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Chen Y, Huang L, Qi X, Chen C. Insulin Receptor Trafficking: Consequences for Insulin Sensitivity and Diabetes. Int J Mol Sci 2019; 20:ijms20205007. [PMID: 31658625 PMCID: PMC6834171 DOI: 10.3390/ijms20205007] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
Insulin receptor (INSR) has been extensively studied in the area of cell proliferation and energy metabolism. Impaired INSR activities lead to insulin resistance, the key factor in the pathology of metabolic disorders including type 2 diabetes mellitus (T2DM). The mainstream opinion is that insulin resistance begins at a post-receptor level. The role of INSR activities and trafficking in insulin resistance pathogenesis has been largely ignored. Ligand-activated INSR is internalized and trafficked to early endosome (EE), where INSR is dephosphorylated and sorted. INSR can be subsequently conducted to lysosome for degradation or recycled back to the plasma membrane. The metabolic fate of INSR in cellular events implies the profound influence of INSR on insulin signaling pathways. Disruption of INSR-coupled activities has been identified in a wide range of insulin resistance-related diseases such as T2DM. Accumulating evidence suggests that alterations in INSR trafficking may lead to severe insulin resistance. However, there is very little understanding of how altered INSR activities undermine complex signaling pathways to the development of insulin resistance and T2DM. Here, we focus this review on summarizing previous findings on the molecular pathways of INSR trafficking in normal and diseased states. Through this review, we provide insights into the mechanistic role of INSR intracellular processes and activities in the development of insulin resistance and diabetes.
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Affiliation(s)
- Yang Chen
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Lili Huang
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Xinzhou Qi
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
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Khan T, Hamilton MP, Mundy DI, Chua SC, Scherer PE. Impact of simvastatin on adipose tissue: pleiotropic effects in vivo. Endocrinology 2009; 150:5262-72. [PMID: 19819942 PMCID: PMC2795715 DOI: 10.1210/en.2009-0603] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Statins belong to a class of drugs well known for their ability to reduce circulating low-density lipoprotein cholesterol. In addition to cholesterol lowering, they also exhibit potential antiinflammatory and antioxidant properties, suggesting that tissues other than liver may be targeted by statins to exert their beneficial metabolic effects. Adipocytes have received very little attention as a potential target of these drugs, possibly because adipocytes are not a major source of biosynthetic cholesterol. Here, we examine the effects of simvastatin on the secretory pathway, inflammation, and cellular metabolism of adipocytes as well as on whole-body insulin sensitivity. We find that statins have a selective effect on the secretion of the insulin-sensitizing adipokine adiponectin by reducing circulating levels of the high-molecular-weight form of adiponectin specifically with a concomitant increase in intracellular adiponectin levels. However, these effects on adiponectin do not translate into changes in metabolism or whole-body insulin sensitivity, potentially due to additional antiinflammatory properties of statins. In addition, ob/ob mice treated with statins have reduced adiposity and an altered ultrastructure of the plasma membrane with respect to caveolar histology. Our data demonstrate that statins have major effects on the cellular physiology of the adipocyte on multiple levels.
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Affiliation(s)
- Tayeba Khan
- Departments of Cell Biology, Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Schiess R, Mueller LN, Schmidt A, Mueller M, Wollscheid B, Aebersold R. Analysis of cell surface proteome changes via label-free, quantitative mass spectrometry. Mol Cell Proteomics 2009; 8:624-38. [PMID: 19036722 PMCID: PMC2667347 DOI: 10.1074/mcp.m800172-mcp200] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 11/21/2008] [Indexed: 11/06/2022] Open
Abstract
We present a mass spectrometry-based strategy for the specific detection and quantification of cell surface proteome changes. The method is based on the label-free quantification of peptide patterns acquired by high mass accuracy mass spectrometry using new software tools and the cell surface capturing technology that selectively enriches glycopeptides exposed to the cell exterior. The method was applied to monitor dynamic protein changes in the cell surface glycoproteome of Drosophila melanogaster cells. The results led to the construction of a cell surface glycoprotein atlas consisting of 202 cell surface glycoproteins of D. melanogaster Kc167 cells and indicated relative quantitative changes of cell surface glycoproteins in four different cellular states. Furthermore we specifically investigated cell surface proteome changes upon prolonged insulin stimulation. The data revealed insulin-dependent cell surface glycoprotein dynamics, including insulin receptor internalization, and linked these changes to intracellular signaling networks.
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Affiliation(s)
- Ralph Schiess
- Institute of Molecular Systems Biology, Eidgenössische Technische Hochschule (ETH) Zurich, 8093 Zurich, Switzerland
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Cromlish WA, Tang M, Kyskan R, Tran L, Kennedy BP. PTP1B-dependent insulin receptor phosphorylation/residency in the endocytic recycling compartment of CHO-IR cells. Biochem Pharmacol 2006; 72:1279-92. [PMID: 16956584 DOI: 10.1016/j.bcp.2006.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 07/31/2006] [Accepted: 07/31/2006] [Indexed: 12/22/2022]
Abstract
Insulin binds to the alpha subunit of the insulin receptor (IR) on the cell surface. The insulin-IR complex is subsequently internalized and trafficked within the cell. Endocytosed receptors, devoid of insulin, recycle back to the plasma membrane through the endocytic recycling compartment (ERC). Using a high content screening system, we investigate the intracellular trafficking of the IR and its phosphorylation state, within the ERC, in response to protein tyrosine phosphatase-1B (PTP1B) inhibition. Insulin stimulates, in a time- and dose-dependent manner, the accumulation of phosphorylated IR (pY(1158,1162,1163 IR) in the ERC of CHO-IR cells. Treatment of CHO-IR cells with PTP1B-specific inhibitors or siRNA leads to dose-dependent increases in IR residency and phosphorylation within the ERC. The results also demonstrate that PTP1B redistributes within CHO-IR cells upon insulin challenge. The established system will allow for efficient screening of candidate inhibitors for the modulation of PTP1B activity.
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Affiliation(s)
- Wanda A Cromlish
- Department of Biochemistry & Molecular Biology, Merck Frosst Centre for Therapeutic Research, Pointe-Claire-Dorval, Pointe-Claire-Dorval, Quebec, Canada.
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Klarlund JK, Cherniack AD, Czech MP. Divergent mechanisms for homologous desensitization of p21ras by insulin and growth factors. J Biol Chem 1995; 270:23421-8. [PMID: 7559502 DOI: 10.1074/jbc.270.40.23421] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Previous work suggested that desensitization of p21ras in response to growth factors such as epidermal growth factor (EGF) results from receptor down-regulation. Here we show that p21ras is desensitized by insulin in 3T3-L1 adipocytes in the continued presence of activated insulin receptors, while loss of epidermal growth factor and platelet-derived growth factor (PDGF) receptors in response to their ligands correlates with p21ras desensitization. Furthermore, elevated amounts of Grb2/Shc complexes persisted throughout p21ras desensitization by insulin. However, immunoblotting of anti-Son-of-sevenless (Sos) 1 and 2 immunoprecipitates with anti-Grb2 antisera revealed that p21ras desensitization in response to insulin and PDGF, but not EGF, is associated with a marked decrease in cellular complexes containing Sos and Grb2 proteins. Nonetheless, the desensitization of p21ras in response to these stimuli was homologous, in that each peptide could reactivate [32P]GTP loading of p21ras after desensitization by any of the others. Taken together, these data indicate that insulin, EGF, and PDGF all cause disassembly of Sos proteins from signaling complexes during p21ras desensitization, but at least two mechanisms are involved. Insulin elicits dissociation of Sos from Grb2 SH3 domains, whereas EGF signaling is reversed by receptor down-regulation and Shc dephosphorylation, releasing Grb2 SH2 domains. PDGF action triggers both mechanisms of Grb2 disassembly, which probably operate in concert with GAP to attenuate p21ras signaling.
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Affiliation(s)
- J K Klarlund
- Program in Molecular Medicine, University of Massachusetts Medical Center, Worcester 01605, USA
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Lohse MJ. Molecular mechanisms of membrane receptor desensitization. BIOCHIMICA ET BIOPHYSICA ACTA 1993; 1179:171-88. [PMID: 7692969 DOI: 10.1016/0167-4889(93)90139-g] [Citation(s) in RCA: 311] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M J Lohse
- Laboratorium für Molekulare Biologie, Universität München, Max-Planck-Institut für Biochemie, Martinsried, Germany
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Trischitta V, Giorgino F, Frittitta L, Scalisi R, Vigneri R. Relationship between insulin receptor tyrosine kinase activity and internalization in monocytes of non-insulin-dependent diabetes mellitus patients. Metabolism 1993; 42:882-7. [PMID: 8393956 DOI: 10.1016/0026-0495(93)90064-u] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Reduced insulin receptor tyrosine kinase activity and internalization have been reported in non-insulin-dependent diabetes mellitus (NIDDM) patients. To clarify whether in NIDDM the defective internalization is caused by the defective kinase activity, we studied receptor tyrosine kinase activity and internalization in monocytes from eight lean control and six obese subjects and 10 obese NIDDM patients. Receptor internalization was also stimulated by an anti-insulin receptor antibody (MA-10) that is unable to stimulate receptor kinase activity. Basal exogenous tyrosine kinase activity was not different in monocytes from the three groups of subjects. As compared with control subjects (2,690 +/- 637 fmol 32P incorporated), insulin (100 nmol/L)-stimulated tyrosine kinase activity was lower in NIDDM patients (1,262 +/- 318, P < .05), but not in obese subjects (2,640 +/- 731). Basal receptor autophosphorylation did not differ between the three groups, whereas insulin-stimulated autophosphorylation in comparison to that in control subjects was reduced in NIDDM patients (P < .05), but not in obese subjects. In NIDDM patients, receptor internalization induced by both insulin and MA-10, was lower (P < .05) than that in control and obese subjects. No correlation was found between receptor internalization and exogenous tyrosine kinase activity (r = .30, NS) or autophosphorylation (r = .08, NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V Trischitta
- Cattedra di Endocrinologia, Università di Catania, Ospedale Garibaldi, Italy
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Douen AG, Jones MN. Insulin processing and signal transduction in rat adipocytes. BIOCHIMICA ET BIOPHYSICA ACTA 1989; 1010:363-8. [PMID: 2645939 DOI: 10.1016/0167-4889(89)90063-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A glycine-HCl buffer (glycine, 50 mM/NaCl, 0.15 M/HCl, pH 3.5) was used to strip insulin bound to adipocyte cell surfaces. Adipocytes retained their integrity in the glycine buffer and their binding capacity for [125I]iodoinsulin could be completely recovered on transfer of the cells to physiological media. At 37 degrees C, [125I]iodoinsulin binds rapidly to plasma membrane receptors; maximal binding occurs within 10 min. At this temperature, the initial binding is followed by rapid internalization, degradation of the hormone and subsequent loss of label. Insulin treatment, at 37 degrees C, induced internalization of 37% of the plasma membrane insulin receptors. Phenylarsine oxide (PAO), a confirmed inhibitor of protein internalization, allowed insulin binding but completely inhibited degradation of the hormone. Monensin, a carboxylic ionophore which impairs uncoupling hormone-receptor complexes, effectively restricted insulin degradation over short time periods (less than 30 min). Addition of monensin to insulin-stimulated cells did not impair D-glucose uptake. It has previously been reported that PAO inhibits hexose transport through the direct interaction with the glucose transporters and low concentrations of PAO (1 microM) transiently inhibit insulin-stimulated glucose uptake. This recovery phenomenon was again observed when PAO was added to insulin-stimulated, monensin-treated adipocytes. The data suggests that lysosomal degradation of insulin is not requisite for signal transduction.
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Affiliation(s)
- A G Douen
- Department of Biochemistry and Molecular Biology, School of Biological Sciences, University of Manchester, U.K
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Trischitta V, Wong KY, Brunetti A, Scalisi R, Vigneri R, Goldfine ID. Endocytosis, Recycling, and Degradation of the Insulin Receptor. J Biol Chem 1989. [DOI: 10.1016/s0021-9258(18)83696-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fernig DG, Mayer RJ. Insulin processing in primary endosomes is not responsible for insulin resistance observed in parametrial adipocytes from lactating rats. BIOCHIMICA ET BIOPHYSICA ACTA 1989; 1010:237-45. [PMID: 2643441 DOI: 10.1016/0167-4889(89)90167-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The fate of [125I insulin and the insulin receptor after internalization was characterized in parametrial adipocytes from virgin rats. Parallel experiments were carried out on parametrial adipocytes from 2-4-day lactating rats, which are insulin resistant. Similar results were obtained in adipocytes from either group of animals. Insulin caused 10% of the plasma membrane insulin receptor to be translocated to a compartment resistant to extracellular trypsin. The intracellularly located insulin receptor rapidly recycled to the plasma membrane at 37 degrees C. An endosomal compartment involved in both the endocytosis and subsequent recycling of [125I]insulin and the insulin receptor to the plasma membrane was identified on sucrose density floatation gradients. [125I]Insulin internalized at 37 degrees C accumulated in a fraction of modal density 1.12 g/ml. Crosslinking experiments revealed the presence of intact [125I]insulin-insulin receptor complexes in endosomes. After a pulse with [125I]insulin, 55-60% of the 125I radioactivity recovered in the endosome compartment was intact [125I]insulin. The remainder was composed of low molecular weight degradation products. Endosomal 125I radioactivity was rapidly retroendocytosed to the medium with a mean half-life of 6 min. These results suggest: (1) [125I]insulin and the insulin receptor are internalized by parametrial adipocytes into an early endosomal compartment (primary endosomes), from which the receptor, intact [125I]insulin, and [125I]tyrosine are returned to the cell surface; and (2) the damping of the insulin signal observed in parametrial adipocytes from lactating rats is not expressed at the level of altered endocytotic processing of [125I]insulin and the insulin receptor.
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Affiliation(s)
- D G Fernig
- Department of Biochemistry, Queens Medical Centre, University Hospital, Nottingham, U.K
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Trischitta V, Reaven GM. Evidence of a defect in insulin-receptor recycling in adipocytes from older rats. THE AMERICAN JOURNAL OF PHYSIOLOGY 1988; 254:E39-44. [PMID: 3276215 DOI: 10.1152/ajpendo.1988.254.1.e39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although insulin-stimulated glucose uptake is known to be decreased in adipocytes isolated from old obese rats, the cause of this defect is not totally understood. In the present study, we examined the possibility that insulin resistance is associated with defects in the intracellular processing of the insulin-receptor complex. Adipocytes were isolated from control (2-mo-old rats) and obese, insulin-resistant rats (12-mo-old rats), and the following measurements were made: 1) insulin-stimulated glucose uptake; 2) insulin binding; 3) insulin-receptor internalization and recycling; 4) accumulation of insulin within the cell; and 5) rate of loss of insulin from the cell. The results indicated that maximal insulin-stimulated glucose uptake was significantly reduced in adipocytes from obese, insulin-resistant rats (increase over basal value was 500 +/- 53% in obese rats and 1,200 +/- 96 in control rats, P less than 0.01). 125I-insulin (A14) binding (cell-associated radioactivity) and the internalization of the hormone-receptor complex were not different in the two groups of animals studied. In contrast, insulin-receptor recycling was significantly decreased in adipocytes from obese rats (72.0 +/- 6.1 vs. 93.6 +/- 2.6%, P less than 0.01). In addition, loss of intracellular radioactivity was significantly prolonged in insulin-resistant rats (t1/2 = 12.05 +/- 0.9 vs. 9.4 +/- 0.3 min, P less than 0.05). Thus adipocytes isolated from the older rats were resistant to the insulin effect on glucose uptake, and this defect was not associated with a reduction in insulin binding. However, there was a decrease in insulin receptor recycling, and this phenomenon may be related to the insulin resistance present in these cells.
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Affiliation(s)
- V Trischitta
- Department of Medicine, Stanford University School of Medicine, California
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Klein HH, Freidenberg GR, Matthaei S, Olefsky JM. Insulin receptor kinase following internalization in isolated rat adipocytes. J Biol Chem 1987. [DOI: 10.1016/s0021-9258(18)60998-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effect of monoclonal antibodies on human insulin receptor autophosphorylation, negative cooperativity, and down-regulation. J Biol Chem 1987. [DOI: 10.1016/s0021-9258(18)61322-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Effect of depletion of bicarbonate or phosphate ions on insulin action in rat adipocytes. Further characterization of the receptor-effector system. J Biol Chem 1986. [DOI: 10.1016/s0021-9258(18)66810-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Oefelein MG, Arsenis G, Livingston JN. Insulin-stimulated fluid-phase pinocytosis and internalization of the insulin receptor: differences between the U-937 monocyte and rat adipocyte. Metabolism 1986; 35:818-23. [PMID: 3528744 DOI: 10.1016/0026-0495(86)90222-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
U-937 monocytes, a human cell line, respond acutely to insulin by internalization of the insulin receptor and acceleration of fluid-phase pinocytosis. In the present studies, both processes were shown to require energy and both were dependent on the number of insulin receptors. Monocytes with a reduced number of insulin receptors, ie, down-regulated by a 16-hour insulin treatment, had a markedly reduced response to insulin-stimulation of pinocytosis and a decrease in the amount of insulin receptors internalized. This latter feature resulted, however, from the reduction in the cellular content of insulin receptors. The proportion of receptor internalized during a 30-minute acute treatment with insulin (eg, 59% of the cell surface receptors) was slightly greater than the proportion internalized in control cells. Therefore, down-regulation does not selectively destroy receptors that cycle, leaving only a subpopulation of receptors anchored in the membrane. Apparently, there is only one population of insulin receptors, all of which are equally competent with respect to internalization. Although these results suggest a close relationship between pinocytosis and receptor internalization, it was possible to separate the two systems. The addition of poly-L-lysine produced a marked stimulation of fluid-phase pinocytosis in the absence of any increase in insulin receptor internalization. Thus, movement of the receptor into the internal pool requires more than an increase in the rate of pinocytosis. Rat adipocytes were also studied, and the results differed in several aspects from those of U-937 monocytes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Huecksteadt T, Olefsky JM, Brandenberg D, Heidenreich KA. Recycling of photoaffinity-labeled insulin receptors in rat adipocytes. Dissociation of insulin-receptor complexes is not required for receptor recycling. J Biol Chem 1986. [DOI: 10.1016/s0021-9258(19)84430-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hayes GR, Lockwood DH. The role of cell surface sialic acid in insulin receptor function and insulin action. J Biol Chem 1986. [DOI: 10.1016/s0021-9258(17)35856-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Alterations in the tyrosine kinase activity of the insulin receptor produced by in vitro hyperinsulinemia. J Biol Chem 1986. [DOI: 10.1016/s0021-9258(17)42444-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Truglia JA, Livingston JN, Lockwood DH. Insulin resistance: receptor and post-binding defects in human obesity and non-insulin-dependent diabetes mellitus. Am J Med 1985; 79:13-22. [PMID: 3898828 DOI: 10.1016/0002-9343(85)90580-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Insulin resistance is a prominent feature of three clinical conditions: obesity, impaired glucose tolerance, and non-insulin-dependent (type II) diabetes mellitus. Numerous studies over the past 15 years have provided a better understanding, from both a clinical and cellular standpoint, of the pathophysiology of these insulin-resistant states as well as of insulin action. In addition, it has recently been recognized that correction of glucose intolerance leads to an improvement in insulin secretion and a reduction in insulin resistance. Examination of the most recent data suggests that the basis for insulin resistance in these common clinical disorders is often multifactorial. In uncomplicated obesity, the cellular alterations responsible for insulin resistance appear to be at the level of the hepatic insulin receptor and in post-binding processes in peripheral target tissues. In type II diabetes, a post-binding defect(s) in peripheral tissues appears to be the primary lesion. In humans, many of the factors that mediate the changes leading to insulin resistance are still unknown and are the object of current investigations.
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