Endocrinology Vol. 138, No. 11 4821-4829
Copyright © 1997 by The Endocrine Society
Vanadate, But Not Insulin, Inhibits Insulin Receptor Gene Expression in Rat Hepatoma Cells1
Sylvie Bortoli,
Mohamed Amessou,
Martine Collinet,
Bernard Desbuquois and
Soledad Lopez
Unité 30 INSERM, Hôpital Necker-Enfants Malades, 75015
Paris, France
Address all correspondence and requests for reprints to: Bernard Desbuquois, M.D., Unité 30 INSERM, Tour Lavoisier, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, 75015 Paris, France.
 |
Abstract
|
|---|
Insulin and vanadate treatments have recently been shown to reverse the
overexpression of the hepatic insulin receptor (IR) gene in
streptozotocin-induced diabetic rats. To better understand the
mechanisms underlying these effects, the abilities of insulin and
vanadate to affect IR gene expression have been comparatively examined
in Fao hepatoma cells, an insulin-responsive cell line. Exposure of Fao
cells to insulin (1 µM) or vanadate (500
µM) for 24 h led to a 2-fold decrease in IR number
in total cellular membranes. Insulin treatment did not affect IR
messenger RNA (mRNA) level regardless of time of exposure and
concentration. In contrast, vanadate treatment caused a time- and
dose-dependent decrease in IR mRNA level, which was maximal (4-fold
change) after a 24-h exposure to 500 µM vanadate and was
fully reversible. Insulin treatment increased from 28 to 39% the
relative expression of isotype A IR mRNA, but vanadate treatment did
not significantly affect this parameter. Vanadate treatment did not
modify mRNA half-life (3.5 h) in 5, 6 dichlorobenzimidazole
riboside-treated cells but decreased by 4-fold the transcriptional
activity of the IR gene. These data show for the first time that,
although both insulin and vanadate decrease total cellular IR number in
Fao cells, only vanadate decreases IR mRNA level. It does so by
inhibiting transcription of the IR gene, suggesting an action on the
gene promoter which could be mediated by changes in the level of
expression and/or of phosphorylation of trans-acting
factors.
 |
Introduction
|
|---|
THE MULTIPLE pleiotropic effects of insulin
on cellular growth and metabolism are mediated by a specific
cell-surface receptor (1, 2). The insulin receptor (IR) is a
transmembrane glycoprotein composed of two
-subunits and two
ß-subunits linked by disulfide bonds. The
-subunit is located
outside the cell membrane and contains the insulin-binding domain,
whereas the ß-subunit spans the membrane and contains a cytoplasmic
protein tyrosine kinase domain. Binding of insulin to the
-subunit
activates the tyrosine kinase of the ß-subunit and catalyzes the
autophosphorylation of specific tyrosine residues in this subunit,
leading to the phosphorylation of downstream intracellular substrates
involved in insulin signaling.
The
- and ß-subunits of the IR are encoded by a single gene
composed of 22 exons (1, 2). The mature receptor occurs as two isoforms
generated by alternative splicing of exon 11, which encodes a sequence
of 12 amino acids at the carboxy terminus of the
-subunit. This
sequence is present in the type B (exon 11+) isoform but is absent in
the type A (exon 11-) isoform. Isoforms A and B exhibit slight
differences with regard to insulin binding affinity and tyrosine kinase
activity.
Although the IR is ubiquitously expressed, the level of receptors and
the relative expression of receptor isotypes vary among cells and
tissues (1, 2, 3). In addition, receptor expression is regulated by a
variety of agents and environmental conditions including hormones,
metabolic substrates, cell growth and differentiation, and development
(3). Depending on the agent or condition, regulation occurs at
transcriptional, posttranscriptional, and/or postranslational steps.
For example, glucocorticoid hormones up-regulate the IR by stimulating
transcription of the gene (4), whereas insulin down-regulates the
receptor primarily by increasing the rate of degradation of the protein
(5).
Previous studies have shown that the increased number of IRs in liver
of streptozotocin-induced diabetic rats is reversed by treatments with
insulin (6) and vanadate (7), an insulinomimetic agent. Insulin
treatment has also been shown to reverse the increased level of IR
messenger RNA (mRNA) level in liver of diabetic rats (8, 9). Although
these effects may be mediated by the reversal of metabolic
abnormalities potentially involved in IR overexpression, such as
hyperglycemia, they are consistent with the ability of both insulin (3)
and vanadate (10, 11) to decrease the number of cell surface IRs in
isolated cells. However, studies on the effects of insulin on IR mRNA
level in isolated cells have yielded conflicting results (12, 13, 14, 15, 16, 17) and,
to the best of our knowledge, the effects of vanadate on this parameter
have not been studied.
To better understand how insulin and vanadate regulate IR gene
expression, we have analyzed the effects of these agents at different
steps of expression in Fao hepatoma cells, a well differentiated
insulin-responsive cell line. Our results show that, while both insulin
and vanadate decrease IR number, only vanadate decreases IR mRNA level,
and does so, at least in part, by reducing transcription of the IR
gene.
 |
Materials and Methods
|
|---|
Chemicals and reagents
Coons modified Hams F-12 medium and FCS were purchased from
Life Technologies Limited (Uxbridge, UK). Porcine insulin was from
Novo-Nordisk (Bagsvaerd, Denmark). Sodium orthovanadate and
5,6-dichlorobenzimidazole riboside (DRB) were purchased from
Sigma-Aldrich (St. Quentin-Fallavier, France). 125I,
deoxycytidine
5'-[
-32P]-triphosphate
([
-32P]dCTP) (3000 Ci/mmol), uridine
5'-[
-32P]triphosphate
([
-32P]UTP) (3000 Ci/mmol) and the
multiprime DNA labeling kit were from Amersham Life Science (Little
Chalfont, UK). Human glyceraldehyde 3-phosphate dehydrogenase (G3PDH)
complementary DNA (cDNA) probe was from Clontech (Palo Alto, CA).
HI-Taq polymerase was from Bioprobe (Montreuil sous Bois,
France). RNase inhibitor was from Boehringer/Mannheim (Meylan, France).
Avian myeloblastosis virus reverse transcriptase was from Ozyme
(Montigny-le-Bretonneux, France). Random hexamer primers were from
Pharmacia (Upssala, Sweden). Cronex films were from Sterling Diagnostic
Imaging Inc. (Newark, DE).
Cell culture
The Fao hepatoma cell line is a well differentiated subclone
derived from the hepatoma H4IIEC3 line established in culture from the
Reuber H35 rat hepatoma (18, 19). This cell line retains a number of
characteristics of normal hepatocytes, including a high number of IRs
and insulin-sensitive enzymes (20).
Fao cells were cultured attached to 10-cm Falcon plastic Petri dishes
in Coons modified Hams F12 medium supplemented with 5% FCS. They
were incubated at 37 C in a humidified atmosphere composed of 5%
CO2 and 95% air. The culture medium was renewed three
times a week. At each passage, cells were harvested with 0.05 mg/100 ml
trypsin and 0.2 mg/ml EDTA. At subconfluence, the medium was changed to
a serum-free Hams F12 medium and 24 h later cells were treated
with insulin or vanadate as indicated.
Preparation of soluble cell extracts and assay of insulin binding
activity
After rapid washing of the monolayers with 50 mM
Tris-HCl buffer, pH 7.4, the cells were scraped off the plates in the
same medium containing 10 µg/ml aprotinin and 0.2 mM
phenylmethylsulfonyl fluoride, and homogenized in a 7 ml Dounce
homogenizer (15 strokes of the B pestle). The homogenate was
centrifuged at 150,000 x g for 60 min; the particulate
material was resuspended into 5 mM Tris-HCl, pH 7.4, and
solubilized by the addition of Triton X-100 (0.2%, wt/vol). Insoluble
aggregates were removed by centrifugation at 15,000 x
g for 10 min. The soluble extract was stored in aliquots at
-80 C until used.
Insulin binding to solubilized receptors was measured using
125I-insulin (prepared using lactoperoxidase; 400 Ci/mmol)
as ligand. Cell extracts (200 µg protein) were incubated with
[125I]-insulin (0.05 pmol) in 0.3 ml of 50 mM
Tris-HCl buffer, pH 7.4, containing 0.06% Triton X-100, 10 mg/ml BSA,
1 mg/ml bacitracin and, when indicated, different concentrations of
unlabeled insulin. After 2436 h at 4 C, free and receptor bound
insulin were separated by polyethyleneglycol precipitation (21) using
-globulin as a carrier and collecting the precipitate by
centrifugation (22). Results were corrected for nonspecific binding by
performing parallel incubations in the presence of excess (0.51 nmol)
unlabeled insulin.
RNA isolation and Northern blot analysis
Total cellular RNA was isolated by repeated low temperature
extraction by guanidinium thiocyanate/phenol/chloroform followed by
precipitation with cold isopropanol (23). After denaturation by heating
at 65 C for 5 min, it was size-fractionated by electrophoresis on a 1%
agarose/2.2 M formaldehyde gel. RNA was transferred by
capillarity to Nylon membranes in 10 x SSC (1 x SSC =
150 mM NaCl, 15 mM sodium citrate) and fixed by
baking at 80 C for 2 h. The integrity of the blotted RNA was
assessed by UV visualization of the ethidium bromide-stained 28 S and
18 S ribosomal RNA bands.
cDNA probes and hybridization of RNA blots
The following cDNA probes were used for hybridization: a 2.3-kb
EcoRI cDNA fragment coding for the rat IR
-subunit (24)
(a kind gift from Dr. B. Goldstein, Joslin Diabetes Center, Boston,
MA); a 2.6-kb EcoRI-BamHI cDNA fragment
coding for rat phosphoenolpyruvate carboxykinase (PEPCK) (25); a
2.9-kb EcoRI cDNA fragment coding for the human poly A
binding protein (pABP) (26); and a 1.1-kb EcoRI fragment
encoding for the human glyceraldehyde 3-phosphate dehydrogenase
(G3PDH). Probes were labeled (2 x 106 cpm/ng) with
[
-32P] dCTP using a multiprime DNA labeling kit.
For studies on IR mRNA, blots were prehybridized for 45 h at 42 C in
20 ml of 42% formamide, 12.5% dextran sulfate, 3.5 mM
sodium pyrophosphate, 0.8% SDS, 8 x Denhardts reagent, 0.35
M NaCl, 0.042 M Tris-HCl, pH 7.5, and 0.15
mg/ml of denatured salmon sperm DNA. Hybridization was performed
overnight at 42 C by adding heat-denatured cDNA probes (106
cpm/ml final concentration) in the same medium, supplemented with 4 ml
of 50% formamide, 1 mM sodium pyrophosphate, 1% SDS,
10 x Denhardts reagent, 0.05 M Tris-HCl, pH 7.5,
and 0.8 mg/ml of denatured salmon sperm DNA. Blots were washed three
times in 2 x SSC-0.1% SDS at room temperature and then once in
0.1 x SSC-0.1% SDS at 55 C. They were then subjected to
autoradiography with intensifying screens for 1872 h at -80 C. The
intensities of the bands seen on autoradiograms were determined by
scanning densitometry (Hewlett Packard, ScanJet II scanner connected to
Macintosh computer). After hybridization with the IR probe, blots were
rehybridized with the pABP probe and, for each treatment, values of IR
signals were normalized to values of pABP signals. Hybridizations of
the RNA blots to G3PDH and PEPCK probes were carried out basically as
described for the IR.
RT and amplification of IR cDNA isoforms
RT was performed on 1 µg of total RNA with 1 U/µl of RNase
inhibitor and 90 mU/ml of random hexamer primers in a volume of 10
µl. The annealing reaction was carried out for 5 min at 65 C, after
which the incubation mixture was chilled on ice for 2 min. The first
strand cDNA was synthesized by adding 1 U/µl of avian myeloblastosis
virus reverse transcriptase in 1 x RT buffer(50 mM
Tris-HCl, pH 8.3, 60 mM KCl, 10 mM
MgCl2, 1 mM dithiothreitol) supplemented with
0.5 mM deoxynucleotide triphosphates in a final volume of
20 µl. Incubations in the absence of reverse transcriptase were used
as negative controls. After 2 h at 42 C, DNA/RNA hybrids were
denatured at 95 C for 2 min.
Oligonucleotide primers spanning nucleotides 25302550 in exon 10
(sense primer, 5'-CATTCAGGAAGACCTTCGAGG-3') and nucleotides 28222843
in exon 12 (antisens primer, 5'-TGCAATCAGGACTCCCCAGA-3') were used to
amplify a region of the rat IR cDNA. These primers generate a 313- or a
277-bp fragment after amplification of the cDNA encoding the B isoform
or A isoform, respectively. Two microliters of the RT reaction were
mixed with 1 x Taq buffer (10 mM Tris-HCl
pH 8.8, 1.5 mM MgCl2, 50 mM KCl,
0.1% Triton X-100) supplemented with 1 µM sense primer,
1 µM antisense primer, 0.1 mM each
2'-deoxyadenosine 5'-triphosphate, 2'-deoxyguanosine 5'-triphosphate
and 3'-deoxythymidine 5'-triphosphate and 0.06 µCi of
[
-32P]-dCTP in a final volume of 50 µl. The reaction
mixture were overlaid with mineral oil, heated for 5 min at 95 C in a
thermal cycler (Perkin Elmer Instruments) and kept at 72 C. After
addition of 0.2 U/µl HI-Taq DNA polymerase, twenty-five
cycles of amplification were performed. Each cycle consisted of a
60-sec denaturation at 94 C, a 60-sec annealing at 57 C, and an 80-sec
extension at 72 C. The two products of amplification were resolved by
electrophoresis on a 8% polyacrylamide gel and visualized by
autoradiography. They were quantitated by direct measurement of the
radioactivity on the dried gel using a PhosphorImager (Molecular
Dynamics, Sunnyvale, CA).
Measurement of IR mRNA half-life
The half-life of IR mRNA was estimated from sequential
determinations of IR mRNA level after blocking gene transcription with
100 µM DRB (27). This agent has previously been shown not
to affect Fao cell viability (28). RNA was quantitated as described
above 0, 0.5, 1, 2, 4, and 8 h after DRB addition, and results
were plotted semilogarithmically against time. First order decay rate
constants were derived from these plots and used to calculate half-life
values.
Isolation of nuclei and run-on transcription assay
Nuclei were prepared from 65 x 106 cells (five
plates) as described previously (28). After scraping in
phosphate-bufferred saline, cells were resuspended in 2 ml of a lysis
solution consisting of 10 mM Tris-HCl pH 7.5, 10
mM NaCl, 3 mM MgCl2, and 0.5%
Nonidet P40. Nuclei were sedimented by centrifugation at 450 x
g for 5 min, and after resuspension in the lysis solution,
sedimented again. The final sediment was suspended in 50 mM
Tris-HCl, pH 8, 40% (vol/vol) glycerol, 5 mM
MgCl2 and 0,1 mM EDTA, and stored at -80 C
until used.
Transcription assays were performed by incubating 1020 x
106 nuclei in 200 µl (final volume) of 10 mM
Tris-HCl buffer, pH 7.9, 50 mM NaCl, 0.4 mM
EDTA, 1.2 mM dithiothreitol, 0.1 mM
phenylmethylsulfonyl fluoride, 350 mM ammonium sulfate, 4
mM MnCl2, 10 mM phosphocreatine, 10
mg/ml creatine phosphokinase, 2 mM each CTP, ATP and GTP,
500 U/ml RNAsine, 1 mCi/ml [
-32P] UTP for 30 min at 30
C. Incubations were then continued at 37 C in the presence of first 10
µg/ml RNase-free DNase (15 min), then 40 µg/ml proteinase K (15
min), and finally 100 µg/ml proteinase K and 1% SDS (30 min). The
radiolabeled RNA was isolated by sequential guanidinium chloride
extraction and sodium acetate/ethanol precipitation. Labeled RNA
(15 x 106 cpm/blot) was hybridized with 20 µg of
various cDNA probes (IR, PEPCK, pUC) and genomic DNA that had been
previously immobilized on a Nylon membrane using a slot blot apparatus.
Hybridization was carried out in 50% formamide, 4.7% SDS, 0.2 mg/ml
denatured salmon sperm DNA, 0.067 mg/ml tRNA carrier, 1 x
Denhardts reagent, 3 x SSEP (1 x SSEP = 150
mM NaCl, 10 mM NaH2PO4,
1 mM EDTA) for 6570 h at 42 C. Blots were washed
consecutively in: 1) 1 x SSC, 0.1% SDS, 3 x 20 min at 65
C; 2) 1 x SSC,2 x 15 min at 65 C; 3) 1 x SSC, 10
mg/ml RNase A, 30 min at 37 C; and 4) 1 x SSC, 0.1% SDS, 15 min
at 65 C. Blots were then subjected to autoradiography and hybridization
signals were quantitated by densitometric scanning. The relative
transcription rates of the IR and PEPCK genes were referred to as the
ratio between the intensity of the corresponding signals and the
intensity of the genomic DNA signal after subtraction of the intensity
of the pUC signal.
Statistical methods
Statistical analyses were carried out using the nonparametric
Kruskal-Wallis test.
 |
Results
|
|---|
Effect of insulin and vanadate treatments on insulin binding
activity and insulin receptor mRNA level in Fao hepatoma cells
Exposure of Fao cells to 1 µM insulin and 500
µM vanadate for 24 h led to a 40% decrease in the
ability of insulin to bind, at tracer concentrations, to solubilized
cell extracts (Fig. 1
). Competition
studies with unlabeled insulin showed that the decrease in insulin
binding in treated cells was unaffected by insulin concentration, and
that the concentrations required to inhibit binding of
125I-insulin by 50% were similar (0.80.9 nM)
in insulin-treated, vanadate treated and control cells (results not
shown). These results indicate that the main effects of insulin and
vanadate were to decrease IR number. Scatchard analysis of the binding
data using the two-site model showed that insulin and vanadate
treatments decreased by at least 2-fold the number of both high
affinity/low capacity and low affinity/high capacity sites (Table 1
). In addition, vanadate and to a lesser
extent insulin moderately increased the affinity of the two classes of
binding sites.

View larger version (25K):
[in this window]
[in a new window]
|
Figure 1. Effect of insulin and vanadate treatments on
insulin binding activity in Fao cells. Cells were treated with 1
µM insulin (I) or 500 µM vanadate (V) or
left untreated (C) for 24 h. A total particulate fraction was
prepared, solubilized with Triton X-100, and examined for insulin
binding activity, as described in Materials and Methods.
Incubation mixtures contained, in a final volume of 0.3 ml, 200 µg
protein and 0.15 nM [125I]-insulin. Results
are expressed as mean ± SEM of four to five
independent determinations; **, P < 0.05
vs. control cells.
|
|
Total RNA prepared from control cells and from cells treated by insulin
and vanadate as indicated above was analyzed by Northern blotting using
a cDNA receptor probe. As previously observed in Fao hepatoma cells and
normal rodent liver (29), two major mRNA species of 9.5 and 7.5 kb
were found to hybridize to IR cDNA, the 7.5-kb species being the
most abundant (Fig. 2
). The abundance of
these two species was decreased about 4-fold in vanadate-treated cells
but was unchanged in insulin-treated cells. Vanadate treatment did not
affect the abundance of the pABP and G3PDH transcripts, suggesting that
it does not act as a general inhibitor of gene transcription.

View larger version (30K):
[in this window]
[in a new window]
|
Figure 2. Northern blot analysis of IR mRNA in control,
insulin-treated and vanadate-treated Fao cells. Cells were treated with
1 µM insulin (I) or 500 µM vanadate (V) or
left untreated (C) for 24 h. Total RNA (20 µg per lane) was
subjected to Northern blotting and hybridized with the indicated cDNA
probes as described in Materials and Methods. Results
are representative of several independent experiments.
|
|
Blots from untreated and treated cells were also probed with a cDNA for
PEPCK, an insulin-sensitive enzyme that is highly expressed in hepatoma
cells. In agreement with previous studies (30, 31), both insulin and
vanadate led to a comparable decrease in the relative abundance of the
PEPCK transcript. Thus, the lack of effect of insulin on the expression
of the IR gene in Fao cells did not result from a general loss of
insulin effects on gene expression.
Time and dose dependence of insulin and vanadate effects on IR mRNA
level
Insulin failed to affect IR mRNA level regardless of dose and time
of treatment (Fig. 3
, A and B). Because
glucose has been reported to increase IR mRNA level in several
types of cells (32), a potential inhibitory effect of insulin could
have been missed in cells cultured in the presence of glucose. However,
when cells were preincubated in a glucose-deprived medium for 24 h
and subsequently treated by insulin, no effects of insulin on receptor
mRNA were observed whether glucose was present or not during insulin
treatment (Fig. 3B
). In addition, basal IR mRNA in cells incubated in a
glucose-deprived medium were not affected by glucose at 5, 12.5, and 25
mM (Fig. 3C
).

View larger version (34K):
[in this window]
[in a new window]
|
Figure 3. Time course and dose dependence of insulin and
glucose effects on IR mRNA level in Fao cells. A, Cells were treated
with 1 µM insulin for the indicated times; B, cells were
incubated in a glucose-free medium for 24 h then treated by
insulin at the indicated concentrations in a medium containing
(bottom) or not (top) 25 mM
glucose for another 24 h; C, cells were incubated in a
glucose-free medium for 24 h then in a medium containing glucose
at the indicated concentration for another 24 h. In each of these
conditions, IR mRNA was analyzed by Northern blot and quantitated by
scanning densitometry of autoradiograms as described in
Materials and Methods. Results, normalized for pABP mRNA
content, are the mean ± SEM of three independent
determinations, except in B, in which three separate RNA samples were
pooled before analysis.
|
|
The ability of vanadate to decrease IR mRNA level in Fao hepatoma cells
was time and dose dependent (Fig. 4
). In
time studies, there was a 2- to 4-h lag before any decrease was
observed, and a significant effect was seen at 4 h on the 9.5-kb
transcript and at 8 h on the 7.5-kb transcript. The lack of an
apparent effect of vanadate on the 7.5-kb transcript at 4 h could
be due to the higher expression of this transcript relative to the
9.5-kb transcript and to the nonlinearity of the autoradiographic
signal at the exposition time used. The decrease in IR mRNA progressed
gradually, with a lowest level (9.5 kb and 7.5 kb transcripts, 10% and
25% of control, respectively) at 24 h. Dose-response studies
showed that only at concentrations above 100 µM did
vanadate affect IR mRNA level, with a decrease to about 4550% and
7075% of control values at 250 µM and 500
µM, respectively. When cells treated by 500
µM vanadate for 24 h were washed free of vanadate,
IR mRNA level was fully restored in 24 h (Fig. 5
).

View larger version (23K):
[in this window]
[in a new window]
|
Figure 4. Time course and dose dependence of vanadate effect
on IR mRNA level in Fao cells. Cells were treated with 500
µM vanadate for the indicated times (A) or with vanadate
at the indicated concentration for 24 h (B). IR mRNA was analyzed
by Northern blot and quantitated by scanning densitometry of
autoradiograms as described in Materials and Methods.
Results, normalized for pABP mRNA content, are the mean ±
SEM of three independent determinations. *,
P < 0.05 vs. control cells; **,
P < 0.01 vs. control cells; ***,
P < 0.0001 vs. control cells.
|
|

View larger version (22K):
[in this window]
[in a new window]
|
Figure 5. Reversibility of vanadate effect on IR mRNA. Fao
cells were incubated with 500 µM vanadate or left
untreated for 24 h. Vanadate-treated and control cells were then
incubated in a vanadate-free medium for another 24 h (VR and CR,
respectively). IR mRNA was analyzed by Northern blot and quantitated by
scanning densitometry of autoradiograms as described in
Materials and Methods. Results, normalized for pABP mRNA
content, are the mean ± SEM of three to four
independent determinations. **, P < 0.01
vs. control cells.
|
|
Changes in IR isotype expression in insulin- and vanadate-treated
cells
The relative expression of the mRNAs encoding isotypes A (exon
11-) and B (exon 11+) of the IR has been shown to be tissue-specific
and to be influenced by hormonal and environmental factors. To
determine possible effects on insulin and vanadate on receptor isotype
expression in Fao cells, total RNA from untreated and treated cells was
extracted and subjected to RT and radioactive PCR amplification. The
317- and 277-bp radiolabeled products corresponding to the B and A
isotype, respectively, were separated by electrophoresis, visualized by
autoradiography, and quantified using a PhosphorImager (Fig. 6
). Under basal conditions, the B mRNA
isotype was predominant, with the A mRNA isotype accounting for only
28% of total products. Insulin treatment led to a moderate, albeit
significant increase in the relative expression of the A mRNA isotype
(39% of total products), but vanadate treatment did not elicit any
significant effect.

View larger version (29K):
[in this window]
[in a new window]
|
Figure 6. Effect of insulin and vanadate on the relative
abundance of the isotype A and the isotype B IR mRNA. Total RNA was
prepared from Fao cells that had been treated with 1 µM
insulin (I) or 500 µM vanadate (V) for 24 h or left
untreated (C). Partial sequences of IR cDNA including or not exon 11
were generated by RT-PCR amplification using specific oligonucleotide
primers as described in Materials and Methods. The
products of amplification corresponding to the A and B receptor
isotypes were resolved by electrophoresis and quantified using a
PhosphorImager. The results, expressed as the relative expression of
the A isotype (ratio A/A + B x 100), are the mean ±
SEM of three to five independent determinations; *,
P < 0.05 vs. control cells.
|
|
Effect of vanadate on IR mRNA stability
To determine if vanadate decreased the stability of IR mRNA, the
half-life of this mRNA was measured. To achieve this, cells were first
preincubated in the presence or absence of 500 µM
vanadate for 4 h. Ongoing transcription was then inhibited by the
addition of 100 µM DRB, and at subsequent time points the
9.5 and 7.5 kb IR mRNA species were quantitated (Fig. 7
). IR mRNA level decayed at similar
rates whether cells had been treated or not with vanadate and
regardless of the mRNA species considered (t1/2, 3.33.5
h). These results suggest that the decrease in steady-state IR mRNA
level in vanadate-treated cells is not due to a decrease in mRNA
stability.

View larger version (17K):
[in this window]
[in a new window]
|
Figure 7. Effect of vanadate on the half-life of IR mRNA.
Fao cells were treated with 500 µM vanadate or left
untreated for 4 h. DRB (100 µM) was then added and
at the indicated times after DRB addition total RNA was isolated. IR
mRNA was analyzed by Northern blot and quantitated by scanning
densitometry of autoradiograms as described in Materials and
Methods. The first-order decay rate constants were derived and
used to calculate half-life values. Results are representative of three
independent determinations.
|
|
Effect of vanadate on IR gene transcriptional activity
The results described above suggest that the effect of
vanadate on IR mRNA level occurred at the transcriptional level.
Accordingly, run-on transcription experiments were performed with
nuclei isolated from control and vanadate-treated cells. On
autoradiography, a decrease in the intensity of the IR signal was
clearly detectable with nuclei from vanadate-treated cells (Fig. 8
). Densitometric analysis indicated a
4-fold decrease in relative transcriptional activity.

View larger version (26K):
[in this window]
[in a new window]
|
Figure 8. Effect of vanadate on IR gene transcription in
isolated nuclei. A, Nuclei were isolated from Fao cells left untreated
(C) or treated with 500 µM vanadate (V) for 24 h and
used for in vitro transcription as described in
Materials and Methods. After incubation of nuclei with
[ -32P] UTP, 32P-labeled RNA was isolated
and hybridized (15 x106 cpm/blot) to filter-immobilized
DNA complementary to IR, pUC, and PEPCK, and genomic DNA (20 µg
each). Filters were washed and subjected to autoradiography. B, The
signals seen in A were quantitated by scanning densitometry. The
intensities of the IR and PEPCK signals were normalized to the genomic
signal after subtraction of the intensity of the PUC signal. The
results are expressed as the mean ± half the range of two
independent determinations.
|
|
For comparison, the effect of vanadate on the transcriptional
activity of the gene encoding PEPCK was also studied. Vanadate
treatment also resulted in a marked decrease in the hybridization
signal obtained with PEPCK cDNA (about 5-fold). A comparable degree
of inhibition of PEPCK gene transcription in hepatoma cells by vanadate
has been previously reported (31).
 |
Discussion
|
|---|
Vanadate, an inhibitor of phosphotyrosine phosphatases, has
previously been shown to mimic a number of insulins biological
effects, including down-regulation of the IR protein (33). However, the
mechanisms underlying the effect of insulin and vanadate on the
receptor protein appear to differ, at least in certain types of cells
(11). In addition, despite the fact that insulin and vanadate regulate
in a similar manner the expression of several genes, it is unknown
whether, and how, vanadate affects the expression of the IR gene. In
the present study, we show that insulin and vanadate cause a comparable
decrease in the number of total cellular IRs in Fao hepatoma
cells. However, only vanadate decreased the steady-state level of
IR mRNA. It inhibited the transcriptional activity of the IR gene
but did not affect the half-life of receptor mRNA.
Effects of insulin and vanadate on insulin binding activity
As with a number of cells (3), insulin treatment of Fao hepatoma
cells caused a decrease in the number of IRs, which affected to the
same extent high affinity/low capacity and low affinity/high capacity
sites. A comparable decrease in IR number as judged on insulin binding
activity (34), cell surface 125I-labeling of the
-subunit (35) and Western immunoblot of the ß-subunit (36) has
previously been observed in insulin-treated Fao cells by Kahn and his
colleagues. However, an additional effect of insulin described by these
authors, attributed to a loss of the oligomeric forms of the receptor,
was to increase receptor affinity (34, 35). The lesser effect of
insulin treatment on receptor affinity in our study could be related to
the fact that we measured insulin binding activity in Triton X-100
solubilized membranes and not in intact cells as Crettaz and Kahn (34)
did. Conceivably, the relative proportions of the oligomeric forms of
the receptor and their corresponding affinities for insulin may differ
in solubilized extracts and in the intact membrane.
Exposure of Fao hepatoma cells to 0.5 mM vanadate for
24 h led to a decrease in total cellular receptor number
comparable to that observed with insulin. In two previous studies,
vanadate has been shown to decrease cell surface insulin binding
activity in cultured rat adipocytes (10) and human IM9 lymphocytes
(11). However, the effect of vanadate in Fao cells differed from that
observed in IM9 lymphocytes, in which total cellular receptor number
was increased as a result of an inhibition of receptor degradation.
These findings suggest that the main effect of vanadate in Fao cells is
probably to inhibit receptor synthesis, although a positive effect on
receptor stability similar to that observed in IM9 lymphocytes cannot
be excluded. The effect of vanadate on insulin binding activity
described here also differed from that observed after a brief exposure
of freshly isolated adipocytes to vanadate. Under these conditions,
vanadate induced an increase in cell surface insulin binding by
increasing receptor affinity (37) or number (38). The latter effect,
also elicited by a brief exposure to insulin, has been attributed to a
recruitment of receptors within the plasma membrane (38).
Effects of insulin and vanadate on IR mRNA level
Previous studies have given conflicting results with regard to the
effect of insulin on IR mRNA level. In vivo, an increase in
hepatic receptor mRNA level has been reported in hypoinsulinemias
induced by streptozotocin treatment (8, 9) and fasting (8), as well as
in hyperinsulinemias associated with genetic obesity (39) or induced by
insulin infusion (40). In vitro, insulin treatment decreased
IR mRNA level in HepG2 hepatoma (12, 13) and AR42J pancreatic acinar
cells (14) but was without effect in IM9 lymphocytes (15, 16) and HepG2
cells at low concentration (17). In the present study, insulin did not
affect IR mRNA level in Fao cells regardless of concentration and time
of treatment. Insulin did also not affect receptor mRNA level in the
mouse AT3F cell line and in primary cultures of rat hepatocytes (S.
Bortoli, unpublished observations). These findings suggest that, in Fao
cells, insulin decreases the expression of the receptor by acting
postranslationally, presumably by increasing the rate of degradation of
the receptor protein as it does in most cell types (3). They also
suggest that other factors than insulin are implicated in the
regulation of IR mRNA level in vivo.
Because glucose has been shown to increase IR mRNA level in 3T3
fibroblasts overexpressing the human IR (32), a potential inhibitory
effect of insulin may have been masked by the presence of glucose in
the medium. However, insulin failed to affect IR mRNA whether glucose
was present or not, and addition of glucose to glucose-deprived cells
was also ineffective. This could be related to the fact that Fao cells
exhibit a high rate of neoglucogenesis and do not require glucose for
growth.
Unlike insulin treatment, vanadate treatment of Fao hepatoma cells
caused a marked decrease in IR mRNA. This effect coordinately affected
the two receptor transcripts, occurred after a lag phase of 4 h,
achieved a maximum by 24 h, and was fully reversible. The
concentrations at which IR mRNA level was decreased (>200
µM) were closely similar to those required for previously
described effects of vanadate in isolated cells (33). Vanadate
treatment was found to also decrease IR mRNA level in AT3F cells and
cultured hepatocytes (S. Bortoli, unpublished observations).
We have recently found that in vivo vanadate treatment
normalizes hepatic IR mRNA level in streptozotocin-induced diabetic
rats (Amessou et al., submitted for publication). The
present results are consistent with these findings and suggest that,
although vanadate may act in vivo in part by reversing
metabolic abnormalities involved in receptor mRNA overexpression, such
as hyperglycemia (40), it can also inhibit receptor gene expression via
direct effects on insulin target cells. A number of other genes the
expression of which is regulated by vanadate in isolated cells have
been identified. Some of them, such as L-type pyruvate kinase (41),
c-fos (31, 42), and gene 33 (43) are stimulated, whereas
others, such as PEPCK and tyrosine aminotransferase (31), are
inhibited. However, unlike the IR gene, most of these genes are
similarly affected by insulin and vanadate.
Expression of IR mRNA isoforms
The IR occurs as two alternatively spliced isoforms, A (exon 11-)
and B (exon 11+), which exhibit functional differences and are
expressed in a tissue-specific manner (1, 2). In the present study, Fao
hepatoma cells were found to express 70% isoform B, a level of
expression close to that of normal liver cells (90%). At variance with
these findings, the relative expression of isoform B in previous
studies on Fao (44) and HepG2 (45, 46) hepatoma cells was only 30%.
However, it has been shown that the phenotype of HepG2 hepatoma cells
depends on cell density, and that glucocorticoid hormones, probably by
eliciting a more adult phenotype, increase the expression of isoform B
(45). In our study, cells were cultured in the absence of
glucocorticoid hormones but used at subconfluency, a condition which
may have favored the expression of isoform B.
Previous studies have shown that insulin treatment decreases the high
level of receptor isotype A in Fao hepatoma cells (44) but does not
affect isotype expression in HepG2 cells (46). In the present study,
insulin treatment caused a moderate but significant increase in the
relative expression of the A isoform. The latter result is consistent
with the finding that the relative expression of isotype A is increased
in skeletal muscle (47) and liver (48) of spontaneously obese diabetic
rhesus monkeys, ant that, at least in muscle (47), the level of this
isotype is significantly correlated with plasma insulin concentration.
A positive correlation between the expression of the A isoform in
skeletal muscle and plasma insulin has also been observed (48) in a
cohort of obese and non insulin-dependent diabetic human subjects
initially reported (49) as showing no change in isoform expression.
Site of action of vanadate on IR gene expression
In the present study, vanadate treatment of Fao hepatoma cells
decreased the transcriptional activity of the IR gene but did not
affect the half-life of IR mRNA, suggesting a transcriptional site of
vanadate action. Previously, vanadate treatment has also been shown to
inhibit the transcription of the PEPCK gene in FTO 2B hepatoma cells
(31) and a vanadate-responsive sequence, distinct from the
insulin-responsive sequence, has been identified in the PEPCK gene
promoter (31). Because this sequence contains a cAMP-regulatory
element (CRE), it has been proposed that vanadate may alter
transcription of the PEPCK gene by modifying nuclear proteins such as
CREB and C/EBP (30). Interestingly, C/EBP
and C/EBPß have been
shown to bind and transactivate the human IR promoter (50), suggesting
that these factors may also be involved in the transcriptional effect
of vanadate on the IR. Owing to its ability to inhibit phosphotyrosine
phosphatases, vanadate could act on the transcription factors by
altering their level of tyrosine phosphorylation. In addition, the
ability of orally administered vanadate to reverse the altered
expression of C/EBPß (51) and hepatocyte nuclear factor 1 (52) in
diabetic rats suggest that vanadate may also affect the cellular level
of these trans-acting factors.
In summary, we have shown that, although both insulin and vanadate
down-regulate the IR protein in Fao hepatoma cells, only vanadate
decreases IR mRNA level, by inhibiting IR gene transcription. Further
studies are required to identify the cis- and
trans-acting factors involved in the transcriptional effect
of vanadate, and to determine whether this agent affects the level of
expression and/or phosphorylation of the trans-acting
factors.
 |
Acknowledgments
|
|---|
We gratefully thank Dr. Robert Barouki and Dr. Claude Forest for
helpful discussions and their critical review of this manuscript. We
also thank Dr. Bénédicte Antoine (INSERM U129, Paris), Dr.
Bernard Lardeux and Anne-Marie Durand-Schneider (INSERM U 327,
Paris) who provided AT3F cells and hepatocytes in primary culture,
respectively. We appreciate the excellent advice of Jean-François
Pageaux (INSERM U352, Lyon) for Scatchard analyses.
 |
Footnotes
|
|---|
1 This study was supported in part by a grant of the Ministère de
lEnseignement Supérieur et de la Recherche No. 93162. 
Received May 20, 1997.
 |
References
|
|---|
-
Lee J, Pilch P 1994 The insulin receptor:
structure, function and signaling. Am J Physiol 266:C319C334
-
Chetham B, Kahn CR 1995 Insulin action and the
insulin signaling network. Endocr Rev 16:117142[Abstract/Free Full Text]
-
Knutson VP 1991 Cellular trafficking and
processing of the insulin receptor. FASEB J 5:21302138[Abstract]
-
McDonald AR, Goldfine ID 1988 Glucocorticoid
regulation of insulin receptor gene transcription in IM-9 cultured
lymphocytes. J Clin Invest 81:499504
-
Kasuga M, Kahn CR, Hedo JA, Van Obberghen E, Yamada
KM 1981 Insulin-induced receptor loss in cultured human
lymphocytes is due to accelerated receptor degradation. Proc Natl Acad
Sci USA 78:69176921[Abstract/Free Full Text]
-
Davidson MB, Kaplan SA 1977 Increased insulin
binding by hepatic plasma membranes from diabetic rats. J Clin
Invest 59:2230
-
Meyerovitch J, Farfel Z, Sack J, Schechter Y 1987 Oral administration of vanadate normalizes blood glucose levels in
streptozotocin-treated rats. J Biol Chem 262:66586662[Abstract/Free Full Text]
-
Tozzo E, Desbuquois B 1992 Effects of STZ-induced
diabetes and fasting on insulin receptor mRNA expression and insulin
receptor gene transcription in rat liver. Diabetes 41:16091616[Abstract]
-
Secchi LA, Griffin CA, Grady EF, Grunfeld C, Kalinyak
JE, Schambelan M 1992 Tissue specific regulation of the insulin
receptor mRNA levels in rats with STZ-induced diabetes mellitus.
Diabetes 41:11131118[Abstract]
-
Marshall S, Monzon R 1987 Down regulation of cell
surface insulin receptors in primary cultured rat adipocytes by sodium
vanadate. Endocrinology 121:11161122[Abstract/Free Full Text]
-
Torossian K, Freedman D, Fantus IG 1988 Vanadate
downregulates cell surface insulin and growth hormone receptors and
inhibits insulin receptor degradation in cultured human lymphocytes.
J Biol Chem 263:93539359[Abstract/Free Full Text]
-
Levy JR, Krystal G, Glickman P, Dastvan F 1991 Effects of media conditions, insulin, and dexamethasone on
insulin-receptor mRNA and promoter activity in HepG2 cells. Diabetes 40:5865[Abstract]
-
Rohilla AMK, Anderson C, Wood WM, Berhanu P 1991 Insulin down regulates the steady-state level of its receptors
messenger ribonucleic acid. Biochem Biophys Res Commun 175:520526[CrossRef][Medline]
-
Okabayashi Y, Maddux BA, McDonald A, Logsdon CD,
Williams JA, Goldfine ID 1989 Mechanisms of insulin-induced
insulin receptor down-regulation. Decrease of receptor biosynthesis and
mRNA levels. Diabetes 38:182187[Abstract]
-
Maassen JA, Krans HMJ, Moller W 1987 The effect of
insulin, serum and dexamethasone on mRNA levels for the insulin
receptor in the human lymphoblastoid cell line IM9. Biochim Biophys
Acta 930:7278[Medline]
-
Rouiller DG, McKeon C, Taylor SI, Gorden P 1988 Hormonal regulation of insulin receptor gene expression: hydrocortisone
and insulin act by different mechanisms. J Biol Chem 263:1318513190[Abstract/Free Full Text]
-
Hatada EN, McClain DA, Ullrich A, Olefsky JM 1989 Effects of growth and insulin treatment on the levels of insulin
receptors and their mRNA in HepG2 cells. J Biol Chem 264:67416747[Abstract/Free Full Text]
-
Reuber MD 1960 A transplantable bile-secretion
hepatocellular carcinoma in the rat. J Natl Cancer Inst 26:891899
-
Deschatrette J, Weiss MC 1974 Characterization of
differentiated and dedifferentiated clones from a rat hepatoma.
Biochimie 56:16031611[Medline]
-
Crettaz M, Kahn CR 1983 Analysis of insulin action
using differentiated and dedifferentiated hepatoma cells. Endocrinology 113:12011209[Abstract/Free Full Text]
-
Cuatrecasas P 1972 Properties of the insulin
receptor isolated from the liver and fat cell membranes. Proc Natl Acad
Sci USA 69:318322[Abstract/Free Full Text]
-
Desbuquois B, Lopez S, Burlet H 1982 Ligand-induced
translocation of insulin receptors in intact rat liver. J Biol
Chem 257:1085210860[Abstract/Free Full Text]
-
Chomczynski P, Sacchi N 1991 Single-step method of
RNA isolation by acid guanidinium thiocyanate-phenol-chloroform
extraction. Anal Biochem 162:156159[CrossRef]
-
Goldstein BJ, Dudley AL 1990 The rat insulin
receptor: primary structure and conservation of tissue-specific
alternative messenger RNA splicing. Mol Endocrinol 4:235244[Abstract/Free Full Text]
-
Yoo-Warren H, Monaha, JE, Short J, Short H, Bruzel A,
Wynshaw-Boris A, Meisner HM, Samols D, Hanson RW 1983 Isolation
and characterization of the gene encoding for cytosolic
phosphoenolpyruvate carboxykinase (GTP) from the rat. Proc Natl Acad
Sci USA 80:36563660[Abstract/Free Full Text]
-
Grange T, Martins de Sa C, Oddos J, Pictet R 1987 Human mRNA polyadenylate binding protein evolutionary conservation of a
nucleic acid binding motif. Nucleic Acids Res 15:47714777[Abstract/Free Full Text]
-
Zandomeni R, Mittleman B, Bunick D, Ackerman S, Weinman
R 1992 Mechanism of action of
dichloro-beta-D-ribofuranosylbenzimidazole: effect on
in vitro transcription. Proc Natl Acad Sci USA 79:31673170
-
De Wasier I, Garlatti M, Bouguet J, Beaune PH, Barouki
R 1995 Insulin down-regulates cytochrome P450 2B and 2E expression
at the post-transcriptional level in the rat hepatoma cell line Fao.
Mol Pharmacol 47:474479[Abstract]
-
Goldstein BJ, Muller-Wieland D, Kahn CR 1987 Variation in insulin receptor messenger ribonucleic acid expression in
human and rodent tissues. Mol Endocrinol 1:759766[Abstract/Free Full Text]
-
OBrien R, Lucas PC, Forest CD, Magnuson MA, Granner
DK 1990 Identification of a sequence in the PEPCK gene that
mediates a negative effect of insulin on transcription. Science 249:533537[Abstract/Free Full Text]
-
Bosch F, Hatzoglou M, Park EA, Hanson RW 1990 Vanadate inhibits expression of the gene for phosphoenolpyruvate
carboxykinase (GTP) in rat hepatoma cells. J Biol Chem 265:1367713682[Abstract/Free Full Text]
-
Hauguel-De Mouzon S, Mrejen C, Alengrin F, Van Obberghen
E 1995 Glucose-induced stimulation of human insulin receptor mRNA
and tyrosine kinase activity in cultured cells. Biochem J 305:119124
-
Shechter Y 1990 Insulin-mimetic effects of
vanadate. Possible implications for future treatment of diabetes.
Diabetes 39:15[Abstract]
-
Crettaz M, Kahn CR 1984 Insulin receptor regulation
and desensitization in rat hepatoma cells. Concomitant changes in
receptor number and in binding affinity. Diabetes 33:477485[Abstract]
-
Crettaz M, Jialai I, Kasuga M, Kahn CR 1984 Insulin
receptor regulation and desensitization in rat hepatoma cells. The loss
of the oligomeric forms of the receptor correlates with the change in
receptor affinity. J Biol Chem 259:1154311549[Abstract/Free Full Text]
-
Saad MJA, Folli F, Kahn CR 1995 Insulin and
dexamethasone regulate insulin receptors, insulin receptor substrate-1,
and phosphatidylinositol 3-kinase in Fao hepatoma cells. Endocrinology 136:15791588[Abstract]
-
Fantus IG, Ahmad F, Deragon G 1990 Vanadate
augments insulin binding and prolongs insulin action in rat adipocytes.
Endocrinology 127:27162725[Abstract/Free Full Text]
-
Eriksson J, Lönroth P, Smith U 1992 Insulin
can rapidly increase cell surface insulin binding capacity in rat
adipocytes. A novel mechanism related to insulin sensitivity. Diabetes 41:707714[Abstract]
-
Ludwig S, Muller-Wieland D, Goldstein BJ, Kahn CR 1988 The insulin receptor gene and its expression in insulin-resistant
mice. Endocrinology 123:594600[Abstract/Free Full Text]
-
Mrejen C, Hauguel-de Mouzon S, Cauzac M, Girard J 1996 Regulation of hepatic insulin receptor mRNA expression by acute
and chronic hyperglycemia in pregnant rats. Endocrinol Metab 3:125133
-
Miralpeix M, Decaux JF, Kahn A, Bartrons R 1991 Vanadate induction of L-type pyruvate kinase mRNA in adult rat
hepatocytes in primary culture. Diabetes 40:462463[Abstract]
-
Wice B, Milbrandt J, Glaser L 1987 Control of
muscle differentiation in BC3H1 cells by fibroblast growth factor and
vanadate. J Biol Chem 262:18101817[Abstract/Free Full Text]
-
Weinstock RS, Messina JL 1992 Vanadate and insulin
stimulate gene 33 expression. Biochem Biophys Res Commun 189:931937[CrossRef][Medline]
-
Sell SM, Reese D, Ossowski VM 1994 Insulin-inducible changes in insulin receptor mRNA splice variants.
J Biol Chem 269:3076930772[Abstract/Free Full Text]
-
Kosaki A, Webster NJG 1993 Effect of dexamethasone
on the alternative splicing of the insulin receptor mRNA and insulin
action in HepG2 hepatoma cells. J Biol Chem 268:2199021996[Abstract/Free Full Text]
-
Norgren S, Li LS, Luthman H 1994 Regulation of
human insulin receptor mRNA splicing in HepG2 cells: effect of
glucocorticoid and low glucose concentration. Biochem Biophys Res
Commun 199:277284[CrossRef][Medline]
-
Huang Z, Bodkin NL, Ortmeyer HK, Hansen BC, Shuldiner
AR 1994 Hyperinsulinemia is associated with altered insulin
receptor mRNA splicing in muscle of the spontaneously obese diabetic
rhesus monkey. J Clin Invest 94:12891296
-
Huang Z, Bodkin NL, Ortmeyer HK, Zenilman ME, Webster
NJG, Hansen BC, Shuldiner AR 1996 Altered insulin receptor
messenger ribonucleic acid splicing in liver is associated with
deterioration of glucose tolerance in the spontaneously obese and
diabetic rhesus monkey: analysis of controversy between monkey and
human studies. J Clin Endocrinol Metab 81:15521556[Abstract]
-
Anderson CM, Henry RR, Knudson PE, Olefski JM, Webster
NJG 1993 Relative expression of insulin receptor isoforms does not
differ in lean, obese, and non insulin-dependent diabetes mellitus
subjects. J Clin Endocrinol Metab 76:13801382[Abstract]
-
Webster NJG, Kong Y, Cameron KE, Resnik JL 1994 An
upstream element from the human insulin receptor gene promoter contains
binding sites for C/EBPß and NF-1. Diabetes 43:305312[Abstract]
-
Bosch F, Sabater J, Valera A 1995 Insulin inhibits
liver expression of the CCAAT/enhancer-binding protein ß. Diabetes 44:267271[Abstract]
-
Barrera-Hernandez G, Wanke IE, Wong NCW 1996 Phlorizin or vanadate treatment reverses impaired expression of albumin
and hepatocyte nuclear factor 1 in diabetic rats. Diabetes 45:12171222[Abstract]
This article has been cited by other articles:

|
 |

|
 |
 
S. Bose, M A. Farah, H.-C. Jung, J.-H. Lee, and Y. Kim
Molecular mechanism of bis(maltolato)oxovanadium(IV)-induced insulin signaling in 3T3-L1 and IM9 cells: impact of dexamethasone
J. Mol. Endocrinol.,
June 1, 2007;
38(6):
627 - 649.
[Abstract]
[Full Text]
[PDF]
|
 |
|