Molecular basis of insulin resistance in Bardet Biedl syndrome

Bardet Biedl Syndrome (BBS) displays heterogeneity in the genes involved and clinical features. Mutations in 19 genes have been associated with BBS. Eight BBS proteins (BBS1, 2, 4, 5, 7, 8, 9 and 18) form the BBSome. Assembly of the BBSome is mediated by three BBS proteins (BBS6, 10, 12) in a complex with the CCT/Tric chaperonins. The BBSome is involved in formation and maintenance of primary cilia and vesicle trafficking. The clinical features of BBS include obesity, degenerative retinopathy, polydactyly, renal dysfunction, hypogonadism, and learning disability. Diabetes mellitus is commonly associated with BBS, but the mechanisms remain unknown.

Our objective was to understand the molecular mechanism of BBS-associated diabetes. The role of BBS in insulin receptor (IR) signaling in Bbs4^-/-mice was tested by preventing obesity using calorie restriction. These studies demonstrate the genetic defect in BBS directly contributes to the diabetes phenotype independently from the obesity phenotype.

Emerging evidence implicating neuronal mechanisms in various BBS phenotypes led us to test the possibility that loss of Bbs1 in the central nervous system (CNS) disrupts glucose homeostasis. We found that deletion of the Bbs1 gene throughout the CNS or in specific hypothalamic neurons leads to hyperglycemia, glucose intolerance and insulin resistance. Our data demonstrate the critical role of neuronal Bbs1 in the regulation of glucose in an insulin-independent manner.

Finally, the IR was found to interact with BBS proteins. The loss of BBSome proteins leads to a specific reduction in the amount of IR at the cell surface. The results demonstrate that BBSome proteins are required to maintain adequate levels of IR at the cell surface. The role of BBS proteins in transporting IR has not been previously described. Loss of the BBSome appears to be a novel mechanism of insulin resistance.