doi: 10.1161/CIRCRESAHA.107.165472
© 2008 American Heart Association, Inc.
Review |
Role of Mitochondrial Dysfunction in Insulin Resistance
From the Departments of Internal Medicine (J.-a.K., Y.W., J.R.S.), Medical Pharmacology, and Physiology (J.R.S.) and Diabetes and Cardiovascular Center (J.-a.K., Y.W., J.R.S.), University of Missouri–Columbia School of Medicine; and the Harry S. Truman Veterans Affairs Medical Center (J.-a.K., Y.W., J.R.S.), Columbia, Mo.
Correspondence to James R. Sowers, MD, ASCI, APS, FAHA, Professor of Medicine, Pharmacology and Physiology, Vice-Chair for Research, Director of the Division of Endocrinology and Metabolism, Director of the Diabetes and Cardiovascular Center of Excellence, University of Missouri–Columbia School of Medicine, D109 Diabetes Center HSC, One Hospital Dr, Columbia, MO 65212. E-mail sowersj{at}health.missouri.edu
This Review is part of a thematic series on the Role of Mitochondria in Cardiovascular Diseases, which includes the following articles:
Free Radicals, Mitochondria, and Oxidized Lipids: The Emerging Role in Signal Transduction in Vascular Cells
Mitochondrial Dysfunction in Atherosclerosis Defective Mitochondrial Biogenesis: A Hallmark of the High Cardiovascular Risk in the Metabolic Syndrome?
Endothelial Mitochondria: Contributing to Vascular Function and Disease
Role of Mitochondrial Dysfunction in Insulin Resistance
Marshall S. Runge Guest Editor
Insulin resistance is characteristic of obesity, type 2 diabetes, and components of the cardiometabolic syndrome, including hypertension and dyslipidemia, that collectively contribute to a substantial risk for cardiovascular disease. Metabolic actions of insulin in classic insulin target tissues (eg, skeletal muscle, fat, and liver), as well as actions in nonclassic targets (eg, cardiovascular tissue), help to explain why insulin resistance and metabolic dysregulation are central in the pathogenesis of the cardiometabolic syndrome and cardiovascular disease. Glucose and lipid metabolism are largely dependent on mitochondria to generate energy in cells. Thereby, when nutrient oxidation is inefficient, the ratio of ATP production/oxygen consumption is low, leading to an increased production of superoxide anions. Reactive oxygen species formation may have maladaptive consequences that increase the rate of mutagenesis and stimulate proinflammatory processes. In addition to reactive oxygen species formation, genetic factors, aging, and reduced mitochondrial biogenesis all contribute to mitochondrial dysfunction. These factors also contribute to insulin resistance in classic and nonclassic insulin target tissues. Insulin resistance emanating from mitochondrial dysfunction may contribute to metabolic and cardiovascular abnormalities and subsequent increases in cardiovascular disease. Furthermore, interventions that improve mitochondrial function also improve insulin resistance. Collectively, these observations suggest that mitochondrial dysfunction may be a central cause of insulin resistance and associated complications. In this review, we discuss mechanisms of mitochondrial dysfunction related to the pathophysiology of insulin resistance in classic insulin-responsive tissue, as well as cardiovascular tissue.
Key Words: mitochondrial dysfunction • insulin resistance • cardiovascular disease
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