OBJECTIVES-A physiological adaptation to a sugar-rich meal is achieved by increased sugar uptake to match dietary load, resulting from a rapid transient translocation of the fructose/ glucose GLUT2 transporter to the brush border membrane (BBM) of enterocytes. The aim of this study was to define the contributors and physiological mechanisms controlling intestinal sugar absorption, focusing on the action of insulin and the contribution of GLUT2-mediated transport.
RESEARCH DESIGN AND METHODS-The studies were performed in the human enterocytic colon carcinoma TC7 subclone (Caco-2/TC7) cells and in vivo during hyperinsulinemiceuglycemic clamp experiments in conscious mice. Chronic highfructose or high-fat diets were used to induce glucose intolerance and insulin resistance in mice.
RESULTS AND CONCLUSIONS-InCaco-2/TC7 cells, insulin action diminished the transepithelial transfer of sugar and reduced BBM and basolateral membrane (BLM) GLUT2 levels, demonstrating that insulin can target sugar absorption by controlling the membrane localization of GLUT2 in enterocytes. Similarly, in hyperinsulinemic-euglycemic clamp experiments in sensitive mice, insulin abolished GLUT2 (i.e., the cytochalasin B-sensitive component of fructose absorption), decreased BBM GLUT2, and concomitantly increased intracellular GLUT2. Acute insulin treatment before sugar intake prevented the insertion of GLUT2 into the BBM. Insulin resistance in mice provoked a loss of GLUT2 trafficking, and GLUT2 levels remained permanently high in the BBM and low in the BLM. We propose that, in addition to its peripheral effects, insulin inhibits intestinal sugar absorption to prevent excessive blood glucose excursion after a sugar meal. This protective mechanism is lost in the insulin-resistant state induced by high-fat or high-fructose feeding. Diabetes 57: 555-562, 2008 I ntestinal sugar transport constantly adapts to the dietary environment. At low levels, the end products of carbohydrate digestion are absorbed by a twostep membrane-transport process involving the sodium-dependent glucose cotransporter (SGLT1) and the facilitative fructose transporter (GLUT5) in the brush border membrane (BBM) (1) lining the lumen. GLUT2 in the basolateral membrane (BLM) (2) ensures sugar exit into the blood stream (3). The level of sugar absorption is also regulated by a rapid and transient recruitment of GLUT2 into enterocyte BBM (4,5). A high sugar intake is a physiological regulator of this process, increasing monosaccharide uptake threefold in vivo (6). The recruitment of GLUT2 in BBM was also observed in conditions of increased calorie demand and glucagon-like peptide 2 treatment (7-11).The mechanisms by which GLUT2 leaves the BBM in the absence of luminal sugar (interprandial periods) are unknown. Of the possible physiological stimuli occurring during feeding, insulin was thought to be a candidate because it exerts systemic hypoglycemic effects by stimulating the translocation of GLUT4 into the plasma membrane of skeletal muscle and adipose cells (rev. in 12) and d...