Anti-Obesity Drugs: A Review about Their Effects and Safety

Hypolipidemic effects of herbal extracts by reduction of adipocyte differentiation, intracellular neutral lipid content, lipolysis, fatty acid exchange and lipid droplet motility

An increase in adipose tissue is caused by the increased size and number of adipocytes. Lipids accumulate in intracellular stores, known as lipid droplets (LDs). Recent studies suggest that parameters such as LD size, shape and dynamics are closely related to the development of obesity. Berberine (BBR), a natural plant alkaloid, has been demonstrated to possess anti-obesity effects. However, it remains unknown which cellular processes are affected by this compound or how effective herbal extracts containing BBR and other alkaloids actually are. For this study, we used extracts of Coptis chinensis, Mahonia aquifolium, Berberis vulgaris and Chelidonium majus containing BBR and other alkaloids and studied various processes related to adipocyte functionality. The presence of extracts resulted in reduced adipocyte differentiation, as well as neutral lipid content and rate of lipolysis. We observed that the intracellular fatty acid exchange was reduced in different LD size fractions upon treatment with BBR and Coptis chinensis. In addition, LD motility was decreased upon incubation with BBR, Coptis chinensis and Chelidonium majus extracts. Furthermore, Chelidonium majus was identified as a potent fatty acid uptake inhibitor. This is the first study that demonstrates the selected regulatory effects of herbal extracts on adipocyte function.

Morus alba (mulberry), a natural potent compound in management of obesity

Obesity is defined as body mass index, higher than 30 kg/m², which are associated with diverse diseases including type 2 diabetes, hypertension, coronary diseases, certain cancers, osteoarthritis and dyslipidemia. The subject of this review article was to evaluate the potency of Morus alba or "mulberry" as natural potent anti-obesity agent in management of obesity. For writing this manuscript, we searched in all accessible international databases, electronic resources (PubMed, Science Direct, Springer, Wiley and Google), unpublished data (R&D reports, thesis and dissertation). The inhibitory effects of mulberry on digestive enzymes and adipocyte differentiation, and its stimulatory effects on energy expenditures, and lipid metabolism are responsible mechanisms for management of obesity in obese patients. Furthermore, the results of these preclinical studies and its related mechanisms should be evaluated in large clinical trials.

Identification of Cyanobacterial Strains with Potential for the Treatment of Obesity-Related Co-Morbidities by Bioactivity, Toxicity Evaluation and Metabolite Profiling

Obesity is a complex disease resulting in several metabolic co-morbidities and is increasing at epidemic rates. The marine environment is an interesting resource of novel compounds and in particular cyanobacteria are well known for their capacity to produce novel secondary metabolites. In this work, we explored the potential of cyanobacteria for the production of compounds with relevant activities towards metabolic diseases using a blend of target-based, phenotypic and zebrafish assays as whole small animal models. A total of 46 cyanobacterial strains were grown and biomass fractionated, yielding in total 263 fractions. Bioactivities related to metabolic function were tested in different in vitro and in vivo models. Studying adipogenic and thermogenic gene expression in brown adipocytes, lipid metabolism and glucose uptake in hepatocytes, as well as lipid metabolism in zebrafish larvae, we identified 66 (25%) active fractions. This together with metabolite profiling and the evaluation of toxicity allowed the identification of 18 (7%) fractions with promising bioactivity towards different aspects of metabolic disease. Among those, we identified several known compounds, such as eryloside T, leptosin F, pheophorbide A, phaeophytin A, chlorophyll A, present as minor peaks. Those compounds were previously not described to have bioactivities in metabolic regulation, and both known or unknown compounds could be responsible for such effects. In summary, we find that cyanobacteria hold a huge repertoire of molecules with specific bioactivities towards metabolic diseases, which needs to be explored in the future.

Chlorophyll Derivatives from Marine Cyanobacteria with Lipid-Reducing Activities

Marine organisms, particularly cyanobacteria, are important resources for the production of bioactive secondary metabolites for the treatment of human diseases. In this study, a bioassay-guided approach was used to discover metabolites with lipid-reducing activity. Two chlorophyll derivatives were successfully isolated, the previously described 13²-hydroxy-pheophytin a (1) and the new compound 13²-hydroxy-pheofarnesin a (2). The structure elucidation of the new compound 2 was established based on one- and two-dimensional (1D and 2D) NMR spectroscopy and mass spectrometry. Compounds 1 and 2 showed significant neutral lipid-reducing activity in the zebrafish Nile red fat metabolism assay after 48 h of exposure with a half maximal effective concentration (EC₅₀) of 8.9 ± 0.4 µM for 1 and 15.5 ± 1.3 µM for 2. Both compounds additionally reduced neutral lipid accumulation in 3T3-L1 multicellular spheroids of murine preadipocytes. Molecular profiling of mRNA expression of some target genes was evaluated for the higher potent compound 1, which indicated altered peroxisome proliferator activated receptor gamma (PPARγ) mRNA expression. Lipolysis was not affected. Different food materials (Spirulina, Chlorella, spinach, and cabbage) were evaluated for the presence of 1, and the cyanobacterium Spirulina, with GRAS (generally regarded as safe) status for human consumption, contained high amounts of 1. In summary, known and novel chlorophyll derivatives were discovered from marine cyanobacteria with relevant lipid-reducing activities, which in the future may be developed into nutraceuticals.

Chemistry, Analysis, Pharmacokinetics and Pharmacodynamics Aspects of Lorcaserin, a Selective Serotonin 5-HT2C Receptor Agonist: An Update

This review refers to the all-inclusive details of Lorcaserin Hydrochloride on comprehensive information about the synthesis, analytical methods, pharmacodynamics, pharmacokinetics, drug interactions and adverse effects. Lorcaserin Hydrochloride is chemically (R)-8-Chloro-1-methyl-2,3,4,5- tetrahydro-1H-3-benzazepine hydrochloride. Lorcaserin HCl is a novel, synthetic, centrally-acting selective serotonin C (5-HT2c) receptor, l agonist, which results in increased satiety and decreased food consumption in patients. Headache, dizziness and nausea are the most common side effects associated with this drug. Lorcaserin HCl has two major metabolites, one conjugated with glucuronide called N-carbamoyl glucuronide which is excreted in urine and the second Lorcaserin N-sulfamate, which is circulated in the blood. Lorcaserin HCl is synthesized using four different schemes of which a six-step method that resulted in 92.3% yield with 99.8% of purity is employed for scale-up production. It is analyzed quantitatively in the plasma and brain tissue matrix of rats by Ultra Performance Liquid chromatographic (UPLC) method using MS-MS (Mass Spectrometric) detection.

Phytanic acid activates PPARα to promote beige adipogenic differentiation of preadipocytes

A better understanding of the mechanisms of beige and brown adipogenesis is needed for developing strategies to prevent and treat obesity and associated metabolic disorders. Phytanic acid (PA) exists in a wide range of foods, especially in milk fat and marine foods, but its effects on obesity and beige adipogenesis remain poorly defined. The objective is to investigate the effects and regulatory mechanisms of PA in the beige adipogenesis. In 3T3-L1 preadipocytes, PA elevated the expression of brown adipogenic markers, suggesting that PA promotes beige adipogenic differentiation in committed adipogenic cells. In uncommitted C3H10T1/2 cells, while PA increased PGC1α expression, it did not increase brown adipogenic regulators PRDM16 or UCP1 expression, suggesting that PA had no significant effects on brown adipocyte commitment. PA also enhanced mitochondrial biogenesis and oxygen consumption. Promotion of both mitochondriogenesis and beige adipogenic differentiation were blocked by using PPARα antagonist or with Pparα knockdown, showing that PA-mediated beige/brown adipogenic differentiation is dependent on PPARα. Additionally, the PA-regulated effect is independent on β3-adrenergic receptor. Taken together, PA promotes beige adipogenic differentiation, but not the commitment of progenitor cells to the brown adipocyte lineage. PPARα is a key mediator during PA-induced beige/brown adipogenic differentiation.

Possible Mechanisms Involved in the Vasorelaxant Effect Produced by Anorexigenic Drugs in Rat Aortic Rings

Anorexigenics are compounds capable of reducing or suppressing appetite. Their three main types act on different neurotransmitters, either norepinephrine, serotonin or a combination of both. Among the drugs that act on norepinephrine are fenproporex, amfepramone and clobenzorex. Derivatives of the thyroid hormone triiodothyronine have also been associated with weight loss and used as a controversial treatment for obesity, despite their known cardiovascular side effects. Recent data suggest a possible vasodilating effect for these four substances that might be beneficial in a subset of patients. Herein we performed a systematic review of the literature (with emphasis on recent reports) to determine the implications and mechanisms of the vasodilating effects of some anorectics, specifically fenproporex, clobenzorex, amfepramone and triiodothyronine. Data analysis showed these four drugs to be vasodilating agents for rat aortic rings. The different mechanisms of action include endothelium-dependent vasodilation via activation of the NO-cGMP-PKG pathway and the opening of calcium-activated potassium channels. The finding of vasodilating activity indicates a potential role for some anorexigenic drugs in the treatment of obesity in hypertensive patients. Further in vivo studies are needed to test the clinical benefits of these four drugs.

Pathophysiology and Individualized Treatment of Hypothalamic Obesity Following Craniopharyngioma and Other Suprasellar Tumors: A Systematic Review

The development of hypothalamic obesity (HO) following craniopharyngioma (CP) and other suprasellar tumors leads to reduced patient quality of life. No treatment algorithms are currently available for management of HO. Depending on which hypothalamic nuclei are destroyed, the pathophysiologic mechanisms and clinical symptoms that contribute to HO differ among patients. Herein, we review the contribution of the hypothalamus to the pathophysiologic mechanisms and symptoms underlying CP-associated HO. Additionally, we performed a systematic search of MEDLINE and Embase to identify all intervention studies for weight management in patients with CP or other suprasellar tumors published until September 2017. The search yielded 1866 publications, of which 40 were included. Of these 40 studies, we identified four modalities for intervention (i.e., lifestyle, dietary, pharmacotherapeutic, or surgical) within six clinical domains (i.e., psychosocial disorders, hyperphagia, sleep disturbances, decreased energy expenditure, hyperinsulinemia, and hypopituitarism). We used the findings from our systematic review, in addition to current knowledge on the pathophysiology of HO, to develop an evidence-based treatment algorithm for patients with HO caused by CP or other suprasellar tumors. Although the individual effects of the HO interventions were modest, beneficial individual effects may be achieved when the pathophysiologic background and correct clinical domain are considered. These two aspects can be combined in an individualized treatment algorithm with a stepwise approach for each clinical domain. Recently elucidated targets for HO intervention were also explored to improve future management of HO for patients with CP and other suprasellar tumors.

Bioassay-guided isolation of active anti-adipogenic compound from royal jelly and the study of possible mechanisms

Background

Royal jelly (RJ) has been used traditionally for dietary, cosmetic and health purposes for a long time in different parts of the world. Scientific studies have also shown its numerous health-promoting properties including hypoglycemic and anti-hypercholesterolemic action. In this study, we investigated the anti-adipogenic activity of RJ in 3 T3-L1 cells and isolated the major responsible root component for the activity.

Methods

An active anti-adipogenic compound was isolated through bioassay-guided isolation process by successive treatment of RJ and its active fractions on 3 T3-L1 cell line. (E)-10-Hydroxy-2-decenoic Acid (10-HDA) was identified using NMR spectroscopy and ultra-performance liquid chromatography (UPLC). As 10-HDA showed significant anti-adipogenic activity with Oil Red O staining and TG content assay on 3 T3-L1 adipocytes, further study was carried out in molecular level for the expression of adipogenic transcription factors such as PPARγ, FABP4, C/EBPα, SREBP-1c, and Leptin. The effect of 10-HDA on preliminary molecules such as pAkt, pERK, C/EBPβ, and pCREB were studied in the early stage of adipogenesis. The effect of 10-HDA on reactive oxygen species (ROS) production in fully differentiating adipocytes was measured by nitro blue tetrazolium (NBT) assay.

Result

Results showed that triacylglycerol accumulation and ROS production was markedly suppressed by 10-HDA. Preliminary molecules such as pAkt, pERK, pCERB, and C/EBPβ were found to be down-regulated by 10-HDA, which led to down-regulation of key adipogenic transcription factors such as PPARγ, FABP4, CEBPα, SREBP-1c, and Leptin on 3 T3-L1 adipocytes.

Conclusion

Our results suggest that anti-adipogenesis of 10-HDA on 3 T3-L1 adipocyte takes place via two mechanisms: inhibition of cAMP/PKA pathway and inhibition of p-Akt and MAPK dependent insulin signaling pathway. So it is considered that 10-HDA, a major component of RJ, can be a potential therapeutic medicine for obesity.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2423-2) contains supplementary material, which is available to authorized users.

The effects of supplementation with conjugated linoleic acid on anthropometric indices and body composition in overweight and obese subjects: A systematic review and meta-analysis

Clinical trials have indicated conflicting results on the effects of conjugated linoleic acid (CLA) on obesity. The present study aimed to systematically review controlled clinical trials examining the effects of CLA on anthropometric indices and body composition in overweight and obese subjects. Pubmed, Scopus, Web of science, and Cochrane databases were searched between 2000 and December 2017 with no language restriction. Placebo-controlled clinical trials that reported anthropometric indices and body composition in overweight and obese subjects were included. Random-effect model was used to pool the effect estimates. Of 4032 publications, 13 trials were included for the meta-analysis. Pooled effect sizes indicated that CLA significantly reduced body weight (WMD: -0.52 kg, 95% CI: -0.83, -0.21; I²: 48.0%, p = 0.01), BMI (WMD: -0.23 kg/m², 95% CI: -0.39, - 0.06; I²: 64.7%, p = 0.0001), FM (WMD: -0.61 kg, 95% CI: -0.98, -0.24; I²: 53.8%, p = 0.01) and increased LBM (WMD: 0.19 kg, 95% CI: 0.04, 0.34; I²: 81.4%, p = 0.0001) compared to the placebo group. However, the effects of CLA on WC (WMD: 0.05 cm, 95% CI: -0.01, 0.1; I²: 0%, p = 0.93) was not significant. Additionally, its impact on body weight in subjects older than 44 year (WMD: -1.05 kg, 95% CI: -1.75, -0.35; I²: 57.0%, p = 0.01), with longer duration (more than 12 weeks) (WMD: -1.29 kg, 95% CI: -2.29, -0.29; I²: 70.3%, p = 0.003) and dosage more than 3.4 g/day (WMD: -0.77 kg, 95% CI: -1.28, -0.25; I²: 62.7%, p = 0.004) were greater than comparative groups. Supplementation with CLA can slightly reduce body weight and FM and increase LBM in overweight and obese subjects. However, its efficacy was not clinically considerable. Further studies with high methodological quality are needed to shed light on the effects of CLA on anthropometric indices in overweight and obese subjects.

Beneficial Effects of an Aged Black Garlic Extract in the Metabolic and Vascular Alterations Induced by a High Fat/Sucrose Diet in Male Rats

Aged black garlic (ABG) is a functional food with antioxidant and anti-inflammatory properties. Recent studies also report its beneficial metabolic effects in a context of obesity or diabetes, although the mechanisms involved are poorly understood. The aim of this work was to analyze the effects of an ABG extract in the vascular and metabolic alterations induced by a high-fat/sucrose diet in rats. For this purpose, male Sprague–Dawley rats were fed either a standard chow (controls; n = 12) or a high-fat/sucrose diet (HFD; n = 24) for 16 weeks. From week 8 on, half of the HFD rats were treated with a commercial ABG extract concentrated in S-allyl cysteine and melanoidins (ABG10+®; 250 mg/kg daily by gavage; 5 mL/kg). ABG10+®-treated rats showed lower mean caloric intake, body weight, triglycerides, low density lipoprotein cholesterol (LDL-c), insulin and leptin serum concentrations and higher high density lipoprotein cholesterol (HDL-c) and adiponectin serum concentrations than non-treated rats. In the hypothalamus, ABG10+® treatment induced an increase in the gene expression of proopiomelanocortin (POMC) and a decrease in leptin receptor (ObR) mRNA levels. No significant changes were found in visceral adipose tissue except for an overexpression of β3-adrenergic receptor (β3-ADR) in ABG-treated rats. In subcutaneous adipose tissue, ABG10+® treatment decreased adipose weight and downregulated the gene expression of PPAR-γ, LPL, ObR and HSL. In brown adipose tissue, an overexpression of InsR, GLUT-4, UCP-1 and β3-ADR in ABG10+®-treated rats was found, whereas PPAR-γ mRNA levels were significantly decreased. Regarding vascular function, ABG10+® treatment attenuated the obesity-induced vasoconstriction in response to potassium chloride both in presence/absence of perivascular adipose tissue (PVAT). On the contrary, aorta segments from ABG-treated rats showed and improved relaxation in response to acetylcholine only when PVAT was present, with this fact possible being related to the decreased gene expression of proinflammatory cytokines in this tissue. In conclusion, ABG10+® administration partially improves the metabolic and vascular alterations induced by a high-fat/high-sucrose diet in rats through modifications in the gene expression of proteins and neuropeptides involved in inflammation, fat metabolism and food intake regulation. Further studies are required to assess the bioavailability of ABG between rats and humans.

A new enantioselective synthesis of antiobesity drug lorcaserin

A simple and efficient enantioselective synthesis of anti-obesity drug lorcaerin starting from easily accessible 3-chlorostyrene oxide has been described for the first time employing hydrolytic kinetic resolution as a source of chirality.

Chemical constituents, antioxidant, antimicrobial and anti-lipase activities of composites derived from green tea, lemon peels and red wine lees

Abstract Novel sources of nutraceuticals, composites derived from green tea extract, red wine lees and lemon peels extract were produced. The first composite was produced from green tea extract and red wine lees. The second composite was produced from green tea extract, red wine lees and lemon peels. The composites intensively depressed the growth of the gram-positive bacteria Staphylococcus aureus and Rhodococcus sp. The inhibition zones for the first composite were 16.1 and 24.1 mm, respectively and for the second composite – 18.5 and 24.3 mm, respectively. In the case of the gram-negative bacteria Escherichia coli and Pseudomonas aeroginasa, the inhibition zones for the first composite were 18.1 and 6.1 mm, and for the second composite - 6.1 and 10.2 mm, respectively. In the case of the pathogenic fungi Rhizoctonia sp. and Streptomyces glaucus 71MD, the inhibition zones for the first composite were 14.7 and 22.3 mm, and for the second composite - 8.5 and 20.3 mm, respectively. Both composites exhibited approximately 4 times less antioxidant potential than L-ascorbic acid and showed high levels of lipase inhibition, i.e. 12.3% and 10.5% per mg dry matter for the first and second composites, respectively. In comparison with Orlistat® they showed 30% less anti-lipase activity.

RS, Sharma RK, Pothuraju R, Mohanty AK. Ameliorative effect of fermentable fibres on adiposity and insulin resistance in C57BL/6 mice fed a high-fat and sucrose diet

The consumption of diets rich in fat and refined sugars is recognized to be one of the causes of lifestyle disorders, and dietary fibres are being advocated to ameliorate the complications associated with these disorders.

Proteinaceous Pancreatic Lipase Inhibitor from the Seed of Litchi chinensis

A study of the pancreatic lipase inhibitory activity of a protein from the seed of Litchi chinensis was carried out. Protein was isolated by 70% ammonium sulphate precipitation followed by dialysis. Lipase inhibitory activity of the protein was evaluated using both synthetic (p-nitrophenyl palmitate) and natural (olive oil) substrates. Protein at the final concentration of 100 µg/mL was able to inhibit 68.2% pancreatic lipase on synthetic substrate and 60.0% on natural substrate. Proteinaceous nature of the inhibitor was determined using trypsinization assay. Pancreatic lipase inhibitory protein was sensitive to 0.05% trypsin treatment with the loss of 61.9% activity. IC₅₀ of this proteinaceous pancreatic lipase inhibitor was 73.1 µg/mL using synthetic substrate. This inhibitory protein was sensitive to pH, with the highest inhibitory activity at pH=8.0 and the lowest at pH=3.0. Protein was further analyzed using 10% non-reducing sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and, interestingly, it showed the presence of a single band of (61±2) kDa when stained with Coomassie brilliant blue. The isolated protein was finally crystallized to see its homogeneity by batch crystallization method. Crystals were well formed with distinct edges. The isolated protein showed good pancreatic lipase inhibitory activity.

Biological Properties and Bioactive Components of Allium cepa L.: Focus on Potential Benefits in the Treatment of Obesity and Related Comorbidities

Common onion (Allium cepa L.) is one of the oldest cultivated plants, utilized worldwide as both vegetable and flavouring. This species is known to contain sulphur amino acids together with many vitamins and minerals. A variety of secondary metabolites, including flavonoids, phytosterols and saponins, have also been identified. Despite the predominant use of this plant as food, a wide range of beneficial effects have also been proved. Different biological properties, such as antioxidant, antimicrobial and antidiabetic, have been reported. The aim of this review is to provide an overview of the studies concerning the beneficial effects of this species against obesity and its related comorbidities, such as hyperlipidaemia, hypertension and diabetes. Both in vitro and in vivo results about onion dietary supplementation have been taken into account. Furthermore, this review examines the possible role of onion bioactive components in modulating or preventing weight-gain or related diseases, as well as the possible mechanisms behind their activity.

Carnosic Acid Modulates Increased Hepatic Lipogenesis and Adipocytes Differentiation in Ovariectomized Mice Fed Normal or High-Fat Diets

As postmenopausal women experience a rapid increase in cardiovascular disease (CVD) risk with an increase in abdominal fat, dietary interventions to reduce CVD risk have been emphasized. This study was aimed at investigating the effect of a high-fat diet (HFD) in combination with an ovariectomy on liver and adipose tissue fat metabolism. The efficacy of carnosic acid (CA) supplementation in the suppression of HFD- and ovariectomy-induced obesity was also evaluated. Ovariectomized (OVX) or sham-operated mice at eight weeks of age were fed with a normal diet (ND), HFD, ND and 0.02% CA, or HFD and 0.02% CA for 12 weeks. All of the animals were sacrificed at the age of 20 weeks. The blood and tissue markers of the lipogenesis and adipocyte differentiation were measured. As expected, ovariectomy decreased the uterus weight and serum 17β-estradiol concentration. The HFD and ovariectomy significantly contributed to increases in the body weight and total fat mass, which were effectively inhibited by CA supplementation. The circulating concentrations of insulin, leptin, and TG (triglyceride) were significantly higher in the HFD group, and the concentrations were two to five times higher in the OVX and HFD group compared with those of the ND group. The CA supplementation significantly lowered the insulin, leptin, and TG concentrations in the OVX and HFD mice. The hepatic protein expressions of pAMPK and pACC were up-regulated by CA supplementation in OVX mice fed either ND or HFD. The expressions of hepatic SREBP1c and FAS mRNA were the highest in the OVX and HFD group, which were suppressed by CA supplementation. The adipose tissue PPARγ, aP2, and lipoprotein lipase (LPL) mRNA expressions were up-regulated by a HFD or ovariectomy, while they were significantly reduced in the mice fed a CA supplemented diet. The TNF-α and IL-6 mRNA levels in the adipose tissue were decreased by providing CA in the OVX groups. These results suggest that HFD and ovariectomy independently contribute to body fat accumulation, and CA effectively alleviated the ovariectomy-induced increases in lipogenesis and adipocyte differentiation. Further human trials are required in order to evaluate the efficacy of rosemary-derive CA as natural anti-adipogenic compounds, especially in postmenopausal women.

Antihyperglycemic activities of twig extract of indigenous cinnamon (Cinnamomum osmophloeum) on high-fat diet and streptozotocin-induced hyperglycemic rats

BACKGROUND

Cinnamomum osmophloeum (indigenous cinnamon) is an endemic species in Taiwan and its twigs contain abundant A-type proanthocyanidins. C. osmophloeum twig extracts (CoTEs) were found to have α-glucosidase and α-amylase inhibitory activities in vitro. The aim of this study is to further investigate the antihyperglycemic activity of CoTEs in hyperglycemic rats.

RESULTS

Hyperglycemic rats were divided into three groups and were treated orally with high-dosage CoTEs (HCO, 150 mg kg^-1 ), low-dosage CoTEs (LCO, 30 mg kg^-1 ) and positive control (PC, 30 mg kg^-1 pioglitazone). The HCO group showed improved glucose tolerance in an oral glucose tolerance test after 1 month of treatment, contributed by the inhibition of intestinal disaccharidases, amylase, and lipase. Compared with the PC group, both the HCO and LCO groups had decreased weight of visceral fats and lower atherogenic index; while their low-density lipoprotein-cholesterol, food intake, feed efficiency, and biochemical parameters remained unchanged compared with the NC group. Furthermore, the HCO group had decreased weight gain and the LCO group had decreased serum leptin level.

CONCLUSION

These results suggest that CoTE has potential antihyperglycemic activities for treating hyperglycemia without weight gain. © 2018 Society of Chemical Industry.

Vascular targeted nanotherapeutic approach for obesity treatment

Obesity is a global epidemic that poses a serious health concern due to it being a risk factor for life-threatening chronic diseases, such as type 2 diabetes, cancer, and cardiovascular diseases. Pharmacotherapy remains the mainstay for the management of obesity; however, its usefulness is limited due to poor drug efficacy, non-specificity and toxic side effects. Therefore, novel approaches that could provide insights into obesity and obesity-associated diseases as well as development of novel anti-obesity treatment modalities or improvement on the existing drugs are necessary. While the ideal treatment of obesity should involve early intervention in susceptible individuals, targeted nanotherapy potentially provides a fresh perspective that might be better than the current conventional therapies. Independent studies have shown improved drug efficacy by using prohibitin (PHB)-targeted therapy in obese rodents and non-human primates, thus providing a proof of concept that targeted nanotherapy can be a feasible treatment for obesity. This review presents a brief global survey of obesity, its impact on human health, its current treatment and their limitations, and the role of angiogenesis and PHB in the development of obesity. Finally, the role and potential use of nanotechnology coupled with targeted drug delivery in the treatment of obesity are discussed.

A pharmacoinformatic approach on Cannabinoid receptor 2 (CB2) and different small molecules: Homology modelling, molecular docking, MD simulations, drug designing and ADME analysis

CB2 receptor belongs to the family of G-protein coupled receptors (GPCRs), which extensively controls a range of pointer transduction. CB2 plays an essential role in the immune system. It also associates in the pathology of different ailment conditions. In this scenario, the synthetic drugs are inducing side effects to the human beings after the drug use. Therefore, this study is seeking novel alternate drug molecules with least side effects than conventional drugs. The alternative drug molecules were chosen from the natural sources. These molecules were selected from cyanobacteria with the help of earlier research findings. The target and ligand molecules were obtained from recognized databases. The bioactive molecules are selected from various cyanobacterial species, which are selected by their biological and pharmacological properties, after, which we incorporated to the crucial findings such as homology modelling, molecular docking, MD simulations along with absorption, distribution, metabolism, and excretion (ADME) analysis. Initially, the homology modelling was performed to frame the target from unknown sequences of CB2, which revealed 44% of similarities and 66% of identities with the A2A receptor. Subsequently, the CB2 protein molecule has docked with already known and prepared bioactive molecules, agonists and antagonist complex. In the present study, the agonists (5) and antagonist (1) were also taken for comparing the results with natural molecules. At the end of the docking analysis, the cyanobacterial molecules and an antagonist TNC-201 are revealed better docking scores with well binding contacts than the agonists. Especially, the usneoidone shows better results than other cyanobacterial molecules, and it is very close docking scores with that of TCN-201. Therefore, the usneoidone has incorporated to MD simulation with Cannabinoid receptors 2 (CB2). In MD simulations, the complex (CB2 and usneoidone) reveals better stability in 30 ns. Based on the computational outcome, we concluded that usneoidone is an effectual and appropriate drug candidate for activating CB2 receptors and it will be serving as a better component for the complications of CB2. Moreover, these computational approaches can be motivated to discover novel drug candidates in the pharmacological and healthcare sectors.

In vitro α-amylase, α-glucosidase, lipase inhibitory and cytotoxic activities of tuber extracts of Kedrostis africana (L.) Cogn

Kedrostis africana, is a tuberous plant commonly used by traditional healers in the Eastern Cape Province of South Africa for the management of obesity. The aim of this study was to investigate the antiobesity and cytotoxic effects of Kedrostis africana extracts in vitro The α-amylase, α-glucosidase and lipase inhibitory activities of aqueous and ethanol extracts of Kedrostis africana tuber were investigated while the cytotoxic effects of these extracts were analyzed using Hoechst 33342 and propidium iodide (PI) dual staining in combination with Molecular Devices ImageXpress Micro XLS Widefield microscope for high content analysis on human cervical (HeLa) cell line. The ethanol extract exhibited the strongest inhibitory effect on pancreatic lipase (IC₅₀ = 381.86 μg/ml) and on α-glucosidase (IC₅₀ = 157.99 μg/mL) while the aqueous extract has strongest α-amylase (IC₅₀ = 439.45 μg/ml). Both tuber extracts were found nontoxic at tested concentrations on HeLa cell lines as confirmed by the Hoechst 33342 and propidium iodide dual staining respectively. This study revealed that both the aqueous and ethanol tuber extract of K. africana exerts a certain degree of inhibitory effect on α-amylase, α-glucosidase and lipase and were also nontoxic to HeLa cell line at tested concentrations.

Antiobesity Effect of Tricin, a Methylated Cereal Flavone, in High-Fat-Diet-Induced Obese Mice

The antiobesity potential of tricin, a methylated cereal flavonoid, was examined using a high-fat-diet-induced obese mice model. The body weight ( P < 0.01) and body fat mass ( P < 0.05) were significantly decreased in the high-dose tricin supplementation group (TH: 200 mg/kg diet) in comparison to the high fat diet control group (CON) after a 12-week feeding trial. The serum (60.9 ± 2.09 mg/dL) and hepatic triglyceride levels (45.3 ± 4.42 nmol/mg protein) in the TH group were significantly decreased in comparison to the CON group (78.3 ± 5.09 mg/dL, 76.3 ± 8.10 nmol/mg protein), respectively. This antiobesity effect was attributed to a decrease in the expression of lipogenic markers crucial for fat synthesis in the liver (fatty acid synthase, stearoyl-CoA desaturase 1, elongation of long-chain fatty acids family member 6, glycerol-3-phosphate acyltransferase, and diglyceride acyltransferase) and suppressed expression of transcription factors associated with adipocyte differentiation (peroxisome proliferator-activated receptor γ and CCAAT/enhancer-binding protein α). These lipid-lowering effects are mediated by the activation of adenosine 5'-monophosphate-activated protein kinase.

Ilex paraguariensis modulates fat metabolism in Caenorhabditis elegans through purinergic system (ADOR-1) and nuclear hormone receptor (NHR-49) pathways

Ilex paraguariensis is a well-known plant that is widely consumed in South America, primarily as a drink called mate. Mate is described to have stimulant and medicinal properties. Considering the potential anti-lipid effects of I. paraguariensis infusion, we used an extract of this plant as a possible modulator of fat storage to control lipid metabolism in worms. Herein, the I. paraguariensis-dependent modulation of fat metabolism in Caenorhabditis elegans was investigated. C. elegans were treated with I. paraguariensis aqueous extract (1 mg/ml) from L1 larvae stage until adulthood, to simulate the primary form of consumption. Expression of adipocyte triglyceride lipase 1 (ATGL-1) and heat shock protein 16.2, lipid accumulation through C1-BODIPY-C12 (BODIPY) lipid staining, behavioral parameters, body length, total body energy expenditure and overall survival were analyzed. Total body energy expenditure was determined by the oxygen consumption rate in N2, nuclear hormone receptor knockout, nhr-49(nr2041), and adenosine receptor knockout, ador-1(ox489) strains. Ilex paraguariensis extract increased ATGL-1 expression 20.06% and decreased intestinal BODIPY fat staining 63.36%, compared with the respective control group, without affecting bacterial growth and energetic balance, while nhr-49(nr2041) and ador-1(ox489) strains blocked the worm fat loss. In addition, I. paraguariensis increased the oxygen consumption in N2 worms, but not in mutant strains, increased N2 worm survival following juglone exposure, and did not alter hsp-16.2 expression. We demonstrate for the first time that I. paraguariensis can decrease fat storage and increase body energy expenditure in worms. These effects depend on the purinergic system (ADOR-1) and NHR-49 pathways. Ilex paraguariensis upregulated the expression of ATGL-1 to modulate fat metabolism. Furthermore, our data corroborates with other studies that demonstrate that C. elegans is a useful tool for studies of fat metabolism and energy consumption.

Cross-sectional associations between gender-linked personality traits and use of weight-loss and muscle-building products among U.S. young adults

This study examined the cross-sectional associations between gender-linked personality traits and use of products for weight loss and muscle building using data from young adults participating in Wave III of the National Longitudinal Study of Adolescent to Adult Health who completed the short-form Bem Sex-Role Inventory (n = 3,343). Among men, a higher score on the masculinity scale was associated with greater odds of diet pill use, legal performance-enhancing substance (PES) use, and illicit PES use, while a higher score on the femininity scale was associated with lower odds of illicit PES use. These findings can inform interventions for men with weight/shape concerns.

2020 vision - An overview of prospects for diabetes management and prevention in the next decade

After a century of medical progress, people nowadays live longer with diabetes than ever before. However, current preventative approaches, compounded in part by increased life-expectancy, are failing to reduce the prevalence of diabetes. Cardiovascular sequelae account for many of the four million deaths annually attributable to diabetes. Evidence indicates that certain glucose-lowering medications can improve vascular outcomes in some people with type 2 diabetes, which, together with better understanding of using multiple therapies concurrently, offers opportunities for beneficial personalization of medication regimens. However, further well-designed long-term studies are needed to evaluate cardiovascular benefits and safety of new and older medications, particularly in users typical of everyday diabetes care. Although there are numerous other promising advances in pharmacotherapies and biotechnology, these will probably be unaffordable for most people with diabetes globally. Therefore, effective national public health approaches will be essential to reducing the incidence of diabetes and its associated burdens; these may entail politically controversial measures to change unhealthy lifestyle behaviours. Stakeholders could learn from past failures and emulate successes in other health-care initiatives. Without early action at all levels, we face a future in which approaching one-quarter of humans will have diabetes, with more than half afflicted during their lifetime.

Virgin coconut oil is effective to treat metabolic and inflammatory dysfunction induced by high refined carbohydrate-containing diet in mice

The global rise in obesity rates is alarming since this condition is associated with chronic low-grade inflammation and secondary comorbidities as glucose intolerance, cardiovascular disease and liver damage. Therefore, a lot of dietary approaches are proposed to prevent and to treat obesity and its associated disorders. Virgin coconut oil (VCO) is well known as a functional food due to its significant amounts of medium-chain triglycerides. This study aimed to evaluate the effect of VCO on adiposity, metabolic and inflammatory dysfunctions induced by a high-refined carbohydrate-containing (HC) diet in mice. Male BALB/c mice were divided into two groups and fed with control (C) or HC diet to induce obesity for eight weeks. At the 9^th week mice fed with HC diet were randomly regrouped into four groups, and were kept this way until the 12^th week, as following: (i) HC diet alone or HC diet supplemented with three different VCO doses (ii) 1000 mg/kg, (iii) 3000 mg/kg and (iv) 9000 mg/kg. Regardless of the concentration used, VCO supplementation promoted lower adiposity and also improvement in glucose tolerance, lower serum glucose and lipid levels and decreased hepatic steatosis. Moreover, VCO intake induced a lower inflammatory response due to decreased number of leukocytes and TNF-α and IL-6 concentrations in adipose tissue, as well as reduced counts of total leukocytes, mononuclear and polymorphonuclear circulating cells. Our data showed that VCO can be considered as an interesting potential dietary approach to attenuate obesity and its metabolic and inflammatory alterations.

Transient receptor potential (TRP) channels: a metabolic TR(i)P to obesity prevention and therapy

Cellular transport of ions, especially by ion channels, regulates physiological function. The transient receptor potential (TRP) channels, with 30 identified so far, are cation channels with high calcium permeability. These ion channels are present in metabolically active tissues including adipose tissue, liver, gastrointestinal tract, brain (hypothalamus), pancreas and skeletal muscle, which suggests a potential role in metabolic disorders including obesity. TRP channels have potentially important roles in adipogenesis, obesity development and its prevention and therapy because of their physiological properties including calcium permeability, thermosensation and taste perception, involvement in cell metabolic signalling and hormone release. This wide range of actions means that organ-specific actions are unlikely, thus increasing the possibility of adverse effects. Delineation of responses to TRP channels has been limited by the poor selectivity of available agonists and antagonists. Food constituents that can modulate TRP channels are of interest in controlling metabolic status. TRP vanilloid 1 channels modulated by capsaicin have been the most studied, suggesting that this may be the first target for effective pharmacological modulation in obesity. This review shows that most of the TRP channels are potential targets to reduce metabolic disorders through a range of mechanisms.

Effects of long-term oral nitrate administration on adiposity in normal adult female rats

INTRODUCTION

Nitric oxide (NO) deficiency is associated with obesity. Nitrate could act as a substrate for production of NO and is a novel therapeutic agent in obesity. This study aims at determining effects of long-term nitrate administration on obesity indices in normal adult female rats.

METHODS

Female Wistar rats were divided into four groups (n = 10/each): i.e. control group received tap water and three treatment groups received water containing 50, 100 and 150 mg/L sodium nitrate for 6 months. Body weight (g) was measured monthly; naso-anal length (cm) and obesity indices including body mass index (BMI), Lee index, abdominal and thoracic circumferences were determined every two months. Both white adipose tissue (WAT) and brown adipose tissue (BAT) were weighted and then adiposity index was calculated. In addition, level of NOx (nitrate + nitrite) in serum and adipose tissues were measured at the end of the study.

RESULTS

Compared to controls, body weights and naso-anal length were significantly (P < 0.001) lower in all nitrate-treated rats. Compared to controls, nitrate-treated rats had also lower adiposity indices, BMI, Lee index, abdominal and thoracic circumferences (13%, 17% and 22% for BMI and 5%, 6% and 8% for lee index at dose 50, 100, and 150 mg/L, respectively). In addition, nitrate administration increased NOx levels in serum and adipose tissues.

CONCLUSIONS

Long-term nitrate administration has favorable effects on adiposity. It increases brown and decreases white adipose tissues in normal female rats; these observations could potentially help in management of obesity.

Secondary Metabolites, Dietary Fiber and Conjugated Fatty Acids as Functional Food Ingredients against Overweight and Obesity

Obesity is a common serious health problem leading to many serious health disorders. This phenomenon is defined as the over-storage of lipids in adipose tissue that occurs when there is an imbalance between the energy intake and energy used. During obesity, many metabolic alterations occur that can damage several organs, such as vascular or skeletal muscle resulting in the dysfunction of these tissues. In this review, we will discuss molecular genetics and causes of obesity, some of the disorders related to human obesity as well as anti-obesity tool. An interesting solution to the obesity problem is natural substances, revealing anti-obesity activity, as well as functional food enriched with aforementioned substances. Functional foods are products exhibiting a potentially positive effect on health beyond basic nutrition. They contain well-known biologically active natural compounds, which promote optimal health and reduce the risk of many diseases, including obesity.

Heshouwu (Polygonum multiflorum Thunb.) ethanol extract suppresses pre-adipocytes differentiation in 3T3-L1 cells and adiposity in obese mice

This study investigated whether Heshouwu (Polygonum multiflorum Thunb.) root ethanol extract (PME) has anti-obesity activity using 3T3-L1 cells and high-fat diet (HFD)-induced obese mice. Treatment with PME (5 and 10 μg/mL) dose-dependently suppressed 3T3-L1 pre-adipocyte differentiation to adipocytes and cellular triglyceride contents. In addition, PME inhibited mRNA and protein expression of adipogenic transcription factors such as CCAAT/enhancer-binding protein α (C/EBPα) and peroxisome proliferator-activated receptor γ (PPARγ), which led to down-regulation of fatty acid synthase gene expression. After feeding mice PME (0.05%) with HFD for 12 weeks, their visceral fat mass, size and body weight were significantly reduced compared with the HFD group. Furthermore, PME supplementation significantly up-regulated the PPARα, CPT1, CPT2, UCP1 and HSL mRNA levels compared with the HFD group, whereas it down-regulated expression of the PPARγ and DGAT2 genes. Finally, HFD increased serum leptin, insulin, glucose and insulin and glucose levels; however, PME reversed these changes. These results demonstrated that PME might relieve obesity that occurs via inhibition of adipogenesis and lipogenesis as well as through lipolysis and fatty acid oxidation in 3T3-L1 cells and HFD-induced obese mice.

Antiadipogenic Effects of Loganic Acid in 3T3-L1 Preadipocytes and Ovariectomized Mice

Obesity is caused by an excess storage of body fat, resulting from a chronic imbalance between energy intake and expenditure. Gentiana lutea L. (GL) root has been reported to reduce lipid accumulation in the aortic wall of diabetic rats. Here, we performed fractionation and isolation of the bioactive constituent(s) that may be responsible for the antiadipogenic effects of the GL root extract. A single compound, loganic acid, was identified as a candidate component in the 30% ethanol extract of GL. Loganic acid treatment significantly decreased the adipocyte differentiation of 3T3-L1 preadipocytes in a dose-dependent manner. The expression of key adipogenesis-related genes such as adiponectin (Adipoq), peroxisome proliferator-activated receptor gamma (Pparg), lipoprotein lipase (Lpl), perilipin1 (Plin1), fatty acid binding protein 4 (Fabp4), glucose transporter type 4 (Slc2a4), CCAAT/enhancer-binding protein alpha (Cebpa), and tumor necrosis factor-alpha (Tnf) were significantly reduced following treatment with loganic acid. In vivo experiments in an ovariectomy-induced obesity mouse model showed that loganic acid (oral administration with 10 and 50 mg/kg/day) significantly inhibited body weight gain, total fat increase, fatty hepatocyte deposition in the liver, and adipocyte enlargement in the abdominal visceral fat tissues. These results suggest that loganic acid in the GL root extract has antiadipogenic effects in vitro and in vivo. Loganic acid may be beneficial for the prevention and treatment of obesity, particularly in menopausal obese women.

Overweight and obesity management strategies in survivors of paediatric acute lymphoblastic leukaemia: a systematic review protocol

INTRODUCTION

Acute lymphoblastic leukaemia is the most common paediatric cancer. Survivors of childhood acute lymphoblastic leukaemia (SALL) are at risk of obesity and related cardiometabolic diseases including type 2 diabetes, hypertension, stroke and cardiovascular events. Therefore, it is important to address obesity in this population as this may help mitigate future cardiometabolic comorbidities. In this systematic review, we aim to assess current treatment strategies including lifestyle interventions, pharmacotherapy and bariatric surgery to manage overweight and obesity in SALL.

METHODS AND ANALYSIS

We will search the following databases for primary studies: CINAHL, SPORTDiscus, EMBASE, MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. In addition, unpublished primary studies will be searched in ClinicalTrials.gov as well as conference proceedings, presentations, abstracts, editorials and ProQuest Dissertations and Theses A&I. Reviewers will perform title, abstract, and full-text screening as well as data abstraction and risk of bias assessment independently with a third reviewer to be consulted to resolve disagreements. Searches will be run and updated through May 1st, 2018. The overall quality of the evidence will be determined using the Grading of Recommendations, Assessment, Development, and Evaluation criteria for each outcome. A meta-analysis will be performed if two studies deploying similar interventions, populations, and design and outcomes are identified.

ETHICS AND DISSEMINATION

As individual patient data will not be included, we do not require ethics approval. This review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42016051031.

Body weight perception, disordered weight control behaviors, and depressive symptoms among Korean adults: The Korea National Health and Nutrition Examination Survey 2014

BACKGROUND/ PURPOSE

Despite emerging evidence suggesting harmful influences of accurate weight perception on psychological health among individuals with obesity, little is known about the association in Asian populations. The aim of this study was investigate the association between body weight perception and depressive symptoms among Korean adults, and potential differential associations across gender.

METHODS

We used data from the sixth Korea National Health and Nutrition Examination Survey in 2014, comprising 3,318 female (n = 1,876) and male (n = 1,442) participants, aged 19-65 years, with no history of depression and a body-mass index (BMI)> = 18.5kg/m2. Depressive symptoms were measured by the Patient Health Questionnaire-9 Korean version. Weight perception patterns were categorized by comparing self-perceived and objectively measured weight status. Gender-stratified four-level multilevel linear models adjusted for age, BMI, menopause, education, income, marital status, urbanicity, chronic conditions, exercise, smoking, and alcohol use. Subgroup analyses were performed across BMI category.

RESULTS

Among women with obesity, those who underperceived their weight status reported fewer depressive symptoms compared to those who accurately perceived their weight status (β = -1.25, p<0.05). Among women with normal weight, those who overperceived their weight status reported more depressive symptoms compared to those who accurately perceived their weight status (β = 1.00, p<0.05). The same associations were not found in men.

CONCLUSION

Awareness-oriented strategies for obesity prevention and weight management focused on providing information on weight status may need to consider unintended consequences of accurate weight perception on mental health among individuals with obesity, particularly among women.

Antiobesity and Antioxidant Potentials of Selected Palestinian Medicinal Plants

We evaluated the antioxidant and porcine pancreatic lipase inhibition (PPLI) activities of 90 plants extracts. The antioxidant activity was measured using the free-radical scavenging capacity (DPPH) and reducing power (RP) assays. The pancreatic lipase inhibition assay was used to determine the PPLI activity of plant extracts. Among the 90 plant extracts examined, 41.0 % crude extracts showed antilipase activity of more than 50%. The most active plants by means of IC₅₀ value were Camellia sinensis (0.5 mg/ml), Ceratonia siliqua (leaves) (0.8 mg/mL), Curcuma longa (0.8 mg/mL), Sarcopoterium spinosum (1.2 mg/mL), and Mentha spicata (1.2 mg/mL). The antioxidant activity of plant extracts using the DPPH and RP assays reveals comparable results. The most active antioxidant extracts using both assays were the leaves and fruit epicarp of Rhus coriaria, areal parts of Sarcopoterium spinosum, and leaves of Ceratonia siliqua. Our results suggest natural resources that possess strong antioxidant and pancreatic lipase inhibitory activities with potential applications in the treatment and prevention of obesity and overweight. The extracts of Camellia sinensis, Ceratonia siliqua, Curcuma longa, Sarcopoterium spinosum, and Mentha spicata were proved to have a great potential as antioxidants and antiobesity agents.

Perilipin-2 deletion promotes carbohydrate-mediated browning of white adipose tissue at ambient temperature

Mice lacking perilipin-2 (Plin2-null) are resistant to obesity, insulin resistance, and fatty liver induced by Western or high-fat diets. In the current study, we found that, compared with WT mice on Western diet, Plin2-null adipose tissue was more insulin sensitive and inguinal subcutaneous white adipose tissue (iWAT) exhibited profound browning and robust induction of thermogenic and carbohydrate-responsive genetic programs at room temperature. Surprisingly, these Plin2-null responses correlated with the content of simple carbohydrates, rather than fat, in the diet, and were independent of adipose Plin2 expression. To define Plin2 and sugar effects on adipose browning, WT and Plin2-null mice were placed on chow diets containing 20% sucrose in their drinking water for 6 weeks. Compared with WT mice, iWAT of Plin2-null mice exhibited pronounced browning and striking increases in the expression of thermogenic and insulin-responsive genes on this diet. Significantly, Plin2-null iWAT browning was associated with reduced sucrose intake and elevated serum fibroblast growth factor (FGF)21 levels, which correlated with greatly enhanced hepatic FGF21 production. These data identify Plin2 actions as novel mediators of sugar-induced adipose browning through indirect effects of hepatic FGF21 expression, and suggest that adipose browning mechanisms may contribute to Plin2-null resistance to obesity.

Comparing the efficacy of therapeutic packages in Persian Medicine with Classical Medicine in overweight patients: a randomized clinical trial

BACKGROUND

Obesity is a major risk factor for many diseases. In Persian Medicine, much emphasis has been put on the balanced weight that maintains health. Therefore, the treatment of obesity is a top priority for health care in Persian and Classical Medicine.

OBJECTIVE

To compare the efficacy of therapeutic packages in Persian Medicine with Classical Medicine in overweight treatment.

METHODS

This randomized clinical trial was conducted at Ghaem Hospital in Mashhad, Iran, from August 22, 2016 to December 20, 2016. Sixty-nine overweight women with body mass index (BMI) of 27-29.9 and waist circumference more than 88 cm based on inclusion and exclusion criteria, were included in the study. To control bias in sampling, with considering that the age variable is an interventional factor in the process of effective treatment, in addition to using the random allocation method, the population were studied in three groups of 18-30 years old, 31-50 years old and >50 years old, who were classified by blocking method, and three types of treatment interventions were performed in each age group: Group A (Classical diet and orlistat), Group B (Persian diet and MDB) and Group C (classical diet and MDB). Calorie consumption was equivalent in the three groups. Blinding was done only for patients. The treatment period was three months in all three groups. Subsequently, we analyzed the effectiveness of the therapeutic packages on anthropometric index, body composition and laboratory parameters in the three groups. The data were analyzed using SPSS version 16. We used descriptive statistics, Kolmogorov-Smirnov, ANOVA, paired-samples t-test, non-parametric Wilcoxon test and regression methods for the analyses of primary and secondary outcomes.

RESULTS

Although anthropometric index and fat mass decreased highly significantly in all three intervention groups (p<0.001), the B group led to a further decrease in BMI (Mean ± SD: 1.61±1.03), weight (Mean ± SD: 4.79±2.26), waist circumference (Mean ± SD: 4.25±0.59) and Fat mass (Mean ± SD: 3.24±2.70), compared with the other two groups. Lipid profile and FBS in groups B and C had significant decrease before and after the intervention, but Group A had no significant effect before or after the intervention. Other laboratory parameters did not change significantly before or after the treatment in the three groups.

CONCLUSION

In this study, Classical Medicine and Persian Medicine had the same levels of effectiveness but Persian Medicine brought a greater reduction in body weight, fat mass%, lipid profile and fasting blood glucose than Classical Medicine during the study period. So Persian Medicine can be effective in weight loss as an alternative therapy, but more studies are needed.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: (IRCT 2016041927477N1).

FUNDING

This paper is supported by a grant from the Research Council, Mashhad University of Medical Sciences, Mashhad, Iran.

Future Pharmacotherapy for Obesity: New Anti-obesity Drugs on the Horizon

PURPOSE OF REVIEW

Obesity is a global health crisis with detrimental effects on all organ systems leading to worsening disease state and rising costs of care. Persons with obesity failing lifestyle therapies need to be escalated to appropriate pharmacological treatment modalities, medical devices, and/or bariatric surgery if criteria are met and more aggressive intervention is needed. The progression of severe obesity in the patient population coupled with related co-morbidities necessitates the development of novel therapies for the treatment of obesity. This development is preceded by increased understanding of the underpinnings of energy regulation and neurohormonal pathways involved in energy homeostasis.

RECENT FINDINGS

Though there are approved anti-obesity drugs available in the USA, newer drugs are now in the pipeline for development given the urgent need. This review focuses on anti-obesity drugs in the pipeline including centrally acting agents (setmelanotide, neuropeptide Y antagonist [velneperit], zonisamide-bupropion [Empatic], cannabinoid type-1 receptor blockers), gut hormones and incretin targets (new glucagon-like-peptide-1 [GLP-1] analogues [semaglutide and oral equivalents], amylin mimetics [davalintide, dual amylin and calcitonin receptor agonists], dual action GLP-1/glucagon receptor agonists [oxyntomodulin], triple agonists [tri-agonist 1706], peptide YY, leptin analogues [combination pramlintide-metreleptin]), and other novel targets (methionine aminopeptidase 2 inhibitor [beloranib], lipase inhibitor [cetilistat], triple monoamine reuptake inhibitor [tesofensine], fibroblast growth factor 21), including anti-obesity vaccines (ghrelin, somatostatin, adenovirus36). With these new drugs in development, anti-obesity therapeutics have potential to vastly expand allowing better treatment options and personalized approach to obesity care.

Effects of Dietary Intake of Japanese Mushrooms on Visceral Fat Accumulation and Gut Microbiota in Mice

A lot of Japanese people are generally known for having a healthy diet, and consume a variety of mushrooms daily. Many studies have reported anti-obesity effects of mushrooms, but few have investigated the effects of consuming a variety of edible mushroom types together in realistic quantities. In this study, we investigated whether supplementation with a variety of mushroom types affects visceral fat accumulation and gut microbiota in mice. The most popular mushroom varieties in Japan were lyophilized and mixed according to their local production ratios. C57BL/6J mice were fed a normal diet, high-fat (HF) diet, HF with 0.5% mushroom mixture (equivalent to 100 g mushrooms/day in humans) or HF with 3% mushroom mixture (equivalent to 600 g mushrooms/day in humans) for 4 weeks. The mice were then sacrificed, and blood samples, tissue samples and feces were collected. Our results show that mushroom intake suppressed visceral fat accumulation and increased the relative abundance of some short chain fatty acid- and lactic acid-producing gut bacteria. These findings suggest that mushroom intake is an effective strategy for obesity prevention.

Fibroblast Growth Factor 21: A Versatile Regulator of Metabolic Homeostasis

Fibroblast growth factor 21 (FGF21) is an endocrine hormone derived from the liver that exerts pleiotropic effects on the body to maintain overall metabolic homeostasis. During the past decade, there has been an enormous effort made to understand the physiological roles of FGF21 in regulating metabolism and to identify the mechanism for its potent pharmacological effects to reverse diabetes and obesity. Through both human and rodent studies, it is now evident that FGF21 levels are dynamically regulated by nutrient sensing, and consequently FGF21 functions as a critical regulator of nutrient homeostasis. In addition, recent studies using new genetic and molecular tools have provided critical insight into the actions of this endocrine factor. This review examines the numerous functions of FGF21 and highlights the therapeutic potential of FGF21-targeted pathways for treating metabolic disease.

Nanomedicine for obesity treatment

Obesity, as a chronic condition, has been a serious public health issue over the last decades both in the affluent Western world and developing countries. As reported, the risk of several serious diseases increases with weight gain, including type 2 diabetes, coronary heart disease, cancer, and respiratory diseases. In addition to lifestyle modifications, pharmacotherapy has become an important strategy to control weight gain. However, most of the anti-obesity drugs often show poor outcome for weight-loss and cause severe adverse effects. This review surveys recent advances in nanomedicine as an emerging strategy for obesity treatment with an emphasis on the enhanced therapeutic efficiency and minimized side effects. The insights for future development are also discussed.