AMP-activated protein kinase: possible target for treatment of type 2 diabetes.

A considerable amount of data have accumulated showing that contraction of muscle has an acute insulin-like effect, triggering the uptake of glucose. Chronic muscle contraction, as seen in endurance training has effects on insulin sensitivity, enhancing the effect of insulin on glucose uptake. Endurance training results in an increase in levels of GLUT4 in the muscle. This increase in GLUT4 is thought to be responsible in part for the enhancement of insulin sensitivity. Recent experiments have demonstrated that acute and chronic effects of muscle contraction on glucose uptake and the increase in GLUT4 may be due to activation of a protein kinase, AMP-activated protein kinase (AMPK). This kinase is activated by the increase in 5'-AMP and the decline in creatine phosphate that occur during muscle contraction. Phosphorylated AMPK then presumably phosphorylates undefined target proteins, which in turn increase glucose uptake and transcription of the GLUT4 gene. Experiments have demonstrated that this kinase, normally activated during exercise, can be activated artificially in muscle by injecting non-exercising rats with 5-aminoimidazole-4-carboxamide-riboside (AICAR), an adenosine analog. AICAR is taken up into muscle and phosphorylated to form an analog of 5'-AMP. Acute (stimulation of glucose uptake into muscle) and chronic (increase in GLUT4) effects of exercise can be reproduced by injection of this drug. These observations open the door to the possibility of treatment of patients with type 2 diabetes with AMPK activators.