Rodents have two insulin genes: Ins1, the expression of which is mostly restricted to the pancreas, and Ins2, which displays expression in both the pancreas and the brain. Complete knockout of either gene does not alter circulating insulin nor impart any metabolic phenotype, likely due to compensation by the other gene [
13]. Using mice completely lacking Ins2 and heterozygous for Ins1, researchers showed that these mice do not become hyperinsulinemic or obese on a high-fat diet [
14]. Additionally, britening of white adipose depots was observed in mice with genetically reduced HI. Interestingly, suppression of HI via this genetic manipulation was found to provide life-long protection against obesity despite the eventual manifestation of an equivalent degree of HI [
15]. These data imply that suppression of HI could provide protection against obesity later in life. Genetic prevention of HI also greatly blunts weight gain and adiposity in leptin-deficient
ob/ob mice [
16]. These data support the notion that prevention of initial weight gain by reduction of HI may be favorable to reduction of HI as a treatment for obesity. This topic has just been reviewed by the group of Johnson [
17••].
A secondary approach to determining the role of HI in the manifestation of obesity is to inhibit insulin signaling. Use of the LoxP/Cre system allowed for the characterization of reduction of insulin signaling in specific tissues [
18]. Several interesting and unexpected findings were observed [
19]. Knockout of the insulin receptor in adipose tissue results in a severe reduction in fat pad mass and whole body triglyceride content [
20]. Additionally, these mice are resistant to weight gain following ventromedial hypothalamus (VMH) lesion or as the result of normal aging and do not develop glucose intolerance even on a high-fat diet [
20]. Wild-type mice on a high-fat diet have increased level of basal insulin signaling in peripheral tissues as assessed by Akt phosphorylation status [
21]. Increased insulin signaling is a result of HI and is imperative for the accumulation of lipid within insulin-sensitive tissues. This concept is not restricted to peripheral tissues. Intracerebroventricular insulin administration increases fat mass and fat cell size, indicating that central insulin signaling can regulate peripheral lipid metabolism [
22]. Increased insulin signaling in steroidogenic factor 1-expressing neurons of the VMH during obesity has been shown to regulate adiposity in mice on a high-fat diet [
23]. In contrast to neurons of the arcuate nucleus, which become insulin resistant on a high-fat diet, those of the VMH remain sensitive to insulin thus allowing HI to drive peripheral lipid accumulation [
24]. Lipid accumulation can be prevented through use of an inhibitor of phosphoinositide 3-kinase (PI3K), a kinase downstream of the insulin receptor [
25]. Inhibition of PI3K also prevents the manifestation of IR within these tissues, supporting the hypothesis that lipid metabolites play an integral role in the manifestation of IR in obesity and is secondary to increased insulin signaling and HI. Importantly, inhibition of PI3K has been shown to reduce adiposity while sparing lean body mass [
26]. The reduction in body weight and adiposity during treatment with inhibitors of PI3K is not due to a reduction in food intake but rather is due to increased energy expenditure, in part due to browning of white adipose tissue. These results in mice have also been translated to rhesus monkeys [
26]. Daily administration of a PI3K inhibitor reduced adiposity and improved levels of glucose in serum in the absence of any detectable toxicity.
Alternative hypotheses involving specific proteins can be tested in animals using modern molecular and pharmacological techniques. It is critical in these studies to identify only physiologically relevant targets by using heterozygotes that exhibit a phenotype since homozygous phenotypes are analogous to rare monogeneic defects.