OBJECTIVE-Tall-like receptor (TLR)4 has been implicated in the pathogenesis of free fatty acid (FFA)-induced insulin resistance by activating inflammatory pathways, including inhibitor of B (IB)/nuclear factor B (NFB). However, it is not known whether insulin-resistant subjects have abnormal TLR4 signaling. We examined whether insulin-resistant subjects have abnormal TLR4 expression and TLR4-driven (IB/NFB) signaling in skeletal muscle. RESEARCH DESIGN AND METHODS-TLR4gene expression and protein content were measured in muscle biopsies in 7 lean, 8 obese, and 14 type 2 diabetic subjects. A primary human myotube culture system was used to examine whether FFAs stimulate IB/NFB via TLR4 and whether FFAs increase TLR4 expression/content in muscle.RESULTS-Obese and type 2 diabetic subjects had significantly elevated TLR4 gene expression and protein content in muscle. TLR4 muscle protein content correlated with the severity of insulin resistance. Obese and type 2 diabetic subjects also had lower IB␣ content, an indication of elevated IB/NFB signaling. The increase in TLR4 and NFB signaling was accompanied by elevated expression of the NFB-regulated genes interleukin (IL)-6 and superoxide dismutase (SOD)2. In primary human myotubes, acute palmitate treatment stimulated IB/NFB, and blockade of TLR4 prevented the ability of palmitate to stimulate the IB/NFB pathway. Increased TLR4 content and gene expression observed in muscle from insulin-resistant subjects were reproduced by treating myotubes from lean, normal-glucose-tolerant subjects with palmitate. Palmitate also increased IL-6 and SOD2 gene expression, and this effect was prevented by inhibiting NFB.CONCLUSIONS-Abnormal TLR4 expression and signaling, possibly caused by elevated plasma FFA levels, may contribute to the pathogenesis of insulin resistance in humans. Diabetes 57: [2595][2596][2597][2598][2599][2600][2601][2602] 2008 T he mechanism(s) by which free fatty acids (FFAs) cause insulin resistance is not fully understood. Considerable evidence suggests that the deleterious effect of FFAs on insulin action is caused by intramyocellular FFA metabolites that stimulate inflammatory pathways leading to impaired insulin signaling/action (1). However, recent reports demonstrate that FFAs directly can stimulate plasma membrane receptors (2,3), suggesting an alternate model in which FFAs cause insulin resistance by stimulating inflammatory pathways through the direct activation of plasma membrane receptors. Consistent with this hypothesis, FFAs have been shown to bind to toll-like receptor (TLR)4 (4), a transmembrane receptor, and TLR4-driven inflammatory cascades, such as the inhibitor of B (IB)/nuclear factor B (NFB) pathway, are implicated in the pathogenesis of insulin resistance (5-7).TLRs play an important role in the innate immune system by activating inflammatory pathways in response to microbial agents (8). TLR4 functions as the receptor for lipopolysaccharide (LPS) of gram-negative bacterial cell walls (8). Saturated FFAs acylated in the lipid A moiety of...

Activation of AMP-activated protein kinase (AMPK) by exercise induces several cellular processes in muscle. Exercise activation of AMPK is unaffected in lean (BMI ϳ25 kg/m 2 ) subjects with type 2 diabetes. However, most type 2 diabetic subjects are obese (BMI >30 kg/m 2 ), and exercise stimulation of AMPK is blunted in obese rodents. We examined whether obese type 2 diabetic subjects have impaired exercise stimulation of AMPK, at different signaling levels, spanning from the upstream kinase, LKB1, to the putative AMPK targets, AS160 and peroxisome proliferator-activated receptor coactivator (PGC)-1␣, involved in glucose transport regulation and mitochondrial biogenesis, respectively. Twelve type 2 diabetic, eight obese, and eight lean subjects exercised on a cycle ergometer for 40 min. Muscle biopsies were done before, during, and after exercise. Subjects underwent this protocol on two occasions, at low (50% VO 2max ) and moderate (70% VO 2max ) intensities, with a 4 -6 week interval. Exercise had no effect on LKB1 activity. Exercise had a time-and intensity-dependent effect to increase AMPK activity and AS160 phosphorylation. Obese and type 2 diabetic subjects had attenuated exercise-stimulated AMPK activity and AS160 phosphorylation. Type 2 diabetic subjects had reduced basal PGC-1 gene expression but normal exercise-induced increases in PGC-1 expression. Our findings suggest that obese type 2 diabetic subjects may need to exercise at higher intensity to stimulate the AMPK-AS160 axis to the same level as lean subjects. Diabetes 56:836 -848, 2007

The regulation of vascular endothelial growth factor (VEGF) levels and angiogenic events during skeletal muscle regeneration remains largely unknown. This study examined angiogenesis, VEGF levels, and muscle regeneration after cardiotoxin (CT)-induced injury in mice lacking the CC chemokine receptor 2 (CCR2). Muscle regeneration was significantly decreased in CCR2−/− mice as was the early accumulation of macrophages after injury. In both mouse strains, tissue VEGF was similar at baseline (no injections) and significantly decreased at day 3 post-CT. Tissue VEGF in wild-type (WT) mice was restored within 7 days postinjury but remained significantly reduced in CCR2−/− mice until day 21. Capillary density (capillaries/mm2) within regenerating muscle was maximal in WT mice at day 7 and double that of baseline muscle. In comparison, maximal capillary density in CCR2−/− mice occurred at 21 days postinjury. Maximal capillary density developed concurrent with the restoration of tissue VEGF in both strains. A highly significant, inverse relationship existed between the size of regenerated muscle fibers and capillaries per square millimeter. Although this relationship was comparable in WT and CCR2−/− animals, there was a significant decrease in the magnitude of this response in the absence of CCR2, reflecting the observation that regenerated muscle fiber size in CCR2−/− mice was only 50% of baseline at 42 days postinjury, whereas WT mice had attained baseline fiber size by day 21. Thus CCR2-dependent events in injured skeletal muscle, including impaired macrophage recruitment, contribute to restoration of tissue VEGF levels and the dynamic processes of capillary formation and muscle regeneration.

PK. Fat accumulation with altered inflammation and regeneration in skeletal muscle of CCR2Ϫ/Ϫ mice following ischemic injury.