Diabetes
dysfunctional metabolic sensing of blood sugar
insulin normally stimulates the uptake of glucose from the blood
incidence rapidly increasing
diabetes type 1
genetically
no insulin production in the pancreas
diabetes type 2
target tissue doesn’t respond to insulin
triggered with age & lifestyle (consume more processed food (lipids) than glucides
metabolic syndrome
central obesity
high blood pressure
high triglycerides
low HDL-cholesterol
insulin resistance
10-30%
increases with age
more frequent in woman
depends on ethnic origin
nutrition and longevity
live longer with caloric restrictions
imbalance body energy homeostasis
obesity, diabetes type 2, cardiovascular diseases
on the cellular scale: apoptosis, energy stress
molecular mechanisms of cellular energy homeostasis
enzymatic phosphotransfer
metabolic feedback
cell signaling by protein kinases
transcriptional regulation
principle of cell signaling
extracellular signal molecule sensed by receptor protein in the membrane
intracellular signaling protein cascade—>transmission of activation state
activation target protein (altered metabolism, altered gene expression, altered cell shape or movement)
Molecular switches
have on and off-state
reversible addition of phosphate group to proteins altering the nucleotide state of a small G-protein
signaling by phosphorylation: reversible phosphorylation of the protein
signaling by GTP-binding protein: exchange between GDP & GTP (GTP bound active protein)
Energy and nutrient sensing and signaling
Insulin receptor IR phosphorylated upon binding of insulin
phosphorylation cascade via insulin receptor substrate IRS
activation of Akt (central kinase, triggers many cellular pathways)
inhibits TSC2 which normally dephosphorylates Rheb to inactive Rheb-GDP
due to inhibition active Rheb-GTP
phosphorylation of mTOR—>activated mTOR leads to protein synthesis (use of energy for proliferation)
amino acids also activate mTOR, but in the absence of glucose TSC2 active & inactive Rheb-GDP—>reduced protein synthesis
energy: AMPK sense rati between AMP/ATP, activated at low levels of energy —>activates TSC2—>inactivation Rheb & mTOR inactive—>downregulation of protein synthesis (high energy consumption
Glucose / insulin sensing
via Akt
insulin binding to IR leads to phosphorylation of IRS-1 recruiting GRB2 (activation Ras pathway)
IRS-1 activates PI-3 kinase: phosphorylation membrane lipid PIP2 to PIP3 (back via PTEN)
PIP3 binds protein kinase Akt which is activated by other protein kinases
Akt catalyzes the phosphorylation of key proteins leading to an increase in glycogen synthase activity & recruitment of glucose transporter GLUT4
pathways triggered by IR
enzymes/transporters regulated in activity—>direct response in cytosol
goes into the nucleus & changes gene expression—>slow response, longterm changes
Amino acid sensing
via mTOR
mTOR
mTORC1 involved in insulin pathway & AA sensing —>ribosome biogenesis & translation
mTORC2 involved in WNT pathway (different subunits in heterotrimer)—>works on the cytoskeleton
also stimulation of gene expression & protein synthesis
energy sensing and signaling
via AMPK
second messenger for low energy state
AMP
ATP stable for a long time as regenerated via adenylate kinase (2 ADP —> AMP+ATP)
AMP concentration changes over 4 orders of magnitude, ATP rather stable—>better to sense ADP & AMP
Regulation of energy homeostasis by AMPK
in catabolism normally rephosphorylation of ADP to ATP
if limited/too much ATP consumed accumulation ADP & activation adenylate kinase—>accumulation AMP
activates AMPK (disequilibrium ATP/AMP) —>accelerated ATP regeneration and slows down ATP consumption
inhibition catabolism: under metabolic stress (hypoxia, glucose deprivation, metformin)
increased ATP consumption under cell growth/division, activation of motor proteins
activation AMP-activated protein kinase
allosteric activation: allosteric binding of AMP, conformational change exposes phosphorylation site
LKB1/CamKKß: phosphorylates AMP bound AMPK to activate it, itself controlled by endocrine signals & calcium (extracellular signals)
PP2Cα: phosphatase inactivating AMPK, inhibited by ADP&
activated aMPK: increases catabolic pathways & decreases anabolic pathways
targets of AMPK
Glucose metabolism
—>increase glucose uptake (GLUT4/1), glycolysis
Lipid metabolism
—>increased fatty acid uptake, oxidation & synthesis
protein metabolism
—>decreased rRNA & protein synthesis
mitochondrial biogenesis & autophagy
AMPK structure
complex of 3 subunits
α chain with kinase domain, ß &γ regulatory
γ has a binding site for AMP & regulates kinase activity
—>upon binding big conformational change allows phosphorylation of threonine
interplay of the subunits allows sensing & regulation
pharmacological activators of AMPK
metformin/phenformin: slight increase in AMP leads to chronic basal activation of AMPK at chronic low level
AICAR: metabolized to AMP analog ZMP activating AMPK but many side effects
A-769662 (binds ß subunit AMPK)
PT1 acts on α-subunit (with kinase domain)
AMPK in human pathophysiology
regulation of insulin-dependent glucose uptake and fat utilization - potential drug for diabetes type II (AMPK activators)
AMPK against metabolic syndrome
AMPK stimulated by adiponectin, metformin, TZD —>activation has same effect as exercise & low calorie intake—>benefical against metabolic syndrome
benefits AMPK activation
decrease: glucose, lipid synthesis
increase: insulin sensitivity, mitochondrial biogenesis, lipid oxidation
exercise mimetic
AMPK therapy for type II diabetes
via acitvation of AMPK
sensitize tissue for insulin & accelerate glycolysis (activation of rate-limiting enzyme phosphofructokinase PFK1 via allosteric activation with fructose 2,6 bisphosphate generated by PFK2)
activate translocation of GLUT4 on the insulin-independent pathway
fatty acid import into mitochondria
transport of activated fatty acids = acyl CoA with Carnitine Palmitoyltransferase CPTI as Acyl-Carnitine
uptake of lipids into mitochondria limiting step for ß-oxidation
AMPK switch controling fat metabolism
AMPK inhibits Acetyl-CoA carboxylase ACC —>prevents fatty acid synthesis due to the reduction of malonyl-CoA
activation CPT1 & uptake of fatty acids in mitochondria and fatty acid oxidation
without AMPK fatty acid synthesis & inhibition of CPT1 when enough glucose present
inhibition by malonyl-CoA
AMPK controls body energy balance
has different effects on different organs
hypothalamus: reduced food intake by leptin mediated by decreased AMPK activity
increased food intake by ghrelin is mediated by stimulated AMPK activity
in heart FA oxidation, glucose uptake & glycolysis
cant be used to lower blood glucose in diabetes type II as too many side effects
AMPK activators as mediators of morphological and metabolic adaptations to exercise
used in AICAR doping
production of nucleotide analog ZMP and activation AMPK
used widely even if not tested in humans before, nowadays detectable
familial cardiac hypertrophy
due to mutations in γ-subunit causing glycogen storage diseases
AMPK inhibition?
leads to reduced but constitutive AMPK activation
mutation close to the AMP binding side
altered glycogen storage and cell growth, mainly causing cardiac syndrome
AMPK as tumorsuppressor
AMPK upstream kinase LKB1 is a tumor suppressor and metformin reduces cancer incidence
slows down protein synthesis & cell cycle progression—>diminishes proliferation bad in the early stage of cancer
in the beginning inhibitory effect on cancer might be used as prevention against hereditary cancer but would need tight surveilence
AMPK in advanced solid tumors
metabolic adaptation and resistance against apoptosis mediated by AMPK (would need inhibitor)
anti-stress factor in solid tumors where cellular metabolism is not in equilibrium
release of ATP would allow cell division & protein synthesis
in later stages rather tumor progressor
mTOR tumorsuppressor
used to shut down protein synthesis
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