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Agent and cell-type specificity in the induction of insulin resistance by HIV protease inhibitors

Ben-Romano, Ronita; Rudich, Assafd; Török, Dórad; Vanounou, Sharona; Riesenberg, Klarisb; Schlaeffer, Franciscb; Klip, Amirad; Bashan, Navaa,c

Basic Science

Objective: To test agent and cell-type specificity in insulin resistance induced by prolonged exposure to HIV protease inhibitors (HPI), and to assess its relation to the direct, short-term inhibition of insulin-stimulated glucose uptake.

Methods: Following prolonged (18 h) and short (5–10 min) exposure to HPI, insulin-stimulated glucose transport, protein kinase B (PKB) phosphorylation, and GLUT4 translocation were evaluated in 3T3-L1 adipocytes, fibroblasts, L6 myotubes, and L6 cells overexpressing a myc tag on the first exofacial loop of GLUT4 or GLUT1.

Results: Prolonged exposure of 3T3-L1 adipocytes to nelfinavir, but not to indinavir or saquinavir, resulted in increased basal lipolysis but decreased insulin-stimulated glucose transport and PKB phosphorylation. In addition, impaired insulin-stimulated glucose uptake and PKB phosphorylation were also observed in the skeletal muscle cell line L6, and in 3T3-L1 fibroblasts. Interestingly, this coincided with increased basal glucose uptake as well as with elevated total-membrane glucose transporter GLUT1 protein content. In contrast to these unique effects of nelfinavir, the mere presence of any of the agents in the 5 min transport assay inhibited insulin-stimulated glucose-uptake activity. This appeared to be caused by direct and specific interaction of the drugs with GLUT4 fully assembled at the plasma membrane, since insulin-stimulated cell-surface exposure of an exofacial myc epitope on GLUT4 was normal.

Conclusions: Independent mechanisms for HPI-induced insulin resistance exist: prolonged exposure to nelfinavir interferes with insulin signaling and alters cellular metabolism of adipocytes and muscle cells, whereas a direct inhibitory effect on insulin-stimulated glucose uptake may occurs through specific interaction of HPI with GLUT4.

From the aDepartment of Clinical Biochemistry, Ben-Gurion University of the Negev, Beer-Sheva the bInfectious Disease Unit, and the cChildren Metabolic Laboratory, Soroka Medical Center, Beer-Sheva, Israel and the dProgramme in Cell Biology, the Hospital for Sick Children, Toronto, Ontario, Canada.

Requests for reprints to: Dr N. Bashan, Department of Clinical Biochemistry, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, IL-84105, Israel. Email:

Received: 28 March 2002; revised: 8 July 2002; accepted: 28 August 2002.

© 2003 Lippincott Williams & Wilkins, Inc.