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Journal of Applied Physiology
Vol. 82, No. 1, pp. 359-363, January 1997

RAPID COMMUNICATION

Evidence that nitric oxide increases glucose transport in skeletal muscle

Thomas W. Balon Jerry L. Nadler
(With the Technical Assistance of Arnie Jasman)

Department of Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, California 91010

ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
ACKNOWLEDGEMENTS
FOOTNOTES
REFERENCES


ABSTRACT

Balon, Thomas W., and Jerry L. Nadler. Evidence that nitric oxide increases glucose transport in skeletal muscle. J. Appl. Physiol. 82(1): 359-363, 1997.---Nitric oxide synthase (NOS) is expressed in skeletal muscle. However, the role of nitric oxide (NO) in glucose transport in this tissue remains unclear. To determine the role of NO in modulating glucose transport, 2-deoxyglucose (2-DG) transport was measured in rat extensor digitorum longus (EDL) muscles that were exposed to either a maximally stimulating concentration of insulin or to an electrical stimulation protocol, in the presence of NG-monomethyl-L-arginine, a NOS inhibitor. In addition, EDL preparations were exposed to sodium nitroprusside (SNP), an NO donor, in the presence of submaximal and maximally stimulating concentrations of insulin. NOS inhibition reduced both basal and exercise-enhanced 2-DG transport but had no effect on insulin-stimulated 2-DG transport. Furthermore, SNP increased 2-DG transport in a dose-responsive manner. The effects of SNP and insulin on 2-DG transport were additive when insulin was present in physiological but not in pharmacological concentrations. Chronic treadmill training increased protein expression of both type I and type III NOS in soleus muscle homogenates. Our results suggest that NO may be a potential mediator of exercise-induced glucose transport.

insulin; nitric oxide synthase isoforms; treadmill running; sodium nitroprusside; 2-deoxyglucose transport


INTRODUCTION

RECENT IMMUNOCYTOCHEMICAL STUDIES by Kobzik and co-workers (8, 9) have noted that both the type I (neuronal) and type III (endothelial) isoforms of nitric oxide synthase (NOS) are expressed in skeletal muscle. In conjunction with these findings, we have observed that nitric oxide (NO) is released from incubated skeletal muscle preparations (1). Furthermore, muscle NO release is augmented by prior electrically induced contractions (1). Although the complete physiological significance of NO in skeletal muscle remains to be determined (17), a number of different researchers (8, 13-15) have noted that NO may play a role in modulating contractile function.

A previous study (1) has demonstrated that incubation of skeletal muscle with a NOS inhibitor decreased glucose transport (1). Both insulin and exercise stimulate glucose transport utilization (5). However, the potential role of NO in modulating glucose transport by these stimuli is unknown. Accordingly, we designed experiments utilizing both a NOS inhibitor and a NO donor to address the hypothesis of whether NO is a potential mediator of either exercise-enhanced or insulin-stimulated glucose transport.

Exercise protocols have been demonstrated to affect a number of proteins within skeletal muscle (3). However, the effects of exercise training on the expression of different NOS isoforms in skeletal muscle have not been studied. Thus additional experiments were performed to determine the effects of a chronic endurance-training protocol on NOS protein expression in rat skeletal muscle.

These results indicate that NO might be a potential mediator of glucose transport in skeletal muscle during the resting and postexercise state. Furthermore, chronic exercise stimulates the protein expression of both type I and type III NOS isoforms in soleus muscle.


MATERIALS AND METHODS

Treatment of animals. Male Sprague-Dawley rats (Charles River, Hollister, CA) fed ad libitum were used for all experiments. All protocols were approved by the Research Animal Care Committee of the City of Hope National Medical Center and Beckman Research Institute of the City of Hope, CA. For muscle incubation studies, rats weighing between 50 and 64 g were anesthetized with pentobarbital sodium (5 mg/100 g body wt ip). With the use of the exact procedures of Maizels and associates (12), extensor digitorum longus (EDL) muscles were dissected for incubation.

Training protocol. Rats, initially weighing 160-170 g, ran on a motor-driven treadmill at a speed of 15 m/min for 15 min/day. The duration and speed of the training period were increased by 5 min and 3 m/min every third work bout until the rats were able to run 36 m/min, 90 min/day, 5 days/wk. After the terminal speed and duration were obtained, 1-min sprints of 42 m/min were performed every 10 min throughout the 90-min bout of exercise. After an 8-wk training period, the rats were anesthetized with pentobarbital sodium (5 mg/100 g body wt ip), 72 h after the last training session to minimize the residual effects of the last bout of exercise. Soleus muscles were rapidly excised, trimmed of extraneous fat and connective tissue, blotted on filter paper, and dropped into liquid nitrogen. Subsequently, the soleus muscles were wrapped in aluminum foil and stored in liquid nitrogen until further analysis.

Electrical stimulation. Under anesthesia, a small incision was made through an avascular junction between the caudofemoralis and the quadratus femoris muscles proximal to the lateral side of the patella. The sciatic nerve complex was exposed and isolated. A dastre electrode was placed around the common peroneal nerve just distal of the bifurcation to the tibial nerve. The protocol for inducing muscle contractions by electrical stimulation has been described in detail previously (1). In brief, the nerve was stimulated for two 5-min periods separated by 1 min of rest. Each stimulation period consisted of one 500-ms train/s, with each train consisting of repeated 6- to 8-V pulses of 0.1-ms duration delivered at 100 Hz. Immediately after stimulation, the EDL muscles were isolated, ablated, and prepared for incubation.

Incubations. Each EDL muscle was tied to a stainless steel clip to maintain it at its in vivo resting length. EDL were incubated initially in 25 ml Erlenmeyer flasks for 60 min. The flasks contained 3 ml of oxygenated Krebs-Henseleit bicarbonate (KRB) buffer with 8 mM glucose, 32 mM mannitol, 0.1% bovine serum albumin (BSA; fraction V, Miles-Pentex) to allow for equilibration. Flasks were gassed with 5% CO2-95% O2 before muscles were added and subsequently placed into a shaking Dubnoff incubator, which was maintained at 33°C and 100 oscillations/min. After the initial hour of incubation, EDL muscles were transferred to freshly oxygenated flasks containing 3 ml of KRB, containing 0.1% BSA and 40 mM mannitol, and then incubated for 10 min. Subsequently, EDL muscles were transferred to another flask containing 3 ml of KRB containing 0.1% BSA, 1 mM 2-deoxy-[1,2-3H]glucose (20 µCi/mmol) and 39 mM [U-14C] mannitol (0.5 µCi/mmol) and incubated for 20 min. After this third incubation period, the muscles were blotted on paper towels and frozen in liquid nitrogen until processed.

When used, sodium nitroprusside (SNP; Sigma Chemical, St. Louis, MO) or NG-monomethyl-L-arginine (L-NMMA; Calbiochem, LaJolla, CA) was present or absent during the initial hour of incubation, washout, and transport measurement periods.

Biochemical analysis. For tissue processing of 2-deoxyglucose (2-DG) uptake, muscles were weighed in tared graduated test tubes containing 1.0 ml of 0.5 N NaOH. Test tubes were then transferred to a boiling water bath and incubated for 45 min with occasional vortexing. After the tubes cooled to room temperature, 30 µl of 5 N HCl were added to the hydrolysate, which was then vortexed. Next, 500 µl of neutralized tissue extract were added to 10 ml of scintillant (Scintiverse II, Fisher) and counted on a Beckman LS9800 scintillation counter programmed for dual-channel counting. Separate 100-µl aliquots of incubation medium were also counted. The radioactivity in the 14C channel and the specific activity of the incubation medium were used to determine the extracellular space of the tissue. The specific uptake of 2-DG by the muscle was calculated by subtracting the 3H activity in the extracellular space from the total 3H activity of each muscle tissue.

To measure ATP and creatine phosphate (CP) concentrations, EDL samples were removed from the clips, quickly weighed in a test tube precooled in a methanol-solid CO2 bath, and homogenized in 2 ml of ice-cold 6% (vol/vol) perchloric acid. The muscle samples were then centrifuged at (4°C) at 834 g for 20 min. A portion of the resulting supernatant was neutralized with a solution of 2 M KOH containing 0.5 M triethanolamine, and the precipated salt was removed by centrifugation at (4°C) at 834 g for 20 min. A portion of the subsequent supernatant was analyzed enzymatically for ATP and CP (10).

Western blot analysis. Soleus muscles were homogenized (1:10 wt/vol) in a solution consisting of 1× phosphate-buffered saline, 10 mM N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid, 1 mM EDTA, 1 mM ethylene glycol-bis(beta -aminoethyl ether)-N,N,N',N'-tetraacetic acid, 1% Triton X-100, 0.1% sodium dodecyl sulfate (SDS), 2 mM dithiothreitol, and 1 µl/ml sodium vanadate by a polytron (Brinkmann, Westbury, NY) at a setting of 6 for 90 s. After homogenization, leupeptin (6 µl/ml), pepstatin A (1 µl/ml), and phenylmethylsulfonyl fluoride (1 µl/ml) were added to the homogenates, and tubes were placed on ice for 30 min. Homogenates were centrifuged at 1,876 g for 3 min. The resulting supernatants were assayed for protein by a dye-binding procedure (Bio-Rad, Hercules, CA). The proteins were heated at 90°C for 10 min in a water bath. Then 40 µg of protein from the soleus muscles were separated by electrophoresis through a 6.5% SDS-polyacrylamide gel. The gel was run at constant mA: 10 mA through a stacking gel and 15 mA through the separating gel. Proteins were transferred from the gel to polyvinylidene difluride membrane (Bio-Rad) by using a Semiphor Semi-Dry transfer unit (Hoefer, San Francisco, CA). The membranes were then washed with tris(hydroxymethyl)aminomethane (Tris)-buffered saline-Tween 20 (TBST), consisting of 10 mM Tris (pH 7.5) with 100 mM NaCl and 0.1% Tween 20, for 5 min and were placed into fresh TBST and allowed to incubate overnight at 4°C. A Western-Light Chemiluminescent Detection System (Tropix, Bedford, MA) was used in conjunction with primary antibodies for type I and type III NOS isoforms (Transduction Laboratories, Lexington, KY). Rat brain and human endothelial cell lysates were used as positive controls for type I and type III NOS isoforms, respectively. After exposure to film, densitometry was used for quantification.

Statistics. All data are expressed as means ± SE. When two means were compared, analysis was performed by an unpaired t-test, except when the muscles were taken from the contralateral leg for comparison with the opposite leg. In this case, the paired t-test was employed. When multiple means were compared, analyses were performed by an analysis of variance. If a significant F ratio was found, further analysis was performed by a Tukey's post hoc comparison. P < 0.05 was selected for acceptance of statistical significance.


RESULTS

Effects of SNP on 2-DG transport. Figure 1 shows that SNP significantly (P < 0.05) increases 2-DG transport over a wide variety of concentrations. However at a concentration of 2 × 10-2 M, SNP significantly (P <0.01) decreased 2-DG transport to rate that was 75 ± 5% of that observed in control incubations, which contained no SNP or insulin. SNP at a concentration of 5 × 10-2 M resulted in an even larger (50 ± 16%) reduction in 2-DG transport.
Fig. 1. Dose response. Effect of sodium nitroprusside (SNP) on 2-deoxyglucose (2-DG) transport by incubated rat extensor digitorum longus (EDL) muscles. Values are means ± SE of 4-22 observations. * Significantly different from control at P < 0.05.
[View Larger Version of this Image (14K GIF file)]

Figure 2 shows the effects of insulin and SNP alone and in combination with one another on 2-DG transport. Each agent, when used alone at the listed concentrations, has a significant (P < 0.05) submaximal effect on stimulating 2-DG transport. However, when used in combination at these submaximal stimulating concentrations with one another, there is an additive effect on the stimulation of 2-DG transport. When the muscles are exposed to a maximal stimulating concentration of insulin (20,000 µU/ml), SNP has no additional effect on the stimulation of 2-DG transport.
Fig. 2. Effect of SNP and insulin concentrations on 2-DG transport by incubated rat EDL muscles. Values are means ± SE of 6-11 observations. a-e Significant differences between groups at P < 0.05.
[View Larger Version of this Image (43K GIF file)]

Effects of SNP on high-energy phosphate concentrations of skeletal muscle. SNP, when used at a concentration equal to or <10-2 M, did not alter either ATP or CP concentrations of previously incubated EDL muscle (results not shown). However, there was a significant decrease in ATP (2.45 ± 0.21 vs. 5.26 ± 1.12 µmol/g) and CP (1.50 ± 0.22 vs. 14.51 ± 0.72 µmol/g) concentrations (both n = 5; P < 0.05) after incubation with 2 × 10-2 M SNP, demonstrating that an incubation with a high concentration of SNP compromises metabolic integrity of the muscle.

Effects of NOS inhibition on 2-DG transport. Incubation with L-NMMA decreases basal 2-DG by ~30% (Table 1, Fig. 3). In marked contrast, L-NMMA has no effect on insulin-stimulated 2-DG transport at either physiological (Fig. 3) or pharmacological concentrations (Table 1). However, contraction-enhanced 2-DG transport is nearly completely abolished by NOS inhibition (Table 1).

Table 1. Effects of L-NMMA and electrical stimulation on 2-deoxyglucose transport in rat extensor digitorum longus muscle


Condition Control Stimulated Insulin, 20,000 µU/ml

No addition 23.29 ± 0.91  41.69 ± 2.48  63.12 ± 3.40 
L-NMMA added 17.46 ± 0.61* 25.00 ± 2.11dagger 67.21 ± 5.22

Values are means ± SE of 10-12 observations per group. L-NMMA, N G-monomethyl-L-arginine; 2-deoxyglucose transport measured in nmol · g-1 · min-1. * Significant difference between no addition and L-NMMA addition, P < 0.05; dagger significant difference between no addition and L-NMMA addition, P < 0.01.


Fig. 3. Effect of a physiological concentration of insulin and a nitric oxide synthase (NOS) inhibitor NG-monomethyl-L-arginine (L-NMMA) on 2-DG transport. Values are means ± SE of 6-8 observations. a-c Significant differences between groups at P < 0.05.
[View Larger Version of this Image (29K GIF file)]

Effect of exercise training on NOS protein expression. Type I NOS protein is barely detectable in soleus muscle homogenates of sedentary rats (Fig. 4). However, soleus muscle obtained from trained rats shows a marked fourfold increase (P < 0.01) in type I NOS protein expression (4.09 ± 0.18 arbitrary units; n = 6) compared with their sedentary counterparts (1.00 ± 0.15 arbitrary units; n = 6). Type III NOS protein expression is also increased (P < 0.05) in soleus muscle samples obtained from trained rats (1.98 ± 0.40 arbitrary units; n = 6) compared with sedentary counterparts [1.00 ± 0.15 arbitrary units (n = 6)].
Fig. 4. Representative autograph showing effect of training on type I NOS protein contents in whole soleus homogenates.
[View Larger Version of this Image (39K GIF file)]


DISCUSSION

The major finding of the current studies is our observation that NOS inhibition selectively inhibits exercise enhanced 2-DG transport. Although it has been observed by ourselves (7, 21) and others (4, 5) that different factors activate glucose uptake in skeletal muscle, the signaling molecules or mechanisms remain obscure. Although further investigation is needed, we hypothesize that exercise activates glucose transport through a NO-mediated pathway, whereas insulin increases glucose-transport through a NO-independent mechanism.

Our finding that type I NOS protein can be increased by chronic endurance exercise is another example of a specific protein (i.e., GLUT-4 and hexokinase II) that has a key regulatory role in the control of glucose flux and can be upregulated by increased contractile activity (16, 20). These results support the potentially important regulatory role of specific NOS isoforms in exercise-induced improvement in glucose metabolism.

Our demonstration of increasing NOS protein expression of type I and type III isoforms by chronic endurance training extends the work of others (18) who have demonstrated that chronic exercise increases endothelial cell (type III) NOS gene expression in aortic extracts. It is possible that the increase in skeletal muscle NOS protein is a compensatory mechanism in response to the increase in metabolic demand.

Another major finding of these experiments that reinforces support for the role of NO in glucose transport regulation is that exposure to SNP, a NO donor, increases 2-DG transport in skeletal muscle over a wide range of concentrations. With high concentrations of SNP, 2-DG transport decreased. The stimulatory effects of SNP on glucose transport appear to be varied and dependent on the cell or tissue type examined. For example, Lander and associates (11) found that SNP, S-nitroso-N-acetylpenicillamine, or a NO gas-saturated medium increased glucose uptake in human peripheral blood mononuclear cells . Conversely, Emani and Perry (6) found that SNP had no stimulatory effect on glucose uptake in adipocytes. However, it should be noted that exposure to SNP did enhance triglyceride synthesis and protein synthesis in adipocytes, suggesting NO may selectively enhance certain insulin sensitive processes, depending on cell type (6). Furthermore, it should be noted that higher concentrations of SNP increased lactate dehydrogenase leakage from adipocytes, thus indicating a compromised metabolic integrity of the cell (6).

The concentration of SNP utilized in the majority of the current experiments was the same used by a number of other groups examining NO and skeletal muscle function (8, 13, 14). The aforementioned studies have noted that NO enhances force maintenance and is essential for optimal muscle function. These combined studies suggest that millimolar concentrations of SNP, when added for relatively short periods of times, are not detrimental to integrity of skeletal muscle metabolism.

In agreement with our prior investigation (1), we again demonstrated that NOS inhibition decreases basal glucose transport. However, NOS inhibition did not diminish 2-DG transport in skeletal muscle preparations by either submaximal or maximally stimulating concentrations of insulin. These results are somewhat different from those of Baron and co-workers (2), who observed insulin resistance after a bolus administration of L-NMMA, a NOS inhibitor. The disparity between studies most likely is because of the difference in the models utilized. We are examining skeletal muscle metabolism directly by using an incubated muscle preparation, whereas Baron et al. (2) examined whole body insulin responsiveness. Thus insulin in vivo may increase endothelial cell NO, resulting in vasodilatory responses and improved insulin responsiveness (19).

In conclusion, these new results suggest that modulation of the NO pathway in skeletal muscle could provide a novel approach to increasing glucose transport. Furthermore, the data indicate a potentially important role of NO in mediating exercise-induced glucose transport.


ACKNOWLEDGEMENTS

We thank Emilia Balon for technical assistance.


FOOTNOTES

   This research was initially supported by National Institute of Arthritis and Musculoskeletal Diseases Grant AR-39974 and later by a grant from the American Diabetes Association.

Address for reprint requests: T. W. Balon, Dept. of Diabetes, Endocrinology and Metabolism, City of Hope National Medical Center, Duarte, CA 91010 (E-mail: TBALON{at}smtplink.coh.org).

Received 7 August 1996; accepted in final form 8 October 1996.


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