Regulation of Endogenous Glucose Production in
Glucose Transporter 4 Over-Expressing Mice
Eric D. Berglund1*, Candice Y. Li1, Julio E. Ayala1,2, Owen P. McGuinness1,2, David H. Wasserman1,2
1Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America, 2Mouse Metabolic
Phenotyping Center, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
Strategies to amplify whole-body glucose disposal are key therapies to treat type 2 diabetes. Mice that over-express glucose
transporter 4 (Glut4) in skeletal muscle, heart, and adipose tissue (G4Tg) exhibit increased fasting glucose disposal and thus
lowered blood glucose. Intriguingly, G4Tg mice also exhibit improved insulin-stimulated suppression of endogenous
glucose production even though Glut4 is not present in the liver. It is unclear, however, if hepatic gluco-regulation is altered
in G4Tg mice in the basal, non-insulin-stimulated state. The current studies were performed to examine fasting hepatic
glucose metabolism in G4Tg mice and to determine whether gluco-regulatory adaptations exist in the non-insulin-
stimulated condition. To test this question, phloridzin-glucose clamps were used to match blood glucose and pancreatic
hormone levels while tracer dilution techniques were used to measure glucose flux. These techniques were performed in
chronically-catheterized, conscious, and un-stressed 5h-fasted G4Tg and wild-type (WT) littermates. Results show reduced
blood glucose, hepatic glycogen content, and hepatic glucokinase (GK) activity/expression as well as higher endogenous
glucose production, glucose disposal, arterial glucagon, and hepatic glucose-6-phosphatase (G6Pase) activity/expression in
G4Tg mice versus WT controls. Clamping blood glucose for 90 min at ,115 mg/dLin G4Tg and WT mice normalized nearly
all variables. Notably, however, net hepatic glycogen synthetic rates were disproportionately elevated compared to changes
in blood glucose. In conclusion, these studies demonstrate that basal improvements in glucose tolerance due to increased
uptake in extra-hepatic sites provoke important gluco-regulatory adaptations in the liver. Although changes in blood
glucose underlie the majority of these adaptations, net hepatic glycogen synthesis is sensitized. These data emphasize that
anti-diabetic therapies that target skeletal muscle, heart, and/or adipose tissue likely positively impact the liver.
Citation: Berglund ED, Li CY, Ayala JE, McGuinness OP, Wasserman DH (2012) Regulation of Endogenous Glucose Production in Glucose Transporter 4 Over-
Expressing Mice. PLoS ONE 7(12): e52355. doi:10.1371/journal.pone.0052355
Editor: Giovanni Di Pasquale, National Institutes of Health, United States of America
Received September 7, 2012; Accepted November 14, 2012; Published December 17, 2012
Copyright: ? 2012 Berglund et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was funded by NIH DK050277 and DK059637 (awarded to DHW). The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: email@example.com
Defects in gluco-regulation define type 2 diabetes, and therapies
to control dysregulated blood glucose are a fundamental
component of disease management. A network of organs including
skeletal muscle, heart, adipose tissue, and liver contribute to
regulating whole-body glucose homeostasis . Glucose trans-
porter 4 (Glut4) is an insulin- and exercise-sensitive glucose
transporter present in skeletal muscle, heart, and adipose tissue [1–
3]. Over-expression of Glut4 in these sites results in a mouse model
(G4Tg) characterized by lowered blood glucose, reduced insulin,
and improved whole-body glucose tolerance [4–9]. G4Tg mice
also exhibit improved whole-body insulin action as shown by
increased exogenous glucose infusion requirements to maintain
euglycemia during a hyperinsulinemic-euglycemic clamp [4,8].
Surprisingly, this is not due to enhanced insulin-stimulated glucose
uptake in short-term fast mice [4,8]. Instead, insulin-mediated
suppression of endogenous glucose production accounted for
higher glucose requirements in G4Tg mice [4,8]. These results
suggest that G4Tg mice exhibit a hepatic phenotype. This is
noteworthy because the liver does not express Glut4.
The present study tests the hypothesis that an increase in whole-
body peripheral glucose disposal due to over-expression of Glut4
in skeletal muscle, heart, and adipose tissue provokes adaptations
in basal hepatic glucose metabolism. Liver glucose production was
assessed under fasting conditions as well as during phloridzin-
glucose clamps. The latter was done to acutely abolish differences
in blood glucose, and thus insulin and glucagon, between wild-type
(WT) and G4Tg littermates. These analyses were performed using
chronically-catheterized mice and isotopic tracer techniques which
permit serial blood sampling and analysis of glucose flux in
conscious, unstressed animals .
Animals Care and Husbandry
All procedures were approved by the Vanderbilt University
Animal Care and Use Committee. G4Tg mice on a C57BL/6J
background have been previously described . Littermates were
used as controls. Equal numbers of male and female mice were
used in each group. Mice had free access to a standard chow diet
and water and were studied at four months of age.
Surgical procedures to implant catheters in the left common
carotid artery and right jugular vein for sampling and infusing,
PLOS ONE | www.plosone.org1December 2012 | Volume 7 | Issue 12 | e52355
respectively, have been previously described [10,12]. Mice were
housed individually during a 5 d recovery. Only mice returning to
within 10% of pre-surgical body weight were studied.
On the day of the study, mice began a 5 h fast at ,8:00am to
ensure that animals are post-absorptive and replete with liver
Figure 1. Hormonal and glucose flux responses to acutely normalizing blood glucose in glucose transporter 4 over-expressing mice
(G4Tg) and wild-type (WT) littermates. A 90 min phloridzin (80 mg?kg21?min21)-glucose (115 mg?dL21) clamp was performed in conscious,
chronically-catheterized, 5 h-fasted mice that over-express glucose transporter 4 (Glut4) in skeletal muscle, heart, and adipose tissue and wild-type
(WT) littermates to normalize basal differences in arterial blood glucose (A) using an exogenous glucose infusion rate (B). Basal and clamp
endogenous appearance (endoRa; C) and disappearance (Rd; D) of glucose were measured using a primed, constant infusion of [3-3H] glucose (50 mCi
bolus +0.05 mCi?min21). Basal and clamp arterial insulin, non-esterified fatty acids (NEFA), and glucagon are shown in panels E-G, respectively. Data
are presented as means 6 SEM and * and w indicate p,0.05 compared to WT littermates or to basal values within a genotype, respectively. n=7–
8 mice in each group.
Regulation of Glucose Production in G4Tg Mice
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glycogen . At t =290 min, [3-3H]glucose was infused (50 mCi
bolus +0.05 mCi?min21) to measure glucose turnover. Blood
samples were taken at t=230, 220, 210, and 0 min to
determine basal endogenous glucose appearance (endoRa) and
disappearance (Rd). Blood samples were taken at t=230 and
t=0 min to measure basal arterial glucagon and insulin.
Additional blood was taken at t=230 min to measure basal
non-esterified fatty acids (NEFAs) and hematocrit. A continuous
infusion of saline-washed erythrocytes was started at t=230 min
to prevent a .5% fall in hematocrit. At t=0 min, phloridzin
(80 mg?kg21?min21) was infused and the [3-3H]glucose infusion
was increased to 0.1 mCi?min21. Arterial blood glucose was
measured every 10 min thereafter using a glucose meter. A
variable glucose infusion rate (GIR) was adjusted to maintain
euglycemia at ,115 mg?dl21. Blood samples were taken at t=60,
70, 80 and 90 min to determine glucose turnover. Additional
samples were taken at t=60 and 90 min to assess insulin,
glucagon, and NEFA. Blood was taken at t=80 min to assess
hematocrit. Mice were anesthetized at t=90 min and tissues were
excised and frozen. In a subgroup of animals (n=7 mice/
genotype), mice were anesthetized at t=0 min (e.g. prior to
infusion of phloridzin) and tissues were excised and frozen to
provide basal data.
Arterial Plasma Analyses
The measurement of [3-3H]glucose in plasma was performed as
described . Insulin and glucagon were determined by the
Vanderbilt Mouse Metabolic Phenotyping Center (MMPC) .
NEFA were determined using a kit (Wako, NEFA C kit, Wako
Chemicals Inc., Richmond VA).
Liver samples used to assess glucokinase (GK) and glucose-6-
phosphatase (G6Pase) activity were homogenized 1:10 (w/v) in
buffer (50 mM HEPES, 0.1 mM KCl, 1 mM EDTA, 5 mM
MgCl2and 2.5 mM dithioerythritol) and centrifuged (100,000 g)
at 4uC for 45 minutes. GK activity was assessed on supernatant.
G6Pase activity was determined on pellets after re-suspension in
buffer. For GK assays, supernatants were incubated at 37uC in
buffer (50 mM HEPES, 0.1 mM KCl, 7.5 mM MgCl2, 2.5 mM
dithioerythritol, 10 mg/ml NAD, 4 U/ml glucose-6-phosphate
dehydrogenase, 5 mM ATP, and either 0.5 mM or 100 mM
glucose). GK activity was calculated as the difference in
radioactivity in the presence of 0.5 mM and 100 mM glucose.
For G6Pase assays, samples were incubated at 37uC for 20 min
with 0, 10, 20, 50, 100, or 200 mM glucose-6-phosphate.
Liver samples to assess glycogen phosphorylase (GP) and
glycogen synthase (GS) were homogenized 1:10 (w/v) in buffer
(50 mM Tris (pH 6.8), 10 mM EDTA, 100 mM NaF, 5 mM
dithioerythritol, and 0.5% glycogen). GP activity was measured
after incubation of supernatant with phosphorylase reaction
medium (150 mM NaF, 1.5% glycogen, 15 mM glucose-1-
phosphate, 5 uCi [14C]glucose-1-phosphate, and either 0.75 mM
caffeine or 7.5 mM AMP). GS activity was assessed following
addition of supernatant to synthase reaction medium (50 mM Tris
(pH 7.5), 5 mM EDTA, 1% glycogen, 1.5 mM UDP-glucose,
5 uCi [14C] UDP-glucose, and either 15 mM Na2SO4or 3 mM
glucose-6-phosphate). Reactions were incubated at 37uC and
aliquots were spotted onto Whatman chromatography filter paper
every 10 min for 40 min. Samples were washed in ethanol and
radioactivity was measured. GP activity was calculated by the ratio
of activity in the presence of 7.5 mM AMP compared to 0.75 mM
caffeine. GS activity was calculated by the ratio of activity in the
presence of 3 mM glucose-6-phosphate compared to 15 mM
Liver glycogen was determined enzymatically as previously
described . Hepatic mRNA was determined as previously
described . Taqman Assay-on-Demand primers were used to
measure expression of genes of interest normalized to cyclophilin
using the DDCtcalculation.
Calculation and Statistical Analyses
EndoRaand Rdwere calculated as previously described .
All values are presented as means 6 SE. Differences between
groups were tested using Student’s t tests and differences were
considered significant if p,0.05.
Phloridzin-glucose clamps were performed in G4Tg and WT
littermate mice to normalize basal 5 h fasted differences in arterial
blood glucose, insulin, glucagon, and glucose turnover (Table 1
and Figure 1A). There were no differences in body weight between
the two genotypes (Table 1). During the clamp, the GIR required
to achieve the target arterial glucose concentration of ,115 mg/
dL (Figure 1A) was ,3-fold higher in G4Tg mice (Figure 1B).
Relative changes in blood glucose levels from basal to clamp
217.561.8% from basal in G4Tg and WT mice, respectively).
Basal endoRaand Rdwere higher in G4Tg mice versus WT
littermates (Figures 1C and 1D). In response to equalizing blood
glucose, clamp endoRa was lowered in G4Tg mice to rates
comparable to WT mice (Figure 1C). Clamp endoRain WT mice
remained similar to basal rates (Figure 1C). Clamp Rdin G4Tg
mice was elevated from basal rates and was higher than WT mice
(Figure 1D). Clamp Rdwas unchanged from basal rates in WT
mice (Figure 1D).
Arterial Insulin, Glucagon, and NEFA Concentrations
Basal arterial insulin and NEFA levels were comparable in
G4Tg and WT littermates and were unaltered by clamp-induced
normalization of arterial glucose (Figures 1E and 1F). Basal
arterial glucagon levels in G4Tg mice were higher than WT
littermates (Figure 1G). This difference was abolished by
normalization of arterial glucose during the clamp (Figure 1G).
Table 1. Basal characteristics of wild-type (WT) and littermate
mice with over-expression of glucose transporter 4 (G4Tg).
Body Weight (g)24612661
Blood Glucose (mg?dL21)14168 9163*
Glucagon (pg?mL21) 416460610*
Measurements were taken in 5h fasted mice prior to phloridzin-glucose clamps
and represent combined data from control and experimental animals. *
indicates p,0.05 compared to WT littermates.
Regulation of Glucose Production in G4Tg Mice
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Changes in Hepatic Glycogen, Enzyme Activity, and Gene
Basal 5 h fasted hepatic glycogen content was lower in G4Tg
mice versus WT littermates (Figure 2A). WT mice had an ,25%
reduction in hepatic glycogen over the course of the experimental
period (Figure 2A). In contrast, normalizing arterial glucose by the
phloridzin-glucose clamp resulted in repletion of hepatic glycogen
levels in G4Tg mice to those observed in WT mice in the basal
state (Figure 2A). Changes in liver glycogen (shown as net hepatic
glycogen breakdown in Figure 2B) associated with normalizing
arterial glucose are nearly equal to the respective changes in
endoRain G4TG and WT littermate mice (denoted by dashed
lines in Figure 2B and shown in Figure 1C).
To better understand differences in glycogen metabolism and
glucose fluxes, activities and expression of key gluco-regulatory
enzymes were measured in the basal state and following the clamp
in G4Tg and WT littermates. Consistent with the accelerated rate
of hepatic glucose production, basal hepatic GK and G6Pase
enzyme activities were lower and higher, respectively, in G4Tg
mice compared to WT controls (Figures 2C and 2D). Normalizing
blood glucose between the two genotypes eliminated these
differences (Figures 2C and 2D). In contrast to GK and G6Pase,
hepatic GP and GS enzyme activity ratios did not differ between
G4Tg mice and WT littermates and were unchanged following the
Figure 2. Hepatic glycogen and related enzyme activities in response to acutely normalizing blood glucose in glucose transporter 4
over-expressing mice (G4Tg) and wild-type (WT) littermates. Hepatic glycogen content (A), hepatic glycogen breakdown (B), and activities or
activity ratios of glucokinase (GK; C), glucose-6-phosphatase (G6Pase; D), glycogen phosphorylase (GP; E), and glycogen synthase (GS; F)] are shown
before and after normalizing blood glucose in 5 h-fasted mice that over-express glucose transporter 4 (Glut4) in skeletal muscle, heart, and adipose
tissue and wild-type (WT) littermates using a 90 min phloridzin (80 mg?kg21?min21)-glucose (115 mg?dL21) clamp. Separate cohorts of mice were
used to obtain basal and clamp data. Dashed lines in panel B denote changes in endogenous appearance of glucose (endoRa; shown in Figure 1C).
Data are presented as means 6 SEM and * and w indicate p,0.05 compared to WT littermates or to basal values within a genotype, respectively.
n=7–8 mice in each group.
Regulation of Glucose Production in G4Tg Mice
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clamp (Figures 2E and 2F). In agreement with hepatic enzyme
activity ratio data, basal hepatic expression of GK and G6Pase
were lower and higher, respectively, in G4Tg mice versus WT
littermates (Figures 3A and 3B). Hepatic GK expression was
elevated in both genotypes to a similar extent following the clamp
(Figure 3A). Hepatic G6Pase gene expression was increased and
decreased with respect to expression in the basal state in WT and
G4Tg mice, respectively (Figure 3B).
These current data in G4Tg mice prior to normalizing blood
glucose are consistent with previous studies showing lowered blood
glucose, higher glucagon, and comparable NEFA levels compared
to WT littermates [4,6–9]. The present results also support
previous work demonstrating enhanced whole-body glucose
production and glucose disposal in G4Tg mice . The current
findings in the basal, pre-clamp condition provide additional
details that G4Tg mice exhibit an altered hepatic gluco-regulatory
phenotype that is characterized by higher and lower activities and
gene expression of G6Pase and GK, respectively, as well as greatly
reduced liver glycogen content. This shift in carbohydrate flux
away from storage in the liver is consistent with the need to
support elevated systemic glucose removal from the blood in the
The most salient findings from this work were obtained using
phloridzin-glucose clamps to study G4Tg mice in the absence of
hyperinsulinemia or differences in arterial glucose levels compared
to WT littermates. Phloridzin is an agonist for sodium/glucose co-
transporters in kidney and intestine and is used in the current
context as a tool in conjunction with an exogenous glucose
infusion to establish a comparable glycemic background .
Importantly, these glucose clamp results reveal that acutely
creating a comparable glycemic background eliminates many,
but not all differences observed in the basal (e.g. pre-clamp)
condition. Notably, matching arterial blood glucose to the mid-
point of the respective 5 h fasted levels in G4Tg and WT
littermate mice results in comparable clamp endoRaand plasma
glucagon levels. Clamp results in G4Tg mice do suggest a
disproportionate increase in hepatic glycogen content relative to
the change in blood glucose when compared to WT littermates.
This conclusion is based on the fact that the magnitude of change
in blood glucose was similar between G4Tg and WT mice, but the
corresponding change in hepatic glycogen content was greater in
G4Tg mice. In addition, hepatic GK expression does not fall in
G4Tg mice despite the normalization of blood glucose. These
findings suggest that the G4Tg mouse liver is primed to store liver
Although the purpose of the present experiments was not to
study changes in blood glucose per se, the clamp results in both
genotypes also demonstrate how sensitive hepatic gluco-regulatory
pathways are to changes in blood glucose. In particular, these data
demonstrate that modest and acute changes in blood glucose
potently alter hepatic GK and G6Pase expression in both G4Tg
and WT mice. It is important to consider that these aforemen-
tioned changes occur after only a 60 min steady-state period
during which arterial glucose was matched to the same interme-
diate value of ,115 mg/dL. It is also important to note that this
approach to use the mid-point between the two genotypes as the
glucose clamp target instead of the more extreme approach of
raising or lowering the respective blood glucose levels in G4Tg or
WT to match the other genotype was selected because it allowed
steady-state conditions to be obtained in both genotypes in a
shorter time frame.
An additional experimental point of emphasis in the current
studies is that blood glucose was controlled in WT and G4Tg using
a clamp protocol in which the jugular vein and carotid artery were
chronically catheterized for sampling and infusing purposes,
respectively. This mouse model differs from those generally used
 and is advantageous because it does not induce a stress
response (e.g. a rise in catecholamines) that occurs with the more
common tube restraint and cut-tail blood sampling approach .
This point is important in the current context because increases in
stress would be predicted to alter both hepatic and extra-hepatic
glucose metabolism [10,17]. Erythrocytes were also replaced in the
current experiments to prevent the fall in hematocrit that occurs
following repeated blood sampling and consequent loss of red
blood cell volume.
In conclusion, these experiments show that a peripheral increase
in fasting glucose disposal exerts positive effects on liver glucose
metabolism. These results also clarify that these beneficial changes
occur due to both blood glucose-dependent and –independent
mechanisms. The finding that blood glucose per se is important
since these results suggest that therapeutic strategies to reduce
blood glucose levels, regardless of site of action or mechanism(s), in
contexts of insulin resistance and type 2 diabetes may ultimately
benefit multiple tissues involved in gluco-regulation. Here we focus
on improvement to glucose disposal in peripheral tissues benefit-
ting the liver, but the converse remains an area of on-going study.
Additional work is also needed to better understand glucose-
independent regulatory factors that may be exploited to positively
impact hepatic glucose metabolism.
Conceived and designed the experiments: EDB CYL DHW. Performed the
experiments: CYL JEA. Analyzed the data: EDB CYL DHW. Contributed
reagents/materials/analysis tools: OPM. Wrote the paper: EDB DHW.
Figure 3. Hepatic expression of gluco-regulatory enzymes after
acutely normalizing blood glucose in glucose transporter 4
over-expressing mice (G4Tg) and wild-type (WT) littermates.
Hepatic expression of glucokinase (GK; A), glucose-6-phosphatase
(G6Pase; B), and cytosolic phosphoenolpyruvate kinase (PEPCK; C) are
shown before and after normalizing blood glucose in 5h-fasted mice
that over-express glucose transporter 4 (Glut4) in skeletal muscle, heart,
and adipose tissue (G4Tg) and wild-type (WT) littermates during a
90 min phloridzin (80 mg?kg21?min21)-glucose (115 mg?dL21) clamp.
Separate cohorts of mice were used to obtain basal and clamp data.
Data are presented as means 6 SEM and normalized to cyclophilin
expression and basal levels in WT mice. * and w indicate p,0.05
compared to WT littermates or to basal values within a genotype,
respectively. n=7–8 mice in each group.
Regulation of Glucose Production in G4Tg Mice
PLOS ONE | www.plosone.org5December 2012 | Volume 7 | Issue 12 | e52355
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