Cited by 2,294Metabolism, Diabetes, and CancerAdipokines, Inflammation, and Metabolic DiseasesDiabetes, Cardiovascular Risks, and Lipoproteins

Mechanisms for Insulin Resistance: Common Threads and Missing Links

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Samuel, Varman T., Shulman, Gerald I.·2012·Cell

Abstract

Insulin resistance is a complex metabolic disorder that defies explanation by a single etiological pathway. Accumulation of ectopic lipid metabolites, activation of the unfolded protein response (UPR) pathway, and innate immune pathways have all been implicated in the pathogenesis of insulin resistance. However, these pathways are also closely linked to changes in fatty acid uptake, lipogenesis, and energy expenditure that can impact ectopic lipid deposition. Ultimately, these cellular changes may converge to promote the accumulation of specific lipid metabolites (diacylglycerols and/or ceramides) in liver and skeletal muscle, a common final pathway leading to impaired insulin signaling and insulin resistance.

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Crossref · 10.1016/j.cell.2012.02.017

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  • Administration of glucocorticoids to bolster late afternoon and early evening cortisol levels induces insulin resistance through post-receptor mechanisms.

    “Administration of glucocorticoids to bolster cortisol levels in the late afternoon and early evening also induces insulin resistance [69, 73, 74] through post-receptor mechanisms [90–92].”

    From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [92]

    The Ectopic Lipid Accumulation section describes insulin resistance arising from impaired insulin signaling, and the References section lists a study of glucocorticoid-induced insulin resistance. The paper does not link post-receptor mechanisms to glucocorticoid administration or discuss raising cortisol in the late afternoon or early evening. Page numbers are unavailable in our copy. (LLM, conf=0.78)

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  • A mismatch between lipid availability and lipid oxidation may induce ectopic fat deposition and lipotoxicity.

    “A mismatch between availability and oxidation of lipids might induce ectopic fat deposition and lipotoxicity (17,24).”
  • When adipose tissue cannot store excess fat, lipids accumulate inappropriately in the liver, muscle, and pancreas.

    “When the adipose tissue cannot store excess fat, lipids accumulate inappropriately in the liver, muscle, and pancreas.”

    From Mitochondrial fatty acid oxidation in obesity (2013) · cites this paper as [145]

  • Increased circulating free fatty acids and triglyceride accumulation in ectopic sites is produced.

    “and increased circulating FFA and TG accumulation in ectopic sites is produced ([145](#B145)).”

    From Mitochondrial fatty acid oxidation in obesity (2013) · cites this paper as [145]

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Authors
Samuel, V. T., & Shulman, G. I.
Affiliations
  • Veterans Health Administration (US)
  • Howard Hughes Medical Institute (US)
Corresponding author
  • Samuel, Varman T.
  • Shulman, Gerald I.
Venue
Cell
Publisher
Elsevier BV
Published
2012-03
Volume
148
Issue
5
Pages
852-871
ISSN
0092-8674 (ISSN-L)
OpenAlex
W2086102771
Cited by
2,294
References
182
Citations by year
2026: 202 · 2025: 153 · 2024: 126 · 2023: 107 · 2022: 116 · 2021: 145 · 2020: 137 · 2019: 155 · 2018: 169 · 2017: 171 · 2016: 177 · 2015: 206 · 2014: 183 · 2013: 186 · 2012: 59
FWCI
18.49
Type
journal article
Language
en
Open access
Locations
  • Cell (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Howard Hughes Medical Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK-49230, R01DK049230, DK40936, DK 45735, R01DK040936, U24DK059635, DK-08638, R24DK085638, DK059635, P30DK045735, P01DK068229)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
insulin resistance, ectopic fat deposition, unfolded protein response, innate immunity, fatty acid uptake, lipogenesis, energy expenditure, diacylglycerol, ceramide, hepatic insulin signaling, skeletal muscle insulin signaling, pathogenesis
MeSH terms
Animals, Diabetes Mellitus, Type 2, Diet, Fatty Liver, Humans, Insulin, Insulin Resistance, Liver, Signal Transduction, Muscle, Skeletal, Lipid Metabolism, Unfolded Protein Response, Endoplasmic Reticulum Stress, Non-alcoholic Fatty Liver Disease

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