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Kokkorakis M, Katsarou A, Katsiki N, Mantzoros CS. Milestones in the journey towards addressing obesity; Past trials and triumphs, recent breakthroughs, and an exciting future in the era of emerging effective medical therapies and integration of effective medical therapies with metabolic surgery. Metabolism 2023; 148:155689. [PMID: 37689110 DOI: 10.1016/j.metabol.2023.155689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023]
Abstract
The 21st century is characterized by an increasing incidence and prevalence of obesity and the burden of its associated comorbidities, especially cardiometabolic diseases, which are reaching pandemic proportions. In the late '90s, the "black box" of adipose tissue and energy homeostasis was opened with the discovery of leptin, transforming the adipose tissue from an "inert fat-storage organ" to the largest human endocrine organ and creating the basis on which more intensified research efforts to elucidate the pathogenesis of obesity and develop novel treatments were based upon. Even though leptin was eventually not proven to be the "standalone magic bullet" for the treatment of common/polygenic obesity, it has been successful in the treatment of monogenic obesity syndromes. Additionally, it shifted the paradigm of treating obesity from a condition due to "lack of willpower" to a disease due to distinct underlying biological mechanisms for which specific pharmacotherapies would be needed in addition to lifestyle modification. Subsequently, the melanocortin pathway proved to be an equally valuable pathway for the pharmacotherapy of obesity. Melanocortin receptor agonists have recently been approved for treating certain types of syndromic obesity. Other molecules- such as incretins, implicated in energy and glucose homeostasis- are secreted by the gastrointestinal tract. Glucagon-like peptide 1 (GLP-1) is the most prominent one, with GLP-1 analogs approved for common/polygenic obesity. Unimolecular combinations with other incretins, e.g., GLP-1 with gastric inhibitory polypeptide and/or glucagon, are expected to be approved soon as more effective pharmacotherapies for obesity and its comorbidities. Unimolecular combinations with other compounds and small molecules activating the receptors of these molecules are currently under investigation as promising future pharmacotherapies. Moreover, metabolic and bariatric surgery has also demonstrated impressive results, especially in the case of morbid obesity. Consequently, this broadening therapeutic armamentarium calls for a well-thought-after and well-coordinated multidisciplinary approach, for instance, through cardiometabolic expertise centers, that would ideally address effectively and cost-effectively obesity and its comorbidities, providing tangible benefits to large segments of the population.
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Affiliation(s)
- Michail Kokkorakis
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Angeliki Katsarou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA 02115, USA.
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Boutari C, Pappas PD, Mintziori G, Nigdelis MP, Athanasiadis L, Goulis DG, Mantzoros CS. The effect of underweight on female and male reproduction. Metabolism 2020; 107:154229. [PMID: 32289345 DOI: 10.1016/j.metabol.2020.154229] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.
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Affiliation(s)
- Chrysoula Boutari
- Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Panagiotis D Pappas
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Loukas Athanasiadis
- 3(rd) Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Christos S Mantzoros
- Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Saxena A, Tiwari P, Wahi N, Kumar A, Mathur SK. The common pathophysiologic threads between Asian Indian diabetic's 'Thin Fat Phenotype' and partial lipodystrophy: the peripheral adipose tissue transcriptomic evidences. Adipocyte 2020; 9:253-263. [PMID: 32491965 PMCID: PMC7469556 DOI: 10.1080/21623945.2020.1776082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
T2D is a complex disease with poorly understood mechanisms. In Asian Indians, it is associated with “thin fat” phenotype which resembles with partial lipodystrophy. We hypothesized that disturbed expression of lipodystrophy genes might play a role in T2D pathogenesis. Therefore, we attempted to establish a link between these two diseases by studying the overlap between the network of lipodystrophy genes and the differentially expressed genes (DEGs) in the peripheral subcutaneous adipose tissue of Asian Indians diabetics. We found that 16, out of 138 lipodystrophy genes were differentially regulated in diabetics and around 18% overlap between their network and the DEGs; the expression level of lipodystrophy genes showed an association with disease-related intermediate phenotypic traits among diabetics but not in the control group. We also attempted to individualize the diabetic patients based on ±2 fold altered expression of lipodystrophy genes as compared to their average expression in the control group. In conclusion, significant overlap exists between some of the lipodystrophy genes and their network with DEGs in the peripheral adipose tissue in diabetics. They possibly play a role in the pathogenesis of diabetes and individualization of diabetics is possible based on their altered expression in their peripheral adipose tissue.
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Affiliation(s)
- Aditya Saxena
- Department of Biotechnology, Institute of Applied Sciences and Humanities, GLA University, Mathura, India
| | - Pradeep Tiwari
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, Jaipur, India
- Department of Biotechnology and Bioinformatics, Birla Institute of Scientific Research (BISR), Jaipur, India
- Department of Chemistry, School of Basic Sciences, Manipal University Jaipur, Jaipur, India
| | - Nitin Wahi
- Department of Bioinfoirmatics, Pathfinder Research and Training Foundation, Gr. Noida, India
| | - Anshul Kumar
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - Sandeep Kumar Mathur
- Department of Endocrinology, Sawai Man Singh Medical College and Hospital, Jaipur, India
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Akinci B, Onay H, Demir T, Savas-Erdeve Ş, Gen R, Simsir IY, Keskin FE, Erturk MS, Uzum AK, Yaylali GF, Ozdemir NK, Atik T, Ozen S, Yurekli BS, Apaydin T, Altay C, Akinci G, Demir L, Comlekci A, Secil M, Oral EA. Clinical presentations, metabolic abnormalities and end-organ complications in patients with familial partial lipodystrophy. Metabolism 2017; 72:109-119. [PMID: 28641778 DOI: 10.1016/j.metabol.2017.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Familial partial lipodystrophy (FPLD) is a rare genetic disorder characterized by partial lack of subcutaneous fat. METHODS This multicenter prospective observational study included data from 56 subjects with FPLD (18 independent Turkish families). Thirty healthy controls were enrolled for comparison. RESULTS Pathogenic variants of the LMNA gene were determined in nine families. Of those, typical exon 8 codon 482 pathogenic variants were identified in four families. Analysis of the LMNA gene also revealed exon 1 codon 47, exon 5 codon 306, exon 6 codon 349, exon 9 codon 528, and exon 11 codon 582 pathogenic variants. Analysis of the PPARG gene revealed exon 3 p.Y151C pathogenic variant in two families and exon 7 p.H477L pathogenic variant in one family. A non-pathogenic exon 5 p.R215Q variant of the LMNB2 gene was detected in another family. Five other families harbored no mutation in any of the genes sequenced. MRI studies showed slightly different fat distribution patterns among subjects with different point mutations, though it was strikingly different in subjects with LMNA p.R349W pathogenic variant. Subjects with pathogenic variants of the PPARG gene were associated with less prominent fat loss and relatively higher levels of leptin compared to those with pathogenic variants in the LMNA gene. Various metabolic abnormalities associated with insulin resistance were detected in all subjects. End-organ complications were observed. CONCLUSION We have identified various pathogenic variants scattered throughout the LMNA and PPARG genes in Turkish patients with FPLD. Phenotypic heterogeneity is remarkable in patients with LMNA pathogenic variants related to the site of missense mutations. FPLD, caused by pathogenic variants either in LMNA or PPARG is associated with metabolic abnormalities associated with insulin resistance that lead to increased morbidity.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey.
| | - Huseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Tevfik Demir
- Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey
| | - Şenay Savas-Erdeve
- Division of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Ramazan Gen
- Division of Endocrinology, Mersin University, Mersin, Turkey
| | | | - Fatma Ela Keskin
- Division of Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ayse Kubat Uzum
- Division of Endocrinology, Capa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | - Tahir Atik
- Division of Pediatric Genetics, Ege University, Izmir, Turkey
| | - Samim Ozen
- Division of Pediatric Endocrinology, Ege University, Izmir, Turkey
| | | | - Tugce Apaydin
- Division of Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Gulcin Akinci
- Division of Pediatric Neurology, Dr.Behcet Uz Children's Hospital, Izmir, Turkey
| | - Leyla Demir
- Department of Biochemistry, Ataturk Training Hospital, Izmir, Turkey
| | | | - Mustafa Secil
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Elif Arioglu Oral
- Division of Endocrinology and Metabolism, Brehm Center for Diabetes Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Abstract
Leptin, a 167 amino acid adipokine, plays a major role in human energy homeostasis. Its actions are mediated through binding to leptin receptor and activating JAK-STAT3 signal transduction pathway. It is expressed mainly in adipocytes, and its circulating levels reflect the body's energy stores in adipose tissue. Recombinant methionyl human leptin has been FDA approved for patients with generalized non-HIV lipodystrophy and for compassionate use in subjects with congenital leptin deficiency. The purpose of this review is to outline the role of leptin in energy homeostasis, as well as its interaction with other hormones.
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Affiliation(s)
- Georgios A Triantafyllou
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, ST 820, Boston, MA 02215, USA
| | - Stavroula A Paschou
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, ST 820, Boston, MA 02215, USA
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, ST 820, Boston, MA 02215, USA.
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Bhaskar V, Goldfine ID, Gerstner R, Michelson K, Tran C, Nonet G, Bohmann D, Pongo E, Zhao J, Horwitz AH, Takeuchi T, White M, Corbin JA. An allosteric antibody to the leptin receptor reduces body weight and reverses the diabetic phenotype in the Lep(ob) /Lep(ob) mouse. Obesity (Silver Spring) 2016; 24:1687-94. [PMID: 27330016 DOI: 10.1002/oby.21539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/08/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Leptin (LEP) deficiency results in major metabolic perturbations, including obesity, dyslipidemia, and diabetes. Although LEP deficiency can be treated with daily injections of a recombinant LEP, generation of an antibody activating the LEP receptor (LEPR) that has both an intrinsically long half-life and low immunogenicity could be useful in the treatment of this condition. METHODS Phage display technology coupled with flow cytometry and cell-based in vitro assays were employed to identify an allosteric agonist of the mouse LEPR. LEP-deficient Lep(ob) /Lep(ob) mice were used to compare in vivo effects of LEP to antibody administration. To evaluate hypothalamic effects of treatment, changes in mRNA levels of neuropeptide Y and proopiomelanocortin were measured. RESULTS XPA.80.037 is a monoclonal antibody that demonstrates allosteric agonism of the mouse LEPR. Treatment of Lep(ob) /Lep(ob) mice with XPA.80.037 markedly reduced hyperphagia and body weight, normalized blood glucose and plasma insulin levels, and corrected dyslipidemia. These metabolic alterations correlated with changes in mRNA levels of neuropeptide Y and proopiomelanocortin, suggesting that XPA.80.037 had hypothalamic effects. CONCLUSIONS Agonist allosteric monoclonal antibodies to the LEPR can correct metabolic effects associated with LEP deficiency in vivo and thereby have the potential to treat conditions of LEP deficiency.
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Affiliation(s)
- Vinay Bhaskar
- Preclinical Development, XOMA Corporation, Berkeley, California, USA
| | - Ira D Goldfine
- Preclinical Development, XOMA Corporation, Berkeley, California, USA
| | - Resi Gerstner
- Discovery Research, XOMA Corporation, Berkeley, California, USA
| | | | - Catarina Tran
- Discovery Research, XOMA Corporation, Berkeley, California, USA
| | - Genevieve Nonet
- Discovery Research, XOMA Corporation, Berkeley, California, USA
| | - David Bohmann
- Discovery Research, XOMA Corporation, Berkeley, California, USA
| | - Elizabeth Pongo
- Discovery Research, XOMA Corporation, Berkeley, California, USA
| | - Jingsong Zhao
- Preclinical Development, XOMA Corporation, Berkeley, California, USA
| | | | | | - Mark White
- Discovery Research, XOMA Corporation, Berkeley, California, USA
| | - John A Corbin
- Discovery Research, XOMA Corporation, Berkeley, California, USA
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Tiliscan C, Aramă V, Mihăilescu R, Munteanu DI, Streinu-Cercel A, Ion DA, Rădulescu MA, Popescu C, Lobodan AE, Negru AR, Aramă ŞS. Leptin expression in HIV-infected patients during antiretroviral therapy. Germs 2015; 5:92-8. [PMID: 26405677 DOI: 10.11599/germs.2015.1076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Leptin is an adipokine with complex metabolic, neuroendocrine and immune functions. Our objective was to evaluate leptin serum levels in a cohort of Romanian HIV-infected patients undergoing antiretroviral therapy in relation to their immune-virological status, lipid and glucose metabolic abnormalities and the presence of metabolic syndrome (MS). METHODS We enrolled consecutive non-diabetic HIV-infected patients aged 18 and over on stable cART for at least 6 months. Blood samples were tested for: leptin, CD4 T cells count, HIV viral load and lipid panel. RESULTS A total of 90 HIV-infected patients were included in the study: 50 males (55.6%) with a mean age of 33.3 years and 40 females with a mean age of 30.4 years. Most patients (74.4%) had HIV viral load below the limit of detection and the median CD4 count for the cohort was 476 (410) cells/cmm. More than one third of the patients (41.1%) had hypoleptinemia. The prevalence of MS was 13.3%. Hypoleptinemia was significantly more frequent in men. In a subset of patients with undetectable HIV viral load, the median leptin value was 0.6 (6.07) ng/mL in patients with poor immune recovery (CD4 count ≤ 200/cmm) compared to 2 (3.07) ng/mL for those with better immune response (CD4 count > 200/cmm), without statistical significance. The median values of leptin were similar for persons with and without MS criteria. HDL-cholesterol values were positively correlated to leptin values in a linear regression model. CONCLUSION A significant proportion of patients in our study presented low levels of leptin; this finding was not associated with immune and virological parameters or the presence of MS. Hypoleptinemia was significantly correlated with lower levels of HDL-cholesterol, a key cardiovascular risk factor.
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Affiliation(s)
- Cătălin Tiliscan
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Victoria Aramă
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Raluca Mihăilescu
- MD, PhD, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Daniela Ioana Munteanu
- MD, PhD, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romani
| | - Adrian Streinu-Cercel
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Daniela Adriana Ion
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihaela Andreea Rădulescu
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Cristina Popescu
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Alina Elena Lobodan
- MD, PhD student, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Anca Ruxandra Negru
- MD, PhD student, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, National Institute for Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania
| | - Ştefan Sorin Aramă
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
Lipodystrophies are a genetically heterogeneous group of disorders characterized by loss of subcutaneous adipose tissue and metabolic dysfunction, including insulin resistance, increased levels of free fatty acids, abnormal adipocytokine secretion, and ectopic fat deposition, which are also observed in patients with visceral obesity and/or type 2 diabetes mellitus. Pathophysiological, biochemical, and genetic studies suggest that impairment in multiple adipose tissue functions, including adipocyte maturation, lipid storage, formation and/or maintenance of the lipid droplet, membrane composition, DNA repair efficiency, and insulin signaling, results in severe metabolic and endocrine consequences, ultimately leading to specific lipodystrophic phenotypes. In this review, recent evidences on the causes and metabolic processes of lipodystrophies will be presented, proposing a disease model that could be potentially informative for better understanding of common metabolic diseases in humans, including obesity, metabolic syndrome, and type 2 diabetes.
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Affiliation(s)
- Romina Ficarella
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, n. 11, 70124, Bari, Italy,
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Londraville RL, Macotela Y, Duff RJ, Easterling MR, Liu Q, Crespi EJ. Comparative endocrinology of leptin: assessing function in a phylogenetic context. Gen Comp Endocrinol 2014; 203:146-57. [PMID: 24525452 PMCID: PMC4128956 DOI: 10.1016/j.ygcen.2014.02.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 12/11/2022]
Abstract
As we approach the end of two decades of leptin research, the comparative biology of leptin is just beginning. We now have several leptin orthologs described from nearly every major clade among vertebrates, and are moving beyond gene descriptions to functional studies. Even at this early stage, it is clear that non-mammals display clear functional similarities and differences with their better-studied mammalian counterparts. This review assesses what we know about leptin function in mammals and non-mammals, and gives examples of how these data can inform leptin biology in humans.
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Affiliation(s)
- Richard L Londraville
- Department of Biology and Program in Integrated Biosciences, University of Akron, Akron, OH, USA.
| | - Yazmin Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Robert J Duff
- Department of Biology and Program in Integrated Biosciences, University of Akron, Akron, OH, USA
| | - Marietta R Easterling
- School of Biological Sciences and Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA
| | - Qin Liu
- Department of Biology and Program in Integrated Biosciences, University of Akron, Akron, OH, USA
| | - Erica J Crespi
- School of Biological Sciences and Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA
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Aldehyde dehydrogenase 1A1: friend or foe to female metabolism? Nutrients 2014; 6:950-73. [PMID: 24594504 PMCID: PMC3967171 DOI: 10.3390/nu6030950] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/08/2014] [Accepted: 02/18/2014] [Indexed: 02/08/2023] Open
Abstract
In this review, we summarize recent advances in understanding vitamin A-dependent regulation of sex-specific differences in metabolic diseases, inflammation, and certain cancers. We focus on the characterization of the aldehyde dehydrogenase-1 family of enzymes (ALDH1A1, ALDH1A2, ALDH1A3) that catalyze conversion of retinaldehyde to retinoic acid. Additionally, we propose a “horizontal transfer of signaling” from estrogen to retinoids through the action of ALDH1A1. Although estrogen does not directly influence expression of Aldh1a1, it has the ability to suppress Aldh1a2 and Aldh1a3, thereby establishing a female-specific mechanism for retinoic acid generation in target tissues. ALDH1A1 regulates adipogenesis, abdominal fat formation, glucose tolerance, and suppression of thermogenesis in adipocytes; in B cells, ALDH1A1 plays a protective role by inducing oncogene suppressors Rara and Pparg. Considering the conflicting responses of Aldh1a1 in a multitude of physiological processes, only tissue-specific regulation of Aldh1a1 can result in therapeutic effects. We have shown through successful implantation of tissue-specific Aldh1a1−/− preadipocytes that thermogenesis can be induced in wild-type adipose tissues to resolve diet-induced visceral obesity in females. We will briefly discuss the emerging role of ALDH1A1 in multiple myeloma, the regulation of reproduction, and immune responses, and conclude by discussing the role of ALDH1A1 in future therapeutic applications.
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Paniagua JA, Escandell-Morales JM, Gil-Contreras D, Berral de la Rosa FJ, Romero-Jimenez M, Gómez-Urbano A, Sanchez-Lopez A, Bellido E, Poyato A, Calatayud B, Vidal-Puig AJ. Central obesity and altered peripheral adipose tissue gene expression characterize the NAFLD patient with insulin resistance: Role of nutrition and insulin challenge. Nutrition 2014; 30:177-85. [PMID: 24377452 DOI: 10.1016/j.nut.2013.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 07/13/2013] [Accepted: 07/18/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Insulin resistance (IR) and white adipose tissue (WAT) dysfunction frequently are associated with nonalcoholic fatty liver disease (NAFLD); however, the pathogenic mechanisms contributing to their clustering are not well defined. The aim of this study was to define some nutritional, anthropometric, metabolic, and genetic mechanisms contributing to their clustering. METHODS Forty-five (20 men, 25 women) patients (age 45.7 ± 11.1 y) with recent diagnosis of NAFLD were grouped according to IR state. Energy balance was assessed using a food questionnaire and indirect calorimetry, and body composition with anthropometry and dual-energy x-ray absorptiometry. Biochemical and hormonal parameters combined with adipose tissue gene expression were determined. Microarray analysis of gene expression was performed in a subset of WAT samples from IR patients (n = 9), in the fasted state, after specific test meals (monounsaturated fatty acid [MUFA], saturated fat [SAT], and carbohydrate-rich) and after being challenged with insulin. RESULTS IR patients exhibited higher trunk fat to leg fat ratio (P < 0.05) and had a higher ratio of SAT/MUFA fat intake (P < 0.05) than insulin-sensitive (IS) individuals. Deposition of fat in the trunk but not in the leg was directly related to liver enzyme levels (P < 0.05). IR patients also had lower adiponectin serum levels and leptin (LEP) mRNA expression in WAT compared with IS patients (P < 0.01 and P < 0.05, respectively). Microarray analysis after insulin challenge confirmed that insulin treatment induces the expression of PPARG gene and LEP and decreases GCGR gene (P < 0.05 for all) in WAT. No changes in these genes were observed in the postprandial state induced after the acute effect of specific diets. CONCLUSIONS Patients exhibiting NAFLD and IR had preferential central fat deposition directly related to their serum alanine aminotransferase levels. These patients showed peripheral adipose tissue dysfunction and exhibited inappropriately low LEP biosynthesis that could be partially restored after anabolic conditions induced by insulin signaling.
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Affiliation(s)
- J A Paniagua
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain; Endocrinology and Nutrition Services, University Hospital Reina Sofia, Cordoba, Spain.
| | - J M Escandell-Morales
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain
| | - D Gil-Contreras
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain
| | | | - M Romero-Jimenez
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain
| | - A Gómez-Urbano
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain
| | - A Sanchez-Lopez
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain
| | - E Bellido
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain; Laboratory Services, University Hospital Reina Sofia, Cordoba, Spain
| | - A Poyato
- Liver Research Unit, University Hospital Reina Sofia, Maimonides Institute of Biomedical Research, Cordoba, Spain
| | - B Calatayud
- Insulin Resistance, Metabolism and Adipose Tissue Unit, Maimonides Institute of Biomedical Research, University Hospital Reina Sofia, Córdoba, Spain
| | - A J Vidal-Puig
- Metabolic Research Laboratories Institute of Metabolic Science, Addenbrooke's Hospital Cambridge, Cambridge, England
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Dalamaga M, Karmaniolas K, Chamberland J, Nikolaidou A, Lekka A, Dionyssiou-Asteriou A, Mantzoros CS. Higher fetuin-A, lower adiponectin and free leptin levels mediate effects of excess body weight on insulin resistance and risk for myelodysplastic syndrome. Metabolism 2013; 62:1830-9. [PMID: 24140093 DOI: 10.1016/j.metabol.2013.09.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/24/2013] [Accepted: 09/12/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Excess body weight has been implicated in the pathogenesis of myelodysplastic syndrome (MDS). We thus explored the role of serum fetuin-A reflecting ectopic hepatic fat deposition when storage capacity of adipocytes has been exceeded, free leptin reflecting overall fat mass and adiponectin reflecting visceral fat mass, all potential mediators of the effects of obesity on insulin resistance and, consequently, to MDS risk. MATERIALS & METHODS In a hospital-based case-control study, we studied 101 cases with incident, histologically confirmed primary MDS and 101 controls matched on gender, age and date of diagnosis, between 2004 and 2007. Serum fetuin-A, adiponectin, leptin, leptin receptor, free leptin and insulin were determined. RESULTS Higher serum fetuin-A, lower adiponectin and lower free leptin were all individually and independently associated with higher risk of MDS before and after controlling for matching and risk factors, such as age, gender, date of diagnosis, body mass index (BMI), family history of lymphohematopoietic cancer, smoking history and serum insulin. Interestingly, we have shown that these associations were prominent among overweight/obese individuals and persisted after controlling for BMI and serum insulin indicating that their effects are above and beyond insulinemia only. CONCLUSION Elevated serum fetuin-A but lower adiponectin and free leptin are associated with higher risk of MDS particularly among overweight/obese individuals. These findings suggest that the association between excessive weight gain and the risk of MDS could be mediated by fetuin-A, adiponectin and free leptin, which may have potential clinical and preventive implications.
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Affiliation(s)
- Maria Dalamaga
- Department of Clinical Biochemistry, Medical School, University of Athens, "Attikon" General University Hospital, 1 Rimini street, Chaidari, 12462 Athens, Greece.
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Michalakis K, Goulis DG, Vazaiou A, Mintziori G, Polymeris A, Abrahamian-Michalakis A. Obesity in the ageing man. Metabolism 2013; 62:1341-9. [PMID: 23831443 DOI: 10.1016/j.metabol.2013.05.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/15/2013] [Accepted: 05/29/2013] [Indexed: 12/20/2022]
Abstract
As the population is ageing globally, both ageing and obesity are recognized as major public health challenges. The aim of this narrative review is to present and discuss the current evidence on the changes in body composition, energy balance and endocrine environment that occur in the ageing man. Obesity in the ageing man is related to changes in both body weight and composition due to alterations in energy intake and total energy expenditure. In addition, somatopenia (decreased GH secretion), late-onset hypogonadism (LOH), changes in thyroid and adrenal function, as well as changes in appetite-related peptides (leptin, ghrelin) and, most importantly, insulin action are related to obesity, abnormal energy balance, redistribution of the adipose tissue and sarcopenia (decreased muscle mass). A better understanding of the complex relationship of ageing-related endocrine changes and obesity could lead to more effective interventions for elderly men.
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Affiliation(s)
- K Michalakis
- First Department of Internal Medicine, National and Kapodestrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
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14
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Michalakis K, Mintziori G, Kaprara A, Tarlatzis BC, Goulis DG. The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review. Metabolism 2013; 62:457-78. [PMID: 22999785 DOI: 10.1016/j.metabol.2012.08.012] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/13/2012] [Accepted: 08/18/2012] [Indexed: 12/16/2022]
Abstract
The aim of this narrative review is to provide current evidence for the interaction between obesity, metabolic syndrome (MS) and reproductive axis. Gonadotropin-releasing hormone (GnRH) pulses and, consequently, normal function of reproductive (hypothalamus-pituitary-gonadal) axis depend on normal energy balance, which presupposes sufficient food intake, reasonable energy consumption and average thermoregulatory costs. In case of an energy imbalance, reproductive dysfunction may occur. In young women, excessive leanness is accompanied by puberty delay, whereas premature puberty might be a manifestation of obesity. In a similar way, obesity in men affects fertility. Excess adipose tissue results in increased conversion of testosterone to estradiol, which may lead to secondary hypogonadism through reproductive axis suppression. Moreover, oxidative stress at the level of the testicular micro-environment may result in decreased spermatogenesis and sperm damage. Products of the adipocyte, such as leptin, adiponectin and resistin, and gut peptides, such as ghrelin, are considered to be crucial in the interaction between energy balance and reproduction. Finally, an indirect evidence for the interplay between MS and reproductive axis is the fact that when treating components of one, parameters of the other can be improved as well. These therapeutic interventions include lifestyle modifications, pharmacological agents, such as sex hormone replacement therapy, and surgical procedures. Although many issues remain unclear, the elucidation of the complex interaction between MS and reproductive axis will have obvious clinical implications in the therapeutic approach of both entities.
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Affiliation(s)
- Konstantinos Michalakis
- First Department of Internal Medicine, Laikon University Hospital, Athens University Medical School, Greece
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15
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Garg M, Thamotharan M, Dai Y, Lee PW, Devaskar SU. Embryo-transfer of the F2 postnatal calorie restricted female rat offspring into a control intra-uterine environment normalizes the metabolic phenotype. Metabolism 2013; 62:432-41. [PMID: 23021963 PMCID: PMC4208919 DOI: 10.1016/j.metabol.2012.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 08/23/2012] [Accepted: 08/30/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Postnatal calorie and growth restriction (PNGR) in the first generation (F1) rat female offspring causes a lean and glucose tolerant phenotype associated with hypoinsulinemia and reduced glucose-stimulated insulin secretion (GSIS). Despite the absence of gestational hyperglycemia in the F1 PNGR female, naturally born second generation (F2) PNGR female adult offspring reportedly exhibit obesity, hyperglycemia with insulin resistance. The objective of this study was to determine the role of the intrauterine environment on the heritability of the trans-generational phenotypic expression in the F2 PNGR female adult offspring. MATERIALS/METHODS We performed embryo transfer (ET) of the F2 embryos from the procreating F1 pregnant PNGR or control (CON) females to gestate in control recipient rat mothers. Employing stable isotopes glucose metabolic kinetics was determined. RESULTS Birth weight, postnatal growth pattern and white adipose tissue in female F2 ET-PNGR were similar to ET-CON. Similarly, no differences in basal glucose and insulin concentrations, GSIS, glucose futile cycling and glucose clearance were seen. When compared to F2 ET-CON, F2 ET-PNGR showed no overall difference in glucose or hepatic glucose production (HGP) AUCs with minimal hyperglycemia (p<0.04) as a result of unsuppressed endogenous HGP (p<0.02) observed only during the first phase of IVGTT. CONCLUSIONS We conclude that the lean, glucose tolerant and hypoinsulinemic phenotype with reduced GSIS in the F1 generation is nearly normalized when the embryo-transferred F2 offspring gestates in a normal metabolic environment. This observation supports a role for the intra-uterine environment in modifying the heritability of the trans-generational PNGR phenotype.
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Affiliation(s)
- Meena Garg
- Department of Pediatrics, Division of Neonatology & Developmental Biology and Neonatal Research Center, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752
| | - Manikkavasagar Thamotharan
- Department of Pediatrics, Division of Neonatology & Developmental Biology and Neonatal Research Center, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752
| | - Yun Dai
- Department of Pediatrics, Division of Neonatology & Developmental Biology and Neonatal Research Center, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752
| | - Paul W.N. Lee
- Harbor-UCLA Medical Center 1000 W. Carson Street, Torrance, California 90502
| | - Sherin U. Devaskar
- Department of Pediatrics, Division of Neonatology & Developmental Biology and Neonatal Research Center, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752
- Address all correspondence to: Sherin U. Devaskar M.D., , Professor, Department of Pediatrics, 10833, Le Conte Avenue, MDCC-22-412, Los Angeles, CA 90095-1752, Phone No. 310-825-9357; FAX No. 310-267-0154
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Yang ZH, Miyahara H, Iwasaki Y, Takeo J, Katayama M. Dietary supplementation with long-chain monounsaturated fatty acids attenuates obesity-related metabolic dysfunction and increases expression of PPAR gamma in adipose tissue in type 2 diabetic KK-Ay mice. Nutr Metab (Lond) 2013; 10:16. [PMID: 23360495 PMCID: PMC3570324 DOI: 10.1186/1743-7075-10-16] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/27/2013] [Indexed: 12/31/2022] Open
Abstract
The objective of present study was to examine the effect of long-chain monounsaturated fatty acids (LC-MUFAs) with chain lengths longer than 18 (i.e., C20:1 and C22:1 isomers combined) on obesity-related metabolic dysfunction and its molecular mechanisms. Type-2 diabetic KK-Ay mice (n = 20) were randomly assigned to the 7% soybean oil-diet group (control group) and 4% LC-MUFA concentrate-supplemented-diet group (LC-MUFA group). At 8 weeks on the diet, the results showed that plasma, liver and adipose tissue levels of C20:1 and C22:1 isomers increased significantly with LC-MUFA treatment. Supplementation with LC-MUFAs markedly reduced white fat pad weight as well as adipocyte size in the mice. The levels of plasma free fatty acids, insulin, and leptin concentration in the obese diabetic mice of the LC-MUFA group were also decreased as compared with the mice in the soybean oil-diet control group. Dietary LC-MUFAs significantly increased the mRNA expression of peroxisome proliferator-activated receptor gamma (Pparg), lipoprotein lipase (Lpl), fatty acid transport protein (Fatp), fatty acid translocase/CD36 (Cd36), as well as mRNA expression of genes involved in lipid oxidation such as carnitine palmitoyltransferase-1A (Cpt1a) and citrate synthase (Cs), and decreased the mRNA expression of inflammatory marker serum amyloid A 3 (Saa3) in the adipose tissues of diabetic mice. The results suggest that LC-MUFAs may ameliorate obesity-related metabolic dysfunction partly through increased expression of Pparg as well as its target genes, and decreased inflammatory marker expression in white adipose tissue.
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Affiliation(s)
- Zhi-Hong Yang
- Central Research Laboratory, Tokyo Innovation Center, Nippon Suisan Kaisha, Ltd,, 32-3 Nanakuni 1 Chome Hachioji, Tokyo, 192-0991, Japan.
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Ozkan Y, Timurkan ES, Aydin S, Sahin İ, Timurkan M, Citil C, Kalayci M, Yilmaz M, Aksoy A, Catak Z. Acylated and desacylated ghrelin, preptin, leptin, and nesfatin-1 Peptide changes related to the body mass index. Int J Endocrinol 2013; 2013:236085. [PMID: 24371438 PMCID: PMC3858877 DOI: 10.1155/2013/236085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/17/2013] [Accepted: 11/05/2013] [Indexed: 01/18/2023] Open
Abstract
This study examines the levels of acylated and desacylated ghrelin, preptin, leptin, and nesfatin-1 peptide changes related to the body mass index (BMI). The subjects were allocated to 5 groups depending on their BMIs as follows: Group I (BMI <18.5 kg/m(2)); Group II (BMI 18.5-24.9 kg/m(2)); Group III (BMI 25-29.9 kg/m(2)); Group IV (BMI 30-39.9 kg/m(2)); Group V (BMI >40 kg/m(2)). Serum acylated and desacylated ghrelin, preptin, and leptin levels were measured by the enzyme-linked immunosorbent assay (ELISA) and nesfatin-1 was measured by the enzyme immunoassay (EIA). Desacylated ghrelin levels showed a gradual and statistically significant drop from Group I to Group V, while preptin and leptin levels exhibited a gradual and significant increase from Group I to Group IV. Serum nesfatin-1 levels gradually, but not significantly, increased from Group I to Group III and showed a significant decrease in Groups IV and V. In conclusion, leptin, preptin, and acylated ghrelin (AG) levels increased with higher BMI, whereas desacylated ghrelin (DAG) decreased and nesfatin-1 showed no clear relationship to BMI.
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Affiliation(s)
- Yusuf Ozkan
- Department of Endocrinology and Metabolism, Firat University Hospital, 23119 Elazig, Turkey
| | - Esra Suay Timurkan
- Department of Endocrinology and Metabolism, Firat University Hospital, 23119 Elazig, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University Hospital, 23119 Elazig, Turkey
- *Suleyman Aydin:
| | - İbrahim Sahin
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University Hospital, 23119 Elazig, Turkey
- Department of Histology and Embryology, Medical School, Erzincan University, 24100 Erzincan, Turkey
| | - Mustafa Timurkan
- Department of Endocrinology and Metabolism, Firat University Hospital, 23119 Elazig, Turkey
| | - Cihan Citil
- Atatürk Vocational School of Health Science, Kafkas University, 36040 Kars, Turkey
| | - Mehmet Kalayci
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University Hospital, 23119 Elazig, Turkey
| | - Musa Yilmaz
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University Hospital, 23119 Elazig, Turkey
| | - Aziz Aksoy
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University Hospital, 23119 Elazig, Turkey
- Department of Nutrition and Dietetic, Bitlis Eren University, 13000 Bitlis, Turkey
| | - Zekiye Catak
- Department of Medical Biochemistry and Clinical Biochemistry, Firat Hormones Research Group, Firat University Hospital, 23119 Elazig, Turkey
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