Acute AMPK activation does not adequately stimulate insulin signaling in skeletal muscle models of Myotonic Dystrophy Type 1

Abstract Myotonic Dystrophy Type 1 (DM1) is a multisystemic neuromuscular disorder characterized by skeletal muscle weakness, muscle atrophy, myotonia, cognitive impairments, gastrointestinal complications, and insulin resistance. While insulin resistance is well characterized in type 2 diabetes, its pathomechanism in DM1 remains unclear. Our study aims to elucidate the pathomechanism of insulin resistance in DM1 and how the pathway responds to AMPK stimulation. Proteomic analysis from sedentary wildtype and sedentary HSA-LR mice, a common DM1 mouse model, revealed downregulation of the AMPK-PGC-1α axis. Analysis of sedentary HSA-LR mice and exercised HSA-LR mice revealed activation of the AMPK-PGC-1α axis in exercised animals. To investigate this pathway, we treated WT and HSA-LR mice with the AMPK activator AICAR to examine the impact of AMPK stimulation on insulin signaling in DM1. This revealed impaired responses in the insulin pathway activation in the HSA-LR mice. Next, we examined whether these differences extended to a human model by treating control and DM1 myotubes with insulin and/or AICAR. In DM1 myotubes, both treatments produced dampened responses of key insulin signaling intermediates compared to controls. Taken together, these results suggest impaired activation of insulin signaling pathways in DM1 models and confirm the presence of insulin resistance with an impaired response to acute AMPK stimulation.