Insulin resistance stands as a significant threat to public health worldwide, and a largely unmet medical need. To unravel the complex biology of this protean syndrome, we have endeavored to apply genetic techniques to probe gene function and tissue interactions related to metabolism, and identify tractable targets for pharmacological intervention in type 2 diabetes. Over the past five years, the notable contributions of this grant to our knowledge of the insulin resistance syndrome have been: (i) a critical reassessment of the relative roles of insulin- dependent and -independent mechanisms of glucose disposal in metabolic homeostasis;(ii) the discovery of mechanisms by which non-canonical sites of insulin action, such as central nervous system (CNS) and endocrine pancreas, play an early and decisive role in the progression from insulin resistance to diabetes;and (iii) the notion that pancreatic beta cells are an "insulin-sensitive" cell type. Building on these lessons, the PI proposes studies of the integrated physiology of insulin action that will focus primarily on the contribution of CNS, liver and enteroendocrine system to the insulin-resistant state. The PI presents data putatively identifying an "insulin-sensitive" neuron population, characterized by Glut4 expression;as well as a novel gut epithelial progenitor cell with the unique ability to give rise to bona fide insulin-secreting, "Beta-like" endocrine cells in vivo.
Three aims are outlined:
Aim 1 will tackle the role of insulin signaling in brain glucose metabolism, using a novel approach to identify Glut4-expressing neurons and characterize their contribution to systemic metabolism.
Aim 2 will delve into the pathophysiology of hepatic insulin resistance, and specifically into the identification of transcription factors that cause the paradoxical admixture of increased glucose production and triglyceride synthesis that characterizes the diabetic liver.
Aim 3 will study the role of insulin signaling in a newly identified sub-population of gut epithelial progenitor cells that express the insulin-regulated transcription factor Foxo1 and show the surprising ability to be reprogrammed into "Beta-like" cells that secrete insulin in response to glucose. The proposed body of work will advance our understanding of the insulin-resistant syndrome at the biochemical, genetic, and integrated physiological levels, with the ultimate goal of translating newly acquired information into innovative approaches to its treatment.

Public Health Relevance

In the last decade, we endeavored to unravel the 'insulin code'-a concerted succession of biochemical and cell biological events that underlie the integrated physiology of insulin action. We documented the contribution of Insulin Receptor, its main substrates and signaling intermediates to the key abnormalities of insulin resistance: decreased glucose disposal, increased glucose production, and impaired pancreatic beta cell function. We used genetic techniques to probe hormonal and nutritional communication among different tissues, and analyze the progression from insulin resistance to overt diabetes. We demonstrated how tissues with insulin-dependent glucose disposal (muscle and fat) interact with those that utilize glucose independent of insulin (liver, brain, pancreatic islets) to determine various aspects of insulin resistance. We developed a theory integrating 2 cell function with insulin resistance;and delved into the pathophysiology of the brain's contribution to glucose homeostasis. We also examined the bimodal involvement of the liver in diabetes as a site of mixed sensitivity and resistance to insulin. In the process, we burrowed into the Foxo1 pathway, demonstrating the central position of this transcription factor in the regulation of hepatic glucose production and neuropeptide processing. Reversal of insulin resistance remains a critical goal of diabetes treatment, and arguably one of the largest unmet medical needs. Work supported by this grant has defined mechanisms that we believe to be new, linking insulin action in specific organs and cell types with the pathophysiology of insulin resistance, and disclosing biochemical and molecular circuits that can be exploited for diabetes treatment. We envision that the studies proposed for the next funding cycle will reveal new dimensions to the insulin resistance syndrome and expand the repertoire of currently available targets for diabetes therapy and prevention. The proposed experiments build on lessons of the past funding cycle

National Institute of Health (NIH)
Method to Extend Research in Time (MERIT) Award (R37)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Silva, Corinne M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Columbia University (N.Y.)
Internal Medicine/Medicine
Schools of Medicine
New York
United States
Zip Code
Haeusler, Rebecca A; Hartil, Kirsten; Vaitheesvaran, Bhavapriya et al. (2014) Integrated control of hepatic lipogenesis versus glucose production requires FoxO transcription factors. Nat Commun 5:5190
Heinrich, Garrett; Meece, Kana; Wardlaw, Sharon L et al. (2014) Preserved energy balance in mice lacking FoxO1 in neurons of Nkx2.1 lineage reveals functional heterogeneity of FoxO1 signaling within the hypothalamus. Diabetes 63:1572-82
Ren, Hongxia; Yan, Shijun; Zhang, Baifang et al. (2014) Glut4 expression defines an insulin-sensitive hypothalamic neuronal population. Mol Metab 3:452-9
Bouchi, Ryotaro; Foo, Kylie S; Hua, Haiqing et al. (2014) FOXO1 inhibition yields functional insulin-producing cells in human gut organoid cultures. Nat Commun 5:4242
Ren, Hongxia; Plum-Morschel, Leona; Gutierrez-Juarez, Roger et al. (2013) Blunted refeeding response and increased locomotor activity in mice lacking FoxO1 in synapsin-Cre-expressing neurons. Diabetes 62:3373-83
Tsuchiya, Kyoichiro; Accili, Domenico (2013) Liver sinusoidal endothelial cells link hyperinsulinemia to hepatic insulin resistance. Diabetes 62:1478-89
Tsuchiya, Kyoichiro; Westerterp, Marit; Murphy, Andrew J et al. (2013) Expanded granulocyte/monocyte compartment in myeloid-specific triple FoxO knockout increases oxidative stress and accelerates atherosclerosis in mice. Circ Res 112:992-1003
Qiang, Li; Accili, Domenico (2012) FGF21 and the second coming of PPAR?. Cell 148:397-8
Lin, Hua V; Ren, Hongxia; Samuel, Varman T et al. (2011) Diabetes in mice with selective impairment of insulin action in Glut4-expressing tissues. Diabetes 60:700-9
Lin, Hua V; Accili, Domenico (2011) Reconstitution of insulin action in muscle, white adipose tissue, and brain of insulin receptor knock-out mice fails to rescue diabetes. J Biol Chem 286:9797-804

Showing the most recent 10 out of 13 publications