrate oxidation. Serum endotoxin was also measured. Subsequently, subjects were randomized to receive either VSL#3 (2 satchets) or placebo during 4 weeks of consuming a high fat (55% fat), hypercaloric diet (+1,000 kcal/day). Macronutrient composition of the high fat diet was 55% fat, 30% carbohydrate, and 15% protein. Results: There were no differences between the groups in subject characteristics or in the dependent variables at baseline. Body weight and fat mass increased less (P<0.045) following the high fat diet with VSL#3 compared to placebo. Insulin sensitivity (and other IVGTT variables) and both glucose and fat oxidation did not change significantly with time or VSL#3 treatment. Serum endotoxin concentration was not different between groups following the high-fat diet. Conclusions: VSL#3, a multi-strain probiotic, attenuated body weight and fat gain following a 4-week high fat, hypercaloric diet compared with a placebo. There were no differences between the VSL and control in circulating endotoxin, insulin sensitivity (and other IVGTT variables) or in skeletal muscle substrate oxidation. / Ph. D.

Background: Canine hypothyroidism is thought to cause abnormalities in glucose homeostasis, but the effect on glucose tolerance and insulin sensitivity has not been determined to date. Hypothesis/Objectives: The purpose of the study was to investigate whether hypothyroidism has an effect on glucose tolerance and insulin sensitivity in dogs. We hypothesized that hypothyroidism causes insulin resistance. Animals: Sixteen euthyroid bitches were randomly selected and allocated into two groups. In 8 dogs, hypothyroidism was induced by administration of 1 mCi/kg I-131. Experiments were performed on non-anesthetized, fasted dogs in anestrous approximately 12 months after hypothyroidism was induced. Methods: The insulin-modified frequently sampled intravenous glucose tolerance test (FSIGT) and minimal model analysis were used to determine basal insulin and glucose concentrations, acute insulin response to glucose (AIRg), insulin sensitivity (SI), glucose effectiveness (SG) and the disposition index (DI). Results: In the hypothyroid group, basal glucose concentrations were mildly decreased (P = 0.0079), whereas basal insulin was increased (P = 0.019). Insulin sensitivity was reduced in the hypothyroid group (P<0.001), whereas AIRg was higher (P=0.01). Other parameters were not different between groups. Conclusions/Clinical Importance: Hypothyroidism negatively affects glucose homeostasis by inducing insulin resistance. In hypothyroid dogs, the disposition index (insulin sensitivity x insulin secretion) remained unchanged due to a compensatory increase in insulin secretion, thereby maintaining glucose tolerance. In cases with impaired insulin secretion, such as canine diabetes mellitus, concurrent hypothyroidism can have important clinical implications in the successful management of the disease. / Master of Science

Given the high and increasing social, health and economic costs of type 2 diabetes, early diagnosis and prevention are critical. Insulin sensitivity and insulin secretion are important etiological factors of type 2 diabetes and are used to define an individual’s risk or progression to the disease state. The dynamic insulin sensitivity and secretion test (DISST) concurrently measures insulin sensitivity and insulin secretion. The protocol uses glucose and insulin boluses as stimulus, and the participant response is observed during a relatively short protocol via glucose, insulin and C-peptide assays. In this research, the DISST insulin sensitivity value was successfully validated against the gold standard euglycaemic clamp with a high correlation (R=0.82), a high insulin resistance diagnostic equivalence (ROC c-unit=0.96), and low bias (-10.6%). Endogenous insulin secretion metrics obtained via the DISST were able to describe clinically important distinctions in participant physiology that were not observed with euglycaemic clamp, and are not available via most established insulin sensitivity tests. The quick dynamic insulin sensitivity test (DISTq) is a major extension of the DISST that uses the same protocol but uses only glucose assays. As glucose assays are usually available immediately, the DISTq is capable of providing insulin sensitivity results immediately after the final blood sample, creating a real-time clinical diagnostic. The DISTq correlated well with the euglycaemic clamp (R=0.76), had a high insulin resistance diagnostic equivalence (ROC c-unit=0.89), and limited bias (0.7%). These DISTq results meet or exceed the outcomes of most validation studies from established insulin sensitivity tests such as the IVGTT, HOMA and OGTT metrics. Furthermore, none of the established insulin sensitivity tests are capable of providing immediate or real-time results. Finally, and most of the established tests require considerably more intense clinical protocols than the DISTq. A range of DISST-based tests that used the DISST protocol and varying assay regimens were generated to provide optimum compromises for any given clinical or screening application. Eight DISST-based variants were postulated and assessed via their ability to replicate the fully sampled DISST results. The variants that utilised insulin assays correlated well to the fully sampled DISST insulin sensitivity values R~0.90 and the variants that assayed C-peptide produced endogenous insulin secretion metrics that correlated well to the fully-sampled DISST values (R~0.90 to 1). By taking advantage of the common clinical protocol, tests in the spectrum could be used in a hierarchical system. For example, if a DISTq result is close to a diagnostic threshold, stored samples could be re-assayed for insulin, and the insulin sensitivity value could be ‘upgraded’ without an additional protocol. Equally, adding C-peptide assays would provide additional insulin secretion information. Importantly, one clinical procedure thus yields potentially several test results. In-silico investigations were undertaken to evaluate the efficacy of two additional, specific DISTq protocol variations and to observe the pharmacokinetics of anti-diabetic drugs. The first variation combined the boluses used in the DISTq and reduced the overall test time to 20 minutes with only two glucose assays. The results of this investigation implied no significant degradation of insulin sensitivity values is caused by the change in protocol and suggested that clinical trials of this protocol are warranted. The second protocol variant added glucose content to the insulin bolus to enable observation of first phase insulin secretion concurrently with insulin sensitivity from glucose data alone. Although concurrent observation was possible without simulated assay noise, when clinically realistic noise was added, model identifiability was lost. Hence, this protocol is not recommended for clinical investigation. Similar analyses are used to apply the overall dynamic, model-based clinical test approach to other therapeutics. In-silico analysis showed that although the pharmacokinetics of insulin sensitizers drugs were described well by the dynamic protocol. However, the pharmacokinetics of insulin secretion enhancement drugs were less observable. The overall thesis is supported by a common model parameter identification method. The iterative integral parameter identification method is a development of a single, simple integral method. The iterative method was compared to the established non-linear Levenberg-Marquardt parameter identification method. Although the iterative integral method is limited in the type of models it can be used with, it is more robust, accurate and less computationally intense than the Levenberg-Marquardt method. Finally, a novel, integral-based method for the evaluation of a-priori structural model identifiability is also presented. This method differs significantly from established, derivative based approaches as it accounts for sample placement, measurement error, and probable system responses. Hence, it is capable of defining the true nature of identifiability, which is analogous, not binary as assumed by the established methods. The investigations described in this thesis were centred on model-based insulin sensitivity and secretion identification from dynamic insulin sensitivity tests with a strong focus on maximising clinical efficacy. The low intensity and informative DISST was successfully validated against the euglycaemic clamp. DISTq further reduces the clinical cost and burden, and was also validated against the euglycaemic clamp. DISTq represents a new paradigm in the field of low-cost insulin sensitivity testing as it does not require insulin assays. A number of in-silico investigations were undertaken and provided insight regarding the suitability of the methods for clinical trials. Finally, two novel mathematical methods were developed to identify model parameters and asses their identifiability, respectively.

Type 2 diabetes has reached epidemic proportions worldwide. The resulting increase in chronic and costly diabetes related complications has potentially catastrophic implications for healthcare systems, and economics and societies as a whole. One of the key pathological factors leading to type 2 diabetes is insulin resistance (IR), which is the reduced or impaired ability of the body to make use of available insulin to maintain safe glucose concentrations in the bloodstream. It is essential to understand the physiology of glucose and insulin when investigating the underlying factors contributing to chronic diseases such as diabetes and cardiovascular disease. For many years, clinicians and researchers have been working to develop and use model-based methods to increase understanding and aid therapeutic decision support. However, the majority of practicable tests cannot yield more than basic metrics that allow only a threshold-based assessment of the underlying disorder. This thesis gives an overview on several dynamic model-based methodologies with different clinical applications in assessing glycaemia via measuring effects of treatment or medication on insulin sensitivity. Other tests are clinically focused, designed to screen populations and diagnose or detect the risk of developing diabetes. Thus, it is very important to observe sensitivity metrics in various clinical and research settings. Interstitial insulin kinetics and their influence on model-based insulin sensitivity observation was analysed using data from the clinical pilot study of the dynamic insulin sensitivity and secretion (DISST) test and the glucose-insulin PK-PD models. From these inputs, a model of interstitial insulin dose-response that best links insulin action in plasma to response in blood glucose levels was developed. The critical parameters influencing interstitial insulin pharmacokinetics (PKs) are saturation in insulin receptor binding (αG) and the plasma-interstitium diffusion rate (nI). Population values for these parameters are found to be [αG, nI]=[0.05,0.055]. Critically ill patients are regularly fed via constant enteral (EN) nutrition infusions. The impact of incretin effects on endogenous insulin secretion in this cohort remains unclear. It is hypothesised that the identified SI would decrease during interruptions of EN and would increase when EN is resumed, where, for short periods around transition, the true patient SI would be assumed constant. The model-based analysis was able to elucidate incretin effects by tracking the identified model-based insulin sensitivity (SI) in a cohort of critically ill patients. Thus, changes in model-based SI given the fixed assumed endogenous secretion by the model would support the presence of an EN-related incretin effect in the population of non-diabetic, critically ill patients studied. The PD feedback-control model of Uen was designed to investigate endogenous insulin secretion amongst subjects with different metabolic states and levels of insulin resistance. The underlying effects that influence insulin secretion i.e. incretin effects were also defined by tracking the control model gain/response and the identified insulin sensitivity (SI) using intravenous (IV) bolus and oral glucose responses of insulin sensitivity tests. This new PD control model allowed the characterisation of both static (basal) and dynamic insulin responses, which defined the pancreatic β-cell glucose sensitivity parameters. However, incretin effects were unobserved during oral glucose responses as the PD control gains failed to simulate the true endogenous insulin secretion due to potentially inaccurate glucose appearance rates and low data resolution of glucose concentrations. The net effect of haemodialysis (HD) treatment on glycaemic regulation and insulin sensitivity in a critically ill cohort was investigated. It was hypothesized that the observed SI would decrease during HD due to enhanced insulin clearance compared to the model, and would be recaptured again when HD is stopped. The changes in model-based SI metric at HD transitions in a cohort of critically ill patients were evaluated. Significant changes of -29% in model-based SI was observed during HD therapy. However, there were insignificant changes when HD treatment was ended. Thus, the changes in model-based SI would thus offer a unique observation on insulin kinetics and action in this population of critically ill patients with ARF that would better inform metabolic care.

The term sedentary refers to a distinct class of activities which involve sitting or reclining and which do not cause an increase in energy expenditure above resting levels. Observational studies have reported positive associations between both sedentary time and the number of hours spent sitting per day, with risk for a number of health outcomes that are independent of moderate to vigorous physical activity (MVPA). The total time spent sitting can be amassed in different patterns (long and short bouts) and different types (watching TV, driving, working at a computer) that may have differential associations with health outcomes as well as different confounders that have yet to be properly explored. Further, limitations in current measures used to quantify sedentary behaviour and the possibility of residual confounding, mean that it is unclear whether the posture of sitting itself represents a risk to health or whether sitting is actually a proxy for low energy expenditure. This thesis aimed to examine; the associations between five separate sitting types with health risk, the prevalence of sitting behaviour in England, and the biological mechanisms which might underpin the observed negative health consequences of sitting. Using data from the Whitehall II cohort study the first four studies of this thesis examined prospective associations between sitting at work, TV viewing, non-TV leisure time sitting, total leisure time sitting (TV and non-TV leisure sitting combined) and total sitting from work and leisure, with four health outcomes; mortality, cardiovascular disease, type II diabetes and obesity. No association between any of the sitting indicators with risk for mortality or incident cardiovascular disease was found. TV viewing and total sitting were associated with an increase in risk for type II diabetes following adjustment for sociodemographic covariates and MVPA, but were attenuated following further adjustment for body mass index. None of the five sitting indicators were associated with incident obesity but being obese prior to the measurement of sitting was associated with the number of reported hours of daily TV viewing. The final study of this thesis examined the acute effect of sustained versus interrupted sitting on glucose and insulin metabolism. Interrupting sitting with repeated short bouts of light intensity walking significantly improved insulin sensitivity while repeated short bouts of standing did not. Sitting is a prevalent behaviour in English adults and varies by socio-demographic characteristics. Previously reported associations between sitting time and health risk may be confounded by light intensity physical activity and obesity. The absence of an effect of repeated standing bouts (a change in posture without a change in energy expenditure) suggests that promoting reductions in sitting without also promoting increases in movement are not likely to lead to improvements in metabolic health. New measures of sedentary behaviour are required that can be used in population studies, and can discriminate between the posture of sitting, standing and very low levels of physical activity of a light intensity. This would permit further studies that are needed to clarify the precise nature of the association between sitting and health.

Résumé : Une dysrégulation de la lipolyse des tissus adipeux peut conduire à une surexposition des tissus non-adipeux aux acides gras non-estérifiés (AGNE), qui peut mener à un certain degré de lipotoxicité dans ces tissus. La lipotoxicité constitue, par ailleurs, l’une des causes majeures du développement de la résistance à l’insuline et du diabète de type 2. En plus de ses fonctions glucorégulatrices, l’insuline a pour fonction d’inhiber la lipolyse et donc de diminuer les niveaux d’AGNE en circulation, prévenant ainsi la lipotoxicité. Il n’y a pas d’étalon d’or pour mesurer la sensibilité de la lipolyse à l’insuline. Le clamp euglycémique hyperinsulinémique constitue la méthode étalon d’or pour évaluer la sensibilité du glucose à l’insuline mais il est aussi utilisé pour mesurer la suppression de la lipolyse par l’insuline. Par contre, cette méthode est couteuse et laborieuse, et ne peut pas s’appliquer à de grandes populations. Il existe aussi des indices pour estimer la fonction antilipolytique de l’insuline dérivés de l’hyperglycémie provoquée par voie orale (HGPO), un test moins dispendieux et plus simple à effectuer à grande échelle. Cette étude vise donc à : 1) Étudier la relation entre les indices de suppressibilité des AGNE par l’insuline dérivés du clamp et ceux dérivés de l’HGPO; et 2) Déterminer laquelle de ces mesures corrèle le mieux avec les facteurs connus comme étant reliés à la dysfonction adipeuse : paramètres anthropométriques et indices de dysfonction métabolique. Les résultats montrent que dans le groupe de sujets étudiés (n=29 femmes, 15 témoins saines et 14 femmes avec résistance à l’insuline car atteintes du syndrome des ovaires polykystiques), certains indices de sensibilité à l’insuline pour la lipolyse dérivés de l’HGPO corrèlent bien avec ceux dérivés du clamp euglycémique hyperinsulinémique. Parmi ces indices, celui qui corrèle le mieux avec les indices du clamp et les paramètres anthropométriques et de dysfonction adipeuse est le T50[indice inférieur AGNE] (temps nécessaire pour diminuer de 50% le taux de base – à jeun – des AGNE). Nos résultats suggèrent donc que l’HGPO, facile à réaliser, peut être utilisée pour évaluer la sensibilité de la lipolyse à l’insuline. Nous pensons que la lipo-résistance à l’insuline peut être facilement quantifiée en clinique humaine. / Abstract : It has been shown that a dysfunctional regulation of adipose-tissue lipolysis could conduct to non-adipose tissues overexpos ure to non exterified fatty acids (NEFA), leading to lipotoxicity. Lipotoxicity is considered as a key factor in the development of insulin resistance and type 2 diabetes. Insulin regulates glucose metabolism but also NEFA storage and release. To our knowledge, there is no gold standard for evaluating insulin sensitivity for lipolysis. The gold standard to measure insulin sensitivity for glucose is the euglycemic-hyperinsulinemic clamp. This method is simple to interpret because it achieves static levels of metabolic parameters at the end of each step of the clamp. The major limit of the clamp is that it is time-consuming, expensive and cannot be used on large population. On the other hand, the oral glucose tolerance test (OGTT) consists in a dynamic test also used to estimate insulin mediated glucose disappearance after ingestion of 75 g of glucose. Since the OGTT is easier to use, less expensive and can be suggested in large cohort studies, its potential use has been suggested to estimate insulin sensitivity for lipolysis, as well. T his work is the first to validate the use of simple indices derived from OGTT to estimate insulin sensitivity for lipolysis against the euglycemic clamp and adipose-tissue dysfunction in women. The results of this study clearly show in a group of 29 women (15 normal and 14 with polycystic ovary syndrome, who are used to increase the range of insulin resistance) that T50[subscript NEFA] (time to suppress 50% of NEFA baseline levels) during OGTT is the best index associated with glucose insulin clamp indices and clinical markers related to adipose tissue dysfunction and metabolic parameters. T50[subscript NEFA] (OGTT) was also better associated with central adiposity and metabolic parameters than clamp-derived indices. Since the OGTT is much easier to perform and is less expensive than the clamp technique, the use of OGTT to calculate T50[subscript NEFA] seems to be a valid method to assess antilipolytic action of insulin in large cohorts.

Obesity is widely considered a primary risk factor for type 2 diabetes (T2D). However, less is known about the early adaptive responses to short-term periods of high-fat energy excess (HFEE). Previous reports detailing whole-body adaptation to fat and energy oversupply are equivocal, perhaps, in part, owing to use of different experimental protocols, varying durations of dietary manipulation and participant cohorts with individuals of varying characteristics. In addition to use of different dietary protocols between studies, alterations in functional end-point measures due to the type of dietary fat consumed warrants consideration. Daily n-3 PUFA intake, commonly obtained from pelagic fish oil (FO) consumption, has been shown to positively associate with insulin sensitivity in epidemiological studies and thus may be a useful dietary strategy for slowing insulin resistance development. Chapter 2 of this thesis extends previous literature by demonstrating that 6 d HFEE (150 % habitual energy intake; 60 % of energy from fat) does not clearly alter whole- body insulin sensitivity, irrespective of FO consumption. However, investigation of metabolism at the tissue level, as presented in Chapter 3 of this thesis, offers insight into a potential tissue-specific level of regulation that precedes whole-body regulation. Skeletal muscle insulin signalling protein (e.g. protein kinase B (PKB)) activity, levels of certain ceramide species, and AMPK α2 activity were altered following HFEE and may explain the early maladaptive responses to short-term HFEE. Moreover, FO intake as 10 % of total fats mediated some of these molecular responses, including PKB and AMPK α2 activity, reflecting possible functional effects of FO at the subcellular level. Regulation of these metabolic / molecular responses at both the tissue and whole- body level can be explained, in part, by genetic predisposition, environmental influence and more recently epigenetics, including microRNAs (miRNAs). In Chapter 4, we characterised the plasma and skeletal muscle miRNA responses to HFEE and oral glucose ingestion. We demonstrate transient changes in levels of certain miRNAs following oral glucose ingestion in both tissue types and in response to HFEE in skeletal muscle. However, no significant correlations between basal plasma and skeletal muscle miRNA levels were observed, suggesting that our candidate plasma miRNAs may be co-ordinating functional changes in other tissue types. Plasma miR- 145-5p and skeletal muscle miR-204-5p predicted a significant proportion of the variance in mean whole-body insulin sensitivity change in response to HFEE. These data indicate that these miRNAs may be useful biomarkers of insulin resistance development following HFEE. A constraint of this thesis is that all conclusions are made within the context of statistically unaltered insulin sensitivity. Therefore, future investigations of diet-induced maladaptation should consider establishing a time course of insulin resistance development in response to HFEE, or use different study populations. Populations that are more susceptible to T2D development, e.g., overweight, sedentary individuals would be of particular interest. These data would aid development of a working model of diet-induced insulin resistance that has more direct application to T2D progression and extends the data presented herein.

Doctor of Philosophy / Department of Human Nutrition / Mark D. Haub / Objective: The objective was to compare the postprandial glycemic and insulinemic responses to nutrition bars containing either cross-linked RS type 4 (RS4[subscript]XL) or standard wheat starch in normoglycemic adults (n=13; age= 27±5 yr; BMI=25±3 kg/m²). Methods: Volunteers completed three trials during which they consumed a glucose beverage (GLU), a puffed wheat control bar (PWB), and a bar containing RS4[subscript]XL matched for available carbohydrate content. Serial blood samples were collected over two hours and glucose and insulin concentrations were determined and the incremental area under the curve (iAUC) was calculated. Results: The RS4[subscript]XL peak glucose and insulin concentrations were lower than the GLU and PWB (p<0.05). The iAUC for glucose and insulin were lower following ingestion of RS4[subscript]XL compared with the GLU and PWB trials. Conclusions: These data illustrate, for the first time, that directly substituting standard starch with RS4[subscript]XL, while matched for available carbohydrates, attenuated postprandial glucose and insulin levels in humans. It remains to be determined whether this response was due to the dietary fiber and/or resistant starch aspects of the RS4[subscript]XL bar. Keywords: insulin sensitivity, diabetes, dietary fiber, prebiotic, glycemic index