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Vaishnavi Nalla S, Jayapradha P, Lalruatmawii, Nandheeswari K, Naxine P, Vigneshwaran G, Rohilla G, Dubey I, Kushwaha S. Irisin as an emerging target in the regulation of reproductive functions in health and disease. Gen Comp Endocrinol 2024; 353:114529. [PMID: 38643847 DOI: 10.1016/j.ygcen.2024.114529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/22/2023] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
Germ cells are highly conserved in the gonads, nurtured to either develop into a gamete or self-renew into a stem cell reserve. Preserving the germ cell pool and protecting the reproductive organs is essential for maintaining an individual's fertility. Several factors, including a sedentary lifestyle, pollutants, hormonal disruption, drugs, and a disease condition, have been shown to impair normal reproductive function. Irisin has recently been identified as an adipomyokine involved in modulating physiological functions based on the body's metabolic status. It is being studied for its role in various functions, including fertility. Findings show the localization of irisin in various parts of the reproductive axis, with the highest levels observed during puberty and pregnancy. This raises questions about its role and function in reproduction. Studies support irisin's role in protecting against disease-induced reproductive abnormalities and infertility. Therefore, the current review focuses on how irisin influences spermatogenesis and ovarian follicular development and plays a significant role in indirectly preserving the germ cell pool by protecting the gonads against oxidative stress and inflammation.
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Affiliation(s)
- Sree Vaishnavi Nalla
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - P Jayapradha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Lalruatmawii
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - K Nandheeswari
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Pratik Naxine
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - G Vigneshwaran
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Gaurav Rohilla
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Itishree Dubey
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Sapana Kushwaha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India.
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Cellular and Molecular Mechanisms Associating Obesity to Bone Loss. Cells 2023; 12:cells12040521. [PMID: 36831188 PMCID: PMC9954309 DOI: 10.3390/cells12040521] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Obesity is an alarming disease that favors the upset of other illnesses and enhances mortality. It is spreading fast worldwide may affect more than 1 billion people by 2030. The imbalance between excessive food ingestion and less energy expenditure leads to pathological adipose tissue expansion, characterized by increased production of proinflammatory mediators with harmful interferences in the whole organism. Bone tissue is one of those target tissues in obesity. Bone is a mineralized connective tissue that is constantly renewed to maintain its mechanical properties. Osteoblasts are responsible for extracellular matrix synthesis, while osteoclasts resorb damaged bone, and the osteocytes have a regulatory role in this process, releasing growth factors and other proteins. A balanced activity among these actors is necessary for healthy bone remodeling. In obesity, several mechanisms may trigger incorrect remodeling, increasing bone resorption to the detriment of bone formation rates. Thus, excessive weight gain may represent higher bone fragility and fracture risk. This review highlights recent insights on the central mechanisms related to obesity-associated abnormal bone. Publications from the last ten years have shown that the main molecular mechanisms associated with obesity and bone loss involve: proinflammatory adipokines and osteokines production, oxidative stress, non-coding RNA interference, insulin resistance, and changes in gut microbiota. The data collection unveils new targets for prevention and putative therapeutic tools against unbalancing bone metabolism during obesity.
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O’Reilly C, Lin L, Wang H, Fluckey J, Sun Y. Ablation of Ghrelin Receptor Mitigates the Metabolic Decline of Aging Skeletal Muscle. Genes (Basel) 2022; 13:genes13081368. [PMID: 36011279 PMCID: PMC9407208 DOI: 10.3390/genes13081368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
The orexigenic hormone ghrelin has multifaceted roles in health and disease. We have reported that ablation of the ghrelin receptor, growth hormone secretagogue receptor (GHS-R), protects against metabolic dysfunction of adipose tissues in aging. Our further observation interestingly revealed that GHS-R deficiency phenocopies the effects of myokine irisin. In this study, we aim to determine whether GHS-R affects the metabolic functions of aging skeletal muscle and whether GHS-R regulates the muscular functions via irisin. We first studied the expression of metabolic signature genes in gastrocnemius muscle of young, middle-aged and old mice. Then, old GHS-R knockout (Ghsr−/−) mice and their wild type counterparts were used to assess the impact of GHS-R ablation on the metabolic characteristics of gastrocnemius and soleus muscle. There was an increase of GHS-R expression in skeletal muscle during aging, inversely correlated with the decline of metabolic functions. Remarkedly the muscle of old GHS-R knockout (Ghsr−/−) mice exhibited a youthful metabolic profile and better maintenance of oxidative type 2 muscle fibers. Furthermore, old Ghsr−/− mice showed improved treadmill performance, supporting better functionality. Also intriguing to note was the fact that old GHS-R-ablated mice showed increased expression of the irisin precursor FNDC5 in the muscle and elevated plasma irisin levels in circulation, which supports a potential interrelationship between GHS-R and irisin. Overall, our work suggests that GHS-R has deleterious effects on the metabolism of aging muscle, which may be at least partially mediated by myokine irisin.
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Affiliation(s)
- Colleen O’Reilly
- Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA;
| | - Ligen Lin
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA;
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China
| | - Hongying Wang
- Department of Nutrition, Texas A & M University, College Station, TX 77843, USA;
| | - James Fluckey
- Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA;
- Correspondence: (J.F.); (Y.S.)
| | - Yuxiang Sun
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Nutrition, Texas A & M University, College Station, TX 77843, USA;
- Correspondence: (J.F.); (Y.S.)
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Slate-Romano JJ, Yano N, Zhao TC. Irisin reduces inflammatory signaling pathways in inflammation-mediated metabolic syndrome. Mol Cell Endocrinol 2022; 552:111676. [PMID: 35569582 PMCID: PMC10084474 DOI: 10.1016/j.mce.2022.111676] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/24/2022] [Accepted: 05/09/2022] [Indexed: 12/26/2022]
Abstract
Irisin is an exercise induced myokine first shown to induce the browning of white adipose tissue (WAT) which increases energy expenditure, improves glucose tolerance, and reduces insulin resistance. Among irisin's involvement in lipid homeostasis, osteoblast proliferation, and muscle growth, it also acts as a mediator of many inflammatory pathways throughout the body. This review aims to describe the role of irisin in inflammatory processes and understand how targeting irisin can alter the inflammatory response in metabolic syndrome (MetS). The mechanisms involved in irisin's anti-inflammatory functions include reducing production of pro-inflammatory cytokines while increasing production of anti-inflammatory cytokines, reducing macrophage proliferation, inducing alternatively activated (M2-type) macrophage polarization, inhibiting pathways of increased vascular permeability, and preventing the formation of inflammasomes. While there are some contradictory results, most studies found reduced levels of irisin in MetS and type II diabetes mellitus (T2DM). Irisin treatment of cells exposed to inflammatory stimuli ameliorates the inflammatory response and promotes cellular viability. Numerous methods have been studied to increase plasma irisin levels including dietary, behavioral, and pharmaceutical. Further investigation is necessary to understand how irisin can be targeted for disease modification.
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Affiliation(s)
- John J Slate-Romano
- Warren Alpert Medical School of Brown University School of Medicine, 222 Richmond St. Providence, RI, 02903, USA
| | - Naohiro Yano
- Department of Surgery, Rhode Island Hospital, 593 Eddy St. Providence, RI, 02903, USA
| | - Ting C Zhao
- Department of Plastic Surgery, Department of Surgery, Rhode Island Hospital, Warren Alpert School of Medicine, 593 Eddy St. Providence, RI, 02903, USA.
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Irisin, An Exercise-induced Bioactive Peptide Beneficial for Health Promotion During Aging Process. Ageing Res Rev 2022; 80:101680. [DOI: 10.1016/j.arr.2022.101680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/11/2022]
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Ahmadabadi F, Nakhaei H, Mogharnasi M, Huang CJ. Aerobic interval training improves irisin and chemerin levels of both liver and visceral adipose tissues and circulating asprosin in rats with metabolic syndrome. Physiol Int 2021; 108:383-397. [PMID: 34529587 DOI: 10.1556/2060.2021.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022]
Abstract
The perturbation of adipokinetic hormones, such as irisin, chemerin, and asprosin has been reported to participate in pathological conditions (e.g., insulin resistance) and chronic inflammation. However, exercise training has been long established as an effective intervention for prevention and treatment of these chronic and metabolic diseases. This study was to examine the effects of aerobic continuous training (ACT) and aerobic interval training (AIT) on irisin and chemerin levels of liver tissue (LT) and visceral adipose tissue (VAT), circulating asprosin, and their relationships with cardiometabolic risk factors in rats with metabolic syndrome (MetS). Thirty-two male Wistar rats were randomly divided into four equal groups: normal control (N-Ctr), control (Ctr-MetS), ACT, and AIT. After familiarization, rats with exercise intervention performed either ACT or AIT five times a week over eight weeks. The level of irisin in both ACT and AIT groups was higher than the Ctr-MetS group in LT and VAT, with a greater improvement of LT level observed in AIT vs. ACT groups. Furthermore, the level of chemerin in LT and VAT was lower in both ACT and AIT groups than the Ctr-MetS group, whereas only AIT group exhibited a reduction of serum asprosin when compared to ACT and Ctr-MetS, along with the improvements of cardiometabolic markers, such as HOMA-IR and lipid profile. These findings may support the efficiency and effectiveness of AIT intervention in the modulation of these novel metabolic hormones and cardiometabolic risk factors for reduced risk of metabolic syndrome.
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Affiliation(s)
- Fereshteh Ahmadabadi
- 1 Department of Exercise Physiology, Faculty of Sport Sciences, University of Birjand, Birjand, Iran
| | - Hossein Nakhaei
- 2 Health Promotion Research Centre, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Mogharnasi
- 1 Department of Exercise Physiology, Faculty of Sport Sciences, University of Birjand, Birjand, Iran
| | - Chun-Jung Huang
- 3 Exercise Biochemistry Laboratory, Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL 33431, United States
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Li H, Wang F, Yang M, Sun J, Zhao Y, Tang D. The Effect of Irisin as a Metabolic Regulator and Its Therapeutic Potential for Obesity. Int J Endocrinol 2021; 2021:6572342. [PMID: 33790964 PMCID: PMC7997758 DOI: 10.1155/2021/6572342] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/05/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity is a worldwide health problem due to the imbalance of energy intake and energy expenditure. Irisin, a newly identified exercise-responsive myokine, which is produced by the proteolytic cleavage of fibronectin type III domain-containing protein 5 (FNDC5), has emerged as a promising therapeutic strategy to combat obesity and obesity-related complications. Various studies in mice have shown that irisin could respond to systematic exercise training and promote white-to-brown fat transdifferentiation, but the role and function of irisin in humans are controversial. In this review, we systematically introduced and analyzed the factors that may contribute to these inconsistent results. Furthermore, we also described the potential anti-inflammatory properties of irisin under a variety of inflammatory conditions. Finally, the review discussed the existing unresolved issues and controversies about irisin, including the transcription of the irisin precursor FNDC5 gene in humans, the cleavage site of the yet unknown proteolytic enzyme that cleaves irisin from FNDC5, and the reliability of irisin levels measured with available detection methods.
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Affiliation(s)
- Hui Li
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Fang Wang
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Mu Yang
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Jiao Sun
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Yi Zhao
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Dongqi Tang
- Center for Gene and Immunotherapy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
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Ma C, Ding H, Deng Y, Liu H, Xiong X, Yang Y. Irisin: A New Code Uncover the Relationship of Skeletal Muscle and Cardiovascular Health During Exercise. Front Physiol 2021; 12:620608. [PMID: 33597894 PMCID: PMC7882619 DOI: 10.3389/fphys.2021.620608] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022] Open
Abstract
Exercise not only produces beneficial effects on muscle itself via various molecular pathways, but also mediates the interaction between muscles and other organs in an autocrine/paracrine manner through myokines, which plays a positive role in maintaining overall health. Irisin, an exercise-derived myokine, has been found involved in the regulation of some cardiovascular diseases. However, the relationship between irisin and cardiovascular health is not fully elucidated and there are some divergences on the regulation of irisin by exercise. In this review, we present the current knowledge on the origin and physiology of irisin, describe the regulation of irisin by acute and chronic exercises, and discuss the divergences of the related research results. Importantly, we discuss the role of irisin as a biomarker in the diagnosis of cardiovascular diseases and describe its treatment and molecular mechanism in some cardiovascular diseases. It is expected that irisin will be used as a therapeutic agent to combat cardiovascular diseases or other disorders caused by inactivity in the near future.
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Affiliation(s)
- Chunlian Ma
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Haichao Ding
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Yuting Deng
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Hua Liu
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Xiaoling Xiong
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Yi Yang
- College of Health Science, Wuhan Sports University, Wuhan, China
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Marrano N, Biondi G, Borrelli A, Cignarelli A, Perrini S, Laviola L, Giorgino F, Natalicchio A. Irisin and Incretin Hormones: Similarities, Differences, and Implications in Type 2 Diabetes and Obesity. Biomolecules 2021; 11:286. [PMID: 33671882 PMCID: PMC7918991 DOI: 10.3390/biom11020286] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
Incretins are gut hormones that potentiate glucose-stimulated insulin secretion (GSIS) after meals. Glucagon-like peptide-1 (GLP-1) is the most investigated incretin hormone, synthesized mainly by L cells in the lower gut tract. GLP-1 promotes β-cell function and survival and exerts beneficial effects in different organs and tissues. Irisin, a myokine released in response to a high-fat diet and exercise, enhances GSIS. Similar to GLP-1, irisin augments insulin biosynthesis and promotes accrual of β-cell functional mass. In addition, irisin and GLP-1 share comparable pleiotropic effects and activate similar intracellular pathways. The insulinotropic and extra-pancreatic effects of GLP-1 are reduced in type 2 diabetes (T2D) patients but preserved at pharmacological doses. GLP-1 receptor agonists (GLP-1RAs) are therefore among the most widely used antidiabetes drugs, also considered for their cardiovascular benefits and ability to promote weight loss. Irisin levels are lower in T2D patients, and in diabetic and/or obese animal models irisin administration improves glycemic control and promotes weight loss. Interestingly, recent evidence suggests that both GLP-1 and irisin are also synthesized within the pancreatic islets, in α- and β-cells, respectively. This review aims to describe the similarities between GLP-1 and irisin and to propose a new potential axis-involving the gut, muscle, and endocrine pancreas that controls energy homeostasis.
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Affiliation(s)
| | | | | | | | | | | | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, I-70124 Bari, Italy; (N.M.); (G.B.); (A.B.); (A.C.); (S.P.); (L.L.); (A.N.)
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Zhang R, Fu T, Zhao X, Qiu Y, Hu X, Shi H, Yin X. Association of Circulating Irisin Levels with Adiposity and Glucose Metabolic Profiles in a Middle-Aged Chinese Population: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:4105-4112. [PMID: 33162755 PMCID: PMC7642586 DOI: 10.2147/dmso.s275878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The myokine irisin has been proposed to affect obesity and metabolism disorders. However, data about the association of irisin with obesity and glucose metabolic status in humans remains controversial, and limited data are available concerning the Chinese population. This study aimed to evaluate the association between serum irisin concentrations and obesity, as well as glucose metabolic and cardiovascular factors in the middle-aged physical activity-matched Chinese Han race population. METHODS A total of 740 participants were included in this cross-sectional study, who were divided into a normal weight (NW) group, overweight/obese (OB) group, normal weight type 2 diabetes (DM-NW) group and overweight/obese diabetes (DM-OB) group, and physical activity was evaluated and matched for the four groups. Circulating irisin levels were analyzed and compared among the groups with different adiposity and glucose status. Linear regression analysis was performed to test the relationship between serum irisin and adiposity indices, glucose metabolic and other cardiovascular risk factors. RESULTS Circulating irisin levels were significantly correlated with higher levels of direct and indirect adiposity markers, including BMI, waist circumference and fat mass, and other cardiovascular risk factors, such as plasma triglyceride and low-density lipoprotein cholesterol level (p < 0.01). Diabetes patients had lower irisin levels compared to non-diabetes participants, in either normal weight and obese group, resulting in a correlation of irisin with HbA1c, HOMA-IR and HOMA-IS (p < 0.01). Linear regression analysis demonstrated that irisin serum concentrations were independently associated with sex, BMI, HbA1c, HOMA-IR and HOMA-IS (R2 = 0.465). CONCLUSION These data indicated that circulating irisin was affected by adiposity and glucose metabolism condition in the middle-aged Chinese population. The increase of irisin under conditions of obesity may indicate its physiological function to improve glucose tolerance which is often impaired in obese subjects, but this compensatory secretion of irisin seems likely to be progressing to a secretion failure once diabetes developed.
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Affiliation(s)
- Ruibin Zhang
- Department of Medicine, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong, People’s Republic of China
| | - Tingting Fu
- Department of Clinical Medicine, Qilu College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Xin Zhao
- Department of Clinical Laboratory, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong, People’s Republic of China
| | - Yao Qiu
- Department of Surgery, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong, People’s Republic of China
| | - Xiaolin Hu
- Department of Endocrinology and Metabolism, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong, People’s Republic of China
| | - Hongyan Shi
- Department of Surgery, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong, People’s Republic of China
| | - Xiao Yin
- Department of Endocrinology and Metabolism, Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong, People’s Republic of China
- Correspondence: Xiao Yin Department of Endocrinology and Metabolism, Shandong University Affiliated Jinan Central Hospital, Linong Road 8, 5-1-801, Jinan250013, People’s Republic of ChinaTel +86-15318816220 Email
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