Division of Family Medicine (Y.Y.W.), Division of Endocrinology and Metabolism (S.Y. L., Y.H.C., W.H.H.S.), Department of Medical Research (C.J.C.), Taichung Veterans General Hospital, Taichung, Taiwan; and Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan (Y.Y.W., K.C.T.); and School of Medicine, National Yang Ming University, Taipei, Taiwan (Y.Y.W, S.Y.L., W.H.H.S.).
Endocrinology. 2014 Apr;155(4):1235-46. doi: 10.1210/en.2013-1593. Epub 2014 Jan 17.
Patients who experience acute ischemic stroke may develop hyperglycemia, even in the absence of diabetes. In the current study we determined the effects of acute stroke on hepatic insulin signaling, TNF-α expression, endoplasmic reticulum (ER) stress, the activities of c-Jun N-terminal kinase (JNK), inhibitor κB kinase β (IKK-β), and nuclear factor-κB (NF-κB) pathways. Rats with cerebral ischemia developed higher blood glucose, and insulin levels, and insulin resistance index, as well as hepatic gluconeogenic enzyme expression compared with the sham-treated group. The hepatic TNF-α mRNA and protein levels were elevated in stroke rats in association with increased ER stress, phosphorylation of JNK1/2 and IKK-β proteins, IκB/NF-κB signaling, and phosphorylation of insulin receptor-1 (IRS-1) at serine residue. The basal and insulin-stimulated tyrosine phosphorylation of IRS-1 and AKT proteins was reduced. In addition, acute stroke increased circulating catecholamines in association with hepatic adrenergic signaling activation. After administration of a nonselective β-adrenergic receptor blocker (propranolol) before induction of cerebral ischemic injury, hepatic adrenergic transduction, TNF-α expression, ER stress, and the activation of the JNK1/2, IKK-β, and NF-κB pathways, and serine phosphorylation of IRS-1 were all attenuated. In contrast, the phosphorylated IRS-1 at tyrosine site and AKT levels were partially restored with improved poststroke hyperglycemia and insulin resistance index. These results suggest that acute ischemic stroke can activate proinflammatory pathways in the liver by the catecholamines and is associated with the development of hepatic insulin resistance.
患有急性缺血性中风的患者可能会出现高血糖,即使没有糖尿病。在本研究中,我们确定了急性中风对肝胰岛素信号、TNF-α表达、内质网(ER)应激、c-Jun N 末端激酶(JNK)、抑制剂κB 激酶β(IKK-β)和核因子-κB(NF-κB)途径的影响。与假手术组相比,脑缺血大鼠的血糖和胰岛素水平以及胰岛素抵抗指数升高,肝糖异生酶表达升高。与 ER 应激、JNK1/2 和 IKK-β 蛋白磷酸化、IκB/NF-κB 信号转导和胰岛素受体-1(IRS-1)丝氨酸残基磷酸化增加相关,中风大鼠肝 TNF-αmRNA 和蛋白水平升高。IRS-1 和 AKT 蛋白的基础和胰岛素刺激酪氨酸磷酸化减少。此外,急性中风增加循环儿茶酚胺与肝肾上腺素能信号激活有关。在诱导脑缺血损伤前给予非选择性β-肾上腺素能受体阻滞剂(普萘洛尔)后,肝肾上腺素能转导、TNF-α表达、ER 应激以及 JNK1/2、IKK-β 和 NF-κB 途径的激活和 IRS-1 的丝氨酸磷酸化均减弱。相反,磷酸化 IRS-1 酪氨酸位点和 AKT 水平部分恢复,改善了中风后高血糖和胰岛素抵抗指数。这些结果表明,儿茶酚胺可激活急性缺血性中风肝脏中的促炎途径,并与肝胰岛素抵抗的发展有关。