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The actions of insulin on cells include:
* Increased glycogen synthesis – insulin forces storage of glucose in liver (and muscle)
cells in the form of glycogen; lowered levels of insulin cause liver cells to convert glycogen to
glucose and excrete it into the blood. This is the clinical action of insulin which is directly useful
in reducing high blood glucose levels as in diabetes.
* Increased fatty acid synthesis – insulin forces fat cells to take in blood lipids which are
converted to triglycerides; lack of insulin causes the reverse.
* Increased esterification of fatty acids – forces adipose tissue to make fats (i.e.,
triglycerides) from fatty acid esters; lack of insulin causes the reverse.
* Decreased proteinolysis – forces reduction of protein degradation; lack of insulin
increases protein degradation.
* Decreased lipolysis – forces reduction in conversion of fat cell lipid stores into blood fatty
acids; lack of insulin causes the reverse.
* Decreased gluconeogenesis – decreases production of glucose from non-sugar
substrates, primarily in the liver (remember, the vast majority of endogenous insulin arriving at
the liver never leaves the liver) ; lack of insulin causes glucose production from assorted
substrates in the liver and elsewhere.
* Increased amino acid uptake – forces cells to absorb circulating amino acids; lack of
insulin inhibits absorption.
* Increased potassium uptake – forces cells to absorb serum potassium; lack of insulin
inhibits absorption.
* Arterial muscle tone – forces arterial wall muscle to relax, increasing blood flow, especially
in micro arteries; lack of insulin reduces flow by allowing these muscles to contract.
The active sites of tyrosine kinases each have a binding site for ATP. The enzymatic activity
catalyzed by a tyrosine kinase is the transfer of the terminal phosphate from ATP to tyrosine
residues on its substrates, a process known as protein tyrosine phosphorylation. Imatinib works
by binding to the ATP binding site of bcr-abl and inhibiting the enzyme activity of the protein
competitively. Imatinib is quite selective for bcr-abl – it does also inhibit other targets mentioned
above (c-kit and PDGF-R), but no other known tyrosine kinases. Imatinib also inhibits the abl
protein of non-cancer cells but cells normally have additional redundant tyrosine kinases which
allow them to continue to function even if abl tyrosine kinase is inhibited. Some tumour cells,
however, have a dependence on bcr-abl.[1] Inhibition of the bcr-abl tyrosine kinase also
stimulates its entry in to the nucleus, where it is unable to perform any of its normal anti-
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