-AMP-activated protein kinase (AMPK) is a meta-bolic stress sensor present in all eukaryotes. A dominant missense mutation (R225Q) in pig PRKAG3, encoding the muscle-specific ␥3 isoform, causes a marked increase in glycogen content. To determine the functional role of the AMPK ␥3 isoform, we generated transgenic mice with skeletal muscle-specific expression of wild type or mutant (225Q) mouse ␥3 as well as Prkag3 knockout mice. Glycogen resynthesis after exercise was impaired in AMPK ␥3 knock-out mice and markedly enhanced in transgenic mutant mice. An AMPK activator failed to increase skeletal muscle glucose uptake in AMPK ␥3 knock-out mice, whereas contraction effects were preserved. When placed on a high fat diet, transgenic mutant mice but not knock-out mice were protected against excessive triglyceride accumulation and insulin resistance in skeletal muscle. Transfection experiments reveal the R225Q mutation is associated with higher basal AMPK activity and diminished AMP dependence. Our results validate the muscle-specific AMPK ␥3 isoform as a therapeutic target for prevention and treatment of insulin resistance.AMPK 1 is a heterotrimeric serine/threonine protein kinase composed of a catalytic ␣ subunit and non-catalytic ␤ and ␥ subunits (1, 2). The mammalian genome contains seven AMPK genes encoding two ␣, two ␤, and three ␥ isoforms. AMPK signaling is elicited by cellular stresses that deplete ATP (and consequently elevate AMP) by either inhibiting ATP production (e.g. hypoxia) or accelerating ATP consumption (e.g. muscle contraction). AMPK is activated allosterically by AMP and through phosphorylation of Thr 172 in the ␣ subunit by an upstream AMPK kinase, the tumor-suppressor protein kinase LKB1 (3, 4). AMPK is likely to be important for diverse functions in many cell types, but particular interest has been focused on elucidating the role of AMPK in the regulation of lipid and carbohydrate metabolism in skeletal muscle (5-10). AMPK activity has been correlated with an increase in glucose uptake and fatty acid oxidation and an inhibition of glycogen synthase activity and fatty acid synthesis. Exercise, as well as skeletal muscle contractions in vitro, leads to AMPK activation. Pharmacological activation of AMPK also can be achieved using 5-aminoimidazole-4-carboxamide-1-␤-D-ribonucleoside (AICAR). Once taken up by the cell, AICAR is phosphorylated to 5-aminoimidazole-4-carboxamide riboside monophosphate (ZMP) and mimics effects of AMP on AMPK (1, 2). AMPK function is closely related to glycogen storage. AMPK phosphorylates glycogen synthase in vitro (11) and co-immunoprecipitates with glycogen synthase and glycogen phosphorylase from skeletal muscle (12). Mutations of the ␥3 or ␥2 subunit, respectively, affect glycogen storage in pigs (13, 14) or glycogen storage associated with cardiac abnormalities in humans (15). The recent identification of a glycogen-binding domain in the AMPK ␤1 subunit provides a molecular relationship between AMPK and glycogen (16,17). The formation of heterotrimers appears to be...

The AMP-activated protein kinase (AMPK) is a metabolic-stress-sensing protein kinase that regulates metabolism in response to energy demand and supply by directly phosphorylating rate-limiting enzymes in metabolic pathways as well as controlling gene expression.

Background-Mutations in the ␥ 2 subunit (PRKAG2) of AMP-activated protein kinase produce an unusual human cardiomyopathy characterized by ventricular hypertrophy and electrophysiological abnormalities: Wolff-ParkinsonWhite syndrome (WPW) and progressive degenerative conduction system disease. Pathological examinations of affected human hearts reveal vacuoles containing amylopectin, a glycogen-related substance. Methods and Results-To elucidate the mechanism by which PRKAG2 mutations produce hypertrophy with electrophysiological abnormalities, we constructed transgenic mice overexpressing the PRKAG2 cDNA with or without a missense N488I human mutation. Transgenic mutant mice showed elevated AMP-activated protein kinase activity, accumulated large amounts of cardiac glycogen (30-fold above normal), developed dramatic left ventricular hypertrophy, and exhibited ventricular preexcitation and sinus node dysfunction. Electrophysiological testing demonstrated alternative atrioventricular conduction pathways consistent with WPW. Cardiac histopathology revealed that the annulus fibrosis, which normally insulates the ventricles from inappropriate excitation by the atria, was disrupted by glycogen-filled myocytes. These anomalous microscopic atrioventricular connections, rather than morphologically distinct bypass tracts, appeared to provide the anatomic substrate for ventricular preexcitation. Conclusions-Our data establish PRKAG2 mutations as a glycogen storage cardiomyopathy, provide an anatomic explanation for electrophysiological findings, and implicate disruption of the annulus fibrosis by glycogen-engorged myocytes as the cause of preexcitation in Pompe, Danon, and other glycogen storage diseases.