Mitochondrial handling of excess lipid substrate may be an important determinant of insulin resistance. Animal models support insulin signaling defects resulting from both defective fatty acid oxidation (FAO) with subsequent intra-cellular lipid accumulation on the one hand and enhanced FAO flux on the other. To explore the relationship between FAO and insulin sensitivity, we measured the change in intra-hepatic lipids (IHL) by MRS and hepatic insulin sensitivity during a 5-hour hyperinsulinemic euglycemic clamp with co-infusion of either a control glycerol solution versus a 20% intralipid solution, in random order and separated by 4 months. The study cohort included 18 subjects with an inherited defect in FAO (FAOD; including Carnitine Palmitoyltransferase 2, Long chain 3-Hydroxyacyl-CoA Dehydrogenase, Very Long-chain or Medium-chain Acyl-CoA Dehydrogenase Deficiencies) and 18 matched normal healthy controls. Endogenous glucose production (EGP) before the start of the insulin infusion was similar between FAOD and controls. In controls, insulin suppressed EGP during the glycerol control clamp but this effect was significantly reduced during intralipid infusion (P<0.05, reduced hepatic insulin sensitivity) . In FAOD subjects, insulin suppressed EGP similarly during the glycerol and intralipid clamps (no impairment in insulin action) . Untargeted lipidomics /metabolomics of plasma measured at the end of the intralipid clamp demonstrated significant elevations of plasma acylcarnitines and some triglyceride species but lower production of ketones, and several phospholipids in subjects with FAOD compared to controls. Neither increased IHL nor elevated plasma acylcarnitines in FAOD subjects were associated with hepatic insulin resistance. In fact, impaired FAO protected against intralipid-induced hepatic insulin resistance suggesting that increased FAO flux rather than impaired mitochondrial function is a major determinant of insulin resistance in the liver.


J.Q.Purnell: Advisory Panel; Novo Nordisk. A.N.Gregor: None. D.Choi: None. E.Baetscher: None. W.Rooney: Consultant; Ultragenix, Research Support; Italofarmco, Revalesio. C.O.Harding: None. M.B.Gillingham: None.



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