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Insulin is an anabolic hormone produced by pancreatic islet β-cells and the key regulator of glucose and lipid metabolism. Among its many functions, insulin regulates glucose uptake, glycogen synthesis, gluconeogenesis, protein synthesis, lipogenesis, and lipolysis1. The initial molecular signal after insulin interaction with its receptor (IR) is the activation of the intrinsic tyrosine protein kinase activity of IR2, resulting in its autophosphorylation3 and the subsequent activation of a family of proteins known as insulin receptor substrates (IRS), which binds to adaptor proteins leading to activation of a cascade of protein kinases4. Insulin activates two main signaling pathways: phosphatidylinositol 3-kinase (PI3K)-protein kinase B (AKT) and Ras-mitogen-activated protein kinase (MAPK). The former constitutes a major branch point or node4,5 for the activation of numerous downstream effectors involved in diverse physiological functions, including the regulation of fuel homeostasis, whereas the latter regulates cell growth and differentiation4,6. Insulin actions ultimately depend on the cell type and physiological context7.
One of the main insulin-responsive metabolic tissues is the adipose tissue. White adipose tissue is the most abundant type of fat in humans and rodents, distributed within subcutaneous fat (between the skin and muscles) and visceral fat (around the organs in the abdominal cavity). Given their large volume, adipocytes or fat cells are the most abundant cell type in adipose tissue. These fat cells can be brown/beige (thermogenic), pink (in the mammary gland), and white8,9. White adipocytes keep the main energy reserves in the body in the form of triglycerides, an insulin-dependent process. Insulin promotes glucose transport and lipogenesis, while it inhibits lipolysis or lipid breakdown7,10. It also facilitates the differentiation of preadipocytes into adipocytes — the mature fat-storing cells11.
Insulin resistance occurs when a normal insulin level produces an attenuated biological response, resulting in compensatory hyperinsulinemia12. Insulin resistance is a condition associated with overweight and obesity5, that when combined leads to type 2 diabetes (T2D) and other metabolic diseases13. Hyperinsulinemia compensates insulin resistance in peripheral tissues to maintain normal blood glucose levels14. However, eventual β-cell loss or exhaustion, together with exacerbated insulin resistance, leads to elevated blood glucose levels consistent with T2D5. Therefore, insulin resistance and hyperinsulinemia can contribute to the development of obesity-derived metabolic diseases15. Furthermore, obesity may cause chronic low-grade local inflammation promoting insulin resistance in adipose tissue15,16,17. In addition, obesity-derived alterations in adipose tissue, such as fibrosis, inflammation, and reduced angiogenesis and adipogenesis, lead to lower adiponectin serum levels (an insulin sensitizer) and increased secretion of factors such as plasminogen activator inhibitor 1 (PAI-1), free fatty acids, and exosomes into the bloodstream, exacerbating insulin resistance17.
Many aspects underlying insulin resistance remain unknown. In vitro and in vivo models have been developed to study the mechanisms mediating insulin resistance in major target tissues, including adipose tissue. The advantage of in vitro models is that researchers have more control of the environmental conditions and can evaluate insulin resistance in specific cell types. Particularly, adipocyte precursor cells (APCs) have the individual phenotype of the donor tissue, which might reflect physiology better than adipocyte cell lines. A main factor inducing insulin resistance in vitro is tumor necrosis factor-α (TNF-α). TNF-α is a proinflammatory cytokine secreted by adipocytes and macrophages in adipose tissue18. While it is required for proper adipose tissue remodeling and expansion19, long-term exposure to TNF-α induces insulin resistance in adipose tissue in vivo and in adipocytes in vitro20. Chronic TNF-α treatment of several cell types leads to increased serine phosphorylation of both IR and IRS-1, thereby promoting decreased tyrosine phosphorylation21. Increased phosphorylation of IRS-1 on serine residues inhibits the IR tyrosine kinase activity and may be one of the key mechanisms by which chronic TNF-α treatment impairs insulin action22,23. TNF-α activates pathways involving the serine/threonine kinase inhibitor of nuclear factor ĸB kinase β (IKKβ) and c-Jun N terminal kinase (JNK)24. JNK induces a complex proinflammatory transcriptional program but also directly phosphorylates IRS-16.
Understanding the pathogenesis of insulin resistance has become increasingly important to guide the development of future therapies against T2D. APCs have proven to be an excellent model for the study of fat cell biology, including the sensitivity and resistance to insulin, and for identifying the intrinsic properties of adipocytes independent of the systemic environment. APCs can be easily obtained from different adipose depots, and under the appropriate conditions, differentiated into mature adipocytes. With this method, direct effects on insulin resistance/sensitivity can be evaluated in adipocytes.