Mitochondrial dysfunction and lipotoxicity

Mitochondrial dysfunction in skeletal muscle has been suggested to underlie the development of insulin resistance and type 2 diabetes mellitus. Reduced mitochondrial capacity will contribute to the accumulation of lipid intermediates, desensitizing insulin signaling and leading to insulin resistance. Why mitochondrial function is reduced in the (pre-)diabetic state is, however, so far unknown. Although it is tempting to suggest that skeletal muscle insulin resistance may result from an inherited or acquired reduction in mitochondrial function in the pre-diabetic state, it cannot be excluded that mitochondrial dysfunction may in fact be the consequence of the insulin-resistant/diabetic state. Lipotoxicity, the deleterious effects of accumulating fatty acids in skeletal muscle cells, may lie at the basis of mitochondrial dysfunction: next to producing energy, mitochondria are also the major source of reactive oxygen species (ROS). Fatty acids accumulating in the vicinity of mitochondria are vulnerable to ROS-induced lipid peroxidation. Subsequently, these lipid peroxides could have lipotoxic effects on mtDNA, RNA and proteins of the mitochondrial machinery, leading to mitochondrial dysfunction. Indeed, increased lipid peroxidation has been reported in insulin resistant skeletal muscle and the mitochondrial uncoupling protein-3, which has been suggested to prevent lipid-induced mitochondrial damage, is reduced in subjects with an impaired glucose tolerance and in type 2 diabetic patients. These findings support the hypothesis that fat accumulation in skeletal muscle may precede the reduction in mitochondrial function that is observed in type 2 diabetes mellitus.     

Obesity as a clinical and public health problem: Is there a need for a new definition based on lipotoxicity effects?

The risk functions for obesity (defined as the quantitative relation between degree of obesity throughout its range and the risk of health problems) have been used to define ‘obesity’ as an excess storage of fat in the body to such an extent that it causes health problems leading to increased mortality. The lipotoxicity theory implies that the fat stored in droplets of triglycerides in the cells are biologically inert and that the metabolic dysfunctions are primarily due to the increased exposure of the cells to fatty acids. If this is true, it has profound implications for the interpretations of the multiple epidemiological studies of the risk functions. It is obvious from all these studies that the sizes of the fat depots are risk indicators of health effects in various ways. Paradoxically, the sizes of the fat stores are also indicators of the preceding implementation of the ability of the body to protect itself against the toxic effects of the free fatty acids. The current risk of metabolic dysfunctions appears to be determined by the balance between the rate of loading of the body with fatty acids and the rate of eliminating the fatty acids by either triglyceride storage or oxidation. The progress in the development of the dysfunction then depends on the persistence of the imbalance leading to future cumulative exposure of the cells to the toxic effects of the fatty acids rather than on the current size of the fat depots. This may be considered as a reason for changing the definition of obesity to one based on better estimates of future risks of health problems derived from later metabolic dysfunctions rather than on the past coping with the exposure to the fatty acids by storage as triglycerides. Implementation of such definition would require a test that measures this residual capacity to avoid excess exposure of the cells to the fatty acids before the metabolic dysfunctions have emerged. In analogy with the glucose tolerance test, a fatty acid tolerance test may be needed to identify individuals who are at a level of risk for developing lipotoxicity induced metabolic dysfunctions such that they require intervention. This test would ideally be a single biomarker that would determine residual capacity for adipose expansion, fatty acid oxidation and safe ectopic lipid deposition.     

Downregulation of islet hormone-sensitive lipase during long-term high-fat feeding

Lipid accumulation in pancreatic beta-cells during high-fat (HF) feeding may be involved in inducing a defective insulin secretion due to lipotoxicity. Hormone-sensitive lipase (HSL) is expressed and active in beta-cells, but its importance for islet dysfunction during the development of type 2 diabetes is not known. In this study, prolonged HF feeding of C57BL/6J mice, resulted in decreased HSL expression in islets, representing only 25+/-4% of the levels observed in controls. This was paralleled by triglyceride accumulation and blunted insulin secretion both in vivo and in vitro. After switching the HF diet to a LF diet, HSL expression increased 10-fold compared to the HF fed mice. This was accompanied by reduced triglyceride levels and a restored insulin secretion. These results support the notion that HSL plays a critical role in the regulation of intracellular triglyceride levels in beta-cells, and that downregulation of the enzyme may serve to protect against fatty acid-induced islet dysfunction.     

吡格列酮治疗对2 型糖尿病合并代谢综合征患者血糖、胰岛素抵抗和炎症因子的影响

目的:探讨吡格列酮治疗对2型糖尿病合并代谢综合征患者血糖、胰岛素抵抗和炎症因子的影响。方法:回顾性分析我院2013年8月-2015年2月收治的96例2型糖尿病合并代谢综合征患者病例资料,根据治疗方法的不同分为观察组和对照组,每组48例,两组患者均给予糖尿病常规基础治疗,在此基础上,观察组患者给予吡格列酮治疗,治疗3个月。检测治疗前后血糖指标包括空腹血糖(FPG)、餐后2小时血糖(2h PG)以及糖化血糖蛋白(Hb A1c),胰岛素抵抗指标包括空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)和炎症因子包括超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)。结果:观察组治疗后FPG、2 h PG、Hb A1c分别为(6.19±2.24)mmol/L、(8.30±2.48)mmol/L和(6.01±1.23)%,均显著低于治疗前和对照组治疗后,差异有统计学意义(P0.05);观察组治疗后FINS和HOMA-IR分别为(6.60±1.92)m IU/L和2.08±1.00,均较治疗前和对照组治疗后显著降低,差异有统计学意义(P0.05);观察组治疗后hs-CRP、IL-6和TNF-α分别为(6.12±1.67)ng/L、(62.65±10.30)ng/L和(83.16±16.55)ng/L,均较治疗前和对照组治疗后显著降低,差异有统计学意义(P0.05)。结论:吡格列酮治疗可以显著降低2型糖尿病合并代谢综合征患者血糖水平,改善胰岛素抵抗,降低炎症反应,值得进一步研究。     

Sub-chronic administration of stable GIP analog in mice decreases serum LPL activity and body weight

GIP receptor knockout mice were shown to be protected from the development of obesity on a high fat diet, suggesting a role of GIP in the development of obesity. In our study we aimed to test the hypothesis if excess of GIP could accelerate development of obesity and to identify GIP gene targets in adipose tissue. Therefore, mice were kept on a chow or a high fat diet and during the last 2 weeks D-Ala²-GIP or PBS injections were performed. Afterwards, serum LPL activity and several biochemical parameters (TG, FFA, cholesterol, glucose, insulin, resistin, IL-6, IL-1β, TNFα, GIP) were measured. Fat tissue was isolated and QPCR was performed for a set of genes involved in energy metabolism and inflammation. A DNA-microarray was used to identify GIP gene targets in adipose tissue of the chow diet group. We found that the D-Ala²-GIP injections caused a significant decrease in both body weight and LPL activity compared to controls. Serum biochemical parameters were not affected by D-Ala²-GIP, with an exception for resistin and insulin. The set of inflammatory genes were significantly decreased in adipose tissue in the D-Ala²-GIP injected animals on a chow diet. A DNA-microarray revealed that APO-genes and CYP-genes were affected by D-Ala²-GIP treatment in adipose tissue. These results suggest that the body weight-reducing effect of D-Ala²-GIP may be explained by lower LPL activity and insulin serum level. Moreover, the identified GIP candidate gene targets in adipose tissue link GIP action to lipid metabolism exerted by APO and CYP genes.     

Lipid oversupply,selective insulin resistance,and lipotoxicity: Molecular mechanisms

The accumulation of fat in tissues not suited for lipid storage has deleterious consequences on organ function, leading to cellular damage that underlies diabetes, heart disease, and hypertension. To combat these lipotoxic events, several therapeutics improve insulin sensitivity and/or ameliorate features of metabolic disease by limiting the inappropriate deposition of fat in peripheral tissues (i.e. thiazolidinediones, metformin, and statins). Recent advances in genomics and lipidomics have accelerated progress towards understanding the pathogenic events associated with the excessive production, underutilization, or inefficient storage of fat. Herein we review studies applying pharmacological or genetic strategies to manipulate the expression or activity of enzymes controlling lipid deposition, in order to gain a clearer understanding of the molecular mechanisms by which fatty acids contribute to metabolic disease.     

Low resistin levels in adipose tissues and serum in high-fat fed mice and genetically obese mice: development of an ELISA system for quantification of resistin

Obesity is a major risk factor for insulin resistance. Resistin, an adipocyte-derived hormone-like molecule, is considered to serve as an important link between obesity and insulin resistance. However, the physiological role of resistin and the mechanism by which it neutralizes insulin action are still unclear. There are also conflicting reports that cast doubt on the cause of insulin resistance. In this study, we developed an enzyme-linked immunosorbent assay (ELISA) system for quantification of mouse resistin levels, analyzed in relation to insulin resistance. C57BL/6J mice fed high-fat diet compared with normal diet had low resistin levels (by 70%, P<0.01) in epididymal adipose tissues. Genetically obese mice, db/db and KK-A(y), had hyperinsulinemia and hyperglycemia but low resistin levels (decreases by 83 and 90%, both P<0.01) compared with C57/BL6J mice in epididymal adipose tissues. Serum resistin levels determined by Western blotting showed a similar pattern to those in adipose tissues. Resistin levels in adipose tissues correlated with serum adiponectin concentrations positively (r=0.49). Our results indicate that the novel ELISA system is suitable for measurement of resistin levels in adipose tissues. The results do not support a role for resistin in insulin resistance.     

代谢综合征患者血液流变学及多因素相关分析

目的:探讨代谢综合征(MS)患者血液流变学及多因素的相关性。方法:检测49例2型糖尿病(T2DM)和40例MS患者的肥胖指标、血脂、血黏度,并进行比较和相关性分析。结果:(1)MS组的BMI(体重指数),FAT%(体脂百分率),W(腰围),LP(脂蛋白),TG(甘油三酯),TC(总胆固醇),血浆黏度均显著高于T2DM组(p＜0．05);(2)T2DM组的血浆黏度与TC及MS组的W与BMI,FAT%正相关(p＜0．05)。结论:(1)MS较T2DM存在更高的血浆黏度,可能是多因素综合作用的结果。(2)FAT%的测定对中心性肥胖的评估具有一定意义。     

微量白蛋白尿与2型糖尿病合并代谢综合征的相关性

目的:探讨2型糖尿病(T2DM)患者微量白蛋白尿与代谢综合征(MS)的相关性。方法:282例T2DM患者根据是否合并MS分为MS组(163例)和非MS组(119例),测定24h尿白蛋白(UAlb)及相关生化指标,比较两组UAlb水平及糖尿病肾病(DN)患病率,采用多元Logistic回归方法分析T2DM患者微量白蛋白尿的危险因素。结果:MS组的UAlb及DN患病率明显高于非MS组,且随着MS组分增加,UAlb水平显著升高。多元Logistic回归分析表明甘油三酯、糖化血红蛋白、收缩压为影响UAlb的独立危险因素。结论:T2DM患者微量白蛋白尿与MS密切相关,需采取综合干预措施避免或延缓DN的发生发展。     

高糖高脂致大鼠非酒精性脂肪肝合并高血糖动物模型的研究

目的建立饮食诱导非酒精性脂肪肝病（NAFLD）合并高血糖动物模型并观察其特点。方法将64只SD大鼠随机分为2组。正常对照组（用普通饲料饲喂）32只,高糖高脂组（饲以高糖高脂饲料）32只,连续喂养12个月。于实验第3月末、第6月末、第9月末、第12月末观察动物体重、内脏脂肪重量;比较血液中有关血脂、血糖、炎症介质等方面的生化指标以及组织病理学观察。结果与正常对照组相比,各阶段高糖高脂组大鼠体重、内脏脂肪重量明显增加;血清ALT、FFA、LPS、TNFα、FPG、FINS和HOMA-IR的水平都升高,其差异有统计学意义;而HOMA-β以第六个月出现代偿性增强后进行性衰退。病理组织学显示肝脏发生严重的脂变、脂肪肝进而发生肝炎、纤维化及肝硬化;随时间进展胰岛逐渐萎缩并伴有炎性浸润;脂肪细胞逐渐增大并伴有炎性浸润。结论高糖高脂饮食可建立大鼠NAFLD合并高血糖动物模型,该模型可在NAFLD和相关的糖尿病研究中发挥作用。     

Protection of palmitic acid-mediated lipotoxicity by arachidonic acid via channeling of palmitic acid into triglycerides in C2C12

Background

Excessive saturated fatty acids have been considered to be one of major contributing factors for the dysfunction of skeletal muscle cells as well as pancreatic beta cells, leading to the pathogenesis of type 2 diabetes.

Results

PA induced cell death in a dose dependent manner up to 1.5 mM, but AA protected substantially lipotoxicity caused by PA at even low concentration of 62 μM, at which monounsaturated fatty acids including palmitoleic acid (POA) and oleic acid (OA) did not protect as much as AA did. Induction of cell death by PA was resulted from mitochondrial membrane potential loss, and AA effectively blocked the progression of apoptosis. Furthermore, AA rescued significantly PA-impaired glucose uptake and -signal transduction of Akt in response to insulin.Based on the observations that polyunsaturated AA generated competently cellular droplets at low concentration within the cytosol of myotubes compared with other monounsaturated fatty acids, and AA-driven lipid droplets were also enhanced in the presence of PA, we hypothesized that incorporation of harmful PA into inert triglyceride (TG) may be responsible for the protective effects of AA against PA-induced lipotoxicity. To address this assumption, C2C12 myotubes were incubated with fluorescent probed-PA analogue 4, 4-difluoro-5, 7-dimethyl-4-boro-3a,4a-diaza-s-indacene-3-hexadecanoic acid (BODIPY FL C16) in the presence of AA and their subsequent lipid profiles were analyzed. The analyses of lipids on thin layer chromatograpy (TLC) showed that fluorescent PA analogue was rapidly channeled into AA-driven TG droplets.

Conclusion

Taken together, it is proposed that AA diverts PA into inert TG, therefore reducing the availability of harmful PA into intracellular target molecules.     

Adipose tissue in health and disease

Adipose, or fat, tissue (AT) was once considered an inert tissue that primarily existed to store lipids, and was not historically recognized as an important organ in the regulation and maintenance of health. With the rise of obesity and more rigorous research, AT is now recognized as a highly complex metabolic organ involved in a host of important physiological functions, including glucose homeostasis and a multitude of endocrine capabilities. AT dysfunction has been implicated in several disease states, most notably obesity, metabolic syndrome and type 2 diabetes. The study of AT has provided useful insight in developing strategies to combat these highly prevalent metabolic diseases. This review highlights the major functions of adipose tissue and the consequences that can occur when disruption of these functions leads to systemic metabolic dysfunction.     

2 型糖尿病伴脂肪肝患者血浆FGF21水平与肥胖、脂代谢及胰岛素抵抗的相关性

目的:研究2型糖尿病伴脂肪肝患者血浆成纤维细胞生长因子21(FGF21)水平与肥胖、脂代谢及胰岛素抵抗的相关性,为临床诊疗提供依据。方法:选取2013年5月到2015年11月我院收治的2型糖尿病伴脂肪肝患者100例为研究组,另选取同期单纯脂肪肝患者100例为脂肪肝组,健康体检者100例为对照组,比较各组入选次日清晨FGF21、谷丙转氨酶(ALT)、谷草转氨酶(AST)、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、游离脂肪酸(FFA)、体重指数(BMI)、腰臀比(WHR)、空腹胰岛素(FINS)、空腹血糖(FBG)以及胰岛素抵抗指数(HOMA-IR)。结果:研究组TG、TC、AST、ALT、LDL-C、FFA、FBG、BMI、WHR、FINS、HOMA-IR以及FGF21均显著高于对照组,HDL-C显著低于对照组,比较差异具有统计学意义(P0.05);研究组FFA、TG、FINS、FBG、HOMA-IR以及FGF21显著高于脂肪肝组,BMI和WHR显著低于脂肪肝组,比较差异具有统计学意义(P0.05);相关性分析显示:FGF21与TG、FFA、BMI以及HOMA-IR呈正相关关系(P0.05)。结论:2型糖尿病合并脂肪肝患者FGF21水平会显著升高,且与脂肪代谢、肥胖以及胰岛素抵抗有关。     

Immunity as a link between obesity and insulin resistance

Obesity is a major public health problem in the United States and worldwide. Further, obesity is causally linked to the pathogenesis of insulin resistance, metabolic syndrome and type-2 diabetes (T2D). A chronic low-grade inflammation occurring in adipose tissue is at least in part responsible for the obesity-induced insulin resistance. This adipose tissue inflammation is characterized by changes in immune cell populations giving rise to altered adipo/cytokine profiles, which in turn induces skeletal muscle and hepatic insulin resistance. Detailed molecular mechanisms of insulin resistance, adipose tissue inflammation and the implications of these findings on therapeutic strategies are discussed in this review.     

内脂素与2型糖尿病关系的研究进展

内脂素是新近被发现的主要由内脏脂肪合成的一种脂肪细胞因子,它具有类胰岛素样作用,能降低血糖和促进脂肪组织的分化与合成。内脂素还可以调节血管平滑肌的成熟和影响胰岛细胞的胰岛素的分泌,亦具有调节炎症反应和免疫功能的作用。随着研究的发展,人们对内脂素的结构特性、分布、表达调控及其生物学功能有了更加深入的认识。2型糖尿病是以胰岛素抵抗和糖代谢紊乱为特征的代谢性疾病,研究发现内脂素与2型糖尿病密切相关,其中与肥胖、胰岛素抵抗及胰岛素分泌方面的关系尤为显著,深入研究内脂素的生理和病理生理作用将会有力地促进对2型糖尿病的进一步认识、治疗与预防。     

2型糖尿病肠道菌群研究进展

2型糖尿病是一种常见的慢性消耗性疾病,其发病机制十分复杂,流行病学研究表明,肥胖、高热量饮食、体力活动不足及年龄增大是2型糖尿病最主要的环境因素。它是一种以胰岛素抵抗和胰岛素分泌不足为特征的代谢性疾病。肠道菌群作为进入人体的一个重要环境因素,肠道微生物的菌群变化影响宿主能量物质的吸收,调节肠道的分泌功能和非特异性免疫功能,从营养、代谢、疾病等各方面与我们生命活动相关。肠道菌群已成为我们身体的一部分,影响宿主的免疫,在肥胖、糖尿病、代谢综合征等疾病中都具有非常重要的作用。     

Conditioned medium obtained from in vitro differentiated adipocytes and resistin induce insulin resistance in human hepatocytes

Adipocyte-derived factors might play a role in the development of hepatic insulin resistance. Resistin was identified as an adipokine linking obesity and insulin resistance. Resistin is secreted from adipocytes in rodents but in humans it was proposed to originate from macrophages and its impact for insulin resistance has remained elusive. To analyze the role of adipokines in general and resistin as a special adipokine, we cultured the human liver cell line HepG2 with adipocyte-conditioned medium (CM) containing various adipokines such as IL-6 and MCP-1, and resistin. CM and resistin both induce insulin resistance with a robust decrease in insulin-stimulated phosphorylation of Akt and GSK3. Insulin resistance could be prevented by co-treatment with troglitazone but not by co-stimulation with adiponectin. As human adipocytes do not secrete resistin, HepG2 cells were also treated with resistin added into CM. CM with resistin addition induced stronger insulin resistance than CM alone pointing to a specific role of resistin in the initiation of hepatic insulin resistance in humans.