Abstract-Impaired insulin signaling via phosphatidylinositol 3-kinase/Akt to endothelial nitric oxide synthase (eNOS) in the vasculature has been postulated to lead to arterial dysfunction and hypertension in obesity and other insulin resistant states. To investigate this, we compared insulin signaling in the vasculature, endothelial function, and systemic blood pressure in mice fed a high-fat (HF) diet to mice with genetic ablation of insulin receptors in all vascular tissues (TTr-IR Ϫ/Ϫ ) or mice with genetic ablation of Akt1 (Akt1Ϫ/Ϫ). HF mice developed obesity, impaired glucose tolerance, and elevated free fatty acids that was associated with endothelial dysfunction and hypertension. Basal and insulin-mediated phosphorylation of extracellular signal-regulated kinase 1/2 and Akt in the vasculature was preserved, but basal and insulin-stimulated eNOS phosphorylation was abolished in vessels from HF versus lean mice. In contrast, basal vascular eNOS phosphorylation, endothelial function, and blood pressure were normal despite absent insulinmediated eNOS phosphorylation in TTr-IR Ϫ/Ϫ mice and absent insulin-mediated eNOS phosphorylation via Akt1 in Akt1Ϫ/Ϫ mice. In cultured endothelial cells, 6 hours of incubation with palmitate attenuated basal and insulinstimulated eNOS phosphorylation and NO production despite normal activation of extracellular signal-regulated kinase 1/2 and Akt. Moreover, incubation of isolated arteries with palmitate impaired endothelium-dependent but not vascular smooth muscle function. Collectively, these results indicate that lower arterial eNOS phosphorylation, hypertension, and vascular dysfunction following HF feeding do not result from defective upstream signaling via Akt, but from free fatty acid-mediated impairment of eNOS phosphorylation. Key Words: arterial insulin signaling Ⅲ hypertension Ⅲ endothelial dysfunction Ⅲ mice Ⅲ diabetes S timulation of insulin receptors in the vasculature leads to increased activation of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway and the mitogen-activated protein (MAP) kinase (eg, extracellular signaling-regulated kinase [ERK]1/2) pathway. [1][2][3][4] Insulin receptor (IR)-mediated stimulation of PI3K/Akt leads to endothelial nitric oxide (NO) synthase (eNOS) phosphorylation, NO production, and vasorelaxation. 4 -7 Insulin-mediated activation of ERK1/2 leads to endothelin (ET)-1 production, inhibition of eNOS phosphorylation, and subsequent vasocontraction. 1,4,8 Evidence from several experimental models of insulin resistance reveals impaired insulin-mediated PI3K/Aktdependent signaling in the vasculature, whereas ERK1/2 pathways are preserved or even augmented. 2,8,9 Collectively, these observations have led to the hypothesis that an imbalance in vascular insulin-mediated signaling can precipitate cardiovascular complications including endothelial dysfunction and hypertension. 1,4 Recently, it was shown that insulinmediated Akt phosphorylation was preserved, but NOmediated vasorelaxation was blunted, in arteries from obese, glucose ...

The intracellular signalling kinases Akt/protein kinase B (Akt), protein kinase A (PKA) and adenosine monophosphate-activated protein kinase (AMPK) are phosphorylated in response to increased mechanical force or perfusion rate in cultured endothelial cells or isolated blood vessels. All three kinases phosphorylate endothelial nitric oxide synthase (eNOS) on serine (S) 1177, while Akt and PKA additionally phosphorylate eNOS on S617 and S635 respectively. Although these kinases might contribute to subsequent activation of eNOS during dynamic exercise, the specific mediators of exercise-induced eNOS phosphorylation and activation in vivo are unknown. We determined the impact of 50 min of treadmill running on the phosphorylation of Akt, AMPK, cyclic adenosine monophosphate response element binding protein (CREB -a target of PKA) and eNOS (S 1177, 635 and 617 and threonine (T) 495) in the presence or absence of pharmacological inhibition of PI3 kinase (PI3K) and Akt signalling using wortmannin. Compared to arteries from sedentary mice, eNOS enzyme activity was greater in vessels from treadmill-running animals and was associated with increased phosphorylation of Akt (S473), CREB (S133), AMPK (T172), and eNOS at S1177 and S617 but not at S635 or T495. These data suggest that Akt signalling is a major mediator of eNOS activation. To confirm this, treadmill-running was performed in the presence of vehicle (DMSO) or PI3K inhibition. Compared to results from sedentary mice, vascular Akt phosphorylation and eNOS phosphorylation at S617 during treadmill-running were prevented by wortmannin but not vehicle treatment, whereas exercise-related increases in AMPK and CREB phosphorylation were similar between groups. Arterial eNOS phosphorylation at S1177 increased during exercise after wortmannin treatment relative to values obtained from sedentary animals, but the elevation was blunted by ∼50% compared to results from vehicle-treated mice. These findings indicate that Akt and AMPK contribute importantly to vascular eNOS S1177 phosphorylation during treadmill-running, and that AMPK is sufficient to activate p-eNOS S1177 in the presence of PI3K inhibition. Frictional forces along the surface of the endothelium exerted by flowing blood are potent stimuli for endothelial nitric oxide (NO) production (Jo et al. 1997). These forces are proportional to the product of blood viscosity and blood velocity at the endothelial wall and collectively have been termed 'endothelial shear stress' . Endothelial surfaces possess mechanoreceptors that detect shear stress and data concerning the pathways responsible for phosphorylation and activation of endothelial NO synthase (eNOS) are emerging (

Aerobic exercise training and resistance exercise training are both well-known for their ability to improve human health; especially in individuals with type 2 diabetes. However, there are critical differences between these two main forms of exercise training and the adaptations that they induce in the body that may account for their beneficial effects. This article reviews the literature and highlights key gaps in our current understanding of the effects of aerobic and resistance exercise training on the regulation of systemic glucose homeostasis, skeletal muscle glucose transport and skeletal muscle glucose metabolism.

Background Exercise is recommended as a cornerstone of treatment for type 2 diabetes mellitus (T2DM), however, it is often poorly adopted by patients. Even in the absence of apparent cardiovascular disease, persons with T2DM have an impaired ability to carry out maximal and submaximal exercise and these impairments are correlated with cardiac and endothelial dysfunction. Glucagon-like pepetide-1 (GLP-1) augments endothelial and cardiac function in T2DM. We hypothesized that administration of a GLP-1 agonist (exenatide) would improve exercise capacity in T2DM. Methods and Results Twenty-three participants (64±4 years; mean±SE) with uncomplicated T2DM were randomized in a double-blinded manner to receive either 10mcg BID of exenatide or matching placebo after baseline measurements. Treatment with exenatide did not improve VO2peak (P=0.1464) or VO2 kinetics (P=0.2775). Diastolic function, assessed via resting lateral E:E’, was improved with administration of exenatide compared with placebo (Placebo Pre: 7.6±1.0 vs. Post: 8.4±1.2 vs. Exenatide Pre: 8.1±0.7 vs. Post: 6.7±0.6; P=0.0127). Additionally, arterial stiffness measured by pulse wave velocity, was reduced with exenatide treatment compared with placebo (Placebo Pre: 10.5±0.8 vs. Post: 11.5±1.1 seconds vs. Exenatide Pre: 11.4±1.8 vs. Post: 10.2±1.4 seconds; P=0.0373). Exenatide treatment did not improve endothelial function (P=0.1793). Conclusions Administration of exenatide improved cardiac function and reduced arterial stiffness, however, these changes were not accompanied by improved functional exercise capacity. In order to realize the benefits of this drug on exercise capacity, combining exenatide with aerobic exercise training in participants with T2DM may be warranted. Clinical Trials Registration www.clinicaltrials.gov NCT01364584