Some Approaches to an Understanding of the Molecular Pathway of Insulin Resistance.
Activation of hormone receptors often initiates reactions that dampen the effects of that hormone. One of the first systems which was identified was the adrenergic beta receptor kinase or "ßark" reaction. Here, activation of the beta adrenergic receptor activates a kinase (ßark) that phosphorylates and inactivates the beta adrenergic receptor. A similar "feedback" effect is seen in the case of the insulin receptor. A family of proteins known as "suppressor of cytokine signaling" or SOCS bind to the insulin receptor substrate (IRS 1 and 2) and inhibit their activity. This is but one of the many feedback reactions controlling insulin signaling. Many of these are described in the article by Shepherd. A figure from that article is reproduced here. We can see that activation of the insulin receptor pathway not only activates metabolic enzymes etc., but also initiates "turn-off" reactions. The activated metabolic enzymes phosphorylate members of the signaling family and reduce their activity. Additionally, the SOCS gene is activated and SOCS (or SOCS3 here) is turned on and inhibits the insulin receptor. This diagram is quite complex but in no way underestimates the control mechanisms involved in insulin's action.
Resistance to insulin and the following increased secretion of the hormone from ß-cells is characteristic for people with glucose intolerance. They are on the way toward developing type two diabetes. In most patients the insulin receptors respond normally to the hormone and phosphorylate IRS1and 2. The insulin signal is dampened further down the line. Which of the protein kinase cascades leading from IRS1/2 is affected in the resistant target cells?
Bidding and Kahn have summarized many possible sites for loss of sensitivity to insulin in the figure to the left. No single fail can be pointed out as the cause for insulin resistance. A reduction in the numbers of receptors is found in some few persons. A very small percentage develop antibodies to the receptor. Decreased autophosphorylation of tyrosine residues can follow inflammation of target cell membranes and obesity. Phosphotyrosine and phosphoserine phosphatases can reduce the outcome of receptor activation. Phosphatidylinositol-3 kinase is subject to modification by a number of factors and these will alter IP(3,4,5)P3 levels and insulin signaling.