Although abnormal glucose metabolism defines type 2 diabetes mellitus (T2DM) and accounts for many of its symptoms and complications, efforts to understand the pathogenesis of T2DM are increasingly focused on disordered lipid metabolism. Here we review recent human studies exploring the mechanistic links between disorders of fatty acid/lipid metabolism and insulin resistance. As “mouse models of insulin resistance” were comprehensively reviewed in Physiological Reviews by Nandi et al. in 2004, we will concentrate on human studies involving the use of isotopes and/or magnetic resonance spectroscopy, occasionally drawing on mouse models which provide additional mechanistic insight.

Recent genome-wide association studies have described many loci implicated in type 2 diabetes (T2D) pathophysiology and beta-cell dysfunction, but contributed little to our understanding of the genetic basis of insulin resistance. We hypothesized that genes implicated in insulin resistance pathways may be uncovered by accounting for differences in body mass index (BMI) and potential interaction between BMI and genetic variants. We applied a novel joint meta-analytical approach to test associations with fasting insulin (FI) and glucose (FG) on a genome-wide scale. We present six previously unknown FI loci at P<5×10−8 in combined discovery and follow-up analyses of 52 studies comprising up to 96,496non-diabetic individuals. Risk variants were associated with higher triglyceride and lower HDL cholesterol levels, suggestive of a role for these FI loci in insulin resistance pathways. The localization of these additional loci will aid further characterization of the role of insulin resistance in T2D pathophysiology.

Recent studies in murine models suggest that resistin (also called Fizz3 [1]), a novel cysteine-rich protein secreted by adipocytes, may represent the long-sought link between obesity and insulin resistance (2). Furthermore, peroxisome proliferator-activated receptor-␥ (PPAR-␥) agonists appear to inhibit resistin expression in murine adipocytes, providing a possible explanation for the mode of action of this class of insulin sensitizers (2). Using a fluorescent real-time reverse transcriptase-polymerase chain reaction-based assay, we found that resistin mRNA levels in whole adipose tissue samples were increased in morbidly obese humans compared with lean control subjects. However, in freshly isolated human adipocytes, resistin mRNA levels were very low and showed no correlation with BMI. Resistin mRNA was undetectable in preadipocytes, endothelial cells, and vascular smooth muscle cells, but it was readily detectable in circulating mononuclear cells. Although exposure of human mononuclear cells to PPAR-␥ agonists markedly upregulated fatty acid-binding protein-4 expression, these agents had no effect on mononuclear cell resistin expression. Finally, resistin mRNA was undetectable in adipocytes from a severely insulinresistant subject with a dominant-negative mutation in PPAR-␥ (3). We conclude that the recently described relationships of murine resistin/Fizz3 expression with obesity, insulin resistance, and PPAR-␥ action may not readily translate to humans. Further studies of this novel class of proteins are needed to clarify their roles in human metabolism. Diabetes 50:2199 -2202, 2001 S teppan et al. (2) recently reported a novel cysteine-rich secreted protein, which they termed resistin, the expression of which was markedly decreased by treatment of a murine adipocyte cell line with an agonist of the nuclear hormone receptor peroxisome proliferator-activated receptor-␥ (PPAR-␥). Serum levels of resistin were elevated in obese mice, and immunoneutralization of circulating resistin in these animals improved insulin sensitivity. Administration of recombinant resistin impaired insulin action in vivo in mice and ex vivo in an adipocyte cell line. These observations led the authors to conclude that resistin might represent an adipocyte-derived mediator of the link between obesity and insulin resistance. They also suggested that the suppression of resistin expression by PPAR-␥ agonists might explain the beneficial effects of these compounds in insulin-resistant states. Contrasting conclusions were reached by Way et al. (4), who found reduced resistin mRNA levels in white adipose tissue (WAT) of several obese rodent models. Furthermore, treating these animals with PPAR-␥ agonists increased resistin mRNA levels in WAT. These discrepant observations are difficult to reconcile and indicate the need for further studies. We developed a real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR)-based assay for human resistin using primers based in exons 1 and 2 of the human gene and used it to examine ...

Insulin resistance is a key mediator of obesity-related cardiometabolic disease, yet the mechanisms underlying this link remain obscure. Using an integrative genomic approach, we identify 53 genomic regions associated with insulin resistance phenotypes (higher fasting insulin adjusted for BMI, lower HDL cholesterol and higher triglycerides) and provide evidence that their link with higher cardiometabolic risk is underpinned by an association with lower adipose mass in peripheral compartments. Using these 53 loci, we show a polygenic contribution to familial partial lipodystrophy-type 1, a severe form of insulin resistance, and highlight shared molecular mechanisms between common/mild and rare/severe insulin resistance. Population-level genetic analyses combined with experiments in cellular models implicate CCDC92, DNAH10 and L3MBTL3 as previously unrecognised molecules influencing adipocyte differentiation. Our findings support the notion that limited storage capacity of peripheral adipose tissue is an important aetiological component in insulin-resistant cardiometabolic disease and highlight genes and mechanisms underpinning this link.