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Podgórski R, Galiniak S, Mazur A, Podgórska D, Domin A. Serum Levels of Hormones Regulating Appetite in Patients with Fetal Alcohol Spectrum Disorders. Nutrients 2023; 15:4215. [PMID: 37836499 PMCID: PMC10574197 DOI: 10.3390/nu15194215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Prenatal alcohol exposure is the cause of impaired growth and a wide range of developmental and behavioral disorders in the child. Improper eating patterns are commonly associated with fetal alcohol spectrum disorders (FASD) and may contribute to poor nutrition and growth restriction. To date, there have been only a few studies investigating the hormonal regulation of appetite in patients with FASD. We analyzed the levels of neuropeptide Y (NPY), Agouti signaling protein (ASP), alpha-melanocyte-stimulating hormone (α-MSH), and kisspeptin (KISS1) in 57 patients with FASD and 23 healthy controls. A comparison of the hormone levels studied was also performed in subgroups of fetal alcohol syndrome (FAS) and neurobehavioral disorder associated with prenatal alcohol exposure (ND PAE), as well as in males and females. We have found no differences in hormone levels tested between affected individuals and the controls and between FASD subgroups. In addition, sex had no effect on hormone levels. However, we identified some associations between hormone concentrations and parameters describing the clinical status of patients with FASD. Most of them concerned ASP, which has shown a positive correlation with age and hormones involved in appetite and metabolism, such as proopiomelanocortin (POMC) and adrenocorticotropic hormone (ACTH). We have also found a negative correlation of α-MSH with age, BMI percentile, and glycated hemoglobin (HbA1c). Furthermore, we found a weak negative correlation of NPY with HbA1c. Although FASD has been associated with impaired child growth and development, including nutrition and puberty onset, we did not identify differences in the levels of the hormones studied, which may suggest that prenatal alcohol exposure does not affect the levels of these metabolites.
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Affiliation(s)
- Rafał Podgórski
- Department of Biochemistry, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Sabina Galiniak
- Department of Biochemistry, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Artur Mazur
- Department of Pediatric, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (A.M.); (A.D.)
| | - Dominika Podgórska
- Department of Rheumatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Agnieszka Domin
- Department of Pediatric, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (A.M.); (A.D.)
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Peptide YY 3-36 concentration in acute- and long-term recovered anorexia nervosa. Eur J Nutr 2020; 59:3791-3799. [PMID: 32166384 PMCID: PMC7669786 DOI: 10.1007/s00394-020-02210-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
Purpose The gut–brain axis could be a possible key factor in the pathophysiology of anorexia nervosa. The neuropeptide peptide YY3–36, secreted by endocrine L cells of the gastrointestinal tract, is a known regulator of appetite and food intake. The objective of this study was to investigate peptide YY3–36 plasma concentrations at different stages of anorexia nervosa in a combined cross-sectional and longitudinal design to differentiate between effects of acute undernutrition and more enduring characteristics. Methods We measured fasting plasma peptide YY3–36 concentrations in young patients with acute anorexia nervosa (n = 47) and long-term recovered patients (n = 35) cross-sectionally in comparison to healthy control participants (n = 58), and longitudinally over the course of inpatient treatment. Physical activity was controlled as it may modulate peptide YY secretion. Results There was no group difference in peptide YY3–36 concentration among young acutely underweight anorexia nervosa patients, long-term recovered anorexia nervosa patients, and healthy control participants. Longitudinally, there was no change in peptide YY3–36 concentration after short-term weight rehabilitation. For acute anorexia nervosa patients at admission to treatment, there was a negative correlation between peptide YY3–36 concentration and body mass index. Conclusions The current study provides additional evidence for a normal basal PYY3–36 concentration in AN. Future studies should study multiple appetite-regulating peptides and their complex interplay and also use research designs including a food challenge. Electronic supplementary material The online version of this article (10.1007/s00394-020-02210-7) contains supplementary material, which is available to authorized users.
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Berner LA, Brown TA, Lavender JM, Lopez E, Wierenga CE, Kaye WH. Neuroendocrinology of reward in anorexia nervosa and bulimia nervosa: Beyond leptin and ghrelin. Mol Cell Endocrinol 2019; 497:110320. [PMID: 30395874 PMCID: PMC6497565 DOI: 10.1016/j.mce.2018.10.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/19/2018] [Accepted: 10/27/2018] [Indexed: 12/14/2022]
Abstract
The pathophysiology of anorexia nervosa (AN) and bulimia nervosa (BN) are still poorly understood, but psychobiological models have proposed a key role for disturbances in the neuroendocrines that signal hunger and satiety and maintain energy homeostasis. Mounting evidence suggests that many neuroendocrines involved in the regulation of homeostasis and body weight also play integral roles in food reward valuation and learning via their interactions with the mesolimbic dopamine system. Neuroimaging data have associated altered brain reward responses in this system with the dietary restriction and binge eating and purging characteristic of AN and BN. Thus, neuroendocrine dysfunction may contribute to or perpetuate eating disorder symptoms via effects on reward circuitry. This narrative review focuses on reward-related neuroendocrines that are altered in eating disorder populations, including peptide YY, insulin, stress and gonadal hormones, and orexins. We provide an overview of the animal and human literature implicating these neuroendocrines in dopaminergic reward processes and discuss their potential relevance to eating disorder symptomatology and treatment.
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Affiliation(s)
- Laura A Berner
- University of California, San Diego, Eating Disorders Center for Treatment and Research, Department of Psychiatry, United States.
| | - Tiffany A Brown
- University of California, San Diego, Eating Disorders Center for Treatment and Research, Department of Psychiatry, United States
| | - Jason M Lavender
- University of California, San Diego, Eating Disorders Center for Treatment and Research, Department of Psychiatry, United States
| | - Emily Lopez
- University of California, San Diego, Eating Disorders Center for Treatment and Research, Department of Psychiatry, United States
| | - Christina E Wierenga
- University of California, San Diego, Eating Disorders Center for Treatment and Research, Department of Psychiatry, United States
| | - Walter H Kaye
- University of California, San Diego, Eating Disorders Center for Treatment and Research, Department of Psychiatry, United States
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Keel PK, Bodell LP, Forney KJ, Appelbaum J, Williams D. Examining weight suppression as a transdiagnostic factor influencing illness trajectory in bulimic eating disorders. Physiol Behav 2019; 208:112565. [PMID: 31153878 PMCID: PMC6636832 DOI: 10.1016/j.physbeh.2019.112565] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/14/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022]
Abstract
Recent research indicates that weight suppression (WS: defined as the difference between highest lifetime and current weight) prospectively predicts illness trajectory across eating disorders characterized by binge eating, including AN binge-purge subtype (ANbp), bulimia nervosa (BN), and binge eating disorder (BED), collectively referred to as bulimic eating disorders. Through a series of studies, we have developed a model to explain the link between WS and illness trajectory in bulimic eating disorders. Our model posits that WS contributes to reduced circulating leptin, which leads to reduced postprandial glucagon-like peptide 1 (GLP-1) response. Diminished leptin and GLP-1 function contribute to alterations in two reward-related constructs in the Research Domain Criteria (RDoC): reward value/effort and reward satiation. Respectively, these changes increase drive/motivation to consume food and decrease ability for food consumption to lead to a state of satiation/satisfaction. Combined, these alterations increase risk for experiencing large, out-of-control binge-eating episodes. The following review presents evidence that contributed to the development of this model as well as preliminary findings from an on-going project funded to test this model.
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Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, USA.
| | | | | | | | - Diana Williams
- Department of Psychology and Program in Neuroscience, Florida State University, USA
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Maussion G, Demirova I, Gorwood P, Ramoz N. Induced Pluripotent Stem Cells; New Tools for Investigating Molecular Mechanisms in Anorexia Nervosa. Front Nutr 2019; 6:118. [PMID: 31457016 PMCID: PMC6700384 DOI: 10.3389/fnut.2019.00118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Anorexia nervosa (AN) is a dramatic psychiatric disorder characterized by dysregulations in food intake and reward processing, involving molecular and cellular changes in several peripheral cell types and central neuronal networks. Genomic and epigenomic analyses have allowed the identification of multiple genetic and epigenetic modifications highlighting the complex pathophysiology of AN. Behavioral and genetic rodent models have been used to recapitulate and investigate, with some limitations, the cellular and molecular changes that potentially underlie eating disorders. In the last 5 years, the use of induced pluripotent stem cells (IPSCs), combined with CRISPR-Cas9 technology, has led to the generation of specific neuronal cell subtypes engineered from human somatic samples, representing a powerful tool to complement observations made in human samples and data collected from animal models. Systems biology using IPSCs has indeed proved to be a valuable approach for the study of metabolic disorders, in addition to neurodevelopmental and psychiatric disorders. The manuscript, while reviewing the main findings related to the genetic, epigenetic, and cellular bases of AN, will present how new studies published, or to be performed, in the field of IPSC-derived cells should improve our current understanding of the pathophysiology of AN and provide potential therapeutic strategies addressing specific endophenotypes.
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Affiliation(s)
- Gilles Maussion
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Iveta Demirova
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France.,Hôpital Sainte-Anne (CMME), University Paris-Descartes, Paris, France
| | - Nicolas Ramoz
- INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
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Nilsson IAK. The anx/anx Mouse - A Valuable Resource in Anorexia Nervosa Research. Front Neurosci 2019; 13:59. [PMID: 30804742 PMCID: PMC6370726 DOI: 10.3389/fnins.2019.00059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/21/2019] [Indexed: 01/31/2023] Open
Abstract
Animal models are invaluable resources in research concerning the neurobiology of anorexia nervosa (AN), to a large extent since valid clinical samples are rare. None of the existing models can capture all aspects of AN but they are able to mirror the core features of the disorder e.g., elective starvation, emaciation and premature death. The anorectic anx/anx mouse is of particular value for the understanding of the abnormal response to negative energy balance seen in AN. These mice appear normal at birth but gradually develops starvation and emaciation despite full access to food, and die prematurely around three weeks of age. Several changes in hypothalamic neuropeptidergic and -transmitter systems involved in regulating food intake and metabolism have been documented in the anx/anx mouse. These changes are accompanied by signs of inflammation and degeneration in the same hypothalamic regions; including activation of microglia cells and expression of major histocompatibility complex I by microglia and selective neuronal populations. These aberrances are likely related to the dysfunction of complex I (CI) in the oxidative phosphorylation system of the mitochondria, and subsequent increased oxidative stress, which also has been revealed in the hypothalamus of these mice. Interestingly, a similar CI dysfunction has been shown in leukocytes from patients with AN. In addition, a higher expression of the Neurotrophic Receptor Tyrosine Kinase 3 gene has been shown in the anx/anx hypothalamus. This agrees with AN being associated with specific variants of the genes for brain derived neurotrophic factor and Neurotrophic Receptor Tyrosine Kinase 2. The anx/anx mouse is also glucose intolerant and display pancreatic dysfunction related to increased levels of circulating free fatty acids (FFA) and pancreatic inflammation. An increased incidence of eating disorders has been reported for young diabetic women, and as well has increased levels of circulating FFAs in AN. Also similar to individuals with AN, the anx/anx mouse has reduced leptin and increased cholesterol levels in serum. Thus, the anx/anx mouse shares several characteristics with patients with AN, including emaciation, starvation, premature death, diabetic features, increased FFA and low leptin, and is therefore a unique resource in research on the (neuro)biology of AN.
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Affiliation(s)
- Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Centre for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden
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Paslakis G, Maas S, Gebhardt B, Mayr A, Rauh M, Erim Y. Prospective, randomized, double-blind, placebo-controlled phase IIa clinical trial on the effects of an estrogen-progestin combination as add-on to inpatient psychotherapy in adult female patients suffering from anorexia nervosa. BMC Psychiatry 2018; 18:93. [PMID: 29631553 PMCID: PMC5891970 DOI: 10.1186/s12888-018-1683-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 04/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is a need for novel treatment approaches in anorexia nervosa (AN). While there is broad knowledge with regard to altered appetite regulation and neuropsychological deficits in AN patients on the one hand, and the effects of estrogen replacement upon neuropsychological performance in healthy subjects on the other, up to now, no study has implemented estrogen replacement in AN patients, in order to examine its effects upon AN-associated and general psychopathology, neuropsychological performance and concentrations of peptide components of the hypothalamus-pituitary-adrenal (HPA) axis and within appetite-regulating circuits. METHODS This is a randomized placebo-controlled clinical trial on the effects of a 10-week oral estrogen replacement (combination of ethinyl estradiol 0.03 mg and dienogest 2 mg) in adult female AN patients. The primary target is the assessment of the impact of sex hormone replacement upon neuropsychological performance by means of a neuropsychological test battery consisting of a test for verbal intelligence, the Trail making test A and B, a Go/No-go paradigm with food cues and the Wisconsin Card Sorting Test. Secondary targets include a) the examination of safety and tolerability (as mirrored by the number of adverse events), b) assessments of the impact upon eating disorder-specific psychopathology by means of the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory-2 (EDI-2), c) the influence upon anxiety using the State-Trait-Anxiety Inventory (STAI), d) assessments of plasma cortisol levels during a dexamethasone-suppression test and appetite-regulating plasma peptides (ghrelin, leptin, insulin, glucose) during an oral glucose tolerance test and, e) a possible impact upon the prescription of antidepressants. DISCUSSION This is the first study of its kind. There are no evidence-based psychopharmacological options for the treatment of AN. Thus, the results of this clinical trial may have a relevant impact on future treatment regimens. Novel approaches are necessary to improve rates of AN symptom remission and increase the rapidity of treatment response. Identifying the underlying biological (e.g. neuroendocrinological) factors that maintain AN or may predict patient treatment response represent critical future research directions. Continued efforts to incorporate novel pharmacological aspects into treatments will increase access to evidence-based care and help reduce the burden of AN. TRIAL REGISTRATION European Clinical Trials Database, EudraCT number 2015-004184-36, registered November 2015; ClinicalTrials.gov Identifier: NCT03172533 , retrospectively registered May 2017.
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Affiliation(s)
- Georgios Paslakis
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Stefanie Maas
- Center for Clinical Studies, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Bernd Gebhardt
- Center for Clinical Studies, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University, Universitätsstrasse 22, 91054, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Loschgestraße 15, 91054, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
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Kim DY, Yu J, Mui RK, Niibori R, Taufique HB, Aslam R, Semple JW, Cordes SP. The tyrosine kinase receptor Tyro3 enhances lifespan and neuropeptide Y (Npy) neuron survival in the mouse anorexia ( anx) mutation. Dis Model Mech 2017; 10:581-595. [PMID: 28093506 PMCID: PMC5451163 DOI: 10.1242/dmm.027433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/12/2016] [Indexed: 01/01/2023] Open
Abstract
Severe appetite and weight loss define the eating disorder anorexia nervosa, and can also accompany the progression of some neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS). Although acute loss of hypothalamic neurons that produce appetite-stimulating neuropeptide Y (Npy) and agouti-related peptide (Agrp) in adult mice or in mice homozygous for the anorexia (anx) mutation causes aphagia, our understanding of the factors that help maintain appetite regulatory circuitry is limited. Here we identify a mutation (C19T) that converts an arginine to a tryptophan (R7W) in the TYRO3 protein tyrosine kinase 3 (Tyro3) gene, which resides within the anx critical interval, as contributing to the severity of anx phenotypes. Our observation that, like Tyro3-/- mice, anx/anx mice exhibit abnormal secondary platelet aggregation suggested that the C19T Tyro3 variant might have functional consequences. Tyro3 is expressed in the hypothalamus and other brain regions affected by the anx mutation, and its mRNA localization appeared abnormal in anx/anx brains by postnatal day 19 (P19). The presence of wild-type Tyro3 transgenes, but not an R7W-Tyro3 transgene, doubled the weight and lifespans of anx/anx mice and near-normal numbers of hypothalamic Npy-expressing neurons were present in Tyro3-transgenic anx/anx mice at P19. Although no differences in R7W-Tyro3 signal sequence function or protein localization were discernible in vitro, distribution of R7W-Tyro3 protein differed from that of Tyro3 protein in the cerebellum of transgenic wild-type mice. Thus, R7W-Tyro3 protein localization deficits are only detectable in vivo Further analyses revealed that the C19T Tyro3 mutation is present in a few other mouse strains, and hence is not the causative anx mutation, but rather an anx modifier. Our work shows that Tyro3 has prosurvival roles in the appetite regulatory circuitry and could also provide useful insights towards the development of interventions targeting detrimental weight loss.
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Affiliation(s)
- Dennis Y Kim
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Joanna Yu
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Ryan K Mui
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Rieko Niibori
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - Hamza Bin Taufique
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
| | - Rukhsana Aslam
- Keenan Research Centre for Biomedical Science, St. Michaels Hospital, Toronto, ON M5B 1W8, Canada
- Canadian Blood Services, 67 College Street, Toronto, ON M5G 2M1, Canada
| | - John W Semple
- Keenan Research Centre for Biomedical Science, St. Michaels Hospital, Toronto, ON M5B 1W8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
- Canadian Blood Services, 67 College Street, Toronto, ON M5G 2M1, Canada
| | - Sabine P Cordes
- Lunenfeld-Tanenbaum Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's Crescent, Toronto, ON M5S 1A8, Canada
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Neuropeptide Y (NPY) as a therapeutic target for neurodegenerative diseases. Neurobiol Dis 2016; 95:210-24. [PMID: 27461050 DOI: 10.1016/j.nbd.2016.07.022] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/29/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
Neuropeptide Y (NPY) and NPY receptors are widely expressed in the mammalian central nervous system. Studies in both humans and rodent models revealed that brain NPY levels are altered in some neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Huntington's disease and Machado-Joseph disease. In this review, we will focus on the roles of NPY in the pathological mechanisms of these disorders, highlighting NPY as a neuroprotective agent, as a neural stem cell proliferative agent, as an agent that increases trophic support, as a stimulator of autophagy and as an inhibitor of excitotoxicity and neuroinflammation. Moreover, the effect of NPY in some clinical manifestations commonly observed in Alzheimer's disease, Parkinson's disease, Huntington's disease and Machado-Joseph disease, such as depressive symptoms and body weight loss, are also discussed. In conclusion, this review highlights NPY system as a potential therapeutic target in neurodegenerative diseases.
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Su X, Xu B, Liang H, Olsen J, Yuan W, Cnattingius S, László KD, Li J. Prenatal maternal bereavement and risk of eating disorders in infants and toddlers: a population-based cohort study. BMC Psychiatry 2015; 15:229. [PMID: 26403981 PMCID: PMC4582887 DOI: 10.1186/s12888-015-0612-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 09/17/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prenatal stress has been associated to a number of neuropsychiatric diseases but its role on the development of eating disorders (ED) remains unknown. Infants and toddlers with feeding or eating disorders are also at an increased risk of such diseases in later childhood and adolescence. We aimed to examine whether prenatal stress following maternal bereavement is associated with ED in infants and toddlers. METHODS This population-based cohort study included children born from 1977 to 2008 in Denmark (N = 2,127,126) and from 1977 to 2006 in Sweden (N = 2,974,908). Children were categorized as exposed if they were born to mothers who lost a close relative one year prior to or during pregnancy and were categorized as unexposed otherwise. They were followed until the age of 3 for a first diagnosis of ED. Poisson regression models were used to examine incidence rate ratio (IRR) between the exposed and the unexposed cohort. RESULTS A total of 9,403 ED cases were identified and 179 of whom were in the exposed cohort. Offspring born to mothers bereaved by loss of a core family member (older child or spouse) within the six months before pregnancy had a higher risk of ED than the unexposed offspring (IRR: 1.63, 95% confidence intervals (CI): 1.07-2.47). In stratified analyses, bereavement during the six months before pregnancy was associated with an increased risk of ED in boys (IRR: 2.21, 95% CI: 1.28-3.82), but not in girls (IRR: 1.18, 95% CI: 0.61-2.27). DISCUSSION This is the first population-based study to explore the association between prenatal stress and the risk of ED in infants and toddlers within two Nordic countries. This study added new evidence of early life stress for etiology of ED while the potential mechanism still needs further studies. CONCLUSIONS Prenatal stress following maternal bereavement by loss of a core family member is associated with an increased risk of ED among infants and toddlers. The six months before conception may be a susceptible time window, especially for boys.
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Affiliation(s)
- Xiujuan Su
- Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, PR China. .,Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark.
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, PR China.
| | - Hong Liang
- Department of Reproductive Epidemiology and Social Science, National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai Institute of Planned Parenthood Research, Shanghai, 200032, PR China.
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark.
| | - Wei Yuan
- Department of Reproductive Epidemiology and Social Science, National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai Institute of Planned Parenthood Research, Shanghai, 200032, PR China.
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | - Krisztina D. László
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Jiong Li
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark.
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Zgheib S, Méquinion M, Lucas S, Leterme D, Ghali O, Tolle V, Zizzari P, Bellefontaine N, Legroux-Gérot I, Hardouin P, Broux O, Viltart O, Chauveau C. Long-term physiological alterations and recovery in a mouse model of separation associated with time-restricted feeding: a tool to study anorexia nervosa related consequences. PLoS One 2014; 9:e103775. [PMID: 25090643 PMCID: PMC4121212 DOI: 10.1371/journal.pone.0103775] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Background Anorexia nervosa is a primary psychiatric disorder, with non-negligible rates of mortality and morbidity. Some of the related alterations could participate in a vicious cycle limiting the recovery. Animal models mimicking various physiological alterations related to anorexia nervosa are necessary to provide better strategies of treatment. Aim To explore physiological alterations and recovery in a long-term mouse model mimicking numerous consequences of severe anorexia nervosa. Methods C57Bl/6 female mice were submitted to a separation-based anorexia protocol combining separation and time-restricted feeding for 10 weeks. Thereafter, mice were housed in standard conditions for 10 weeks. Body weight, food intake, body composition, plasma levels of leptin, adiponectin, IGF-1, blood levels of GH, reproductive function and glucose tolerance were followed. Gene expression of several markers of lipid and energy metabolism was assayed in adipose tissues. Results Mimicking what is observed in anorexia nervosa patients, and despite a food intake close to that of control mice, separation-based anorexia mice displayed marked alterations in body weight, fat mass, lean mass, bone mass acquisition, reproductive function, GH/IGF-1 axis, and leptinemia. mRNA levels of markers of lipogenesis, lipolysis, and the brown-like adipocyte lineage in subcutaneous adipose tissue were also changed. All these alterations were corrected during the recovery phase, except for the hypoleptinemia that persisted despite the full recovery of fat mass. Conclusion This study strongly supports the separation-based anorexia protocol as a valuable model of long-term negative energy balance state that closely mimics various symptoms observed in anorexia nervosa, including metabolic adaptations. Interestingly, during a recovery phase, mice showed a high capacity to normalize these parameters with the exception of plasma leptin levels. It will be interesting therefore to explore further the central and peripheral effects of the uncorrected hypoleptinemia during recovery from separation-based anorexia.
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Affiliation(s)
- Sara Zgheib
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Mathieu Méquinion
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
- UMR INSERM 837, Développement et Plasticité du Cerveau Post-natal, Lille, France
| | - Stéphanie Lucas
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Damien Leterme
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Olfa Ghali
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Virginie Tolle
- UMR-S 894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Philippe Zizzari
- UMR-S 894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nicole Bellefontaine
- Université Lille Nord de France, Boulogne sur Mer, France
- UMR INSERM 837, Développement et Plasticité du Cerveau Post-natal, Lille, France
| | - Isabelle Legroux-Gérot
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
- Service de Rhumatologie, Hôpital Roger Salengro, CHU Lille, France
| | - Pierre Hardouin
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Odile Broux
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Odile Viltart
- Université Lille Nord de France, Boulogne sur Mer, France
- UMR INSERM 837, Développement et Plasticité du Cerveau Post-natal, Lille, France
- Université de Lille1, Villeneuve d’Ascq, France
| | - Christophe Chauveau
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
- * E-mail:
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Tortorella A, Brambilla F, Fabrazzo M, Volpe U, Monteleone AM, Mastromo D, Monteleone P. Central and peripheral peptides regulating eating behaviour and energy homeostasis in anorexia nervosa and bulimia nervosa: a literature review. EUROPEAN EATING DISORDERS REVIEW 2014; 22:307-20. [PMID: 24942507 DOI: 10.1002/erv.2303] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 02/03/2023]
Abstract
A large body of literature suggests the occurrence of a dysregulation in both central and peripheral modulators of appetite in patients with anorexia nervosa (AN) and bulimia nervosa (BN), but at the moment, the state or trait-dependent nature of those changes is far from being clear. It has been proposed, although not definitively proved, that peptide alterations, even when secondary to malnutrition and/or to aberrant eating behaviours, might contribute to the genesis and the maintenance of some symptomatic aspects of AN and BN, thus affecting the course and the prognosis of these disorders. This review focuses on the most significant literature studies that explored the physiology of those central and peripheral peptides, which have prominent effects on eating behaviour, body weight and energy homeostasis in patients with AN and BN. The relevance of peptide dysfunctions for the pathophysiology of eating disorders is critically discussed.
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Abstract
Disordered eating behavior is the core symptom of the complex disorders anorexia nervosa and bulimia nervosa. Twin and family studies derive high heritability estimates. Hence, substantial genetic influences on the etiology can be assumed for both. Initially, candidate gene studies pertaining to the monoaminergic neurotransmitter systems and to body weight regulation comprised the core of the genetic analyses. Unfortunately, confirmed, solid findings substantiated in meta-analyses are rare, so that eventually none of these associations is unequivocal. Thus, systematic, genome-wide approaches emerged to identify genes with no a priori evidence for their involvement in eating disorders. Genome-wide association studies have hinted to formerly unknown genetic regions. However, significant genome-wide findings have not yet been reported.
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Monteleone P, Maj M. Dysfunctions of leptin, ghrelin, BDNF and endocannabinoids in eating disorders: beyond the homeostatic control of food intake. Psychoneuroendocrinology 2013; 38:312-30. [PMID: 23313276 DOI: 10.1016/j.psyneuen.2012.10.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 12/18/2022]
Abstract
A large body of literature documents the occurrence of alterations in the physiology of both central and peripheral modulators of appetite in acute patients with anorexia nervosa (AN) and bulimia nervosa (BN). Until more recently the role of most of the appetite modulators in the control of eating behavior was conceptualized solely in terms of their influence on homeostatic control of energy balance. However, it is becoming more and more evident that appetite modulators also affect the non-homeostatic cognitive, emotional and rewarding component of food intake as well as non food-related reward, and, recently, AN and BN have been pathophysiologically linked to dysfunctions of reward mechanisms. Therefore, the possibility exists that observed changes in appetite modulators in acute AN and BN may represent not only homeostatic adaptations to malnutrition, but also contribute to the development and/or the maintenance of aberrant non-homeostatic behaviors, such as self-starvation and binge eating. In the present review, the evidences supporting a role of leptin, ghrelin, brain-derived neurotrophic factor and endocannabinoids in the homeostatic and non-homeostatic dysregulations of patients with AN and BN will be presented. The reviewed literature is highly suggestive that changes in the physiology of these modulators may play a pivotal role in the pathophysiology of eating disorders by providing a possible link between motivated behaviors, reward processes, cognitive functions and energy balance.
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Affiliation(s)
- Palmiero Monteleone
- Department of Medicine and Surgery, University of Salerno, via S. Allende, 84084 Baronissi (Salerno), Italy.
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15
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Smitka K, Papezova H, Vondra K, Hill M, Hainer V, Nedvidkova J. The role of "mixed" orexigenic and anorexigenic signals and autoantibodies reacting with appetite-regulating neuropeptides and peptides of the adipose tissue-gut-brain axis: relevance to food intake and nutritional status in patients with anorexia nervosa and bulimia nervosa. Int J Endocrinol 2013; 2013:483145. [PMID: 24106499 PMCID: PMC3782835 DOI: 10.1155/2013/483145] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/11/2013] [Indexed: 12/13/2022] Open
Abstract
Eating disorders such as anorexia (AN) and bulimia nervosa (BN) are characterized by abnormal eating behavior. The essential aspect of AN is that the individual refuses to maintain a minimal normal body weight. The main features of BN are binge eating and inappropriate compensatory methods to prevent weight gain. The gut-brain-adipose tissue (AT) peptides and neutralizing autoantibodies play an important role in the regulation of eating behavior and growth hormone release. The mechanisms for controlling food intake involve an interplay between gut, brain, and AT. Parasympathetic, sympathetic, and serotoninergic systems are required for communication between brain satiety centre, gut, and AT. These neuronal circuits include neuropeptides ghrelin, neuropeptide Y (NPY), peptide YY (PYY), cholecystokinin (CCK), leptin, putative anorexigen obestatin, monoamines dopamine, norepinephrine (NE), serotonin, and neutralizing autoantibodies. This extensive and detailed report reviews data that demonstrate that hunger-satiety signals play an important role in the pathogenesis of eating disorders. Neuroendocrine dysregulations of the AT-gut-brain axis peptides and neutralizing autoantibodies may result in AN and BN. The circulating autoantibodies can be purified and used as pharmacological tools in AN and BN. Further research is required to investigate the orexigenic/anorexigenic synthetic analogs and monoclonal antibodies for potential treatment of eating disorders in clinical practice.
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Affiliation(s)
- Kvido Smitka
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Hana Papezova
- Psychiatric Clinic, First Faculty of Medicine, Charles University, Ke Karlovu 11, 121 08 Prague 2, Czech Republic
| | - Karel Vondra
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Vojtech Hainer
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Jara Nedvidkova
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
- *Jara Nedvidkova:
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Méquinion M, Langlet F, Zgheib S, Dickson S, Dehouck B, Chauveau C, Viltart O. Ghrelin: central and peripheral implications in anorexia nervosa. Front Endocrinol (Lausanne) 2013; 4:15. [PMID: 23549309 PMCID: PMC3581855 DOI: 10.3389/fendo.2013.00015] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/01/2013] [Indexed: 11/15/2022] Open
Abstract
Increasing clinical and therapeutic interest in the neurobiology of eating disorders reflects their dramatic impact on health. Chronic food restriction resulting in severe weight loss is a major symptom described in restrictive anorexia nervosa (AN) patients, and they also suffer from metabolic disturbances, infertility, osteopenia, and osteoporosis. Restrictive AN, mostly observed in young women, is the third largest cause of chronic illness in teenagers of industrialized countries. From a neurobiological perspective, AN-linked behaviors can be considered an adaptation that permits the endurance of reduced energy supply, involving central and/or peripheral reprograming. The severe weight loss observed in AN patients is accompanied by significant changes in hormones involved in energy balance, feeding behavior, and bone formation, all of which can be replicated in animals models. Increasing evidence suggests that AN could be an addictive behavior disorder, potentially linking defects in the reward mechanism with suppressed food intake, heightened physical activity, and mood disorder. Surprisingly, the plasma levels of ghrelin, an orexigenic hormone that drives food-motivated behavior, are increased. This increase in plasma ghrelin levels seems paradoxical in light of the restrained eating adopted by AN patients, and may rather result from an adaptation to the disease. The aim of this review is to describe the role played by ghrelin in AN focusing on its central vs. peripheral actions. In AN patients and in rodent AN models, chronic food restriction induces profound alterations in the « ghrelin » signaling that leads to the development of inappropriate behaviors like hyperactivity or addiction to food starvation and therefore a greater depletion in energy reserves. The question of a transient insensitivity to ghrelin and/or a potential metabolic reprograming is discussed in regard of new clinical treatments currently investigated.
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Affiliation(s)
- Mathieu Méquinion
- UMR INSERM 837, Development and Plasticity of Postnatal BrainLille, France
| | - Fanny Langlet
- UMR INSERM 837, Development and Plasticity of Postnatal BrainLille, France
| | - Sara Zgheib
- Pathophysiology of inflammatory of bone diseases, Université Lille Nord de France-ULCO – Lille 2Boulogne sur Mer, France
| | - Suzanne Dickson
- Department of Physiology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of GothenburgGothenburg, Sweden
- Department of Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of GothenburgGothenburg, Sweden
| | - Bénédicte Dehouck
- UMR INSERM 837, Development and Plasticity of Postnatal BrainLille, France
- Université Lille Nord de France – Université d’ArtoisLiévin, France
| | - Christophe Chauveau
- Pathophysiology of inflammatory of bone diseases, Université Lille Nord de France-ULCO – Lille 2Boulogne sur Mer, France
| | - Odile Viltart
- UMR INSERM 837, Development and Plasticity of Postnatal BrainLille, France
- Université Lille Nord de France-USTL (Lille 1)Villeneuve d’Ascq, France
- *Correspondence: Odile Viltart, Development and Plasticity of the Postnatal Brain, Team 2, Jean-Pierre Aubert Research Center, UMR INSERM 837, Bât Biserte, 1 place de Verdun, 59,045 Lille cedex, France. e-mail:
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The role of NMDA receptors in human eating behavior: evidence from a case of anti-NMDA receptor encephalitis. Cogn Behav Neurol 2012; 25:93-7. [PMID: 22596107 DOI: 10.1097/wnn.0b013e31825921a6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research in animal models has implicated N-methyl-D-aspartate (NMDA) receptors (NMDARs) in the control of food intake. Until now, these findings have been not replicated in humans. Here we describe a 22-year-old woman with anti-NMDAR encephalitis and no prior neurological or psychiatric history. Her clinical course was marked by successive eating disorders: anorexia followed by hyperphagia. We propose that, much as they do in other animals, NMDARs in humans interact with the neuroendocrine, homeostatic, and reward systems controlling food intake in the central and peripheral nervous system structures related to feeding and satiety.
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Smitka K, Papezova H, Vondra K, Hill M, Hainer V, Nedvidkova J. A higher response of plasma neuropeptide Y, growth hormone, leptin levels and extracellular glycerol levels in subcutaneous abdominal adipose tissue to Acipimox during exercise in patients with bulimia nervosa: single-blind, randomized, microdialysis study. Nutr Metab (Lond) 2011; 8:81. [PMID: 22093818 PMCID: PMC3245450 DOI: 10.1186/1743-7075-8-81] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 11/17/2011] [Indexed: 01/25/2023] Open
Abstract
Background Neuropeptide Y (NPY) is an important central orexigenic hormone predominantly produced by the hypothalamus, and recently found to be secreted in adipose tissue (AT). Acipimox (Aci) inhibits lipolysis in AT and reduces plasma glycerol and free fatty acid (FFA) levels. Exercise and Aci are enhancers of growth hormone (GH) and NPY secretion and exercise may alter leptin levels. We expect to find abnormal neuropeptidergic response in plasma and AT in patients with bulimia nervosa (BN). We hypothesize that Aci influences these peptides via a FFA-independent mechanism and that Aci inhibits lipolysis through a cyclic adenosine monophosphate (cAMP)-dependent pathway. Dysregulations of the AT-brain axis peptides might be involved in binge eating as is the case in BN. Methods The objective of this study was to determine the responses of plasma NPY, GH, leptin, FFA and glycerol levels to exercise in BN patients and healthy women (C) given the anti-lipolytic drug Aci or placebo. The secondary objective of this study was to compare the responses of extracellular glycerol levels and plasma glycerol levels to exercise alone or together with Aci administration in BN patients and C women. Extracellular glycerol was measured in vivo in subcutaneous (sc) abdominal AT using microdialysis. Eight BN and eight C women were recruited for this single-blind, randomized study. Aci or placebo was given 1 hour before the exercise (45 min, 2 W/kg of lean body mass [LBM]). NPY, GH, leptin, FFA, glycerol plasma and AT glycerol levels were measured using commercial kits. Results The primary outcome of this study was that the exercise with Aci administration resulted in plasma NPY and GH increase (after a 45-minute exercise) and leptin (after a 90-minute post-exercise recovering phase) increased more in BN patients. The secondary outcomes of this study were that the exercise with Aci administration induced a higher decrease of extracellular glycerol in BN patients compared to the C group, while the exercise induced a higher increase of glycerol concentrations in sc abdominal AT of BN patients. Plasma glycerol levels decreased more in BN patients and plasma FFA levels were depressed in both groups after the exercise with Aci administration. The exercise induced similar increases in plasma NPY, GH, FFA and glycerol levels, and a similar decrease in the plasma leptin level in both groups. Conclusions We confirm the results of a single-blind, randomized, microdialysis study, i.e. that the Aci-induced elevation in plasma NPY and GH levels during the exercise is higher in BN patients and that Aci increased plasma leptin levels in the post-exercise recovering phase (90-minute) more in BN patients. The post-exercise rise (45-minute) in AT glycerol is much more attenuated by acute Aci treatment in BN patients. Simultaneously, we found facilitated turnover of plasma glycerol after the exercise together with Aci administration in BN. Our results support the hypotheses that Aci exerts an effect on the FFA-independent and cAMP-dependent mechanism. Trial Registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000955910
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Affiliation(s)
- Kvido Smitka
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Hana Papezova
- Psychiatric Clinic, First Faculty of Medicine, Charles University, Ke Karlovu 11, 121 08 Prague 2, Czech Republic
| | - Karel Vondra
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Vojtech Hainer
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Jara Nedvidkova
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
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Lawson EA, Eddy KT, Donoho D, Misra M, Miller KK, Meenaghan E, Lydecker J, Herzog D, Klibanski A. Appetite-regulating hormones cortisol and peptide YY are associated with disordered eating psychopathology, independent of body mass index. Eur J Endocrinol 2011; 164:253-61. [PMID: 21098684 PMCID: PMC3677777 DOI: 10.1530/eje-10-0523] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Disordered eating occurs in women at both weight extremes of anorexia nervosa (AN) and obesity. Cortisol, peptide YY (PYY), leptin, and ghrelin are hormones involved in appetite and feeding behavior that vary with weight and body fat. Abnormal levels of these hormones have been reported in women with AN, functional hypothalamic amenorrhea (HA), and obesity. The relationship between appetite-regulating hormones and disordered eating psychopathology is unknown. We therefore studied the relationship between orexigenic and anorexigenic hormones and disordered eating psychopathology in women across a range of weights. DESIGN A cross-sectional study of 65 women, 18-45 years: 16 with AN, 12 normal-weight with HA, 17 overweight or obese, and 20 normal-weight in good health. METHODS Two validated measures of disordered eating psychopathology, the Eating Disorders Examination-Questionnaire (EDE-Q) and Eating Disorders Inventory-2 (EDI-2), were administered. Fasting PYY, leptin, and ghrelin levels were measured; cortisol levels were pooled from serum samples obtained every 20 min from 2000 to 0800 h. RESULTS Cortisol and PYY levels were positively associated with disordered eating psychopathology including restraint, eating concerns, and body image disturbance, independent of body mass index (BMI). Although leptin levels were negatively associated with disordered eating psychopathology, these relationships were not significant after controlling for BMI. Ghrelin levels were generally not associated with EDE-Q or EDI-2 scores. CONCLUSIONS Higher levels of cortisol and PYY are associated with disordered eating psychopathology independent of BMI in women across the weight spectrum, suggesting that abnormalities in appetite regulation may be associated with specific eating disorder pathologies.
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Affiliation(s)
- Elizabeth A Lawson
- Neuroendocrine Unit, Bulfinch 457B Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Germain N, Galusca B, Grouselle D, Frere D, Billard S, Epelbaum J, Estour B. Ghrelin and obestatin circadian levels differentiate bingeing-purging from restrictive anorexia nervosa. J Clin Endocrinol Metab 2010; 95:3057-62. [PMID: 20339027 DOI: 10.1210/jc.2009-2196] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Anorexia nervosa (AN) patients present with restrictive food behavior (AN-R). Some of them develop episodes of bulimia (AN-BP) without any clear pathophysiological explanation to date. Their clinical differentiation is important but not easily performed. Orexigenic/anorexigenic peptides measurements could provide some clues for that matter. OBJECTIVE The objective of the study was to determine whether the circadian profile of total and acylated ghrelin, obestatin, and peptide YY (PYY) levels is different in AN-R subjects when compared with AN-BP patients. DESIGN AND SETTINGS This was a cross-sectional study in an endocrinological unit. PATIENTS AND CONTROL SUBJECTS Four groups of age-matched young women: 22 AN-R, 10 AN-BP, 16 normal-weight bulimia nervosa (BN), and nine controls. MAIN OUTCOME MEASURES Twelve-point circadian profiles of plasma total and acylated ghrelin, obestatin, and PYY were measured. RESULTS Total and acylated ghrelin and obestatin circadian levels were increased in AN-R when compared with controls but decreased in both AN-BP and BN groups (P < 0.001). PYY was decreased in all groups with eating disorders. Acylated to total ghrelin ratio was decreased in AN-BP and BN (P < 0.001), whereas obestatin to acylated ghrelin and PYY to acylated ghrelin ratios were increased in both groups with bingeing-purging behavior (P < 0.0001). CONCLUSIONS Patients with AN-associated bingeing-purging behavior present a very different profile of appetite regulatory peptides when compared with the pure restrictive type. The assessment of ghrelin (and eventually obestatin) could be of particular interest for differential diagnosis. Very low ghrelin levels and increased anorexigenic to orexigenic peptide ratios suggest either a lack of adaptation to a starvation state or a higher facility to cope with undernutrition.
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Affiliation(s)
- Natacha Germain
- Service d'Endocrinologie, Centre Hospitalier Universitaire, 42055 Saint Etienne, France
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22
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Sainsbury A, Zhang L. Role of the arcuate nucleus of the hypothalamus in regulation of body weight during energy deficit. Mol Cell Endocrinol 2010; 316:109-19. [PMID: 19822185 DOI: 10.1016/j.mce.2009.09.025] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 09/21/2009] [Accepted: 09/28/2009] [Indexed: 12/14/2022]
Abstract
Acute or long-term energy deficit in lean or obese rodents or humans stimulates food intake or appetite and reduces metabolic rate or energy expenditure. These changes contribute to weight regain in post-obese animals and humans. Some studies show that the reduction in metabolic rate with energy deficit in overweight people is transient. Energy restriction has been shown in some but not all studies to reduce physical activity, and this may represent an additional energy-conserving adaptation. Energy restriction up-regulates expression of the orexigenic neuropeptide Y, agouti related peptide and opioids and down-regulates that of the anorexigenic alpha-melanocyte stimulating hormone or its precursor pro-opioomelanocortin and the co-expressed cocaine and amphetamine-regulated transcript in the arcuate nucleus of the hypothalamus. Recapitulating these hypothalamic changes in sated animals mimics the effects of energy deficit, namely increased food intake, reduced physical activity and reduced metabolic rate, suggesting that these energy-conserving adaptations are at least partially mediated by the hypothalamus.
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Affiliation(s)
- A Sainsbury
- Neuroscience Research Program, Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW 2010, Australia.
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Lawson EA, Miller KK, Bredella MA, Phan C, Misra M, Meenaghan E, Rosenblum L, Donoho D, Gupta R, Klibanski A. Hormone predictors of abnormal bone microarchitecture in women with anorexia nervosa. Bone 2010; 46:458-63. [PMID: 19747572 PMCID: PMC2818221 DOI: 10.1016/j.bone.2009.09.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/01/2009] [Accepted: 09/04/2009] [Indexed: 11/15/2022]
Abstract
Osteopenia is a complication of anorexia nervosa (AN) associated with a two- to three-fold increase in fractures. Nutritional deficits and hormonal abnormalities are thought to mediate AN-induced bone loss. Alterations in bone microarchitecture may explain fracture risk independent of bone mineral density (BMD). Advances in CT imaging now allow for noninvasive evaluation of trabecular microstructure at peripheral sites in vivo. Few data are available regarding bone microarchitecture in AN. We therefore performed a cross-sectional study of 23 women (12 with AN and 11 healthy controls) to determine hormonal predictors of trabecular bone microarchitecture. Outcome measures included bone microarchitectural parameters at the ultradistal radius by flat-panel volume CT (fpVCT); BMD at the PA and lateral spine, total hip, femoral neck, and ultradistal radius by dual energy X-ray absorptiometry (DXA); and IGF-I, leptin, estradiol, testosterone, and free testosterone levels. Bone microarchitectural measures, including apparent (app.) bone volume fraction, app. trabecular thickness, and app. trabecular number, were reduced (p<0.03) and app. trabecular spacing was increased (p=0.02) in AN versus controls. Decreased structural integrity at the ultradistal radius was associated with decreased BMD at all sites (p<or=0.05) except for total hip. IGF-I, leptin, testosterone, and free testosterone levels predicted bone microarchitecture. All associations between both IGF-I and leptin levels and bone microarchitectural parameters and most associations between androgen levels and microarchitecture remained significant after controlling for body mass index. We concluded that bone microarchitecture is abnormal in women with AN. Endogenous IGF-I, leptin, and androgen levels predict bone microarchitecture independent of BMI.
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Affiliation(s)
- Elizabeth A Lawson
- Neuroendocrine Unit, Bulfinch 457B, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Eating disorders: the current status of molecular genetic research. Eur Child Adolesc Psychiatry 2010; 19:211-26. [PMID: 20033240 PMCID: PMC2839487 DOI: 10.1007/s00787-009-0085-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 12/04/2009] [Indexed: 12/31/2022]
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are complex disorders characterized by disordered eating behavior where the patient's attitude towards weight and shape, as well as their perception of body shape, are disturbed. Formal genetic studies on twins and families suggested a substantial genetic influence for AN and BN. Candidate gene studies have initially focused on the serotonergic and other central neurotransmitter systems and on genes involved in body weight regulation. Hardly any of the positive findings achieved in these studies were unequivocally confirmed or substantiated in meta-analyses. This might be due to too small sample sizes and thus low power and/or the genes underlying eating disorders have not yet been analyzed. However, some studies that also used subphenotypes (e.g., restricting type of AN) led to more specific results; however, confirmation is as yet mostly lacking. Systematic genome-wide linkage scans based on families with at least two individuals with an eating disorder (AN or BN) revealed initial linkage regions on chromosomes 1, 3 and 4 (AN) and 10p (BN). Analyses on candidate genes in the chromosome 1 linkage region led to the (as yet unconfirmed) identification of certain variants associated with AN. Genome-wide association studies are under way and will presumably help to identify genes and pathways involved in these eating disorders. The elucidation of the molecular mechanisms underlying eating disorders might improve therapeutic approaches.
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Hinney A, Scherag S, Hebebrand J. Genetic findings in anorexia and bulimia nervosa. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2010; 94:241-70. [PMID: 21036328 DOI: 10.1016/b978-0-12-375003-7.00009-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are complex disorders associated with disordered eating behavior. Heritability estimates derived from twin and family studies are high, so that substantial genetic influences on the etiology can be assumed for both. As the monoaminergic neurotransmitter systems are involved in eating disorders (EDs), candidate gene studies have centered on related genes; additionally, genes relevant for body weight regulation have been considered as candidates. Unfortunately, this approach has yielded very few positive results; confirmed associations or findings substantiated in meta-analyses are scant. None of these associations can be considered unequivocally validated. Systematic genome-wide approaches have been performed to identify genes with no a priori evidence for their relevance in EDs. Family-based scans revealed linkage peaks in single chromosomal regions for AN and BN. Analyses of candidate genes in one of these regions led to the identification of genetic variants associated with AN. Currently, an international consortium is conducting a genome-wide association study for AN, which will hopefully lead to the identification of the first genome-wide significant markers.
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Affiliation(s)
- Anke Hinney
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany
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Frassetto SS, Bitencourt GOD. Aspectos da leptina na anorexia nervosa: possíveis efeitos benéficos no tratamento da hiperatividade. REV NUTR 2009. [DOI: 10.1590/s1415-52732009000500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pesquisas recentes demonstram a relação direta da leptina na regulação do balanço energético e como um dos fatores envolvidos em transtornos alimentares. Com ação no sistema nervoso central, a leptina interfere na ingestão alimentar, no metabolismo da glicose, no peso corporal, na produção de hormônios sexuais e na atividade física. As pesquisas realizadas tanto em seres humanos como em animais demonstram que a queda nos níveis de leptina está relacionada aos sintomas apresentados na anorexia nervosa: a baixa ingestão alimentar, a perda excessiva de peso corporal, a amenorréia e a hiperatividade. Assim, o grau de hipoleptinemia não é apenas uma forte indicação de baixa reserva de tecido adiposo, mas também de severa desordem, sendo que os níveis de leptina podem ser utilizados para avaliar melhor a gravidade da doença. Pesquisas estão sendo realizadas com o objetivo de discutir a possibilidade de utilização da leptina como coadjuvante no tratamento de pacientes com anorexia nervosa para a diminuição da hiperatividade. Acredita-se que o tratamento com leptina associado à medicação e à psicoterapia, poderia ser benéfico em pacientes anoréxicas extremamente ativas, deixando-as mais suscetíveis ao tratamento adicional. Uma realimentação suficiente, a medicação, a psicoterapia e um ambiente acolhedor durante o tratamento com leptina devem ser assegurados. Assim, este artigo tem como objetivo discorrer sobre a leptina e aspectos relacionados à anorexia, e discutir como esta informação pode ser importante na avaliação clínica de pacientes com este transtorno alimentar.
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Green MA, Hallengren JJ, Davids CM, Riopel CM, Skaggs AK. An association between eating disorder behaviors and autonomic dysfunction in a nonclinical population. A pilot study. Appetite 2009; 53:139-42. [DOI: 10.1016/j.appet.2009.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 05/04/2009] [Accepted: 05/07/2009] [Indexed: 11/16/2022]
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Yoshizawa M, Tashiro M, Fukudo S, Yanai K, Utsumi A, Kano M, Karahasi M, Endo Y, Morisita J, Sato Y, Adachi M, Itoh M, Hongo M. Increased brain histamine H1 receptor binding in patients with anorexia nervosa. Biol Psychiatry 2009; 65:329-35. [PMID: 18814859 DOI: 10.1016/j.biopsych.2008.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 08/04/2008] [Accepted: 08/04/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND The central histaminergic neuron system modulates various brain functions, including eating behavior. We hypothesized that women have higher density of histamine H1 receptor (H1R) in the limbic system than men and that the density of central H1R is increased in patients with anorexia nervosa (AN). METHODS Subjects were 12 female AN patients, 12 healthy female subjects, and 11 healthy male subjects. Positron emission tomography with H1R radioligand [(11)C]doxepin was performed on all subjects and regions of interest based analysis was conducted to evaluate brain H1R binding potential (BP). Abnormal eating behavior, depression, and anxiety of subjects were evaluated using the Eating Attitude Test-26 (EAT-26), Self-Rating Depression Scale (SDS), and State-Trait Anxiety Inventory (STAI), respectively. RESULTS Binding potential of [(11)C]doxepin in female subjects was significantly higher than that in male subjects at the following brain sites: amygdala, hippocampus, medial prefrontal cortex, orbitofrontal cortex, and temporal cortex. Anorexia nervosa patients showed significantly higher BP of [(11)C]doxepin in the amygdala and lentiform nucleus than the control female subjects. In AN patients, BP of [(11)C]doxepin in the amygdala and thalamus negatively correlated with EAT-26 scores. There was a significant negative correlation between BP of [(11)C]doxepin and SDS or STAI scores in the amygdala, anterior cingulate cortex, and orbitofrontal cortex of AN patients. CONCLUSIONS These findings support the hypothesis that women have higher H1R density in the limbic system than men and suggest that AN patients may have higher expression of H1R in the limbic brain, particularly in the amygdala.
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Affiliation(s)
- Masahiko Yoshizawa
- Department of Psychosomatic Medicine, Tohoku University School of Medicine, Japan
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Södersten P, Nergårdh R, Bergh C, Zandian M, Scheurink A. Behavioral neuroendocrinology and treatment of anorexia nervosa. Front Neuroendocrinol 2008; 29:445-62. [PMID: 18602416 DOI: 10.1016/j.yfrne.2008.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 05/29/2008] [Accepted: 06/06/2008] [Indexed: 12/20/2022]
Abstract
Outcome in anorexia nervosa remains poor and a new way of looking at this condition is therefore needed. To this aim, we review the effects of food restriction and starvation in humans. It is suggested that body weight remains stable and relatively low when the access to food requires a considerable amount of physical activity. In this condition, the human homeostatic phenotype, body fat content is also low and as a consequence, the synthesis and release of brain neurotransmitters are modified. As an example, the role of neuropeptide Y is analyzed in rat models of this state. It is suggested that the normal behavioral role of neuropeptide Y is to facilitate the search for food and switch attention from sexual stimuli to food. Descriptive neuroendocrine studies on patients with anorexia nervosa have not contributed to the management of the patients and the few studies in which hormones have been administered have, at best, reversed an endocrine consequence secondary to starvation. In a modified framework for understanding the etiology and treatment of anorexia nervosa it is suggested that the condition emerges because neural mechanisms of reward and attention are engaged. The neural neuropeptide Y receptor system may be involved in the maintenance of the behavior of eating disorder patients because the localization of these receptors overlaps with the neural systems engaged in cue-conditioned eating in limbic and cortical areas. The eating behavior of patients with anorexia nervosa, and other eating disorders as well, is viewed as a cause of the psychological changes of the patients. Patients are trained to re-learn normal eating habits using external support and as they do, their symptoms, including the psychological symptoms, dissolve.
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Affiliation(s)
- P Södersten
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, AB Mando Novum, S-141 57 Huddinge, Sweden.
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30
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Endocrine abnormalities in anorexia nervosa. ACTA ACUST UNITED AC 2008; 4:407-14. [PMID: 18542109 DOI: 10.1038/ncpendmet0872] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 04/30/2008] [Indexed: 12/23/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric disease associated with notable medical complications and increased mortality. Endocrine abnormalities, including hypogonadotropic hypogonadism, hypercortisolemia, growth hormone resistance and sick euthyroid syndrome, mediate the clinical manifestations of this disease. Alterations in anorexigenic and orexigenic appetite-regulating pathways have also been described. Decreases in fat mass result in adipokine abnormalities. Although most of the endocrine changes that occur in AN represent physiologic adaptation to starvation, some persist after recovery and might contribute to susceptibility to AN recurrence. In this Review, we summarize key endocrine alterations in AN, with a particular focus on the profound bone loss that can occur in this disease. Although AN is increasingly prevalent among boys and men, the disorder predominantly affects girls and women who are, therefore, the focus of this Review.
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Monteleone P, Castaldo E, Maj M. Neuroendocrine dysregulation of food intake in eating disorders. ACTA ACUST UNITED AC 2008; 149:39-50. [PMID: 18582958 DOI: 10.1016/j.regpep.2007.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 10/25/2007] [Indexed: 10/22/2022]
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are psychiatric disorders characterized by abnormal eating behaviors and imbalance of energy homeostasis. Changes of both central and peripheral neuroendocrine substances involved in the modulation of food intake and energy expenditure have been described in acutely ill patients with eating disorders. This review selectively focuses on the most recent findings supporting abnormal changes in the physiology of some peripheral adipokines and gut-secreted peptides, brain-derived neurotrophic factor and endocannabinoids in patients with AN or BN. Literature data do suggest a dysregulation of these neuroendocrine feeding regulators but, at the moment, they do not allow to establish the state or trait-dependent nature of those aberrations. It has been proposed, although not definitively proved, that neuroendocrine alterations, even when secondary to malnutrition and/or to aberrant eating behaviors, might contribute to the genesis and the maintenance of some symptomatic aspects of AN and BN, thus affecting the course and the prognosis of these disorders. Future studies should clarify whether neuroendocrine alterations are part of the genetically transmitted biological vulnerability to eating disorders.
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Affiliation(s)
- Palmiero Monteleone
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
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Connan F, Troop N, Landau S, Campbell IC, Treasure J. Poor social comparison and the tendency to submissive behavior in anorexia nervosa. Int J Eat Disord 2007; 40:733-9. [PMID: 17610250 DOI: 10.1002/eat.20427] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to confirm an association between low social rank (SR) and anorexia nervosa (AN), and to test the hypotheses that low SR is (a) present after recovery from the illness, (b) mediates an association between increased childhood interpersonal adversity (CIA) and AN. METHOD Participants were 18 women with active AN, 13 recovered women, and 16 healthy controls. General and specific psychopathology, childhood adversity, and indices of SR were assessed using self-report measures. RESULTS Low SR was observed in both the active and the recovered AN groups and was a significant mediator in the relationship between CIA and AN status. CONCLUSION CIA may contribute to the risk of developing AN via its impact on the development of low SR. The latter may be a shared risk factor for AN and affective disorder, and could be a useful therapeutic target.
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Affiliation(s)
- Frances Connan
- Institute of Psychiatry, Kings College London, London, SE5 8AF, United Kingdom.
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Nergårdh R, Ammar A, Brodin U, Bergström J, Scheurink A, Södersten P. Neuropeptide Y facilitates activity-based-anorexia. Psychoneuroendocrinology 2007; 32:493-502. [PMID: 17467917 DOI: 10.1016/j.psyneuen.2007.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 03/02/2007] [Accepted: 03/03/2007] [Indexed: 10/23/2022]
Abstract
The hypothesis that treatment with neuropeptide Y (NPY) can increase running activity and decrease food intake and body weight was tested. Female rats with a running wheel lost more weight than sedentary rats and ran progressively more as the availability of food was gradually reduced. When food was available for only 1h/day, the rats lost control over body weight. Correlatively, the level of NPY mRNA was increased in the hypothalamic arcuate nucleus. This phenomenon, activity-based-anorexia, was enhanced by intracerebroventricular infusion of NPY in rats which had food available during 2h/day. By contrast, NPY stimulated food intake but not wheel running in rats which had food available continuously. These findings are inconsistent with the prevailing theory of the role of the hypothalamus in the regulation of body weight according to which food intake is a homeostatic process controlled by "orexigenic" and "anorexigenic" neural networks. However, the finding that treatment with NPY, generally considered an "orexigen", can increase physical activity and decrease food intake and cause a loss of body weight is in line with the clinical observation that patients with anorexia nervosa are physically hyperactive and eat only little food despite having depleted body fat and up-regulated hypothalamic "orexigenic" peptides.
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Affiliation(s)
- R Nergårdh
- Section of Molecular Neuropharmacology, Department of Physiology and Pharmacology, Karolinska Institutet, S-171 77 Stockholm, Sweden
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Otto B, Cuntz U, Otto C, Heldwein W, Riepl RL, Tschöp MH. Peptide YY release in anorectic patients after liquid meal. Appetite 2007; 48:301-4. [PMID: 17157959 DOI: 10.1016/j.appet.2006.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 06/27/2006] [Accepted: 06/28/2006] [Indexed: 12/25/2022]
Abstract
Fasting and postprandial levels of human peptide YY (PYY) were recently found to be lower in obesity. To investigate whether PYY levels are correspondingly high in patients with anorexia nervosa, PYY concentrations were analyzed under basal conditions and in response to a liquid meal. We investigated PYY plasma levels in 16 female anorectic (BMI 15.2+/-0.3 kg/m2) and seven lean subjects (BMI 21.3+/-0.6 kg/m2) before and after ingestion of a liquid meal (250 kcal; 15% protein, 55% carbohydrates, and 30% fat). PYY levels were analyzed using PYY ELISA (DSL, USA). Values are given as mean+/-SEM. Basal PYY levels in anorectic patients (89.0+/-14.4 pg/mL) were not significantly different from lean subjects (64.1+/-12.1 pg/mL). Postprandial PYY levels in healthy volunteers increased significantly after 20 and 60 min (80.4+/-12.7 and 96.0+/-19.9 pg/mL, respectively). In anorectic women PYY was increased at 20 min (137.9+/-19.5 pg/mL) and at 60 min (151.3+/-19.2 pg/mL). No difference was found between both groups. We conclude that basal and postprandial PYY levels in normal weight women are not different from anorectic patients. We could not confirm the recently published blunted postprandial PYY response in anorexia, a finding that merits further study.
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Affiliation(s)
- B Otto
- Medical Department, University Hospital-Innenstadt, Ziemssenstr. 1, D-80336 Munich, Germany.
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Kinzig KP, Coughlin JW, Redgrave GW, Moran TH, Guarda AS. Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration. Am J Physiol Endocrinol Metab 2007; 292:E1441-6. [PMID: 17264227 DOI: 10.1152/ajpendo.00347.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prolonged malnutrition in individuals with anorexia nervosa (AN) has been associated with alterations in endocrine function that may play a sustaining role in the disorder. We hypothesized that abnormalities in endocrine responses to ingestion of a meal in AN are reversible and depend on weight restoration. We measured meal-induced endocrine responses in AN subjects at three time points during hospitalization: before refeeding (n = 13, mean BMI 16.7 kg/m(2)), after 2 wk of refeeding (mean BMI 18.0 kg/m(2)), and in the weight-restored state (mean BMI 20.3 kg/m(2)). Control subjects (n = 13, BMI 19-24.9 kg/m(2)) were tested once. Tests were 2.5-h sessions in which blood was drawn every 15 min before, during, and after a approximately 650-kcal test breakfast. Relative to controls, peak levels of glucose were depressed and peak levels of insulin in response to ingestion of the test meal were delayed, with response patterns in the third trial most similar to controls. Pancreatic polypeptide (PP) levels were increased in AN relative to controls regardless of weight status. The delay in insulin release and elevated PP levels did not correct with short-term refeeding and may contribute to the high relapse rates and maintenance of AN.
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Affiliation(s)
- Kimberly P Kinzig
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana 47907, USA.
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Germain N, Galusca B, Le Roux CW, Bossu C, Ghatei MA, Lang F, Bloom SR, Estour B. Constitutional thinness and lean anorexia nervosa display opposite concentrations of peptide YY, glucagon-like peptide 1, ghrelin, and leptin. Am J Clin Nutr 2007; 85:967-71. [PMID: 17413094 DOI: 10.1093/ajcn/85.4.967] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Food intake is controlled by the arcuate nucleus through integration of peripheral hormonal signals such as leptin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). The most common condition resulting in underweight young women in the developed world is restrictive anorexia nervosa (AN). However, constitutional thinness (CT) is also known to exist in the same low-weight range. Women with CT have normal menstrual periods and do not have the psychological or hormonal features of AN. Little is currently known about regulation of food intake in subjects with CT. OBJECTIVE We tested the hypothesis that concentrations of leptin, ghrelin, PYY, and GLP-1 in persons with AN are significantly different from those in persons with CT. DESIGN Concentrations of PYY, GLP-1, ghrelin, and leptin were measured in 3 groups of young women: normal weight (n = 7), CT (n = 10), and AN (n = 12). Samples were collected every 4 h for 24 h. RESULTS PYY concentrations were significantly higher in CT subjects than in AN or control subjects. GLP-1 concentrations were significantly higher in AN than in CT subjects, whereas ghrelin was significantly higher in AN subjects than in control and CT subjects. CT subjects had the lowest ghrelin concentrations. Leptin concentrations were significantly lower in AN subjects. PYY and leptin circadian variations were not significantly different between CT and control subjects, whereas these profiles were blunted in AN subjects. CONCLUSIONS Orexigenic and anorexigenic hormones in CT contrast with an adaptative profile characterizing AN. The hormones appear to be valuable biomarkers for distinguishing these 2 categories of severely underweight subjects.
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Affiliation(s)
- Natacha Germain
- Departments of Endocrinology and Psychiatry, CHU Saint Etienne, St Etienne, France, and Endocrine Unit, Imperial College Faculty of Medicine, Hammersmith Hospital, London, United Kingdom
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Södersten P, Bergh C, Zandian M. Understanding eating disorders. Horm Behav 2006; 50:572-8. [PMID: 16890228 DOI: 10.1016/j.yhbeh.2006.06.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 06/20/2006] [Accepted: 06/21/2006] [Indexed: 11/15/2022]
Abstract
The outcome in eating disorders remains poor and commonly used methods of treatment have little, if any effect. It is suggested that this situation has emerged because of the failure to realize that the symptoms of eating disorder patients are epiphenomena to starvation and the associated disordered eating. Humans have evolved to cope with the challenge of starvation and the neuroendocrine mechanisms that have been under this evolutionary pressure are anatomically versatile and show synaptic plasticity to allow for flexibility. Many of the neuroendocrine changes in starvation are responses to the externally imposed shortage of food and the associated neuroendocrine secretions facilitate behavioral adaptation as needed rather than make an individual merely eat more or less food. A parsimonious, neurobiologically realistic explanation why eating disorders develop and why they are maintained is offered. It is suggested that the brain mechanisms of reward are activated when food intake is reduced and that disordered eating behavior is subsequently maintained by conditioning to the situations in which the disordered eating behavior developed via the neural system for attention. In a method based on this framework, patients are taught how to eat normally, their physical activity is controlled and they are provided with external heat. The method has been proven effective in a randomized controlled trial.
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Affiliation(s)
- Per Södersten
- Karolinska Institutet, Section of Applied Neuroendocrinology, Center for Eating Disorders, AB Mando, Novum, S-141 57 Huddinge, Sweden.
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Abstract
The role of gastrointestinal hormones in the regulation of appetite is reviewed. The gastrointestinal tract is the largest endocrine organ in the body. Gut hormones function to optimize the process of digestion and absorption of nutrients by the gut. In this capacity, their local effects on gastrointestinal motility and secretion have been well characterized. By altering the rate at which nutrients are delivered to compartments of the alimentary canal, the control of food intake arguably constitutes another point at which intervention may promote efficient digestion and nutrient uptake. In recent decades, gut hormones have come to occupy a central place in the complex neuroendocrine interactions that underlie the regulation of energy balance. Many gut peptides have been shown to influence energy intake. The most well studied in this regard are cholecystokinin (CCK), pancreatic polypeptide, peptide YY, glucagon-like peptide-1 (GLP-1), oxyntomodulin and ghrelin. With the exception of ghrelin, these hormones act to increase satiety and decrease food intake. The mechanisms by which gut hormones modify feeding are the subject of ongoing investigation. Local effects such as the inhibition of gastric emptying might contribute to the decrease in energy intake. Activation of mechanoreceptors as a result of gastric distension may inhibit further food intake via neural reflex arcs. Circulating gut hormones have also been shown to act directly on neurons in hypothalamic and brainstem centres of appetite control. The median eminence and area postrema are characterized by a deficiency of the blood-brain barrier. Some investigators argue that this renders neighbouring structures, such as the arcuate nucleus of the hypothalamus and the nucleus of the tractus solitarius in the brainstem, susceptible to influence by circulating factors. Extensive reciprocal connections exist between these areas and the hypothalamic paraventricular nucleus and other energy-regulating centres of the central nervous system. In this way, hormonal signals from the gut may be translated into the subjective sensation of satiety. Moreover, the importance of the brain-gut axis in the control of food intake is reflected in the dual role exhibited by many gut peptides as both hormones and neurotransmitters. Peptides such as CCK and GLP-1 are expressed in neurons projecting both into and out of areas of the central nervous system critical to energy balance. The global increase in the incidence of obesity and the associated burden of morbidity has imparted greater urgency to understanding the processes of appetite control. Appetite regulation offers an integrated model of a brain-gut axis comprising both endocrine and neurological systems. As physiological mediators of satiety, gut hormones offer an attractive therapeutic target in the treatment of obesity.
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Affiliation(s)
| | | | - Steve Bloom
- Department of Metabolic Medicine, Imperial College Faculty of MedicineHammersmith Hospital, Du Cane Road, London W12 ONN, UK
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Hermsdorff HHM, Vieira MADQM, Monteiro JBR. Leptina e sua influência na patofisiologia de distúrbios alimentares. REV NUTR 2006. [DOI: 10.1590/s1415-52732006000300008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A leptina é uma proteína secretada pelos adipócitos com papel regulador em vários sistemas do organismo, como sistema imune, respiratório e reprodutivo, bem como no balanço energético via ação hipotalâmica. Sua ação primária ocorre no núcleo hipotalâmico arqueado, no qual inicia uma cascata de eventos para inibição da ingestão energética e aumento do gasto energético. As concentrações de leptina são influenciadas pela adiposidade, fatores hormonais e nutricionais. A restrição e os episódios de compulsão alimentar, presentes na anorexia nervosa e bulimia, respectivamente, são considerados, na literatura científica, fatores determinantes na leptinemia. Seus níveis também alterados no tratamento desses distúrbios alimentares sugerem uma relação entre as alterações neuroendócrinas e conseqüentes modificações nos sinais de fome e saciedade, com a patogenia ou manutenção dos quadros clínicos. Trabalhos têm encontrado impacto dessas alterações na saúde dos pacientes, em curto e longo prazos. Esta revisão tem como objetivo esclarecer quais são as funções da leptina nos tecidos nervoso e periférico, quais os mecanismos que interferem na sua concentração nos distúrbios alimentares e como isso reflete na saúde do paciente anoréxico ou bulímico.
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Abstract
BACKGROUND Anorexia Nervosa (AN) is an illness characterised by extreme concern about body weight and shape, severe self-imposed weight loss, and endocrine dysfunction. In spite of its high mortality, morbidity and chronicity, there are few intervention studies on the subject. OBJECTIVES The aim of this review was to evaluate the efficacy and acceptability of antidepressant drugs in the treatment of acute AN. SEARCH STRATEGY The strategy comprised of database searches of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, MEDLINE (1966 to April 28th, 2005), EMBASE (1980 to week 36, 2004), PsycINFO (1969 to August week 5, 2004), handsearching the International Journal of Eating Disorders and searching the reference lists of all papers selected. Personal letters were sent to researchers in the field requesting information on unpublished or in-progress trials. SELECTION CRITERIA All randomised controlled trials of antidepressant treatment for AN patients, as defined by the Diagnostic and Statistical Manual, fourth edition (DSM-IV) or similar international criteria, were selected. DATA COLLECTION AND ANALYSIS Quality ratings were made giving consideration to the strong relationship between allocation concealment and potential for bias in the results; studies meeting criteria A and B were included. Trials were excluded if non-completion rates were above 50%. The standardised mean difference and relative risk were used for continuous data and dichotomous data comparisons, respectively. Whenever possible, analyses were performed according to intention-to-treat principles. Heterogeneity was tested with the I-squared statistic. Weight change was the primary outcome. Secondary outcomes were severity of eating disorder, depression and anxiety symptoms, and global clinical state. Acceptability of treatment was evaluated by considering non-completion rates. MAIN RESULTS Only seven studies were included. Major methodological limitations such as small trial size and large confidence intervals decreased the power of the studies to detect differences between treatments, and meta-analysis of data was not possible for the majority of outcomes. Four placebo-controlled trials did not find evidence that antidepressants improved weight gain, eating disorder or associated psychopathology. Isolated findings, favouring amineptine and nortriptyline, emerged from the antidepressant versus antidepressant comparisons, but cannot be conceived as evidence of efficacy of a specific drug or class of antidepressant in light of the findings from the placebo comparisons. Non-completion rates were similar between the compared groups. AUTHORS' CONCLUSIONS A lack of quality information precludes us from drawing definite conclusions or recommendations on the use of antidepressants in acute AN. Future studies testing safer and more tolerable antidepressants in larger, well designed trials are needed to provide guidance for clinical practice.
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Affiliation(s)
- A M Claudino
- Federal University of São Paulo - UNIFESP / Escola Paulista de Me, Department of Psychiatry, Rua dos Otonis 887, São Paulo, SP Brazil, CEP 04025 002.
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Roerig JL, Mitchell JE, Steffen KJ. New targets in the treatment of anorexia nervosa. Expert Opin Ther Targets 2005; 9:135-51. [PMID: 15757487 DOI: 10.1517/14728222.9.1.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pathophysiology of anorexia nervosa (AN) is complex and involves alterations of serotonin, dopamine and histamine neurotransmitters. In addition, receptor activity is disturbed, presumably in response to the neurotransmitter changes. These alterations are reviewed in relation to symptomatology and outcome of AN. Neuropeptide and peripheral orexigenic and satiety peptide research is in its infancy but holds much promise to shed light on the pathophysiological mechanisms involved in this illness. Current drug therapies have not demonstrated the efficacy desired in the treatment of AN. Current therapies are reviewed and new drug targets are explored. Compounds that interact with serotonin, histamine and dopamine receptors may offer unique treatment opportunities. In the future, the manipulation of peptides may add to the therapeutic potential of pharmacotherapy.
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Affiliation(s)
- James L Roerig
- University of North Dakota, Department of Clinical Neuroscience, School of Medicine and Health Sciences, Grand Forks, USA.
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Stock S, Leichner P, Wong ACK, Ghatei MA, Kieffer TJ, Bloom SR, Chanoine JP. Ghrelin, peptide YY, glucose-dependent insulinotropic polypeptide, and hunger responses to a mixed meal in anorexic, obese, and control female adolescents. J Clin Endocrinol Metab 2005; 90:2161-8. [PMID: 15657373 DOI: 10.1210/jc.2004-1251] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To determine whether peptide YY (PYY), ghrelin, glucose-dependent insulinotropic polypeptide (GIP), and satiety responses to food intake are impaired in anorexia or obesity, we studied 30 female adolescents with anorexia nervosa [body mass index (BMI) 16.3 kg/m2], obesity (BMI 34.3 kg/m2), or normal weight (BMI 20.2 kg/m2). PYY, ghrelin, GIP, insulin, and glucose concentrations and four markers of satiety were measured for 240 min after a mixed meal. The area under the curve for glucose was similar in obese (OB) and normal-weight control (C) subjects but was 15% lower in anorexic (AN) subjects. The area under the curve for insulin was 47% lower in AN and 87% higher in OB subjects, compared with C subjects. After the meal, PYY increased significantly in C (+41%, P < 0.05) but not in AN or OB adolescents. Ghrelin concentrations were highest in AN subjects and lowest in the OB group, compared with C subjects and fell significantly by 25% in all three groups. GIP concentrations were lower in AN subjects throughout the test and increased in all three groups after the mixed meal. AN adolescents reported being less hungry than OB and C adolescents. There was a negative correlation between fasting ghrelin (but not PYY or GIP) and BMI and insulin (r2= 0.33) and a positive correlation between the decrease in hunger 15 min after the meal and PYY concentrations at 15 min (r2= 0.20). In conclusion, the blunted PYY response to a meal in OB adolescents suggests that PYY plays a role in the pathophysiology of obesity. Ghrelin is unlikely to play a causal role in anorexia nervosa or obesity. The lower GIP observed in AN subjects despite a similar caloric intake may appropriately prevent an excessive insulin response in these patients.
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Affiliation(s)
- Sue Stock
- Endocrinology and Diabetes Unit, Room K4-212, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada
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Kojima S, Nakahara T, Nagai N, Muranaga T, Tanaka M, Yasuhara D, Masuda A, Date Y, Ueno H, Nakazato M, Naruo T. Altered ghrelin and peptide YY responses to meals in bulimia nervosa. Clin Endocrinol (Oxf) 2005; 62:74-8. [PMID: 15638873 DOI: 10.1111/j.1365-2265.2004.02176.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In recent years great advances have been made in our understanding of the peripheral signals produced within the gastrointestinal tract that regulate appetite, such as ghrelin and peptide YY (PYY). While ghrelin elicites hunger signals, PYY elicites satiety. Therefore, alterations in hormone physiology may play a role in the pathogenesis of bulimia nervosa (BN). In this study, we investigated the postprandial profile of ghrelin and PYY levels in patients with BN. DESIGN AND PATIENTS Postprandial plasma ghrelin and PYY levels and insulin and glucose responses were measured in 10 patients with BN and 12 control patients in response to a standard 400 kcal meal. RESULTS Basal ghrelin levels present in BN subjects (265.0 +/- 25.5 pmol/l) were significantly higher than those in healthy controls (199.3 +/- 18.4 pmol/l, P < 0.05), while basal PYY levels were equivalent in BN (14.6 +/- 1.3 pmol/l) and control (12.8 +/- 1.1 pmol/l, P = 0.30) subjects. Postprandial ghrelin suppression (decremental ghrelin area under the curve) was significantly attenuated in BN patients, compared to controls (-96.3 +/- 26.8 pmol/l x 3 h vs. -178.2 +/- 25.7 pmol/l x 3 h, P < 0.05). After a meal, the incremental PYY area under the curve in BN patients was significantly blunted from that observed in controls (9.2 +/- 2.6 pmol/l x 3 h vs. 26.8 +/- 3.2 pmol/l x 3 h, P < 0.01). Glucose and insulin responses to meals were similar between the two groups. CONCLUSIONS BN patients exhibit elevated ghrelin levels before meals with reduced ghrelin suppression after eating. In bulimia nervosa subjects, the rise in PYY levels after meals is also blunted. A gut-hypothalamic pathway involving peripheral signals, such as ghrelin and PYY, may be involved in the pathophysiology of BN.
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Affiliation(s)
- Shinya Kojima
- Division of Behavioural Medicine, Department of Social Science and Behavioural Medicine, Course for Health Science, Kagoshima University Graduate School of Medicine and Dental Science, Kagoshima, Japan.
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Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders of eating and weight-related behavior that together afflict some 1-3% of women in the United States. One of the remarkable features about each of the eating disorders is how persistent the disordered eating behavior becomes once it has begun. Substantial psychological, social, and physiological disturbances are associated with eating disorders, and it has been very difficult to disentangle those factors that may result from the disturbed behavior from the factors that may have predisposed individuals to, or precipitated the development of, the disorder. This article will briefly review the definitions, phenomenology, and identified risk factors for development of each of the major eating disorders. Pathophysiology will be discussed, with a particular focus on candidate factors that might sustain disordered eating behavior, as informed by clinical and basic science research. Future research directions will be suggested.
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Affiliation(s)
- Diane Alix Klein
- Columbia University/NYSPI, Unit #98, 1051 Riverside Drive, New York, NY 10032, USA.
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Abstract
Leptin is an adipocyte-derived hormone, which is involved predominantly in the long-term regulation of body weight and energy balance by acting as a hunger suppressant signal to the brain. Leptin is also involved in the modulation of reproduction, immune function, physical activity, and some endogenous endocrine axes. Since anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by abnormal eating behaviors, dysregulation of endogenous endocrine axes, alterations of reproductive and immune functions, and increased physical activity, extensive research has been carried out in the last decade in order to ascertain a role of this hormone in the pathophysiology of these syndromes. In this article, we review the available data on leptin physiology in patients with eating disorders. These data support the idea that leptin is not directly involved in the etiology of AN or BN. However, malnutrition-induced alterations in its physiology may contribute to the genesis and/or the maintenance of some clinical manifestations of AN and BN and may have an impact on the prognosis of AN.
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Affiliation(s)
- Palmiero Monteleone
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
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Abstract
The past decade has witnessed a dramatic acceleration in research on the role of the neuropeptides in the regulation of eating behavior and body weight homeostasis. This expanding research focus has been driven in part by increasing public health concerns related to obesity and the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN). Preclinical advances have been facilitated by the development of new molecular and behavioral research methodologies. With a focus on clinical investigations in AN and BN, this article reviews research on selected hypothalamic and gut-related peptide systems with prominent effects on eating behavior. Studies of the orexigenic peptides neuropeptide Y and the opioid peptides have shown state-related abnormalities in patients with eating disorders. With respect to gut-related peptides, there appears to be substantial evidence for blunting in the meal-related release of the satiety promoting peptide cholecystokinin in BN. Fasting plasma levels of the orexigenic peptide ghrelin have been found to be elevated in patients with AN. As discussed in this review, additional studies will be needed to assess the role of nutritional and body weight changes in neuropeptide alterations observed in symptomatic eating disorder patients, and to identify stable trait-related abnormalities in neuropeptide regulation that persist in individuals who have recovered from an eating disorder.
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Affiliation(s)
- David C Jimerson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Abstract
Anorexia nervosa (AN) is commonly attributed to psychological conflicts, attempts to be fashionably slender, neuroendocrine dysfunction, or some combination of these factors. Considerable research reveals these theories to be incomplete. Psychological and societal factors account for the decision to diet but not for the phenomenology of the disorder; theories of biological defects fail to explain neuroendocrine findings that suggest coordinated physiological mechanisms. This article presents evidence that AN's distinctive symptoms of restricting food, denial of starvation, and hyperactivity are likely to be evolved adaptive mechanisms that facilitated ancestral nomadic foragers leaving depleted environments; genetically susceptible individuals who lose too much weight may trigger these archaic adaptations. This hypothesis accounts for the occurrence of AN-like syndromes in both humans and animals and is consistent with changes observed in the physiology, cognitions, and behavior of patients with AN.
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Abstract
Eating disorders, i.e. anorexia and bulimia nervosa, are disorders of eating behavior and body weight regulation. Most likely because there are few, if any, effective treatments, eating disorders are considered to be chronic disorders interrupted only by intermittent periods of short-lived remission. The neurobiology of eating, most of which explores hypothalamic mechanisms, has had no influence on the treatment of eating disorders, with the exception of psychopharmacology. However, while most patients are treated with psychoactive drugs, there is no evidence that these are effective. This may be because pharmacological attempts so far have targeted the wrong symptoms. We review the symptomatology of anorexia and bulimia and the outcome of presently used interventions. Everybody agrees that outcome must improve and to attack this clinical problem, we suggest a neurobiologically plausible framework for how the disorders develop and how they are maintained and outline a method of treatment and its results.
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Affiliation(s)
- Per Södersten
- Section of Applied Neuroendocrinology, AB Mando, Center for Eating Disorders, Karolinska Institutet, Novum, S-141 57, Huddinge, Sweden.
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Pohl A, Nordin C. Body mass index influences plasma concentration of neuropeptide Y in healthy female volunteers: a pilot study. Gynecol Endocrinol 2003; 17:409-12. [PMID: 14710589 DOI: 10.1080/09513590312331290308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Neuropeptide Y (NPY) was measured in plasma obtained from healthy female volunteers twice in the natural menstrual cycle or the hormonal cycle caused by oral contraceptives about 2 weeks apart. The ratio between the NPY plasma concentration in the second sample and the first sample was influenced negatively by body mass index (BMI). There were no differences in NPY plasma concentrations on comparing the first and second samples. Age and the use or non-use of oral contraceptives did not exert any influence. BMI might be a confounding factor when determining NPY in the plasma of healthy women.
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Affiliation(s)
- A Pohl
- Division of Psychiatry, Department of Neuroscience and Locomotion, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden
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