Hemodynamic actions of insulin: beyond the endothelium

Abstract

BRIEF HISTORICAL OVERVIEW Insulin’s hemodynamic actions are being progressively unraveled over the last two decades (Baron, 1994; Clark, 2008). Originally, Baron et al (Laakso et al., 1990) reported insulin-mediated increase in total blood flow, suggesting an associated higher delivery of nutrients and insulin to target tissues. Nonetheless, the physiological meaning of that extensive hemodynamic action of insulin is controversial, given that lower insulin concentrations than those required to increase total blood flow, stimulate muscle glucose uptake (Yki-Jarvinen and Utriainen, 1998; Zhang et al., 2004). Afterward, a distinct vascular action of insulin was observed, which resulted in capillary recruitment (Rattigan et al., 1997). Such capillary recruitment occurs at physiological concentrations of insulin, precedes increases in total blood flow and is directly correlated to glucose uptake in skeletal muscle (Rattigan et al., 1997, 1999; Coggins et al., 2001). Provided that insulin transcapillary transport plausibly involves a predominant non-saturable process in skeletal muscle (Steil et al., 1996; Hamilton-Wessler et al., 2002; Majumdar et al., 2012), insulin-mediated capillary recruitment emerges as a crucial action of insulin, coupling vascular and metabolic physiology. An integrative pathophysiological view of the relationships between hemodynamic and metabolic functions of insulin has been presented in detail in previous reviews (Muniyappa et al., 2007; Clark, 2008; Muris et al., 2013). Likewise, it has been recognized a similar vascular and metabolic insulin-signaling via insulin receptor/phosphatidylinositol 3kinase (PI3K) pathways (Kim et al., 2006; Kubota et al., 2011), which are present in both endothelium and vascular smooth muscle (VSM), leading to nitric oxide synthase (NOS) activation, increased nitric oxide (NO) production and subsequent vasodilation (Zeng and Quon, 1996; Anfossi et al., 2002). Most previous research in this field has focused on insulin actions in and/or through the endothelium, assumed as the preponderant sensor/effector organ underlying the vascular effects of insulin (Muniyappa et al., 2007; Kubota et al., 2011). However, recently increased animal and human evidence suggests a leading hemodynamic role for the direct insulin action in VSM (Rossi et al., 2005; Newman et al., 2009; Montero et al., 2013a,c), thus requiring to reconsider widely held conceptions in this field.