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Science 306 (5695): 457-461

Copyright © 2004 by the American Association for the Advancement of Science

Endoplasmic Reticulum Stress Links Obesity, Insulin Action, and Type 2 Diabetes

Umut Özcan,1* Qiong Cao,1* Erkan Yilmaz,1 Ann-Hwee Lee,2 Neal N. Iwakoshi,2 Esra Özdelen,1 Gürol Tuncman,1 Cem Görgün,1 Laurie H. Glimcher,2,3 Gökhan S. Hotamisligil1{dagger}

Abstract: Obesity contributes to the development of type 2 diabetes, but the underlying mechanisms are poorly understood. Using cell culture and mouse models, we show that obesity causes endoplasmic reticulum (ER) stress. This stress in turn leads to suppression of insulin receptor signaling through hyperactivation of c-Jun N-terminal kinase (JNK) and subsequent serine phosphorylation of insulin receptor substrate–1 (IRS-1). Mice deficient in X-box–binding protein–1 (XBP-1), a transcription factor that modulates the ER stress response, develop insulin resistance. These findings demonstrate that ER stress is a central feature of peripheral insulin resistance and type 2 diabetes at the molecular, cellular, and organismal levels. Pharmacologic manipulation of this pathway may offer novel opportunities for treating these common diseases.

1 Department of Genetics and Complex Diseases, Harvard Medical School, Boston, MA 02115, USA.
2 Department of Immunology and Infectious Diseases, Harvard School of Public Health, Harvard Medical School, Boston, MA 02115, USA.
3 Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.

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* These authors contributed equally to this work.

{dagger} To whom correspondence should be addressed. E-mail: ghotamis{at}hsph.harvard.edu


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X. Hui, H. Li, Z. Zhou, K. S. L. Lam, Y. Xiao, D. Wu, K. Ding, Y. Wang, P. M. Vanhoutte, and A. Xu (2010)
J. Biol. Chem. 285, 10273-10280
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Diabetes Mellitus, Inflammation, Obesity: Proposed Treatment Pathways for Current and Future Therapies.
T. E Sonnett, T. L Levien, B. J Gates, J. D Robinson, and R K. Campbell (2010)
Ann. Pharmacother. 44, 701-711
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Nitric oxide reduces SLC29A1 promoter activity and adenosine transport involving transcription factor complex hCHOP-C/EBP{alpha} in human umbilical vein endothelial cells from gestational diabetes.
M. Farias, C. Puebla, F. Westermeier, M. J. Jo, M. Pastor-Anglada, P. Casanello, and L. Sobrevia (2010)
Cardiovasc Res 86, 45-54
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An Increase in the Circulating Concentration of Monocyte Chemoattractant Protein-1 Elicits Systemic Insulin Resistance Irrespective of Adipose Tissue Inflammation in Mice.
S. Tateya, Y. Tamori, T. Kawaguchi, H. Kanda, and M. Kasuga (2010)
Endocrinology 151, 971-979
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Enhanced Signaling Downstream of Ribonucleic Acid-Activated Protein Kinase-Like Endoplasmic Reticulum Kinase Potentiates Lipotoxic Endoplasmic Reticulum Stress in Human Islets.
L. Ladriere, M. Igoillo-Esteve, D. A. Cunha, J.-P. Brion, M. Bugliani, P. Marchetti, D. L. Eizirik, and M. Cnop (2010)
J. Clin. Endocrinol. Metab. 95, 1442-1449
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CD14+ Monocytes Are Vulnerable and Functionally Impaired Under Endoplasmic Reticulum Stress in Patients With Type 2 Diabetes.
T. Komura, Y. Sakai, M. Honda, T. Takamura, K. Matsushima, and S. Kaneko (2010)
Diabetes 59, 634-643
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Hexosamine biosynthesis pathway flux promotes endoplasmic reticulum stress, lipid accumulation, and inflammatory gene expression in hepatic cells.
A. T Sage, L. A Walter, Y. Shi, M. I. Khan, H. Kaneto, A. Capretta, and G. H. Werstuck (2010)
Am J Physiol Endocrinol Metab 298, E499-E511
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Exercise maintains euglycemia in association with decreased activation of c-Jun NH2-terminal kinase and serine phosphorylation of IRS-1 in the liver of ZDF rats.
M. A. Kiraly, J. Campbell, E. Park, H. E. Bates, J. T. Y. Yue, V. Rao, S. G. Matthews, G. Bikopoulos, M. Rozakis-Adcock, A. Giacca, et al. (2010)
Am J Physiol Endocrinol Metab 298, E671-E682
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Mammalian Tribbles homolog 3 impairs insulin action in skeletal muscle: role in glucose-induced insulin resistance.
J. Liu, X. Wu, J. L. Franklin, J. L. Messina, H. S. Hill, D. R. Moellering, R. G. Walton, M. Martin, and W. T. Garvey (2010)
Am J Physiol Endocrinol Metab 298, E565-E576
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Hepatic Bax Inhibitor-1 Inhibits IRE1{alpha} and Protects from Obesity-associated Insulin Resistance and Glucose Intolerance.
B. Bailly-Maitre, B. F. Belgardt, S. D. Jordan, B. Coornaert, M. John von Freyend, A. Kleinridders, J. Mauer, M. Cuddy, C. L. Kress, D. Willmes, et al. (2010)
J. Biol. Chem. 285, 6198-6207
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Reduction of AMP-Activated Protein Kinase {alpha}2 Increases Endoplasmic Reticulum Stress and Atherosclerosis In Vivo.
Y. Dong, M. Zhang, B. Liang, Z. Xie, Z. Zhao, S. Asfa, H. C. Choi, and M.-H. Zou (2010)
Circulation 121, 792-803
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Relationship Between Functional Promoter Polymorphism in the XBP1 Gene (-116C/G) and Obesity.
E. Yilmaz, M. Berberoglu, and N. Akar (2010)
Clinical and Applied Thrombosis/Hemostasis 16, 99-102
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Palmitate Attenuates Insulin Signaling and Induces Endoplasmic Reticulum Stress and Apoptosis in Hypothalamic Neurons: Rescue of Resistance and Apoptosis through Adenosine 5' Monophosphate-Activated Protein Kinase Activation.
C. M. Mayer and D. D. Belsham (2010)
Endocrinology 151, 576-585
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Endoplasmic Reticulum Stress-Induced Activation of Activating Transcription Factor 6 Decreases cAMP-Stimulated Hepatic Gluconeogenesis via Inhibition of CREB.
H.-Y. Seo, M.-K. Kim, A.-K. Min, H.-S. Kim, S.-Y. Ryu, N.-K. Kim, K. M. Lee, H.-J. Kim, H.-S. Choi, K.-U. Lee, et al. (2010)
Endocrinology 151, 561-568
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A Point Mutation in Sec61{alpha}1 Leads to Diabetes and Hepatosteatosis in Mice.
D. J. Lloyd, M. C. Wheeler, and N. Gekakis (2010)
Diabetes 59, 460-470
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A Crucial Role for RACK1 in the Regulation of Glucose-Stimulated IRE1{alpha} Activation in Pancreatic {beta} Cells.
Y. Qiu, T. Mao, Y. Zhang, M. Shao, J. You, Q. Ding, Y. Chen, D. Wu, D. Xie, X. Lin, et al. (2010)
Science Signaling 3, ra7
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