Paradoxical elevation of high-molecular weight adiponectin in acquired extreme insulin resistance due to insulin receptor antibodies.
Total plasma adiponectin and high-molecular weight (HMW) polymeric adiponectin are strongly positively correlated with insulin sensitivity. However, we have recently reported paradoxical hyperadiponectinemia in patients with severe insulin resistance due to genetically defective insulin receptors. This implies either that the insulin receptor has a critical physiological role in controlling adiponectin production and/or clearance or that constitutive insulin receptor dysfunction influences adiponectin levels through developmental effects. The aim of the current study was to distinguish between these possibilities using a human model of reversible antibody-mediated insulin receptor dysfunction and to refine the previous observations by determining adiponectin complex distribution. Cross-sectional and longitudinal determination of fasting plasma adiponectin and adiponectin complex distribution was undertaken in patients with extreme insulin resistance due to insulin receptor mutations, anti-insulin receptor antibodies (type B insulin resistance), or an undefined cause. Despite extreme insulin resistance, patients with type B insulin resistance (all women; mean age 42 years [range 12-54]) had dramatically elevated total plasma adiponectin compared with the general population (mean 43.0 mg/l [range 31.3-54.2] vs. 8.9 mg/l [1.5-28.5 for BMI <25 kg/m(2)]), which was accounted for largely by HMW polymers. Hyperadiponectinemia resolved in parallel with reduction of insulin receptor antibodies and clinical resolution of insulin resistance. Although the well-established inverse relationship between plasma insulin and adiponectin levels may, in part, reflect positive effects of adiponectin on insulin sensitivity, these data suggest that the magnitude of the effect of insulin action on adiponectin levels may have been underestimated.
Semple
Robert K
RK
Department of Clinical Biochemistry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. rks16@cam.ac.uk
Halberg
Nils H
NH
Burling
Keith
K
Soos
Maria A
MA
Schraw
Todd
T
Luan
Jian'an
J
Cochran
Elaine K
EK
Dunger
David B
DB
Wareham
Nicholas J
NJ
Scherer
Philipp E
PE
Gorden
Phillip
P
O'Rahilly
Stephen
S
D052242:Adiponectin / Q000097:blood; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D002648:Child; D005006:Ethnicity; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D020738:Leptin / Q000097:blood; D008137:Longitudinal Studies; D008875:Middle Aged; D008970:Molecular Weight; D011972:Receptor, Insulin / Q000276:immunology*; D012016:Reference Values
C499918:ADIPOQ protein, human; D052242:Adiponectin; D001323:Autoantibodies; D020738:Leptin; D011972:Receptor, Insulin