Fat tissue as the primary target organ of insulin resistance in diabetes mellitus. From antidiabetics to "adipeuticums"

Abstract

Insulin resistance is a pathological condition in which the effect of endogenous or externally administered (exogenous) insulin to promote tissue glucose uptake and utilization falls short of that observed in metabolically healthy individuals. It affects the entire organism, but the pathogenetic and underlying molecular biological processes of its selected target tissues - the liver, muscle and adipose tissue - are partially different. Recently, knowledge about the role of adipose tissue has expanded significantly, and it increasingly seems that dysfunctional adipose tissue is the central player in these pathological events. The manuscript reviews the structure of adipose tissue, the regulation of adipogenesis and lipolysis, data on the relationship between the microbiome and adipose tissue, the typical differences of the acute and chronic insulin resistance as well as the therapeutic tools currently available to reduce adipose tissue insulin resistance. It may well be that a molecule with a selective adipose tissue attack point and enabling safe long-term use in humans is not yet within the hoped-for proximity, the first animal experimental observations related to the first "adipeuticum"being under development outline the promise of a new treatment option.