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Vilà R, Cabot C, Villarreal L, Monegal A, Ayet E, Romero MDM, Grasa MDM, Esteve M, Fernández-López JA, Remesar X, Alemany M. Oleoyl-estrone is a precursor of an estrone-derived ponderostat signal. J Steroid Biochem Mol Biol 2011; 124:99-111. [PMID: 21310232 DOI: 10.1016/j.jsbmb.2011.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 01/11/2023]
Abstract
Oleoyl-estrone (OE) is a powerful anti-obesity compound that decreases food intake, decreases insulin resistance and circulating cholesterol. OE stimulates a severe loss of body fat by decreasing adipose tissue lipid synthesis and maintaining lipolysis. Therefore, the body economy loses lipid energy because energy expenditure is maintained. This study analyses the discrepancy between OE effects and the distribution of labelled OE in plasma. Estrone radioimmunoassay of organic solvent plasma extracts of rats treated with OE showed the massive presence of acyl-estrone, but saponification did not release estrone, but containing similar unknown compound. Analysis of label distribution in plasma after oral gavages of (3)H-OE showed the presence of a more hydrophilic compound than OE or any estrogen as well as (3)H(2)O, formed from (3)H-OE in the acidic stomach medium. OE was not attached to a specific transporter in plasma. Through serum HPLC analysis we found W, a labelled derivative more hydrophilic than OE or estrone. The results were confirmed using (14)C-OE. HPLC-MS/MS studies showed that plasma OE levels were one order of magnitude lower than those of W. When liver cell cytosols from rats laden with (3)H-OE were incubated with nuclei from untreated rats, the OE-derived label (i.e., Ws) was found attached to nuclear DNA. Neither estradiol nor estrone interfered with its binding. W is a fairly hydrophilic compound of low molecular weight containing the estrone nucleus, but it is not an ester because saponification or esterases do not yield estrone as OE does. It is concluded that OE acts through its conversion to W, its active form; which binds to a nuclear receptor different from that of estrogen. The estimated W serum levels are proportional to the pharmacological OE effects in vivo. We postulate W as a new type of hormone that exerts the full range of in vivo effects thus far attributed to OE. The full identification of W is anticipated to open the way for the development of new OE-like anti-obesity drugs.
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Affiliation(s)
- Ruth Vilà
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, Barcelona, Spain.
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Abstract
Oleoyl-estrone (OE) is a powerful slimming agent that is also present in plasma and adipose tissue, where it is synthesized. It acts through the formation of a derivative W. OE effects (and W levels) are proportional to the dose. OE reduces food intake but maintains energy expenditure (thermogenesis). The energy gap is fulfilled with adipose tissue fat, sparing body protein and maintaining glycemia (and glycogen) with lower insulin and leptin levels. OE (in fact W) acts through specific receptors, different from those of estrogen. OE increases cholesterol catabolism, reducing hypercholesterolemia in obese rats. The main metabolic effect on adipose tissue is lowering of lipid synthesis, maintaining unchanged the intracellular lipolytic processes; the imbalance favors the progressive loss of fat, which is largely used by the muscle. OE administration induces additive effects with other antiobesity agents, such as β(3)-adrenergic agonists, forcing a massive loss of lipid. Corticosteroids markedly limit OE action by altering the liver control of lipogenesis. OE also inhibits the action of 17β-hydroxysteroid dehydrogenase, decreasing the synthesis of β-estradiol and testosterone. Discontinuous treatment allows for maximal efficacy both in rats and humans. OE has the advantage that the loss of fat is maintained and does not require additional dietary limitations.
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Affiliation(s)
- Xavier Remesar
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, Barcelona, Spain
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Site-specific modulation of white adipose tissue lipid metabolism by oleoyl-estrone and/or rosiglitazone in overweight rats. Naunyn Schmiedebergs Arch Pharmacol 2010; 381:339-48. [DOI: 10.1007/s00210-010-0495-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
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Romero MDM, Esteve M, Alemany M, Fernández-López JA. Gene expression modulation of rat liver cholesterol metabolism by oleoyl-estrone. Obes Res Clin Pract 2010; 4:e1-e82. [DOI: 10.1016/j.orcp.2009.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 09/08/2009] [Accepted: 09/09/2009] [Indexed: 12/01/2022]
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Short-term oral oleoyl-estrone decreases the expression of ghrelin in the rat stomach. ACTA ACUST UNITED AC 2008; 152:79-81. [PMID: 18848587 DOI: 10.1016/j.regpep.2008.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 09/10/2008] [Accepted: 09/18/2008] [Indexed: 11/22/2022]
Abstract
Oleoyl-estrone (OE) mobilizes body fat and decreases food intake. The precise mechanism of its modulation of appetite is unknown. Since the effects of OE on food intake appear early, here we studied the effect of OE on the expression of gut peptides that affect short-term ingestive behavior: ghrelin, leptin, CCK, PYY, and GLP-1. Two hours after a single OE dose, adult male rats were killed and their stomach fundus and intestine sections were dissected and processed for real-time PCR amplification. Semi-quantitative estimation of gene mRNA tissue levels showed that OE markedly decreased ghrelin expression in the stomach; leptin mRNA was unchanged; CCK mRNA decreased in the proximal intestine while PYY and GLP-1 expression in the intestine was not altered. Our results indicate that the short-term decrease in food intake induced by OE may be essentially the consequence of a marked decrease in the expression of ghrelin in the stomach.
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Serrano-Muñoz M, Grasa MM, González-Martínez D, Cabot C, Fernández-López JA, Alemany M. Intestinal oleoyl-estrone esterase activity in the Wistar rat. J Endocrinol Invest 2008; 31:125-31. [PMID: 18362503 DOI: 10.1007/bf03345578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Low-dose oral oleoyl-estrone (OE) (i.e. in dairy products) is hydrolysed to estrone, which promotes growth and fat deposition. However, pharmacological doses of OE are absorbed largely intact and elicit fat losses. Thus, in order to find out how the intestine handles OE, esterase activity (at pH 5, 7 or 8) was measured in rat stomach, duodenum, jejunum, ileum, cecum, large intestine, and liver using OE as substrate. There were no sex-related differences. Pure pancreatic cholesterol-ester esterase hydrolysed OE even in the absence of taurocholate. The differences in the pH-related activity distribution pattern and selective inhibition and taurocholate dependence show that, in addition to the luminal (i.e. pancreatic) cholesterol-ester esterase, other esterases hydrolyse OE; these combined activities may be sufficient to rapidly dispose of pharmacological doses of OE. Female rats received a tritium-labeled OE gavage; the luminal and tissue label content were measured up to 24 h. The high retention of label in the stomach suggest that this may be a significant site of absorption. The rapid decrease of label in intestinal lumen (and rat tissues) shortly after the administration, hint at rapid absorption and disposal. In conclusion, the high OE-esterase activity and early absorption of OE are indicative of upper gastro-intestinal tract absorption skipping most of the medium-tract esterases.
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Affiliation(s)
- M Serrano-Muñoz
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, Barcelona, Spain
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Salas A, Noé V, Ciudad CJ, Romero MM, Remesar X, Esteve M. Short-term oleoyl-estrone treatment affects capacity to manage lipids in rat adipose tissue. BMC Genomics 2007; 8:292. [PMID: 17725831 PMCID: PMC2020488 DOI: 10.1186/1471-2164-8-292] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 08/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short-term OE (oleoyl-estrone) treatment causes significant decreases in rat weight mainly due to adipose tissue loss. The aim of this work was to determine if OE treatment affects the expression of genes that regulate lipid metabolism in white adipose tissue. RESULTS Gene expression in adipose tissue from female treated rats (48 hours) was analysed by hybridization to cDNA arrays and levels of specific mRNAs were determined by real-time PCR. Treatment with OE decreased the expression of 232 genes and up-regulated 75 other genes in mesenteric white adipose tissue. The use of real-time PCR validate that, in mesenteric white adipose tissue, mRNA levels for Lipoprotein Lipase (LPL) were decreased by 52%, those of Fatty Acid Synthase (FAS) by 95%, those of Hormone Sensible Lipase (HSL) by 32%, those of Acetyl CoA Carboxylase (ACC) by 92%, those of Carnitine Palmitoyltransferase 1b (CPT1b) by 45%, and those of Fatty Acid Transport Protein 1 (FATP1) and Adipocyte Fatty Acid Binding Protein (FABP4) by 52% and 49%, respectively. Conversely, Tumour Necrosis Factor (TNFalpha) values showed overexpression (198%). CONCLUSION Short-term treatment with OE affects adipose tissue capacity to extract fatty acids from lipoproteins and to deal with fatty acid transport and metabolism.
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Affiliation(s)
- Anna Salas
- Departament de Nutrició i Bromatologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal 645, 08028 Barcelona, Spain
| | - Véronique Noé
- Departament de Bioquímica i Biologia Molecular, Facultat de Farmàcia, Universitat de Barcelona, Joan XXIII s/n, 08028 Barcelona, Spain
| | - Carlos J Ciudad
- Departament de Bioquímica i Biologia Molecular, Facultat de Farmàcia, Universitat de Barcelona, Joan XXIII s/n, 08028 Barcelona, Spain
| | - M Mar Romero
- Departament de Nutrició i Bromatologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal 645, 08028 Barcelona, Spain
| | - Xavier Remesar
- Departament de Nutrició i Bromatologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal 645, 08028 Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Spain
| | - Montserrat Esteve
- Departament de Nutrició i Bromatologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal 645, 08028 Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Spain
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Hazra A, Pyszczynski NA, DuBois DC, Almon RR, Jusko WJ. Modeling of corticosteroid effects on hepatic low-density lipoprotein receptors and plasma lipid dynamics in rats. Pharm Res 2007; 25:769-80. [PMID: 17674160 PMCID: PMC4196440 DOI: 10.1007/s11095-007-9371-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 06/04/2007] [Indexed: 02/07/2023]
Abstract
PURPOSE This study examines methylprednisolone (MPL) effects on the dynamics of hepatic low-density lipoprotein receptor (LDLR) mRNA and plasma lipids associated with increased risks for atherosclerosis. MATERIALS AND METHODS Normal male Wistar rats were given 50 mg/kg MPL intramuscularly (IM) and sacrificed at various times. Measurements included plasma MPL and CST, hepatic glucocorticoid receptor (GR) mRNA, cytosolic GR density and hepatic LDLR mRNA, and plasma total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol (HDLC), and triglycerides (TG). RESULTS MPL showed bi-exponential disposition with two first-order absorption components. Hepatic GR and LDLR mRNA exhibited circadian patterns which were disrupted by MPL. Down-regulation in GR mRNA (40-50%) was followed by a delayed rebound phase. LDLR mRNA exhibited transient down-regulation (60-70%). Cytosolic GR density was significantly suppressed but returned to baseline by 72 h. Plasma TC and LDLC showed increases (55 and 142%) at 12 h. A mechanistic receptor/gene pharmacokinetic/pharmacodynamic model was developed to describe CS effects on hepatic LDLR mRNA and plasma cholesterols. CONCLUSIONS Our PK/PD model was able to satisfactorily capture the MPL effects on hepatic LDLR, its relationship to various plasma cholesterols, and builds the foundation to explore this area in the future.
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Affiliation(s)
- Anasuya Hazra
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, 565 Hochstetter Hall, State University of New York at Buffalo, Buffalo, New York, 14260, USA
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del Mar Grasa M, Serrano M, Fernández-López JA, Alemany M. Corticosterone inhibits the lipid-mobilizing effects of oleoyl-estrone in adrenalectomized rats. Endocrinology 2007; 148:4056-63. [PMID: 17510239 DOI: 10.1210/en.2007-0331] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Oleoyl-estrone (OE) is an adipose-derived signal that decreases energy intake and body lipid, maintaining energy expenditure and glycemic homeostasis. Glucocorticoids protect body lipid and the metabolic status quo. We studied the combined effects of OE and corticosterone in adrenalectomized female rats: daily OE gavages (0 or 10 nmol/g) and slow-release corticosterone pellets at four doses (0, 0.5, 1.7, and 4.8 mg/d). Intact and sham-operated controls were also included. After 8 d, body composition and plasma metabolites and hormones were measured. OE induced a massive lipid mobilization (in parallel with decreased food intake and maintained energy expenditure). Corticosterone increased fat deposition and inhibited the OE-elicited mobilization of body energy, even at the lowest dose. OE enhanced the corticosterone-induced rise in plasma triacylglycerols, and corticosterone blocked the OE-induced decrease in leptin. High corticosterone and OE increased insulin resistance beyond the effects of corticosterone alone. The presence of corticosterone dramatically affected OE effects, reversing its decrease of body energy (lipid) content, with little or no change on food intake or energy expenditure. The maintenance of glycemia and increasing insulin in parallel to the dose of corticosterone indicate a decrease in insulin sensitivity, which is enhanced by OE. The reversal of OE effects on lipid handling, insulin resistance, can be the consequence of a corticosterone-induced OE resistance. Nevertheless, OE effects on cholesterol were largely unaffected. In conclusion, corticosterone administration effectively blocked OE effects on body lipid and energy balance as well as insulin sensitivity and glycemia.
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Affiliation(s)
- Maria del Mar Grasa
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, Av. Diagonal 645, 08028 Barcelona, Spain
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Cabot C, González-Martínez D, Fernández-López JA, Alemany M. In the rat, estrone sulphate is the main serum metabolite of oral oleoyl-estrone. J Endocrinol Invest 2007; 30:376-81. [PMID: 17598968 DOI: 10.1007/bf03346313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Two different oral doses of oleoyl-estrone: 1 and 10 nmol/g a day were given once to male Wistar rats. The serum levels of free estrone, estrone sulphate, estradiol, and acyl-estrone were measured at intervals up to 72 h after the gavage. Oleoyl-estrone was rapidly absorbed; with the 1 nmol/g dose no changes were observed in plasma acyl-estrone but levels increased dramatically with 10 nmol/g, peaking at 6 h; high acyl-estrone levels were maintained up to 24 h, returning to normalcy at 48 h. With the 10 nmol/g dose, free estrone at most doubled its levels but estrone sulphate concentrations rose by one order of magnitude; in both cases, the increases soon (2 h) reached a plateau that was maintained for almost two days. Estradiol levels remained unchanged except for a transient peak at 2 h at the 10 nmol/g dose. The relationship between free estrone and its sulphate was linear, and those of estrone and estrone sulphate versus acyl-estrone showed the existence of an upper serum concentration limit for both molecules. The results hint at estrone sulphate being an important metabolite of oleoyl-estrone disposal, confirm the limited estrogenic response to oleoyl-estrone administration and agree with a rapid absorption and disposal of oleoyl-estrone, nevertheless maintaining high circulating levels of the ester for a time after its oral administration.
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Affiliation(s)
- C Cabot
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
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Romero MM, Esteve M, Fernández-López JA, Alemany M. The conjugated linoleic acid ester of estrone induces the mobilisation of fat in male Wistar rats. Naunyn Schmiedebergs Arch Pharmacol 2007; 375:283-90. [PMID: 17387456 DOI: 10.1007/s00210-007-0148-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
We investigated whether the substitution of the fatty acid moiety in oleoyl-estrone (OE) by conjugated linoleic acid, i.e. conjugated linoleoyl-estrone (cLE) may help improve the antiobesity effects of OE. Overweight (17% fat) male rats were treated for 10 days with oral OE or cLE (10 nmol/g per day) and compared with controls receiving only the oily vehicle. Rat weight and food intake were measured daily. After killing by decapitation, body composition and main plasma parameters were analysed. cLE induced marked decreases in body weight, energy intake, carcass energy and body lipid, whilst sparing protein; the effects were not significantly different from those obtained with OE. Energy expenditure was unchanged, but energy intake decreased to 46% (OE) or 55% (cLE) of controls; whole body energy decreased by 29% (OE) or 24% (cLE) in the 10-day period studied. Plasma composition showed almost identical decreases in glucose and cholesterol elicited by OE and cLE, with a more marked decrease in triacylglycerols by OE and no effect of either on NEFA. OE decreased leptin and insulin levels, but the effects of cLE were more marked on both, with similar decreases in adiponectin. It can be concluded that cLE is a new drug of the OE family; its overall effects on energy were akin to those of OE, albeit fractionally less effective at the single dose tested. However, this lower potency on lipid mobilisation does not affect other effects, such as powerful hypercholesterolemic effects or the modulation of adiponectin. And last, but not least, cLE seems to produce a more marked decrease in leptin and insulin than OE, which may reflect a coordinate action of the conjugated linoleic acid moiety and the "OE effect" on target tissues. If that were the case, cLE may constitute an improvement over OE in its action on insulin resistance.
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Affiliation(s)
- M M Romero
- Department of Nutrition and Food Science, University of Barcelona, 08028 Barcelona, Spain
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Ferrer-Lorente R, Cabot C, Fernández-López JA, Alemany M. Effects of Combined Oleoyl-Estrone and Rimonabant on Overweight Rats. J Pharmacol Sci 2007; 104:176-82. [PMID: 17558182 DOI: 10.1254/jphs.fp0061441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Oleoyl-estrone (OE) decreases appetite, maintains energy expediture, induces lipolysis (sparing protein), and decreases cholesterolemia and insulin resistance. Rimonabant (SR141716) is a cannabinoid-receptor inhibitor that decreases appetite and mobilizes fat. We studied whether their combination improves their slimming effects. Male overweight rats received daily gavages of 5.3 mg/kg OE, 10 mg/kg rimonabant, or both drugs during 10 days. Body weight and composition, energy balance, adipose tissue weight, and serum hormones and metabolites were measured. OE halved food intake and maintained energy expenditure at the expense of body fat. Rimonabant effects on appetite and energy balance were less marked, resulting in lower lipid mobilization. OE and rimonabant followed the OE pattern, with no additive or synergic effects. Glycemia was maintained, but OE decreased insulin, GLP-1, and cholesterol, whilst rimonabant increased cholecystokinin and cholesterol, and decreased NEFA. Both drugs decreased leptin and triacylglycerols; ghrelin was unchanged. The results hint at different mechanisms of action of both drugs: we can assume that OE effects do not involve the cannabinoid pathway. OE does not seem to act, either, after 10 days, through the secretion of ghrelin or the intestinal appetite-controlling peptides tested.
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Affiliation(s)
- Raquel Ferrer-Lorente
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, Spain
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Romero MM, Esteve M, Alemany M. Combined effects of oral oleoyl-estrone and limited food intake on body composition of young overweight male rats. Int J Obes (Lond) 2006; 30:1149-56. [PMID: 16418752 DOI: 10.1038/sj.ijo.0803224] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The combined effects of limited food intake and OE treatment have been analysed in order to determine whether hypocaloric diets enhance the slimming effects of OE on mature overweight male rats. Two levels of dietary limitation at 50 and 25% of a standard intake were established, roughly corresponding to the human LCDs and VLCDs. DESIGN Wistar male rats (6 weeks old) were made overweight by a cafeteria diet. After transition to standard diet, they were subjected to food restriction: down to 50 or 25% with respect to the transition period. Half the animals were given daily oral gavages of 10 nmol/g oleoyl-estrone (OE), and the rest received only the vehicle during 10 days. MEASUREMENTS Changes in weight and body composition: water, lipid, protein or gross energy were determined by comparing the final pool size with that of day 0, calculated from the initial body weight and the composition of untreated rats. Energy and nitrogen balances were estimated. Plasma levels of metabolites and hormones were also measured. RESULTS OE induced changes in body composition similar to those elicited by a 50% reduction in food, with massive loss of lipid and energy. OE-treated rats ate less than the controls, but additional effects on body composition on reduced diet were minimal. OE improved metabolic homoeostasis: better maintained glycaemia, lower cholesterol and shallower hormonal changes, but at the expense of slightly increased protein mobilisation. CONCLUSIONS The data presented suggest that no advantages are accomplished by combining OE treatment and hypocaloric diets compared with OE alone, at least under the experimental conditions tested, since the effects were not additive. Despite OE affecting food intake, mechanisms other than that are deemed responsible for the mobilisation of body fat, since intake alone cannot explain the effects on body weight, nor the metabolic and hormonal changes in OE-treated rats. It is concluded that the combination of food restriction and OE may result in unwanted increased protein mobilisation with no synergy between both slimming treatments.
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Affiliation(s)
- M M Romero
- Departament de Nutrició i Bromatologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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