Cited by 203Regulation of Appetite and ObesityAdipokines, Inflammation, and Metabolic DiseasesHypothalamic control of reproductive hormones

The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index; none of the 56 sources its claims cite is checked for support yet.

Leptin in humans: lessons from translational research

Open access
Blüher, Susann, Mantzoros, Christos S·2009·The American Journal of Clinical Nutrition

Abstract

Leptin has emerged over the past decade as a key hormone in not only the regulation of food intake and energy expenditure but also in the regulation of neuroendocrine and immune function as well as the modulation of glucose and fat metabolism as shown by numerous observational and interventional studies in humans with (complete) congenital or relative leptin deficiency. These results have led to proof-of-concept studies that have investigated the effect of leptin administration in subjects with complete (congenital) leptin deficiency caused by mutations in the leptin gene as well as in humans with relative leptin deficiency, including states of lipoatrophy or negative energy balance and neuroendocrine dysfunction, as for instance seen with hypothalamic amenorrhea in states of exercise-induced weight loss. In those conditions, most neuroendocrine, metabolic, or immune disturbances can be restored by leptin administration. Leptin replacement therapy is thus a promising approach in several disease states, including congenital complete leptin deficiency, states of energy deprivation, including anorexia nervosa or milder forms of hypothalamic amenorrhea, as well as syndromes of insulin resistance seen in conditions such as congenital or acquired lipodystrophy. In contrast, states of energy excess such as garden-variety obesity are associated with hyperleptinemia that reflects either leptin tolerance or leptin resistance. For those conditions, development of leptin sensitizers is currently a focus of pharmaceutical research. This article summarizes our current understanding of leptin's role in human physiology and its potential role as a novel therapeutic option in human disease states associated with a new hormone deficiency, ie, leptin deficiency.

Overview

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TL;DR

This review synthesizes observational and interventional human studies showing that leptin is a key hormone regulating food intake, energy expenditure, neuroendocrine axes, immune function, and glucose/fat metabolism, with its major physiologic role being to signal inadequate rather than excess energy stores. Leptin replacement therapy restores neuroendocrine, metabolic, and immune function in states of absolute or relative leptin deficiency, whereas states of energy excess (garden-variety obesity) are characterized by hyperleptinemia reflecting leptin tolerance or resistance.

Key findings

  • Leptin, a 167-amino acid peptide primarily expressed in adipose tissue, circulates in free (biologically active) form and is secreted in a pulsatile, diurnal-nocturnal pattern; pulse amplitude is higher in obese subjects, while pulsatility characteristics are otherwise similar between lean and obese subjects.
  • In congenital leptin deficiency (leptin or leptin receptor mutations), subjects present with hypogonadotropic hypogonadism, low FSH/LH, loss of LH pulsatility, lack of pubertal growth spurt, primary/secondary amenorrhea, growth delay with low IGF-I and IGF-BP3, and hypothalamic hypothyroidism; leptin administration in replacement doses restores these neuroendocrine features and immune function.
  • In relative leptin deficiency (hypothalamic amenorrhea, lipoatrophy, anorexia nervosa), r-metHuLeptin in replacement doses restored reproductive function, induced ovulation, increased thyroxine, IGF-I, IGF-BP3, and bone markers, restored GnRH pulsatility, and improved insulin resistance and metabolic profile in HAART-induced lipoatrophy.
  • In leptin-sufficient obese subjects with type 2 diabetes, r-metHuLeptin for 4 or 16 wk produced high pharmacologic leptin concentrations but did not activate the TNF-α system or raise cytokines/inflammatory markers above normal, supporting a permissive (not etiopathogenic) role for leptin in immune regulation; placebo-controlled trials in obese persons over 24 wk showed statistically significant but clinically unimpressive weight loss.

Methods

  • Narrative review summarizing observational and interventional human studies on leptin physiology and pathophysiology, including pharmacokinetic studies and leptin replacement therapy.
  • Evidence drawn from subjects with congenital complete leptin deficiency, leptin receptor mutations, lipoatrophy (congenital/acquired, including HIV/HAART-associated), hypothalamic amenorrhea, anorexia nervosa, and garden-variety obesity, plus healthy normal-weight subjects undergoing fasting/starvation with r-metHuLeptin administration.
  • Includes two summary tables: factors regulating circulating leptin concentrations (Table 1) and leptin deficiency/resistance states with estimated prevalences (Table 2), plus a schematic figure of energy deficiency/excess effects on neuroendocrine axes.

Limitations

  • Stated: the exact long-term effect of leptin on the hypothalamic-pituitary-GH-IGF axis remains to be fully elucidated; whether resolution of insulin resistance in congenital leptin deficiency is a primary leptin effect or secondary to fat loss/redistribution remains to be clarified; mechanisms of leptin's effects on the thyroid axis are not completely understood; more long-term interventional studies are needed in congenital leptin deficiency; whether r-metHuLeptin alone or combined with other treatments will find a therapeutic place remains to be seen.
  • Stated: the role of leptin in the adrenal axis in humans remains controversial, with interventional studies in healthy normal-weight subjects failing to show an effect on adrenal steroids.
  • Evident from the text: this is a narrative review without systematic search or meta-analytic synthesis, and several cited findings rest on small proof-of-concept studies; the authors also note their own laboratory received funds from Amgen and Amylin.

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Registry

Crossref · 10.3945/ajcn.2008.26788e

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  1. Tsiodras, 2006, The role of leptin and adiponectin in the HAART induced metabolic syndrome., Am J Infect Dis, 2, 141

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Metadata

Authors
Blüher, S., & Mantzoros, C. S.
Affiliations
Beth Israel Deaconess Medical Center (US)
Corresponding author
Mantzoros, Christos S
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2009-03
Volume
89
Issue
3
Pages
991S-997S
ISSN
0002-9165 (ISSN-L)
OpenAlex
W2085745363
Cited by
203
References
43
Citations by year
2026: 1 · 2025: 2 · 2024: 6 · 2023: 11 · 2022: 8 · 2021: 12 · 2020: 7 · 2019: 7 · 2018: 3 · 2017: 5 · 2016: 14 · 2015: 19 · 2014: 14 · 2013: 12 · 2012: 27
FWCI
2.94
Type
journal article
Language
en
Open access
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Amgen
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK079929, DK 79929, DK 58785)
Topics
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
leptin, leptin deficiency, leptin replacement therapy, congenital leptin deficiency, hypothalamic amenorrhea, anorexia nervosa, lipodystrophy, insulin resistance, leptin resistance, obesity, hyperleptinemia, energy balance, food intake regulation, energy expenditure, immune function, glucose metabolism, fat metabolism, neuroendocrine dysfunction
MeSH terms
Animals, Humans, Neurosecretory Systems, Leptin

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