Cited by 880Adipokines, Inflammation, and Metabolic DiseasesRegulation of Appetite and ObesityLipid metabolism and biosynthesis

Lipotoxic diseases

Unger, Roger H.·2002·Annual Review of Medicine

Abstract

I review evidence that leptin is a liporegulatory hormone that controls lipid homeostasis in nonadipose tissues during periods of overnutrition. When adipocytes store excess calories as triacylglycerol (TG), leptin secretion rises so as to prevent accumulation of lipids in nonadipose tissues, which are not adapted for TG storage. Whenever leptin action is lacking, whether through leptin deficiency or leptin resistance, overnutrition causes disease of nonadipose tissues with generalized steatosis, lipotoxicity, and lipoapoptosis. Examples of such disorders of liporegulation include generalized lipodystrophies, mutations of leptin and leptin receptor genes, and diet-induced obesity. Lipotoxicity of pancreatic beta-cells, myocardium, and skeletal muscle leads, respectively, to type 2 diabetes, cardiomyopathy, and insulin resistance. In humans this constellation of abnormalities is referred to as the metabolic syndrome, a major health problem in the United States. When lipids overaccumulate in nonadipose tissues during overnutrition, fatty acids enter deleterious pathways such as ceramide production, which, through increased nitric oxide formation, causes apoptosis of lipid-laden cells, such as beta-cells and cardiomyocytes. Lipoapoptosis can be prevented by caloric restriction, by thiazolidinedione treatment, and by administration of nitric oxide blockers. There is now substantial evidence that complications of human obesity may reflect lipotoxicity similar to that described in rodents.

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Crossref · 10.1146/annurev.med.53.082901.104057

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Authors
Unger, R. H.
Affiliations
Dallas VA Medical Center (US)
Corresponding author
Unger, Roger H.
Venue
Annual Review of Medicine
Published
2002-02
Volume
53
Issue
1
Pages
319-336
ISSN
  • 0066-4219 (ISSN-L)
  • 1545-326X
OpenAlex
W4254261652
Cited by
875
References
71
Citations by year
2026: 9 · 2025: 14 · 2024: 25 · 2023: 15 · 2022: 18 · 2021: 31 · 2020: 22 · 2019: 21 · 2018: 22 · 2017: 30 · 2016: 32 · 2015: 30 · 2014: 29 · 2013: 49 · 2012: 34
FWCI
10.58
Type
journal article
Language
en
Open access
closed
Locations
  • Annual Review of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Lipid metabolism and biosynthesis
Keywords
leptin, lipotoxicity, lipid homeostasis, lipoapoptosis, leptin resistance, leptin deficiency, lipodystrophy, leptin receptor mutation, diet-induced obesity, type 2 diabetes, cardiomyopathy, insulin resistance, metabolic syndrome, ceramide, nitric oxide, caloric restriction, thiazolidinediones, obesity complications
MeSH terms
Adipose Tissue, Animals, Homeostasis, Humans, Lipids, Myocardium, Obesity, Risk Factors, Leptin, Metabolic Syndrome

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