Farese Robert V, Lee Mackenzie C, Sajan Mini P
Research Service-108, James. A. Haley Veterans Medical Center, 13000 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
Medical and Research Services, James A. Haley Veterans Medical Center, Tampa, FL 33612, USA.
J Clin Med. 2014 Jul 7;3(3):724-40. doi: 10.3390/jcm3030724.
This review focuses on how insulin signals to metabolic processes in health, why this signaling is frequently deranged in Western/Westernized societies, how these derangements lead to, or abet development of, insulin-resistant states of obesity, the metabolic syndrome and type 2 diabetes mellitus, and what our options are for restoring insulin signaling, and glucose/lipid homeostasis. A central theme in this review is that excessive hepatic activity of an archetypal protein kinase enzyme, "atypical" protein kinase C (aPKC), plays a critically important role in the development of impaired glucose metabolism, systemic insulin resistance, and excessive hepatic production of glucose, lipids and proinflammatory factors that underlie clinical problems of glucose intolerance, obesity, hepatosteatosis, hyperlipidemia, and, ultimately, type 2 diabetes. The review suggests that normally inherited genes, in particular, the aPKC isoforms, that were important for survival and longevity in times of food scarcity are now liabilities in times of over-nutrition. Fortunately, new knowledge of insulin signaling mechanisms and how an aberration of excessive hepatic aPKC activation is induced by over-nutrition puts us in a position to target this aberration by diet and/or by specific inhibitors of hepatic aPKC.
本综述聚焦于胰岛素在健康状态下如何向代谢过程发出信号,为何在西方/西方化社会中这种信号传导常常紊乱,这些紊乱如何导致或助长肥胖、代谢综合征和2型糖尿病等胰岛素抵抗状态的发展,以及我们恢复胰岛素信号传导和葡萄糖/脂质稳态有哪些选择。本综述的一个核心主题是,一种原型蛋白激酶酶,即“非典型”蛋白激酶C(aPKC)的肝脏活性过高,在葡萄糖代谢受损、全身胰岛素抵抗以及肝脏过度产生葡萄糖、脂质和促炎因子的发展过程中起着至关重要的作用,而这些正是葡萄糖不耐受、肥胖、肝脂肪变性、高脂血症以及最终2型糖尿病临床问题的基础。该综述表明,正常遗传的基因,特别是aPKC亚型,在食物匮乏时期对生存和长寿很重要,但在营养过剩时期却成为负担。幸运的是,关于胰岛素信号传导机制以及营养过剩如何导致肝脏aPKC过度激活异常的新知识,使我们能够通过饮食和/或肝脏aPKC的特异性抑制剂来针对这种异常。