瘦素水平与代谢综合症的关系

随着代谢综合症在世界范围内的广为流行,已经引起人们的高度重视.代谢综合征以肥胖和代谢异常为特征,胰岛素抵抗为主要的病理机制.瘦素主要来源于脂肪组织,是调节体内脂肪储量和维持能量平衡的一种内分泌激素.瘦素缺乏和瘦素抵抗不仅可以直接引起胰岛素抵抗,而且可以通过导致肥胖继而参与胰岛素抵抗的发生,最终引起代谢综合征.瘦素作为一种新的代谢综合征致病因子,参与代谢综合征的发生发展,故调节瘦素水平为临床治疗代谢综合症提供了新的思路和方法.本文综述了瘦素水平与代谢综合症的关系,以及调节瘦素水平治疗代谢综合征的方法.     

脂肪源性外泌体在动脉粥样硬化病理进展中的作用

动脉粥样硬化是一种病因复杂的血管壁慢性炎症性疾病,近年来其发病率持续增高,肥胖和糖尿病是其公认的危险因素。脂肪组织作为机体内重要的代谢器官,同时亦具有强大的内分泌功能。在肥胖和糖尿病情况下,脂肪组织来源的多种细胞因子及外泌体介导了器官、细胞间的信息交流,参与多种疾病的发生和发展。外泌体作为细胞间重要的通讯媒介,调控多种心血管疾病病理进程,与动脉粥样硬化密切相关。本文围绕动脉粥样硬化病理进程中的内皮功能障碍、炎症反应、脂质代谢紊乱和胰岛素抵抗四个重要的病变过程,就脂肪源性外泌体的作用机制展开综述,以期为该疾病的研究和诊疗提供参考。     

前列腺素E_2受体EP4与脂肪生成及代谢

脂肪是身体的储能器官,能量以脂滴的形式储存在脂肪细胞中,脂肪组织的功能稳态是机体维持正常代谢活动的基础。前列腺素E_2 (prostaglandin E_2, PGE_2)是体内重要的脂质活性分子,广泛表达于机体组织中,参与血压、糖脂代谢、炎症等众多生理过程的调节。大量证据表明PGE_2合成酶及其受体在白色脂肪组织中大量表达,提示PGE_2参与脂肪代谢的调节。PGE_2发挥生物学功能,需要通过其G蛋白耦联受体EP1～4介导,其中EP4受体亚型在脂肪生成及代谢中发挥了重要作用,EP4受体的激活可以抑制前脂肪细胞的分化,EP4受体的缺失促进脂质分解。本文将综述EP4受体与脂肪发生及代谢的关系,并提出EP4受体有可能成为肥胖及相关代谢疾病新的治疗靶点。     

内脏脂肪组织中免疫细胞与炎症的关系

长期以来,人们对免疫系统有了一定的认识和研究。无论在病理状态还是非病理状态,免疫系统都会监视和作用被称之为"免疫代谢"。大量的事实显示,肥胖及相关疾病,均能激活先天性免疫系统和获得性免疫系统。肥胖相关的慢性炎症,是内脏脂肪发生胰岛素抵抗的始动因素。脂肪因子和天然免疫淋巴细胞,尤其是巨噬细胞调节脂肪炎症和葡萄糖稳态。本综述就脂肪组织中的免疫细胞类型及对炎症和胰岛素抵抗的调节过程进行讨论。     

脂肪细胞对胰岛β细胞功能的内分泌调节作用

脂肪因子包括脂肪细胞分泌的多种活性因子,它们通过内分泌方式调节胰岛β细胞的胰岛素分泌、基因表达以及细胞凋亡等多方面的功能。本文提出脂肪因子影响胰岛β细胞功能主要通过三条相互联系的途径而实现。第一是调节β细胞内葡萄糖和脂肪的代谢;第二是影响β细胞离子通道的活性;第三是改变β细胞本身的胰岛素敏感性。脂肪细胞的内分泌功能是一个动态过程,在不同的代谢状态下,各脂肪因子的分泌发生不同变化。从正常代谢状态发展到肥胖以及2型糖尿病的过程中,脂肪因子参与了胰岛β细胞功能障碍的发生与发展。     

PBEF/Nampt/Visfatin——脂肪因子、蛋白酶、炎症因子?

脂肪因子是由脂肪组织分泌的肽类物质,影响着整个机体的能量代谢,在多种病理过程中起着关键性调节作用。PBEF/Nampt/Visfatin是2005日本学者新发现的一种脂肪因子,由于其具有类胰岛素作用而成为研究热点。目前对该因子属性、作用及作用机制的探讨十分激烈。尽管对PBEF/Nampt/Visfatin的认识尚未明了,但其在代谢性疾病中的作用为该类疾病的病理机制做了重要补充,并且为攻克这类疾病提供了新思路、新靶点。     

脂肪组织对糖异生的调控作用

糖异生是在空腹或饥饿状态下机体产生内源性葡萄糖的主要途径,激素信号以及相关转录激活因子共同调控糖异生途径关键限速酶葡萄糖-6-磷酸酶(G-6-Pase)和磷酸烯醇式丙酮酸羧激酶(PEPCK)的基因表达。随着深入的研究发现,脂肪组织分泌的脂肪因子以及分解代谢过程中产生的游离脂肪酸也参与这类酶的表达调控,进而影响胰岛素抵抗及糖异生的发生。因此通过干预脂肪组织对糖异生的调控,能有效抑制肝脏过度糖异生,改善胰岛素抵抗,对肥胖和2型糖尿病等代谢综合征的治疗有重要意义。     

脂肪组织中自噬信号通路及其功能

细胞自噬是一种真核生物中高度保守的代谢过程,包括巨自噬、微自噬以及分子伴侣介导的自噬等。自噬过程可以清除受损的细胞器,降解糖原、脂类和蛋白质等生物大分子物质,供细胞重新利用,维持细胞内代谢平衡。自噬障碍与多种疾病的病理发生过程息息相关,包括肿瘤、2型糖尿病、肥胖、骨骼肌病以及神经退行性疾病等。脂肪组织是人体脂质储存的重要场所,广泛分布于全身各处,如内脏和皮下等。脂肪组织通过储存冗余脂肪并分泌脂肪因子,防止脂肪的异位堆积和脂毒性的发生,维持机体的脂质稳态。近期的许多研究表明,自噬进程深度参与脂肪细胞的细胞分化与能量代谢。因此,深入探究脂肪组织自噬过程与机体脂质稳态的调控关系,有利于揭示机体脂质平衡的内在机制,为新型药物靶点的开发提供扎实的理论依据和数据支持。本文就近年来关于自噬影响脂肪组织脂质代谢的最新研究进展作一综述。     

炎症-内质网应激-肠道菌群在胰岛素抵抗发病中的作用

胰岛素抵抗(insulin resistance,IR)是肥胖导致的代谢综合征的典型表现,因其作用器官广泛和作用机制复杂成为糖尿病等代谢性疾病治疗中的一大难题。胰岛素抵抗涉及多个代谢器官、多种细胞因子和多条信号转导通路的交互作用,呈现出极其复杂的作用网络。目前认为,炎症、内质网应激和肠道菌群失调是引起胰岛素抵抗的最主要的三大机制。本文将综述胰岛素抵抗的三大病理机制,并探讨三者之间的关联性。     

脂联素与心血管疾病

脂联素（adiponectin）是一种具有胰岛素增敏作用的脂肪因子。近年来的研究发现,脂联素及其受体与心血管系统有广泛而密切的联系。脂联素影响心肌、平滑肌及内皮细胞功能,参与心肌肥大、心力衰竭、动脉粥样硬化、高血压及血管新生等病理生理过程。脂联素可能是代谢综合征和心血管事件的一个重要生物标志及治疗靶分子。     

Adipokines oversecreted by omental adipose tissue in human obesity

Central-omental obesity plays a causative role in the pathogenesis of the metabolic syndrome. Adipokines are involved in the pathogenesis of this syndrome. However, adipokines secreted by omental adipose tissue (OAT) are still poorly characterized in human obesity. Therefore, we searched for novel adipokines abnormally secreted by OAT in obesity and examined their relationships with some features of metabolic syndrome and the respective contribution of adipocytes vs. stromal-vascular cells. OAT from obese and nonobese men was fractionated into adipocytes and SV cells, which were then cultured. Medium was screened by medium-scale protein arrays and ELISAs. Adipokine mRNA levels were measured by real-time RT-qPCR. We detected 16 cytokines secreted by each cellular fraction of lean and obese subjects. Of the 16 cytokines, six adipokines were newly identified as secretory products of OAT, which were dysregulated in obesity: three chemokines (growth-related oncogen factor, RANTES, macrophage inflammatory protein-1beta), one interleukin (IL-7), one tissue inhibitor of metalloproteinases (TIMP-1), and one growth factor (thrombopoietin). Their secretion and expression were enhanced in obesity, with a relatively similar contribution of the two fractions. The higher proportion of macrophages and endothelial cells in obesity may contribute to this enhanced production as well as changes in intrinsic properties of hypertrophied adipocytes. Accordingly, mRNA concentrations of most of these adipokines increased during adipocyte differentiation. Eventually, expression of the investigated adipokines did correlate with several features of the metabolic syndrome. In conclusion, six adipokines were newly identified as oversecreted by OAT in obesity. These adipokines may link obesity to its cardiovascular or metabolic comorbidities.     

The Roles of Adipokines,Proinflammatory Cytokines,and Adipose Tissue Macrophages in Obesity-Associated Insulin Resistance in Modest Obesity and Early Metabolic Dysfunction

The roles of adipokines, proinflammatory cytokines, and adipose tissue macrophages in obesity-associated insulin resistance have been explored in both animal and human studies. However, our current understanding of obesity-associated insulin resistance relies on studies of artificial metabolic extremes. The purpose of this study was to explore the roles of adipokines, proinflammatory cytokines, and adipose tissue macrophages in human patients with modest obesity and early metabolic dysfunction. We obtained omental adipose tissue and fasting blood samples from 51 females undergoing gynecologic surgery. We investigated serum concentrations of proinflammatory cytokines and adipokines as well as the mRNA expression of proinflammatory and macrophage phenotype markers in visceral adipose tissue using ELISA and quantitative RT-PCR. We measured adipose tissue inflammation and macrophage infiltration using immunohistochemical analysis. Serum levels of adiponectin and leptin were significantly correlated with HOMA-IR and body mass index. The levels of expression of MCP-1 and TNF-α in visceral adipose tissue were also higher in the obese group (body mass index ≥ 25). The expression of mRNA MCP-1 in visceral adipose tissue was positively correlated with body mass index (r = 0.428, p = 0.037) but not with HOMA-IR, whereas TNF-α in visceral adipose tissue was correlated with HOMA-IR (r = 0.462, p = 0.035) but not with body mass index. There was no obvious change in macrophage phenotype or macrophage infiltration in patients with modest obesity or early metabolic dysfunction. Expression of mRNA CD163/CD68 was significantly related to mitochondrial-associated genes and serum inflammatory cytokine levels of resistin and leptin. These results suggest that changes in the production of inflammatory biomolecules precede increased immune cell infiltration and induction of a macrophage phenotype switch in visceral adipose tissue. Furthermore, serum resistin and leptin have specific roles in the regulation of adipose tissue macrophages in patients with modest obesity or early metabolic dysfunction.     

Metabolic syndrome in mice induced by expressing a transcriptional activator in adipose tissue

Metabolic syndrome is a combination of medical disorders that increases the risk of developing cardiovascular disease and diabetes. Constitutive overexpression of 11β-HSD1 in adipose tissue in mice leads to metabolic syndrome. In the process of generating transgenic mice overexpressing 11β-HSD1 in an inducible manner, we found a metabolic syndrome phenotype in control, transgenic mice, expressing the reverse tetracycline-transactivator (rtTA) in adipose tissue. The control mice exhibited all four sequelae of metabolic syndrome (visceral obesity, insulin resistance, dyslipidemia, and hypertension), a pro-inflammatory state and marked hepatic steatosis. Gene expression profiling of the adipose tissue, muscle and liver of these mice revealed changes in expression of genes involved in lipid metabolism, insulin resistance, and inflammation. Transient transfection of rtTA, but not tTS, into 3T3-L1 cells resulted in lipid accumulation. We conclude that expression of rtTA in adipose tissue causes metabolic syndrome in mice.     

Biological specificity of visceral adipose tissue and therapeutic intervention

With excess energy storage, obesity develops, leading to increased risk for type 2 diabetes and cardiovascular diseases. The distribution of body fat appears to be even more important than the total amount of fat. Abdominal and, in particular, visceral adiposity is strongly linked to insulin resistance, type 2 diabetes, hypertension, dyslipidaemia, sleep apnea, and other complications of obesity. Visceral adiposity, manifested as a high waist circumference, is now accepted as a major component of the metabolic syndrome. However, the biological mechanisms underlying the adverse impact of visceral fat accumulation remain to be established. This review will focus on the analysis of the biological specificity of adipose tissue located in the abdominal region, and will explore intervention strategies targeting the impaired function of the visceral adipocyte as potential therapies for the cardio-metabolic outcomes of patients with the metabolic syndrome.     

The renin–angiotensin system in adipose tissue and its metabolic consequences during obesity

Obesity is a worldwide disease that is accompanied by several metabolic abnormalities such as hypertension, hyperglycemia and dyslipidemia. The accelerated adipose tissue growth and fat cell hypertrophy during the onset of obesity precedes adipocyte dysfunction. One of the features of adipocyte dysfunction is dysregulated adipokine secretion, which leads to an imbalance of pro-inflammatory, pro-atherogenic versus anti-inflammatory, insulin-sensitizing adipokines. The production of renin–angiotensin system (RAS) components by adipocytes is exacerbated during obesity, contributing to the systemic RAS and its consequences. Increased adipose tissue RAS has been described in various models of diet-induced obesity (DIO) including fructose and high-fat feeding. Up-regulation of the adipose RAS by DIO promotes inflammation, lipogenesis and reactive oxygen species generation and impairs insulin signaling, all of which worsen the adipose environment. Consequently, the increase of circulating RAS, for which adipose tissue is partially responsible, represents a link between hypertension, insulin resistance in diabetes and inflammation during obesity. However, other nutrients and food components such as soy protein attenuate adipose RAS, decrease adiposity, and improve adipocyte functionality. Here, we review the molecular mechanisms by which adipose RAS modulates systemic RAS and how it is enhanced in obesity, which will explain the simultaneous development of metabolic syndrome alterations. Finally, dietary interventions that prevent obesity and adipocyte dysfunction will maintain normal RAS concentrations and effects, thus preventing metabolic diseases that are associated with RAS enhancement.     

Fuzzy algorithms: Application to adipose tissue quantification on MR images

Metabolic syndrome, which is related to abdominal obesity, is a fast growing disease in our western countries. Its presence greatly increases the risk of developing cardiovascular diseases. The accumulation of visceral adipose tissue plays a key role in the development of the metabolic syndrome. The increase of waist circumference is one of the five criteria of the metabolic syndrome diagnosis. But this increase can be due to visceral or subcutaneous adipose tissues. And these adipose tissues do not play the same rule in metabolic syndrome. The purpose of this study was to develop software for automatic and reliable quantification of visceral and subcutaneous adipose tissues, to detect patient with high risk to develop metabolic syndrome and to follow the evolution of adipose tissue repartition after treatment. A gradient echo magnetic resonance (MR) technique is used, with a TE such that fat and water are opposed in phase. The developed process is based on two fuzzy algorithms. First, we fuzzy generalized clustering algorithms allow to merge pixels according to their intensities. Then, fuzzy connectedness algorithm allows to merge pixels according to cost function related to distance, gradient distance and intensities. A validation is performed with a comparison between expert results made by manual drawing and purpose-made software results. Our software provides an automatic and reliable method to segment visceral and subcutaneous adipose tissue and additionally avoids in some case the problem of inhomogeneity of signal intensity.     

Secretome analysis of rat adipose tissues shows location-specific roles for each depot type

Obesity prevalence is reaching pandemic proportions becoming a major public health threat for many industrialized nations. It is especially worrying as it causes a higher risk of premature death due to associated diseases such as type 2 diabetes, cardiovascular disease, and some cancers. Current evidence shows biological and genetic differences between adipose tissues depending on its anatomical location. Particularly, upper body/visceral fat distribution in obesity is closely linked to metabolic complications. In this report, we characterize for the first time the secretome of rat adipose tissue explants from different anatomical localizations and its differential analysis. Visceral, subcutaneous, and gonadal fat specific secretomes and differentially secreted proteins among the three fat depots were analyzed by 2-DE and MS. Reference maps for location-specific adipose tissue secretomes are shown and the 45 most significant differences are listed. Identified proteins include classical adipokines and novel secreted proteins. Interestingly, our results show that the type of proteins and their role in different biological processes diverge significantly when comparing the set of proteins identified from visceral, subcutaneous and gonadal fat explants. This study emphasizes and supports the differential role of adipose tissue in accordance to its anatomical localization.     

Bofu-Tsu-Shosan,an Oriental Herbal Medicine,Exerts a Combinatorial Favorable Metabolic Modulation Including Antihypertensive Effect on a Mouse Model of Human Metabolic Disorders with Visceral Obesity

Accumulating evidence indicates that metabolic dysfunction with visceral obesity is a major medical problem associated with the development of hypertension, type 2 diabetes (T2DM) and dyslipidemia, and ultimately severe cardiovascular and renal disease. Therefore, an effective anti-obesity treatment with a concomitant improvement in metabolic profile is important for the treatment of metabolic dysfunction with visceral obesity. Bofu-tsu-shosan (BOF) is one of oriental herbal medicine and is clinically available to treat obesity in Japan. Although BOF is a candidate as a novel therapeutic strategy to improve metabolic dysfunction with obesity, the mechanism of its beneficial effect is not fully elucidated. Here, we investigated mechanism of therapeutic effects of BOF on KKAy mice, a model of human metabolic disorders with obesity. Chronic treatment of KKAy mice with BOF persistently decreased food intake, body weight gain, low-density lipoprotein cholesterol and systolic blood pressure. In addition, both tissue weight and cell size of white adipose tissue (WAT) were decreased, with concomitant increases in the expression of adiponectin and peroxisome proliferator-activated receptors genes in WAT as well as the circulating adiponectin level by BOF treatment. Furthermore, gene expression of uncoupling protein-1, a thermogenesis factor, in brown adipose tissue and rectal temperature were both elevated by BOF. Intriguingly, plasma acylated-ghrelin, an active form of orexigenic hormone, and short-term food intake were significantly decreased by single bolus administration of BOF. These results indicate that BOF exerts a combinatorial favorable metabolic modulation including antihypertensive effect, at least partially, via its beneficial effect on adipose tissue function and its appetite-inhibitory property through suppression on the ghrelin system.     

Vaspin gene in rat adipose tissue: relation to obesity-induced insulin resistance

Visceral adipose fat has been claimed to be the link between obesity and insulin resistance through the released adipokines. This study aimed to assess the expression of vaspin as one of the recent adipokines in rats abdominal subcutaneous and visceral fat in diet-induced obese (DIO) and in DIO performing 3 weeks swimming exercise (DIO + EXE) compared to control and control + exercise (C + EXE) groups. Vaspin mRNA and protein expression assessed using RT-PCR and Western blotting analysis revealed vaspin expression in DIO and DIO + EXE but not in controls groups. In DIO group, visceral vaspin expression was higher than in that of subcutaneous fat and was positively correlated with body weight. Upregulation of visceral vaspin expression in DIO was concomitant with the development of insulin resistance (increase in fasting serum insulin and HOMA-IR) and rise in serum leptin level. Unchanged visceral vaspin mRNA in DIO + EXE rats, with significant improvements of insulin resistance parameters and serum leptin compared to DIO group was found. In conclusion, increased visceral vaspin expression in obesity was associated with insulin resistance. Further investigations into the molecular links between vaspin and obesity may unravel innovative therapeutic strategies in people affected by obesity-linked insulin resistance, metabolic syndrome, and type 2 diabetes.     

Combined Impact of Cardiorespiratory Fitness and Visceral Adiposity on Metabolic Syndrome in Overweight and Obese Adults in Korea

Background

Obesity, especially visceral obesity, is known to be an important correlate for cardiovascular disease and increased mortality. On the other hand, high cardiorespiratory fitness is suggested to be an effective contributor for reducing this risk. This study was conducted to determine the combined impact of cardiorespiratory fitness and visceral adiposity, otherwise known as fitness and fatness, on metabolic syndrome in overweight and obese adults.

Methods

A total of 232 overweight and obese individuals were grouped into four subtypes according to their fitness level. This was measured by recovery heart rate from a step test in addition to visceral adiposity defined as the visceral adipose tissue area to subcutaneous adipose tissue area ratio (VAT/SAT ratio). Associations of fitness and visceral fatness were analyzed in comparison with the prevalence of metabolic syndrome.

Results

The high visceral fat and low fitness group had the highest prevalence of metabolic syndrome [Odds Ratio (OR) 5.02; 95% Confidence Interval (CI) 1.85–13.61] compared with the reference group, which was the low visceral adiposity and high fitness group, after adjustments for confounding factors. Viscerally lean but unfit subjects were associated with a higher prevalence of metabolic syndrome than more viscerally obese but fit subjects (OR 3.42; 95% CI 1.27–9.19, and OR 2.70; 95% CI 1.01–7.25, respectively).

Conclusions

Our study shows that visceral obesity and fitness levels are cumulatively associated with a higher prevalence of metabolic syndrome in healthy overweight and obese adults. This suggests that cardiorespiratory fitness is a significant modifier in the relation of visceral adiposity to adverse metabolic outcomes in overweight and obese individuals.