SorCS1 binds the insulin receptor to enhance insulin sensitivity

Type II diabetes mellitus (T2DM) has reached endemic levels and comprises a substantial burden to the patient and the society. Along with lifestyle factors, a number of genetic loci predisposing to T2DM have been suggested including SORCS1 that encodes a type-1 transmembrane receptor. Here we establish SorCS1 as a high-affinity binding partner for the insulin receptor (IR) that increases insulin affinity, Akt activation, and peripheral glucose uptake. Mice lacking full-length SorCS1 develop age-dependent insulin resistance characterized by increased plasma glucose and insulin levels and a blunted response to exogenous insulin. SorCS1 exists in three forms; as a transmembrane monomer and dimer, and as a truncated soluble form (sol-SorCS1) produced in adipose tissue and is present in plasma. Whereas dimeric SorCS1 engages the proform of the insulin receptor (proIR) during biosynthesis and supports its maturation, the monomeric form stabilizes the mature IR at the plasma membrane. In its soluble form, SorCS1 positively correlates with body mass index and inversely with plasma glucose in diabetic patients, and in mouse models of insulin resistance, overexpression or exogenous administration of the monomeric soluble receptor domain restores insulin sensitivity. We conclude that SorCS1 is a critical regulator of peripheral insulin sensitivity operating in both a cell autonomous and endocrine manner, and we propose sol-SorCS1 as a novel adipokine.