Rs. Savkur et al., Aberrant regulation of insulin receptor alternative splicing is associatedwith insulin resistance in myotonic dystrophy, NAT GENET, 29(1), 2001, pp. 40-47
Myotonic dystrophy type 1 (DM1) is caused by a CTG trinucleotide expansion
in the 3' untranslated region of the DM protein kinase gene. People with DM
1 have an unusual form of insulin resistance caused by a defect in skeletal
muscle. Here we demonstrate that alternative splicing of the insulin recep
tor (IR) pre-mRNA is aberrantly regulated in DM1 skeletal muscle tissue, re
sulting in predominant expression of the lower-signaling nonmuscle isoform
(IR-A). IR-A also predominates in DM1 skeletal muscle cultures, which exhib
it a decreased metabolic response to insulin relative to cultures from norm
al controls. Steady-state levels of CUG-BP, a regulator of pre-mRNA splicin
g proposed to mediate some aspects of DM1 pathogenesis, are increased in DM
1 skeletal muscle; overexpression of CUG-BP in normal cells induces a switc
h to IR-A. The CUG-BP protein mediates this switch through an intronic elem
ent located upstream of the alternatively spliced exon 11, and specifically
binds within this element in vitro. These results support a model in which
increased expression of a splicing regulator contributes to insulin resist
ance in DM1 by affecting IR alternative splicing.