Incretin physiology and its role in type 2 diabetes mellitus.

Incretins are hormones that are released after ingestion of a meal and augment the secretion of insulin. Current research suggests that GLP-1 (glucagon-like peptide 1) is the most important. Their action is terminated by enzymes known as dipeptidyl peptidase-4 (DPP-4). The observation that the incretin response may be diminished in individuals with type 2 diabetes mellitus has led to advances in the management of this disease. Agents that act as incretin mimetics, such as exenatide and liraglutide, and DPP-4 inhibitors, such as sitagliptin phosphate and saxagliptin, improve glycated hemoglobin levels either as monotherapy or in combination with other agents. Importantly, these agents either lead to weight loss or are weight neutral and are associated with a low risk of hypoglycemia--properties that further contribute to their clinical utility.

Role of the perifornical hypothalamic monoamine neurotransmitter systems in anorectic effects of endotoxin.

The cachexia-anorexia syndrome, in which patients suffering from chronic illness lack the desire to eat and experience weight loss, creates a serious clinical problem when patients are attempting to overcome the disease process. Endotoxin (ET) has many actions in the brain and peripheral injections can affect regulation of monoamines in brain areas as diverse as the olfactory lobes and the locus coeruleus. Certainly, ET is involved in the febrile process and it plays a prominent role in the regulation of food intake and maintenance of body weight during chronic illnesses. Monoamine neurotransmitters in specific regions of the hypothalamus also participate in the regulation of food intake and body weight and have been well characterized. In this regard, the hypothalamic perifornical nucleus (PFN) is of interest to our lab due to its role in drug-induced anorexia caused by amphetamines. It is also the most sensitive site in the hypothalamic monoaminergic system that involves dopamine (DA) and epinephrine (EPI). DA antagonist, stereotaxically placed in this site, can stimulate feeding, and specific injections of DA or EPI can result in a 70-90% decrease in food intake, even in food-deprived animals. We have shown in our studies that ET in a dose (0.2 mg/kg of lipopolysaccharide) that does not induce noticeable ambulatory (lack of movement) effects (related to malaise) can cause a significant decrease in food intake in lean Zucker rats. We hypothesize that exogenous ET causes an increase in the extracellular concentrations of monoamines in the perifornical hypothalamus, which in turn can mediate the decrease in food intake. Microdialysis was utilized to measure extracellular concentrations of EPI, norepinephrine, 5-hydroxyindoleacetic acid, DA, and serotonin or 5-hydroxytryptamine. These measurements were taken at a post-ET time period that coincides with an ET-induced decrease (4x) in food intake. Extracellular DA and EPI both significantly increased in the PFN in response to injection of ET. Increases in extracellular DA were dose related and were significant (p < 0.05) compared to zero baseline and saline at both doses of ET. No statistically significant differences were found in 5-hydroxyindoleacetic acid, norepinephrine, and serotonin in microdialysates of this part of the hypothalamus. The present data suggest that catecholamines, namely DA and EPI which are known to decrease food intake, in the PFN may be involved in the regulation of decreases in food intake caused by peripherally administered ET. This does not rule out a role for locally produced inflammatory molecules in the brain in this process.

Dehydroepiandrosterone (DHEA) blocks the increase in food intake caused by neuropeptide Y (NPY) in the Zucker rat.

Recent studies have demonstrated that neuropeptide Y (NPY) reduced the neural production of dehydroepiandrosterone (DHEA) in frog hypothalamic explants. The objective of this study was to assess if DHEA can block the NPY induced increase in food intake in lean and obese Zucker rats. Rats were given one of the following four treatments: sterile water/dimethylsulfoxide (DMSO), NPY/DMSO, water/DHEA, and NPY/DHEA. Immediately after administration of their respective treatment, rats were exposed to macronutrients for 4 h and food intake was monitored. NPY caused a significant increase in total calories consumed compared to control. Co-administration of DHEA along with NPY blocked this NPY dependent effect. These results suggest that DHEA blocks the over-eating in satiated rats induced by NPY. Measurement of changes in regional hypothalamic and raphe monoamine neurotransmitters known to affect food intake suggested a possible role of serotonin fluctuations in the ventromedial hypothalamus (VMH) guiding this behaviour.

The influence of dehydroepiandrosterone and 8-OH-DPAT on the caloric intake and hypothalamic neurotransmitters of lean and obese Zucker rats.

The 5 HT(1A) receptor agonist 8-hydroxy-2-(di-n-propylamino)-tetraline (8-OH-DPAT) increases the food intake of satiated Zucker rats, both lean and obese. Associated with this increased intake are changes in the hypothalamic content of serotonin and its metabolite, 5-HIAA (5-hydroxyindole-3-acetic acid); serotonin is increased while the level of 5-HIAA is decreased. Analysis of individual 5-HIAA/5-hydroxytryptamine (5-HT) ratios, a measure of serotonin turnover indicate that 8-OH DPAT affected serotonin turnover equally and dramatically in both phenotypes. This would be an expected physiological action of an autofeedback mechanism by a 5-HT(1A) receptor agonist. Dehydroepiandrosterone (DHEA) at doses as low as 10 mg/kg blocks the 8-OH-DPAT-induced increase in food intake but does not alter food intake of control satiated Zucker rats. The mechanism of DHEA's action was investigated by monitoring the steroid's effect on hypothalamic neurotransmitters in this satiated model. DHEA by itself induced some change in 5-HIAA in the obese satiated model but not the lean. 8-OH-DPAT, by itself, dramatically decreased serotonin turnover in either lean or obese rats, and DHEA combined with 8-OH-DPAT did not further change serotonin turnover, suggesting DHEA may work through mechanisms other than monoamines to cause its inhibition of 8-OH-DPAT-induced behavioral effects at such low doses.

Pharmacologic therapy for obesity.

Obesity is a chronic condition, and long-term treatment will most likely be needed. Approved prescription medications for weight loss appear to have similar efficacy in controlled studies. No predictors of responsiveness in an individual patient or class of patients have been established. The choice of a medication is based on the underlying medical indication or contraindication of a particular drug, concurrent medication, age of the patient, need for monitoring, anticipation of the length of therapy, and the preference of a patient. Behavioral and dieting interventions, and increased physical activity are considered the primary means to promote and maintain weight loss. Weight-loss medications should be considered only as an adjunct for patients who are at substantial risk because of their obesity and in whom non-pharmacologic treatments have not resulted in sufficient weight loss to improve health or to prevent weight regain.

Leptin, adiposity, and testosterone in captive male macaques.

Leptin is considered to act as a signal relating somatic energetic status to the reproductive system. However, the nature of that signal and its relationship with male reproductive function across nonhuman primate species are unclear. We suggest that species-specific differences in leptin physiology may be related to the degree of environmental variation and variation in the importance of energy stores for male reproduction. In order to test the role of seasonality in species differences among nonhuman primates, we compared leptin, testosterone, and body composition in male rhesus (n = 69) and pig-tailed (n = 43) macaques. Despite having larger abdominal fat deposits, the rhesus macaques did not exhibit significantly higher leptin levels (rhesus, 2.21 +/- 0.43 ng/ml; pig-tailed, 2.12 +/- 0.39 ng/ml). Both species showed increases in leptin across adolescent, subadult, and adult age-groups (P = 0.036 for rhesus; P = 0.0003 for pig-tailed by ANCOVA). Testosterone was not significantly associated with leptin in either the rhesus (r = 0.039; P = 0.754) or pig-tailed (r = 0.2862; P = 0.066) samples. Comparison of leptin levels across the two species using univariate modeling procedures showed no significant age-group by abdominal fat interaction. These findings suggest little difference in leptin production between these two closely related species, despite the difference in breeding seasonality.

Caloric intake and hypothalamic neurotransmitters in Zucker rats made acutely diabetic with streptozocin.

Zucker rats, lean and obese, treated with low dose intraperitoneal injections of streptozocin become hyperglycemic within 24h. Insulin levels fall, although the obese animal remains hyperinsulinemic. Associated with these changes in glucose and insulin there are transient decreases in caloric intake. Macronutrient selection studies show that protein consumption decreases. There is a trend for fat intake to decrease. The levels of hypothalamic neurotransmitters in the lean animals are not altered by streptozocin. The levels of 5-hydroxyindoleacetic acid increases in the streptozocin-treated obese animal in the paraventricular region, ventromedial region and the raphe. Serotonin is also significantly increased in the paraventricular region of the obese rat. These results suggest that acutely, treatment with streptozocin injures pancreatic islets, causing, in turn, decreases in insulin levels so that hyperglycemia ensues in both phenotypes. Associated with these perturbations are decreases in caloric intake. The magnitude of change in insulin levels is much greater in the obese rat. It is hypothesized that in the obese Zucker rat decrements in food intake are mediated by increase in serotonin turnover in the hypothalamus and these changes are related to changes of insulin levels. These data support the concept that circulating insulin affects hypothalamic neurotransmitters.

Dehydroepiandrosterone-sulfate as a biomarker of senescence in male non-human primates.

Numerous studies have suggested important and varying roles for dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEA-S) in primate physiological functions. Despite these numerous claims, specific actions and significance of DHEA and DHEA-S are still equivocal. A decline of these hormones in adult humans may have functional significance, yet there is no clear relationship between functional impairments of aging and the decline in DHEA or DHEA-S levels. This current study attempts to address the natural history of adrenal hormones by presenting non-human primate evidence of the endocrinology of aging; the age-related patterns of adrenal hormone decline in three species of the subfamily Cercopithecinae, Macaca mulatta, Macaca nemestrina, and Papio cynocephalus are compared. It is concluded that DHEA-S and cortisol represent lineage specific markers of senescence among primates and that parallel age-related patterns of DHEA-S and cortisol likely reflect lineage specific effects, or rather, phylogenetic similarities of endocrine senescence. The use of relative adrenal hormone levels to approximate species' life expectancies is discussed.

Levels of hypothalamic neurotransmitters in lean and obese Zucker rats.

Hypothalamic neurotransmitter levels were compared between groups of Zucker rats. Animals were grouped by gender, phenotype and preference for dietary fat. Before sacrifice all animals consumed a standard rat chow diet and were fasted overnight. Five rats from each of eight groups were assayed. Hypothalamic regions (lateral, LH; ventromedial, VMH; paraventricular, PVN) and the raphe were isolated and analyzed for dopamine, norepinephrine, epinephrine, serotonin and 5-hydroxyindoleacetic acid. A factorial analysis of variance was used to compare the concentrations of these biogenic amines in the four regions across phenotypic, gender and fat preference profiles. No differences were demonstrated between groups based upon fat food preference. Epinephrine and 5-HIAA content varied between lean and obese animals but there were no differences in the content of serotonin, norepinephrine or dopamine. The results are consistent with the hypothesis that the obese animal eats more because it releases less of the satiety-inducing neurotransmitter serotonin in the hypothalamus.