Diabetes 51:1884-1888, 2002 © 2002 by the American Diabetes Association, Inc. Plasma Adiponectin Concentration Is Associated With Skeletal Muscle Insulin Receptor Tyrosine Phosphorylation, and Low Plasma Concentration Precedes a Decrease in Whole-Body Insulin Sensitivity in Humans
1 Clinical Diabetes and Nutrition Section, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
Adiponectin, the most abundant adipose-specific protein, has been found to be negatively associated with degree of adiposity and positively associated with insulin sensitivity in Pima Indians and other populations. Moreover, adiponectin administration to rodents has been shown to increase insulin-induced tyrosine phosphorylation of the insulin receptor (IR) and also increase whole-body insulin sensitivity. To further characterize the relationship between plasma adiponectin concentration and insulin sensitivity in humans, we examined 1) the cross-sectional association between plasma adiponectin concentration and skeletal muscle IR tyrosine phosphorylation and 2) the prospective effect of plasma adiponectin concentration at baseline on change in insulin sensitivity. Fasting plasma adiponectin concentration, body composition (hydrodensitometry or dual energy X-ray absorptiometry), insulin sensitivity (insulin-stimulated glucose disposal, hyperinsulinemic clamp), and glucose tolerance (75-g oral glucose tolerance test) were measured in 55 Pima Indians (47 men and 8 women, aged 31 ± 8 years, body fat 29 ± 8% [mean ± SD]; 50 with normal glucose tolerance, 3 with impaired glucose tolerance, and 2 with diabetes). Group 1 (19 subjects) underwent skeletal muscle biopsies for the measurement of basal and insulin-stimulated tyrosine phosphorylation of the IR (stimulated by 100 nmol/l insulin). The fold increase after insulin stimulation was calculated as the ratio between maximal and basal phosphorylation. Group 2 (38 subjects) had follow-up measurements of insulin-stimulated glucose disposal. Cross-sectionally, plasma adiponectin concentration was positively associated with insulin-stimulated glucose disposal (r = 0.58, P < 0.0001) and negatively associated with percent body fat (r = -0.62, P < 0.0001) in the whole group. In group 1 plasma adiponectin was negatively associated with the basal (r = -0.65, P = 0.003) and positively associated with the fold increase in IR tyrosine phosphorylation (r = 0.69, P = 0.001) before and after the adjustment for percent body fat (r = -0.58, P = 0.01 and r = 0.54, P = 0.02, respectively). Longitudinally, after adjustment for age, sex, and percent body fat, low plasma adiponectin concentration at baseline was associated with a decrease in insulin sensitivity (P = 0.04). In conclusion, our cross-sectional data suggest a role of physiological concentration of fasting plasma adiponectin in the regulation of skeletal muscle IR tyrosine phosphorylation. Prospectively, low plasma adiponectin concentration at baseline precedes a decrease in insulin sensitivity. Our data indicate that adiponectin plays an important role in regulation of insulin sensitivity in humans.
Adipose tissue serves not only as an energy storage organ, but also secretes hormones and metabolites that are thought to regulate insulin sensitivity and energy metabolism (1,2). Adiponectin, the most abundant adipose-specific protein, is exclusively expressed in and secreted from adipose tissue (35). Plasma adiponectin concentration is decreased in individuals with obesity (46) and type 2 diabetes (7) and is more closely related to whole-body insulin sensitivity than to adiposity (8). In rhesus monkeys, plasma adiponectin concentration has been shown to decrease in parallel with increases in insulin sensitivity during the progression to type 2 diabetes (9). Whereas these findings provide circumstantial evidence that adiponectin may modulate insulin sensitivity, more recent studies demonstrate that administration of adiponectin to rodents increases insulin-induced tyrosine phosphorylation of the insulin receptor (IR) in skeletal muscle, resulting in improved glucose tolerance in these animals (10). The role of adiponectin in modulating insulin signaling in humans remains unknown. In vivo insulin-mediated glucose disposal occurs primarily in skeletal muscle (11). In Pima Indians, obesity and insulin resistance are associated with impairments of skeletal muscle IR tyrosine phosphorylation in response to insulin (12). To further characterize the relationship between adiponectin and glucose/insulin metabolism in humans, we examined 1) the cross-sectional association between plasma adiponectin concentration and skeletal muscle IR tyrosine phosphorylation and 2) the prospective association between plasma adiponectin concentration at baseline and change in whole-body insulin sensitivity.
Subjects. A total of 55 Pima Indians (Table 1) who were participants in ongoing studies of the pathogenesis of obesity and type 2 diabetes were included in this analysis. Subjects for the present analysis were selected from participants of a longitudinal study of the risk factors of obesity and type 2 diabetes and had been admitted to the metabolic ward for measurements including muscle insulin-stimulated IR phosphorylation (12) and plasma adiponectin (8). All subjects were between 18 and 50 years of age and were nonsmokers at the time of the study. Except for two subjects with type 2 diabetes, all subjects were healthy according to a physical examination and routine laboratory tests. Subjects were then invited back at approximately annual intervals for repeated oral glucose tolerance tests (OGTTs) and, in a subgroup of subjects, for repeated assessment of insulin sensitivity. The protocol was approved by the Tribal Council of the Gila River Indian Community and by the Institutional Review Board of the National Institute of Diabetes and Digestive and Kidney Diseases, and all subjects provided written informed consent before participation.
Cross-sectional analyses were carried out in all subjects (n = 55) who were characterized for plasma adiponectin concentration, glucose tolerance, percent body fat, insulin sensitivity; in addition, a subgroup (group 1, n = 19) underwent muscle biopsies for measurement of skeletal muscle IR tyrosine phosphorylation. Subjects included in this analysis represented a wide range of glucose tolerance (14 normal glucose tolerant, 3 impaired glucose tolerant, and 2 type 2 diabetic subjects, according to the 1997 American Diabetes Association diagnostic criteria (13). Prospective analyses were performed in a subgroup of subjects (group 2, n = 38) who were normal glucose tolerant at baseline, were nondiabetic at follow-up, and had baseline measurements of plasma adiponectin concentration, percent body fat, 2-h glucose, insulin-stimulated glucose disposal, and follow-up measurements of insulin-stimulated glucose disposal (group 2).
Methods. Body composition was estimated by underwater weighing with determination of residual lung volume by helium dilution (14) or by total body dual-energy X-ray absorptiometry (DPX-L; Lunar, Madison, WI) (15,16). Percent body fat, fat mass, and fat-free mass were calculated as previously described (17), and a conversion equation (16) was used to make measurements comparable between the two methods. After a 12-h overnight fast, subjects underwent a 75-g OGTT. Baseline blood samples were drawn for the determination of fasting plasma glucose, insulin, and adiponectin concentrations. Plasma glucose concentration was determined by the glucose oxidase method (Beckman Instruments, Fullerton, CA) in the fasting state and 2 h after glucose ingestion for the assessment of glucose tolerance, according to the 1997 American Diabetes Association diagnostic criteria (13). Plasma insulin concentration was determined by an automated immunoassay (Access; Beckman Instruments). Blood samples for the measurement of fasting plasma adiponectin concentration were drawn with prechilled syringes, transferred into prechilled EDTA tubes, and immediately placed on ice. All tubes were cold centrifuged (+4°C) within several minutes of collection and stored at 70°C until assayed at the Department of Internal Medicine and Molecular Sciences, Osaka University, Osaka, Japan. Fasting plasma adiponectin concentration was determined using a validated sandwich enzyme-linked immunosorbent assay (ELISA) employing an adiponectin-specific antibody (intra-assay and interassay coefficients of variation 3.3 and 7.4%, respectively).
Hyperinsulinemic-euglycemic glucose clamp.
IR tyrosine kinase activity.
Statistical analyses. In cross-sectional analyses, relationships between plasma adiponectin concentration, percent body fat, insulin-stimulated glucose disposal, and IR tyrosine phosphorylation were examined by calculation of Pearsons correlation coefficients. Partial correlation was used to examine the relationships between plasma adiponectin and phosphorylation status, independent of percent body fat. In prospective analyses, the predictive effect of plasma adiponectin concentration at baseline on change (follow-up adjusted for baseline) in insulin-stimulated glucose disposal was evaluated using multiple linear regression models. Models were adjusted for sex, follow-up age, change in percent body fat, and time of follow-up.
The anthropometrical and metabolic characteristics for the subjects included in the cross-sectional and longitudinal analyses are summarized in Table 1.
Cross-sectional analysis.
Prospective analysis. Low plasma adiponectin concentration at baseline was associated with a decrease in insulin-stimulated glucose disposal after adjustment for sex, age at follow-up, time of follow-up, and change in percent body fat (P = 0.04) (Table 2 and Fig. 2).
In the present study, we found that a low fasting plasma adiponectin concentration was cross-sectionally associated with a high basal and low insulin-stimulated skeletal muscle IR tyrosine phosphorylation and prospectively associated with a decrease in insulin sensitivity. Our results are consistent with the notion that adiponectin plays a role in insulin sensitivity in humans. We have previously established that adiponectin is associated with whole-body insulin sensitivity in humans (8). We now show that low plasma adiponectin concentration is associated with a high basal and decreased insulin-stimulated tyrosine phosphorylation of the IR in skeletal muscle, which is consistent with experimental observations in rodents (10). A high basal level of phosphorylation of the IR at tyrosine residues has been shown to be associated with hyperinsulinemia in the sand rat model of type 2 diabetes (21). In humans, little is known about the relationships between basal IR tyrosine phosphorylation and insulin sensitivity. Nevertheless, a high basal phosphorylation of IR substrate-1 (IRS-1), which is downstream of tyrosine phosphorylation of the IR (22), has been associated with insulin resistance and type 2 diabetes (23,24). Increased basal phosphorylation of IRS-1 would thus reflect high basal IR tyrosine kinase activity and be compatible with our data. In addition, high IR tyrosine phosphorylation in the basal state has been associated with fasting hyperinsulinemia in an animal model (21).
Previously, we have shown that fasting hyperinsulinemia is associated with low plasma adiponectin concentration (8). Here we report a negative correlation between basal IR tyrosine phosphorylation and plasma adiponectin concentration. We hypothesize that adiponectin decreases basal phosphorylation by promoting insulin signaling downstream of the IR. This might result in increased insulin sensitivity and decreased fasting plasma insulin concentration. Therefore, when adiponectin concentration is low, fasting hyperinsulinemia, which is associated with decreased insulin sensitivity, may increase basal phosphorylation of the IR. Moreover, we found a relationship between adiponectin and basal phosphorylation independent of fasting plasma insulin, suggesting that factors other than insulin, such as tumor necrosis factor- Skeletal muscle insulin-stimulated IR tyrosine phosphorylation is an important step in the insulin-signaling cascade and has been shown to decrease with increasing insulin resistance (12). In addition, we have previously shown that the degree of insulin-stimulated phosphorylation of immunocaptured IR correlated strongly with its kinase activity (12). Impaired skeletal muscle tyrosine kinase activity has been shown in obesity and type 2 diabetes (26,27,28) and has been suggested to be an early or primary event in the development of insulin resistance. In our study, subjects with a high basal skeletal muscle tyrosine phosphorylation of the IR also have the lowest fold increase in tyrosine phosphorylation upon insulin stimulation. This may suggest that the relationship between the fold increase in phosphorylation and plasma adiponectin concentration may be a function of basal phosphorylation. We also investigated whether a low plasma adiponectin concentration at baseline has an effect on future changes in whole-body insulin sensitivity. We found that a low fasting plasma adiponectin concentration at baseline is associated with a decrease in insulin sensitivity, independently of changes in percent body fat. Thus, the presented results extend our previous observation of a close association between hypoadiponectinemia and insulin resistance (8) by indicating that a low plasma adiponectin concentration precedes the decline in insulin sensitivity. Possible mechanisms for the insulin-sensitizing effects of adiponectin other than its direct effect on skeletal muscle IR tyrosine phosphorylation may include increased lipid oxidation in muscle (29) and enhancement of hepatic insulin action (30), possibly also by interaction with insulin signaling. In summary, our cross-sectional data suggest a role of physiological concentration of fasting plasma adiponectin in the regulation of skeletal muscle IR tyrosine kinase activity in humans. Prospectively, low plasma adiponectin concentration at baseline precedes a decrease in insulin sensitivity. Our data indicate that adiponectin plays an important role in regulation of insulin sensitivity in humans.
The authors thank Dr. Ira Goldfine for the contribution to the study. We gratefully acknowledge the help of the nursing and dietary staffs of the National Institutes of Health (NIH) Metabolic Unit for the care of the volunteers. We also thank the technical staff of the NIH Clinical Diabetes and Nutrition Section in Phoenix and of the Department of Internal Medicine and Molecular Sciences, Osaka University, Japan, for assisting in the laboratory analyses. Finally, we are grateful to the members and leaders of the Gila River Indian Community for their continuing cooperation in our studies.
Address correspondence and reprint requests to Norbert Stefan, Clinical Diabetes and Nutrition Section, National Institutes of Health, 4212 N. 16th St., Rm. 5-41, Phoenix, AZ 85016. E-mail: nstefan{at}mail.nih.gov. Received for publication 19 January 2002 and accepted in revised form 6 March 2002. N.S. and B.V. contributed equally to this work. T.F. and Y.M. were supported by the Japan Society for the Promotion of Science and Education (JSP-RFTF 97L00801) and a grant from the Fuji Foundation for Protein Research. ELISA, enzyme-linked immunosorbent assay; EMBS, estimated metabolic body size (fat free mass + 17.7 kg); IR, insulin receptor; IRS-1, IR substrate-1; OGTT, oral glucose tolerance test.
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||