Background: Mechanisms of insulin resistance in type 2 diabetes are not known. Results: A first dynamic mathematical model based on data from human adipocytes yields systems level understanding of insulin resistance. Conclusion: Attenuation of an mTORC1-derived feedback in diabetes explains reduced sensitivity and signal strength throughout the insulin-signaling network. Significance: Findings give a molecular basis for insulin resistance in the signaling network.

Type 2 diabetes is a metabolic disease that profoundly affects energy homeostasis. The disease involves failure at several levels and subsystems and is characterized by insulin resistance in target cells and tissues (i.e. by impaired intracellular insulin signaling). We have previously used an iterative experimental-theoretical approach to unravel the early insulin signaling events in primary human adipocytes. That study, like most insulin signaling studies, is based on in vitro experimental examination of cells, and the in vivo relevance of such studies for human beings has not been systematically examined. Herein, we develop a hierarchical model of the adipose tissue, which links intracellular insulin control of glucose transport in human primary adipocytes with whole-body glucose homeostasis. An iterative approach between experiments and minimal modeling allowed us to conclude that it is not possible to scale up the experimentally determined glucose uptake by the isolated adipocytes to match the glucose uptake profile of the adipose tissue in vivo. However, a model that additionally includes insulin effects on blood flow in the adipose tissue and GLUT4 translocation due to cell handling can explain all data, but neither of these additions is sufficient independently. We also extend the minimal model to include hierarchical dynamic links to more detailed models (both to our own models and to those by others), which act as submodules that can be turned on or off. The resulting multilevel hierarchical model can merge detailed results on different subsystems into a coherent understanding of whole-body glucose homeostasis. This hierarchical modeling can potentially create bridges between other experimental model systems and the in vivo human situation and offers a framework for systematic evaluation of the physiological relevance of in vitro obtained molecular/cellular experimental data.

Background: Molecular mechanisms of insulin resistance in diabetes are poorly understood. Results: Quantitative systems-wide data reveal that a single mechanism can explain insulin resistance throughout the signaling network in human adipocytes. Conclusion:The most important aspect of the insulin resistance mechanism is an attenuated feedback signal. Significance: The study demonstrates how insulin resistance originates and propagates throughout the signaling network in cells from patients with diabetes.

Insulin resistance is a major aspect of type 2 diabetes (T2D), which results from impaired insulin signaling in target cells. Signaling to regulate forkhead box protein O1 (FOXO1) may be the most important mechanism for insulin to control transcription. Despite this, little is known about how insulin regulates FOXO1 and how FOXO1 may contribute to insulin resistance in adipocytes, which are the most critical cell type in the development of insulin resistance. We report a detailed mechanistic analysis of insulin control of FOXO1 in human adipocytes obtained from non-diabetic subjects and from patients with T2D. We show that FOXO1 is mainly phosphorylated through mTORC2-mediated phosphorylation of protein kinase B at Ser 473 and that this mechanism is unperturbed in T2D. We also demonstrate a cross-talk from the MAPK branch of insulin signaling to stimulate phosphorylation of FOXO1. The cellular abundance and consequently activity of FOXO1 are halved in T2D. Interestingly, inhibition of mTORC1 with rapamycin reduces the abundance of FOXO1 to the levels in T2D. This suggests that the reduction of the concentration of FOXO1 is a consequence of attenuation of mTORC1, which defines much of the diabetic state in human adipocytes. We integrate insulin control of FOXO1 in a network-wide mathematical model of insulin signaling dynamics based on compatible data from human adipocytes. The diabetic state is network-wide explained by attenuation of an mTORC1-to-insulin receptor substrate-1 (IRS1) feedback and reduced abundances of insulin receptor, GLUT4, AS160, ribosomal protein S6, and FOXO1. The model demonstrates that attenuation of the mTORC1-to-IRS1 feedback is a major mechanism of insulin resistance in the diabetic state.Insulin has a crucial function to maintain energy homeostasis at the whole-body level and at the cellular level in a variable environment of nutrient supply. Failure to sustain this function is at the center of diabetes. Type 2 diabetes (T2D) 2 is characterized by failure to properly respond to insulin in target cells (insulin resistance) and by impaired production of the hormone. Because of the central role of insulin in energy homeostasis, effects of insulin are pleiotropic, affecting almost every aspect of cellular metabolism, which is reflected in a highly branched signaling network in target cells of the hormone. T2D is also closely related to obesity (1), and the insulin resistance first develops in the adipocytes of an expanding adipose tissue. Failure to store fat in the adipose tissue then leads to ectopic fat deposition in other organs, such as liver and muscle, which is believed to spread the insulin resistance to those organs (2). Eventually the insulin-producing ␤-cells often fail to compensate for the insulin resistance, and T2D can be diagnosed. It is therefore of primary importance to understand the disease mechanisms in human adipocytes to be able to treat the disease at an early stage before other organs are affected.Forkhead box protein O1 (FOXO1) may be the most important mediator o...