Oakes N D, Cooney G J, Camilleri S, Chisholm D J, Kraegen E W
Garvan Institute of Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia.
Diabetes. 1997 Nov;46(11):1768-74. doi: 10.2337/diab.46.11.1768.
To elucidate cellular mechanisms of insulin resistance induced by excess dietary fat, we studied conscious chronically high-fat-fed (HFF) and control chow diet-fed rats during euglycemic-hyperinsulinemic (560 pmol/l plasma insulin) clamps. Compared with chow diet feeding, fat feeding significantly impaired insulin action (reduced whole body glucose disposal rate, reduced skeletal muscle glucose metabolism, and decreased insulin suppressibility of hepatic glucose production [HGP]). In HFF rats, hyperinsulinemia significantly suppressed circulating free fatty acids but not the intracellular availability of fatty acid in skeletal muscle (long chain fatty acyl-CoA esters remained at 230% above control levels). In HFF animals, acute blockade of beta-oxidation using etomoxir increased insulin-stimulated muscle glucose uptake, via a selective increase in the component directed to glycolysis, but did not reverse the defect in net glycogen synthesis or glycogen synthase. In clamp HFF animals, etomoxir did not significantly alter the reduced ability of insulin to suppress HGP, but induced substantial depletion of hepatic glycogen content. This implied that gluconeogenesis was reduced by inhibition of hepatic fatty acid oxidation and that an alternative mechanism was involved in the elevated HGP in HFF rats. Evidence was then obtained suggesting that this involves a reduction in hepatic glucokinase (GK) activity and an inability of insulin to acutely lower glucose-6-phosphatase (G-6-Pase) activity. Overall, a 76% increase in the activity ratio G-6-Pase/GK was observed, which would favor net hepatic glucose release and elevated HGP in HFF rats. Thus in the insulin-resistant HFF rat 1) acute hyperinsulinemia fails to quench elevated muscle and liver lipid availability, 2) elevated lipid oxidation opposes insulin stimulation of muscle glucose oxidation (perhaps via the glucose-fatty acid cycle) and suppression of hepatic gluconeogenesis, and 3) mechanisms of impaired insulin-stimulated glucose storage and HGP suppressibility are not dependent on concomitant lipid oxidation; in the case of HGP we provide evidence for pivotal involvement of G-6-Pase and GK in the regulation of HGP by insulin, independent of the glucose source.
为阐明过量膳食脂肪诱导胰岛素抵抗的细胞机制,我们在正常血糖-高胰岛素血症(血浆胰岛素浓度为560 pmol/l)钳夹期间,对清醒状态下长期高脂喂养(HFF)的大鼠和对照普通饮食喂养的大鼠进行了研究。与普通饮食喂养相比,高脂喂养显著损害胰岛素作用(降低全身葡萄糖处置率、降低骨骼肌葡萄糖代谢以及降低胰岛素对肝糖生成[HGP]的抑制能力)。在HFF大鼠中,高胰岛素血症显著抑制循环游离脂肪酸,但不影响骨骼肌中脂肪酸的细胞内可用性(长链脂肪酰辅酶A酯仍比对照水平高230%)。在HFF动物中,使用依托莫昔抑制β-氧化可通过选择性增加糖酵解成分来增加胰岛素刺激的肌肉葡萄糖摄取,但不能逆转净糖原合成或糖原合酶的缺陷。在钳夹HFF动物中,依托莫昔并未显著改变胰岛素抑制HGP的降低能力,但导致肝糖原含量大幅减少。这意味着通过抑制肝脂肪酸氧化减少了糖异生,并且HFF大鼠中HGP升高涉及另一种机制。随后获得的证据表明,这涉及肝葡萄糖激酶(GK)活性降低以及胰岛素无法急性降低葡萄糖-6-磷酸酶(G-6-Pase)活性。总体而言,观察到G-6-Pase/GK活性比值增加了76%,这有利于HFF大鼠肝葡萄糖的净释放和HGP升高。因此,在胰岛素抵抗的HFF大鼠中,1)急性高胰岛素血症未能消除肌肉和肝脏中升高的脂质可用性,2)升高的脂质氧化对抗胰岛素对肌肉葡萄糖氧化的刺激(可能通过葡萄糖-脂肪酸循环)以及对肝糖异生的抑制,3)胰岛素刺激的葡萄糖储存受损和HGP抑制能力受损的机制不依赖于伴随的脂质氧化;就HGP而言,我们提供证据表明G-6-Pase和GK在胰岛素对HGP的调节中起关键作用,与葡萄糖来源无关。