Cited by 227Adipokines, Inflammation, and Metabolic DiseasesRegulation of Appetite and ObesityLipid metabolism and disorders

The DOI matches its Crossref record; 43 of the 45 references it cites were found in a registry or an index; none of the 52 sources its claims cite is checked for support yet.

Long-Term Efficacy of Leptin Replacement in Patients With Generalized Lipodystrophy

Open access

Abstract

Ectopic fat accumulation has been implicated as a contributing factor in the abnormal metabolic state of obesity. One human model of ectopic fat deposition is generalized lipodystrophy. Generalized lipodystrophy is a rare disorder characterized by a profound deficiency of adipose tissue with resultant loss of triglyceride storage capacity and reduced adipokines, including leptin. Subjects with generalized lipodystrophy and reduced leptin levels often have an increased appetite leading to hyperphagia. Excess fuel consumption, coupled with a lack of adipose tissue, contributes to the significant ectopic triglyceride accumulation in the muscle and liver seen in these subjects. This ectopic fat, along with the deficiency in leptin signaling and perhaps other adipokines, likely contributes to insulin resistance, diabetes, and hepatic steatosis. We report here the long-term effects of leptin replacement in a cohort of these subjects. Fifteen patients with generalized lipodystrophy were treated with twice-daily recombinant methionyl human leptin (r-metHuLeptin) for 12 months. We evaluated metabolic parameters at baseline and every 4 months. Antidiabetes medications were decreased or discontinued as necessary. Reductions were seen in serum fasting glucose (from 205 ± 19 to 126 ± 11 mg/dl; P < 0.001), HbA1c (from 9 ± 0.4 to 7.1 ± 0.5%; P < 0.001), triglycerides (from 1,380 ± 500 to 516 ± 236 mg/dl; P < 0.001), LDL (from 139 ± 16 to 85 ± 7 mg/dl; P < 0.01), and total cholesterol (from 284 ± 40 to 167 ± 21 mg/dl; P < 0.01). HDL was unchanged (from 31 ± 3 to 29 ± 2 mg/dl; P = 0.9). Liver volumes were significantly reduced (from 3,663 ± 326 to 2,190 ± 159 cm3; P < 0.001), representing loss of steatosis. Decreases were seen in total body weight (from 61.8 ± 3.6 to 57.4 ± 3.4 kg; P = 0.02) and resting energy expenditure (from 1,929 ± 86 to 1,611 ± 101 kcal/24 h; P < 0.001). R-metHuLeptin led to significant and sustained improvements in glycemia, dyslipidemia, and hepatic steatosis. Leptin represents the first novel, effective, long-term treatment for severe forms of lipodystrophy.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In 15 patients with generalized lipodystrophy, 12 months of twice-daily recombinant methionyl human leptin produced sustained improvements in glycemia, dyslipidemia, and hepatic steatosis, with many able to reduce or discontinue antidiabetes medications. The authors conclude leptin replacement represents the first novel, effective, long-term treatment for severe forms of lipodystrophy.

Key findings

  • Glycemic control improved: fasting glucose fell from 205 ± 19 to 126 ± 11 mg/dl (P < 0.001) and HbA1c from 9 ± 0.4 to 7.1 ± 0.5% (P < 0.001). Insulin sensitivity more than doubled by the K constant (0.0074 to 0.015, P < 0.001).
  • Lipids improved: triglycerides decreased from 1,380 ± 500 to 516 ± 236 mg/dl (P < 0.001), LDL from 139 ± 16 to 85 ± 7 mg/dl (P < 0.01), and total cholesterol from 284 ± 40 to 167 ± 21 mg/dl (P < 0.01); HDL was unchanged (31 ± 3 to 29 ± 2 mg/dl, P = 0.9).
  • Liver volume decreased from 3,663 ± 326 to 2,190 ± 159 cm³ (P < 0.001), representing loss of steatosis. Weight fell from 61.8 ± 3.6 to 57.4 ± 3.4 kg (P = 0.02), BMI from 21.5 to 20 kg/m² (P < 0.001), and resting energy expenditure from 1,929 ± 86 to 1,611 ± 101 kcal/24 h (P < 0.001).
  • Antidiabetes therapy decreased: 9 of 15 patients were on insulin at baseline (mean dose 916 units daily); at 12 months, 3 of 15 remained on insulin (mean dose 322 units daily), and six patients discontinued insulin. Six of eight patients discontinued oral agents.

Methods

  • Open-label pilot study of 27 consecutive patients with congenital or acquired generalized lipodystrophy; 20 met inclusion criteria for r-metHuLeptin, and 15 completed at least 1 year of treatment and were analyzed. Inclusion required hypoleptinemia (male <4 ng/ml, female <5 ng/ml) and metabolic abnormalities such as hypertriglyceridemia, hyperinsulinemia, or diabetes.
  • r-metHuLeptin was self-administered twice daily subcutaneously, escalated over 2 months, then usual replacement doses of 0.06–0.08 mg/kg/day for females and 0.04 mg/kg/day for males. Patients were evaluated at the NIH Clinical Center at baseline and every 4 months for 1 year.
  • Results are means ± SE; one-way ANOVA for repeated measures was used, with log10 transformation for non-normally distributed parameters, plus paired t tests where applicable; P < 0.05 was considered significant.

Limitations

  • The authors state the study power is limited by its small size, its nonrandomized open-label nature, and the combination of r-metHuLeptin with conventional medications.
  • Five of the 20 patients who initiated therapy withdrew before 12 months; the authors note they cannot exclude the possibility that leptin therapy was associated with exacerbation of underlying renal disease in two patients with acquired generalized lipodystrophy.
  • Evident from the text: there was no control group, and the open-label design plus concomitant medication changes limit causal attribution of all observed improvements to leptin alone.

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Integrity signals

Registry

Crossref · 10.2337/diabetes.54.7.1994

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

49 Own result · 33 Not checked yet · 20 Own interpretation · 9 No basis given · 8 Own method

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Show all 54 claims

  • Probably not a substantial claim. 27
  • It may state two separate claims as one. 47
  • The quote only partly states this claim. 3
65 of 65
  • The paper relies on this without support.

    Before this study, there were no substantial data demonstrating the long-term effectiveness of leptin replacement therapy.

    “Until now, however, there have been no substantial data demonstrating the long-term effectiveness of leptin replacement therapy.”
  • The paper relies on this without support.

    Generalized lipodystrophy leads to severe metabolic abnormalities, including hypertriglyceridemia, NAFLD, insulin resistance, and diabetes.

    “Generalized lipodystrophy leads to severe metabolic abnormalities, including hypertriglyceridemia, NAFLD, in- sulin resistance, and diabetes.”
  • The paper relies on this without support.

    The lack of subcutaneous and visceral adipose tissue results in the storage of triglycerides in ectopic locations such as muscle and liver.

    “The lack of subcutaneous and visceral adipose tissue results in the storage of triglycerides in ectopic locations such as muscle and liver.”
  • The paper relies on this without support.

    The degree of ectopic fat accumulation is further compounded by hyperphagia, which is characteristic of the hypoleptinemic state in rodents and humans.

    “The degree of ectopic fat accumulation is further compounded by hyperphagia, which is characteristic of the hypoleptinemic state in rodents and humans.”
  • The paper relies on this without support.

    Generalized lipodystrophy is characterized by absence of adipose tissue with hypoleptinemia, hyperphagia, and excessive ectopic fat accumulation.

    “The third example is generalized lipodystrophy, characterized by absence of adipose tissue with hypoleptinemia, hyperphagia, and excessive ectopic fat accumulation.”
  • The paper relies on this without support.

    Leptin is crucial in mitochondrial function.

    “Leptin is believed to be crucial in mitochondrial function.”
  • The paper relies on this without support.

    Hyperinsulinemia leads to increased androgen production from the ovaries, forming the basis of polycystic ovarian syndrome.

    “Hyperinsulinemia leads to increased androgen production from the ovaries, forming the basis of polycystic ovarian syndrome.”
  • The paper relies on this without support.

    Leptin is the first and only adipokine to be administered to humans for long-term therapeutic purposes.

    “Leptin is the first and only adipokine to be administered to humans for long-term therapeutic purposes.”
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Metadata

Authors
Javor, E. D., Cochran, E. K., Musso, C., Young, J. R., DePaoli, A. M., & Gorden, P.
Affiliations
  • National Institutes of Health (US)
  • Amgen (United States) (US)
  • Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Venue
Diabetes
Published
2005-07-01
Volume
54
Issue
7
Pages
1994-2002
ISSN
  • 0012-1797 (ISSN-L)
  • 1939-327X
OpenAlex
W2100364658
Cited by
226
References
45
Citations by year
2025: 3 · 2024: 7 · 2023: 4 · 2022: 4 · 2021: 9 · 2020: 3 · 2019: 8 · 2018: 6 · 2017: 5 · 2016: 11 · 2015: 16 · 2014: 20 · 2013: 19 · 2012: 11
FWCI
13.15
Type
journal article
Language
en
Open access
Locations
  • Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords
generalized lipodystrophy, leptin replacement, recombinant human leptin, ectopic fat deposition, insulin resistance, hypertriglyceridemia, hepatic steatosis, liver volume, hyperphagia, adipose tissue deficiency, long-term metabolic outcomes, weight loss, lipid profile, HbA1c, LDL cholesterol, HDL cholesterol, triglycerides
MeSH terms
Adolescent, Adult, Blood Glucose, Child, Female, Glycated Hemoglobin, Humans, Lipodystrophy, Male, Triglycerides, Cohort Studies, Body Mass Index, Leptin

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