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Impaired Insulin Signaling in Endothelial Cells Reduces Insulin-Induced Glucose Uptake by Skeletal Muscle
Open accessAbstract
In obese patients with type 2 diabetes, insulin delivery to and insulin-dependent glucose uptake by skeletal muscle are delayed and impaired. The mechanisms underlying the delay and impairment are unclear. We demonstrate that impaired insulin signaling in endothelial cells, due to reduced Irs2 expression and insulin-induced eNOS phosphorylation, causes attenuation of insulin-induced capillary recruitment and insulin delivery, which in turn reduces glucose uptake by skeletal muscle. Moreover, restoration of insulin-induced eNOS phosphorylation in endothelial cells completely reverses the reduction in capillary recruitment and insulin delivery in tissue-specific knockout mice lacking Irs2 in endothelial cells and fed a high-fat diet. As a result, glucose uptake by skeletal muscle is restored in these mice. Taken together, our results show that insulin signaling in endothelial cells plays a pivotal role in the regulation of glucose uptake by skeletal muscle. Furthermore, improving endothelial insulin signaling may serve as a therapeutic strategy for ameliorating skeletal muscle insulin resistance.
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“Restoration of NOS3 phosphorylation in endothelial-specific insulin receptor substrate 2 (IRS-2) knockout mice using beraprost (a stable prostaglandin analog) was sufficient to rescue capillary recruitment and to promote adequate insulin and glucose delivery to skeletal muscle [179].”
From Regulation of obesity and insulin resistance by nitric oxide (2014) · cites this paper as [179]
In the citing paper
“the gradient in insulin concentration from plasma to interstitial fluid is increased in humans with prediabetes and in mouse models of prediabetes during an insulin clamp,152-154 suggesting impaired microvascular insulin delivery.”
From The Vasculature in Prediabetes (2018) · cites this paper as [153]
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Microvascular Contributions to Insulin Resistance
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“Insulin signaling is critical for the regulation of glucose levels and the avoidance of diabetes mellitus, whereas defective insulin signaling may cause insulin resistance, leading to multiple diseases, including T2D and obesity (62, 128).”
Rathjen, T., Kunkemoeller, B. H., Cederquist, C., Wang, X., Lockhart, S. M., Patti, J. C., Willenbrock, H., Olsen, G. S., Povlsen, G. K., Beck, H. C., et al. (2022) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.122.317476 · Cited by 15
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“The study showed that knockout of IRS2 caused inhibition of eNOS activation and almost completely inhibits insulin’s transendothelial delivery to the interstitium within 60 min after initiating the insulin clamp (20).”
BackgroundHuemer, M., Huth, C., Schederecker, F., Klug, S. J., Meisinger, C., Köenig, W., Rathmann, W., Peters, A., & Thorand, B. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001321 · Cited by 13
“This leads to decreased insulin delivery to the skeletal muscle, reducing the uptake of glucose into skeletal muscle 35 and in the long run possibly to the manifestation of type 2 diabetes.”
Hemodynamic actions of insulin: beyond the endothelium
Montero, D. (2013) · Frontiers in Physiology · doi:10.3389/fphys.2013.00389 · Cited by 13
“…recognized a similar vascular and metabolic insulin-signaling via insulin receptor/phosphatidylinositol 3- kinase (PI3K) pathways (Kim et al., 2006; Kubota et al., 2011), which are present in both endothelium and vascular smooth muscle (VSM), leading to nitric oxide synthase (NOS) activation,…”
InfluentialTaurochenodeoxycholic acid alleviates obesity-induced endothelial dysfunction
Lu, H., Wu, Z., Meng, W., Xiong, S., Huang, X., Liu, T., Jiang, X., He, L., Ma, C., Cui, H., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf766 · Cited by 12
“40 While most studies assess obesity-induced ED using animal models or non-invasive human methods, wire myograph on ex vivo human arterioles remains the gold standard for evaluating vascular function, offering a unique bridge from laboratory research to clinical insights.”
Hayashi, T., Kubota, T., Inoue, M., Takamoto, I., Aihara, M., Sakurai, Y., Wada, N., Miki, T., Yamauchi, T., Kubota, N., et al. (2021) · Diabetes · doi:10.2337/db20-0482 · Cited by 12
Characterizing skeletal muscle dysfunction in women with polycystic ovary syndrome
McDonnell, T., Cussen, L., McIlroy, M., & O’Reilly, M. (2022) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/20420188221113140 · Cited by 15
Understanding Insulin Actions Beyond Glycemic Control: A Narrative Review
Riachi, R., Khalife, E., Kędzia, A. W., & Niechciał, E. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14145039 · Cited by 16
Tobe, K., Suganami, H., & Kaku, K. (2017) · Journal of Diabetes Investigation · doi:10.1111/jdi.12761 · Cited by 12
Treating Diabetes by Blocking a Vascular Growth Factor
Carmeliet, P., Wong, B. W., & Bock, K. D. (2012) · Cell Metabolism · doi:10.1016/j.cmet.2012.10.015 · Cited by 12
Hinton, P. S. (2016) · Medical Hypotheses · doi:10.1016/j.mehy.2016.05.008 · Cited by 12
The relationship between insulin resistance and endothelial dysfunction in obese adolescents
Brar, P. C., Patel, P., & Katz, S. D. (2017) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2016-0404 · Cited by 12
“Insulin signaling in vascular endothelial cells is impaired in IR and this leads to ED [3].”
BackgroundHicks, Z. M., & Yates, D. T. (2021) · Frontiers in Animal Science · doi:10.3389/fanim.2021.761421 · Cited by 17
“EPA infusion also improved whole hindlimb mass as well as loin and flexor digitorum superficialis muscle mass in the IUGR fetuses, which is indicative of improvedmuscle growth during late gestation (Lacey et al., 2021).”
InfluentialMa, J., Zeng, P., Liu, L., Zhu, M., Zheng, J., Wang, C., Zhao, X.-K., Hu, W., Yang, X., Duan, Y., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.817784 · Cited by 12
“A study has showed that skeletal muscle insulin resistance may be caused by impaired insulin signaling pathways in endothelial cells (Kubota et al., 2011).”
BackgroundNovel Link Between Inflammation, Endothelial Dysfunction, and Muscle Insulin Resistance
Mauvais‐Jarvis, F. (2013) · Diabetes · doi:10.2337/db12-1434 · Cited by 14
“In addition, mice with insulin resistance in the endothelium resulting from double IR substrates IRS1 and IRS-2 deficiencies had decreased insulin-stimulated glucose uptake in skeletal muscle (18).”
BackgroundLittle, P. J., Offermanns, S., Cho, H., Liu, Z., Yang, P., Su, Q., Wade, H., Yang, W., Kamato, D., Cohen, N. D., et al. (2026) · iNew Medicine · doi:10.1002/inm3.70028 · Cited by 21
Liu, Y., Zhang, J., An, C., Liu, C., Zhang, Q., Ding, H., Ma, S., & Xue, W.-J. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241914828 · Cited by 11
“Among the main target tissues of insulin resistance, skeletal muscles are responsible for ingesting and metabolizing over 80% of glucose, making it an important tissue for regulating glucose homeostasis [31].”
Furuzono, S., Kubota, T., Taura, J., Konishi, M., Naito, A., Tsutsui, M., Karasawa, H., Kubota, N., & Kadowaki, T. (2021) · Communications Biology · doi:10.1038/s42003-021-02491-6 · Cited by 11
Costello, P. M., Hollis, L. J., Cripps, R. L., Bearpark, N., Patel, H. P., Sayer, A. A., Cooper, C. C., Hanson, M. A., Ozanne, S. E., & Green, L. (2013) · Reproductive Sciences · doi:10.1177/1933719113477494 · Cited by 14
“In mice, impaired insulin signaling in endothelial cells led to attenuated insulininduced capillary recruitment and insulin delivery, and reduced glucose uptake in skeletal muscle.(38) Our observation of decreased Akt1 (significant) and IGF-IR (trend only) levels in LBCS offspring vastus muscle are consistent with dec…”
Acute Nitric Oxide Synthase Inhibition Accelerates Transendothelial Insulin Efflux In Vivo
Williams, I. M., McClatchey, P. M., Bracy, D. P., Valenzuela, F. A., & Wasserman, D. H. (2018) · Diabetes · doi:10.2337/db18-0288 · Cited by 12
“Furthermore, the ability of insulin to activate endothelial NOS (eNOS) in endothelial cells (ECs) is impaired in mouse models of obesity and insulin resistance (14).”
BackgroundMohammed, M. A., Mahmoud, M. O., Awaad, A. S., Gamal, G. M., & Abdelfatah, D. (2019) · Steroids · doi:10.1016/j.steroids.2019.01.004 · Cited by 11
“the insulin and glucose supply to the muscles [41] through a production of endothelial nitric oxide (NO) results from the activation of the AMPK and Akt signaling pathways [42].”
Vincenzi, M., & Nebigil, C. G. (2025) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2025.02.006 · Cited by 11
Endothelium-Dependent Delivery of Insulin to Muscle Interstitium
Rask‐Madsen, C., & King, G. L. (2011) · Cell Metabolism · doi:10.1016/j.cmet.2011.02.008 · Cited by 10
“In the study by Kubota et al. (2011), plasma glucose levels measured 30 min after glucose administration were approximately 180 mg/dl higher in high-fat-fed mice but only 40 mg/dl higher in ETIrs2KO mice, compared with controls.”
BackgroundResultInfluentialSasaki, N., Itakura, Y., & Toyoda, M. (2017) · Oncotarget · doi:10.18632/oncotarget.23726 · Cited by 10
“At the moment, beraprost sodium is available as a potential therapeutic for vascular insulin resistance that acts by upregulating eNOS levels, but therapeutic strategies still need further development [9].”
BackgroundGeng, X., Ji, J., Liu, Y., Li, X., Chen, Y., Su, L., & Zhao, L. (2021) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202100742 · Cited by 11
Warmke, N., Walker, A. M., & Cubbon, R. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809657-4.99736-9 · Cited by 10
Emanuel, A. L., de Clercq, N. C., Koopen, A. M., van Poelgeest, E. M., Serlie, M. J. M., van Raalte, D. H., Kramer, M. H. H., Nieuwdorp, M., Eringa, E. C., & Serné, E. H. (2018) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13410 · Cited by 10
“In addition, glucose uptake in isolated skeletal muscle from mice treated with beraprost remained unchanged.(6) This study reveals that, in patients with type 2 diabetes, insulin reduces skeletal muscle MBV.”
BackgroundInfluentialKunkemoeller, B. H., Chen, K., Lockhart, S. M., Wang, X., & Rask‐Madsen, C. (2021) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00435.2020 · Cited by 9
Altered Transendothelial Transport of Hormones as a Contributor to Diabetes
Yoon, N., Dang, T. Q., Chasiotis, H., Kelly, S. P., & Sweeney, G. (2014) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2014.38.2.92 · Cited by 9
“Indeed, the efficiency and extent of insulin delivery to the interstitial space can be inhibited physiologically by diet [30].”
BackgroundCarlsson, P., & Jansson, L. E. (2015) · Diabetes · doi:10.2337/db14-1523 · Cited by 9
“Skeletal muscle endothelium deficiency of Irs2 has previously been shown to reduce Akt and endothelial nitric oxide synthase phosphorylation influencing nitric oxide production (12).”
BackgroundKatsuyama, H., Hakoshima, M., Adachi, H., Masui, Y., Sako, A., Inokuma, S., & Yanai, H. (2022) · Cardiology Research · doi:10.14740/cr1371 · Cited by 8
“The upregulation of HSP 70 enhances the phosphorylation of endothelial nitric oxide synthase (eNOS), which, in turn, elevates insulin signaling and glucose uptake by the skeletal muscle [27].”
BackgroundMicrovascular insulin resistance with enhanced muscle glucose disposal in CD36 deficiency
Shibao, C. A., Peche, V. S., Pietka, T., Samovski, D., Williams, I. M., Abumrad, N. N., Gamazon, E. R., Goldberg, I. J., Wasserman, D. H., & Abumrad, N. A. (2024) · Diabetologia · doi:10.1007/s00125-024-06292-4 · Cited by 10
Crissey, J. M., Padilla, J., Jenkins, N. T., Martin, J. S., Rector, R. S., Thyfault, J. P., & Laughlin, M. H. (2013) · Microcirculation · doi:10.1111/micc.12078 · Cited by 8
“In healthy individuals, insulin-mediated increases in skeletal muscle blood flow account for as much as 40–50% of total insulinstimulated glucose uptake in skeletal muscle [4,29,46].”
BackgroundSafety of artificial pancreas in hepato-biliary-pancreatic surgery: A prospective study
Hayashi, H., Tajima, H., Hanazaki, K., Takamura, H., Gabata, R., Okazaki, M., Ohbatake, Y., Nakanuma, S., Makino, I., Miyashita, T., et al. (2019) · Asian Journal of Surgery · doi:10.1016/j.asjsur.2019.03.011 · Cited by 8
Kaneto, H., Obata, A., Kimura, T., Shimoda, M., Sanada, J., Fushimi, Y., Katakami, N., Matsuoka, T., & Kaku, K. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21249444 · Cited by 8
Transendothelial movement of adiponectin is restricted by glucocorticoids
Dang, T. Q., Yoon, N., Chasiotis, H., Dunford, E. C., Feng, Q., He, P., Riddell, M. C., Kelly, S. P., & Sweeney, G. (2017) · Journal of Endocrinology · doi:10.1530/joe-16-0363 · Cited by 8
“Indeed, delivery of insulin to the interstitial space has been shown to be altered by diet (Kubota et al. 2011).”
Insulin Resistance and Endothelial Dysfunction: Macro and Microangiopathy
Arce‐Esquivel, A. A., Aaron, K. E., Catherine, R., & Laughli, M. H. (2013) · InTech eBooks · doi:10.5772/56475 · Cited by 9
Awsakulsutthi, S., Punpho, K., Mamom, J., Baikrut, P., & Yingchoorod, P. (2014) · Annals of Vascular Diseases · doi:10.3400/avd.oa.13-00092 · Cited by 7
Metadata
- Authors
- Kubota, T., Kubota, N., Kumagai, H., Yamaguchi, S., Kozono, H., Takahashi, T., Inoue, M., Itoh, S., Takamoto, I., Sasako, T., Kumagai, K., Kawai, T., Hashimoto, S., Kobayashi, T., Sato, M., Tokuyama, K., Nishimura, S., Tsunoda, M., Ide, T., Murakami, K., Yamazaki, T., Ezaki, O., Kawamura, K., Masuda, H., Moroi, M., Sugi, K., Oike, Y., Shimokawa, H., Yanagihara, N., Tsutsui, M., Terauchi, Y., Tobe, K., Nagai, R., Kamata, K., Inoue, K., Kodama, T., Ueki, K., & Kadowaki, T.
- Affiliations
- Toho University Ohashi Medical Center (JP)
- National Institute of Health and Nutrition (JP)
- The University of Tokyo (JP)
- Hosei University (JP)
- University of Tsukuba (JP)
- Akita University (JP)
- Kumamoto University (JP)
- Tohoku University (JP)
- University of Occupational and Environmental Health Japan (JP)
- University of the Ryukyus (JP)
- Yokohama City University (JP)
- University of Toyama (JP)
- Research Center for Advanced Science and Technology, The University of Tokyo (JP)
- Corresponding author
- Kubota, Naoto
- Kadowaki, Takashi
- ORCID
- Kubota, Tetsuya
- Kubota, Naoto
- Takahashi, Takehiro
- Inoue, Mariko
- Itoh, Shinsuke
- Sasako, Takayoshi
- Kumagai, Katsuyoshi
- Kawai, Tomoko
- Kobayashi, Tsuneo
- Sato, Maki
- Tokuyama, Kumpei
- Nishimura, Satoshi
- Murakami, Koji
- Yamazaki, Tomomi
- Ezaki, Osamu
- Masuda, Hirotake
- Moroi, Masao
- Oike, Yuichi
- Shimokawa, Hiroaki
- Tsutsui, Masato
- Terauchi, Yasuo
- Tobe, Kazuyuki
- Nagai, Ryozo
- Inoue, Kenji
- Kodama, Tatsuhiko
- Ueki, Kohjiro
- Kadowaki, Takashi
- Venue
- Cell Metabolism
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 13
- Issue
- 3
- Pages
- 294-307
- ISSN
- 1550-4131 (ISSN-L)
- OpenAlex
- W1978030502
- Cited by
- 435
- References
- 33
- Citations by year
- 2026: 16 · 2025: 25 · 2024: 11 · 2023: 19 · 2022: 30 · 2021: 29 · 2020: 23 · 2019: 31 · 2018: 26 · 2017: 34 · 2016: 28 · 2015: 40 · 2014: 33 · 2013: 47 · 2012: 30
- FWCI
- 15.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Cell Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Science and Technology Corporation
- Ministry of Education, Culture, Sports, Science and Technology (16209030, 18209033, 19591037, 20229008, 21390279)
- Core Research for Evolutional Science and Technology
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- insulin receptor substrate 2, eNOS phosphorylation, skeletal muscle glucose uptake, insulin delivery, capillary recruitment, endothelial dysfunction, type 2 diabetes, obesity, skeletal muscle insulin resistance, high-fat diet, endothelial-specific knockout mice
- MeSH terms
- Animals, Dietary Fats, Glucose, Insulin, Mice, Obese, Phosphorylation, Signal Transduction, Mice, Knockout, Muscle, Skeletal, Endothelial Cells, Mice, Nitric Oxide Synthase Type III, Insulin Receptor Substrate Proteins
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