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LEPTIN Going for the 3 Increases: Increase in Health, Increase in Happiness & Increase in Energy Strategies for Success in Weight Management By: James J. Messina, Ph.D. What is Leptin About fifty years ago genetic mutation was discovered which causes massive obesity in mice In 1994 mutation was characterized as an inactivation of a specific gene product Gene product was subsequently termed leptin (from Greek for low-weight) because when product was injected into mice they lost weight Leptin System: What is Leptin? Leptin was found to be produced in fat cells, so amount of leptin in blood is generally proportional to weight of person Since absence of leptin causes obesity & leptin itself reduces body fat, it was hypothesized that physiological function of leptin was to serve as a reporter of degree of body fat What is Leptin? Broad outlines of physiologic circuit of appetite regulation & energy expenditure regulated by leptin have been mapped Leptin levels rise in proportion to adiposity (fat cells) but at any given level of adipose there is wide variability in concentration of plasma leptin Leptin levels are elevated in persons with obesity & insulin resistance What research has told us about Leptin It was quickly apparent that leptin is generally ineffective as signal for excessive body fat, since obese people generally have higher, not lower, levels of leptin, but yet remain obese Probably more important role of leptin is to signal to body that body fat has fallen to dangerously low levels (for example during starvation) & thus signal that appropriate metabolic changes should occur to preserve metabolic resources. This current view of leptin was supported by the results of clinical trials of leptin on overweight individuals. What research has told us about Leptin Over 200 candidate genes for obesity-most remain unidentified in humans Considerable amount of research has focused on hypothetical link between obesity & type 2 diabetes in region of leptin receptor gene But sequence variations that have been detected have not yet been linked to body fat mass What we know about Leptin Women have higher leptin levels than men, even after accounting for estrogen status (e.g., there are no consistent differences among premenopausal women, postmenopausal women, and postmenopausal women on estrogen replacement) There is a possibility that testosterone in men might have a suppressive effect on production of leptin by the adipocyte What we know about Leptin- A key factor is body energy status Short-term energy restriction leads to a marked fall in circulating leptin levels, even after adjusting for changes in adipose mass Fall is associated with increased hunger, which may be an early impediment to compliance with a low-energy diet to achieve weight loss While a number of potential signals could mediate the acute fall in leptin with energy restriction Plasma insulin concentrations decline in parallel with leptin levels in this condition What we know about Leptin-Dietary Composition Dietary composition can affect leptin production by the adipocyte High-fat diet reduces leptin levels more than a high-carbohydrate diet does Fructose reduces leptin levels more than glucose does These findings have obvious implications for the relation of dietary compositionspecifically high-fat diets-to weight gain How does Leptin work in Obesity Appears that leptin is primarily a signal that is active in response to insufficient energy supply rather than one that is activated to prevent an oversupply of energy Apparent ineffectiveness of leptin in obese persons despite high circulating levels raises questions of whether "leptin resistance" is operating in these individuals & whether it can be overcome to benefit overweight patients Latest Research Finding about Leptin Researchers have successfully used hormone leptin to treat patients suffering from lipodystrophy-rare & difficult-to-treat disorder that shares some characteristics of typical type 2 diabetes People with lipodystrophy have few or no fat cells & thus lack leptin, a hormone produced by & stored in fat cells Latest Research Finding about Leptin – What is lipodystrophy? Because they have no fat cells, people with condition usually store huge amounts of lipids (fat) in inappropriate places like muscle or liver & have extremely high levels of lipids in their blood They are likely to be insulin resistant-meaning their bodies don't readily respond to insulinhormone that allows muscle & fat cells to properly use glucose. Another Latest Research Finding Establishes a new connection in metabolic machinery, tying leptin to crucial pathway in fat metabolism in muscle Pathway suggests a role for leptin in clearing fat out of cells and sheds light on connection between diabetes & obesity. Another Latest Research Finding In light of new knowledge about leptin's role in fuel metabolism, it makes sense to revisit idea of targeting leptin's actions to treat obesity Obese people develop resistance to leptin, so ability to target downstream pathway & bypass leptin resistance may be more beneficial than treating with leptin itself