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Rosenbaum JL, Melhorn SJ, Schoen S, Webb MF, De Leon MRB, Humphreys M, Utzschneider KM, Schur EA. Evidence That Hypothalamic Gliosis Is Related to Impaired Glucose Homeostasis in Adults With Obesity. Diabetes Care 2022; 45:416-424. [PMID: 34848489 PMCID: PMC8914420 DOI: 10.2337/dc21-1535] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Preclinical research implicates hypothalamic glial cell responses in the pathogenesis of obesity and type 2 diabetes (T2D). In the current study we sought to translate such findings to humans by testing whether radiologic markers of gliosis in the mediobasal hypothalamus (MBH) were greater in individuals with obesity and impaired glucose homeostasis or T2D. RESEARCH DESIGN AND METHODS Using cross-sectional and prospective cohort study designs, we applied a validated quantitative MRI approach to assess gliosis in 67 adults with obesity and normal glucose tolerance, impaired glucose tolerance (IGT), or T2D. Assessments of glucose homeostasis were conducted via oral glucose tolerance tests (OGTT) and β-cell modeling. RESULTS We found significantly greater T2 relaxation times (a marker of gliosis by MRI), that were independent of adiposity, in the groups with IGT and T2D as compared with the group with normal glucose tolerance. Findings were present in the MBH, but not control regions. Moreover, positive linear associations were present in the MBH but not control regions between T2 relaxation time and glucose area under the curve during an OGTT, fasting glucose concentrations, hemoglobin A1c, and visceral adipose tissue mass, whereas negative linear relationships were present in the MBH for markers of insulin sensitivity and β-cell function. In a prospective cohort study, greater MBH T2 relaxation times predicted declining insulin sensitivity over 1 year. CONCLUSIONS Findings support a role for hypothalamic gliosis in the progression of insulin resistance in obesity and thus T2D pathogenesis in humans.
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Affiliation(s)
- Jennifer L Rosenbaum
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA
| | - Susan J Melhorn
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA.,UW Medicine Diabetes Institute, University of Washington, Seattle, WA
| | - Stefan Schoen
- University of Washington School of Medicine, Seattle, WA
| | - Mary F Webb
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA.,UW Medicine Diabetes Institute, University of Washington, Seattle, WA
| | - Mary Rosalynn B De Leon
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA.,UW Medicine Diabetes Institute, University of Washington, Seattle, WA
| | - Madelaine Humphreys
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA.,UW Medicine Diabetes Institute, University of Washington, Seattle, WA
| | - Kristina M Utzschneider
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA.,Research and Development, Department of Veterans Affairs, Seattle, WA
| | - Ellen A Schur
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA.,UW Medicine Diabetes Institute, University of Washington, Seattle, WA
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Sewaybricker LE, Melhorn SJ, Rosenbaum JL, Askren MK, Tyagi V, Webb MF, De Leon MRB, Grabowski TJ, Schur EA. Reassessing relationships between appetite and adiposity in people at risk of obesity: A twin study using fMRI. Physiol Behav 2021; 239:113504. [PMID: 34147511 DOI: 10.1016/j.physbeh.2021.113504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neuroimaging studies suggest that appetitive drive is enhanced in obesity. OBJECTIVE To test if appetitive drive varies in direct proportion to the level of body adiposity after accounting for genetic factors that contribute to both brain response and obesity risk. SUBJECTS/METHODS Participants were adult monozygotic (n = 54) and dizygotic (n = 30) twins with at least one member of the pair with obesity. Body composition was assessed by dual-energy X-ray absorptiometry. Hormonal and appetite measures were obtained in response to a standardized meal that provided 20% of estimated daily caloric needs and to an ad libitum buffet meal. Pre- and post-meal functional magnetic resonance imaging (fMRI) assessed brain response to visual food cues in a set of a priori appetite-regulating regions. Exploratory voxelwise analyses outside a priori regions were performed with correction for multiple comparisons. RESULTS In a group of 84 adults, the majority with obesity (75%), body fat mass was not associated with hormonal responses to a meal (glucose, insulin, glucagon-like peptide-1 and ghrelin, all P>0.40), subjective feelings of hunger (β=-0.01 mm [95% CI -0.35, 0.34] P = 0.97) and fullness (β=0.15 mm [-0.15, 0.44] P = 0.33), or buffet meal intake in relation to estimated daily caloric needs (β=0.28% [-0.05, 0.60] P = 0.10). Body fat mass was also not associated with brain response to high-calorie food cues in appetite-regulating regions (Pre-meal β=-0.12 [-0.32, 0.09] P = 0.26; Post-meal β=0.18 [-0.02, 0.37] P = 0.09; Change by a meal β=0.29 [-0.02, 0.61] P = 0.07). Conversely, lower fat mass was associated with being weight reduced (β=-0.05% [-0.07, -0.03] P<0.001) and greater pre-meal activation to high-calorie food cues in the dorsolateral prefrontal cortex (Z = 3.63 P = 0.017). CONCLUSIONS In a large study of adult twins, the majority with overweight or obesity, the level of adiposity was not associated with excess appetitive drive as assessed by behavioral, hormonal, or fMRI measures.
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Affiliation(s)
- Leticia E Sewaybricker
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA
| | - Susan J Melhorn
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA
| | - Jennifer L Rosenbaum
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA
| | - Mary K Askren
- Departments of Radiology and Neurology, University of Washington, 1959 NE Pacific St. Seattle, WA, 98195 USA
| | - Vidhi Tyagi
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA
| | - Mary F Webb
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA
| | - Mary Rosalynn B De Leon
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA
| | - Thomas J Grabowski
- Departments of Radiology and Neurology, University of Washington, 1959 NE Pacific St. Seattle, WA, 98195 USA
| | - Ellen A Schur
- Department of Medicine, University of Washington, 1959 NE Pacific St. Box 356420, Seattle, WA, 98195 USA.
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Sewaybricker LE, Melhorn SJ, Papantoni A, Webb MF, Hua J, Roth CL, Carnell S, Schur EA. Pilot multi-site and reproducibility study of hypothalamic gliosis in children. Pediatr Obes 2021; 16:e12732. [PMID: 33084253 PMCID: PMC8096323 DOI: 10.1111/ijpo.12732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Quantitative magnetic resonance imaging (MRI) evidence of mediobasal hypothalamic (MBH) gliosis positively correlates with body mass index (BMI) in adults. This has neither been well explored in children nor have other brain regions involved in appetitive processing been tested for evidence of gliosis. METHODS Multi-site cross-sectional study in children to test for differences in quantitative T2 signal (measure of gliosis) by region and to assess relationships with age and BMI. Participants underwent brain MRI using the same equipment and protocol to quantify T2 relaxation time in six bilateral regions of interest (ROIs): putamen, caudate, ventral striatum, amygdala, hippocampus and MBH, and three control regions: white matter, motor cortex and dorsal hypothalamus. RESULTS Thirty-one participants (61% female) were included in a combined sample from the University of Washington (N = 9) and John Hopkins University (N = 22). Mean age was 14 ± 3 years, and BMI z-score was 0.7 ± 1.1 (26% with obesity). No study site-related differences were seen in T2 relaxation time across all nine regions (chi2 (8): 9.46, P = .30). Regional differences in T2 relaxation time were present (P < .001). MBH presented longer T2 relaxation time, suggestive of gliosis, when compared to all regions (P < .001), including an intra-hypothalamic control. Physiological age-related declines in T2 relaxation times were found in grey matter ROIs, but not in the MBH (r = -0.14, P = .46). MBH was the only region with a positive correlation between T2 relaxation time and BMI z-score (r = 0.38, P = .03). CONCLUSIONS In a multi-site study, pilot data suggest that quantitative MRI detected normal maturation-related brain variation as well as evidence that MBH gliosis is associated with increased adiposity in children.
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Affiliation(s)
| | | | - Afroditi Papantoni
- Dept. of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary F. Webb
- Dept. of Medicine, University of Washington, Seattle, WA, USA
| | - Jun Hua
- Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Christian L. Roth
- Dept. of Pediatrics, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Susan Carnell
- Dept. of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen A. Schur
- Dept. of Medicine, University of Washington, Seattle, WA, USA
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Berkseth KE, Rubinow KB, Melhorn SJ, Webb MF, Rosalynn B De Leon M, Marck BT, Matsumoto AM, Amory JK, Page ST, Schur EA. Hypothalamic Gliosis by MRI and Visceral Fat Mass Negatively Correlate with Plasma Testosterone Concentrations in Healthy Men. Obesity (Silver Spring) 2018; 26:1898-1904. [PMID: 30460775 PMCID: PMC6251490 DOI: 10.1002/oby.22324] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to determine whether a relationship was evident between gliosis in the mediobasal hypothalamus (MBH) and plasma testosterone concentrations in men. METHODS A total of 41 adult men (aged 18-50 years) from 23 twin pairs underwent fasting morning blood draw and brain magnetic resonance imaging. T2 relaxation time was used to quantify gliosis in the MBH and control areas in the putamen and amygdala. Plasma concentrations of testosterone and 17β-estradiol were measured by liquid chromatography-tandem mass spectrometry. Body composition including visceral adiposity was measured by dual x-ray absorptiometry. RESULTS A negative association was found between MBH T2 relaxation time and plasma concentrations of both free and total testosterone (r = -0.29, P < 0.05 and r = -0.37, P < 0.01, respectively). Visceral adiposity exhibited a negative correlation with plasma total testosterone concentration (r = -0.45, P = 0.001) but a positive correlation with MBH T2 relaxation time (r = 0.24, P = 0.03). The negative correlation between plasma total testosterone and MBH T2 relaxation time remained significant after adjustment for visceral adiposity, age, BMI, and insulin resistance. CONCLUSIONS In healthy men across a range of BMIs, MBH gliosis was associated with higher visceral adiposity but lower endogenous testosterone. These findings suggest that MBH gliosis could provide novel mechanistic insights into gonadal dysfunction in men with obesity.
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Affiliation(s)
- Kathryn E Berkseth
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Katya B Rubinow
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan J Melhorn
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mary F Webb
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Mary Rosalynn B De Leon
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brett T Marck
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - John K Amory
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ellen A Schur
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
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Melhorn SJ, Askren MK, Chung WK, Kratz M, Bosch TA, Tyagi V, Webb MF, De Leon MRB, Grabowski TJ, Leibel RL, Schur EA. FTO genotype impacts food intake and corticolimbic activation. Am J Clin Nutr 2018; 107:145-154. [PMID: 29529147 PMCID: PMC6454473 DOI: 10.1093/ajcn/nqx029] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/15/2017] [Indexed: 01/08/2023] Open
Abstract
Background Variants in the first intron of the fat mass and obesity-associated (FTO) gene increase obesity risk. People with "high-risk" FTO genotypes exhibit preference for high-fat foods, reduced satiety responsiveness, and greater food intake consistent with impaired satiety. Objective We sought central nervous system mechanisms that might underlie impaired satiety perception in people with a higher risk of obesity based on their FTO genotype. Design We performed a cross-sectional study in a sample that was enriched for obesity and included 20 higher-risk participants with the AA (risk) genotype at the rs9939609 locus of FTO and 94 lower-risk participants with either the AT or TT genotype. We compared subjective appetite, appetite-regulating hormones, caloric intake at a buffet meal, and brain response to visual food cues in an extended satiety network using functional MRI scans acquired before and after a standardized meal. Results Higher-risk participants reported less subjective fullness (χ2 = 7.48, P < 0.01), rated calorie-dense food as more appealing (χ2 = 3.92, P < 0.05), and consumed ∼350 more kilocalories than lower-risk participants (β = 348 kcal, P = 0.03), even after adjusting for fat or lean mass. Premeal, the higher-risk group had greater activation by "fattening" food images (compared with objects) in the medial orbital frontal cortex (β = 11.6; 95% CI: 1.5, 21.7; P < 0.05). Postmeal, the higher-risk subjects had greater activation by fattening (compared with nonfattening) food cues in the ventral tegmental area/substantia nigra (β = 12.8; 95% CI: 2.7, 23.0; P < 0.05), amygdala (β = 10.6; 95% CI: 0.7, 20.5; P < 0.05), and ventral striatum (β = 6.9; 95% CI: 0.2, 13.7; P < 0.05). Moreover, postmeal activation by fattening food cues within the preselected extended satiety network was positively associated with energy intake at the buffet meal (R2 = 0.29, P = 0.04) and this relation was particularly strong in the dorsal striatum (R2 = 0.28, P = 0.01), amygdala (R2 = 0.28, P = 0.03), and ventral tegmental area/substantia nigra (R2 = 0.27, P = 0.01). Conclusion The findings are consistent with a model in which allelic variants in FTO raise obesity risk through impaired central nervous system satiety processing, thereby increasing food intake. This study is registered at clinicaltrials.gov as NCT02483663.
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Affiliation(s)
- Susan J Melhorn
- Departments of Medicine and Radiology, University of Washington, Seattle, WA
| | - Mary K Askren
- Departments of Radiology, University of Washington, Seattle, WA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY,Departments of Medicine, Columbia University Medical Center, New York, NY
| | - Mario Kratz
- Department of Epidemiology, University of Washington & Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tyler A Bosch
- College of Education and Human Development, University of Minnesota, Minneapolis, MN
| | - Vidhi Tyagi
- Departments of Medicine and Radiology, University of Washington, Seattle, WA
| | - Mary F Webb
- Departments of Medicine and Radiology, University of Washington, Seattle, WA
| | | | | | - Rudolph L Leibel
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY
| | - Ellen A Schur
- Departments of Medicine and Radiology, University of Washington, Seattle, WA,Address correspondence to EAS (e-mail: )
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Melhorn SJ, Mehta S, Kratz M, Tyagi V, Webb MF, Noonan CJ, Buchwald DS, Goldberg J, Maravilla KR, Grabowski TJ, Schur EA. Brain regulation of appetite in twins. Am J Clin Nutr 2016; 103:314-22. [PMID: 26739033 PMCID: PMC4733261 DOI: 10.3945/ajcn.115.121095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neural responses to highly energetic food cues are robust and are suppressed by eating. It is not known if neural responsiveness to food cues is an inherited trait and possibly even one that mediates the genetic influences on body weight that have been previously observed. OBJECTIVE We investigated the inherited influence on brain responses to high-calorie visual food cues before and after a meal. DESIGN With the use of a monozygotic twin study design, 21 healthy monozygotic twin pairs consumed a standardized breakfast and, 3.5 h later, underwent the first of 2 functional MRI (fMRI) scans with the use of visual food cues. After the first fMRI session, twins consumed a standardized meal, which was followed by the second fMRI. Serial ratings of appetite and food appeal were obtained. An ad libitum buffet was used to measure total caloric and macronutrient intakes. Intraclass correlations (ICCs) were used to test for inherited influences by comparing whether intrapair similarity was greater than interpair similarity. RESULTS Body mass index was highly correlated within twin pairs (ICC: 0.96; P < 0.0001). ICCs also showed a strong intrapair similarity for the meal-induced change in hunger (ICC: 0.41; P = 0.03), fullness (ICC: 0.39; P = 0.04), and the appeal of fattening food (ICC: 0.57; P < 0.001). Twins ate a similar number of kilocalories at the buffet (ICC: 0.43; P = 0.02). Before the meal, the global brain activation across regions involved in satiety processing was not more similar in twins than in unrelated individuals. However, significant ICCs were present after the meal (ICC: 0.39; P = 0.04) and for the meal-induced change in activation by high-calorie visual food cues (ICC: 0.52; P < 0.01). CONCLUSION Inherited factors influence both satiety perception and the effect of a meal to alter regional brain responses to images of highly energetic food. This trial was registered at clinicaltrials.gov as NCT02483663.
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Affiliation(s)
| | - Sonya Mehta
- Department of Radiology, Integrated Brain Imaging Center
| | - Mario Kratz
- Department of Epidemiology, Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle WA; and
| | - Vidhi Tyagi
- Department of Medicine, General Internal Medicine
| | | | | | | | - Jack Goldberg
- Department of Epidemiology, VA Epidemiologic Research and Information Center, Vietnam Era Twin Registry, Seattle, WA
| | | | - Thomas J Grabowski
- Department of Radiology, Integrated Brain Imaging Center, Department of Neurology, University of Washington, Seattle, WA
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Schur EA, Melhorn SJ, Oh SK, Lacy JM, Berkseth KE, Guyenet SJ, Sonnen JA, Tyagi V, Rosalynn M, De Leon B, Webb MF, Gonsalves ZT, Fligner CL, Schwartz MW, Maravilla KR. Radiologic evidence that hypothalamic gliosis is associated with obesity and insulin resistance in humans. Obesity (Silver Spring) 2015; 23:2142-8. [PMID: 26530930 PMCID: PMC4634110 DOI: 10.1002/oby.21248] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/10/2015] [Accepted: 07/25/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To use quantitative magnetic resonance imaging (MRI) to test whether mediobasal hypothalamic (MBH) gliosis is associated with obesity and insulin resistance in humans. METHODS Sixty-seven participants underwent a fasting blood draw and MRI. Cases with radiologic evidence of MBH gliosis (N = 22) were identified as the upper tertile of left MBH T2 relaxation time and were compared to controls (N = 23) from the lowest tertile. In a separate postmortem study, brain slices (N = 10) through the MBH were imaged by MRI and stained for glial fibrillary acidic protein (GFAP). RESULTS In all participants, longer T2 relaxation time in the left MBH was associated with higher BMI (P = 0.01). Compared with controls, cases had longer T2 relaxation times in the right MBH (P < 0.05), as well as higher BMI (P < 0.05), fasting insulin concentrations (P < 0.01), and HOMA-IR values (P < 0.01), adjusted for sex and age. Elevations in insulin and HOMA-IR were also independent of BMI. In the postmortem study, GFAP staining intensity was positively associated with MBH T2 relaxation time (P < 0.05), validating an MRI-based method for the detection of MBH gliosis in humans. CONCLUSIONS These findings link hypothalamic gliosis to insulin resistance in humans and suggest that the link is independent of the level of adiposity.
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Affiliation(s)
- Ellen A Schur
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Susan J Melhorn
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Seok-Kyun Oh
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - J Matthew Lacy
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Kathryn E Berkseth
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Stephan J Guyenet
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Joshua A Sonnen
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Vidhi Tyagi
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | | | - B De Leon
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Mary F Webb
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Zenobia T Gonsalves
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Corinne L Fligner
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Michael W Schwartz
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
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Webb MF. My stroke--mens sana in corpore non sano. J R Coll Physicians Lond 1994; 28:474-5. [PMID: 7807440 PMCID: PMC5401033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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