Stimulatory effect of increased non-esterified fatty acid concentrations on proinsulin processing in healthy humans

To assess the effect of increased concentrations of non-esterified fatty acids (NEFA) on proinsulin processing in healthy humans.

We did a hyperglycaemic clamp (130 min duration, 8 mmol/l glucose, with a 5-g arginine bolus at min 120) before and after a 5-h infusion of Intralipid/heparin in 14 healthy subjects. Of the subjects eight underwent a saline control experiment. The proinsulin:insulin (PI:I) ratio immediately after the arginine bolus (122.5 to 125 min) was considered to provide an estimate for the conversion of proinsulin to insulin in the beta cell.

Concentrations of NEFA were 757 +/- 86 micromol/l and 1669 +/- 134 micromol/l (p < 0.001) after the 5-h infusion of saline or Intralipid, respectively. Insulin secretion rates were no different between the Intralipid and saline infusions (p = 0.73). There was no statistically significant difference for either the proinsulin concentration or the PI:I ratio during glucose stimulation alone (0 to 120 min). In response to arginine, in contrast, proinsulin remained unchanged during the saline infusion (from 31 +/- 6 to 29 +/- 7 pmol/l, p = 0.50) but decreased during 5 h of lipid infusion from (21 +/- 3 to 15 +/- 2 pmol/l, p = 0.02). The PI:I ratio in response to the arginine bolus was higher during the saline infusion (2.0 +/- 0.2% vs 1.7 +/- 0.2%, p = 0.04) but decreased during the Intralipid infusion (from 1.6 +/- 0.2% to 1.2 +/- 0.1%, p = 0.04).

The statistically significantly lower PI:I ratio in response to arginine during experimentally increased concentrations of NEFA suggests that NEFA increase the conversion of proinsulin to insulin in humans in vivo.