Mechanisms of Insulin Action and Insulin Resistance.

By Max C. Petersen, Gerald I. Shulman. Physiological Reviews, 2018

2,417 citations recorded by the source corpus.

The 1921 discovery of insulin was a Big Bang from which a vast and expanding universe of research into insulin action and resistance has issued. In the intervening century, some discoveries have matured, coalescing into solid and fertile ground for clinical application; others remain incompletely investigated and scientifically controversial. Here, we attempt to synthesize this work to guide further mechanistic investigation and to inform the development of novel therapies for type 2 diabetes (T2D). The rational development of such therapies necessitates detailed knowledge of one of the key pathophysiological processes involved in T2D: insulin resistance. Understanding insulin resistance, in turn, requires knowledge of normal insulin action. In this review, both the physiology of insulin action and the pathophysiology of insulin resistance are described, focusing on three key insulin target tissues: skeletal muscle, liver, and white adipose tissue. We aim to develop an integrated physiological perspective, placing the intricate signaling effectors that carry out the cell-autonomous response to insulin in the context of the tissue-specific functions that generate the coordinated organismal response. First, in section II, the effectors and effects of direct, cell-autonomous insulin action in muscle, liver, and white adipose tissue are reviewed, beginning at the insulin receptor and working downstream. Section III considers the critical and underappreciated role of tissue crosstalk in whole body insulin action, especially the essential interaction between adipose lipolysis and hepatic gluconeogenesis. The pathophysiology of insulin resistance is then described in section IV. Special attention is given to which signaling pathways and functions become insulin resistant in the setting of chronic overnutrition, and an alternative explanation for the phenomenon of ‟selective hepatic insulin resistanceˮ is presented. Sections V, VI, and VII critically examine the evidence for and against several putative mediators of insulin resistance. Section V reviews work linking the bioactive lipids diacylglycerol, ceramide, and acylcarnitine to insulin resistance; section VI considers the impact of nutrient stresses in the endoplasmic reticulum and mitochondria on insulin resistance; and section VII discusses non-cell autonomous factors proposed to induce insulin resistance, including inflammatory mediators, branched-chain amino acids, adipokines, and hepatokines. Finally, in section VIII, we propose an integrated model of insulin resistance that links these mediators to final common pathways of metabolite-driven gluconeogenesis and ectopic lipid accumulation.

Subfields: Biochemistry, Molecular Biology, Physiology

View Paper: https://www.semanticscholar.org/paper/e32eae6b0d73deb59dc1ea8cc0b5912af1175057

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Citations in the corpus

Trends in insulin resistance: insights into mechanisms and therapeutic strategy (2022, background): “Insulin stimulated protein synthesis is mediated by activation of the protein kinases Akt and mTOR (specifically mTORC1 and mTORC2) in numerous insulin-responsive cell types, such as hepatocytes, adipocytes, and myocytes.(130) AKT also phosphorylates the TSC1-TSC2 complex to relieve its inhibition o”
Mechanisms of Oxidative Stress in Metabolic Syndrome (2023, background): “Studies have shown that oxidative stress impairs insulin signaling and leads to insulin resistance [20,128].”
Adipose tissue plasticity in health and disease (2022, background): “Indeed, adipose-tissue insufficiency (as in lipodystrophy) or dysfunction (as in obesity) leads to the excessive deposition of lipids in other organs like liver and muscle, which is a hallmark of and major contributor to insulin resistance (Petersen and Shulman, 2018).”
Why Does Obesity Cause Diabetes? (2022, background): “People with obesity and people with type 2 diabetes typically have an impairment in both insulin-stimulated muscle glucose oxidation and glycogen synthesis caused by a downregulation in the number and function of insulin receptors and multiple defects in post-receptor insulin signaling (Mitrakou et ”
Mechanisms and disease consequences of nonalcoholic fatty liver disease (2021, background): “Development of hepatic insulin resistance, where insulin activation of glycogen synthase is impaired (Petersen and Shulman, 2018), would also be expected to redirect glucose into lipogenic pathways and further promote NAFLD.”
Insulin Resistance: From Mechanisms to Therapeutic Strategies (2021, background): “In addition, insulin suppresses HGP by inhibiting the expressions of gluconeogenic genes and lipolysis in adipose tissue [5].”
Mitochondrial dysfunction: mechanisms and advances in therapy (2024, background): “300,301 As NAFLD progresses to nonalcoholic steatohepatitis (NASH), mitochondria evidence a distinct shift to metabolic maladaptation, indicated by ultrastructural damage, compromised ETC activity, upregulated uncoupling protein content, and increased ROS production.”