Circulating follistatin is liver-derived and regulated by the glucagon-to-insulin ratio
Open accessAbstract
CONTEXT: Follistatin is a plasma protein recently reported to increase under conditions with negative energy balance, such as exercise and fasting in humans. Currently, the perception is that circulating follistatin is a result of para/autocrine actions from various tissues. The large and acute increase in circulating follistatin in response to exercise suggests that it may function as an endocrine signal. OBJECTIVE: We assessed origin and regulation of circulating follistatin in humans. DESIGN/INTERVENTIONS: First, we assessed arterial-to-venous difference of follistatin over the splanchnic bed at rest and during exercise in healthy humans. To evaluate the regulation of plasma follistatin we manipulated glucagon-to-insulin ratio in humans at rest as well as in cultured hepatocytes. Finally, the impact of follistatin on human islets of Langerhans was assessed. RESULTS: We demonstrate that in humans the liver is a major contributor to circulating follistatin both at rest and during exercise. Glucagon increases and insulin inhibits follistatin secretion both in vivo and in vitro, mediated via the secondary messenger cAMP in the hepatocyte. Short-term follistatin treatment reduced glucagon secretion from islets of Langerhans, whereas long-term follistatin treatment prevented apoptosis and induced proliferation of rat β cells. CONCLUSIONS: In conclusion, in humans, the liver secretes follistatin at rest and during exercise, and the glucagon-to-insulin ratio is a key determinant of circulating follistatin levels. Circulating follistatin may be a marker of the glucagon-to-insulin tone on the liver.
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Follistatin is an exercise-inducible hepatokine that increases transitorily in the recovery period after a bout of exercise.
“Studies in humans have identified follistatin as an exercise-inducible hepatokine that increases transitorily in the recovery period after a bout of exercise [117,134,183].”
Other exercise-induced factors, such as irisin, follistatin, and OCN, directly protect β-cells from damage, further potentiating their beneficial metabolic properties.
“Concurrently, other exercise-induced factors, such as irisin [66], follistatin [183], and OCN [209], directly protect β-cells from damage, further potentiating their beneficial metabolic properties.”
Under conditions of prolonged fasting or increased energy demands, FST is significantly upregulated in response to increased and decreased amounts of glucagon and insulin, respectively.
“Under conditions of prolonged fasting or increased energy demands (such as exercise), FST is significantly upregulated in response to increased and decreased amounts of glucagon and insulin, respectively [190].”
From Hepatokines and metabolism: Deciphering communication from the liver (2021) · cites this paper as [190]
FST is thought to be acutely regulated by the glucagon-to-insulin ratio.
“it is thought that FST is acutely regulated by the glucagon-to-insulin ratio [190].”
From Hepatokines and metabolism: Deciphering communication from the liver (2021) · cites this paper as [190]
The liver is a key contributor to circulating levels of FST in humans.
“recent work indicated that the liver is a key contributor to circulating levels of FST in humans [[188], [189], [190]].”
From Hepatokines and metabolism: Deciphering communication from the liver (2021) · cites this paper as [190]
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- Authors
- Hansen, J. S., Rutti, S., Arous, C., Clemmesen, J. O., Secher, N. H., Drescher, A., Gonelle-Gispert, C., Halban, P. A., Pedersen, B. K., Weigert, C., Bouzakri, K., & Plomgaard, P.
- Affiliations
- University of Geneva (CH)
- Corresponding author
- Plomgaard, Peter
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2016-02
- Volume
- 101
- Issue
- 2
- Pages
- 550-560
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2193288511
- Cited by
- 125
- References
- 51
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 15 · 2023: 16 · 2022: 12 · 2021: 11 · 2020: 12 · 2019: 11 · 2018: 12 · 2017: 7 · 2016: 7 · 2015: 1
- FWCI
- 9.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- HAL (submittedVersion)
- Site cant be reached (submittedVersion)
- PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion)
- Funders
- National Research Foundation
- Deutsche Forschungsgemeinschaft
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- Danmarks Grundforskningsfond (09-067009, DNRF55, 09-075724)
- Rigshospitalet
- Region Hovedstaden (DNRF55)
- TrygFonden
- Schweizerischen Gesellschaft für Endokrinologie und Diabetologie
- Center for Strategic Research
- Topics
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fibroblast Growth Factor Research
- Keywords
- follistatin, liver, physical activity, hepatic secretion, cAMP signaling, hepatocytes, pancreatic islets, beta-cell apoptosis, beta-cell proliferation, negative energy balance, hormone signaling
- MeSH terms
- Cyclic AMP, Animals, Cell Survival, Cells, Cultured, Emulsions, Glucagon, Humans, Insulin, Islets of Langerhans, Liver, Male, Phospholipids, Soybean Oil, Exercise, Hepatocytes, Follistatin, Cell Line, Tumor, Cell Proliferation, Insulin-Secreting Cells, Rats, Young Adult
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