title: Impaired insulin action despite upregulation of proximal insulin signaling: novel insights into skeletal muscle insulin resistance in liver cirrhosis.
abstract: OBJECTIVE
  Disturbance in glucose metabolism is a common feature in liver diseases and this is associated with skeletal muscle insulin resistance. However, the underlying molecular mechanisms are unclear. To characterize skeletal muscle insulin resistance associated with liver disease, we examined muscles from animals after an acute, 5 weeks perturbation of the common bile duct. Clinical findings, elevated plasma levels of liver enzymes and histological examinations confirmed cirrhosis.
  
  
  RESULTS
  : Cirrhotic animals were insulin resistant and this was associated with reduced glucose transport into muscles. Interestingly, activity in the proximal part of the insulin signaling cascade was not decreased, as evinced by increased activity of key enzymes in the signal to glucose transport. Expression of the glucose transporter, GLUT4, was normal. So together these results indicate that signaling downstream of PKB/Akt and/or the translocation of GLUT4 is impaired in skeletal muscle from cirrhotic animals.
  
  
  CONCLUSIONS
  In conclusion, in an animal model of liver cirrhosis whole body insulin resistance is associated with insulin resistance in skeletal muscles. Unlike other common forms of insulin resistance, muscles from cirrhotic animals have increased activity in the proximal insulin signaling cascade. This emphasizes the fact that skeletal muscle insulin resistance associated with liver cirrhosis is a unique entity.
authors.affiliation: Medical Research Laboratory and Medical Department M (Endocrinology and Diabetes), Aarhus University Hospital, Aarhus Sygehus (NBG), DK-8000 Aarhus C, Denmark. Niels.Jessen@ki.au.dk
authors.forename: Niels
authors.initials: N
authors.lastname: Jessen
authors.forename: Esben Selmer
authors.initials: ES
authors.lastname: Buhl
authors.forename: Ole
authors.initials: O
authors.lastname: Schmitz
authors.forename: Sten
authors.initials: S
authors.lastname: Lund
mesh_terms: D000818:Animals; D001693:Biological Transport, Active / Q000502:physiology*; D015153:Blotting, Western; D004195:Disease Models, Animal; D018450:Disease Progression; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D051275:Glucose Transporter Type 4 / Q000096:biosynthesis; D006003:Glycogen / Q000378:metabolism; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance / Q000502:physiology*; D008106:Liver Cirrhosis, Experimental / Q000378:metabolism* / Q000473:pathology; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism*; D051381:Rats; D017208:Rats, Wistar
chemical_list: D051275:Glucose Transporter Type 4; D007328:Insulin; C495692:SLC2A4 protein, human; D006003:Glycogen; D005947:Glucose