Hoofbeats, zebras, and insights into insulin resistance

In this issue of the JCI, Semple and colleagues report phenotypic evaluation of patients with a germline mutation in the gene encoding serine/threonine kinase AKT2 (see the related article beginning on page 315). Their findings support the idea that the postreceptor actions of insulin in the liver--suppression of gluconeogenesis and stimulation of lipogenesis--are mediated through divergent pathways that can be uncoupled. The results appear to refine the arrangement of crucial steps along these pathways and show how comprehensive study of the phenotype, "deep phenotyping," of patients who carry rare mutations might complement other types of experiments to elucidate complex pathways and mechanisms.