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Wrba L, Halbgebauer R, Roos J, Huber-Lang M, Fischer-Posovszky P. Adipose tissue: a neglected organ in the response to severe trauma? Cell Mol Life Sci 2022; 79:207. [PMID: 35338424 PMCID: PMC8956559 DOI: 10.1007/s00018-022-04234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 01/01/2023]
Abstract
Despite the manifold recent efforts to improve patient outcomes, trauma still is a clinical and socioeconomical issue of major relevance especially in younger people. The systemic immune reaction after severe injury is characterized by a strong pro- and anti-inflammatory response. Besides its functions as energy storage depot and organ-protective cushion, adipose tissue regulates vital processes via its secretion products. However, there is little awareness of the important role of adipose tissue in regulating the posttraumatic inflammatory response. In this review, we delineate the local and systemic role of adipose tissue in trauma and outline different aspects of adipose tissue as an immunologically active modifier of inflammation and as an immune target of injured remote organs after severe trauma.
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Affiliation(s)
- Lisa Wrba
- Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Rebecca Halbgebauer
- Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany
| | - Julian Roos
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstr. 24, 89075, Ulm, Germany
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Ulm, Germany
| | - Pamela Fischer-Posovszky
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstr. 24, 89075, Ulm, Germany.
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Potential role of adipose tissue and its hormones in burns and critically III patients. Burns 2020; 46:259-266. [DOI: 10.1016/j.burns.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/17/2018] [Accepted: 01/30/2019] [Indexed: 12/26/2022]
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Alipoor E, Mohammad Hosseinzadeh F, Hosseinzadeh-Attar MJ. Adipokines in critical illness: A review of the evidence and knowledge gaps. Biomed Pharmacother 2018; 108:1739-1750. [PMID: 30372877 DOI: 10.1016/j.biopha.2018.09.165] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/28/2022] Open
Abstract
Adipose tissue products or adipokines play a major role in chronic endocrine and metabolic disorders; however, little is known about critical conditions. In this article, the experimental and clinical evidence of alterations of adipokines, adiponectin, leptin, resistin, visfatin, asymmetric dimethylarginine (ADMA), and ghrelin in critical illness, their potential metabolic, diagnostic, and prognostic value, and the gaps in the field have been reviewed. The results showed considerable changes in the concentration of the adipokines; while the impact of adipokines on metabolic disorders such as insulin resistance and inflammation has not been well documented in critically ill patients. There is no consensus about the circulatory and functional changes of leptin and adiponectin. However, it seems that lower concentrations of adiponectin at admission with gradual consequent increase might be a useful pattern in determining better outcomes of critical illness. Some evidence has suggested the adverse effects of elevated resistin concentration, potential prognostic importance of visfatin, and therapeutic value of ghrelin. High ADMA levels and low arginine:ADMA ratio were also proposed as predictors of ICU mortality and morbidities. However, there is no consensus on these findings. Although primary data indicated the role of adipokines in critical illness, further studies are required to clarify whether the reason of these changes is pathophysiological or compensatory. The relationship of pathophysiological background, disease severity, baseline nutritional status and nutrition support during hospitalization, and variations in body fat percentage and distribution with adipokines, as well as the potential prognostic or therapeutic role of these peptides should be further investigated in critically ill patients.
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Affiliation(s)
- Elham Alipoor
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammad Hosseinzadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.
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Abstract
BACKGROUND Adipose tissue is an endocrine organ that plays a critical role in immunity and metabolism by virtue of a large number of hormones and cytokines, collectively termed adipokines. Dysregulation of adipokines has been linked to the pathogenesis of multiple diseases, but some questions have arisen concerning the value of adipokines in critical illness setting. The objective of this review was to evaluate the associations between blood adipokines and critical illness outcomes. METHODS PubMed, CINAHL, Scopus, and the Cochrane Library databases were searched from inception through July 2016 without language restriction. Studies reporting the associations of adipokines, leptin, adiponectin, resistin, and/or visfatin with critical illness outcomes mortality, organ dysfunction, and/or inflammation were included. RESULTS A total of 38 articles were selected according to the inclusion/exclusion criteria of the study. Significant alterations of circulating adipokines have been reported in critically ill patients, some of which were indicative of patient outcomes. The associations of leptin and adiponectin with critical illness outcomes were not conclusive in that blood levels of both adipokines did not always correlate with the illness severity scores or risks of organ failure and mortality. By contrast, studies consistently reported striking increase of blood resistin and visfatin, independently of the critical illness etiology. More interestingly, increased levels of these adipokines were systematically associated with severe inflammation, and high incidence of organ failure and mortality. CONCLUSIONS There is strong evidence to indicate that increased levels of blood resistin and visfatin are associated with poor outcomes of critically ill patients, including higher inflammation, and greater risk of organ dysfunction and mortality. LEVEL OF EVIDENCE Systematic review, level III.
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Jacobsson S, Larsson P, Johansson G, Norberg M, Wadell G, Hallmans G, Winsö O, Söderberg S. Leptin independently predicts development of sepsis and its outcome. JOURNAL OF INFLAMMATION-LONDON 2017; 14:19. [PMID: 28919840 PMCID: PMC5594589 DOI: 10.1186/s12950-017-0167-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/04/2017] [Indexed: 02/01/2023]
Abstract
Background Sepsis is a life-threatening condition and obesity is related to the clinical outcome. The underlying reasons are incompletely understood, but the adipocyte derived hormones leptin and adiponectin may be involved. Methods Patients aged 18 years or more with documented first time sepsis events were included in a nested case-referent study if they had participated in previous health surveys. Two matched referents free of known sepsis were identified. Circulating levels of leptin and adiponectin were determined in stored plasma, and their impact on a future sepsis event and its outcome was evaluated. Results We identified 152 patients (62% women) with a sepsis event and a previous participation in a health survey. Eighty-three % had also blood samples from the acute event. Hyperleptinemia at health survey associated with a future sepsis event (OR 1.77, 95% CI 1.04–3.00) and with hospital death. After adjustment for BMI leptin remained associated with sepsis in men, but not in women. High levels in the acute phase associated with increased risk for in hospital death in women (OR 4.18, 95% CI 1.17–15.00), while being protective in men (OR 0.05, 95% CI 0.01–0.48). Furthermore, leptin increased more from baseline to the acute phase in men than in women. Adiponectin did not predict sepsis and did not relate to outcome. Conclusions Hyperleptinemia independently predicted the development of sepsis and an unfavourable outcome in men, and inertia in the acute response related to worse outcome.
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Affiliation(s)
- Sofie Jacobsson
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University Hospital, Umeå University, S-901 85 Umeå, Sweden
| | - Peter Larsson
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University Hospital, Umeå University, S-901 85 Umeå, Sweden
| | - Göran Johansson
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University Hospital, Umeå University, S-901 85 Umeå, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Göran Wadell
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Ola Winsö
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University Hospital, Umeå University, S-901 85 Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
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Abstract
Obesity has reached epidemic proportions over the last few decades. Obesity is associated with increased morbidity and mortality in hypertension, cardiovascular diseases, stroke, and cancer and is feared to decrease overall life expectancy over the next few decades. There is a growing body of evidence suggesting that obesity is a chronic inflammatory disease. Obesity is becoming a cause of concern in critically ill patients as well. Sepsis is the number one cause of morbidity and mortality in noncoronary artery disease critical care units all over the world and is associated with a high cost of care. An increase in morbidity in obese septic patients compared with lean people is a cause of growing concern. Laboratory evidence suggests that there is exaggeration in the inflammatory and prothrombogenic phenotype assumed by obese compared with lean septic animals. The exact mechanisms underlying this phenomenon are unknown. This article reviews some of the pathophysiological processes responsible for the underlying inflammation in obesity and sepsis and reviews the literature for the association of the two.
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Affiliation(s)
- Vidula Vachharajani
- Wake Forest University Health Sciences Center, Winston-Salem, North Carolina, USA.
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Lindgren C, Naredi S, Söderberg S, Koskinen LO, Hultin M. Leptin levels after subarachnoid haemorrhage are gender dependent. SPRINGERPLUS 2016; 5:667. [PMID: 27350906 PMCID: PMC4899384 DOI: 10.1186/s40064-016-2321-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Abstract
Background Subarachnoid hemorrhage (SAH) is a neurological disease where the majority of the patients are critically ill. The adipokine leptin has in cerebral emergencies been related to severity of disease and to adverse outcome. The aim of this study was to examine leptin levels over time after SAH and associations to gender, age, body mass index, severity of disease, parenteral lipids, systemic organ failure and outcome. Methods Prospective observational study in 56 patients. Leptin was obtained 0–240 h after SAH, in 48 h intervals. Severity of disease was assessed with the Hunt and Hess score, organ failure with the sequential organ failure assessment score, and outcome with Glasgow outcome scale. Leptin levels in the SAH group were compared with controls from the same geographical area. Results At admission, Leptin was significantly higher in SAH patients compared to controls, both in female (28.6 ± 25.6 vs 13.0 ± 2.3 ng/mL, p = 0.001) and male patients (13.3 ± 8.4 vs 4.3 ± 0.7 ng/mL, p = 0.001). Leptin levels remained stable over time. Female patients had significantly higher leptin levels than male patients, and deceased female patients had higher leptin levels than female survivors (85.5 ± 20.5 vs 50.5 ± 34.6, n = 4/35, p < 0.05). Leptin levels did not differ between male survivors and non-survivors. Leptin levels were not associated with severity of disease, organ failure or parenteral lipids. Conclusion Leptin levels were significantly higher in both male and female patients compared to controls. Higher leptin levels were related to outcome and organ failure in women but not in men. When analysing leptin levels gender-related differences should be considered.
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Affiliation(s)
- Cecilia Lindgren
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
| | - Silvana Naredi
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - Lars-Owe Koskinen
- Department of Pharmacology and Clinical Neuroscience, Neurosurgery, Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
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Pérez LM, Pareja-Galeano H, Sanchis-Gomar F, Emanuele E, Lucia A, Gálvez BG. 'Adipaging': ageing and obesity share biological hallmarks related to a dysfunctional adipose tissue. J Physiol 2016; 594:3187-207. [PMID: 26926488 DOI: 10.1113/jp271691] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Abstract
The increasing ageing of our societies is accompanied by a pandemic of obesity and related cardiometabolic disorders. Progressive dysfunction of the white adipose tissue is increasingly recognized as an important hallmark of the ageing process, which in turn contributes to metabolic alterations, multi-organ damage and a systemic pro-inflammatory state ('inflammageing'). On the other hand, obesity, the paradigm of adipose tissue dysfunction, shares numerous biological similarities with the normal ageing process such as chronic inflammation and multi-system alterations. Accordingly, understanding the interplay between accelerated ageing related to obesity and adipose tissue dysfunction is critical to gain insight into the ageing process in general as well as into the pathophysiology of obesity and other related conditions. Here we postulate the concept of 'adipaging' to illustrate the common links between ageing and obesity and the fact that, to a great extent, obese adults are prematurely aged individuals.
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Affiliation(s)
- Laura M Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Helios Pareja-Galeano
- Universidad Europea de Madrid, Spain.,Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | | | | | - Alejandro Lucia
- Universidad Europea de Madrid, Spain.,Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Beatriz G Gálvez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Universidad Europea de Madrid, Spain
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Endocrine, metabolic, and morphologic alterations of adipose tissue during critical illness. Crit Care Med 2013; 41:317-25. [PMID: 23135416 DOI: 10.1097/ccm.0b013e318265f21c] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Observational studies report lower mortality in obese than in lean critically ill patients, an association referred to as the "obesity paradox." This may suggest a possible protective role for adipose tissue during severe illness. DATA SOURCES Relevant publications were identified based on searches in PubMed and on secondary searches of their bibliographies. DATA SYNTHESIS The endocrine functions of adipose tissue might play a role in the adaptation to critical illness. In the acute phase of illness, the anti-inflammatory adiponectin is reduced, whereas proinflammatory cytokine expression in adipose tissue is up-regulated. In the prolonged phase of critical illness, both adiponectin and anti-inflammatory cytokine production are increasing. Studies on the proinflammatory adipokine leptin during critical illness are inconsistent, possibly due to confounders such as gender, body mass index, and feeding. Morphologically, adipose tissue of critically ill patients reveals an increased number of newly differentiated, smaller adipocytes. Accentuated macrophage accumulation showing a phenotypic switch to M2-type suggests an adaptive response to the microenvironment of severe illness. Functionally, adipose tissue of critically ill patients develops an increased ability to store glucose and triglycerides. CONCLUSIONS Endocrine, metabolic, and morphologic properties of adipose tissue change during critical illness. These alterations may suggest a possible adaptive, protective role in optimizing chances of survival. More research is needed to understand the exact role of adipose tissue in lean vs. obese critically ill patients, in order to understand how illness-associated alterations contribute to the obesity paradox.
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Modan-Moses D, Kanety H, Dagan O, Ehrlich S, Lotan D, Pariente C, Novikov I, Paret G. Leptin and the post-operative inflammatory response. More insights into the correlation with the clinical course and glucocorticoid administration. J Endocrinol Invest 2010; 33:701-6. [PMID: 20386086 DOI: 10.1007/bf03346673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiac surgery involving cardiopulmonary bypass (CPB) causes a systemic inflammatory process which can lead to multiple organ failure and postoperative morbidity. Recent animal and human studies suggested a possible involvement of leptin in the systemic inflammatory response. AIM To characterize the response of leptin to open heart surgery (OHS) and the relationship between the time course of leptin levels and the post-operative clinical course, and to examine the effect of exogenous glucocorticoids. PATIENTS AND METHODS Forty-seven pediatric patients, undergoing OHS for congenital heart disease were studied. Thirty-four patients (Group 1) received methylprednisolone during CPB while 13 (group 2) did not. Serial blood samples were collected perioperatively and up to 24 h after surgery, and assayed for leptin and cortisol. RESULTS All patients' leptin levels decreased significantly during CPB (to 44-48% of baseline, p<0.001); they then increased, peaking at 12 h post-operatively. The levels of groups 1 and 2 were similar up to 8 h post-operatively; thereafter, those of group 1 were significantly higher. Recovery of leptin levels in patients with a more complicated post-operative course was comparatively slower. Cortisol levels of all patients increased significantly during CPB (p<0.001), gradually decreasing afterwards. Cortisol and leptin levels were inversely correlated in both patients' groups. CONCLUSIONS CPB is associated with acute changes in circulating leptin levels. A complicated postoperative course is associated with lower leptin levels which are inversely correlated with cortisol levels. Leptin may participate in post-CPB inflammatory and hemodynamic responses.
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Affiliation(s)
- D Modan-Moses
- Pediatric Endocrinology Unit, the Edmond and Lily Safra Children's Hospital, Tel Aviv, Israel.
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Bracho-Riquelme RL, Reyes-Romero MA. Leptin in sepsis: a well-suited biomarker in critically ill patients? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:138. [PMID: 20392294 PMCID: PMC2887146 DOI: 10.1186/cc8917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The value of monitoring serum leptin in critically ill patients is important for early diagnosis and differentiation between sepsis and non-infectious systemic inflammatory response syndrome (SIRS). The early diagnosis of sepsis, the identification of its origin, and an adequate therapeutic management are crucial to overcome sepsis-associated mortality. Cytokine levels are an obvious choice as sepsis markers, since cytokines are key mediators of the inflammatory response to sepsis. Leptin, a hormone mainly generated by adipocytes, acts centrally in the hypothalamus to regulate body weight and energy expenditure. There is, however, strong evidence that leptin is also involved in cell-mediated immunity and cytokine crosstalk. The finding that a serum leptin threshold of 38 microg/l can distinguish between sepsis and non-infectious SIRS (sensitivity 91.2%, specificity 85%) is the major finding in the article by Yousef and colleagues (in this issue). Much remains to be learned about the precise mechanisms by which leptin signaling participates in sepsis and non-infectious SIRS. This knowledge will potentially contribute to new therapeutic approaches.
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Affiliation(s)
- Rodolfo Leonel Bracho-Riquelme
- Universidad Juárez del Estado de Durango, Facultad de Medicina, División de Estudios de Posgrado e Investigación, Azucenas 157, Fracc, Jardines de Durango, Durango, Dgo. CP., México.
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Vachharajani V, Russell JM, Scott KL, Conrad S, Stokes KY, Tallam L, Hall J, Granger DN. Obesity Exacerbates Sepsis-Induced Inflammation and Microvascular Dysfunction in Mouse Brain. Microcirculation 2010; 12:183-94. [PMID: 15828130 DOI: 10.1080/10739680590904982] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Obese patients with sepsis have higher morbidity and mortality than lean counterparts, but the mechanisms involved are unknown. The authors examined the inflammatory and thrombogenic responses of the cerebral microvasculature to sepsis induced by cecal ligation and perforation in obese and lean wild-type mice. METHODS Leukocyte and platelet adhesion in cerebral microvasculature and behavioral responses were measured in wild-type and obese mice 4 h postperforation. P-selectin expression in different vascular beds was assessed 6 h postperforation. The effects of immunoblockade of P-selectin, ICAM-1, and CD18 on leukocyte and platelet recruitment were evaluated in obese septic animals. RESULTS Cerebral venules of obese and wild-type mice assumed a proinflammatory and prothrombogenic phenotype 4 h post-perforation, with greatly exaggerated responses in obese mice compared to the lean counterparts. These enhanced responses were attenuated by blocking P-selectin, CD18, or ICAM-1. Obese mice also exhibited a more profound behavioral deficit after sepsis, which appears to be unrelated to the recruitment of leukocytes and platelets. Cecal ligation and perforation-induced P-selectin expression was greater in obese mice compared with lean counterparts. CONCLUSIONS These findings suggest that the increased morbidity to sepsis in obesity may result from exaggerated microvascular inflammatory and thrombogenic responses that include the activation of endothelial cells with subsequent expression of adhesion molecules, such as P-selectin.
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Affiliation(s)
- Vidula Vachharajani
- Department of Critical Care Medicine, Louisiana State University Health Sciences Center, Shreveport 71130-3932, USA
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Abstract
Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are common indications for ICU admission and mechanical ventilation. ALI/ARDS also consumes significant health care resources and is a common cause of death in ICU patients. Obesity produces changes in respiratory system physiology that could affect outcomes for ALI/ARDS patients and their response to treatment. Additionally, the biochemical alterations seen in obese patients, such as increased inflammation and altered metabolism, could affect the risk of developing ALI/ARDS in patients with another risk factor (eg, sepsis). The few studies that have examined the influence of obesity on the outcomes from ALI/ARDS are inconclusive. Furthermore, observed results could be biased by disparities in provided care.
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Lyoussi B, Ragala MA, M'guil M, Chraibi A, Israili ZH. Gender-Specific Leptinemia and Its Relationship with Some Components of the Metabolic Syndrome in Moroccans. Clin Exp Hypertens 2009. [DOI: 10.1081/ceh-57441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Modan-Moses D, Prince A, Kanety H, Pariente C, Dagan O, Roller M, Vishne T, Efrati O, Paret G. Patterns and prognostic value of troponin, interleukin-6, and leptin after pediatric open-heart surgery. J Crit Care 2009; 24:419-25. [PMID: 19427762 DOI: 10.1016/j.jcrc.2009.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 02/02/2009] [Accepted: 02/12/2009] [Indexed: 01/19/2023]
Abstract
PURPOSE Leptin and interleukin-6 (IL-6) are inversely correlated and associated with decreased survival in critically ill patients. We investigated changes in leptin, IL-6, and troponin in children undergoing open-heart surgery, hypothesizing that IL-6 and troponin will increase after cardiopulmonary bypass (CPB) and will be negatively correlated with leptin. PATIENTS AND METHODS Serial blood samples were collected from 21 patients 24 hours before and up to 48 hours after surgery. RESULTS Leptin levels decreased by 50% during CPB (P < .001), then gradually increased, reaching baseline levels 12 hours after surgery. The IL-6 levels increased (P < .001) during CPB, peaking 2 hours after surgery and remaining slightly elevated at 24 hours after surgery (P < .001). Leptin and IL-6 were negatively correlated (R = -0.448, P < .001). Troponin levels increased during CPB (P < .001). Postoperative leptin and troponin were inversely correlated (r = -0.535, P < .001). Patients with modest elevations in troponin levels (<20 microg/L) had a shorter aortic clamp and CPB time (P < .01), lower IL-6 peak levels (P = .03), and shorter duration of ventilation and inotropic support compared with patients with peak troponin levels greater than 20 microg/L. CONCLUSIONS Lower leptin and higher IL-6 levels correlated with troponin, a marker of myocardial injury. Because leptin may have cardioprotective effects, the postoperative drop in its levels may further contribute to myocardial dysfunction.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology Unit, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.
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Yukawa M, Phelan EA, Callahan HS, Spiekerman CF, Abrass IB, Weigle DS. Leptin levels recover normally in healthy older adults after acute diet-induced weight loss. J Nutr Health Aging 2008; 12:652-6. [PMID: 18953464 PMCID: PMC2730823 DOI: 10.1007/bf03008277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVES Involuntary weight loss affects 20% of community dwelling older adults. The underlying mechanism for this disorder is unknown. Objective is to determine if failure of older persons to regain weight is associated with elevated pro-inflammatory cytokine and leptin levels. DESIGN Prospective diet intervention study. SETTING University of Washington Medical Center from 2001-2005. PARTICIPANTS Twenty-one younger (18-35 years old) and nineteen older (>or= 70 years old) men and women. INTERVENTION Each subject was placed for two weeks on a weight-maintaining diet, followed in sequence by 2 weeks of 30% caloric restriction, then 4 weeks of ad libitum food intake. MEASUREMENTS Plasma leptin levels, fasting serum pro-inflammatory cytokine levels, and peripheral blood mononuclear cell cytokine levels were measured. RESULTS Leptin levels in the two cohorts decreased after caloric restriction and increased after ad-libitum food consumption resumed. Plasma TNF alpha levels were higher in older subjects compared to younger adults. However, there was no association between changes in TNF alpha levels and changes in AUC leptin. CONCLUSION Leptin levels in healthy older individuals responded appropriately in a compensatory manner to changes in body weight. These data do not support a cytokine dependent elevation in leptin levels as being responsible for the failure of older adults to regain weight.
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Affiliation(s)
- M Yukawa
- Harborview Medical Center, Division of Gerontology and Geriatric Medicine, 325 9th Ave Box 359755, Seattle, WA 98104, USA.
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Wong AK, ALZadjali MA, Choy AMJ, Lang CC. Insulin Resistance: A Potential New Target for Therapy in Patients with Heart Failure. Cardiovasc Ther 2008; 26:203-13. [DOI: 10.1111/j.1755-5922.2008.00053.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Abstract
Leptin is an adipokine which conveys information on energy availability. In humans, leptin influences energy homeostasis and regulates neuroendocrine function primarily in states of energy deficiency. As a cytokine, leptin also affects thymic homeostasis and, similar to other proinflammatory cytokines, leptin promotes Th1 cell differentiation and cytokine production. We review herein recent advances on the role of leptin in the pathophysiology of immune responses.
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Affiliation(s)
- Giuseppe Matarese
- Gruppo di ImmunoEndocrinologia, Istituto di Endocrinologia e Oncologia Sperimenttale, Consiglio Nazionale delle Ricerche, Naples, Italy
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Ramos EJB, Suzuki S, Marks D, Inui A, Asakawa A, Meguid MM. Cancer anorexia-cachexia syndrome: cytokines and neuropeptides. Curr Opin Clin Nutr Metab Care 2004; 7:427-34. [PMID: 15192446 DOI: 10.1097/01.mco.0000134363.53782.cb] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cancer anorexia-cachexia syndrome is observed in 80% of patients in the advanced stages of cancer and is a strong independent risk factor for mortality. Numerous cytokines produced by tumor and immune cells, interacting with the neuropeptidergic system, mediate the cachectic effect of cancer. Since there is currently no effective pharmacological treatment and the anorexia-cachexia syndrome continues to be defined biochemically, we review the role of cytokines and neuropeptides in this process. RECENT FINDINGS Currently data suggest that cancer anorexia-cachexia syndrome results from a multifactorial process involving many mediators, including hormones (e.g. leptin), neuropeptides (e.g. neuropeptide Y, melanocortin, melanin-concentrating hormone and orexin) and cytokines (e.g. interleukin 1, interleukin 6, tumor necrosis factor alpha and interferon gamma). It is likely that close interrelation among these mediators exists in the hypothalamus, decreasing food intake and leading to cachexia. SUMMARY In the pathogenesis of cancer anorexia, cytokines play a pivotal role influencing the imbalance of orexigenic and anorexigenic circuits that regulate the homeostatic loop of body-weight regulation, leading to cachexia. Interfering pharmacologically with cytokine expression or neural transduction of cytokine signals can be an effective therapeutic strategy in anorectic patients before they develop cancer anorexia-cachexia syndrome.
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Affiliation(s)
- Eduardo J B Ramos
- Surgical Metabolism and Nutrition Laboratory, Neuroscience Program, Department of Surgery, University Hospital, Upstate Medical University, Syracuse, NY 13210, USA
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Davis MP, Dreicer R, Walsh D, Lagman R, LeGrand SB. Appetite and Cancer-Associated Anorexia: A Review. J Clin Oncol 2004; 22:1510-7. [PMID: 15084624 DOI: 10.1200/jco.2004.03.103] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Appetite is governed by peripheral hormones and central neurotransmitters that act on the arcuate nucleus of the hypothalamus and nucleus tactus solitarius of the brainstem. Cancer anorexia appears to be the result of an imbalance between neuropeptide-Y and pro-opiomelanocortin signals favoring pro-opiomelanocortin. Many of the appetite stimulants redress this imbalance. Most of our understanding of appetite neurophysiology and tumor-associated anorexia is derived from animals and has not been verified in humans. There have been few clinical trials and very little translational research on anorexia despite its prevalence in cancer.
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Affiliation(s)
- Mellar P Davis
- Harry R. Horvitz Center for Palliative Medicine, Department of Hematology/Medical Oncology, FCCP, Cleveland Clinic Foundation, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA.
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Gaetke LM, Oz HS, Frederich RC, McClain CJ. Anti-TNF-alpha antibody normalizes serum leptin in IL-2 deficient mice. J Am Coll Nutr 2004; 22:415-20. [PMID: 14559934 DOI: 10.1080/07315724.2003.10719325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE A recent study reports that the interleukin-2 deficient (IL-2(-/-)) mouse model of autoimmune and inflammatory bowel disease (IBD) with elevated pro-inflammatory cytokine production has elevated leptin concentrations during food deprivation. The objective of this study was to examine whether increased tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory cytokine, contributes to the abnormally elevated leptin in IL-2(-/-) mice. METHODS Eight week old, IL-2(-/-) and wild-type control (IL-2(+/+)), male mice were fed regular laboratory mouse food for two weeks. At the end of the study, blood was collected in the fed state, IL-2(-/-) and IL-2(+/+) mice were injected with either anti-TNF-alpha monoclonal antibody or normal saline, and blood was collected in the starved state. RESULTS The IL-2(-/-) mice consumed less food and lost weight. Administration of anti-TNF-alpha antibody markedly reduced serum leptin concentrations in IL-2(-/-) and control mice after food deprivation. Serum leptin in the IL-2(-/-) mice not receiving anti-TNF-alpha antibody increased significantly in the starved state. Serum concentrations of TNF-alpha were higher in IL-2(-/-) mice compared to controls in both the fed and starved state. CONCLUSIONS These results suggest that elevated TNF-alpha may be one mechanism for the sustained elevated leptin observed in IL-2(-/-) mice during food deprivation.
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Affiliation(s)
- Lisa M Gaetke
- Department of Nutrition and Food Science, University of Kentucky, and the Lexington Veterans Administration Medical Center, Lexington 40506-0054, USA.
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Quasim T, McMillan DC, Wallace AM, Kinsella J. The relationship between leptin concentrations, the systemic inflammatory response and illness severity in surgical patients admitted to ITU. Clin Nutr 2004; 23:233-8. [PMID: 15030963 DOI: 10.1016/j.clnu.2003.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Accepted: 07/03/2003] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS The relationship between circulation leptin concentrations, mediators of the systemic inflammatory response and illness severity in critically ill patients remains unclear. The aim of the present study was to examine these relationships in critically ill surgical patients admitted to the intensive therapy unit (ITU). PATIENTS AND METHODS Patients (n = 38) who had undergone surgery and subsequently admitted to ITU were prospectively entered into a cross-sectional study. Circulating concentrations of leptin, cortisol, growth hormone, interleukin-6, C-reactive protein and albumin were measured. Sex and age matched controls (n = 14) were also studied. RESULTS On day 1, the critically ill group had lower BMI and leptin concentrations and a pronounced systemic inflammatory response compared with controls. There was a weak positive correlation between leptin concentrations and BMI in the critically ill patients (r = 0.42, P<0.10). In contrast, leptin was inversely correlated with C-reactive protein (r = -0.59, P<0.05) but not with cortisol, growth hormone, interleukin-6, APACHE II or predicted mortality. Leptin concentrations did not alter with the day of admission to ITU. CONCLUSIONS On ITU admission, leptin concentrations appeared to be low for BMI, related to the magnitude of the systemic inflammatory response but did not appear to be regulated by proposed mediators in critically ill surgical patients.
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Affiliation(s)
- Tara Quasim
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, Scotland, UK
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Somasundar P, McFadden DW, Hileman SM, Vona-Davis L. Leptin is a growth factor in cancer. J Surg Res 2004; 116:337-49. [PMID: 15013374 DOI: 10.1016/j.jss.2003.09.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2003] [Indexed: 12/12/2022]
Affiliation(s)
- Ponnandai Somasundar
- West Virginia University, Department of Surgery, PO Box 9238, Morgantown, West Virginia 26506, USA
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Schwenk A, Hodgson L, Rayner CFJ, Griffin GE, Macallan DC. Leptin and energy metabolism in pulmonary tuberculosis. Am J Clin Nutr 2003; 77:392-8. [PMID: 12540399 DOI: 10.1093/ajcn/77.2.392] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pulmonary tuberculosis is the classic cause of "consumption," but the pathogenesis of such wasting is largely unknown. Animal studies in other conditions suggest that leptin may be a mediator between proinflammatory cytokine activity and wasting. OBJECTIVE We tested whether the leptin concentration, after control for body fat mass, is higher during active pulmonary tuberculosis than after recovery and whether it correlates with energy metabolism and proinflammatory cytokine activity. DESIGN Nondiabetic adults with pulmonary tuberculosis (n = 32) were recruited into a prospective observational study. Patients found to be antibody positive for human immunodeficiency virus were excluded from the study. Dual-energy X-ray absorptiometry, indirect calorimetry, and food intake protocols were performed at baseline and after 1 and 6 mo of tuberculosis treatment. Fasting plasma leptin, tumor necrosis factor alpha and its soluble receptor, and interleukin 6 were measured by enzyme-linked immunosorbent assay. RESULTS Resting energy expenditure was close to Harris-Benedict predictions and did not change significantly during treatment, but energy intake increased. Leptin concentration was correlated in a log-linear fashion with percentage body fat but was independent of cytokines and energy intake. There was no significant difference in leptin, corrected for energy balance and fat mass, at baseline and after 1 and 6 mo of treatment. CONCLUSIONS These data are compatible with recovery from anorexia or starvation without discernible hyper- or hypometabolism. The close correlation of leptin with body fat mass is similar to observations in healthy subjects. No additional influence of disease state or proinflammatory cytokine activity was found. Leptin does not appear to be a component of the immune response to human pulmonary tuberculosis, and thus it cannot account for the weight loss and anorexia associated with tuberculosis.
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Affiliation(s)
- Achim Schwenk
- Department of Infectious Diseases, St George's Hospital Medical School, London, United Kingdom.
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Santolaria F, Pérez-Cejas A, Alemán MR, González-Reimers E, Milena A, de la Vega MJ, Martínez-Riera A, Gómez-Rodríguez MA. Low serum leptin levels and malnutrition in chronic alcohol misusers hospitalized by somatic complications. Alcohol Alcohol 2003; 38:60-6. [PMID: 12554610 DOI: 10.1093/alcalc/agg015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIMS Leptin is a peptide produced by fat cells which regulates fat mass by decreasing food intake and increasing resting energy expenditure, so an increase of serum leptin could be an indicator of malnutrition. Our objective was to determine serum leptin levels (at admission and on the 15th day) in 79 male alcohol misusers, hospitalized by somatic complications, who drink more than 80 g ethanol/day, and to analyse its relationships with nutritional status assessed by anthropometry and dual-energy X-ray absortiometry (DEXA), insulin-like growth factor (IGF-1) and its binding protein (IGF1BP-3); acute phase reaction assessed by C-reactive protein (CRP), interleukin-6 (IL-6) and type II soluble receptor of tumour necrosis factor (TNF) (sTNFRII); serum oestradiol and testosterone; and the amount and duration of ethanol intake, the smoking habit and the presence of liver cirrhosis. METHODS Patients were admitted through the emergency room, and blood for the above-mentioned determinations was taken at 08.00 on the following day, so none of the patients was acutely intoxicated at this time. The control group was composed of 32 healthy male (age-matched) subjects. RESULTS Malnutrition was frequent among alcoholics. Serum leptin levels were closely related to total fat both in controls and in alcoholics. Serum leptin levels were decreased in alcoholics, even after adjusting for the amount of fat. Those alcoholics who reported anorexia and weight loss showed decreased leptin levels. After 15 days of hospitalization, serum leptin did not increase, in contrast with LDL cholesterol, serum albumin, prealbumin, IGF-1, IGF1BP-3 and testosterone which increased, whereas oestradiol and acute phase reactants, such as CRP, IL-6 and sTNFRII, were decreased. Serum leptin was not related to gonadal hormones at admission, but on day 15 we found a negative correlation between leptin and testosterone, and a positive one with oestradiol. CONCLUSIONS Serum leptin levels are related to many factors, e.g. fat mass, age, smoking, serum testosterone and oestradiol levels, growth factors such as IGF-1 and CRP, and cytokines, such as IL-6 and sTNFRII. The most important of these is fat mass, as shown by multivariate analysis. Since serum leptin levels are decreased in alcohol misusers, we consider this decrease to be a consequence of a low fat mass.
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Schulze PC, Kratzsch J, Linke A, Schoene N, Adams V, Gielen S, Erbs S, Moebius-Winkler S, Schuler G. Elevated serum levels of leptin and soluble leptin receptor in patients with advanced chronic heart failure. Eur J Heart Fail 2003; 5:33-40. [PMID: 12559213 DOI: 10.1016/s1388-9842(02)00177-0] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Patients with chronic heart failure (CHF) have metabolic abnormalities, leading to a catabolic syndrome, with progressive loss of skeletal muscle in advanced stages of the disease. Leptin, the product of an obesity gene, has been associated with energy expenditure and weight regulation. The aim of this study was to assess serum levels of leptin and its soluble receptor in relation to exercise intolerance and neurohumoral activation in patients with CHF. We investigated 53 patients with CHF left ventricular ejection fraction (LVEF) 25+/-1%, age 56.6+/-1.3 years, Maximal oxygen uptake (VO(2) max) 16.3+/-0.6 ml/min.kg) sub-classified according to peak oxygen consumption of > or <or=14 ml/min.kg and 11 age-matched controls (LVEF 70+/-1, age 60.5+/-4.0 years, (VO(2)max) 26.9+/-1.6 ml/min.kg). Body mass index-adjusted serum levels of leptin and soluble leptin receptor were increased in patients with CHF compared to the controls (0.28+/-0.03 vs. 0.22+/-0.04 ng.m(2)/ml.kg and 32.6+/-1.9 ng/ml vs. 22.9+/-2.3, P<0.05). This increase was even more pronounced in patients with CHF and severe exercise intolerance (0.43+/-0.08 vs. 0.21+/-0.02 and 0.22+/-0.04 ng.m(2)/ml.kg; P<0.01 vs. VO(2)max>14 ml/min.kg and controls). Elevated levels of leptin correlated with an increased serum concentration of TNFalpha (r=0.749, P<0.01) in this subgroup of patients with CHF. We conclude that patients with advanced CHF show elevated serum levels of leptin and its soluble receptor. This finding indicates that leptin may participate in the catabolic state leading to the development of cardiac cachexia in the course of CHF.
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Affiliation(s)
- P Christian Schulze
- Department of Cardiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Alemán MR, Santolaria F, Batista N, de La Vega M, González-Reimers E, Milena A, Llanos M, Gómez-Sirvent JL. Leptin role in advanced lung cancer. A mediator of the acute phase response or a marker of the status of nutrition? Cytokine 2002; 19:21-6. [PMID: 12200109 DOI: 10.1006/cyto.2002.1051] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Leptin is an anorexia inductor peptide produced by adipocytes and related to fat mass. Leptin is also produced by fat under proinflammatory cytokine action. Our objective is to study serum leptin levels in relation to nutritional status and acute phase response in advanced-stage non-small cell lung cancer.Seventy-six patients newly diagnosed of non surgical non-small cell lung cancer before chemotherapy treatment and 30 healthy controls were included. BMI, serum leptin and cholesterol levels and lymphocyte count were decreased in lung cancer patients. Cytokine IL-6, TNF-alpha, sTNF-RII, sIL-2R, IL-12, IL-10 and IFN-gamma, and other acute phase reactants as alpha1 antitrypsin, ferritin, CRP and platelets were all raised in patients, whereas the IL-2 was decreased. We found a direct relationship between leptin and other indicators of the status of nutrition, especially total fat mass. We also found a close relationship between the status of nutrition and the performance status (Karnofsky index). However, serum leptin and nutritional status were inversely correlated with acute phase proteins and proinflammatory cytokines, suggesting a stress-type malnutrition. Although serum leptin levels, nutritional status and Karnofsky index are related to survival, at multivariate analysis they all were displaced by the acute phase reaction markers. These results suggest that cancer anorexia and cachexia are not due to a dysregulation of leptin production. Circulating leptin concentrations are not elevated in weight-losing cancer patients and are inversely related to the intensity of the inflammatory response. In advanced lung cancer patients serum leptin concentrations only depend on the total amount of fat.
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