Theranostics 2020; 10(14):6149-6166. doi:10.7150/thno.46053

Research Paper

DR-region of Na+/K+-ATPase is a target to ameliorate hepatic insulin resistance in obese diabetic mice

Hai-Jian Sun1, Lei Cao1, Meng-Yuan Zhu1, Zhi-Yuan Wu1, Chen-You Shen2, Xiao-Wei Nie1,2, Jin-Song Bian1,3✉

1. Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
2. Center of Clinical Research, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, PR China; Lung Transplant Group, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China.
3. National University of Singapore (Suzhou) Research Institute, Suzhou, China.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Sun HJ, Cao L, Zhu MY, Wu ZY, Shen CY, Nie XW, Bian JS. DR-region of Na+/K+-ATPase is a target to ameliorate hepatic insulin resistance in obese diabetic mice. Theranostics 2020; 10(14):6149-6166. doi:10.7150/thno.46053. Available from

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Reduced hepatic Na+/K+-ATPase (NKA) activity and NKAα1 expression are engaged in the pathologies of metabolism diseases. The present study was designed to investigate the potential roles of NKAα1 in hepatic gluconeogenesis and glycogenesis in both hepatocytes and obese diabetic mice.

Methods: Insulin resistance was mimicked by glucosamine (GlcN) in either human hepatocellular carcinoma (HepG2) cells or primary mouse primary hepatocytes. Obese diabetic mice were induced by high-fat diet (HFD) feeding for 12 weeks.

Results: We found that both NKA activity and NKAα1 protein level were downregulated in GlcN-treated hepatocytes and in the livers of obese diabetic mice. Pharmacological inhibition of NKA with ouabain worsened, while activation of NKAα1 with an antibody against an extracellular DR region of NKAα1 subunit (DR-Ab) prevented GlcN-induced increase in gluconeogenesis and decrease in glycogenesis. Likewise, the above results were also corroborated by the opposite effects of genetic knockout/overexpression of NKAα1 on both gluconeogenesis and glycogenesis. In obese diabetic mice, hepatic activation or overexpression of NKAα1 stimulated the PI3K/Akt pathway to suppress hyperglycemia and improve insulin resistance. More importantly, loss of NKA activities in NKAα1+/- mice was associated with more susceptibility to insulin resistance following HFD feeding.

Conclusions: Our findings suggest that NKAα1 is a physiological regulator of glucose homoeostasis and its DR-region is a novel target to treat hepatic insulin resistance.

Keywords: diabetes, insulin resistance, Na+/K+-ATPase, gluconeogenesis, glycogenesis