1 Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
2 Department of Medical Biochemistry, Medical Genetics, Goteborg University, Goteborg, Sweden
3 Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut
4 Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut
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ABSTRACT |
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Insulin resistance is a major characteristic and early requisite event in the development of type 2 diabetes, which is reaching epidemic proportions in the world (1). Although the mechanism of insulin resistance is unknown, alteration in adipocyte metabolism may precede and cause insulin resistance in skeletal muscle and liver (27). Numerous factors implicated in this process include altered expression of adipocyte-derived factors (i.e., resistin, adiponectin, leptin, interleukin-6, tumor necrosis factor-) (813) and fatty acids (1416). Previous studies (813) have demonstrated increased adipocyte expression of resistin, interleukin-6, and tumor necrosis factor-
or reduced expression of adiponectin and leptin to promote insulin resistance. Other studies (17,1820) have shown a strong inverse relationship between intracellular fat content and insulin sensitivity in both animal models and humans. Increases in circulating fatty acid levels and increasing fatty acid delivery into skeletal muscle or liver by tissue-specific overexpression of lipoprotein lipase caused insulin resistance (18). In contrast, decreasing fatty acid uptake into skeletal muscle with deletion of fatty acid transporters (i.e., FAT/CD36 and FATP1) improved insulin sensitivity and protected mice from developing diet-induced insulin resistance (21,22). Thus, it is clear that alteration in adipocyte metabolism plays an important role in the pathogenesis of insulin resistance.
Human winged helix/forkhead transcription factor gene (FOXC2) has been shown to be expressed in adipocytes and plays a key regulatory role in adipocyte metabolism (23). To determine the metabolic role of FOXC2, we have recently generated mice with adipocyte-specific overexpression of FOXC2, and these mice were shown to be protected against diet-induced obesity and glucose intolerance (23). These effects were associated with increased expression of genes associated with adipocyte metabolism (e.g., uncoupling protein-1) and enhanced sensitivity of the ß-adrenergic/cAMP/protein kinase A pathway in the FOXC2 transgenic (FOXC2 Tg) mice (23). Increased number and size of adipocyte mitochondria were also evident in the FOXC2 Tg mice, overall indicating enhanced adipocyte metabolism in the Tg mice (23). These changes in adipocyte metabolism resulted in less adiposity and normal glucose tolerance following high-fat diet compared with the wild-type mice (23). To determine the effects of FOXC2 overexpression on tissue-specific glucose metabolism, we performed a hyperinsulinemic-euglycemic clamp experiment and assessed insulin action and insulin signaling in the FOXC2 Tg mice following 3 weeks of high-fat diet. Our results demonstrate that overexpression of FOXC2 prevented diet-induced insulin resistance in skeletal muscle and liver, and this was associated with reduced accumulation of intracellular fatty acyl CoA levels in skeletal muscle.
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RESEARCH DESIGN AND METHODS |
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At least 4 days before hyperinsulinemic-euglycemic clamp experiments, whole-body fat and lean mass were measured in awake mice using 1H magnetic resonance spectroscopy (Bruker Mini-spec Analyzer; Echo Medical Systems, Houston, TX) (24). Immediately following the measurement, mice were anesthetized with an intraperitoneal injection of ketamine (100 mg/kg body wt) and xylazine (10 mg/kg body wt), and an indwelling catheter was inserted in the right internal jugular vein as previously described (13). After an overnight fast, high-performance liquid chromatographypurified [3-3H]glucose (0.05 µCi/min; PerkinElmer Life and Analytical Sciences, Boston, MA) was infused for 2 h (basal period) to estimate the rate of basal glucose turnover. Following the basal period, a 2-h hyperinsulinemic-euglycemic clamp experiment was conducted with a primed-continuous infusion of human insulin (15 pmol · kg1 · min1, Humulin; Eli Lilly, Indianapolis, IN) to raise plasma insulin levels, while plasma glucose was maintained at basal concentrations with variable rates of 20% glucose infusion. Insulin-stimulated whole-body glucose metabolism rates were estimated with a continuous infusion of [3-3H]glucose (0.1 µCi/min) during the clamps, and 2-deoxy-D-[1-14C]glucose (2-[14C]DG; PerkinElmer Life and Analytical Sciences) was bolus injected at 75 min of clamps to estimate the rates of insulin-stimulated tissue-specific glucose uptake as previously described (13). At the end of clamps, tissues were taken for biochemical measurements.
Biochemical assays and calculation.
Plasma glucose, insulin, and fatty acid concentrations during clamps were analyzed as previously described (13). Plasma concentrations of [3-3H]glucose, 2-[14C]DG, and 3H2O were determined following deproteinization of plasma samples as previously described (13). The radioactivity of 3H in tissue glycogen was determined by digesting tissue samples in potassium hydroxide and precipitating glycogen with ethanol. For the determination of tissue 2-[14C]DG-6-phosphate (2-[14C]DG-6-P) content, tissue samples were homogenized, and the supernatants were subjected to an ion-exchange column to separate 2-[14C]DG-6-P from 2-[14C]DG.
Rates of basal and insulin-stimulated whole-body glucose turnover were determined as the ratio of the [3H]glucose infusion rate (dpm/min) to the specific activity of plasma glucose (dpm/µmol) at the end of the basal period and during the final 30 min of clamps, respectively. Hepatic glucose production during the hyperinsulinemic-euglycemic clamps was determined by subtracting the glucose infusion rate from the whole-body glucose uptake. Whole-body glycolysis was calculated from the rate of increase in plasma 3H2O concentration, determined by linear regression of the measurements at 80, 90, 100, 110, and 120 min of clamps. Whole-body glycogen plus lipid synthesis was estimated by subtracting whole-body glycolysis from whole-body glucose uptake, assuming that glycolysis and glycogen plus lipid synthesis account for the majority of insulin-stimulated glucose uptake. Glucose uptake in individual tissues was calculated from plasma 2-[14C]DG profile, which was fitted with a double exponential or linear curve using MLAB (Civilized Software, Bethesda, MD) and tissue 2-[14C]DG-6-P content. Skeletal muscle glycolysis and glycogen synthesis were calculated as previously described (13).
Insulin signaling analysis.
Skeletal muscle samples (gastrocnemius) were obtained at the end of clamps to measure in vivo activities of insulin receptor substrate (IRS)-1associated phosphatidylinositol (PI) 3-kinase. The activities were assessed by immunoprecipitating IRS-1 using antibodies to IRS-1 (Upstate Biotechnology, Lake Placid, NY) and assessing the incorporation of 32P into PI to yield PI-3-monophosphate as previously described (13).
Measurement of intracellular fatty acyl CoA levels.
To determine the intramuscular concentration of fatty acyl CoAs using liquid chromatography tandem mass spectrometry (LC/MS/MS), muscle samples (quadriceps) were homogenized and extracted as previously described (2527). Briefly, frozen tissue samples (100 mg) were grounded under liquid nitrogen and homogenized in 1 ml of 100 mmol/l KH2PO4 (pH 4.9) and 1 ml of 2-propanol. Heptadecanoyl CoA was added as internal standard. One hundred twenty-five microliters of saturated (NH4)2SO4 and 2 ml of acetonitrile were added to the suspension then vortexed for 2 min. The emulsion was centrifuged for 10 min at 4,000 rpm, and then the supernatant was diluted with 5 ml of 100 mmol/l KH2PO4 (pH 4.9) for the solid-phase extraction. Before the loading, OPC (oligonucleotide purification cartridge) columns were conditioned with 5 ml of acetonitrile and 2 ml of 25 mmol/l KH2PO4 (pH 4.9). After loading the samples, the cartridges were washed with at least 10 ml of distilled H2O, and then long-chain acyl CoAs were eluted slowly with 0.5 ml of 60% acetonitrile. The eluent was dried in Speedvac and finally reconstituted in 100 µl of methanol/H2O for ESI/MS/MS analysis.
PE sciex API 3000 tandem mass spectrometer interfaced with TurboIonSpray ionization source was used for the analysis. The intracellular concentrations of long-chain fatty acyl CoAs (C16:0, C16:1, C18:0, C18:1, C18:2, and C18:3) were detected in negative electrospray mode. The doubly charged ions of these compounds were transmitted, and singly charged product ions were quantified in multiple reaction mode. Long-chain acyl CoA standards were purchased from Sigma Chemical (St. Louis, MO). The calibration of long-chain acyl CoAs showed consistent linearity from 0.2 to 20 ng/µl, and coefficient of variance was 2.15.5% for all long-chain acyl CoA species.
Statistical analysis.
Data are expressed as means ± SE. The significance of the difference in mean values of wild-type mice fed normal chow diet (control) versus wild-type mice fed high-fat diet, FOXC2 transgenic mice fed normal chow diet, and FOXC2 transgenic mice fed high-fat diet was evaluated using the Duncan multiple range test. The statistical significance was at the P < 0.05 level.
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RESULTS |
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Insulin-stimulated whole-body glucose turnover and muscle-specific (gastrocnemius) glucose uptake were not different between wild-type mice and FOXC2 Tg mice fed regular chow diet (Figs. 2A and B). High-fat feeding decreased insulin-stimulated whole-body glucose turnover by 40% in the wild-type mice, and this decrease was mostly accounted for by a 40% decrease in insulin-stimulated skeletal muscle glucose uptake (Figs. 2A and B). In contrast, FOXC2 Tg mice were protected from diet-induced decreases in whole-body and skeletal muscle glucose uptake (Figs. 2A and B). Insulin-stimulated whole-body glucose metabolic flux (i.e., glycolysis and glycogen plus lipid synthesis) and skeletal muscle glucose metabolic flux (i.e., glycolysis and glycogen synthesis) were not different between the wild-type and FOXC2 Tg mice fed regular chow diet (Figs. 2C and D, Figs. 3A and B). High-fat feeding significantly reduced insulin-stimulated whole-body glycolysis and glycogen plus lipid synthesis as well as skeletal muscle glycolysis in the wild-type mice (Figs. 2C and D and Fig. 3A). In contrast, FOXC2 Tg mice were completely protected from diet-induced decreases in whole-body and skeletal muscle glucose metabolism (Figs. 2C and D and Fig. 3A). These findings demonstrate that FOXC2 Tg mice were protected from diet-induced whole-body insulin resistance, and this protective effect was mostly due to their effects on skeletal muscle insulin action.
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Fat-induced defects in skeletal muscle insulin action have been shown to be associated with increases in intramuscular fat and fatty acidderived metabolites. Previous studies (1720) have shown a strong inverse relationship between intramuscular fat content and insulin sensitivity in humans and animals. To examine whether the diet-induced changes in skeletal muscle insulin action were associated with changes in intramuscular fat contents, fatty acyl CoA concentrations were measured in skeletal muscle using LC/MS/MS. Intramuscular (quadriceps) levels of individual species and total fatty acyl CoAs (sum of C16:0, C16:1, C18:0, C18:1, C18:2, and C18:3) did not differ between the normal chowfed wild-type and FOXC2 Tg mice (Fig. 4A). In contrast, intramuscular levels of individual species and total fatty acyl CoAs were markedly reduced in the FOXC2 Tg mice compared with the wild-type mice following high-fat feeding (Fig. 4B).
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DISCUSSION |
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Our recent study has shown that fat-induced insulin resistance in skeletal muscle, using a 5-h lipid infusion, involved initial increases in intramuscular fatty acyl CoA levels and activation of protein kinase C (PKC)- that were subsequently followed by defects in insulin signaling and action (27). The findings of the current study support the notion that intramuscular accumulation of fatty acid metabolites (i.e., fatty acyl CoA) is the causative factor in the development of fat-induced insulin resistance. The mechanism by which increased levels of fatty acidderived metabolites cause insulin resistance involves activation of serine kinase cascade, of which PKC-
and/or inhibitor of
B kinase-ß (IKK-ß) may play a role, leading to the serine phosphorylation of IRS-1 (2933). Recent studies (34,35) have shown that serine phosphorylation of IRS-1 prevents tyrosine phosphorylation of IRS-1 and interferes with its ability to activate PI 3-kinase, leading to insulin resistance, as occurs upon treatment with tumor necrosis factor-
and okadaic acid. In this regard, fatty acyl CoA is a potent activator of PKC-
(36,37), while Itani et al. (30) have shown increased activity of PKC-
in obese insulin-resistant subjects. Additionally, Yuan et al. (31) have demonstrated that activation of IKK-ß resulted in defects in skeletal muscle insulin signaling, while our previous study (29) has shown that mice with heterozygous deletion of IKK-ß were protected from fat-induced insulin resistance in skeletal muscle. Our present results indicate that FOXC2 Tg mice were protected from diet-induced insulin resistance in skeletal muscle and that this effect was associated with normal intramuscular fatty acyl CoA levels, which further supports this hypothesis.
Decreases in intramuscular fatty acid metabolites in the high-fatfed FOXC2 Tg mice may be due to increased lipid metabolism in the adipose tissue of the Tg mice. We have previously shown that adipocytes of FOXC2 Tg mice expressed increased amount of mitochondria and rate of oxygen consumption (23). Elevated adipocyte metabolism also explains reduced whole-body fat mass in the FOXC2 Tg mice compared with the wild-type littermates fed regular chow diet or high-fat diet. These findings are similar to the mice lacking protein-tyrosine phosphatase (PTP)-1B, which have been shown to exhibit increased energy expenditure, low adiposity, and protection from diet-induced obesity (38). Additionally, these characteristics were associated with enhanced insulin sensitivity and skeletal muscle insulin action of the PTP-1Bnull mice (38). However, increased metabolic rate of PTP-1Bnull mice was mostly due to upregulation of mitochondrial biogenesis in the skeletal muscle without alteration of adipocyte metabolism or uncoupling protein expression in the PTP-1Bnull mice (38). Furthermore, increased skeletal muscle insulin action of the PTP-1Bnull mice was partly due to the negative regulatory role of PTP-1B on skeletal muscle insulin signaling (38). In this regard, PTPs have been shown to reduce insulin-mediated tyrosine phosphorylation of IRS-1 and IRS-1associated PI 3-kinase activity in skeletal muscle (3942). These effects of PTP-1B are in marked contrast to the effects of adipocyte overexpression of FOXC2 in which increased skeletal muscle insulin action was secondary to increases in adipocyte metabolism, possibly due to altered distribution of fatty acids into skeletal muscle and adipose tissue. Our findings that intramuscular fatty acyl CoA levels did not significantly increase despite high-fat feeding, contrary to the significant increase in the fat-fed wild-type mice, further implicate the scenario in which fatty acids were largely metabolized by adipose tissue, which in turn prevented their accumulation in skeletal muscle of the FOXC2 Tg mice. Interestingly, whole-body lean mass was increased in the FOXC2 Tg mice fed regular chow diet or high-fat diet at a level similar to decreases in fat mass resulting in comparable total body weight to the wild-type mice. It is unclear how alteration in adipocyte metabolism and/or whole-body insulin sensitivity caused changes in whole-body lean mass of the FOXC2 Tg mice.
The mechanism by which fatty acids were distributed to adipose tissue may involve increased adipocyte expression of perixisome proliferatoractivated receptor (PPAR)- in the FOXC2 Tg mice (23,4345). Our recent study has shown that a treatment of PPAR-
agonist, rosiglitazone, ameliorated insulin resistance in skeletal muscle of the A-ZIP/F-1 lipodystrophic mice by increasing distribution of fatty acids to liver and away from skeletal muscle (46), and this was associated with increased hepatic expression of PPAR-
in the rosiglitazone-treated lipodystrophic mice (47). Thus, this finding is consistent with our observation that adipocyte-specific overexpression of FOXC2 increased adipocyte expression of PPAR-
, caused redistribution of fatty acids, and prevented diet-induced accumulation of fatty acyl CoA and insulin resistance in the skeletal muscle (48,49). Furthermore, FOXC2 Tg mice were also protected from diet-induced insulin resistance in liver, and a similar mechanism involving altered distribution of fatty acids may also be responsible for the liver phenotype.
Alteration in adipocyte metabolism has also been shown to regulate whole-body glucose homeostasis in the mice with adipocyte-specific deletion of insulin receptor (FIRKO; 50). Bluher et al. (50) have recently demonstrated that FIRKO mice exhibited reduced whole-body fat mass and protection from diet-induced obesity as well as insulin resistance. These metabolic effects were associated with increased expression of lipid metabolism genes (e.g., fatty acid synthase) in the adipocytes of FIRKO mice (48). Interestingly, FIRKO mice also exhibited a polarization in adipocyte size in which the range of cell size shifted in favor of smaller adipocyte size than large adipocyte size compared with the wild-type mice (50). Whether such polarization in adipocyte size also occurs in FOXC2 Tg mice and is associated with altered adipocyte metabolism is unknown. Thus, our results indicate indirect effects of adipocyte-specific overexpression of FOXC2 on skeletal muscle and liver glucose metabolism and that such effects most likely stem from enhanced lipid oxidation in white and/or brown adipose tissues (23). Alternatively, altered expression of adipocyte-derived circulating factors (e.g., leptin, adiponectin, resistin), which have recently been shown to play a role in skeletal muscle insulin resistance (5154), may explain some of our findings in the FOXC2 Tg mice.
Overall, our findings demonstrated that FOXC2 Tg mice were protected from diet-induced insulin resistance in skeletal muscle and liver, which was partly due to altered distribution of fatty acids. Altered partitioning of fatty acids was most likely due to increased adipocyte expression of genes associated with metabolism in the FOXC2 Tg mice. Thus, altering the white adipocyte phenotype and gene expression pattern toward those of brown adipocytes (23) may induce favorable metabolic adaptations as reported here. Taken together, our results identify FOXC2 as a novel therapeutic target for the treatment of obesity and obesity-associated type 2 diabetes.
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ACKNOWLEDGMENTS |
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G.I.S. is an investigator of the Howard Hughes Medical Institute. We are grateful to Aida Groszmann for technical assistance.
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FOOTNOTES |
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Address correspondencereprint requests to Prof. Jason K. Kim, Yale University School of Medicine, Department of Internal Medicine, Section of EndocrinologyMetabolism, The Anlyan Center, S269C, 300 Cedar St., P.O. Box 208020, New Haven, CT 06520-8020. E-mail: jason.k.kim{at}yale.edu
Received for publication May 20, 2004 and accepted in revised form March 16, 2005
IKK-ß, inhibitor of B kinase-ß; IRS, insulin receptor substrate; PI, phosphatidylinositol; PKC, protein kinase C; PPAR, perixisome proliferatoractivated receptor; PTP, protein-tyrosine phosphatase
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REFERENCES |
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