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Pan S, A.C. Souza L, Worker CJ, Reyes Mendez ME, Gayban AJB, Cooper SG, Sanchez Solano A, Bergman RN, Stefanovski D, Morton GJ, Schwartz MW, Feng Earley Y. (Pro)renin receptor signaling in hypothalamic tyrosine hydroxylase neurons is required for obesity-associated glucose metabolic impairment. JCI Insight 2024; 9:e174294. [PMID: 38349753 PMCID: PMC11063935 DOI: 10.1172/jci.insight.174294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Glucose homeostasis is achieved via complex interactions between the endocrine pancreas and other peripheral tissues and glucoregulatory neurocircuits in the brain that remain incompletely defined. Within the brain, neurons in the hypothalamus appear to play a particularly important role. Consistent with this notion, we report evidence that (pro)renin receptor (PRR) signaling within a subset of tyrosine hydroxylase (TH) neurons located in the hypothalamic paraventricular nucleus (PVNTH neurons) is a physiological determinant of the defended blood glucose level. Specifically, we demonstrate that PRR deletion from PVNTH neurons restores normal glucose homeostasis in mice with diet-induced obesity (DIO). Conversely, chemogenetic inhibition of PVNTH neurons mimics the deleterious effect of DIO on glucose. Combined with our finding that PRR activation inhibits PVNTH neurons, these findings suggest that, in mice, (a) PVNTH neurons play a physiological role in glucose homeostasis, (b) PRR activation impairs glucose homeostasis by inhibiting these neurons, and (c) this mechanism plays a causal role in obesity-associated metabolic impairment.
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Affiliation(s)
- Shiyue Pan
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Lucas A.C. Souza
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Caleb J. Worker
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Miriam E. Reyes Mendez
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Ariana Julia B. Gayban
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Silvana G. Cooper
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Alfredo Sanchez Solano
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
| | - Richard N. Bergman
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Darko Stefanovski
- New Bolton Center, School of Veterinary Medicine, University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Gregory J. Morton
- University of Washington Medicine Diabetes Institute, University of Washington, Seattle, Washington, USA
| | - Michael W. Schwartz
- University of Washington Medicine Diabetes Institute, University of Washington, Seattle, Washington, USA
| | - Yumei Feng Earley
- Departments of Pharmacology and Physiology & Cell Biology and
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, USA
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2
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Qi M, Fadool DA, Storace DA. An anatomically distinct subpopulation of orexin neurons project from the lateral hypothalamus to the olfactory bulb. J Comp Neurol 2023; 531:1510-1524. [PMID: 37434469 PMCID: PMC10758201 DOI: 10.1002/cne.25518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 07/13/2023]
Abstract
Olfactory cues play a key role in natural behaviors such as finding food, finding mates, and avoiding predators. In principle, the ability of the olfactory system to carry out these perceptual functions would be facilitated by signaling related to an organism's physiological state. One candidate pathway includes a direct projection from the hypothalamus to the main olfactory bulb, the first stage of olfactory sensory processing. The pathway from the hypothalamus to the main olfactory bulb is thought to include neurons that express the neuropeptide orexin, although the proportion that is orexinergic remains unknown. A current model proposes that the orexin population is heterogeneous, yet it remains unknown whether the proportion that innervates the main olfactory bulb reflects a distinct subpopulation of the orexin population. Herein, we carried out combined retrograde tract tracing with immunohistochemistry for orexin-A in the mouse to define the proportion of hypothalamic input to the main olfactory bulb that is orexinergic and to determine what fraction of the orexin-A population innervates the bulb. The numbers and spatial positions of all retrogradely labeled neurons and all the orexin-A-expressing neurons were quantified in sequential sections through the hypothalamus. Retrogradely labeled neurons were found in the ipsilateral hypothalamus, of which 22% expressed orexin-A. The retrogradely labeled neurons that did and did not express orexin-A could be anatomically distinguished based on their spatial position and cell body area. Remarkably, only 7% of all the orexin-A neurons were retrogradely labeled, suggesting that only a small fraction of the orexin-A population directly innervate the main olfactory bulb. These neurons spatially overlapped with the orexin-A neurons that did not innervate the bulb, although the two cell populations were differentiated based on cell body area. Overall, these results support a model in which olfactory sensory processing is influenced by orexinergic feedback at the first synapse in the olfactory processing pathway.
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Affiliation(s)
- Meizhu Qi
- Department of Biological Science, Florida State University, Tallahassee, FL
- Program in Neuroscience, Florida State University, Tallahassee, FL
| | - Debra Ann Fadool
- Department of Biological Science, Florida State University, Tallahassee, FL
- Program in Neuroscience, Florida State University, Tallahassee, FL
- Institute of Molecular Biophysics, Florida State University, Tallahassee, FL
| | - Douglas A. Storace
- Department of Biological Science, Florida State University, Tallahassee, FL
- Program in Neuroscience, Florida State University, Tallahassee, FL
- Institute of Molecular Biophysics, Florida State University, Tallahassee, FL
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3
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Pan S, Worker CJ, Feng Earley Y. The hypothalamus as a key regulator of glucose homeostasis: emerging roles of the brain renin-angiotensin system. Am J Physiol Cell Physiol 2023; 325:C141-C154. [PMID: 37273237 PMCID: PMC10312332 DOI: 10.1152/ajpcell.00533.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
The regulation of plasma glucose levels is a complex and multifactorial process involving a network of receptors and signaling pathways across numerous organs that act in concert to ensure homeostasis. However, much about the mechanisms and pathways by which the brain regulates glycemic homeostasis remains poorly understood. Understanding the precise mechanisms and circuits employed by the central nervous system to control glucose is critical to resolving the diabetes epidemic. The hypothalamus, a key integrative center within the central nervous system, has recently emerged as a critical site in the regulation of glucose homeostasis. Here, we review the current understanding of the role of the hypothalamus in regulating glucose homeostasis, with an emphasis on the paraventricular nucleus, the arcuate nucleus, the ventromedial hypothalamus, and lateral hypothalamus. In particular, we highlight the emerging role of the brain renin-angiotensin system in the hypothalamus in regulating energy expenditure and metabolic rate, as well as its potential importance in the regulation of glucose homeostasis.
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Affiliation(s)
- Shiyue Pan
- Department of Pharmacology, School of Medicine, University of Nevada, Reno, Reno, Nevada, United States
- Department of Physiology & Cell Biology, School of Medicine, University of Nevada, Reno, Reno, Nevada, United States
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, United States
| | - Caleb J Worker
- Department of Pharmacology, School of Medicine, University of Nevada, Reno, Reno, Nevada, United States
- Department of Physiology & Cell Biology, School of Medicine, University of Nevada, Reno, Reno, Nevada, United States
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, United States
| | - Yumei Feng Earley
- Department of Pharmacology, School of Medicine, University of Nevada, Reno, Reno, Nevada, United States
- Department of Physiology & Cell Biology, School of Medicine, University of Nevada, Reno, Reno, Nevada, United States
- Center for Molecular and Cellular Signaling in the Cardiovascular System, University of Nevada, Reno, Reno, Nevada, United States
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4
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Coker CR, White M, Singal A, Bingaman SS, Paul A, Arnold AC, Silberman Y. Minocycline Reduces Hypothalamic Microglia Activation and Improves Metabolic Dysfunction in High Fat Diet-Induced Obese Mice. Front Physiol 2022; 13:933706. [PMID: 35784876 PMCID: PMC9244633 DOI: 10.3389/fphys.2022.933706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/27/2022] [Indexed: 01/27/2023] Open
Abstract
Obesity is associated with insulin resistance, glucose intolerance, inflammation, and altered neuronal activity in brain regions controlling metabolic functions including food intake, energy expenditure, and glucose homeostasis, such as the hypothalamus. In this study, we tested the hypothesis that inhibiting inflammation with minocycline could reduce adverse metabolic consequences associated with high-fat diet (HFD)-induced obesity in mice and sought to determine if metabolic improvements were associated with reduced hypothalamic microglia activity. Male C57Bl/6J mice were placed on 60% HFD for 12 weeks, with minocycline (40 mg/kg, p.o.) or normal tap water given during the last 6 weeks of diet. Age-matched mice maintained on control diet were used as an additional comparator group. Metabolic function was assessed during the last week of treatment. Ramified (resting) and non-ramified (active) microglia were quantified in the hypothalamus following immunohistochemical staining of ionized calcium-binding adaptor 1 (Iba-1) and further assessed by RNAseq. In HFD fed mice, minocycline attenuated body mass and adiposity without altering food intake suggesting enhanced energy expenditure. Minocycline also attenuated hyperinsulinemia and improved insulin sensitivity in HFD mice. Increased microglial activation and autophagy gene network changes were observed in the paraventricular nucleus (PVN) of the hypothalamus of HFD mice, which was prevented by minocycline treatment. Contrary to PVN findings, there were no significant effects of either HFD or minocycline on microglia activation in the hypothalamic arcuate nucleus or central amygdala. Together, these findings suggest that minocycline improves HFD-induced weight gain and insulin resistance in part by reducing inflammatory processes in the PVN, a key hypothalamic region regulating metabolic function.
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Affiliation(s)
- Caitlin R. Coker
- Department of Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC, United States
| | - Melissa White
- Department of Comparative Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Aneesh Singal
- Department of Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Sarah S. Bingaman
- Department of Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Anirban Paul
- Department of Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Amy C. Arnold
- Department of Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Yuval Silberman
- Department of Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
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5
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Shi X, Chen Y, Liu Q, Mei X, Liu J, Tang Y, Luo R, Sun D, Ma Y, Wu W, Tu W, Zhao Y, Xu W, Ke Y, Jiang S, Huang Y, Zhang R, Wang L, Chen Y, Xia J, Pu W, Zhu H, Zuo X, Li Y, Xu J, Gao F, Wei D, Chen J, Yin W, Wang Q, Dai H, Yang L, Guo G, Cui J, Song N, Zou H, Zhao S, Distler JH, Jin L, Wang J. LDLR dysfunction induces LDL accumulation and promotes pulmonary fibrosis. Clin Transl Med 2022; 12:e711. [PMID: 35083881 PMCID: PMC8792399 DOI: 10.1002/ctm2.711] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022] Open
Abstract
Treatments for pulmonary fibrosis (PF) are ineffective because its molecular pathogenesis and therapeutic targets are unclear. Here, we show that the expression of low-density lipoprotein receptor (LDLR) was significantly decreased in alveolar type II (ATII) and fibroblast cells, whereas it was increased in endothelial cells from systemic sclerosis-related PF (SSc-PF) patients and idiopathic PF (IPF) patients compared with healthy controls. However, the plasma levels of low-density lipoprotein (LDL) increased in SSc-PF and IPF patients. The disrupted LDL-LDLR metabolism was also observed in four mouse PF models. Upon bleomycin (BLM) treatment, Ldlr-deficient (Ldlr-/-) mice exhibited remarkably higher LDL levels, abundant apoptosis, increased fibroblast-like endothelial and ATII cells and significantly earlier and more severe fibrotic response compared to wild-type mice. In vitro experiments revealed that apoptosis and TGF-β1 production were induced by LDL, while fibroblast-like cell accumulation and ET-1 expression were induced by LDLR knockdown. Treatment of fibroblasts with LDL or culture medium derived from LDL-pretreated endothelial or epithelial cells led to obvious fibrotic responses in vitro. Similar results were observed after LDLR knockdown operation. These results suggest that disturbed LDL-LDLR metabolism contributes in various ways to the malfunction of endothelial and epithelial cells, and fibroblasts during pulmonary fibrogenesis. In addition, pharmacological restoration of LDLR levels by using a combination of atorvastatin and alirocumab inhibited BLM-induced LDL elevation, apoptosis, fibroblast-like cell accumulation and mitigated PF in mice. Therefore, LDL-LDLR may serve as an important mediator in PF, and LDLR enhancing strategies may have beneficial effects on PF.
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Affiliation(s)
- Xiangguang Shi
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
| | - Yahui Chen
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Qingmei Liu
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
| | - Xueqian Mei
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
| | - Jing Liu
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
- Division of RheumatologyHuashan hospital, Fudan UniversityShanghaiP. R. China
| | - Yulong Tang
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Ruoyu Luo
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Dayan Sun
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Yanyun Ma
- MOE Key Laboratory of Contemporary Anthropology, Department of Anthropology and Human Genetics, School of Life SciencesFudan UniversityShanghaiP. R. China
- Institute for Six‐sector EconomyFudan UniversityShanghaiP. R. China
| | - Wenyu Wu
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
| | - Wenzhen Tu
- Division of RheumatologyShanghai TCM‐Integrated HospitalShanghaiP. R. China
| | - Yinhuan Zhao
- Division of RheumatologyShanghai TCM‐Integrated HospitalShanghaiP. R. China
| | - Weihong Xu
- The Clinical Laboratory of Tongren HosipitalShanghai Jiaotong UniversityShanghaiP. R. China
| | - Yuehai Ke
- Department of Pathology and PathophysiologyZhejiang University School of MedicineHangzhouZhejiang ProvinceP. R. China
| | - Shuai Jiang
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Yan Huang
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
| | - Rui Zhang
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
- Institute for Six‐sector EconomyFudan UniversityShanghaiP. R. China
| | - Lei Wang
- Division of RheumatologyShanghai TCM‐Integrated HospitalShanghaiP. R. China
| | - Yuanyuan Chen
- Division of RheumatologyShanghai TCM‐Integrated HospitalShanghaiP. R. China
| | - Jingjing Xia
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Weilin Pu
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
| | - Honglin Zhu
- Department of Internal Medicine 3 and Institute for Clinical ImmunologyUniversity of ErlangenNurembergGermany
- Department of Rheumatology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceP. R. China
| | - Xiaoxia Zuo
- Department of Rheumatology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceP. R. China
| | - Yisha Li
- Department of Rheumatology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceP. R. China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
| | - Fei Gao
- Wuxi Lung Transplant CenterWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiP. R. China
| | - Dong Wei
- Wuxi Lung Transplant CenterWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiP. R. China
| | - Jingyu Chen
- Wuxi Lung Transplant CenterWuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiP. R. China
| | - Wenguang Yin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongP. R. China
| | - Qingwen Wang
- Rheumatology and Immunology DepartmentPeking University Shenzhen HospitalShenzhenP. R. China
| | - Huaping Dai
- Department of Pulmonary and Critical Care Medicine, China‐Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical ScienceBeijingP. R. China
| | - Libing Yang
- Department of Pulmonary and Critical Care Medicine, China‐Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Institute of Respiratory MedicineChinese Academy of Medical ScienceBeijingP. R. China
- School of MedicineTsinghua UniversityBeijingP. R. China
| | - Gang Guo
- Department of Rheumatology and ImmunologyYiling Hospital Affiliated to Hebei Medical UniversityShijiazhuangHebei ProvinceP. R. China
| | - Jimin Cui
- Department of Rheumatology and ImmunologyYiling Hospital Affiliated to Hebei Medical UniversityShijiazhuangHebei ProvinceP. R. China
| | - Nana Song
- Department of Nephrology, Zhongshan Hospital, Fudan UniversityFudan Zhangjiang InstituteShanghaiP. R. China
| | - Hejian Zou
- Division of RheumatologyHuashan hospital, Fudan UniversityShanghaiP. R. China
- Institute of Rheumatology, Immunology and AllergyFudan UniversityShanghaiP. R. China
| | - Shimin Zhao
- Institute of Metabolism and Integrative BiologyFudan UniversityShanghaiP. R. China
| | - Jörg H.W. Distler
- Department of Internal Medicine 3 and Institute for Clinical ImmunologyUniversity of ErlangenNurembergGermany
| | - Li Jin
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
- Research Unit of Dissecting the Population Genetics and Developing New Technologies for Treatment and Prevention of Skin Phenotypes and Dermatological Diseases (2019RU058)Chinese Academy of Medical SciencesShanghaiP. R. China
| | - Jiucun Wang
- Department of Dermatology, Huashan Hospital and State Key Laboratory of Genetic Engineering, School of Life SciencesFudan UniversityShanghaiP. R. China
- Human Phenome Institute and Collaborative Innovation Center for Genetics and DevelopmentFudan UniversityShanghaiP. R. China
- Institute of Rheumatology, Immunology and AllergyFudan UniversityShanghaiP. R. China
- Research Unit of Dissecting the Population Genetics and Developing New Technologies for Treatment and Prevention of Skin Phenotypes and Dermatological Diseases (2019RU058)Chinese Academy of Medical SciencesShanghaiP. R. China
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Alonge KM, D'Alessio DA, Schwartz MW. Brain control of blood glucose levels: implications for the pathogenesis of type 2 diabetes. Diabetologia 2021; 64:5-14. [PMID: 33043401 PMCID: PMC7718404 DOI: 10.1007/s00125-020-05293-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
Despite a rapidly growing literature, the role played by the brain in both normal glucose homeostasis and in type 2 diabetes pathogenesis remains poorly understood. In this review, we introduce a framework for understanding the brain's essential role in these processes based on evidence that the brain, like the pancreas, is equipped to sense and respond to changes in the circulating glucose level. Further, we review evidence that glucose sensing by the brain plays a fundamental role in establishing the defended level of blood glucose, and that defects in this control system contribute to type 2 diabetes pathogenesis. We also consider the possibility that the close association between obesity and type 2 diabetes arises from a shared defect in the highly integrated neurocircuitry governing energy homeostasis and glucose homeostasis. Thus, whereas obesity is characterised by an increase in the defended level of the body's fuel stores (e.g. adipose mass), type 2 diabetes is characterised by an increase in the defended level of the body's available fuel (e.g. circulating glucose), with the underlying pathogenesis in each case involving impaired sensing of (or responsiveness to) relevant humoral negative feedback signals. This perspective is strengthened by growing preclinical evidence that in type 2 diabetes the defended level of blood glucose can be restored to normal by therapies that restore the brain's ability to properly sense the circulating glucose level. Graphical abstract.
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Affiliation(s)
- Kimberly M Alonge
- UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA
| | - David A D'Alessio
- Duke Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael W Schwartz
- UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA.
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