title: In vivo effects of insulin on tumor and skeletal muscle glucose metabolism in patients with lymphoma.
abstract: BACKGROUND
  The anabolic properties of insulin have been suggested for use to reverse malnutrition associated with cancer. The host and tumor sensitivities to insulin are critical for such treatments, which aim to improve patient nutrition. The authors studied insulin effects on tumor and skeletal muscle metabolism with 2-[18F]-fluoro-2-deoxy-D-glucose ([18F]FDG) and positron emission tomography (PET).
  
  
  METHODS
  Six patients with lymphoma twice underwent [18F]FDG-PET imaging: once after fasting overnight and once during euglycemic hyperinsulinemic clamp. The dynamic uptake of the glucose analogue [18F]FDG was measured in diseased nodes and upper arm skeletal muscle in both metabolic states. The [18F]FDG uptake in muscle and the whole body glucose use during euglycemic hyperinsulinemic clamp were compared with those of weight-matched healthy subjects studied under similar circumstances.
  
  
  RESULTS
  In lymphomatous tissue, [18F]FDG uptake rates were similar in overnight fasting and euglycemic hyperinsulinemic clamp (38 +/- 10 versus 41 +/- 9 mumol/100 g/minute, not significant), whereas glucose uptake in skeletal muscle was increased by insulin (1.7 +/- 0.2 versus 3.8 +/- 0.5 mumol/100 g/minute, P = 0.012). Both basal (2.3 +/- 0.2 mumol/100 g/minute, P = 0.061) and insulin-stimulated (8.5 +/- 1.9 mumol/100 g/minute, P = 0.055) skeletal arm muscle glucose uptake rates were higher in control subjects than in patients. Whole body glucose use was 55% lower in patients than in control subjects (17 +/- 3 mumol/kg/minute versus 38 +/- 3 mumol/kg/minute, P = 0.002), consistent with insulin resistance in cancer.
  
  
  CONCLUSIONS
  We found that insulin does not induce major changes in glucose uptake of lymphomatous tissue. Although insulin sensitivity of skeletal muscle was also reduced in patients with lymphoma, the net insulin effect may counteract imbalance between glucose uptake of tumor and muscle, offering a potential means to circumvent at least some metabolic abnormalities found in cancer.
authors.affiliation: Department of Oncology and Radiotherapy, University of Turku, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Minn
authors.forename: P
authors.initials: P
authors.lastname: Nuutila
authors.forename: P
authors.initials: P
authors.lastname: Lindholm
authors.forename: U
authors.initials: U
authors.lastname: Ruotsalainen
authors.forename: J
authors.initials: J
authors.lastname: Bergman
authors.forename: M
authors.initials: M
authors.lastname: Teräs
authors.forename: M J
authors.initials: MJ
authors.lastname: Knuuti
mesh_terms: D000328:Adult; D000368:Aged; D003847:Deoxyglucose / Q000031:analogs & derivatives / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D015309:Glucose Clamp Technique; D006689:Hodgkin Disease / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D007333:Insulin Resistance; D008223:Lymphoma / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000187:drug effects / Q000378:metabolism*; D014055:Tomography, Emission-Computed
chemical_list: D007328:Insulin; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose; D005947:Glucose