Summary of NP action in the skeletal muscle in healthy individuals (A) and obese individuals with diabetes (B). NPs circulate in reduced concentrations in obese individuals with diabetes compared with the levels in healthy individuals. Furthermore, expression of NPRA, which binds NPs and activates intracellular signaling events, is reduced, while expression of NPRC, which clears NPs in tissues, is increased in obesity and T2D. In healthy individuals, generation of cGMP from guanosine triphosphate (GTP) by the guanylyl cyclase activity of NPRA activates a signaling pathway resulting in the phosphorylation (P) and activation of p38 mitogen-activated protein kinase (p38 MAPK) and the increased transcription of peroxisome proliferator–activated receptor coactivator γ-1α (PGC1α)...
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