Diabetes 57:555-562, 2008 DOI: 10.2337/db07-0928 © 2008 by the American Diabetes Association
Insulin Internalizes GLUT2 in the Enterocytes of Healthy but Not Insulin-Resistant Mice
1 Université Pierre et Marie Curie-Paris 6, Unité Mixte de Recherche S 872, Paris, France Address correspondence and reprint requests to Edith Brot-Laroche, CRC, Team 9, 15 rue de l'Ecole de Médecine, 75006 Paris, France. E-mail: edith.brot-laroche{at}crc.jussieu.fr
Abbreviations:
BBM, brush border membrane; BLM, basolateral membrane; Caco-2/TC7, colon carcinoma TC7 subclone; GIR, glucose infusion rate; 3-OMG, [3H]-3-O-methyl-glucose; PepT1, peptide transporter-1; PiP3, phosphatidylinositol (3,4,5)-trisphosphate; SGLT1, sodium-dependent glucose cotransporter
OBJECTIVES—A physiological adaptation to a sugar-rich meal is achieved by increased sugar uptake to match dietary load, resulting from a rapid transient translocation of the fructose/glucose GLUT2 transporter to the brush border membrane (BBM) of enterocytes. The aim of this study was to define the contributors and physiological mechanisms controlling intestinal sugar absorption, focusing on the action of insulin and the contribution of GLUT2-mediated transport. RESEARCH DESIGN AND METHODS—The studies were performed in the human enterocytic colon carcinoma TC7 subclone (Caco-2/TC7) cells and in vivo during hyperinsulinemic-euglycemic clamp experiments in conscious mice. Chronic high-fructose or high-fat diets were used to induce glucose intolerance and insulin resistance in mice. RESULTS AND CONCLUSIONS—In Caco-2/TC7 cells, insulin action diminished the transepithelial transfer of sugar and reduced BBM and basolateral membrane (BLM) GLUT2 levels, demonstrating that insulin can target sugar absorption by controlling the membrane localization of GLUT2 in enterocytes. Similarly, in hyperinsulinemic-euglycemic clamp experiments in sensitive mice, insulin abolished GLUT2 (i.e., the cytochalasin B-sensitive component of fructose absorption), decreased BBM GLUT2, and concomitantly increased intracellular GLUT2. Acute insulin treatment before sugar intake prevented the insertion of GLUT2 into the BBM. Insulin resistance in mice provoked a loss of GLUT2 trafficking, and GLUT2 levels remained permanently high in the BBM and low in the BLM. We propose that, in addition to its peripheral effects, insulin inhibits intestinal sugar absorption to prevent excessive blood glucose excursion after a sugar meal. This protective mechanism is lost in the insulin-resistant state induced by high-fat or high-fructose feeding. Intestinal sugar transport constantly adapts to the dietary environment. At low levels, the end products of carbohydrate digestion are absorbed by a two-step membrane-transport process involving the sodium-dependent glucose cotransporter (SGLT1) and the facilitative fructose transporter (GLUT5) in the brush border membrane (BBM) (1) lining the lumen. GLUT2 in the basolateral membrane (BLM) (2) ensures sugar exit into the blood stream (3). The level of sugar absorption is also regulated by a rapid and transient recruitment of GLUT2 into enterocyte BBM (4,5). A high sugar intake is a physiological regulator of this process, increasing monosaccharide uptake threefold in vivo (6). The recruitment of GLUT2 in BBM was also observed in conditions of increased calorie demand and glucagon-like peptide 2 treatment (7–11). The mechanisms by which GLUT2 leaves the BBM in the absence of luminal sugar (interprandial periods) are unknown. Of the possible physiological stimuli occurring during feeding, insulin was thought to be a candidate because it exerts systemic hypoglycemic effects by stimulating the translocation of GLUT4 into the plasma membrane of skeletal muscle and adipose cells (rev. in 12) and decreasing liver glucose output. Furthermore, the presence of GLUT2 in BBM was initially found under conditions of experimental diabetes, i.e., lack of insulin and consequent hyperglycemia (13). The underlying mechanisms for the loss of BBM GLUT2, i.e., degradation, internalization, and transcytosis, need to be determined. An acute inhibition of sugar absorption by insulin was interpreted as being an indirect consequence of metabolic flow and entirely attributed to SGLT1 (14). The aim of this study was therefore to analyze the impact of insulin on intestinal sugar absorption, focusing on the localization of GLUT2 in enterocyte membranes in colon carcinoma TC7 subclone (Caco-2/TC7) cells (15) and in vivo in mice. In addition, we aimed to establish whether enterocytes would respond to elevated blood glucose or to plasma insulin under hyperinsulinemic-euglycemic clamp conditions or during the course of a test meal in mice. An increased consumption of fructose is suspected of triggering metabolic disorders including glucose intolerance and insulin resistance (16,17). Glucose homeostasis disorders are also obtained with prolonged exposure to a high-fat diet. A comparison was therefore made of normal and insulin-resistant states using chronic high-fructose or high-fat dieting and associate metabolic disturbances as tools to provide insight into the control by insulin of GLUT2 membrane localization in intestinal membranes.
Cell culture. Caco-2/TC7 on cells filters (3 µm HD; BD Biosciences, Pont de Claix, France) were grown in Dulbecco's modified Eagle's medium (DMEM; Gibco, Paisley, U.K.) supplemented with 25 mmol/l glucose and 10% decomplemented FCS (AbCys, Paris, France) (15). Insulin stimulation (1 mU/ml in basolateral compartment, 1 h, 37°C) was performed in serum-free media. Differentiated cells were washed with ice-cold PBS/Ca2+/Mg2+ buffer before processing.
Fluorescence microscopy, image acquisition, and treatment.
Cell surface biotinylation.
Insulin signaling pathway.
Animals.
Membrane preparations.
Western blotting.
Sugar transport assays.
Statistics.
BBM GLUT2 is decreased by insulin in Caco-2-TC7 cells. The effects of insulin on enterocytes were studied in Caco-2/TC7 cells (15,24), which enabled a separation between the effects of insulin and glucose in vitro. Differentiated Caco-2/TC7 cells segregate sucrase-isomaltase in BBM and NaKATPase in BLM (Supplemental Fig. 1A, available in an online appendix at http://dx.doi.org/10.2337/db07-0928). The β1-insulin receptor was found in BBM and BLM and in intracellular stores (XZ sections). In this experimental setting, glucose was added to the apical side and insulin to the basolateral side of the cells to mimic in vivo sugar absorption. Culture media were supplemented with 10% FCS containing insulin that could induce internalization of the insulin receptor. Glucose concentrations had not changed significantly at harvest (not shown). Insulin receptors were functional, as shown by AKT phosphorylation kinetics (Supplemental Fig. 1B). Confocal microscopy analysis of the colocalization of GLUT2 with sucrase-isomaltase (Fig. 1A) indicated that GLUT2 was associated with BBM. GLUT2 was also abundant in subapical compartments where sucrase-isomaltase was undetectable. The quantification of GLUT2 and sucrase-isomaltase colocalization (Fig. 1A, Merge, line 1) indicated that 1 mU/ml insulin reduced BBM GLUT2 by 60% (Fig. 1D, Fluo).
To distinguish GLUT2 in intracellular membranes from BBM GLUT2, we performed surface biotinylation of proteins with impermeant NHSS-biotin. When biotin was added to the BBM side of cells, Western blotting of biotinylated proteins revealed GLUT5 and GLUT2 in BBM (Fig. 1C). NaKATPase could be biotinylated from the BLM (data not shown) but not from the BBM side of cells (Fig. 1C), indicating integrity of intercellular tight junctions. After exposure to insulin for 1 h, GLUT5, GLUT2, and NaKATPase levels in total membranes were unchanged (Fig. 1C), but BBM GLUT2 levels decreased by 80% (Fig. 1D, Biotin), whereas GLUT5 remained unchanged. A precise deconvoluted image of a single microscopy section at mid-height of enterocytes shows association of GLUT2 with BLM identified by NaKATPase labeling (Fig. 1E). The addition of 25 mmol/l glucose increased BLM GLUT2 twofold after 15 min and fourfold after 30 min compared with sugar-deprived cells (Fig. 1F). BLM GLUT2 at 30 min contained 12% of total GLUT2 in whole cell. Insulin treatment decreased BLM GLUT2 by 45 and 34% after 15 and 30 min, respectively (P < 0.05) (Fig. 1F). To determine the functional consequences of insulin action, we measured the transfer of the nonmetabolizable glucose analog 3-OMG from the apical to the basolateral compartment. The results revealed a 30% (P < 0.01) inhibition after a 30-min insulin treatment (Fig. 1B), which reflected the inhibition of GLUT2-mediated transport in Caco-2/TC7 cells. Thus insulin decreases BBM and BLM GLUT2 levels in enterocytes and limits the transepithelial transport of sugars by a specific internalization of GLUT2 from plasma membranes.
High-fructose or high-fat feeding on intestinal GLUT2 expression and glucose homeostasis in mice in vivo.
The consumption of fructose-rich and high-fat diets perturbed mice glucose homeostasis (Supplemental Table 1, online appendix). Glucose intolerance ( To investigate insulin action in the intestine, we performed hyperinsulinemic-euglycemic clamps in conscious mice. Moderate hyperinsulinemia (2.36 ± 0.34 vs. 0.49 ± 0.05 ng/ml; n = 4) was obtained. GIRs were similar in chow- and fructose-fed mice for 15 days (67 ± 1 and 65 ± 4 mg · kg–1 · min–1; n = 4), indicating similar insulin sensitivity. However, GIRs were decreased at day 30 in fructose-fed mice, indicating that they were insulin resistant (36 ± 6 mg · kg–1 · min–1; n = 6). The GIR of mice fed a high-fat diet for 4 months was reduced even more (7 ± 4 mg · kg–1 · min–1; n = 6), indicating very high insulin resistance. We were then able to study insulin effects on GLUT2 trafficking by comparing sensitive and resistant mice.
Insulin action on the membrane distribution of GLUT2 in insulin-sensitive mice.
Insulin lowered GLUT2 by 60% in PepT1 fractions, indicating removal from BBM (Fig. 2B and C) in absence of major protein degradation because total GLUT2 levels in sham and hyperinsulinemic-euglycemic clamp conditions were unchanged (Fig. 2B, inset). Accordingly, GLUT2 increased in intracellular membranes (Fig. 2C). Thus, insulin promoted GLUT2 internalization from BBM to intracellular membrane stores. The functional significance of the insulin-dependent internalization of BBM GLUT2 with respect to sugar absorption was measured in everted jejunal rings of sham and hyperinsulinemic-euglycemic mice (Fig. 2D). Insulin reduced fructose uptake by 40% (P < 0.001), indicating that sugar transport correlated to BBM transporter abundance. We used cytochalasin B to determine the contributions of GLUT2 and GLUT5 (insensitive to cytochalasin B) to fructose uptake. Fructose uptakes were identical in hyperinsulinemic-euglycemic and sham mice exposed to cytochalasin B, thus confirming that insulin did not change localization and activity of GLUT5. Insulin specifically decreases GLUT2-dependent fructose transport.
Impairment of GLUT2 trafficking by insulin injection before a sugar bolus. Intraperitoneal insulin injections performed 20 min before the fructose test meal produced a threefold elevation of plasma insulin (range 1.2–1.7 ng/ml) to a level similar to that produced during hyperinsulinemic-euglycemic clamp. The recruitment of GLUT2 into BBM in response to luminal fructose was abolished by insulin injection, and the distribution of GLUT2 was similar to that in enterocytes of fasted mice (Fig. 2E). Interestingly, insulin effects tended to be weaker in purified BBM from mice fed 5 days with the fructose-rich compared with the glucose-rich diet (Fig. 2G). Prior insulin treatment counteracted the insertion of GLUT2 into BBM induced by luminal dietary sugar (Fig. 2E).
GLUT2 membrane distribution and trafficking in insulin-resistant mice.
In insulin-resistant mice, BBM localizations were unaffected by insulin in hyperinsulinemic-euglycemic clamp conditions. BLM GLUT2 remained <20% of total GLUT2 (Fig. 3C and F). In addition, BBM GLUT2 levels were correlated with GIR. Insulin-resistant mice exhibited a loss of control by insulin of GLUT2 membrane trafficking, leading to a permanent localization of GLUT2 in enterocyte BBM, a pathological consequence of long-term fructose or fat feeding.
We had previously reported the rapid and transient recruitment of GLUT2 into enterocyte BBM after a bolus of simple sugars, generating a threefold enhancement of uptake (6). The present study demonstrates and quantifies in vitro and in vivo the inhibition by insulin of intestinal sugar uptake, as a result of the internalization of GLUT2 from plasma membranes back into intracellular pools. This important physiological process mediated by insulin at the level of enterocytes probably reveals another mechanism by which insulin limits sugar excursion in the blood during a sugar-rich meal. Furthermore, insulin resistance provoked a loss of control by insulin of GLUT2 membrane trafficking, a pathological consequence of the long-term consumption of a fructose-rich or high-fat diet. Insulin sensitivity and glucose tolerance are important factors in the regulation of intestinal GLUT2 trafficking. In insulin-resistant mice obtained by prolonged fructose-rich or high-fat diets, the distribution of GLUT2 was drastically altered; BBM GLUT2 was permanently high, and insulin was unable to promote GLUT2 internalization and enrichment in intracellular membranes. Insulin resistance resulted in increased intestinal sugar delivery, as reflected by higher initial rise in blood glucose after oral glucose load. Insulin action is transduced via receptors in enterocyte plasma membranes in vivo (25,26) and in vitro in Caco-2/TC7 cells. The functional significance of BLM insulin receptors is obvious, and we speculate that enterocytes akin to epithelial renal cells undergo a rapid phosphatidylinositol (3,4,5)-trisphosphate diffusion after insulin to trigger trafficking of a BBM protein (27). The role of insulin receptors in the BBM is unclear but it creates an opportunity for oral insulin treatment (28) that might target BBM GLUT2 localization and function. Conflicting results concerning acute insulin treatment report inhibition (14) and activation (29) of SGLT1-dependent intestinal sugar absorption ex vivo. In the present work, we describe an insulin action on the high capacity GLUT2 component of fructose transport that leads to a 50% inhibition of total transport, down to GLUT5 basal transport levels. We speculate that this regulation applies to intestinal glucose absorption. In insulin-resistant animals, a permanent BBM GLUT2 might create glucose efflux from enterocytes into the lumen. This is unlikely because permanent SGLT1 recapture would operate. These results highlight the complexity of the regulation of intestinal sugar absorption by insulin to modulate but not block intestinal sugar absorption. In adipocytes and muscle cells, insulin provokes a massive translocation of GLUT4 to the plasma membrane (rev. in 12,30). In sharp contrast, insulin internalizes BBM GLUT2 into intracellular pools. Insulin, by regulating GLUT2 and GLUT4 traffic in opposite direction, controls glucose homeostasis and limits glucose excursion in the course of digestion by increasing peripheral GLUT4-dependent glucose uptake and slowing down intestinal GLUT2-dependent sugar delivery. We therefore propose that the small intestine constitutes an early checkpoint to limit postprandial glucose excursion. We also anticipate that insulin treatment will remove GLUT2 from its permanent BBM localization in type I diabetic patients that are insulin sensitive. Modern westernized diets and eating habits have changed, increasing the amounts of dietary fructose and fat, which are probably a nutritional basis for the obesity and type 2 diabetes pandemics (31). Intestinal adaptation to these diets may be an early event to the onset of metabolic disorders due to the rapid increase in sugar transport capacities and the alteration of insulin action in enterocytes. With time, insulin resistance and metabolic disorders (32) might be worsen by uncontrolled sugar absorption in a small intestine that is no longer responsive to attenuation by insulin. A vicious circle thus develops that equips the intestine for high transport of dietary sugar in organisms already suffering from excessive blood glucose levels. Strategies to ameliorate insulin action on intestinal function therefore constitute another target for therapeutic intervention and control of postprandial glycemia.
V.T. has received an MRT PhD fellowship. M.L.G. has received a Benjamin Delessert prize. E.S. has received an MRT PhD fellowship. A.G.B. has received a grant from FPI Spanish Ministerio de Educacion y Ciencia (BES-2004-4685). This work has received support from Institut National de la Santé et de la Recherche Médicale, University Paris 6, Action Thematique Concertée (ATC) Nutrition (ASEO22129DSA), ALFEDIAM/Merk-Lipha grants. We thank E. Petridi and V. Ondet for their contribution and C. Lasne and E. Dussaulx for technical assistance. We are grateful to J. Chambaz for support, to G.W. Gould (Glasgow, U.K.) for antibodies, and to G.L. Kellett (York, U.K.) for antibodies and for fruitful discussions.
Published ahead of print at http://diabetes.diabetesjournals.org on 5 December 2007. DOI: 10.2337/db07-0928. Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/db07-0928. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received for publication July 16, 2007 and accepted in revised form November 20, 2007
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