Pathogenesis of insulin resistance: modulation of the insulin signal at receptor level.

The insulin resistance of skeletal muscle plays an important role in the pathogenesis of the metabolic endocrine syndrome and diabetes mellitus Type II. Impairment of the signal transmission from the insulin receptor to glycogen synthase and the glucose transport system was shown in insulin resistant subjects. A reduced receptor activation contributes also to insulin resistance. We investigated the mechanisms of modulation of receptor function in isolated cell systems which are transfected with human insulin receptor. Action of TNF alpha and acute hyperglycaemic effects were studied in particular. Acute hyperglycaemia gives rise, in the isolated cell system, to inhibition of the tyrosine kinase activity of the insulin receptor within a few minutes. This inhibitory effect seems to be mediated by translocation and activation of various isoforms of protein kinase C. Activation of protein kinase C probably leads to phosphorylation of the beta-subunit of the insulin receptor at serine residues. The domains of the insulin receptor, which are responsible for the inhibitory effect of hyperglycaemia do not seem to be localized either in the C terminus or in the juxtamembranary region of the insulin receptor. The hyperglycaemic effect can be antagonized in the isolated cell system both by protein kinase C inhibitors and so-called insulin sensitizers such as thiazolidindiones. Similar inhibitory effects, as induced by hyperglycaemia, can also be mediated by administration of the cytokine TNF alpha. As TNF alpha is probably increasingly expressed in obesity, the modulation of receptor kinase activity by TNF alpha could be an important factor for insulin resistance in obesity.