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Insulin Resistance
Insulin Action and its Disturbances in Disease

Sudhesh Kumar (Edited by), S Kumar (Author), Stephen O'Rahilly (Edited by)

9780470850084, Wiley

Hardback, published 19 November 2004

624 pages
24.6 x 17.5 x 3.6 cm, 1.191 kg

"The book is intended for specialists…however with the current interest in obesity and the threats it poses to the general public health, others will also find it of interest." (E-STREAMS, September 2006)

"...a major contribution to the increasing body of work...this book appears at an appropriate moment to educate and excite young investigators…" (New England Journal of Medicine, November 17, 2005)

Diabetes is now one of the major causes of morbidity worldwide. In many cases, the onset of diabetes is progressive, developing via a condition of insulin resistance. This book considers the development of this condition, its consequences and clinical and therapeutic aspects.

The book reviews the normal biology of insulin action on glucose, lipids and proteins. It considers the pathological basis for insulin resistance in animal models and humans, and discusses the influence of heredity, dietary factors and exercise. Clinical consequences including dyslipidaemia, hypertension and polycystic ovary syndrome, and therapeutic strategies for treatment are also examined.
* Provides an expert review of the phenomenon of insulin resistance
* Brings together a host of recent research for the first time
* Written by leading experts in biological and clinical research

Preface xi

List of Contributors xiii

1 The Insulin Receptor and Downstream Signalling 1
Ken Siddle

1.1 Introduction 1

1.2 Insulin receptor structure and function 2

1.3 Insulin receptor substrates 15

1.4 Downstream signalling pathways 23

1.5 The basis of insulin’s signalling specificity 37

1.6 Conclusion 38

References 39

2 Insulin-mediated Regulation of Glucose Metabolism 63
Daniel Konrad, Assaf Rudich and Amira Klip

2.1 Introduction 63

2.2 Insulin as a master regulator of whole body glucose disposal 63

2.3 Insulin-mediated regulation of glucose metabolic pathways 67

2.4 Glucose uptake into skeletal muscle – the rate-limiting step in glucose metabolism 69

Acknowledgements 78

References 78

3 Insulin Action on Lipid Metabolism 87
Keith N. Frayn and Fredrik Karpe

3.1 Introduction: does insulin affect lipid metabolism? 87

3.2 Molecular mechanisms by which insulin regulates lipid metabolism 88

3.3 Insulin and lipolysis 89

3.4 Insulin, lipoprotein lipase and cellular fatty acid uptake 94

3.5 Co-ordinated regulation of fatty acid synthesis and ketogenesis 96

3.6 Insulin and cholesterol synthesis 97

3.7 Insulin effects on lipoprotein metabolism 98

Acknowledgement 99

References 99

4 The Effect of Insulin on Protein Metabolism 105
Laura J. S. Greenlund and K. Sreekumaran Nair

4.1 Introduction 105

4.2 Molecular mechanisms of insulin’s effect on protein turnover 107

4.3 Measurement of protein metabolism (synthesis and breakdown or turnover) in human subjects 111

4.4 Whole body and regional protein turnover 114

Acknowledgements 125

References 125

5 Genetically Modified Mouse Models of Insulin Resistance 133
Gema Medina-Gomez, Christopher Lelliott and Antonio J. Vidal-Puig

5.1 Introduction 133

5.2 Genetic modification as a tool to dissect the mechanisms leading to insulin resistance 134

5.3 Candidate genes involved in the mechanisms of insulin resistance 134

5.4 Insulin signalling network 136

5.5 Factors leading to insulin resistance 137

5.6 Defining the function of the insulin cascade molecules through global knockouts 137

5.7 Double heterozygous mice as models of polygenic forms of diabetes 139

5.8 Defining tissue and/or organ relevance for the maintenance of insulin sensitivity 140

5.9 Genetically modified mice to study modulators of insulin sensitivity 142

5.10 Lipodystrophy versus obesity, the insulin resistance paradox 143

5.11 Excess of nutrients as a cause of insulin resistance 147

5.12 PPARs, key mediators of nutritional-regulated gene expression and insulin sensitivity 148

References 148

6 Insulin Resistance in Glucose Disposal and Production in Man with Specific Reference to Metabolic Syndrome and Type 2 Diabetes 155
Henning Beck-Nielsen, Frank Alford and Ole Hother-Nielsen

6.1 Introduction 155

6.2 Measurement of insulin resistance 157

6.3 Insulin-resistant states 162

6.4 Conclusion and perspectives 171

References 172

7 Central Regulation of Peripheral Glucose Metabolism 179
Stanley M. Hileman and Christian Bjørbæk

7.1 Introduction 179

7.2 Counter-regulation of hypoglycaemia – role of the CNS 180

7.3 Brain regions involved in counter-regulation 182

7.4 Glucosensing neurons 184

7.5 Central control of peripheral organs involved in glucoregulation 187

7.6 Additional afferent signals to the CNS regulating peripheral glucose metabolism 189

7.7 Conclusions and future perspectives 194

Acknowledgements 196

References 196

8 Relationship between Fat Distribution and Insulin Resistance 207
Philip G. McTernan, Aresh Anwar and Sudhesh Kumar

8.1 Introduction 207

8.2 Fat and its distribution 207

8.3 Basis for variation in adipose tissue mass 209

8.4 Change in adipocyte phenotype with obesity 210

8.5 Obesity and its association with insulin resistance 210

8.6 Subcutaneous and visceral adipose tissue 211

8.7 The pathogenic significance of abdominal adipose tissue 211

8.8 Potential mechanisms linking central obesity to the metabolic syndrome 212

8.9 Randle hypothesis/glucose–fatty acid hypothesis 212

8.10 Alternatives to the Randle hypothesis 213

8.11 Ectopic fat storage: fat content in obesity 214

8.12 Adipose tissue as an endocrine organ 214

8.13 Plasminogen activator–inhibitor 1 215

8.14 Renin angiotensin system in adipose tissue 216

8.15 Visceral obesity and steroid hormone metabolism 217

8.16 Glucocorticoid metabolism and obesity 217

8.17 11β-hydroxysteroid dehydrogenase (11β-HSD) 218

8.18 Isoenzymes of 11β-HSD 218

8.19 11β-HSD and obesity 219

8.20 Sex steroid metabolism and obesity: oestrogen biosynthesis 220

8.21 Aromatase 220

8.22 Sex steroids and body fat 222

8.23 Summary 224

Acknowledgement 224

References 224

9 PPARγ and Glucose Homeostasis 237
Robert K. Semple and Stephen O’Rahilly

9.1 Evidence from cell and rodent models 238

9.2 Insights from human studies 251

References 256

10 Adipokines and Insulin Resistance 269
Daniel K. Clarke and Vidya Mohamed-Ali

10.1 Obesity and insulin resistance 270

10.2 Adipokines implicated in insulin resistance 272

10.3 Conclusions 280

References 280

11 Dietary Factors and Insulin Resistance 297
Jeremy Krebs and Susan Jebb

11.1 Introduction 297

11.2 The importance of body fatness 298

11.3 Specific dietary factors 302

11.4 Summary 310

References 311

12 Physical Activity and Insulin Resistance 317
Nicholas J. Wareham, Søren Brage, Paul W. Franks and Rebecca A. Abbott

12.1 Introduction 317

12.2 Evidence from observational studies of the association between physical activity and insulin resistance 318

12.3 Summary of findings from observational studies in adults 318

12.4 Summary of findings from observational studies in children and adolescents 340

12.5 Mechanisms underlying the association between physical activity and insulin resistance 351

12.6 Trials of the effect of physical activity on insulin sensitivity in adults 353

12.7 Trials of the effect of physical activity on insulin sensitivity in children and adolescents 374

12.8 Evidence of heterogeneity of the effect of physical inactivity on insulin resistance in sub-groups of the population 375

12.9 Conclusions 385

References 386

13 Genetics of the Metabolic Syndrome 401
George Argyropoulos, Steven Smith and Claude Bouchard

13.1 Historical perspective 401

13.2 Pathophysiology 404

13.3 Genetic epidemiology 407

13.4 Monogenic disorders 411

13.5 Candidate genes 414

13.6 Genomic scans 426

13.7 Conclusions 427

References 427

14 Insulin Resistance and Dyslipidaemia 451
Benoît Lamarche and Jean-François Mauger

14.1 Introduction 451

14.2 Historical notes 451

14.3 Obesity versus the insulin resistance syndrome 453

14.4 Hypertriglyceridaemia 453

14.5 Reduced HDL cholesterol concentrations 455

14.6 Small, dense LDL particles 457

14.7 LDL cholesterol levels versus LDL particle number 459

14.8 Insulin resistance, dyslipidaemia and the risk of cardiovascular disease 460

14.9 Conclusions 461

References 461

15 Insulin Resistance, Hypertension and Endothelial Dysfunction 467
Stephen J. Cleland and John M. C. Connell

15.1 Introduction 467

15.2 Hyperinsulinaemia, insulin resistance and hypertension 467

15.3 Possible mechanisms linking insulin with blood pressure 468

15.4 Atherosclerosis and insulin resistance 469

15.5 Vascular endothelial dysfunction and mechanisms of atherothrombotic disease 469

15.6 Direct vascular action of insulin 471

15.7 What causes abnormal insulin signalling in metabolic and vascular tissues? 474

15.8 Summary and conclusions (Figure 15.8) 477

References 478

16 Insulin Resistance and Polycystic Ovary Syndrome 485
Neus Potau

16.1 Introduction 485

16.2 Definition of polycystic ovary syndrome (PCOS) and diagnostic criteria 486

16.3 Hyperandrogenism and hyperinsulinism 489

16.4 Assessment of insulin resistance in PCOS 491

16.5 Gene studies on PCOS 492

16.6 Premature pubarche, hyperinsulinism and PCOS 495

16.7 Treatment approach with antiandrogens 497

16.8 Treatment approach with insulin sensitizers (metformin) 498

16.9 Treatment approach with insulin sensitizers (thiazolidinediones) 501

16.10 Conclusion 502

References 502

17 Syndromes of Severe Insulin Resistance (SSIRs) 511
David Savage and Stephen O’Rahilly

17.1 Introduction 511

17.2 General biochemical and clinical features of severe insulin resistance 512

17.3 Classification of specific syndromes of insulin resistance 514

17.4 Primary disorders of insulin action 515

17.5 Lipodystrophic syndromes and a lipocentric approach to diabetes 518

17.6 Complex genetic syndromes associated with severe insulin resistance 525

17.7 Therapeutic options in the syndromes of severe insulin resistance 526

References 527

18 Therapeutic Strategies for Insulin Resistance 535
Harpal S. Randeva, Margaret Clarke and Sudhesh Kumar

18.1 Introduction 535

18.2 Obesity and insulin resistance 535

18.3 Management of obesity 537

18.4 Dietary management of obesity 539

18.5 Exercise and physical activity 540

18.6 Anti-obesity drugs 540

18.7 Surgical management of obesity 543

18.8 Pharmacological treatment of insulin resistance 544

18.9 Insulin sensitizers and cardiovascular risk factors 551

18.10 Conclusions 553

References 554

19 Drug Therapy for Insulin Resistance – a Look at the Future 561
Bei B. Zhang and David E. Moller

19.1 Introduction 561

19.2 Targeting molecules within the insulin signal transduction pathway 563

19.3 Targeting negative modulators of insulin signalling 567

19.4 Targeting obesity and insulin resistance 569

References 575

Index 587

Subject Areas: Family & health [VF]

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