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胰岛素敏感蛋白激酶(非典型蛋白激酶C和蛋白激酶B/Akt):肥胖症和II型糖尿病中的作用及缺陷

Insulin-sensitive protein kinases (atypical protein kinase C and protein kinase B/Akt): actions and defects in obesity and type II diabetes.

作者信息

Farese Robert V, Sajan Mini P, Standaert Mary L

机构信息

James A. Haley Veterans Administration Hospital Research Service and Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA.

出版信息

Exp Biol Med (Maywood). 2005 Oct;230(9):593-605. doi: 10.1177/153537020523000901.

Abstract

Glucose transport into muscle is the initial process in glucose clearance and is uniformly defective in insulin-resistant conditions of obesity, metabolic syndrome, and Type II diabetes mellitus. Insulin regulates glucose transport by activating insulin receptor substrate-1 (IRS-1)-dependent phosphatidylinositol 3-kinase (PI3K) which, via increases in PI-3,4,5-triphosphate (PIP(3)), activates atypical protein kinase C (aPKC) and protein kinase B (PKB/Akt). Here, we review (i) the evidence that both aPKC and PKB are required for insulin-stimulated glucose transport, (ii) abnormalities in muscle aPKC/PKB activation seen in obesity and diabetes, and (iii) mechanisms for impaired aPKC activation in insulin-resistant conditions. In most cases, defective muscle aPKC/PKB activation reflects both impaired activation of IRS-1/PI3K, the upstream activator of aPKC and PKB in muscle and, in the case of aPKC, poor responsiveness to PIP(3), the lipid product of PI3K. Interestingly, insulin-sensitizing agents (e.g., thiazolidinediones, metformin) improve aPKC activation by insulin in vivo and PIP3 in vitro, most likely by activating 5'-adenosine monophosphate-activated protein kinase, which favorably alters intracellular lipid metabolism. Differently from muscle, aPKC activation in the liver is dependent on IRS-2/PI3K rather than IRS-1/PI3K and, surprisingly, the activation of IRS-2/PI3K and aPKC is conserved in high-fat feeding, obesity, and diabetes. This conservation has important implications, as continued activation of hepatic aPKC in hyperinsulinemic states may increase the expression of sterol regulatory element binding protein-1c, which controls genes that increase hepatic lipid synthesis. On the other hand, the defective activation of IRS-1/PI3K and PKB, as seen in diabetic liver, undoubtedly and importantly contributes to increases in hepatic glucose output. Thus, the divergent activation of aPKC and PKB in the liver may explain why some hepatic actions of insulin (e.g., aPKC-dependent lipid synthesis) are increased while other actions (e.g., PKB-dependent glucose metabolism) are diminished. This may explain the paradox that the liver secretes excessive amounts of both very low density lipoprotein triglycerides and glucose in Type II diabetes. Previous reviews from our laboratory that have appeared in the Proceedings have provided essentials on phospholipid-signaling mechanisms used by insulin to activate several protein kinases that seem to be important in mediating the metabolic effects of insulin. During recent years, there have been many new advances in our understanding of how these lipid-dependent protein kinases function during insulin action and why they fail to function in states of insulin resistance. The present review will attempt to summarize what we believe are some of the more important advances.

摘要

葡萄糖转运进入肌肉是葡萄糖清除的初始过程,在肥胖、代谢综合征和2型糖尿病等胰岛素抵抗状态下,该过程普遍存在缺陷。胰岛素通过激活胰岛素受体底物-1(IRS-1)依赖性磷脂酰肌醇3-激酶(PI3K)来调节葡萄糖转运,PI3K通过增加磷脂酰肌醇-3,4,5-三磷酸(PIP(3)),激活非典型蛋白激酶C(aPKC)和蛋白激酶B(PKB/Akt)。在此,我们综述:(i)胰岛素刺激的葡萄糖转运需要aPKC和PKB的证据;(ii)肥胖和糖尿病中肌肉aPKC/PKB激活的异常情况;(iii)胰岛素抵抗状态下aPKC激活受损的机制。在大多数情况下,肌肉aPKC/PKB激活缺陷既反映了IRS-1/PI3K(肌肉中aPKC和PKB的上游激活剂)激活受损,就aPKC而言,也反映了对PI3K的脂质产物PIP(3)反应性较差。有趣的是,胰岛素增敏剂(如噻唑烷二酮类、二甲双胍)在体内可改善胰岛素对aPKC的激活,在体外可改善对PIP3的激活,最可能是通过激活5'-腺苷单磷酸激活的蛋白激酶,从而有利地改变细胞内脂质代谢。与肌肉不同,肝脏中aPKC的激活依赖于IRS-2/PI3K而非IRS-1/PI3K,令人惊讶的是,在高脂喂养、肥胖和糖尿病状态下,IRS-2/PI3K和aPKC的激活是保守的。这种保守性具有重要意义,因为在高胰岛素血症状态下肝脏aPKC的持续激活可能会增加固醇调节元件结合蛋白-1c的表达,该蛋白控制增加肝脏脂质合成的基因。另一方面,糖尿病肝脏中IRS-1/PI3K和PKB的激活缺陷无疑且重要地导致了肝脏葡萄糖输出增加。因此,肝脏中aPKC和PKB的不同激活可能解释了为什么胰岛素的某些肝脏作用(如aPKC依赖性脂质合成)增强,而其他作用(如PKB依赖性葡萄糖代谢)减弱。这可能解释了2型糖尿病中肝脏分泌过量极低密度脂蛋白甘油三酯和葡萄糖这一矛盾现象。我们实验室之前发表在《论文集》上的综述提供了胰岛素用于激活几种蛋白激酶的磷脂信号传导机制的要点,这些蛋白激酶似乎在介导胰岛素的代谢作用中很重要。近年来,我们对这些脂质依赖性蛋白激酶在胰岛素作用过程中如何发挥作用以及它们在胰岛素抵抗状态下为何无法发挥作用的理解有了许多新进展。本综述将试图总结我们认为的一些更重要的进展。

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