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Is insulin the new intermittent hypoxia?

Authors
  • Limberg, Jacqueline K1
  • Curry, Timothy B1
  • Prabhakar, Nanduri R2
  • Joyner, Michael J3
  • 1 Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States. , (United States)
  • 2 Institute for Integrative Physiology and The Center for Systems Biology of Oxygen Sensing, Biological Science Division, University of Chicago, Chicago, IL 60637, United States. , (United States)
  • 3 Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States. Electronic address: [email protected] , (United States)
Type
Published Article
Journal
Medical hypotheses
Publication Date
Jun 01, 2014
Volume
82
Issue
6
Pages
730–735
Identifiers
DOI: 10.1016/j.mehy.2014.03.014
PMID: 24690299
Source
Medline
License
Unknown

Abstract

The sympathoexcitatory effects of insulin are well-established, although the exact mechanisms by which insulin stimulates the sympathetic nervous system are not completely understood. The majority of research supports a primary role for the central nervous system in the gradual and sustained rise in muscle sympathetic nerve activity (MSNA) in response to hyperinsulinemia; in addition, recent studies in animals suggests carotid body chemoreceptors respond to increases in systemic insulin levels. Intermittent activation of the carotid chemoreceptors, similar to that seen in patients with sleep apnea, can result in sensory long term facilitation and may contribute to the observed rise in baseline MSNA in this population. Consistent with this idea, insulin exposure results in sustained increases in MSNA that persist even when plasma insulin levels return to baseline. We propose the carotid chemoreceptors contribute to insulin-mediated sympathoexcitation and the persistent rise in MSNA in patients with sustained hyperinsulinemia. If the carotid chemoreceptors sense and respond to changes in systemic insulin levels, these organs may provide a viable target for the treatment of disorders known to exhibit sustained hyperinsulinemia and sympathoexcitation including, but not limited to, obesity, hypertension, sleep apnea, metabolic syndrome, cardiovascular disease, and diabetes.

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