Growth differentiation factor 15 (GDF15), a distant member of the transforming growth factor (TGF)-β family, is a secreted protein that circulates as a 25-kDa dimer. In humans, elevated GDF15 correlates with weight loss, and the administration of GDF15 to mice with obesity reduces body weight, at least in part, by decreasing food intake. The mechanisms through which GDF15 reduces body weight remain poorly understood, because the cognate receptor for GDF15 is unknown. Here we show that recombinant GDF15 induces weight loss in mice fed a high-fat diet and in nonhuman primates with spontaneous obesity. Furthermore, we find that GDF15 binds with high affinity to GDNF family receptor α-like (GFRAL), a distant relative of receptors for a distinct class of the TGF-β superfamily ligands. Gfral is expressed in neurons of the area postrema and nucleus of the solitary tract in mice and humans, and genetic deletion of the receptor abrogates the ability of GDF15 to decrease food intake and body weight in mice. In addition, diet-induced obesity and insulin resistance are exacerbated in GFRAL-deficient mice, suggesting a homeostatic role for this receptor in metabolism. Finally, we demonstrate that GDF15-induced cell signaling requires the interaction of GFRAL with the coreceptor RET. Our data identify GFRAL as a new regulator of body weight and as the bona fide receptor mediating the metabolic effects of GDF15, enabling a more comprehensive assessment of GDF15 as a potential pharmacotherapy for the treatment of obesity.

Multiple studies suggest that lipid oversupply to skeletal muscle contributes to the development of insulin resistance, perhaps by promoting the accumulation of lipid metabolites capable of inhibiting signal transduction. Herein we demonstrate that exposing muscle cells to particular saturated free fatty acids (FFAs), but not mono-unsaturated FFAs, inhibits insulin stimulation of Akt/protein kinase B, a serine/threonine kinase that is a central mediator of insulin-stimulated anabolic metabolism. These saturated FFAs concomitantly induced the accumulation of ceramide and diacylglycerol, two products of fatty acyl-CoA that have been shown to accumulate in insulin-resistant tissues and to inhibit early steps in insulin signaling. Preventing de novo ceramide synthesis negated the antagonistic effect of saturated FFAs toward Akt/protein kinase B. Moreover, inducing ceramide buildup recapitulated and augmented the inhibitory effect of saturated FFAs. By contrast, diacylglycerol proved dispensable for these FFA effects. Collectively these results identify ceramide as a necessary and sufficient intermediate linking saturated fats to the inhibition of insulin signaling.The peptide hormone insulin stimulates the uptake and storage of glucose in skeletal muscle and adipose tissue while simultaneously inhibiting its efflux from the liver. In certain pathological conditions, including Type 2 diabetes mellitus (1) and metabolic syndrome X (2), these tissues become resistant to insulin such that a maximal dose of the hormone is unable to elicit these anabolic responses. Numerous studies suggest that the oversupply of lipid to peripheral tissues might contribute to the development of this insulin resistance. First, insulin-resistant subjects frequently display signs of abnormal lipid metabolism including obesity (3), increased circulating free fatty acid (FFA) 1 concentrations (4, 5), and elevated intramyocellular lipid levels (6). In fact, the size of the intramyocellular lipid depot correlates more tightly with the severity of insulin resistance than most known risk factors (6). Second, experimentally exposing peripheral tissues to lipids decreases their sensitivity to insulin. For example, (a) incubating isolated muscle strips or cultured muscle cells with FFAs (7-11), (b) infusing lipid emulsions into rodents or humans (12-15), or (c) expressing lipoprotein lipase in skeletal muscle of transgenic mice (16, 17) promotes intramyocellular lipid accumulation and compromises insulin-stimulated glucose uptake. These observations have prompted investigators to hypothesize that increased availability of lipids to peripheral tissues causes insulin resistance, perhaps by promoting the accumulation of one or more fat-derived metabolites capable of inhibiting insulin action (6, 18). The insulin receptor is a heterotetrameric tyrosine kinase receptor that mediates all of the anabolic effects of insulin (19). The activated receptor phosphorylates intracellular docking molecules (termed insulin receptor substrates, or IRS proteins) that r...

The recent implementation of genomic and lipidomic approaches has produced a large body of evidence implicating the sphingolipid ceramide in a diverse range of physiological processes and as a critical modulator of cellular stress. In this review, we discuss from a historical perspective the most important discoveries produced over the last decade supporting a role for ceramide and its metabolites in the pathogenesis of insulin resistance and other obesity-associated metabolic diseases. Moreover, we describe how a ceramide-centric view of insulin resistance might be reconciled in the context of other prominent models of nutrient-induced insulin resistance.

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GLUT4 trafficking to the plasma membrane of muscle and fat cells is regulated by insulin. An important component of insulin-regulated GLUT4 distribution is the Akt substrate AS160 rab GTPase-activating protein. Here we show that Rab10 functions as a downstream target of AS160 in the insulin-signaling pathway that regulates GLUT4 translocation in adipocytes. Overexpression of a mutant of Rab10 defective for GTP hydrolysis increased GLUT4 on the surface of basal adipocytes. Rab10 knockdown resulted in an attenuation of insulin-induced GLUT4 redistribution to the plasma membrane and a concomitant 2-fold decrease in GLUT4 exocytosis rate. Re-expression of a wild-type Rab10 restored normal GLUT4 translocation. The basal increase in plasma-membrane GLUT4 due to AS160 knockdown was partially blocked by knocking down Rab10 in the same cells, further indicating that Rab10 is a target of AS160 and a positive regulator of GLUT4 trafficking to the cell surface upon insulin stimulation.

Insulin controls glucose flux into muscle and fat by regulating the trafficking of GLUT4 between the interior and surface of cells. Here, we show that the AS160 Rab GTPase activating protein (GAP) is a negative regulator of basal GLUT4 exocytosis. AS160 knockdown resulted in a partial redistribution of GLUT4 from intracellular compartments to the plasma membrane, a concomitant increase in basal glucose uptake, and a 3-fold increase in basal GLUT4 exocytosis. Reexpression of wild-type AS160 restored normal GLUT4 behavior to the knockdown adipocytes, whereas reexpression of a GAP domain mutant did not revert the phenotype, providing the first direct evidence that AS160 GAP activity is required for basal GLUT4 retention. AS160 is the first protein identified that is specially required for basal GLUT4 retention. Our findings that AS160 knockdown only partially releases basal GLUT4 retention provides evidence that insulin signals to GLUT4 exocytosis by both AS160-dependent and -independent mechanisms.

Insulin stimulation of the trafficking of the glucose transporter GLUT4 to the plasma membrane is controlled in part by the phosphorylation of the Rab GAP (GTPase-activating protein) AS160 (also known as Tbc1d4). Considerable evidence indicates that the phosphorylation of this protein by Akt (protein kinase B) leads to suppression of its GAP activity and results in the elevation of the GTP form of a critical Rab. The present study examines a similar Rab GAP, Tbc1d1, about which very little is known. We found that the Rab specificity of the Tbc1d1 GAP domain is identical with that of AS160. Ectopic expression of Tbc1d1 in 3T3-L1 adipocytes blocked insulin-stimulated GLUT4 translocation to the plasma membrane, whereas a point mutant with an inactive GAP domain had no effect. Insulin treatment led to the phosphorylation of Tbc1d1 on an Akt site that is conserved between Tbc1d1 and AS160. These results show that Tbc1d1 regulates GLUT4 translocation through its GAP activity, and is a likely Akt substrate. An allele of Tbc1d1 in which Arg(125) is replaced by tryptophan has very recently been implicated in susceptibility to obesity by genetic analysis. We found that this form of Tbc1d1 also inhibited GLUT4 translocation and that this effect also required a functional GAP domain.

Recent studies indicate that insulin resistance and type 2 diabetes result from the accumulation of lipids in tissues not suited for fat storage, such as skeletal muscle and the liver. To elucidate the mechanisms linking exogenous fats to the inhibition of insulin action, we evaluated the effects of free fatty acids (FFAs) on insulin signal transduction in cultured C2C12 myotubes. As we described previously (Chavez, J. A., and Summers, S. A. The peptide hormone insulin stimulates the uptake and storage of glucose into skeletal muscle while simultaneously repressing glucose efflux from the liver. Insulin resistance occurs when a normal dose of the hormone is incapable of eliciting these anabolic responses, and the condition is a major contributor to the pathogenesis of Type 2 Diabetes Mellitus (1) and Metabolic Syndrome X (2). Insulin resistance is often associated with obesity (3), but the relationship between increased fat stores and the development of insulin resistance in tissues other than adipose is unclear. Researchers hypothesize that increased lipid oversupply to tissues not suited for fat storage accounts for the decreased insulin sensitivity, perhaps by promoting the accumulation of fat-derived metabolites that inhibit insulin signaling and action (3, 4). The studies described herein investigate the role of ceramide, sphingosine, and diacylglycerol as potential mediators of the insulin resistance induced by saturated fats.Insulin initiates its pleiotropic actions through its heterotetrameric receptor with intrinsic tyrosine kinase activity. The activated receptor phosphorylates a family of "insulin receptor substrates" (IRS 1 proteins) that recruit and activate intracellular effector enzymes (5). One of these docking proteins, the lipid kinase phosphatidylinositol 3-kinase, catalyzes the phosphorylation of specific phosphoinositides to generate phosphatidylinositol-3,4-bisphosphate and phosphatidylinositol-3,4,5-trisphosphate. These phosphoinositides trigger a signaling cascade leading to the phosphorylation and activation of the serine/threonine kinase Akt/PKB, which is a central regulator of glucose uptake and anabolic metabolism (6). In particular, mice lacking the Akt2/PKB␤ isoform display insulin resistance in both skeletal muscle and the liver (7).Experimentally exposing peripheral tissues to lipids decreases their sensitivity to insulin. For example, (a) incubating isolated muscle strips with free fatty acids (FFAs) (8 -11), (b) infusing lipid emulsions into rodents or humans (12-15), or (c) expressing lipoprotein lipase in skeletal muscle of transgenic mice (16, 17) compromises insulin-stimulated glucose uptake. The mechanism underlying these inhibitory effects has remained both elusive and controversial. In 1963, Randle et al. (18) proposed the existence of a glucose-fatty acid cycle by which glucose and lipids could serve as competitive substrates for oxidation in muscle. More recent studies suggest that FFAs inhibit at least two independent steps in insulin signaling (9, 11, 19 -21). Spec...