11Β-Hydroxysteroid Dehydrogenase Type 1 Regulates Glucocorticoid-Induced Insulin Resistance in Skeletal Muscle
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Diabetes Publish Ahead of Print, published online August 12, 2009 11β-HSD1 and skeletal muscle 11β-hydroxysteroid dehydrogenase type 1 regulates glucocorticoid-induced insulin resistance in skeletal muscle Stuart A Morgan1, Mark Sherlock1, Laura L Gathercole1, Gareth G Lavery1, Carol Lenaghan3, Iwona J Bujalska1, David Laber3, Alice Yu3, Gemma Convey3, Rachel Mayers3, Krisztina Hegyi2, Jaswinder K Sethi2, Paul M Stewart1, David M Smith3 and Jeremy W Tomlinson1 1. Centre for Endocrinology, Diabetes and Metabolism, Institute of Biomedical Research, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK. B15 2TT 2. Department of Clinical Biochemistry, University of Cambridge Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ 3. AstraZeneca Diabetes & Obesity Drug Discovery, Mereside, Alderley Park, Macclesfield, Cheshire, UK. SK10 4TG Brief title: 11β-HSD1 and skeletal muscle Address for correspondence: Jeremy W Tomlinson PhD MRCP E-mail. [email protected] Submitted 9 April 2009 and accepted 16 July 2009. This is an uncopyedited electronic version of an article accepted for publication in Diabetes. The American Diabetes Association, publisher of Diabetes, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version will be available in a future issue of Diabetes in print and online at http://diabetes.diabetesjournals.org. Copyright American Diabetes Association, Inc., 2009 11β-HSD1 and skeletal muscle Objective: Glucocorticoid (GC) excess is characterized by increased adiposity, skeletal myopathy and insulin resistance, but the precise molecular mechanisms are unknown. Within skeletal muscle, 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) converts cortisone (11- dehydrocorticosterone, 11DHC in rodents) to active cortisol (corticosterone in rodents). We aimed to determine the mechanisms underpinning GC-induced insulin resistance in skeletal muscle and indentify how 11βHSD1 inhibitors improve insulin sensitivity. Research Design and Methods: Rodent and human cell cultures, whole tissue explants and animal models were used to determine the impact of GCs and selective 11β-HSD1 inhibition upon insulin signalling and action. Results: Dexamethasone (Dex), decreased insulin-stimulated glucose uptake, decreased IRS1 mRNA and protein expression and increased inactivating pSer307 IRS1. 11β-HSD1 activity and expression were observed in human and rodent myotubes and muscle explants. Activity was predominantly oxo-reductase, generating active GC. A1 (selective 11β-HSD1 inhibitor) abolished enzyme activity and blocked the increase in pSer307 IRS1 and reduction in total IRS1 protein following treatment with 11DHC, but not corticosterone. In C57Bl6/J mice, the selective 11β-HSD1 inhibitor, A2, decreased fasting blood glucose levels and improved insulin sensitivity. In KK mice treated with A2, skeletal muscle pSer307 IRS1 decreased and pTh308 Akt/PKB increased. In addition, A2 decreased both lipogenic and lipolytic gene expression. Conclusion: Pre-receptor facilitation of GC action via 11β-HSD1 increases pSer307 IRS1 and may be crucial in mediating insulin resistance in skeletal muscle. Selective 11β-HSD1 inhibition decreases pSer307 IRS1, increases pTh308 Akt/PKB and decreases lipogenic and lipolytic gene expression which may represent an important mechanism underpinning their insulin sensitizing action. 2 11β-HSD1 and skeletal muscle he pathophysiological effects intracellular domain of the receptor and are of glucocorticoids (GC) are phosphorylated at multiple tyrosine residues T well described and impact upon by the receptor-tyrosine kinase to permit the almost all organ systems within the body. docking of phosphatidylinositol-3-kinase This is highlighted in patients with GC (PI3K) and subsequent generation of excess, Cushing’s syndrome characterised by PI(3,4,5)P3. Generation of this second central obesity, hypertension, proximal messenger acts to recruit the Akt/PKB family myopathy, insulin resistance and in some of serine/theonine kinases to the plasma cases overt type 2 diabetes (T2DM). In membrane which are then activated (6). addition, up to 2.5% of the population are Further downstream, activated Akt1/PKB taking prescribed GCs (1), and their side phosphorylates a rab-GAP (GTPase) protein, effects represent a considerable clinical AS160, which is crucial regulator of the burden for both patient and clinician. translocation of GLUT4 glucose transporter GCs induce whole body insulin storage vesicles to the plasma membrane (7) resistance (2), however the precise molecular and it is this mechanism that permits insulin- mechanism that underpin this observation stimulated glucose entry into target tissues have not been defined in detail. In simple including skeletal muscle (8). obesity and insulin resistance, circulating The molecular mechanisms cortisol levels are not elevated (3), but in key underpinning insulin resistance are complex insulin target tissues including liver, fat and and variable. Serine/threonine muscle, GC availability to bind and activate phosphorylation of IRS1 (in particular serine- the GC receptor (GR) is controlled by 11β- 307 phosphorylation) has been shown to hydroxysteroid dehydrogenase type 1 (11β- negatively regulate insulin signalling through HSD1). 11β-HSD1 is an endo-lumenal multiple mechanisms including decreased enzyme that inter-converts inactive (cortisone affinity for the insulin receptor and increased in humans and 11-dehydrocorticosterone degradation (9;10). (11DHC) in rodents) and active GCs (cortisol The interaction of GC and the insulin in humans and corticosterone (CORT) in signalling cascade has only been examined in rodents) (4). Critically, the directionality of a small number of studies which have offered 11β-HSD1 activity is cofactor (NADPH) variable explanations for the induction of dependent which is supplied by a tightly insulin resistance (11-14). Importantly, the associated endo-lumenal enzyme, Hexose-6- role of serine phosphorylation and the impact phopshate dehydrogenase (H6PDH). of pre-receptor GC metabolism have not been Decreases in H6PDH expression and activity explored. The 11β-HSD1 knockout mouse is decrease 11β-HSD1 oxo-reductase and relatively insulin sensitive (15) and specific increase dehydrogenase activity (5). Despite inhibitors of 11β-HSD1 improve lipid this bidirectional potential, the predominant profiles, glucose tolerance and insulin direction of activity in liver, adipose and sensitivity and have considerable potential as muscle is oxo-reductase generating active GC therapeutic agents (16-18). However the (cortisol and CORT) therefore amplifying molecular mechanisms that underpin these local GC action. observations remain to be defined. Binding of insulin to its cell surface We have therefore characterized the receptor leads to a conformational change and impact of GCs upon the insulin signalling tyrosine autophosphorylation. Consequently, cascade and analyzed the expression, activity the insulin receptor substrate (IRS) family of adaptor proteins are recruited to the 3 11β-HSD1 and skeletal muscle and functional impact of 11β-HSD1 in vitro provided through material transfer agreements and using in vivo mouse models with AstraZeneca (Macclesfield, UK). Inhibitor properties are presented within the RESEARCH DESIGN AND METHODS: results section. Cell culture. Mouse skeletal muscle RNA extraction, RT and Real-Time cell line, C2C12 myoblasts (ECACC, UK) PCR. Total RNA was extracted from cell were grown in DMEM (PAA, UK) lysates using the Tri-Reagent system and supplemented with 10% FBS (37°C, 5% from whole tissue explants using RNeasy CO2). Cells were grown to 60-70% Fibrous Tissue Mini Kit (Qiagen). Integrity, confluence before differentiation (initiated by concentration and reverse transcription were replacing growth media with DMEM with 5% performed as we have previously described horse serum). After 8 days, myoblasts had (20). Specific mRNA levels were determined fused to form multinucleated myotubes. Prior using an ABI 7500 sequence detection system to treatment, cells were washed out with (Perkin-Elmer Applied Biosystems, serum free media for 4 hours. For Warrington, UK). Reactions were performed experiments examining serine-24 in 20µl volumes on 96-well plates in reaction phosphorylation, C2C12 cells stably over- buffer containing 2 x TaqMan Universal PCR expressing myc-rIRS1 were generated and Master mix (Applied Biosystems, Foster City, used as described previously for 3T3-L1 CA, USA). Probes and primers for all genes adipocytes (19). were supplied by applied biosystems ‘assay Primary human myoblasts were on demand’ (Applied Biosystems). All obtained from PromoCell (Heidelberg, reactions were normalised against 18S rRNA Germany). Myoblasts were cultured to as an internal house keeping gene. confluence, as per the manufactures Data were obtained as ct values (ct=cycle guidelines using the supplied media. Once number at which logarithmic PCR plots cross confluent, media was changed to a chemically a calculated threshold line) and used to defined media (PromoCell, Germany) determine ∆ct values (∆ct = (ct of the target including 2% horse serum and cells gene) – (ct of the housekeeping gene). Data differentiated into myotubes for 11 days. are expressed as arbitrary units using the Following differentiation, cells were following transformation [expression