Heinrich K. Wasner

The synthesis of prostaglandylinositol cyclic phosphate (cyclic PIP) is stimulated by insulin and by adrenaline via its a1- and a2- adrenoceptors. Cyclic PIP inhibits protein kinase A and activates protein ser/thr phosphatase holoenzymes. Consequently, it inhibits glycogen phosphorylase and glucose-release. On extra-corporal rat liver perfusion, 0.1 μM cyclic PIP triggers a rapid glucose-release, comparable to the one generated by the calcium ionophore A23187, confirming reports that phenylephrine stimulates glucose-release via a1-adrenoceptors. 10–9 M glucagon stimulates glucose-release nearly 2-fold in male rat livers. Simultaneous stimulation with glucagon and 2 x 10–9 M insulin causes a 65% reduced glucose-release. 10–6 M adrenaline stimulates a rapid first phase and a second, cyclic AMP-triggered phase of glucose-release. Insulin triggers no rapid glucose- release, though both hormones stimulate the synthesis of cyclic PIP. The synthesis of cyclic PIP peaks 1 min after stimulation with adrenaline, but 3–4 min after stimulation with insulin, and cyclic PIP synthesis increases approximately 6-fold slower on insulin than on adrenaline stimulation. This can explain the too low Ca2+ increase on insulin-stimulation in order to “flash- activate” glycogen phosphorylase. In summary, cyclic PIP first “supports” and thereafter antagonizes the cyclic AMP-triggered glucose-release from liver.

The natural cyclic AMP antagonist, prostaglandylinositol cyclic phosphate (cyclic PIP), is biosynthesized from prostaglandin E (PGE) and activated inositol phosphate (n-Ins-P), which is synthesized by a particulate rat-liver-enzyme from GTP and a precursor named inositol phosphate (pr-Ins-P), whose 5-ring phosphodiester structure is essential for n-Ins-P synthesis. Aortic myocytes, preincubated with [³H] myo-inositol, synthesize after angiotensin II stimulation (30 s) [³H] pr-Ins-P (65% yield), which is converted to [³H] n-Ins-P and [³H] cyclic PIP. Acid-treated (1 min) [³H] pr-Ins-P co-elutes with inositol (1,4)-bisphosphate in high performance ion chromatography, indicating that pr-Ins-P is inositol (1:2-cyclic,4)-bisphosphate. Incubation of [³H]-GTP with unlabeled pr-Ins-P gave [³H]-guanosine-labeled n-Ins-P. Cyclic PIP synthase binds the inositol (1:2-cyclic)-phosphate part of n-Ins-P to PGE and releases the [³H]-labeled guanosine as [³H]-GDP. Thus, n-Ins-P is most likely guanosine diphospho-4-inositol (1:2-cyclic)-phosphate. Inositol feeding helps patients with metabolic conditions related to insulin resistance, but explanations for this finding are missing. Cyclic PIP appears to be the key for explaining the curative effect of inositol supplementation: (1) inositol is a molecular constituent of cyclic PIP; (2) cyclic PIP triggers many of insulin’s actions intracellularly; and (3) the synthesis of cyclic PIP is decreased in diabetes as shown in rodents.

The reasons initiating insulin resistance are not identified. Various metabolic derailments have been characterized. These are the outcome and not the initiation of insulin resistance. In animal models of type 2 diabetes and hypertension, a decreased hormonal stimulation of the synthesis of the cyclic AMP antagonist prostaglandylinositol cyclic phosphate (cyclic PIP) was determined. The resultant imbalance of the action of cyclic AMP and cyclic PIP shifts metabolic regulation to the dominance of catabolism and a decrease in imperative anabolism. This dominance develops gradually since the more cyclic AMP dominates, the more the synthesis of cyclic PIP will be inhibited. Vanishing actions of cyclic PIP are its 10-fold activation of glucose uptake in adipocytes, its inhibition of insulin release from pancreatic β-cells, its inhibition of PKA and its 7-fold activation of protein ser/thr phosphatase. Reduced synthesis of cyclic PIP results from (a) decreased substrate availability, (b) long-time elevated cyclic AMP levels resulting from stress overloads and (c) aging and the gradual decrease in the synthesis of hormones which likely maintain mechanisms that stimulate cyclic PIP synthesis. The need is to discover which hormones, such as growth hormone, insulin-like growth factor-1, dehydroepiandrosterone, and testosterone, are involved in maintaining the stimulation of cyclic PIP synthesis.

Dear Ladies and Gentlemen, I thank you for suggesting to submit the manuscript with the title “Insulin resistance develops due to an imbalance in the synthesis of cyclic AMP and the natural cyclic AMP antagonist prostaglandylinositol cyclic phosphate (cyclic PIP)” to the Editorial Board of the MDPI journal Stresses, and I ask for consideration to publish it in the journal Stresses. It was previously submitted to the MDPI journal Int. J. Mol. Sci. (IJMS-195 6513), but it was found that 1) it would not fit within the scope of this special edition and 2) it would primarily deal with cyclic PIP and would have not enough literature citation on the topic insulin resistance. The present version of the manuscript is improved, but the content is the same. The goal of this review is not to write again a summary on nearly all reports on insulin resistance as this was done by Dr. Petersen and Dr. Shulman, whose review has 961 literature citations. The present manuscript compiles what is known on cyclic PIP in relation to insulin resistance and the reason of writing this manuscript was that the discovered facts on cyclic PIP synthesis allow to suggest how insulin resistance most likely starts. Hitherto, reports on insulin resistance did not come close to this question. I am convinced that the manuscript makes an essential contribution to the question what causes the development of insulin resistance, and I have to say that stress overload is one of the reasons. Unfortunately, I have to mention a topic, about which I do not like to talk. Years ago, research groups postulated with rigor that the mediator of insulin action would be a peptide and then they suggested various, extracellularly synthesized glycans as mediators. They caused confusions and a high degree of disbelief in the matter of mediators of insulin action. In my review on cyclic PIP in IUBMB Life from 2020, I wrote in the introduction that cyclic PIP should not be confused with these mediators. But I cannot write this in the introduction of every report. I am keeping fingers crossed so that the editor in charge will find fair and openminded reviewers. Last not least I confirm that neither the manuscript nor any part of its content is currently under consideration or published in another journal. Kind regards, Henrich Wasner, PhD, BioReg Biopharm, TiLab; University of Illinois at Chicago; 2242 West Harrison St., Ste. 201, Chicago, Il 60612; USA

Metformin is the leading drug for treating type 2 diabetics, but the mechanism of action of metformin, despite some suggested mechanisms such as the activation of the AMP-kinase, is largely unknown. Among its many positive effects are the reduction of blood glucose levels, the inhibition of cyclic AMP synthesis, gluconeogenesis and an increase in sensitivity to insulin. Recent studies have described the natural antagonist of cyclic AMP, prostaglandylinositol cyclic phosphate. Synthesis of cyclic PIP is stimulated in all organs by hormones such as insulin and also by drugs such as metformin. Its primary action is to trigger the dephosphorylation of proteins/enzymes, phosphorylated on serine/threonine residues. Cyclic PIP triggers many of the regulations requested by insulin. The parallels between the beneficial effects of metformin and the regulations triggered by cyclic PIP suggest that the mechanism of action of this key drug may well be explained by its stimulation of the synthesis of cyclic PIP.

While searching for a counterpart to cyclic AMP, a new compound was found to inhibit adenylate cyclase. It was identified as prostaglandyl‐(15‐4′)‐myo‐inositol (1′:2′‐cyclic)‐phosphate (cyclic PIP). The substrates for its biosynthesis are prostaglandin E (PGE) and the novel inositol phosphate, guanosine diphospho‐4‐myo‐inositol 1:2‐cyclic phosphate (n‐IP). The basic regulatory properties of cyclic PIP are to inhibit dose‐dependently protein kinase A (PKA) and to seven‐fold activate protein ser/thr phosphatase holoenzyme. These regulations occur as rapidly as the activation of PKA by cyclic AMP. Such regulatory properties are essential for the meticulous regulation of the equilibrium between the phospho‐ and de‐phospho‐form of interconvertible enzymes. The synthesis of cyclic PIP is stimulated by insulin and noradrenaline (α‐receptor action). The insulin‐stimulated cyclic PIP synthase is active in a tyrosine‐phosphorylated state. A comparable characterization of the adrenaline‐stimulated cyclic PIP synthase is still incomplete. In streptozotocin‐diabetic rats, the hormonal stimulation of cyclic PIP synthesis decreases with time. Cyclic PIP synthesis is activated by biguanides as metformin two to four‐fold and by antihypertensive drugs two‐fold. Inhibition of cyclic PIP synthesis leads to a metabolic state as observed in early‐stage type‐2 diabetes. In summary, all living cells synthesize cyclic PIP, which switches on anabolism, whereas cyclic AMP triggers catabolism.

Though insulin signalling is thought by many groups to function without second messenger action, others have provided evidence for the existence and action of such regulators. Chemically quite different compounds, however, have been proposed as mediators, such as various inositol phosphoglycans and prostaglandylinositol cyclic phosphate (cyclic PIP). In spite of marked structural differences, these compounds are reported to have the same regulatory properties, i.e. to activate protein ser/thr phosphatases and to inhibit protein kinase A. In order to clarify this discrepancy, the regulatory potency of these different compounds was assayed under identical conditions. It was found that in contrast to cyclic PIP, the synthetic inositol phosphoglycan PIG41 neither directly inhibited protein kinase A nor activated protein ser/thr phosphatases. However, when added to intact cells, such as primary adipocytes, PIG41 inhibited isoproterenol-stimulated lipolysis. This effect most likely results from tyrosine phosphorylation of insulin receptor substrates (IRSs) by PIG41. This tyrosine phosphorylation is not carried out by the insulin receptor tyrosine kinase but by cytosolic tyrosine kinases. This indicates that cyclic PIP, an intracellular regulator, which primarily acts on protein kinase A and on protein ser/thr phosphatases, operates more downstream in the signal transduction cascade as compared to the inositol phosphoglycan PIG41. Thus, cyclic PIP appears to be a suitable candidate to close the gap between IRSs and the protein kinases/phosphatases involved in the signal transduction of insulin.

Insulin induces a broad spectrum of effects over a wide time interval. It also stimulates the phosphorylation of some cellular proteins, while decreasing the state of phosphorylation of others. These observations indicate the presence of different, but not necessarily mutually exclusive, pathways of insulin action. One well‐known pathway represents a phosphorylation cascade initiated by the tyrosine kinase activity of the insulin receptor followed by involvement of different MAP‐kinases. Another pathway suggests the existence of low molecular weight insulin mediators whose synthesis and/or release is initiated by insulin. Comparable analysis of two kinds of insulin mediators, namely inositolphosphoglycans and prostaglandylinositol cyclic phosphate (cPIP), has been carried out. It has been shown that the expression of a number of enzymes, such as phospholipase A₂, phospholipase C, cyclo‐oxygenase and IRS‐1‐like enzyme, could regulate the biosynthesis of cPIP in both normal and diabetes‐related conditions. Data on the activity of a key enzyme of cPIP biosynthesis termed cPIP synthase (IRS‐1‐like enzyme) in various monkey tissues before and twice during an euglycemic hyperinsulinemic clamp have been presented. It has been concluded that in vivo insulin increases cPIP synthase activity in both liver and subcutaneous adipose tissue of lean normal monkeys. It has been also suggested that abnormal production of cPIP could be related to several pathologies including glucocorticoid‐induced insulin resistance and diabetic embryopathy. Further studies on cPIP and other types of insulin mediators are necessary to aid our understanding of insulin action. Copyright © 2001 John Wiley & Sons, Ltd.

It has been suggested that downstream signaling from the insulin receptor to the level of the protein kinases and protein phosphatases is accomplished by prostaglandylinositol cyclic phosphate (cyclic PIP), a proposed second messenger of insulin. However, evidence points also to both phosphatidylinositol 3-kinase, which binds to the tyrosine phosphorylated insulin receptor substrate-1, and the Ras complex in insulin's downstream signaling. We have examined whether a correlation exists between these various observations. It was found that wortmannin, a specific inhibitor of phosphatidylinositol 3-kinase, prevented insulin-induced, as well as cyclic PIP-induced activation of glucose transport, indicating that PI 3-kinase action on glucose transport involves downstream signaling of both insulin and cyclic PIP. Wortmannin has no effect on cyclic PIP synthase activity nor on the substrate production for cyclic PIP synthesis either, indicating that the functional role of PI 3-kinase is exclusively downstream of cyclic PIP.

Inhibition of prostaglandin synthesis by the drug indomethacin suppresses the synthesis of the cyclic AMP antagonist, prostaglandylinositol cyclic phosphate (cyclic PIP), and leads to a metabolic state comparable to type II diabetes. It was of interest whether prostaglandindeficiency likewise causes sensitization of adenylyl cyclase, as this has been reported for the diabetic state. In liver plasma membranes of indomethacintreated male rats, basal and forskolinstimulated cyclic AMP synthesis remained unchanged when compared to untreated control rats. In control rats, stimulation of cyclic AMP synthesis by fluoride (2.2-fold) or glucagon (3.5-fold) was much lower than stimulation by forskolin (6.6-fold). In contrast, in indomethacin treated rats, stimulation of cAMP synthesis by fluoride (4.6-fold) or glucagon (5.2-fold) nearly matched the stimulation by forskolin (6.4-fold). The level of α[1]adrenergic receptors was slightly reduced, from 450 to 320 fmol/mg protein, by the indomethacin treatment. Independent of the treatment by indomethacin, stimulation of cyclic AMP synthesis by adrenaline failed, in agreement with the low density of adrenergic βreceptors. In conclusion, PGE deficiency sensitizes adenylyl cyclase in rat liver for G proteincoupled receptors (glucagon) and also for fluoride.