As a crossroad between
carbohydrate and
lipid metabolism, pyruvate carboxylase expression in gluconeogenic tissues, adipose tissues and pancreatic islets must be coordinated. In conditions of over nutrition, PC levels are increased in pancreatic β-cells to increase
pyruvate cycling in response to chronically elevated levels of
glucose. In contrast, PC enzyme levels in the liver are decreased by
insulin; during periods of overnutrition adipocyte tissue is expanded with extreme expression of PC and other lipogenic enzymes. Hepatic control of glucose levels is still regulated in an over nutrition situation, but in obesity induced type 2 diabetes the regulation of peripheral glucose levels is no longer under regulation of insulin. In
type 2 diabetic rats, chronic exposure of
β-cells to glucose due to peripheral insulin resistance results in decreased PC enzyme activity and decreased
pyruvate cycling. The continued overproduction of glucose by
hepatocytes causes dramatic alteration of
gene expression in
β-cells with large increases in normally suppressed genes, and equivalent decreases in expression of mRNA for insulin, ion pumps necessary for insulin secretion, and metabolic enzymes related to insulin secretion, including pyruvate carboxylase. Concurrently adipose tissue develops insulin resistance causing accumulation of
triacylglycerols and non-esterified
fatty acids in circulation; these not only further impairing β-cell function, but also further decreasing PC expression. These changes result in the decline of the
β-cell phenotype in decompensated diabetes. A
deficiency of pyruvate carboxylase can cause
lactic acidosis as a result of
lactate build up. Normally, excess
pyruvate is shunted into
gluconeogenesis via conversion of pyruvate into
oxaloacetate, but because of the enzyme deficiency, excess pyruvate is converted into
lactate instead. As a key role of gluconeogenesis is in the maintenance of
blood sugar, deficiency of pyruvate carboxylase can also lead to
hypoglycemia. ==See also==