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© 2004 The American Society for Nutritional Sciences J. Nutr. 134:1045-1050, May 2004


Nutrient-Gene Interactions

Specific Preservation of Biosynthetic Responses to Insulin in Adipose Tissue May Contribute to Hyperleptinemia in Insulin-Resistant Obese Mice1

Tooru M. Mizuno2, Toshiya Funabashi*, Steven P. Kleopoulos and Charles V. Mobbs3

Fishberg Center for Neurobiology, Neurobiology of Aging Laboratories and Department of Geriatrics, Mount Sinai School of Medicine, New York, NY 10029 and * Department of Physiology, Yokohama City University School of Medicine, Yokohama, 236-0004, Japan

3To whom correspondence should be addressed. E-mail: Charles.Mobbs{at}mssm.edu.


    ABSTRACT
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 LITERATURE CITED
 
Obesity is characterized by whole-body insulin resistance, yet the expression of many insulin-stimulated genes, including leptin, is elevated in obesity. These observations suggest that insulin resistance may depend on tissue type and gene. To address this hypothesis, we examined the regulation of immediate-early gene expression in liver and adipose tissue after injection of insulin and glucose, in lean insulin-sensitive, and in Ay/a obese insulin-sensitive and obese insulin-resistant mice. Expression of hepatic jun-B mRNA was robustly increased after insulin injection in lean insulin-sensitive a/a mice and insulin-sensitive Ay/a mice. In contrast, induction of hepatic jun-B and c-fos gene expression by insulin was markedly attenuated in obese insulin-resistant mice. Surprisingly, induction of adipose jun-B and c-fos gene expression by insulin was markedly enhanced in obese insulin-resistant mice. Furthermore, the expressions of jun-B and leptin were also enhanced in insulin-resistant mice after injection of glucose. Leptin mRNA was positively correlated with blood glucose levels and jun-B mRNA in lean but not insulin-resistant mice. Multiple regression analysis indicated that the correlation between leptin mRNA and jun-B mRNA was significant even after removing the effect of blood glucose, but the correlation between leptin mRNA and glucose was no longer significant after removing the effect of jun-B mRNA. These data suggest that some impairments in biosynthetic responses to insulin are manifest primarily in the liver, leading to hyperinsulinemia and stimulating the expression of some adipose insulin-stimulated genes, including leptin. These studies demonstrate the utility of immediate-early gene expression in the analysis of biosynthetic mechanisms of insulin resistance.


KEY WORDS: • insulin resistance • jun-B • c-fos • leptin

The importance of individual tissues in determining whole-body insulin resistance has not yet been fully resolved. Impaired responses to insulin in muscle, fat, and liver can be demonstrated in association with whole-body insulin resistance (1), and insulin resistance in these tissues has classically been considered to contribute to whole-body insulin resistance. On the other hand, recent studies suggested that insulin resistance in muscle and fat may not play a major role in causing whole-body insulin resistance (2). Furthermore, because plasma insulin levels increase to compensate for insulin resistance, plasma glucose levels are often normal in the presence of whole-body insulin resistance. Although insulin resistance may be exactly compensated by hyperinsulinemia at the whole-body level, all responses to insulin may not be equally impaired. If some biosynthetic responses continue to be sensitive to insulin, the presence of hyperinsulinemia may actually produce a state of hyperstimulation. For example, it was proposed that obesity can lead to hypertension because the vasodilatory response to insulin is impaired, but the sodium-retaining effect of insulin is not impaired, thus leading to sodium retention due to hyperinsulinemia (3). Similarly, the maintenance of leptin sensitivity to insulin despite whole-body insulin resistance could explain the elevated expression of leptin (normalized to wet weight or per microgram RNA) observed in obesity (4) because insulin stimulates leptin and insulin is elevated in insulin resistance (4). However, it is unclear whether leptin sensitivity to insulin is normal in the presence of insulin resistance because insulin-induced phosphorylation of signaling proteins is impaired in the fat tissue of insulin-resistant animals (1). On the other hand, it is not clear whether impaired phosphorylation of signaling proteins necessarily implies impaired synthetic responses to insulin.

To address the hypothesis that liver and adipose tissue might exhibit differential impairments in synthetic responses to insulin in the presence of whole-body insulin resistance, it was necessary to assess a synthetic response to insulin exhibited by both tissues. The immediate-early genes c-fos and jun-B have been used as markers of insulin and glucose stimulation in a variety of cell types in vivo and in vitro (512). Furthermore, these immediate-early genes can interact to form the activator protein (AP)-1 transcription factor, and the leptin promoter sequence contains a potential AP-1 binding site (13,14). We therefore assessed expression of c-fos, jun-B, and leptin in liver and fat after insulin or glucose stimulation in insulin-sensitive and insulin-resistant mice. The present studies suggest that some biosynthetic responses to insulin stimulation are impaired in liver before adipose tissue, and that the elevated expression of leptin in insulin-resistant mice may be due to elevated expression of immediate-early genes secondary to hyperinsulinemia acting on insulin-sensitive adipose tissue.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 LITERATURE CITED
 
    Animals and treatment. Male and female wild-type (a/a), and agouti (Ay/a) mice were obtained from The Jackson Laboratory. Mice (7 mo old) were individually housed with free access to feed and water under a 12-h light:dark cycle (lights on at 0700 h). Mice were fed a standard rodent diet (#5053, 16.82 kJ/g, Purina Mills) containing (g/kg diet): carbohydrate (550), fat (50), protein (220), fiber (50), and ash (60). All studies were approved by the Institutional Animal Care and Use Committee (Mount Sinai School of Medicine). In the first study, using female mice only, food was removed 7 h before lights out to produce an equivalent state of acute nutritional stimulation because acute nutritional status of mice consuming feed ad libitum may vary greatly depending on the precise timing of individual meals. Thus, mice were food deprived for 7 h and were injected i.p. with insulin (human insulin, Novolin, Novo Nordisk Pharmaceuticals, 2 mU/g body weight) or saline, and were killed (between 1700 and 1900h) 30 min after injection by exposure to carbon dioxide followed by decapitation. In subsequent studies, male wild-type (a/a) and agouti (Ay/a) mice (also 7 mo old) were food deprived for 7 h before lights out, and were injected i.p. with either insulin (bovine insulin, Sigma, 33 mU/g body weight) or glucose (2 mg/g of body weight). Mice were killed (between 1700 and 1900h) 0, 15, 30, or 75 min after glucose injection, or 0 or 30 min after insulin injection, by exposure to carbon dioxide followed by decapitation.

In all studies, upon killing, liver and adipose tissues from the epididymal or gonadal fat pad were removed, frozen on dry ice, and stored at –70°C until use. Blood glucose was measured by a Lifescan One-Touch ll glucose meter (Johnson & Johnson), and serum insulin was measured by a species-nonspecific RIA using rat insulin as a standard (15).

    RNA analysis. Total RNA was extracted in TRIzol (GIBCO BRL); 7 µg of total RNA, estimated by spectrophotometer, was subjected to Northern blot analysis to detect jun-B and c-fos mRNA in the liver and adipose tissue and leptin mRNA in adipose tissue. Northern blot analysis was performed as described previously (4). Templates for a single-stranded cDNA probe for jun-B and c-fos were generated from a source DNA fragments by using PCR. The template for the leptin probe was generated as described previously (4). Primers to generate and label probes were as follows: jun-B forward primer: 5'-CACGACGACTCTTACGCAGC-3', jun-B reverse primer: 5'-GATGCGCCTGTGTCTGATCC-3', c-fos forward primer: 5'-AGCCGACTCCTTCTCGAGCA-3', c-fos reverse primer: 5'-CCTCCTGACAGGCTCTTCAC-3', leptin forward primer: 5'-CTGCAAGGTGCAAGAAGAAG-3', and leptin reverse primer: 5'-TCGGAGATTCTCCAGGTCAT-3'. Single-stranded internally labeled DNA probes were produced as described previously (4). Membranes were reprobed and hybridized with 32P-labeled probe encoding 18S ribosomal RNA. The total integrated densities of hybridization signals were determined by computerized densitometric scanning (MCID System) or phosphoimager (to quantify Northern blots: STORM 860, Molecular Dynamics).

    Statistical analysis. Gene expression data were expressed as a percentage relative to the saline-injected lean control group in each experiment. Data represent means ± SEM. Initially, statistical analysis was performed by a two-way ANOVA followed by a Tukey-Kramer post-hoc test; comparisons between 2 groups was by unpaired Student’s t test. In the time course study after glucose injection, effects of time were analyzed by a two-way ANOVA followed by Dunnett’s post-hoc test to compare each time point with time 0 within each genotype, or a Tukey-Kramer post-hoc test to compare values at same time point between genotypes. When the variances across groups were not equal, the Wilcoxon (nonparametric) test was used to assess statistical significance. Then the relative contributions of factors, such as glucose, to jun-B or leptin mRNA were assessed using the general linear model (GLM) as described previously (16). The statistical analysis was performed using the JMP statistical package (Version 5.0.1a, SAS Institute) implemented on a Macintosh operating system. Part of the data for leptin mRNA was reported previously (4).


    RESULTS
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 LITERATURE CITED
 
    Insulin-induced immediate-early gene expression in obese insulin-sensitive (female) Ay/a mice. Female Ay/a mice were heavier than wild-type mice (a significant main effect of genotype: P < 0.0005, ANOVA, Fig. 1A). Similarly, gonadal fat pad weight was greater in Ay/a mice than in wild-type a/a mice (a significant main effect of genotype: P < 0.01, ANOVA, Fig. 1B). There were no significant effects of treatment (injection) or interaction (genotype x injection) on body weight and fat pad weight (P > 0.05, ANOVA). Although female Ay/a mice were obese, they showed no evidence of whole-body insulin resistance because insulin reduced blood glucose similarly in wild-type (P < 0.01, Tukey-Kramer test) and Ay/a mice (P < 0.05, Tukey-Kramer test, Fig. 1C).



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FIGURE 1 Effect of insulin injection on body weight (A), fat pad weight (B), blood glucose (C), and hepatic jun-B mRNA (D) in a/a and Ay/a mice. Mice were killed 30 min after injection of saline (CON) or insulin (INS). The results are presented as means ± SEM, n = 3–4/group. Means without a common letter differ, P < 0.05, Tukey-Kramer test or Wilcoxon test.

 
Basal expression of hepatic jun-B mRNA did not differ in wild-type and obese Ay/a mice. Furthermore, insulin induced hepatic jun-B mRNA to a similar extent in wild-type (338% of saline-injected wild-type mice, P < 0.01, Tukey-Kramer test) and obese Ay/a mice (347% of saline-injected Ay/a mice, P < 0.05, Wilcoxon test, Fig. 1D), consistent with the whole-body insulin sensitivity observed in female obese mice.

    Insulin-induced hepatic immediate-early gene expression in obese insulin-resistant (male) Ay/a mice. As expected, male Ay/a mice were heavier than wild-type a/a mice (47.8 ± 0.5 g vs. 32.1 ± 0.6 g, P < 0.05, unpaired Student’s t test). In contrast to female Ay/a mice, male Ay/a exhibited clear evidence of insulin resistance because serum insulin was significantly elevated in male Ay/a mice compared with a/a mice (P < 0.05, Tukey-Kramer test, Table 1); insulin injection decreased blood glucose in male a/a mice (from 232.6 ± 14.4 mmol/L to 99.5 ± 26.5 mmol/L, P < 0.001, Tukey-Kramer test), but did not do so in male Ay/a mice (from 200.6 ± 40.5 mmol/L to 158.5 ± 50.7 mmol/L, P = 0.48, Tukey-Kramer test).


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TABLE 1 Blood glucose and serum insulin after glucose injection in a/a and Ay/a mice1

 
There was a significant main effect of genotype (P < 0.005, ANOVA) and injection (P < 0.0005, ANOVA) and a significant interaction (genotype x injection, P < 0.01, ANOVA) on hepatic jun-B mRNA. Basal expression of hepatic jun-B and c-fos mRNA was not different between male a/a and male Ay/a mice. In a/a mice, hepatic jun-B mRNA was increased 30 min after insulin injection (385% of saline-injected a/a mice, P < 0.005, Tukey-Kramer test, Fig. 2A, D), similar to the induction in female wile-type mice (Fig. 1D). The induction of hepatic jun-B mRNA by insulin in male Ay/a mice was only about half the effect observed in wild-type mice (177% of saline-injected Ay/a mice, P < 0.01, Tukey-Kramer test), and the effect of insulin was significantly smaller than in a/a mice. There was a significant main effect of injection (P < 0.05, ANOVA) on hepatic c-fos mRNA without a significant main effect of genotype (P = 0.56, ANOVA) and a significant interaction (genotype x injection, P = 0.07, ANOVA). Although basal expression of c-fos mRNA was lower than jun-B mRNA (Fig. 2A, B), insulin injection also increased c-fos mRNA in a/a mice (377% of saline-injected a/a mice, P < 0.05, Tukey-Kramer test, Fig. 2B, E). However, insulin had no effect on c-fos mRNA in insulin-resistant Ay/a mice (P = 0.66, Tukey-Kramer test).



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FIGURE 2 Effect of insulin injection on hepatic jun-B (A, D), c-fos (B, E) mRNA and 18S rRNA (C) in a/a and Ay/a mice. Lanes 1–2: basal expression (CON) in a/a mice. Lanes 3–4: expression 30 min after insulin injection (INS) in a/a mice. Lanes 5–6: basal expression in Ay/a mice. Lanes 7–8: expression 30 min after insulin injection in Ay/a mice. The results are presented as means ± SEM, n = 4–5/group. Means without a common letter differ, P < 0.05, Tukey-Kramer test or Wilcoxon test.

 
    Insulin-induced adipose immediate-early gene expression in obese insulin-resistant Ay/a mice. There was a significant main effect of genotype (P < 0.001, ANOVA) and injection (P < 0.0005, ANOVA) on adipose jun-B mRNA without a significant interaction (genotype x injection, P = 0.29, ANOVA). Basal expression of adipose jun-B mRNA was higher in Ay/a mice (654% of saline-injected a/a mice, P < 0.001, Tukey-Kramer test) compared with a/a mice (Fig. 3A, D). Adipose jun-B mRNA was increased 30 min after insulin injection in a/a mice (733% of saline-injected a/a mice, P < 0.05, Wilcoxon test, Fig. 3A, D), and insulin further increased adipose jun-B mRNA to above the elevated baseline in insulin-resistant Ay/a mice (256% of saline-injected Ay/a mice, P < 0.05, Tukey-Kramer test). Expression of c-fos mRNA exhibited a pattern similar to that of jun-B mRNA (Fig. 3B, E). There was a significant main effect of genotype (P < 0.0001, ANOVA) and injection (P < 0.0005, ANOVA) and a significant interaction (genotype x injection, P < 0.005, ANOVA) on adipose c-fos mRNA. Thus, adipose c-fos mRNA was increased by insulin in a/a mice (473% of saline-injected a/a mice, P < 0.05, Wilcoxon test). Although basal c-fos mRNA was also elevated in insulin-resistant male Ay/a mice (599% of saline-injected a/a mice, P < 0.001, Tukey-Kramer test) compared with a/a mice, c-fos mRNA was further increased by insulin (437% of saline-injected Ay/a mice, P < 0.005, Tukey-Kramer test).



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FIGURE 3 Effect of insulin injection on adipose jun-B (A, D), c-fos (B, E) mRNA and 18S rRNA (C) in a/a and Ay/a mice. Lanes 1–2: basal expression (CON) in a/a mice. Lanes 3–4: expression 30 min after insulin injection (INS) in a/a mice. Lanes 5–6: basal expression in Ay/a mice. Lanes 7–8: expression 30 min after insulin injection in Ay/a mice. The results are presented as means ± SEM (n = 4–5/group). Means without a common letter differ, P < 0.05, Tukey-Kramer test or Wilcoxon test.

 
    Correlation between immediate-early gene expression and leptin gene expression in obese insulin-resistant male Ay/a mice. In this study, glucose was used as the stimulus because we had already observed a correlation between glucose and leptin gene expression (16), and injection of insulin alone produced hypoglycemia in wild-type but not insulin-resistant mice. Although serum insulin was elevated in Ay/a mice compared with a/a mice (P < 0.05, Tukey-Kramer test, Table 1), blood glucose did not differ between genotypes (P = 0.43, Tukey-Kramer test). Blood glucose was increased within 15 min after i.p. glucose injection in both genotypes (P < 0.05, Dunnett’s test, Table 1).

There was a significant main effect of genotype (P < 0.0001, ANOVA) on adipose jun-B mRNA without a significant main effect of time course (P = 0.09, ANOVA) or a significant interaction (genotype x time course, P = 0.63, ANOVA). Adipose jun-B mRNA was increased 30 min after glucose injection (454% of time 0, P < 0.05 compared with 0 min, Dunnett’s test, Fig. 4A) and remained elevated 75 min after glucose injection (408% of time 0, P < 0.005, Dunnett’s test) in a/a mice. In Ay/a mice, adipose jun-B mRNA was increased by 15 min after glucose injection (P < 0.05, Dunnett’s test, Fig. 4A). There was a significant main effect of genotype (P < 0.0001, ANOVA) and injection (P < 0.005, ANOVA) and a significant interaction (genotype x injection, P < 0.0001, ANOVA) on leptin mRNA. Basal expression of leptin mRNA was elevated in male insulin-resistant Ay/a mice (532% of a/a mice) compared with a/a mice (P < 0.0001, Tukey-Kramer test, Fig. 4B). In a/a mice, leptin mRNA peaked at 30 min after glucose injection (329% of time 0, P < 0.01 compared with 0 min, Dunnett’s test) and returned to basal level at 75 min. In contrast, although leptin mRNA was not changed by 30 min after glucose injection, it was significantly elevated at 75 min in Ay/a mice (173% of time 0, P < 0.005 compared with 0 min, Dunnett’s test, Fig. 4B). Furthermore, leptin mRNA was positively correlated with adipose jun-B mRNA (r = 0.61, P < 0.005, Fig. 4C), blood glucose (r = 0.33, P < 0.05), serum insulin (r = 0.39, P < 0.05), and body weight (r = 0.73, P < 0.0001). The correlation between jun-B mRNA and leptin mRNA was significant even after removing the effect of blood glucose (P < 0.05 by GLM). In contrast, the correlation between blood glucose and leptin mRNA was no longer significant after the effect of jun-B mRNA was removed. In contrast to a/a mice, leptin mRNA in Ay/a mice was not correlated with adipose jun-B mRNA (r = 0.27, P = 0.24), blood glucose (r = 0.29, P = 0.21), serum insulin (r = –0.15, P = 0.53), or body weight (r = –0.07, P = 0.76). However, the correlation between blood glucose and jun-B mRNA was significant in Ay/a mice (r = 0.66, P < 0.005).



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FIGURE 4 Effect of glucose injection on adipose jun-B mRNA (A) and leptin mRNA (B) in a/a and Ay/a mice and correlation between jun-B mRNA and leptin mRNA in a/a mice (C). The results are presented as means ± SEM, n = 5/group. *Different from 0 min in each genotype, P < 0.05, Dunnett’s test. §Different from a/a mice at same time point, P < 0.05, Tukey-Kramer test. Correlations were determined by pooling all time points after glucose injection in panels A and B. Part of the data for leptin mRNA was reported previously (4).

 

    DISCUSSION
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 LITERATURE CITED
 
The present study addresses an apparent paradox, i.e., the expression of leptin (4) and other insulin-stimulated genes (1720) is elevated in obesity, even though obesity is also associated with whole-body insulin resistance. To resolve this paradox, we hypothesized that biosynthetic responses to insulin are impaired in liver (thus leading to whole-body insulin resistance), whereas biosynthetic responses to insulin are relatively less impaired in adipose tissue (thus allowing hyperinsulinemia, secondary to liver insulin resistance, to hyperstimulate leptin and other adipose insulin-stimulated genes). In support of this hypothesis, recent studies indicated surprisingly that ablation of the insulin receptor in muscle and fat does not produce significant whole-body insulin resistance, whereas ablation of the insulin receptor in liver does cause whole-body insulin resistance (2). Therefore, we assessed whether biosynthetic responses to insulin were impaired in liver but not in fat cells in insulin-resistant mice. Because induction of immediate-early genes has been used widely as a molecular marker for the cell activation by a variety of stimulations, we reasoned that expression of such genes might also constitute useful markers for cellular responses to insulin.

The present study demonstrated that both insulin and glucose injection stimulated expression of jun-B and c-fos mRNA in the liver and adipose tissue in lean insulin-sensitive a/a mice. These results are consistent with earlier studies demonstrating that expression of immediate early genes in hepatoma cells and adipose tissue is induced by insulin treatment both in vitro and in vivo (58). In the present study, we also found that induction of jun-B and c-fos mRNA by insulin injection was remarkably attenuated in the liver of obese insulin-resistant Ay/a mice. The impaired induction of liver immediate-early gene expression appeared to be due to insulin resistance, rather than obesity or the presence of the Ay agouti allele, because obese female Ay/a mice that were not insulin resistant did not exhibit impaired insulin-induced immediate-early gene expression.

In contrast to the impairment of immediate-early gene responses to insulin in liver, these responses to insulin were preserved in adipose tissue from insulin-resistant mice. These results are consistent with the observation that insulin inhibited the epinephrine-stimulated lipolysis in adipose tissue in Ay/a mice as well as in a/a mice (21). In fact, even basal expression of immediate-early gene expression was elevated in adipose tissue from insulin-resistant mice. Because insulin-resistant mice exhibited hyperinsulinemia, this latter result is consistent with the hypothesis that fat cells in insulin-resistant mice respond normally to insulin, leading to hyperinsulinemia-induced hyperstimulation of insulin-induced biosynthetic responses to insulin in adipose tissue. To support this hypothesis, adipose jun-B mRNA correlated with blood glucose in Ay/a mice as well as in a/a mice in the present study. However, leptin mRNA was not correlated with either blood glucose or jun-B mRNA in Ay/a mice, suggesting that insulin-resistance might develop downstream of jun-B induction in adipose tissue. It should be noted that at least 1 major cause of insulin resistance, a high-fat diet, leads to impaired insulin-induced phosphorylation of IRS-1 and IRS-2 in adipose and muscle tissue but not in liver (1). The same study demonstrated that inhibition of hepatic glucose output by insulin was impaired in rats fed the high-fat diet (1). The differences in results among these studies may be due to the different variables to be examined (i.e., gene expression vs. phosphorylation of signaling protein) because phosphorylation of signaling proteins may not correlate with functional responses to insulin. In addition, a high-fat diet causes insulin resistance through mechanisms other than those mediating obesity in our study.

Basal (unstimulated) leptin mRNA, like jun-B mRNA, was also elevated in insulin-resistant Ay/a mice, as previously reported (4). Furthermore, leptin mRNA correlated with insulin and glucose, as previously reported (4), and leptin mRNA also correlated with jun-B mRNA. Interestingly, multiple regression analysis indicated that after removal of the effect of glucose, jun-B mRNA continued to predict leptin mRNA, whereas after removal of the effect of jun-B mRNA, glucose no longer predicted leptin mRNA. This observation could be interpreted as indicating that induction of jun-B mRNA is a more proximal factor than glucose in determining leptin mRNA, consistent with the observation that the leptin gene contains a potential AP-1 binding site in the promoter sequence (13,14). It was shown that glucose alone affects the expression of several genes in cultured adipocytes with an additive or synergic effect of insulin (2224). Insulin is also known to exert its effects on gene expression through glucose-dependent and -independent mechanisms (25). Furthermore, leptin promoter activity is increased in the presence of glucose and insulin compared with glucose alone (26); insulin-induced increases in leptin mRNA, secretion of leptin in cultured adipocytes, and leptin promoter activity were closely related to glucose uptake and were attenuated by inhibition of glucose transport or uptake (27,28). In fact, insulin stimulates the translocation of glucose transporter-containing vesicles from intracellular storage sites to the plasma membrane, leading to the stimulation of glucose uptake into peripheral tissue including adipose tissue (2931). Taken together, these results are consistent with previous reports that at least part of the effect of insulin to stimulate leptin production is mediated through enhanced glucose metabolism (3234).

In conclusion, immediate-early genes constitute potentially useful molecular markers for the activation of nutrition-sensitive tissues such as liver and adipose tissue by metabolic factors such as glucose and insulin, and they are also useful molecular markers for hepatic insulin resistance. The present data suggest that biosynthetic responses to insulin may be impaired in the liver before similar biosynthetic responses are impaired in fat cells. Because insulin resistance in the liver may lead to whole-body insulin resistance and hyperinsulinemia, the maintenance of insulin sensitivity in fat cells in the presence of hyperinsulinemia may explain why the elevated expression of leptin and other insulin-stimulated genes is associated with whole-body insulin resistance.


    FOOTNOTES
 
1 Supported by a grant from the National Institutes of Health AG19934–01 and NS41183–01. Back

2 Present affiliation: Division of Endocrinology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Back

Manuscript received 29 October 2003. Initial review completed 16 December 2003. Revision accepted 17 February 2004.


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