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. 2014 Jul;20(7):759-63.
doi: 10.1038/nm.3579. Epub 2014 Jun 15.

Leptin reverses diabetes by suppression of the hypothalamic-pituitary-adrenal axis

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Leptin reverses diabetes by suppression of the hypothalamic-pituitary-adrenal axis

Rachel J Perry et al. Nat Med. 2014 Jul.

Abstract

Leptin treatment reverses hyperglycemia in animal models of poorly controlled type 1 diabetes (T1D), spurring great interest in the possibility of treating patients with this hormone. The antidiabetic effect of leptin has been postulated to occur through suppression of glucagon production, suppression of glucagon responsiveness or both; however, there does not appear to be a direct effect of leptin on the pancreatic alpha cell. Thus, the mechanisms responsible for the antidiabetic effect of leptin remain poorly understood. We quantified liver-specific rates of hepatic gluconeogenesis and substrate oxidation in conjunction with rates of whole-body acetate, glycerol and fatty acid turnover in three rat models of poorly controlled diabetes, including a model of diabetic ketoacidosis. We show that the higher rates of hepatic gluconeogenesis in all these models could be attributed to hypoleptinemia-induced activity of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in higher rates of adipocyte lipolysis, hepatic conversion of glycerol to glucose through a substrate push mechanism and conversion of pyruvate to glucose through greater hepatic acetyl-CoA allosteric activation of pyruvate carboxylase flux. Notably, these effects could be dissociated from changes in plasma insulin and glucagon concentrations and hepatic gluconeogenic protein expression. All the altered systemic and hepatic metabolic fluxes could be mimicked by infusing rats with Intralipid or corticosterone and were corrected by leptin replacement. These data demonstrate a critical role for lipolysis and substrate delivery to the liver, secondary to hypoleptinemia and HPA axis activity, in promoting higher hepatic gluconeogenesis and hyperglycemia in poorly controlled diabetes.

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Figures

Fig. 1
Fig. 1
Leptin reverses hyperglycemia and excess gluconeogenesis from pyruvate and glycerol in streptozotocin-induced type 1 diabetic (T1D) rats. (a)–(d) Fasting plasma glucose, insulin, glucagon, and leptin concentrations. In panel (d), n=16 for all groups. (e) Hepatic gluconeogenesis from pyruvate (lower bars) and glycerol (upper bars). P-values over the bars represent comparisons of total gluconeogenic flux. Gluconeogenesis from both pyruvate and glycerol was increased (P<0.05 and P<0.0001, respectively) in T1D rats vs. controls, and decreased (P<0.001 and P<0.0001, respectively) in T1D-leptin treated vs. T1D rats. (f)–(h) Whole-body glycerol, fatty acid (palmitate), and acetate turnover. (i) Liver acetyl CoA concentration. (j) 12 p.m. plasma corticosterone concentrations. Data are mean ± S.E. If not otherwise specified, n=6–8 per group. *P<0.05, ***P<0.001, ****P<0.0001 vs. control; ##P<0.01, ###P<0.001, ####P<0.0001 vs. T1D; §§§P<0.001 vs. T1D-leptin 6 hr.
Fig. 2
Fig. 2
24 hr lipid infusion in 3-day high fat fed rats replicates the perturbations to fluxes seen in T1D and hyperinsulinemic-diabetic rats and implicates increased substrate supply in the excess gluconeogenesis of T1D. (a) Plasma glucose. (b) Hepatic gluconeogenesis from pyruvate (lower bars) and glycerol (upper bars). Gluconeogenesis from both pyruvate and glycerol was increased (P<0.001 and P<0.01, respectively) in lipid-infused rats. (c) TCA cycle flux from fatty acid oxidation (lower bars) and through PDH (upper bars). VTCA from fatty acid oxidation was increased and VTCA through PDH was decreased (P<0.05) in lipid-infused rats. (d), (e) Whole-body glycerol and fatty acid (palmitate) turnover. (f) Liver acetyl CoA concentration. In all panels, data are mean ± S.E. of n=6 per group. *P<0.05, **P<0.01, ***P<0.001, ****P<0.0001.
Fig. 3
Fig. 3
Substrate (Intralipid/heparin) infusion blocks leptin’s effect to suppress hepatic gluconeogenesis in T1D rats. (a) Fasting plasma glucose. (b) Hepatic gluconeogenesis from pyruvate (lower bars) and glycerol (upper bars). Gluconeogenesis from both pyruvate and glycerol was increased (P<0.01 and P<0.001, respectively) in lipid-infused rats. (c) VTCA from fatty acid oxidation (lower bars) and through pyruvate dehydrogenase (upper bars). VTCA through PDH was increased (P<0.05) in lipid-infused rats. (d), (e) Whole-body glycerol and palmitic acid oxidation. (f) Liver acetyl CoA concentration. In all panels, data are mean ± S.E. of n=6 per group. *P<0.05, **P<0.01, ***P<0.001, ****P<0.0001.
Fig. 4
Fig. 4
Matching plasma corticosterone in high fat fed-corticosterone infused rats to that of T1D animals drives excess lipolysis, gluconeogenesis, and hyperglycemia. (a) Fasting plasma glucose. (b) Hepatic gluconeogenesis from pyruvate (solid bars) and glycerol (dashed bars). Gluconeogenesis from glycerol was increased (P<0.01) in corticosterone-infused rats. (c) Fasting plasma insulin. (d) TCA cycle flux from fatty acid oxidation (solid bars) and through PDH (dashed bars). (e)–(g) Whole-body glycerol, fatty acid (palmitate) and acetate turnover. (h) Liver acetyl CoA concentration. In all panels, data are mean ± S.E.M., n=6 per group. *P<0.05, **P<0.01, ****P<0.0001.

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References

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