Mechanisms involved in follistatin-induced hypertrophy and increased insulin action in skeletal muscle

BackgroundSkeletal muscle wasting is often associated with insulin resistance. A major regulator of muscle mass is the transforming growth factor {beta} (TGF-{beta}) superfamily, including activin A, which causes atrophy. TGF-{beta} superfamily ligands also negatively regulate insulin-sensitive proteins, but whether this pathway contributes to insulin action remains to be determined.\n\nMethodsTo elucidate if TGF-{beta} superfamily ligands regulate insulin action we used an adeno-associated virus gene editing approach to overexpress the activin A inhibitor, follistatin (Fst288) in mouse muscle of lean and diet-induced obese mice. We determined basal and insulin-stimulated 2 deoxy-glucose uptake using isotopic tracers in vivo. Furthermore, to evaluate whether circulating Fst and activin A concentrations are associated with obesity, insulin resistance, and weight loss in humans we analysed serum from morbidly obese subjects before, 1 week, and 1 year after Roux-en-Y gastric bypass (RYGB).\n\nResultsFst288 muscle overexpression markedly increased in vivo insulin-stimulated (but not basal) glucose uptake (+75%, p<0.05) and increased protein expression and intracellular insulin signalling of AKT, TBC1D4, PAK1, PDH-E1, and p70S6K (p<0.05). No correlation was observed between the Fst288-driven hypertrophy and the increase in insulin-stimulated glucose uptake but Fst288 increased basal and insulin-stimulated protein synthesis. Importantly, Fst288 completely normalized muscle glucose uptake in insulin-resistant diet-induced obese mice. RYGB surgery doubled circulating Fst and reduced Activin A (-24%, p<0.05) concentration 1 week after surgery before any significant weight loss in morbidly obese normoglycemic patients, while major weight loss after 1 year did not further change the concentrations.\n\nConclusionsWe here present evidence that Fst is a potent regulator of insulin action in muscle and in addition to AKT and p70S6K, we identify TBC1D1, TBC1D4 and PAK1 as Fst targets. A possible role for Fst in regulating glycemic control is suggested because circulating Fst more than doubled post RYGB surgery, a treatment that markedly improved insulin sensitivity. These findings demonstrate the therapeutic potential of inhibiting TGF-{beta} superfamily ligands to improve insulin action and Fsts relevance to muscle wasting associated insulin resistant conditions in mice and humans.