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Qian YX, Rao SS, Tan YJ, Wang Z, Yin H, Wan TF, He ZH, Wang X, Hong CG, Zeng HJ, Luo Y, Duan YX, Zhu H, Hu XY, Zou L, Zhang Y, Liu BB, Wang ZX, Du W, Chen CY, Xie H. Intermittent Fasting Targets Osteocyte Neuropeptide Y to Relieve Osteoarthritis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400196. [PMID: 38978353 PMCID: PMC11425897 DOI: 10.1002/advs.202400196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/20/2024] [Indexed: 07/10/2024]
Abstract
Osteoarthritis is a highly prevalent progressive joint disease that still requires an optimal therapeutic approach. Intermittent fasting is an attractive dieting strategy for improving health. Here this study shows that intermittent fasting potently relieves medial meniscus (DMM)- or natural aging-induced osteoarthritic phenotypes. Osteocytes, the most abundant bone cells, secrete excess neuropeptide Y (NPY) during osteoarthritis, and this alteration can be altered by intermittent fasting. Both NPY and the NPY-abundant culture medium of osteocytes (OCY-CM) from osteoarthritic mice possess pro-inflammatory, pro-osteoclastic, and pro-neurite outgrowth effects, while OCY-CM from the intermittent fasting-treated osteoarthritic mice fails to induce significant stimulatory effects on inflammation, osteoclast formation, and neurite outgrowth. Depletion of osteocyte NPY significantly attenuates DMM-induced osteoarthritis and abolishes the benefits of intermittent fasting on osteoarthritis. This study suggests that osteocyte NPY is a key contributing factor in the pathogenesis of osteoarthritis and intermittent fasting represents a promising nonpharmacological antiosteoarthritis method by targeting osteocyte NPY.
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Affiliation(s)
- Yu-Xuan Qian
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Shan-Shan Rao
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Yi-Juan Tan
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Zun Wang
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Hao Yin
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Teng-Fei Wan
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Ze-Hui He
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Xin Wang
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Chun-Gu Hong
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Hai-Jin Zeng
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Yi Luo
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Yan-Xin Duan
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Hao Zhu
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Xin-Yue Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Ling Zou
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Yan Zhang
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bing-Bing Liu
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, 410083, China
| | - Zhen-Xing Wang
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
| | - Wei Du
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
- Department of Rehabilitation, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Chun-Yuan Chen
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Hui Xie
- Department of Orthopedics, Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Angmedicine, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
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Kloock S, Haerting N, Herzog G, Oertel M, Geiger N, Geier A, Sequeira V, Nickel A, Kohlhaas M, Fassnacht M, Dischinger U. Effects of NPY-2 Receptor Antagonists, Semaglutide, PYY 3-36, and Empagliflozin on Early MASLD in Diet-Induced Obese Rats. Nutrients 2024; 16:904. [PMID: 38542814 PMCID: PMC10974407 DOI: 10.3390/nu16060904] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/09/2024] [Accepted: 03/19/2024] [Indexed: 01/04/2025] Open
Abstract
(1) Background: Modulators of the Neuropeptide Y (NPY) system are involved in energy metabolism, but the effect of NPY receptor antagonists on metabolic-dysfunction-associated steatotic liver disease (MASLD), a common obesity-related comorbidity, are largely unknown. In this study, we report on the effects of antagonists of the NPY-2 receptor (Y2R) in comparison with empagliflozin and semaglutide, substances that are known to be beneficial in MASLD. (2) Methods: Diet-induced obese (DIO) male Wistar rats were randomized into the following treatment groups: empagliflozin, semaglutide ± PYY3-36, the Y2R antagonists JNJ 31020028 and a food-restricted group, as well as a control group. After a treatment period of 8 weeks, livers were weighed and histologically evaluated. QrtPCR was performed to investigate liver inflammation and de novo lipogenesis (in liver and adipose tissue). Serum samples were analysed for metabolic parameters. (3) Results: Semaglutide + PYY3-36 led to significant weight loss, reduced liver steatosis (p = 0.05), and decreased inflammation, insulin resistance, and leptin levels. JNJ-31020028 prevented steatosis (p = 0.03) without significant weight loss. Hepatic downregulation of de novo lipogenesis-regulating genes (SREBP1 and MLXIPL) was observed in JNJ-31020028-treated rats (p ≤ 0.0001). Food restriction also resulted in significantly reduced weight, steatosis, and hepatic de novo lipogenesis. (4) Conclusions: Body weight reduction (e.g., by food restriction or drugs like semaglutide ± PYY3-36) is effective in improving liver steatosis in DIO rats. Remarkably, the body-weight-neutral Y2R antagonists may be effective in preventing liver steatosis through a reduction in de novo lipogenesis, making this drug class a candidate for the treatment of (early) MASLD.
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Affiliation(s)
- Simon Kloock
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (S.K.); (N.H.); (M.O.); (N.G.); (M.F.)
| | - Niklas Haerting
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (S.K.); (N.H.); (M.O.); (N.G.); (M.F.)
| | - Gloria Herzog
- Institute of Pathology, University of Wuerzburg, 97070 Wuerzburg, Germany;
| | - Marie Oertel
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (S.K.); (N.H.); (M.O.); (N.G.); (M.F.)
| | - Niklas Geiger
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (S.K.); (N.H.); (M.O.); (N.G.); (M.F.)
| | - Andreas Geier
- Department of Internal Medicine, Division of Hepatology, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany;
| | - Vasco Sequeira
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (V.S.); (A.N.); (M.K.)
| | - Alexander Nickel
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (V.S.); (A.N.); (M.K.)
| | - Michael Kohlhaas
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (V.S.); (A.N.); (M.K.)
| | - Martin Fassnacht
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (S.K.); (N.H.); (M.O.); (N.G.); (M.F.)
| | - Ulrich Dischinger
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (S.K.); (N.H.); (M.O.); (N.G.); (M.F.)
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany; (V.S.); (A.N.); (M.K.)
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Tassinari R, Tammaro A, Martinelli A, Valeri M, Maranghi F. Sex-Specific Effects of Short-Term Oral Administration of Food-Grade Titanium Dioxide Nanoparticles in the Liver and Kidneys of Adult Rats. TOXICS 2023; 11:776. [PMID: 37755786 PMCID: PMC10536411 DOI: 10.3390/toxics11090776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
Titanium dioxide (TiO2) nanomaterial is used in several items (implant materials, pills composition, cosmetics, etc.). Although TiO2 is no longer considered safe as a food additive, the general population is exposed daily through different routes, and information is lacking on some aspects of animal and human health. This study evaluated liver and kidney toxicity of food-grade TiO2 nanoparticles (NPs) (primary size < 25 nm) in male and female rats that were orally exposed for 5 days to 0, 1, and 2 mg/kg body weight per day (comparable with daily E171 consumption). Selected liver and kidney toxicity endpoints included serum biomarkers, histopathological analysis and expression of osteopontin (SPP1), vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), and neuropeptide Y (NPY). Although TiO2 NPs are known to affect the gastric mucosa, short-term exposure induced sex-specific effects: general toxicity parameters were predominantly altered in female rats, whereas the liver appeared to be more affected than the kidneys in male rats, which also showed overexpression of NPY and SPP1. In the kidneys, the TiO2 NP effects were quantitatively similar but qualitatively different in the two sexes. In conclusion, careful consideration should be paid to the presence of TiO2 NPs in other items that can lead to human exposure.
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Affiliation(s)
- Roberta Tassinari
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.T.); (A.T.)
| | - Alessia Tammaro
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.T.); (A.T.)
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00173 Rome, Italy
| | - Andrea Martinelli
- Experimental Animal Welfare Sector, Istituto Superiore di Sanità, 00161 Rome, Italy; (A.M.); (M.V.)
| | - Mauro Valeri
- Experimental Animal Welfare Sector, Istituto Superiore di Sanità, 00161 Rome, Italy; (A.M.); (M.V.)
| | - Francesca Maranghi
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (R.T.); (A.T.)
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López-Méndez I, Maldonado-Rojas ADC, Uribe M, Juárez-Hernández E. Hunger & satiety signals: another key mechanism involved in the NAFLD pathway. Front Endocrinol (Lausanne) 2023; 14:1213372. [PMID: 37753211 PMCID: PMC10518611 DOI: 10.3389/fendo.2023.1213372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent metabolic disease, although prevalence could change according to region, nowadays is considered a public health problem whose real impact on the health system is unknown. NAFLD has a multifactorial and complex pathophysiology, due to this, developing a unique and effective pharmacological treatment has not been successful in reverting or avoiding the progression of this liver disease. Even though NAFLD pathophysiology is known, all actual treatments are focused on modifying or regulating the metabolic pathways, some of which interplay with obesity. It has been known that impairments in hunger and satiety signals are associated with obesity, however, abnormalities in these signals in patients with NAFLD and obesity are not fully elucidated. To describe these mechanisms opens an additional option as a therapeutic target sharing metabolic pathways with NAFLD, therefore, this review aims to describe the hormones and peptides implicated in both hunger-satiety in NAFLD. It has been established that NAFLD pharmacological treatment cannot be focused on a single purpose; hence, identifying interplays that lead to adding or modifying current treatment options could also have an impact on another related outcome such as hunger or satiety signals.
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Affiliation(s)
- Iván López-Méndez
- Hepatology and Transplants Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - Misael Uribe
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Zhu F, Yu D, Qin X, Qian Y, Ma J, Li W, Liu Q, Wang C, Zhang Y, Li Y, Jiang D, Wang S, Xia P. The neuropeptide CGRP enters the macrophage cytosol to suppress the NLRP3 inflammasome during pulmonary infection. Cell Mol Immunol 2023; 20:264-276. [PMID: 36600053 PMCID: PMC9970963 DOI: 10.1038/s41423-022-00968-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
The NLRP3 inflammasome plays an essential role in resistance to bacterial infection. The nervous system secretes multiple neuropeptides affecting the nervous system as well as immune cells. The precise impact of the neuropeptide CGRP on NLRP3 inflammasome activation is still unclear. Here, we show that CGRP negatively regulates the antibacterial process of host cells. CGRP prevents NLRP3 inflammasome activation and reduces mature IL-1β secretion. Following NLRP3 inflammasome stimulation that triggers endosome leakage, CGRP internalized to endosomal compartments is released into the cell cytosol. Cytosolic CGRP binds directly to NLRP3 and dismantles the NLRP3-NEK7 complex, which is crucial for NLRP3 inflammasome activation. CGRP administration exacerbates bacterial infection, while the treatment with a CGRP antagonist has the opposite effect. Our study uncovers a unique role of CGRP in inhibiting inflammasome activation during infections, which might shed new light on antibacterial therapies in the future.
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Affiliation(s)
- Fangrui Zhu
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Dou Yu
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, 100101, Beijing, China
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, 430071, China
| | - Xiwen Qin
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Yan Qian
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Juan Ma
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Weitao Li
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Qiannv Liu
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Chunlei Wang
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Yan Zhang
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China
| | - Yi Li
- Department of Anesthesiology, Peking University Third Hospital, 100191, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, 100191, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, 100191, Beijing, China
| | - Shuo Wang
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, 100101, Beijing, China.
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, 430071, China.
| | - Pengyan Xia
- Department of Immunology, School of Basic Medical Sciences, Peking University, 100191, Beijing, China.
- NHC Key Laboratory of Medical Immunology, Peking University, 100191, Beijing, China.
- Key Laboratory of Molecular Immunology, Chinese Academy of Medical Sciences, 100191, Beijing, China.
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Puente-Ruiz SC, Jais A. Reciprocal signaling between adipose tissue depots and the central nervous system. Front Cell Dev Biol 2022; 10:979251. [PMID: 36200038 PMCID: PMC9529070 DOI: 10.3389/fcell.2022.979251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
In humans, various dietary and social factors led to the development of increased brain sizes alongside large adipose tissue stores. Complex reciprocal signaling mechanisms allow for a fine-tuned interaction between the two organs to regulate energy homeostasis of the organism. As an endocrine organ, adipose tissue secretes various hormones, cytokines, and metabolites that signal energy availability to the central nervous system (CNS). Vice versa, the CNS is a critical regulator of adipose tissue function through neural networks that integrate information from the periphery and regulate sympathetic nerve outflow. This review discusses the various reciprocal signaling mechanisms in the CNS and adipose tissue to maintain organismal energy homeostasis. We are focusing on the integration of afferent signals from the periphery in neuronal populations of the mediobasal hypothalamus as well as the efferent signals from the CNS to adipose tissue and its implications for adipose tissue function. Furthermore, we are discussing central mechanisms that fine-tune the immune system in adipose tissue depots and contribute to organ homeostasis. Elucidating this complex signaling network that integrates peripheral signals to generate physiological outputs to maintain the optimal energy balance of the organism is crucial for understanding the pathophysiology of obesity and metabolic diseases such as type 2 diabetes.
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