Cited by 181Diabetes, Cardiovascular Risks, and LipoproteinsMetabolism, Diabetes, and CancerDiabetes Treatment and Management

Effect of a Sustained Reduction in Plasma Free Fatty Acid Concentration on Intramuscular Long-Chain Fatty Acyl-CoAs and Insulin Action in Type 2 Diabetic Patients

Bajaj, Mandeep, Suraamornkul, Swangjit, Romanelli, Anthony, Cline, Gary W., Mandarino, Lawrence J., Shulman, Gerald I., DeFronzo, Ralph A.·2005·Diabetes

Abstract

To investigate the effect of a sustained (7-day) decrease in plasma free fatty acid (FFA) concentrations on insulin action and intramyocellular long-chain fatty acyl-CoAs (LCFA-CoAs), we studied the effect of acipimox, a potent inhibitor of lipolysis, in seven type 2 diabetic patients (age 53 ± 3 years, BMI 30.2 ± 2.0 kg/m2, fasting plasma glucose 8.5 ± 0.8 mmol/l, HbA1c 7.5 ± 0.4%). Subjects received an oral glucose tolerance test (OGTT) and 120-min euglycemic insulin (80 mU/m2 per min) clamp with 3-[3H]glucose/vastus lateralis muscle biopsies to quantitate rates of insulin-mediated whole-body glucose disposal (Rd) and intramyocellular LCFA-CoAs before and after acipimox (250 mg every 6 h for 7 days). Acipimox significantly reduced fasting plasma FFAs (from 563 ± 74 to 230 ± 33 μmol/l; P < 0.01) and mean plasma FFAs during the OGTT (from 409 ± 44 to 184 ± 22 μmol/l; P < 0.01). After acipimox, decreases were seen in fasting plasma insulin (from 78 ± 18 to 42 ± 6 pmol/l; P < 0.05), fasting plasma glucose (from 8.5 ± 0.8 to 7.0 ± 0.5 mmol/l; P < 0.02), and mean plasma glucose during the OGTT (from 14.5 ± 0.8 to 13.0 ± 0.8 mmol/l; P < 0.05). After acipimox, insulin-stimulated Rd increased from 3.3 ± 0.4 to 4.4 ± 0.4 mg · kg−1 · min−1 (P < 0.03), whereas suppression of endogenous glucose production (EGP) was similar and virtually complete during both insulin clamp studies (0.16 ± 0.10 vs. 0.14 ± 0.10 mg · kg−1 · min−1; P > 0.05). Basal EGP did not change after acipimox (1.9 ± 0.2 vs. 1.9 ± 0.2 mg · kg−1 · min−1). Total muscle LCFA-CoA content decreased after acipimox treatment (from 7.26 ± 0.58 to 5.64 ± 0.79 nmol/g; P < 0.05). Decreases were also seen in muscle palmityl CoA (16:0; from 1.06 ± 0.10 to 0.75 ± 0.11 nmol/g; P < 0.05), palmitoleate CoA (16:1; from 0.48 ± 0.05 to 0.33 ± 0.05 nmol/g; P = 0.07), oleate CoA (18:1; from 2.60 ± 0.11 to 1.95 ± 0.31 nmol/g; P < 0.05), linoleate CoA (18:2; from 1.81 ± 0.26 to 1.38 ± 0.18 nmol/g; P = 0.13), and linolenate CoA (18:3; from 0.27 ± 0.03 to 0.19 ± 0.02 nmol/g; P < 0.03) levels after acipimox treatment. Muscle stearate CoA (18:0) did not decrease after acipimox treatment. The increase in Rd correlated strongly with the decrease in muscle palmityl CoA (r = 0.75, P < 0.05), oleate CoA (r = 0.76, P < 0.05), and total muscle LCFA-CoA (r = 0.74, P < 0.05) levels. Plasma adiponectin did not change significantly after acipimox treatment (7.9 ± 1.8 vs. 7.5 ± 1.5 μg/ml). These data demonstrate that the reduction in intramuscular LCFA-CoA content is closely associated with enhanced insulin sensitivity in muscle after a chronic reduction in plasma FFA concentrations in type 2 diabetic patients despite the lack of an effect on plasma adiponectin concentration.

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Crossref · 10.2337/diabetes.54.11.3148

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  • Reducing plasma free fatty acid concentration in insulin-resistant individuals, such as type 2 diabetic subjects, augments insulin-stimulated glucose disposal in skeletal muscle, and the improvement in insulin sensitivity is closely associated with a reduction in intramyocellular fatty acyl-CoA concentration.

    “Conversely, reduction of plasma FFA concentration in insulin resistant individuals, for example, type 2 diabetic subjects, augments insulin-stimulated glucose disposal in skeletal muscle [69–72], and the improvement in insulin sensitivity is closely associated with a reduction in intramyocellular FACoA concentration [69].”

    From Pathogenesis of insulin resistance in skeletal muscle (2010) · cites this paper as [69]

  • Reducing plasma free fatty acid concentration with acipimox in insulin-resistant individuals is associated with a reduction in intracellular fatty acyl-CoA content, and the magnitude of the decrease in insulin resistance correlates with the decrease in fatty acyl-CoA content.

    “(ii) the decrease in insulin resistance brought about by reducing the plasma FFA concentration with acipimox in insulin resistant individuals is associated with a reduction in intracellular FACoA content, and the magnitude of decrease in insulin resistance strongly correlates with the decrease in FACoA content [69];”

    From Pathogenesis of insulin resistance in skeletal muscle (2010) · cites this paper as [69]

  • Decreasing fatty acid flux in humans by pharmacological inhibition of lipolysis or in rats by discontinuing lipid-plus-heparin infusion decreases intramuscular triglyceride concentration and/or accumulation of fatty acid intermediates.

    “In contrast, decreasing fatty acid flux in humans via pharmacological inhibition of lipolysis (49) or by discontinuing a lipid-plus-heparin infusion in rats (58) decreases IMTG concentration and/or the accumulation of fatty acid intermediates.”
  • Pharmacological inhibition of lipolysis lowers fatty acid levels and rapidly improves insulin sensitivity in diabetic and nondiabetic, lean and obese subjects.

    “Further evidence linking fatty acids to insulin sensitivity comes from clinical studies showing that pharmacological inhibition of lipolysis decreases fatty acid levels and rapidly enhances insulin sen-sitivity in diabetic and nondiabetic, lean and obese subjects (48,49).”

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Authors
Bajaj, M., Suraamornkul, S., Romanelli, A., Cline, G. W., Mandarino, L. J., Shulman, G. I., & DeFronzo, R. A.
Affiliations
  • The University of Texas at San Antonio Health Science Center (US)
  • Howard Hughes Medical Institute (US)
Venue
Diabetes
Published
2005-11-01
Volume
54
Issue
11
Pages
3148-3153
ISSN
  • 0012-1797 (ISSN-L)
  • 1939-327X
OpenAlex
W2160930691
Cited by
181
References
55
Citations by year
2026: 2 · 2025: 5 · 2024: 1 · 2023: 5 · 2022: 10 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 8 · 2017: 4 · 2016: 5 · 2015: 11 · 2014: 6 · 2013: 9 · 2012: 11
FWCI
8.49
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK 45735, DK 24092, DK-068229, P30DK045735, P01DK068229)
  • National Center for Research Resources (M01RR01346, M01RR001346)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 2 diabetes, plasma free fatty acids, acipimox, lipolysis inhibition, long-chain fatty acyl-CoA, intramyocellular lipid, insulin action, insulin sensitivity, glucose disposal, insulin-stimulated glucose uptake, endogenous glucose production, insulin resistance, hyperinsulinemic-euglycemic clamp, oral glucose tolerance test, fatty acid oxidation
MeSH terms
Acyl Coenzyme A, Hypolipidemic Agents, Diabetes Mellitus, Type 2, Fatty Acids, Nonesterified, Female, Glucose Tolerance Test, Humans, Hyperlipidemias, Insulin, Male, Middle Aged, Pyrazines, Muscle, Skeletal, Adiponectin

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