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Lee YJ, Jung SY, Lee YA, Kim J, Lee SY, Shin CH. Relationship Between the Serum FGF21 Level and Growth in Children of Short Stature. J Korean Med Sci 2023; 38:e63. [PMID: 36808549 PMCID: PMC9941013 DOI: 10.3346/jkms.2023.38.e63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND This study investigated the relationship between fibroblast growth factor 21 (FGF21) levels and growth in children with growth hormone deficiency (GHD) and idiopathic short stature (ISS), and the effects of the FGF21 level on response to growth hormone (GH) treatment. METHODS We included 171 pre-pubertal children with a GHD (n = 54), ISS (n = 46), and normal height (n = 71). Fasting FGF21 levels were measured at baseline and every 6 months during GH treatment. Factors associated with growth velocity (GV) after GH therapy were investigated. RESULTS The FGF21 level was higher in short children than in the controls without significant difference between the GHD and ISS groups. In the GHD group, the FGF21 level was inversely associated with the free fatty acid (FFA) level at baseline (r = -0.28, P = 0.039), however, was positively correlated with the FFA level at 12 months (r = 0.62, P = 0.016). The GV over 12 months of GH therapy was positively associated with the delta insulin-like growth factor 1 level (β = 0.003, P = 0.020). The baseline log-transformed FGF21 level was inversely associated with GV with marginal significance (β = -0.64, P = 0.070). CONCLUSION The FGF21 level was higher in children of short stature, both those with GHD and the ISS, than in children with normal growth. The pretreatment FGF21 level negatively affected the GV of children with GH-treated GHD. These results suggest the existence of a GH/FFA/FGF21 axis in children.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - So Yoon Jung
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Yong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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2
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Simpson SJ, Raubenheimer D, Black KI, Conigrave AD. Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage. BJOG 2023; 130:4-10. [PMID: 36073244 PMCID: PMC10952331 DOI: 10.1111/1471-0528.17290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen J. Simpson
- Charles Perkins Centre (D17), School of Life and Environmental SciencesUniversity of SydneySydneyNew South WalesAustralia
| | - David Raubenheimer
- Charles Perkins Centre (D17), School of Life and Environmental SciencesUniversity of SydneySydneyNew South WalesAustralia
| | - Kirsten I. Black
- Speciality of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Menopause ClinicConcord Repatriation General HospitalConcordNew South WalesAustralia
| | - Arthur D. Conigrave
- Charles Perkins Centre (D17), School of Life and Environmental SciencesUniversity of SydneySydneyNew South WalesAustralia
- Department of EndocrinologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
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3
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Akduman F, Şıklar Z, Özsu E, Doğan Ö, Kır MK, Berberoğlu M. Fibroblast Growth Factor 21 Levels and Bone Mineral Density in Metabolically Healthy and Metabolically Unhealthy Obese Children. J Clin Res Pediatr Endocrinol 2022; 14:433-443. [PMID: 35859690 PMCID: PMC9724058 DOI: 10.4274/jcrpe.galenos.2022.2022-1-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The harmful or beneficial effect of obesity on bone mineral density (BMD) remains controversial in children and adolescents. Fibroblast growth factor 21 (FGF21) is a metabolic factor that plays a specific role in the regulation of carbohydrate and lipid metabolism. However, the role of FGF21 in bone metabolism appears paradoxical and is complex. To determine whether serum FGF21 level was associated with BMD in obese children and adolescents. METHODS The study was conducted with the participation of children and adolescents aged 8-18 years. Ninety-eight obese children were included in the study group and 44 children were included in the control group. BMD, in addition to the routine obesity workup, which includes fasting blood glucose, fasting insulin levels, lipid profile, and liver enzymes; serum FGF21 levels have been analyzed. RESULTS The mean age of the obese group (n=98) was 13.34±2.24 years and the mean age of controls (n=44) was 13.48±2.87 years. Based on International Diabetes Federation criteria, 15 of 98 (15.3%) patients were metabolically unhealthy. FGF21 levels were 193.54±139.62 mg/dL in the obese group and 158.69±151.81 mg/dL in the control group (p=0.06). There was no difference between the FGF21 and BMD z-score values of girls and boys in the obese and control groups (p>0.05). CONCLUSION BMD-z-score was increased in obese children compared to healthy control. Moreover, BMD-z-score tended to be higher when more metabolic risk factors were present. However, there was no significant relationship between FGF21 levels and BMD z-score values in obese children.
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Affiliation(s)
- Filiz Akduman
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey,* Address for Correspondence: Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey Phone: +90 507 443 24 42 E-mail:
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Elif Özsu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Özlem Doğan
- Ankara University Faculty of Medicine, Department of Clinical Biochemistry, Ankara, Turkey
| | - Metin Kemal Kır
- Ankara University School of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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4
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Herrmann JR, Fink EL, Fabio A, Au AK, Berger RP, Janesko-Feldman K, Clark RSB, Kochanek PM, Jackson TC. Serum levels of the cold stress hormones FGF21 and GDF-15 after cardiac arrest in infants and children enrolled in single center therapeutic hypothermia clinical trials. Resuscitation 2022; 172:173-180. [PMID: 34822938 PMCID: PMC8923906 DOI: 10.1016/j.resuscitation.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Fibroblast Growth Factor 21 (FGF21) and Growth Differentiation Factor-15 (GDF-15) are putative neuroprotective cold stress hormones (CSHs) provoked by cold exposure that may be age-dependent. We sought to characterize serum FGF21 and GDF-15 levels in pediatric cardiac arrest (CA) patients and their association with use of therapeutic hypothermia (TH). METHODS Secondary analysis of serum samples from clinical trials. We measured FGF21 and GDF-15 levels in pediatric patients post-CA and compared levels to both pediatric intensive care (PICU) and healthy controls. Post-CA, we compared normothermia (NT) vs TH (33 °C for 72 h) treated cohorts at < 24 h, 24 h, 48 h, 72 h, and examined the change in CSHs over 72 h. We also assessed association between hospital mortality and initial levels. RESULTS We assessed 144 samples from 68 patients (27 CA [14 TH, 13 NT], 9 PICU and 32 healthy controls). Median initial FGF21 levels were higher post-CA vs. healthy controls (392 vs. 40 pg/mL, respectively, P < 0.001). Median GDF-15 levels were higher post-CA vs. healthy controls (7,089 vs. 396 pg/mL, respectively, P < 0.001). In the CA group, the median change in FGF21 from PICU day 1-3 (after 72 h of temperature control), was higher in TH vs. NT (231 vs. -20 pg/mL, respectively, P < 0.05), with no difference in GDF-15 over time. Serum GDF-15 levels were higher in CA patients that died vs. survived (19,450 vs. 5,337 pg/mL, respectively, P < 0.05), whereas serum FGF21 levels were not associated with mortality. CONCLUSION Serum levels of FGF21 and GDF-15 increased after pediatric CA, and FGF21 appears to be augmented by TH.
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Affiliation(s)
- Jeremy R Herrmann
- Departments of Critical Care Medicine, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ericka L Fink
- Departments of Critical Care Medicine, Pittsburgh, PA, USA; Pediatrics, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony Fabio
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alicia K Au
- Departments of Critical Care Medicine, Pittsburgh, PA, USA; Pediatrics, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel P Berger
- Pediatrics, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Keri Janesko-Feldman
- Departments of Critical Care Medicine, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Robert S B Clark
- Departments of Critical Care Medicine, Pittsburgh, PA, USA; Pediatrics, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick M Kochanek
- Departments of Critical Care Medicine, Pittsburgh, PA, USA; Pediatrics, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Travis C Jackson
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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5
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Mateus Brandão LE, Espes D, Westholm JO, Martikainen T, Westerlund N, Lampola L, Popa A, Vogel H, Schürmann A, Dickson SL, Benedict C, Cedernaes J. Acute sleep loss alters circulating fibroblast growth factor 21 levels in humans: A randomised crossover trial. J Sleep Res 2021; 31:e13472. [PMID: 34476847 DOI: 10.1111/jsr.13472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/14/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022]
Abstract
The hormone fibroblast growth factor 21 (FGF21) modulates tissue metabolism and circulates at higher levels in metabolic conditions associated with chronic sleep-wake disruption, such as type 2 diabetes and obesity. In the present study, we investigated whether acute sleep loss impacts circulating levels of FGF21 and tissue-specific production, and response pathways linked to FGF21. A total of 15 healthy normal-weight young men participated in a randomised crossover study with two conditions, sleep loss versus an 8.5-hr sleep window. The evening before each intervention, fasting blood was collected. Fasting, post-intervention morning skeletal muscle and adipose tissue samples underwent quantitative polymerase chain reaction and DNA methylation analyses, and serum FGF21 levels were measured before and after an oral glucose tolerance test. Serum levels of FGF21 were higher after sleep loss compared with sleep, both under fasting conditions and following glucose intake (~27%-30%, p = 0.023). Fasting circulating levels of fibroblast activation protein, a protein which can degrade circulating FGF21, were not altered by sleep loss, whereas DNA methylation in the FGF21 promoter region increased only in adipose tissue. However, even though specifically the muscle exhibited transcriptional changes indicating adverse alterations to redox and metabolic homeostasis, no tissue-based changes were observed in expression of FGF21, its receptors, or selected signalling targets, in response to sleep loss. In summary, we found that acute sleep loss resulted in increased circulating levels of FGF21 in healthy young men, which may occur independent of a tissue-based stress response in metabolic peripheral tissues. Further studies may decipher whether changes in FGF21 signalling after sleep loss modulate metabolic outcomes associated with sleep or circadian disruption.
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Affiliation(s)
| | - Daniel Espes
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Jakub Orzechowski Westholm
- Department of Biochemistry and Biophysics, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Stockholm University, Stockholm, Sweden
| | | | | | - Lauri Lampola
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Alexandru Popa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Heike Vogel
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,German Center for Diabetes Research, Neuherberg, Germany.,Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, , The Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany
| | - Annette Schürmann
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Suzanne L Dickson
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Jonathan Cedernaes
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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6
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Stone SI, Wegner DJ, Wambach JA, Cole FS, Urano F, Ornitz DM. Digenic Variants in the FGF21 Signaling Pathway Associated with Severe Insulin Resistance and Pseudoacromegaly. J Endocr Soc 2020; 4:bvaa138. [PMID: 33210059 PMCID: PMC7653638 DOI: 10.1210/jendso/bvaa138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
Insulin-mediated pseudoacromegaly (IMPA) is a rare disease of unknown etiology. Here we report a 12-year-old female with acanthosis nigricans, hirsutism, and acromegalic features characteristic of IMPA. The subject was noted to have normal growth hormone secretion, with extremely elevated insulin levels. Studies were undertaken to determine a potential genetic etiology for IMPA. The proband and her family members underwent whole exome sequencing. Functional studies were undertaken to validate the pathogenicity of candidate variant alleles. Whole exome sequencing identified monoallelic, predicted deleterious variants in genes that mediate fibroblast growth factor 21 (FGF21) signaling, FGFR1 and KLB, which were inherited in trans from each parent. FGF21 has multiple metabolic functions but no known role in human insulin resistance syndromes. Analysis of the function of the FGFR1 and KLB variants in vitro showed greatly attenuated ERK phosphorylation in response to FGF21, but not FGF2, suggesting that these variants act synergistically to inhibit endocrine FGF21 signaling but not canonical FGF2 signaling. Therefore, digenic variants in FGFR1 and KLB provide a potential explanation for the subject's severe insulin resistance and may represent a novel category of insulin resistance syndromes related to FGF21.
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Affiliation(s)
- Stephen I Stone
- Department of Pediatrics, Division of Pediatric Endocrinology & Diabetes, Washington University School of Medicine, St. Louis, Missouri, US
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri, US
| | - Daniel J Wegner
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri, US
| | - Jennifer A Wambach
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri, US
| | - F Sessions Cole
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri, US
| | - Fumihiko Urano
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, US
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, US
| | - David M Ornitz
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri, US
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7
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Ruiz-Padilla AJ, Morales-Hernandez G, Ruiz-Noa Y, Alonso-Castro AJ, Lazo-de-la-Vega-Monroy ML, Preciado-Puga MDC, Rangel-Salazar R, Ibarra-Reynoso LDR. Association of the 3'UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity. J Pediatr Endocrinol Metab 2019; 32:921-928. [PMID: 31323006 DOI: 10.1515/jpem-2018-0546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/18/2019] [Indexed: 12/31/2022]
Abstract
Background Fibroblast growth factor 21 (FGF21) is considered an important regulator of lipid and glucose metabolism. However, the role of FGF21 in macronutrient intake and metabolic disease, particularly in pediatric population, still needs further clarification. This study aimed to evaluate the association of rs11665896 in the FGF21 gene with metabolic status and macronutrient intake in a cohort of Mexican children with obesity. Methods Eighty-four lean children and 113 children with obesity, from 8 to 11 years of age, were recruited. FGF21 rs11665896 was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Somatometric evaluations, nutrient intake, glucose, lipids, insulin and FGF21 serum levels were measured in the obesity group. Results The T allele of rs11665896 in the FGF21 gene was associated with obesity (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.14-3.46; p = 0.0151). Subjects with obesity carrying the TT genotype consumed less lipids and more carbohydrates compared to other genotypes. Circulating FGF21 levels correlated negatively with carbohydrate intake (r = -0.232, p = 0.022) and positively with body weight (r = 0.269, p = 0.007), waist (r = 0.242, p = 0.016) and hip girth (r = 0.204, p = 0.042). FGF21 levels were lower in carriers of at least one T allele. Conclusions Genetic variants in FGF21 could influence metabolic status, food preferences and qualitative changes in nutritional behavior in children.
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Affiliation(s)
- Alan Joel Ruiz-Padilla
- Department of Pharmacy, Natural and Exact Sciences Division, University of Guanajuato, Guanajuato Campus, Guanajuato, Gto, Mexico
| | | | - Yeniley Ruiz-Noa
- Department of Medical Sciences, Health Sciences Division, University of Guanajuato, Leon Campus, León, Mexico
| | - Angel Josabad Alonso-Castro
- Department of Pharmacy, Natural and Exact Sciences Division, University of Guanajuato, Guanajuato Campus, Guanajuato, Gto, Mexico
| | | | | | - Ruben Rangel-Salazar
- Department of Medical Sciences, Health Sciences Division, University of Guanajuato, Leon Campus, León, Mexico
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8
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Seppä S, Tenhola S, Voutilainen R. Fibroblast Growth Factor 21, Adiponectin, and Irisin as Markers of Unfavorable Metabolic Features in 12-Year-Old Children. J Endocr Soc 2019; 3:825-837. [PMID: 30963140 PMCID: PMC6446887 DOI: 10.1210/js.2018-00399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Among cytokines, fibroblast growth factor 21 (FGF21), adiponectin (Adn), and irisin have been considered potential biomarkers for insulin sensitivity (IS). OBJECTIVE We evaluated whether serum FGF21, Adn, and irisin associate with markers of IS and serum lipids in 12-year-old children. DESIGN PARTICIPANTS AND MAIN OUTCOME MEASURES This cohort study included 192 12-year-old children (109 girls). Seventy-eight of them had been born appropriate for gestational age (AGA), 70 small for gestational age (SGA), and 44 from preeclamptic pregnancies (PREs) as AGA. Fasting serum FGF21, Adn, irisin, lipids, inflammatory markers, and IS markers were measured. Quantitative insulin sensitivity check index (QUICKI) was calculated. RESULTS The means of serum FGF21, high molecular weight (HMW) Adn, and irisin did not differ between the sexes or between the SGA, AGA, and PRE children. In the whole study population, FGF21 associated positively with irisin and uric acid and negatively with leptin and high-density lipoprotein cholesterol (HDL-C). HMW Adn associated positively with total Adn, HDL-C, leptin, and SHBG. Apart from FGF21, irisin associated positively with insulin, high-sensitivity C-reactive protein, γ-glutamyltransferase, and triglycerides, and negatively with QUICKI, SHBG, and IGF binding protein-1. In multivariate regression analyses, irisin predicted lower IS and HMW Adn predicted higher HDL-C body mass index-independently, whereas FGF21 had no independent contribution to IS or lipid variables. CONCLUSION In 12-year-old children, serum irisin was associated with markers reflecting reduced IS. HMW Adn predicted HDL-C, whereas FGF21 did not contribute to IS or lipid parameters in multivariate regression analyses.
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Affiliation(s)
- Satu Seppä
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Sirpa Tenhola
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio
- Department of Pediatrics, Kymenlaakso Central Hospital, Kotka, Finland
| | - Raimo Voutilainen
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio
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Refardt J, Sailer CO, Winzeler B, Betz MJ, Chifu I, Schnyder I, Fassnacht M, Fenske W, Christ-Crain M. FGF-21 levels in polyuria-polydipsia syndrome. Endocr Connect 2018; 7:1501-1506. [PMID: 30592707 PMCID: PMC6311457 DOI: 10.1530/ec-18-0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/04/2018] [Indexed: 11/08/2022]
Abstract
The pathomechanism of primary polydipsia is poorly understood. Recent animal data reported a connection between fibroblast growth factor 21 (FGF-21) and elevated fluid intake independently of hormonal control by the hormone arginine-vasopressin (AVP) and osmotic stimulation. We therefore compared circulating FGF-21 levels in patients with primary polydipsia to patients with AVP deficiency (central diabetes insipidus) and healthy volunteers. In this prospective cohort study, we analyzed FGF-21 levels of 20 patients with primary polydipsia, 20 patients with central diabetes insipidus and 20 healthy volunteers before and after stimulation with hypertonic saline infusion targeting a plasma sodium level ≥150 mmol/L. The primary outcome was the difference in FGF-21 levels between the three groups. Baseline characteristics were similar between the groups except for patients with central diabetes insipidus being heavier. There was no difference in baseline FGF-21 levels between patients with primary polydipsia and healthy volunteers (122 pg/mL (52,277) vs 193 pg/mL (48,301), but higher levels in patients with central diabetes insipidus were observed (306 pg/mL (114,484); P = 0.037). However, this was not confirmed in a multivariate linear regression analysis after adjusting for age, sex, BMI and smoking status. Osmotic stimulation did not affect FGF-21 levels in either group (difference to baseline: primary polydipsia -23 pg/mL (-43, 22); central diabetes insipidus 17 pg/mL (-76, 88); healthy volunteers -6 pg/mL (-68, 22); P = 0.45). To conclude, FGF-21 levels are not increased in patients with primary polydipsia as compared to central diabetes insipidus or healthy volunteers. FGF-21 therefore does not seem to be causal of elevated fluid intake in these patients.
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Affiliation(s)
- Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Clara Odilia Sailer
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Matthias Johannes Betz
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Irina Chifu
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ingeborg Schnyder
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Central Laboratory, University Hospital Würzburg, Würzburg, Germany
| | - Wiebke Fenske
- Department of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - for the CODDI-Investigators
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Central Laboratory, University Hospital Würzburg, Würzburg, Germany
- Department of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
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10
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Li X, Zhu Z, Zhou T, Cao X, Lu T, Liang Y, He J, Liu C, Dou Z, Shen B. Early increases in serum FGF21 levels predict mortality of septic patients. Cytokine 2018; 111:428-433. [PMID: 29861384 DOI: 10.1016/j.cyto.2018.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Potential prognostic biomarkers for patients with sepsis have yet to be identified. The present study evaluated the prognostic value of fibroblast growth factor 21 (FGF21) levels in patients with sepsis. METHODS A total of 120 consecutive Chinese patients with sepsis were prospectively included, and serum levels of FGF21 and biomarkers such as interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL-10, procalcitonin (PCT), C-reactive protein (CRP), and lactate (LAC) were measured within 24 h after intensive care unit admission. The demographic and clinical characteristics including underlying diseases, Sequential Organ Failure Assessment (△SOFA), and acute physiology and chronic health evaluation II (APACHE II) scores were recorded. Patients were categorized into survival and non-survival groups according to the 28-day mortality. Correlations between FGF21, serum indicators, severity score and 28-day mortality were analyzed, and Cox regression analysis was performed to identify prognostic factors. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off of FGF21 for survival prediction. RESULTS Non-survivors had significantly higher levels of FGF21, IL-6, TNF-α, IL-10, PCT, CRP, and LAC as well as higher SOFA and APACHE II scores compared with the survivors. FGF21 levels were positively correlated with age, waist circumference, levels of IL-6, IL-10, TNF- α, PCT, CRP, and LAC, △SOFA and APACHE II scores. ROC curves showed that FGF21 had a high sensitivity of 81.3% and specificity of 89.8% for predicting 28-day mortality. Patients with a FGF21 levels <3200 pg/ml had a significantly better survival rate than those with levels >3200 pg/ml, and thus, FGF21 was an independent prognostic factor for survival. CONCLUSION FGF21 could serve as a new prognostic biomarker for sepsis survival.
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Affiliation(s)
- Xing Li
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Zexiang Zhu
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China.
| | - Tinghong Zhou
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Xiaoyu Cao
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Ting Lu
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Yan Liang
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Jiafen He
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Chuankai Liu
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Zhoulin Dou
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
| | - Bin Shen
- Department of Critical Care Medicine, Changsha of Traditional Chinese Medicine Hospital, Changsha 410010, PR China
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Akyol M, Alacacioglu A, Demir L, Kucukzeybek Y, Yildiz Y, Gumus Z, Kara M, Salman T, Varol U, Taskaynatan H, Oflazoglu U, Bayoglu V, Tarhan MO. The alterations of serum FGF-21 levels, metabolic and body composition in early breast cancer patients receiving adjuvant endocrine therapy. Cancer Biomark 2018; 18:441-449. [PMID: 28106545 DOI: 10.3233/cbm-161507] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In early breast cancer patients, the effects of hormonal therapy (tamoxifen and aromatase inhibitors) on plasma fibroblast growth factor 21 (FGF-21), lipid levels and body composition have not yet been investigated. Therefore, we aimed to analyze the relationship between FGF-21 and body composition as well as the effects of tamoxifen and aromatase inhibitors on plasma lipid levels, FGF-21, and body composition. METHODS A total of 72 patients were treated with either tamoxifen or aromatase inhibitors due to their menopausal status after adjuvant radiotherapy. Each patient was followed-up over a period of 1 year. Changes in body composition and serum lipid profile, glucose and FGF-21 levels were evaluated. We recorded the type of hormonal therapy, body mass index, waist-to-hip ratio, lipid profile, and FGF-21 levels both at the beginning and after 12 months. RESULTS There was a statistically significant decrease in serum FGF-21 levels after 12 months of adjuvant endocrine therapy (46 ± 19.21 pg/ml vs. 30.99 ± 13.81 pg/ml, p< 0.001). Total body water (p< 0.001), serum glucose (p= 0.036) and triglyceride levels (p< 0.001) also exhibited a significant decrease. The decreases in total cholesterol and low-density lipoprotein were not statistically significant. Likewise, high-density lipoprotein increased after adjuvant endocrine therapy, although it did not reach statistical significance. The changes in body composition, glucose, lipid profile and FGF-21 were similar in tamoxifen and aromatase inhibitor groups. A positive correlation was found between basal weight, fat mass, fat-free mass and serum FGF-21 levels; however, the correlation was maintained only for the fat-free mass at the 12th month. CONCLUSION As part of the present study, we suggest that both tamoxifen and aromatase inhibitors can reduce FGF-21 levels independently of body compositions, and these drugs can provide antihyperlipidemic, antidiabetic and cardio-protective effects. We also recommend that serum FGF-21 level can be utilized as a tumor biomarker in early-stage breast cancer and for monitoring purposes. FGF-21 levels may help physicians estimate prognosis, too. Further studies with larger populations may shed light on the role of FGF-21 in breast cancer.
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Affiliation(s)
- Murat Akyol
- Department of Medical Oncology, Manisa State Hospital, Manisa, Turkey
| | - Ahmet Alacacioglu
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Leyla Demir
- Department of Biochemistry, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yuksel Kucukzeybek
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yasar Yildiz
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Zehra Gumus
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Mete Kara
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Tarik Salman
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Umut Varol
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Halil Taskaynatan
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Utku Oflazoglu
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Vedat Bayoglu
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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12
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Staiger H, Keuper M, Berti L, Hrabe de Angelis M, Häring HU. Fibroblast Growth Factor 21-Metabolic Role in Mice and Men. Endocr Rev 2017; 38:468-488. [PMID: 28938407 DOI: 10.1210/er.2017-00016] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/25/2017] [Indexed: 12/18/2022]
Abstract
Since its identification in 2000, the interest of scientists in the hepatokine fibroblast growth factor (FGF) 21 has tremendously grown, and still remains high, due to a wealth of very robust data documenting this factor's favorable effects on glucose and lipid metabolism in mice. For more than ten years now, intense in vivo and ex vivo experimentation addressed the physiological functions of FGF21 in humans as well as its pathophysiological role and pharmacological effects in human metabolic disease. This work produced a comprehensive collection of data revealing overlaps in FGF21 expression and function but also significant differences between mice and humans that have to be considered before translation from bench to bedside can be successful. This review summarizes what is known about FGF21 in mice and humans with a special focus on this factor's role in glucose and lipid metabolism and in metabolic diseases, such as obesity and type 2 diabetes mellitus. We highlight the discrepancies between mice and humans and try to decipher their underlying reasons.
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Affiliation(s)
- Harald Staiger
- Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.,Interfaculty Center for Pharmacogenomics and Pharma Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, 72076 Tübingen, Germany.,Institute of Experimental Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,German Center for Diabetes Research, 85764 Neuherberg, Germany
| | - Michaela Keuper
- Institute of Experimental Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,German Center for Diabetes Research, 85764 Neuherberg, Germany
| | - Lucia Berti
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, 72076 Tübingen, Germany.,Institute of Experimental Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,German Center for Diabetes Research, 85764 Neuherberg, Germany
| | - Martin Hrabe de Angelis
- Institute of Experimental Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,German Center for Diabetes Research, 85764 Neuherberg, Germany.,Chair for Experimental Genetics, Technical University Munich, 85764 Neuherberg, Germany
| | - Hans-Ulrich Häring
- Interfaculty Center for Pharmacogenomics and Pharma Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, 72076 Tübingen, Germany.,German Center for Diabetes Research, 85764 Neuherberg, Germany.,Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry, University Hospital Tübingen, 72076 Tübingen, Germany
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13
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Baek J, Nam HK, Rhie YJ, Lee KH. Serum FGF21 Levels in Obese Korean Children and Adolescents. J Obes Metab Syndr 2017; 26:204-209. [PMID: 31089518 PMCID: PMC6484916 DOI: 10.7570/jomes.2017.26.3.204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 09/06/2017] [Indexed: 12/18/2022] Open
Abstract
Background Serum fibroblast growth factor 21 (FGF21) has been suggested to be a possible biomarker for early detection of metabolic syndrome and type 2 diabetes in adults. However, few studies have investigated the correlation between FGF21 levels and metabolic parameters in children. This study sought to evaluate the relationship between FGF21 and metabolic parameters in obese Korean children and adolescents. Methods Fasting serum FGF21 and adiponectin levels as well as fasting insulin, glucose, transaminases, and lipid profiles were measured by enzyme-linked immunosorbent assays in 45 lean and 70 obese children aged 7-14 years. Independent t-test and multivariate correlation analysis were used to evaluate the relationship between FGF21 and metabolic parameters. Results Serum FGF21 was significantly higher in obese children than in lean children. Serum FGF21 levels were positively correlated with insulin resistance index homeostasis model assessment (HOMA-IR) (r=0.355, P=0.004) and triglycerides (r=0.423, P<0.001) and were negatively correlated with high-density lipoprotein (HDL) cholesterol (r=-0.412, P<0.001). After adjustment for body mass index, triglycerides, HDL cholesterol and adiponectin, FGF21 levels showed a significant correlation with only HOMA-IR on multivariate linear regression analysis. Conclusion Serum FGF21 levels were higher in obese children and significantly correlated with HOMA-IR. Therefore, FGF21 could be a biomarker for obesity-induced insulin resistance in children and adolescents as indicated in adults.
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Affiliation(s)
- Joonwoo Baek
- Department of Pediatrics, Na-Eun Hospital, Incheon, Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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14
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van Leeuwen J, Koes BW, Paulis WD, van Middelkoop M. Differences in bone mineral density between normal-weight children and children with overweight and obesity: a systematic review and meta-analysis. Obes Rev 2017; 18:526-546. [PMID: 28273691 DOI: 10.1111/obr.12515] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/24/2016] [Accepted: 12/13/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study examines the differences in bone mineral density between normal-weight children and children with overweight or obesity. METHODS A systematic review and meta-analysis of observational studies (published up to 22 June 2016) on the differences in bone mineral density between normal-weight children and overweight and obese children was performed. Results were pooled when possible and mean differences (MDs) were calculated between normal-weight and overweight and normal-weight and obese children for bone content and density measures at different body sites. RESULTS Twenty-seven studies, with a total of 5,958 children, were included. There was moderate and high quality of evidence that overweight (MD 213 g; 95% confidence interval [CI] 166, 261) and obese children (MD 329 g; 95%CI [229, 430]) have a significantly higher whole body bone mineral content than normal-weight children. Similar results were found for whole body bone mineral density. Sensitivity analysis showed that the association was stronger in girls. CONCLUSIONS Overweight and obese children have a significantly higher bone mineral density compared with normal-weight children. Because there was only one study included with a longitudinal design, the long-term impact of childhood overweight and obesity on bone health at adulthood is not clear.
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Affiliation(s)
- J van Leeuwen
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - W D Paulis
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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15
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Li G, Yin J, Fu J, Li L, Grant SFA, Li C, Li M, Mi J, Li M, Gao S. FGF21 deficiency is associated with childhood obesity, insulin resistance and hypoadiponectinaemia: The BCAMS Study. DIABETES & METABOLISM 2017; 43:253-260. [PMID: 28139438 DOI: 10.1016/j.diabet.2016.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/23/2016] [Accepted: 12/15/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Fibroblast growth factor 21 (FGF21) exerts beneficial effects on metabolic homoeostasis and has been reported to be regulated by adiponectin, leptin and resistin. However, while an association between increased circulating FGF21 and metabolic disorders has been reported in adults, paediatric-specific data are lacking. DESIGN AND METHODS This study investigated the relationship between FGF21 levels and obesity, insulin resistance (IR), the metabolic syndrome (MetS) and adipokines (adiponectin, leptin and resistin) in a cohort of 3231 Chinese youngsters aged 6-18. RESULTS There were gender- and puberty-related differences in FGF21 levels. Unexpectedly, FGF21 levels were decreased in children with obesity, and negatively correlated with insulin, HOMA-IR and leptin levels after adjusting for age, gender, puberty and lifestyle factors. Moreover, multiple regression analyses showed that serum FGF21 positively predicted adiponectin levels while resistin positively predicted FGF21 levels independent of BMI (P<0.05). Children in the lowest FGF21 quintile were more likely to have IR (OR: 1.85, 95% CI: 1.41-2.42; P=0.002) and MetS (OR: 1.62, 95% CI: 1.14-2.28; P=0.007) than those in the highest quintile. Further adjusting for BMI and/or the three adipokines modified the association of FGF21 with MetS (P>0.10) but not with IR (P<0.01). CONCLUSION Although the associations between adiponectin, leptin, resistin and metabolic abnormalities in our paediatric population were similar to those in adults, correlations of FGF21 levels with obesity, IR and MetS were the inverse of those found in adults. Our present findings suggest that FGF21 deficiency, rather than resistance, contribute to IR and hypoadiponectinaemia independently of obesity in young people.
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Affiliation(s)
- G Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China
| | - J Yin
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China; Department of Endocrinology, First Affiliated Hospital, Shanxi Medical University, Shanxi 030001, China
| | - J Fu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China
| | - L Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China
| | - S F A Grant
- Division of Endocrinology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Human Genetics, The Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - C Li
- Division of Endocrinology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - M Li
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China
| | - M Li
- Department of Endocrinology, Chaoyang Hospital, Capital Medical University, Beijing 100043, China; Division of Endocrinology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - S Gao
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China.
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16
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Pérez-Martí A, Sandoval V, Marrero PF, Haro D, Relat J. Nutritional regulation of fibroblast growth factor 21: from macronutrients to bioactive dietary compounds. Horm Mol Biol Clin Investig 2016; 30:/j/hmbci.ahead-of-print/hmbci-2016-0034/hmbci-2016-0034.xml. [PMID: 27583468 DOI: 10.1515/hmbci-2016-0034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 12/15/2022]
Abstract
Obesity is a worldwide health problem mainly due to its associated comorbidities. Fibroblast growth factor 21 (FGF21) is a peptide hormone involved in metabolic homeostasis in healthy individuals and considered a promising therapeutic candidate for the treatment of obesity. FGF21 is predominantly produced by the liver but also by other tissues, such as white adipose tissue (WAT), brown adipose tissue (BAT), skeletal muscle, and pancreas in response to different stimuli such as cold and different nutritional challenges that include fasting, high-fat diets (HFDs), ketogenic diets, some amino acid-deficient diets, low protein diets, high carbohydrate diets or specific dietary bioactive compounds. Its target tissues are essentially WAT, BAT, skeletal muscle, heart and brain. The effects of FGF21 in extra hepatic tissues occur through the fibroblast growth factor receptor (FGFR)-1c together with the co-receptor β-klotho (KLB). Mechanistically, FGF21 interacts directly with the extracellular domain of the membrane bound cofactor KLB in the FGF21- KLB-FGFR complex to activate FGFR substrate 2α and ERK1/2 phosphorylation. Mice lacking KLB are resistant to both acute and chronic effects of FGF21. Moreover, the acute insulin sensitizing effects of FGF21 are also absent in mice with specific deletion of adipose KLB or FGFR1. Most of the data show that pharmacological administration of FGF21 has metabolic beneficial effects. The objective of this review is to compile existing information about the mechanisms that could allow the control of endogenous FGF21 levels in order to obtain the beneficial metabolic effects of FGF21 by inducing its production instead of doing it by pharmacological administration.
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17
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Korwutthikulrangsri M, Mahachoklertwattana P, Chanprasertyothin S, Pongratanakul S, Poomthavorn P. Serum fibroblast growth factor 21 in overweight and obese Thai children and adolescents: its relation to glucose metabolism and its change after glucose loading. Clin Endocrinol (Oxf) 2015; 83:820-7. [PMID: 25929297 DOI: 10.1111/cen.12808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/20/2015] [Accepted: 04/21/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Fibroblast growth factor 21 (FGF21) has been demonstrated to be beneficial for glucose metabolism in animal and in vitro studies. However, its role in humans is still unclear. This study aimed to determine serum FGF21 in relation to glucose metabolism in obese children and to evaluate serum FGF21 changes during an oral glucose tolerance test (OGTT). DESIGN, PATIENTS AND MEASUREMENTS A cross-sectional study of 301 obese children was conducted in a tertiary hospital. All children underwent an OGTT and had their fasting serum FGF21 and adiponectin measured. A subgroup of 71 children had their serum FGF21 levels serially measured at 0, 60 and 120 min during the OGTT. RESULTS Serum FGF21 levels were progressively increased in children with normal glucose tolerance without hyperinsulinaemia, normal glucose tolerance with hyperinsulinaemia and abnormal glucose tolerance [median (IQR): 72 (34-148), 96 (55-182), 122 (75-220) pg/ml, respectively, P = 0·003]. Log serum FGF21 was associated with homoeostatic model assessment of insulin resistance (r = 0·174, P = 0·002). There was no correlation between log serum FGF21 and serum adiponectin level. During the OGTT, there were changes in serum FGF21 levels with a decrease in FGF21 at 60 min from the baseline and an increase above the baseline at 120 min. CONCLUSIONS Serum FGF21 level was highest in obese children with the highest insulin resistance or abnormal glucose tolerance. Log serum FGF21 was not correlated with serum adiponectin. Changes in serum FGF21 levels during the OGTT were observed.
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Affiliation(s)
| | - Pat Mahachoklertwattana
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sarunyu Pongratanakul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preamrudee Poomthavorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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18
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Abstract
Fibroblast growth factor 21 (FGF21) is a peptide hormone that is synthesized by several organs and regulates energy homeostasis. Excitement surrounding this relatively recently identified hormone is based on the documented metabolic beneficial effects of FGF21, which include weight loss and improved glycemia. The biology of FGF21 is intrinsically complicated owing to its diverse metabolic functions in multiple target organs and its ability to act as an autocrine, paracrine, and endocrine factor. In the liver, FGF21 plays an important role in the regulation of fatty acid oxidation both in the fasted state and in mice consuming a high-fat, low-carbohydrate ketogenic diet. FGF21 also regulates fatty acid metabolism in mice consuming a diet that promotes hepatic lipotoxicity. In white adipose tissue (WAT), FGF21 regulates aspects of glucose metabolism, and in susceptible WAT depots, it can cause browning. This peptide is highly expressed in the pancreas, where it appears to play an anti-inflammatory role in experimental pancreatitis. It also has an anti-inflammatory role in cardiac muscle. Although typically not expressed in skeletal muscle, FGF21 is induced in situations of muscle stress, particularly mitochondrial myopathies. FGF21 has been proposed as a novel therapeutic for metabolic complications such as diabetes and fatty liver disease. This review aims to interpret and delineate the ever-expanding complexity of FGF21 physiology.
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Affiliation(s)
- Ffolliott Martin Fisher
- Department of Medicine, Harvard Medical School, and Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215;
| | - Eleftheria Maratos-Flier
- Department of Medicine, Harvard Medical School, and Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215;
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Hanks LJ, Gutiérrez OM, Ashraf A, Casazza K. Bone Mineral Content as a Driver of Energy Expenditure in Prepubertal and Early Pubertal Boys. J Pediatr 2015; 166:1397-403. [PMID: 25841541 PMCID: PMC4446221 DOI: 10.1016/j.jpeds.2015.02.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/16/2015] [Accepted: 02/19/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine the associations of bone and bone-secreted factors with measures of energy metabolism in prepubertal and early pubertal boys. STUDY DESIGN Participants in this cross-sectional, observational study included 37 (69% black, 31% white) boys, aged 7-12 years (Tanner stage <III). Dual-energy X-ray absorptiometry was used to measure bone mineral content (BMC) and percent body fat. Indirect calorimetry was used to assess resting energy expenditure (REE). Fasting blood levels of osteocalcin (OCN), fibroblast growth factor 23 (FGF23), insulin, glucose, precursor product of type I collagen (N-terminal pro-peptide) and type I collagen, and C-terminal cross-linked telopeptide were measured. Pearson correlations were performed to evaluate relationships among BMC, OCN, FGF23, fasting insulin and glucose, and REE. Multiple linear regression models were used to test associations between OCN and BMC (independent variables) with fasting insulin and glucose and with REE, adjusting for bone turnover markers and further adjusted for percent body fat. RESULTS BMC was correlated with REE and insulin. OCN was correlated with glucose in blacks only (r = 0.45, P < .05). FGF23 was not correlated with any markers of energy metabolism. BMC was associated with insulin level in blacks (β = 0.95, P = .001), which was attenuated by percent body fat (β = 0.47, P = .081). BMC was associated with REE in whites (β = 0.496.7, P < .05) and blacks (β = 619.5, P < .0001); but accounting for percent body fat attenuated the association in whites (β = 413.2, P = .078). CONCLUSION Our findings suggest that BMC is a determinant of fasting insulin and REE, and that the contribution of body fat appears to be race-specific. Endocrine effects of FGF23 and OCN on energy metabolism were not apparent. TRIAL REGISTRATION Registered with ClinicalTrials.gov: NCT02040740, NCT02040727, and NCT01410643.
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Affiliation(s)
- Lynae J. Hanks
- Department of Pediatrics, University of Alabama at Birmingham (UAB)
| | | | - Ambika Ashraf
- Department of Pediatrics, University of Alabama at Birmingham (UAB)
| | - Krista Casazza
- Department of Pediatrics, University of Alabama at Birmingham (UAB)
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Hanks LJ, Gutiérrez OM, Bamman MM, Ashraf A, McCormick KL, Casazza K. Circulating levels of fibroblast growth factor-21 increase with age independently of body composition indices among healthy individuals. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2015; 2:77-82. [PMID: 26042208 PMCID: PMC4450097 DOI: 10.1016/j.jcte.2015.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Circulating FGF21 levels are commonly elevated in disease states. There is limited information regarding concentrations of circulating FGF21 in the absence of disease, as well as age-related differences in body composition that may contribute to FGF21 regulation across groups. OBJECTIVE The objectives of this study were to assess FGF21 levels across age groups (childhood to elder adulthood), and investigate whether body composition indices are associated with age-related differences in circulating FGF21. MATERIALS AND METHODS We cross-sectionally analyzed serum concentrations of FGF21 in 184 healthy subjects aged 5-80y (45% male). Multiple linear regression was performed to assess the independent association of categorical age (children: 5-12y, young adults: 20-29y, adults: 30-50y, older adults: 55-64y, elder adults: 65-80y) with FGF21 concentration taking into account DXA-measured body composition indices [bone mineral density (BMD) and percent lean, trunk, and fat mass]. We also stratified analysis by tertile of FGF21. RESULTS Incremental increases in FGF21 levels were observed across age groups (youngest to highest). Age group was positively associated with FGF21 level independent of body composition indices (age group variable: β=0.25, 0.24, 0.24, 0.23, all P<0.0001, controlling for percent lean, BMD, percent fat, and percent trunk fat, respectively). By FGF21 tertile, age group was associated with FGF21 in the lowest tertile only (β=13.1, 0.19, 0.18, all P≤0.01, accounting for percent lean, fat and trunk fat, respectively), but not when accounting for BMD. CONCLUSIONS Our findings in a healthy population display an age-related increase in serum FGF21, highlighting a potential age effect in response to metabolic demand over the lifecourse. FGF21 levels increase with age independently of body composition. At lower levels of FGF21, BMD, but not other body composition parameters, attenuates the association between FGF21 level and age, suggesting the metabolic demand of the skeleton may provide a link between FGF21 and energy metabolism.
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Affiliation(s)
- Lynae J Hanks
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital of Alabama (COA), University of Alabama at Birmingham (UAB), CPPII M30, 1601 4 Ave S, Birmingham, AL 35233;
| | - Orlando M Gutiérrez
- Department of Medicine, UAB, ZRB 614, 1720 2nd AVE S, Birmingham, AL 35294-0006;
| | - Marcas M Bamman
- Department of Cell, Developmental, and Integrative Biology, Center for Exercise Medicine, Geriatric Research, Education, and Clinical Center, Birmingham Veterans' Affairs (VA) Medical Center, UAB, MCLM 966, 1530 3 Ave S, Birmingham, AL 35294-0005;
| | - Ambika Ashraf
- Department of Pediatrics, Division of Pediatric Endocrinology, COA, UAB, CPPII M30, 1601 4 Ave S, Birmingham, AL 35233;
| | - Kenneth L McCormick
- Department of Pediatrics, Division of Pediatric Endocrinology, COA, UAB, CPPII M30, 1601 4 Ave S, Birmingham, AL 35233;
| | - Krista Casazza
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, COA, UAB, CPPI 310, 1601 4 Ave S, Birmingham, AL 35233-1711;
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Circulating FGF19 and FGF21 surge in early infancy from infra- to supra-adult concentrations. Int J Obes (Lond) 2015; 39:742-6. [PMID: 25599612 DOI: 10.1038/ijo.2015.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/02/2014] [Accepted: 12/18/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVE Fibroblast growth factor 19 (FGF19) and 21 (FGF21) have been linked to obesity and type 2 diabetes in adults. We assessed the circulating concentrations of these factors in human neonates and infants, and their association with the endocrine-metabolic changes associated to prenatal growth restraint. SUBJECTS/METHODS Circulating FGF19 and FGF21, selected hormones (insulin, insulin-like growth factor I and high- molecular-weight (HMW) adiponectin) and body composition (absorptiometry) were assessed longitudinally in 44 infants born appropriate- (AGA) or small-for-gestational-age (SGA). Measurements were performed at 0, 4 and 12 months in AGA infants; at 0 and 4 months in SGA infants; and cross-sectionally in 11 first-week AGA newborns. RESULTS Circulating FGF19 and FGF21 surged >10-fold in early infancy from infra- to supra-adult concentrations, the FGF19 surge appearing slower and more pronounced than the FGF21 surge. Whereas the FGF21 surge was of similar magnitude in AGA and SGA infants, FGF19 induction was significantly reduced in SGA infants. In AGA and SGA infants, cord-blood FGF21 and serum FGF19 at 4 months showed a positive correlation with HMW adiponectin (r=0.49, P=0.013; r=0.43, P=0.019, respectively). CONCLUSIONS Our results suggest that these early FGF19 and FGF21 surges are of a physiological relevance that warrants further delineation and that may extend beyond infancy.
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Patel SJ, Hanks LJ, Ashraf AP, Gutierrez OM, Bamman MM, Casazza K. Effects of 8 week resistance training on lipid profile and insulin levels in overweight/obese peri-pubertal boys-a pilot study. ACTA ACUST UNITED AC 2015. [DOI: 10.7243/2050-0866-4-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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