Karnieli E, Armoni M. Transcriptional regulation of the insulinresponsive glucose transporter GLUT4 gene: from physiology to pathology. Am J Physiol Endocrinol Metab 295: E38 -E45, 2008. First published May 20, 2008 doi:10.1152/ajpendo.90306.2008The insulin-responsive glucose transporter 4 (GLUT4) plays a key role in glucose uptake and metabolism in insulin target tissues. Being a rate-limiting step in glucose metabolism, the expression and function of the GLUT4 isoform has been extensively studied and found to be tightly regulated at both mRNA and protein levels. Adaptation to states of enhanced metabolic demand is associated with increased glucose metabolism and GLUT4 gene expression, whereas states of insulin resistance such as type 2 diabetes mellitus (DM2), obesity, and aging are associated with impaired regulation of GLUT4 gene expression and function. The present review focuses on the interplay among hormonal, nutritional, and transcription factors in the regulation of GLUT4 transcription in health and sickness. adipose; diabetes; gene expression; muscle; obesity; peroxisome proliferator-activated receptor-␥; forkhead box O1 GLUCOSE UPTAKE IN EUKARYOTIC CELLS is mediated by a family of highly related facilitative glucose transporters (GLUT), and to date, 13 GLUT isoforms have already been identified and cloned, with their tissue specificity extensively studied (39, 44). The insulin-regulated glucose transporter GLUT4 is mainly expressed in insulin-responsive tissues, i.e., white and brown adipose (41,99,101), and in heart and skeletal muscles (1,95,115), where it mediates glucose uptake in response to acute insulin stimulation. We also have found expression of GLUT4 in bone and cancer tissues, where it is predominantly regulated through the insulin-like growth factor 1 receptor (8,61,87).Because glucose uptake is a rate-limiting step in glucose metabolism, the expression and function of the GLUT4 isoform have been studied extensively and found to be tightly regulated at both mRNA and protein levels (6, 77). Unlike most other GLUT isoforms, in resting muscle and adipose cells, GLUT4 is sequestered in specialized intracellular membrane compartments, in GLUT4-containing vesicles. According to the translocation hypothesis (24, 48), following insulin stimulation, these vesicles translocate to the plasma membrane and fuse with it via a multistep process that involves numerous docking and fusion proteins (see reviews, Refs. 13,39,42,55). Because glucose transport via GLUT4 is a key component in insulin action, the study of the structure, function, and regulation of GLUT4 has been a major focus of research in the field of diabetes and obesity. The present review focuses on the interplay between factors that govern GLUT4 gene expression in health and sickness. This information will hopefully assist in understanding the molecular processes regulating glucose homeostasis and shed light on potential targets for therapy that are associated with the GLUT4 transcriptional machinery, aiming at improving insulin sensitiv...