Beeson Mary, Sajan Mini P, Dizon Michelle, Grebenev Dmitry, Gomez-Daspet Joaquin, Miura Atsushi, Kanoh Yoshinori, Powe Jennifer, Bandyopadhyay Gautam, Standaert Mary L, Farese Robert V
Department of Internal Medicine, Division of Endocrinology and Metabolism, University of South Florida College of Medicine, Tampa, Florida, USA.
Diabetes. 2003 Aug;52(8):1926-34. doi: 10.2337/diabetes.52.8.1926.
Insulin resistance in type 2 diabetes is partly due to impaired glucose transport in skeletal muscle. Atypical protein kinase C (aPKC) and protein kinase B (PKB), operating downstream of phosphatidylinositol (PI) 3-kinase and its lipid product, PI-3,4,5-(PO(4))(3) (PIP(3)), apparently mediate insulin effects on glucose transport. We examined these signaling factors during hyperinsulinemic-euglycemic clamp studies in nondiabetic subjects, subjects with impaired glucose tolerance (IGT), and type 2 diabetic subjects. In nondiabetic control subjects, insulin provoked twofold increases in muscle aPKC activity. In both IGT and diabetes, aPKC activation was markedly (70-80%) diminished, most likely reflecting impaired activation of insulin receptor substrate (IRS)-1-dependent PI 3-kinase and decreased ability of PIP(3) to directly activate aPKCs; additionally, muscle PKC-zeta levels were diminished by 40%. PKB activation was diminished in patients with IGT but not significantly in diabetic patients. The insulin sensitizer rosiglitazone improved insulin-stimulated IRS-1-dependent PI 3-kinase and aPKC activation, as well as glucose disposal rates. Bicycle exercise, which activates aPKCs and stimulates glucose transport independently of PI 3-kinase, activated aPKCs comparably to insulin in nondiabetic subjects and better than insulin in diabetic patients. Defective aPKC activation contributes to skeletal muscle insulin resistance in IGT and type 2 diabetes, rosiglitazone improves insulin-stimulated aPKC activation, and exercise directly activates aPKCs in diabetic muscle.
2型糖尿病中的胰岛素抵抗部分归因于骨骼肌中葡萄糖转运受损。非典型蛋白激酶C(aPKC)和蛋白激酶B(PKB)在磷脂酰肌醇(PI)3激酶及其脂质产物PI-3,4,5-(PO(4))(3)(PIP(3))的下游发挥作用,显然介导了胰岛素对葡萄糖转运的作用。我们在非糖尿病受试者、糖耐量受损(IGT)受试者和2型糖尿病受试者的高胰岛素-正常血糖钳夹研究中检测了这些信号因子。在非糖尿病对照受试者中,胰岛素使肌肉aPKC活性增加两倍。在IGT和糖尿病患者中,aPKC的激活均显著降低(70-80%),这很可能反映了胰岛素受体底物(IRS)-1依赖性PI 3激酶的激活受损以及PIP(3)直接激活aPKC的能力下降;此外,肌肉PKC-zeta水平降低了40%。IGT患者的PKB激活减少,但糖尿病患者中无显著减少。胰岛素增敏剂罗格列酮改善了胰岛素刺激的IRS-1依赖性PI 3激酶和aPKC激活以及葡萄糖处置率。骑自行车运动可激活aPKC并独立于PI 3激酶刺激葡萄糖转运,在非糖尿病受试者中,其激活aPKC的程度与胰岛素相当,而在糖尿病患者中比胰岛素更好。aPKC激活缺陷导致IGT和2型糖尿病患者骨骼肌胰岛素抵抗,罗格列酮改善胰岛素刺激的aPKC激活,运动可直接激活糖尿病肌肉中的aPKC。