Regulation of GLUT4 traffic and function by insulin and contraction in skeletal muscle.

Glucose transport across the cell surface is a key regulatory step for glucose metabolism in skeletal muscle. Both insulin and exercise increase glucose transport into myofibers through glucose transporter (GLUT) proteins. Skeletal muscle expresses several members of the GLUT family but the GLUT4 glucose transporter is considered the main "regulatable" isoform that is modulated by insulin and contraction. Glucose transport rate can be stimulated either by recruitment of GLUT4 units from intracellular storage vesicles or through activation of cell surface transporters. Insulin activates GLUT4 translocation through a complex signaling cascade involving both the lipid kinase phosphatidylinositol 3-kinase and the proto-oncoprotein c-Cbl. Contraction, on the other hand, appears to trigger GLUT4 translocation at least in part through activation of the metabolite-sensing 5'-AMP-activated protein kinase. Furthermore, recent studies suggest that p38 MAP kinase activation represents a point of convergence of the signaling pathways utilized by insulin and contraction to increase GLUT4 activation at the cell surface. This review will summarize our current knowledge of these alternative pathways of GLUT4 regulation in skeletal muscle.