1. University of Hawaii Cancer Center, Honolulu, HI 96813, USA 2. Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
Diabetes is a widespread, rapidly increasing metabolic disease that is driven by hyperglycemia. Early glycemic control is of primary importance to avoid vascular complications including development of retinal disorders leading to blindness, end-stage renal disease, and accelerated atherosclerosis with a higher risk of myocardial infarction, stroke and limb amputations. Even after hyperglycemia has been brought under control, “metabolic memory,” a cluster of irreversible metabolic changes that allow diabetes to progress, may persist depending on the duration of hyperglycemia. Manipulation of bile acid (BA) receptors and the BA pool have been shown to be useful in establishing glycemic control in diabetes due to their ability to regulate energy metabolism by binding and activating nuclear transcription factors such as farnesoid X receptor (FXR) in liver and intestine as well as the G-protein coupled receptor, TGR5, in enteroendocrine cells and pancreatic β-cells. The downstream targets of BA activated FXR, FGF15/21, are also important for glucose/insulin homeostasis. In this review we will discuss the effect of BAs on glucose and lipid metabolism and explore recent research on establishing glycemic control in diabetes through the manipulation of BAs and their receptors in the liver, intestine and pancreas, alteration of the enterohepatic circulation, bariatric surgery and alignment of circadian rhythms.
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↑Glycogen synthesis/storage from glucose ↓Blood sugar
FGF-21
1° Targets
2° Targets
Cellular effects
Metabolic effects
Originates from BA activation of hepatic FXR
Adipose FGFR4/β-Klotho receptor complex
ERK1/2+ RSK
↑Adipose GLUT1 receptors
↑Adipose glucose uptake ↓Blood sugar
↑Adiponectin secretion
↓Serum ceramide concentration
↑Number of beige adipocytes
↑Energy utilization by adipocytes ↓Lipid storage/obesity
PPARa/FGF21 synergism with PPARα agonists in WAT
Upregulation of Ucp1 and Pgc1α in WAT but not BAT
↑Production of beige adipocytes in WAT
↑β-oxidation of FAs ↑Ketogenesis ↓Lipid storage/obesity ↓Blood sugar ↓Blood insulin
Tab.1
Tissue
FGF15
Conclusion for FGF15
FGF21
Conclusion for FGF21
Liver KO (KlbAlb mice)/ treatments
↓CYP7A1 ↓FGF15/βKlotho-FGFR4 signaling
FGF15/FGFR4 essential for BA homeostasis
No acute effect on CYP7A1, ERK1/2
No acute, direct effect on hepatocytes
HFD (7 days)
DIO both for KO and control with no changes in glucose production, uptake despite elevated FGF15
Hepatic FGF15 not essential for systemic glucose metabolism
2-week administration of FGF15/21
↓Body weight, serum glucose, hepatic TG
Improved metabolic parameters do not require FGF15/21 in liver
↓Body weight, serum glucose, hepatic TG
Improved metabolic parameters do not require FGF15/21 in liver
Adipose KO (BAT,WAT) Klbadipo mice/ longterm treatment FGF15/21
↑Whole body insulin sensitivity ↓Body weight, plasma insulin/glucose, hepatic TGs ↓Hepatic DAG for both control and model mice ↑Expression of Dusp4 in control mice only
The effects of these hormones do not require direct action on the adipocytes in Klbadipo mice but do directly affect ERK1/2 signaling in control mice
↑Whole body insulin sensitivity ↓Body weight, plasma insulin/glucose, hepatic TGs ↓Hepatic DAG for both control and model mice ↑Expression of Dusp4 in control mice only
The effects of these hormones do not require direct action on the adipocytes in Klbadipo mice but do directly affect ERK1/2 signaling in control mice
NS KO (KlbCamk2a mice) Longterm treatment FGF15
Only control mice showed weight loss and improved glycemic control Sympathetic nerve activity in BAT was ↑ in a dose dependent way with FGF15 treatment
FGF15 acts on the NS in a way similar to FGF21 (previous study)[45]
Administration of bFKB1 Ab to the FGFR1 receptor
KlbCamk2a mice were resistant to weight loss and improved gylycemic control
This confirmed the result in the FGF15/21 model
βKlotho/FGFR1 complexes are essential in the NS
Tab.2
Fig.4
Fig.5
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