Cited by 551Mitochondrial Function and PathologyAdipose Tissue and MetabolismMetabolism, Diabetes, and Cancer

The DOI matches its Crossref record; 295 of the 297 references it cites were found in a registry or an index; 2 of the 353 sources its claims cite were checked for support.

The Role of Mitochondria in the Pathogenesis of Type 2 Diabetes

Open access
Patti, Mary-Elizabeth, Corvera, Silvia·2010·Endocrine Reviews

Abstract

The pathophysiology of type 2 diabetes mellitus (DM) is varied and complex.However, the association of DM with obesity and inactivity indicates an important, and potentially pathogenic, link between fuel and energy homeostasis and the emergence of metabolic disease.Given the central role for mitochondria in fuel utilization and energy production, disordered mitochondrial function at the cellular level can impact whole-body metabolic homeostasis.Thus, the hypothesis that defective or insufficient mitochondrial function might play a potentially pathogenic role in mediating risk of type 2 DM has emerged in recent years.Here, we summarize current literature on risk factors for diabetes pathogenesis, on the specific role(s) of mitochondria in tissues involved in its pathophysiology, and on evidence pointing to alterations in mitochondrial function in these tissues that could contribute to the development of DM.We also review literature on metabolic phenotypes of existing animal models of impaired mitochondrial function.We conclude that, whereas the association between impaired mitochondrial function and DM is strong, a causal pathogenic relationship remains uncertain.However, we hypothesize that genetically determined and/or inactivity-mediated alterations in mitochondrial oxidative activity may directly impact adaptive responses to overnutrition, causing an imbalance between oxidative activity and nutrient load.This imbalance may lead in turn to chronic accumulation of lipid oxidative metabolites that can mediate insulin resistance and secretory dysfunction.More refined experimental strategies that accurately mimic potential reductions in mitochondrial functional capacity in humans at risk for diabetes will be required to determine the potential pathogenic role in human insulin resistance and type 2 DM.(Endocrine Reviews 31: 364 -395, 2010) I. Type 2 Diabetes Pathogenesis A. Risk factors associated with type 2 diabetes II.General Overview of Mitochondrial Biology A. The dynamic morphology of mitochondria B. Mechanisms that control mitochondrial density and capacity III.Role of Mitochondria in Tissue-Specific Contexts A. Muscle B. Adipose tissue C. Liver D. Pancreatic ␤-cells IV.Experimental Strategies to Explore the Relationship between Mitochondrial Function and DM A. PGC-1 ␣ and ␤ overexpression B. PGC-1 knockout models C. Other mitochondrial function defects V. Conclusions I. Type 2 Diabetes Pathogenesis T ype 2 diabetes mellitus (DM) in the United States and around the world has reached epidemic proportions.At present, 17.9 million people in the United States have been diagnosed with diabetes, with an additional 5.7 million undiagnosed (1).Together, this encompasses 8% of the population, and thus, diabetes is a major public health issue.In addition, current data indicate that 57 million Americans suffer from prediabetes (defined as fasting blood glucose between 100 and 125 mg/dl) (1).Diabetes disproportionately affects specific ethnic populations, with risk increased 1.8-fold in African-Americans, 1.7fold in Mexican-Americans, and 2.2-fold in Native Amer-

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that impaired mitochondrial oxidative function is strongly associated with type 2 diabetes but that a causal pathogenic relationship remains uncertain. It hypothesizes that genetically determined and/or inactivity-mediated reductions in mitochondrial oxidative activity can create an imbalance between oxidative capacity and nutrient load, promoting lipid metabolite accumulation, insulin resistance, and secretory dysfunction.

Key findings

  • In skeletal muscle, OXPHOS complex I activity was reduced by about 40% in type 2 DM and by 20% in obese individuals; these differences did not remain after normalization for mitochondrial mass, suggesting reduced mitochondrial mass is a major contributor.
  • In offspring of type 2 diabetic subjects, 31P spectroscopy showed fasting mitochondrial OXPHOS rates reduced by 30%, TCA cycle flux reduced by 30%, and muscle mitochondrial density 38% lower; insulin-stimulated ATP synthesis was reduced by more than 90% in nonobese first-degree relatives.
  • OXPHOS mRNA expression was reduced by 20–30% in humans with type 2 DM, and muscle PGC-1α and PGC-1β mRNA were reduced by nearly 50% in diabetes; however, oxidative dysfunction was not observed in all insulin-resistant individuals.
  • Mouse models with PGC-1α or PGC-1β deficiency or other mitochondrial defects often showed normal or enhanced insulin sensitivity, leading the authors to conclude that absolute mitochondrial deficiency alone does not directly produce insulin resistance.

Methods

  • Design: narrative review and critical synthesis of published literature on mitochondrial function in type 2 diabetes pathogenesis.
  • Data/sample: human studies of muscle, adipose tissue, liver, and pancreatic β-cells, plus animal models including PGC-1α/β transgenic and knockout mice and other mitochondrial function defects.
  • Main analysis: qualitative integration of evidence across tissues and experimental models, with summary tables of PGC-1 transgenic and knockout phenotypes; no systematic review, meta-analysis, or new primary data are reported.

Limitations

  • Stated: current human data are insufficient to determine whether impaired oxidative capacity causes insulin resistance or results from it; animal data are limited by interspecies comparisons and difficulty recapitulating subtle human mitochondrial changes and gene–fuel-load interactions.
  • Stated: serial liver biopsies in humans are unlikely to be performed, limiting longitudinal tests of the proposed hepatic hypothesis.
  • Evident from the text: as a narrative review, it does not use a systematic search strategy or formal quality appraisal, and the cited human studies vary by population, obesity, fitness, ethnicity, and tissue, which the authors note may explain discordant findings.

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Integrity signals

Registry

Crossref · 10.1210/er.2009-0027

Cites

295 of 295 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

195 Not checked yet · 80 Own interpretation · 4 No basis given · 2 Partly supported · 1 Own result · accuracy not yet measured

Verify all 351 references — free account
  • It may state two separate claims as one. 142
  • Probably not a substantial claim. 18
  • The quote only partly states this claim. 1
155 of 155
  • The paper relies on this without support.

    Skeletal muscle accounts for more than 80% of insulin-stimulated glucose disposal in humans.

    “Skeletal muscle is the largest insulin-sensitive organ in humans, accounting for more than 80% of insulinstimulated glucose disposal.”
  • The paper relies on this without support.

    Mitochondria are particularly important for skeletal muscle function given the high oxidative demands imposed by intermittent contraction.

    “Mitochondria are particularly important for skeletal muscle function, given the high oxidative demands imposed on this tissue by intermittent contraction.”
  • The paper relies on this without support.

    Healthy muscle tissue predominantly oxidizes lipid in the fasting state and transitions to carbohydrate oxidation during the fed state.

    “For example, healthy muscle tissue predominantly oxidizes lipid in the fasting state, as evidenced by low respiratory quotient (RQ), with subsequent tran-sition to carbohydrate oxidation (increased RQ) during the fed state.”
  • The paper relies on this without support.

    OXPHOS gene expression is coordinately regulated.

    “Additionally, because OXPHOS gene expression is coordinately regulated, patterns of differential OXPHOS expression may be more readily detectable in disease states, yet not necessarily mirror other aspects of mitochondrial oxidative capacity.”
  • The paper relies on this without support.

    Changes in the levels of OXPHOS and other oxidative genes must occur in response to cellular energetic and metabolic needs, and in a coordinated manner that ensures the stoichiometric assembly of the products of distinct genes into functional complexes.

    “Changes in the levels of OXPHOS and other oxidative genes must occur in response to cellular energetic and metabolic needs, and in a coordinated manner that ensures the stoichiometric assembly of the products of distinct genes into functional complexes.”
  • The paper relies on this without support.

    Coordination of OXPHOS gene expression in muscle is mediated in part by the action of coactivators and corepressors.

    “As in other tissues, the coordination of OXPHOS gene expression in muscle is mediated in part by the action of coactivators and corepressors.”
  • The paper relies on this without support.

    Brown adipocyte mitochondria contain high levels of CPT1b, which is critical for the entry of fatty acids into the mitochondria for β-oxidation.

    “Thus, brown adipocyte mitochondria also contain high levels of CPT1b, which is critical for the entry of fatty acids into the mitochondria for ␤-oxidation.”
  • The paper relies on this without support.

    β-Oxidation generates large amounts of reducing equivalents for the ETC.

    “␤-Oxidation, in turn, generates large amounts of reducing equivalents for the ETC.”
8 of 8

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Metadata

Authors
Patti, M.-E., & Corvera, S.
Affiliations
  • Joslin Diabetes Center (US)
  • Harvard University (US)
Venue
Endocrine Reviews
Published
2010-06-01
Volume
31
Issue
3
Pages
364-395
ISSN
  • 0163-769X (ISSN-L)
  • 1945-7189
OpenAlex
W2166954428
Cited by
551
References
297
Citations by year
2026: 18 · 2025: 19 · 2024: 26 · 2023: 30 · 2022: 32 · 2021: 42 · 2020: 27 · 2019: 38 · 2018: 38 · 2017: 36 · 2016: 40 · 2015: 35 · 2014: 51 · 2013: 39 · 2012: 36
FWCI
3.37
Type
journal article
Language
en
Open access
Locations
  • Endocrine Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Joslin Diabetes Center
  • National Institutes of Health (DK32520, LM008748, DK 36836)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK080366, DK36836, DK-062948, R21DK080366, DK 32520, P30DK032520, R01DK060837, DK060837, R01DK062948, P30DK036836)
  • U.S. National Library of Medicine (U54LM008748, LM 008748)
  • National Center for Research Resources (M01RR001032)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Mitochondrial Function and Pathology
  • Health Sciences › Medicine › Physiology (medical) › Adipose Tissue and Metabolism
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
Keywords
type 2 diabetes pathogenesis, mitochondrial dysfunction, insulin resistance, oxidative stress, PGC-1, mitochondrial biogenesis, skeletal muscle, adipose tissue, liver, pancreatic beta cells, obesity, overnutrition, lipid peroxidation, energy homeostasis, mitochondrial morphology
MeSH terms
Animals, Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Mitochondria, Oxidative Phosphorylation

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