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Original Article

Leptin-Replacement Therapy for Lipodystrophy

Elif Arioglu Oral, M.D., Vinaya Simha, M.D., Elaine Ruiz, N.P., Alexa Andewelt, B.S., Ahalya Premkumar, M.D., Peter Snell, Ph.D., Anthony J. Wagner, Ph.D., Alex M. DePaoli, M.D., Marc L. Reitman, M.D., Ph.D., Simeon I. Taylor, M.D., Ph.D., Phillip Gorden, M.D., and Abhimanyu Garg, M.D.

N Engl J Med 2002; 346:570-578February 21, 2002

Abstract

Background

The adipocyte hormone leptin is important in regulating energy homeostasis. Since severe lipodystrophy is associated with leptin deficiency, insulin resistance, hypertriglyceridemia, and hepatic steatosis, we assessed whether leptin replacement would ameliorate this condition.

Methods

Nine female patients (age range, 15 to 42 years; eight with diabetes mellitus) who had lipodystrophy and serum leptin levels of less than 4 ng per milliliter (0.32 nmol per milliliter) received recombinant methionyl human leptin (recombinant leptin). Recombinant leptin was administered subcutaneously twice a day for four months at escalating doses to achieve low, intermediate, and high physiologic replacement levels of leptin.

Results

During treatment with recombinant leptin, the serum leptin level increased from a mean (±SE) of 1.3±0.3 ng per milliliter to 11.1±2.5 ng per milliliter (0.1±0.02 to 0.9±0.2 nmol per milliliter). The absolute decrease in the glycosylated hemoglobin value was 1.9 percent (95 percent confidence interval, 1.1 to 2.7 percent; P=0.001) in the eight patients with diabetes. Four months of therapy decreased average triglyceride levels by 60 percent (95 percent confidence interval, 43 to 77 percent; P<0.001) and liver volume by an average of 28 percent (95 percent confidence interval, 20 to 36 percent; P=0.002) in all nine patients and led to the discontinuation of or a large reduction in antidiabetes therapy. Self-reported daily caloric intake and the measured resting metabolic rate also decreased significantly with therapy. Overall, recombinant leptin therapy was well tolerated.

Conclusions

Leptin-replacement therapy improved glycemic control and decreased triglyceride levels in patients with lipodystrophy and leptin deficiency. Leptin deficiency contributes to the insulin resistance and other metabolic abnormalities associated with severe lipodystrophy.

Media in This Article

Figure 3Effects of Leptin-Replacement Therapy on Insulin Sensitivity and Triglyceride Levels in Patient 1 while She Was Following a Diet Containing 1900 kcal per Day.
Figure 2Mean (±SE) Plasma Glucose Levels in Response to an Insulin-Tolerance Test (Panel A) and an Oral Glucose-Tolerance Test (Panel B) in Nine Patients at Base Line and after Four Months of Leptin-Replacement Therapy.
Article

The adipocyte hormone leptin has a central role in energy homeostasis.1 Serum leptin levels are directly proportional to adipocyte mass.2 Normally, a low leptin level signals starvation and directs the body to adapt to this condition.3 One way to gain insight into the physiological importance of leptin in humans is to study the conditions associated with its absence or deficiency.

Patients with a complete deficiency of leptin as a result of mutations in the leptin gene are morbidly obese from infancy and have a number of hormonal abnormalities, including insulin resistance and hypogonadotropic hypogonadism.4 Physiologic replacement with recombinant leptin for one year in one such patient led to a substantial weight reduction and an improvement in the hormonal abnormalities.5

Severe lipodystrophy, caused by a deficiency or destruction of adipose cells, is another state characterized by low leptin levels.6 Other abnormalities in this condition include hypertriglyceridemia and severe insulin resistance, which is usually accompanied by diabetes mellitus.6,7 There are several genetic and acquired forms of lipodystrophy in humans, and studies of a variety of genetically engineered animal models6,8 demonstrated that the metabolic abnormalities develop as a consequence of fat loss.9 Why is adipose tissue so vital to the prevention of the metabolic abnormalities? One hypothesis is that the adipocyte hormone leptin has a critical role in preventing the insulin resistance and hypertriglyceridemia of lipodystrophy. Interestingly, leptin-replacement therapy at a level meant to achieve physiologic levels led to a dramatic improvement in insulin resistance, hyperglycemia, hypertriglyceridemia, and hepatic steatosis in a mouse model of lipodystrophy.10 Therefore, we sought to determine whether such treatment would improve the insulin resistance, diabetes, and hypertriglyceridemia of patients with lipodystrophy.

Methods

Patients

Eligible patients had to have low serum leptin levels (less than 3 ng per milliliter [0.24 nmol per milliliter] in the case of male patients and less than 4 ng per milliliter [0.32 nmol per milliliter] in the case of female patients) in association with lipodystrophy and at least one of the following metabolic abnormalities: diabetes mellitus, defined according to the criteria of the American Diabetes Association11; serum triglyceride levels (measured after an overnight fast) of more than 200 mg per deciliter (2.23 mmol per liter); and fasting serum insulin levels of more than 30 μU per milliliter (215 pmol per liter). Table 1Table 1Base-Line Characteristics of the Patients and Treatment Regimens at Base Line and after Four Months of Recombinant Leptin. summarizes the base-line clinical characteristics of the nine patients treated in the study. The patients ranged from 15 to 42 years of age. All nine were female, although the study was open to both sexes. Five of the nine patients had congenital generalized lipodystrophy, or the Seip–Berardinelli syndrome, characterized by generalized fat loss from birth in association with other clinical criteria (Online Mendelian Inheritance in Man [OMIM]13 number 269700).14 One patient had Dunnigan's familial partial lipodystrophy (OMIM13 number 151660).15,16 The other three patients had acquired generalized lipodystrophy.

Study Design

The study was designed as a prospective, open-label study at the Diabetes Branch of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH) and the University of Texas Southwestern Medical Center in Dallas. Amgen (Thousand Oaks, Calif.) provided recombinant methionyl human leptin (recombinant leptin). Although Amgen provided the recombinant leptin, the data were held by the academic investigators. The response of each patient was compared with her base-line values. Because of the rarity and clinical variability of lipodystrophy syndromes, it was not feasible to include a randomized, placebo-treated control group. The study was approved by the institutional review boards of the study centers, and written informed consent was obtained from all patients. The study was initiated in August 2000, and data collection was completed at the end of June 2001.

The patients were evaluated as inpatients before treatment and again after one, two, and four months of recombinant leptin therapy. All patients had been receiving stable doses of other medications for at least six weeks (range, six weeks to eight months) before they began to receive leptin-replacement therapy. During the study, the doses of hypoglycemic drugs were tapered or the treatments discontinued as needed (Table 1).

Recombinant leptin was administered subcutaneously every 12 hours. The physiologic replacement dose was estimated to be 0.03 mg per kilogram of body weight per day for girls under 18 years of age and 0.04 mg per kilogram per day for women on the basis of information provided by the manufacturer. These doses are approximately 1/10 of the dose most commonly used in obesity trials. Patients were treated with 50 percent of the replacement dose for the first month, 100 percent for the second month, and 200 percent for the third and fourth months.

Biochemical Analyses

Serum glucose and triglyceride levels were determined according to standard methods with the use of automated equipment (Hitachi, Boehringer Mannheim, Indianapolis) at the NIH and a Beckman instrument (Fullerton, Calif.) at the University of Texas Southwestern Medical Center. Glycosylated hemoglobin values were measured by ion-exchange high-performance liquid chromatography (Bio-Rad Laboratories, Hercules, Calif.), and levels of free fatty acids were measured with use of a commercial kit (Wako, Richmond, Va.). Serum insulin levels were determined by immunoassays with the use of reagents provided by Abbott Instruments (Abbott Park, Ill.) at the NIH and a commercial kit (Linco Research, St. Charles, Mo.) at the University of Texas Southwestern Medical Center. Serum leptin levels were determined by immunoassays with the use of a commercial kit (Linco Research).

Procedures

The resting metabolic rate was measured (Deltatrac equipment, Sensormedics, Yorba Linda, Calif.) between 6 a.m. and 8 a.m. while patients rested, after an overnight fast of more than eight hours. After an overnight fast, each patient underwent an oral glucose-tolerance test in which 75 g of dextrose was administered orally.

A high-dose insulin-tolerance test was performed with the use of 0.2 U of regular insulin per kilogram to assess the patients' sensitivity to insulin. The K constant (the rate of glucose disappearance as a reflection of the body's overall sensitivity to insulin) was calculated as the rate constant for the decrease in blood glucose levels after the intravenous administration of insulin with the use of first-order kinetics.17 The seven patients who were seen at the NIH Clinical Center reported their daily food intake at base line and at four months using a standardized questionnaire.18

Body fat was determined with use of a dual-energy x-ray absorptiometer (model QDR 4500, Hologic, Bedford, Mass.).19 Axial T1-weighted magnetic resonance imaging of the liver was performed with use of a 1.5-T scanner (General Electric Medical Systems, Milwaukee, at the NIH and Philips Medical Systems, Best, the Netherlands, at the University of Texas Southwestern Medical Center).20 Liver volumes were calculated with use of the MEDx image-analysis software package (Sensor Systems, Sterling, Va.).

Statistical Analysis

Values are presented as means ±SE. We used an analysis of variance with repeated measures to compare the study variables during various study periods. Skewed data on triglyceride levels and calculated K constants were log-transformed. We used a paired t-test wherever it was applicable to compare base-line data with data obtained at various times. We analyzed changes in plasma glucose levels during the oral glucose-tolerance test using a two-factor analysis of variance in which the study period and the time during the test were modeled as repeated factors. We calculated 95 percent confidence intervals for the differences between the means according to the method of Hahn and Meeker.21 The manuscript was jointly written by a committee of the investigators.

Results

Base-Line Characteristics of the Patients

Eight of the nine patients in the study had diabetes (Table 1), and all nine had hyperlipidemia (Table 2Table 2Metabolic Values before and during Treatment with Recombinant Leptin.). All patients with diabetes were receiving medications for their diabetes before the study began, and four of the nine patients received lipid-lowering therapy (Table 1). Their average glycosylated hemoglobin value was 9.1±0.5 percent (normal, less than 5.6 percent) at the base-line evaluation. The mean triglyceride levels were elevated at base line, at 1405 mg per deciliter (16 mmol per liter) (range, 322 to 7420 mg per deciliter [3.6 to 83.8 mmol per liter]; normal range, 35 to 155 mg per deciliter [0.4 to 1.7 mmol per liter]). Free fatty acid levels were also increased, at a mean of 1540±407 μmol per liter (normal, 350 to 550).

Changes in Circulating Leptin Levels

The mean serum leptin level was 1.3±0.3 ng per milliliter (0.1±0.02 nmol per milliliter) at base line (Table 1) and increased to 2.3±0.5 ng per milliliter (0.2±0.04 nmol per milliliter) at the end of the first month of therapy, to 5.5±1.2 ng per milliliter (0.4±0.1 nmol per milliliter) at the end of the second month, and to 11.1±2.5 ng per milliliter (0.9±0.2 nmol per milliliter) at the end of the fourth month. Thus, the administration of recombinant leptin resulted in approximately normal serum leptin levels in these patients.12

Changes in Metabolic Control

The first patient treated in this study (Patient 1) was also the most severely affected,22 and her clinical course is shown in Figure 1Figure 1Clinical Course of Patient 1, as Assessed by Changes in Mean Triglyceride Levels, Glycosylated Hemoglobin Values, and Serum Leptin Values.. Leptin-replacement therapy had a marked effect in this patient and in the group as a whole.22 Before the initiation of leptin therapy, the eight patients with diabetes had poor metabolic control, with a mean glycosylated hemoglobin value of 9.1±0.5 percent. After four months of leptin-replacement therapy, the glycosylated hemoglobin value decreased by a mean of 1.9 percentage points (95 percent confidence interval, 1.1 to 2.7; P=0.001). The individual responses of the patients are provided in Table 2. Glycemic control improved despite the fact that antidiabetic therapy was decreased or discontinued during the four months of leptin-replacement therapy (Table 1).

At the end of four months of recombinant leptin therapy, the fasting triglyceride levels had fallen by 60 percent (95 percent confidence interval, 43 to 77 percent; P<0.001). The individual responses of the patients are given in Table 2. During the same period, fasting levels of free fatty acids fell from a mean of 1540±407 μmol per liter to 790±164 μmol per liter (P=0.05).

The insulin-tolerance test showed that plasma glucose levels had significantly decreased at the end of four months of therapy (Figure 2AFigure 2Mean (±SE) Plasma Glucose Levels in Response to an Insulin-Tolerance Test (Panel A) and an Oral Glucose-Tolerance Test (Panel B) in Nine Patients at Base Line and after Four Months of Leptin-Replacement Therapy.). The K constant (the rate of glucose disappearance) increased from 0.007±0.001 to 0.017±0.004, indicating an improvement in whole-body sensitivity to insulin (P=0.04). Furthermore, the glucose levels measured in response to an oral glucose load (75 g of dextrose) were significantly lower than the base-line levels (Figure 2B).

Since all patients derived clinically significant benefit from leptin-replacement therapy, all continue to receive treatment.

Changes in Liver Volume and Liver-Function Tests

At base line, the mean liver volume was 3097±391 ml (approximately four times the volume in age- and sex-matched persons of normal weight). Leptin decreased the liver volume by an average of 28 percent (95 percent confidence interval, 20 to 36 percent) from base line (P=0.002). The decrease in liver size was associated with an improvement in liver-function tests. Base-line alanine aminotransferase levels had decreased from 66±16 to 24±4 U per liter at the end of four months of therapy (P=0.02). Likewise, serum aspartate aminotransferase levels were 53±12 U per liter at base line and 21±2 U per liter at the end of four months of therapy (P=0.03).

Changes in Energy Balance

Data on self-reported daily caloric intake were available for seven patients. The daily caloric intake decreased from a mean of 2680±250 kcal per day at base line to 1600±150 kcal per day after four months of leptin-replacement therapy (P=0.005). There was a parallel decrease in the resting metabolic rate (measured in all nine patients), from 1920±150 to 1580±80 kcal per day (P=0.003).

All but one patient (Patient 3) had lost weight at the end of four months of treatment (mean weight loss, 3.6±0.9 kg; range, –1.7 to 7.3). An important fraction of the weight loss (50 to 65 percent) was attributed to the decrease in liver volume.

Adverse Events

Patient 1 had a severe episode of nausea and vomiting after the first dose of recombinant leptin. After the second dose, Patient 6 had an exacerbation of hypertension associated with flushing. Patient 7 was hospitalized for a streptococcal infection during the third month of therapy. All these events resolved, and none recurred with the continuation of therapy. No skin reactions at injection sites were reported or observed.

Withdrawal of Recombinant Leptin

Since the patients had reduced their intake of food during leptin-replacement therapy, we assessed whether the metabolic values were maintained in the presence of a reduced intake of food. Patient 1 was admitted to the NIH Clinical Center and received 1900 kcal per day (55 percent carbohydrates, 25 percent fat, and 20 percent protein), which was based on the patient's reported intake of food during leptin-replacement therapy and on a measurement of the resting metabolic rate, in the form of three meals and two snacks. Leptin-replacement therapy was stopped after day 5. Plasma glucose levels were measured before each meal and at bedtime, and the daily averages were calculated. Fasting plasma triglyceride and insulin levels were determined. Within 48 hours after the withdrawal of recombinant leptin, the fasting plasma triglyceride and insulin levels began to increase. The effects were corrected by the resumption of leptin-replacement therapy (Figure 3Figure 3Effects of Leptin-Replacement Therapy on Insulin Sensitivity and Triglyceride Levels in Patient 1 while She Was Following a Diet Containing 1900 kcal per Day.).

Discussion

Leptin-replacement therapy led to clear and dramatic metabolic benefits in this group of nine patients with lipodystrophy and leptin deficiency. Treatment with recombinant leptin resulted in an absolute reduction in the glycosylated hemoglobin value of 1.9 percent. Such a reduction is predicted to decrease the relative risk of retinopathy by approximately 48 percent and nephropathy by approximately 22 percent in the diabetic population.23 Furthermore, triglyceride levels fell by 60 percent, and such a reduction is predicted to decrease the relative risk of cardiovascular events in the general population by 35 to 65 percent.24,25

To date, the insulin resistance and hypertriglyceridemia that characterize lipodystrophy have been refractory to treatment.26 Thiazolidinediones appear to be the most effective therapy, albeit an imperfect one.27 Commonly, this condition is managed with a combination of medications, including high doses of insulin, oral hypoglycemic agents (e.g., metformin and thiazolidinediones), and lipid-lowering drugs (e.g., fibrates and statins). Despite such therapy, patients continue to have severe hypertriglyceridemia, leading to recurrent attacks of acute pancreatitis; severe hyperglycemia, posing risks of diabetic retinopathy and nephropathy; and nonalcoholic steatohepatitis, which can result in cirrhosis. Leptin-replacement therapy appears to have the potential to prevent all these complications.

Our results also demonstrate a novel action of leptin. Leptin appears to provide a signal that regulates total-body sensitivity to insulin and triglyceride levels in addition to its known role in the control of energy homeostasis.

Although our study was not randomized, the improved metabolic control appeared to be due to leptin-replacement therapy rather than to an improvement in general compliance associated with participation in a study.

An important unanswered question is the effect of decreased food intake on the changes in metabolic values in this study. In patients with lipodystrophy, limiting caloric intake improves glucose and lipid abnormalities.28 Leptin-replacement therapy reduced food intake in our patients. However, in an analysis involving Patient 1, we observed an additional effect of leptin-replacement therapy on insulin sensitivity and triglyceride metabolism that was independent of food intake. In this patient, fasting insulin and triglyceride levels increased within two and four days, respectively, after recombinant leptin was withdrawn even though the level of food intake remained constant. Similar data have been reported in paired-feeding experiments (with or without leptin administration) involving lipoatrophic mice.10,29

Leptin has been identified as the missing hormone in obese (ob/ob) mice.1 In these mice, leptin-replacement therapy decreased food intake and body weight.30-32 Because of such initial observations, obesity has been the focus of most therapeutic trials with leptin. However, most obese people have high serum leptin levels and are therefore presumed to have leptin resistance.33 Thus far, the average weight loss in obese persons has not been significant,34 except in patients with congenital leptin deficiency.5

Study of various mouse models of lipodystrophy suggests that the absence of adipose tissue is the cause of insulin resistance in this syndrome.35-37 The demonstration that transplantation of adipose tissue into mice with lipodystrophy ameliorates insulin resistance and improves metabolic control provides strong support for this hypothesis.9 However, why adipose tissue was required to maintain whole-body sensitivity to insulin has remained unclear. Shimomura et al. tested the efficacy of leptin replacement in a mouse model and observed a dramatic improvement in glucose and triglyceride levels and hepatic steatosis.10 Taken together, these observations and our results suggest that leptin controls the majority of the regulatory action of adipose tissue on whole-body sensitivity to insulin.

In our study, leptin-replacement therapy was associated with a decline in the resting metabolic rate. This finding is parallel to observations in patients with a congenital absence of leptin.33 Although the mechanism of this effect is unclear, we presume that the leptin-induced decrease in food intake reduces diet-induced thermogenesis.

Unger and colleagues have reported that leptin administration in Zucker rats corrects steatosis in a variety of organs that act as sites of lipid accumulation, such as the liver, islet cells, and the heart.38,39 The accumulation of lipids at these sites may represent a spillover phenomenon resulting from the fact that adipocytes have reached their capacity to store triglycerides. In patients with lipodystrophy, these organs are the only sites that can store lipids. Leptin treatment of mice with lipodystrophy causes a dramatic decrease in hepatic stores of triglycerides. In parallel, leptin-replacement therapy in our patients with lipodystrophy caused a significant reduction in liver volume.

The concept that adipose tissue is an endocrine organ was strongly supported by the discovery of leptin. Leptin has effects (direct or indirect) on the key organs of metabolism, including the brain, liver, muscle, fat, and pancreas. Leptin is certainly not the only circulating adipocyte signal.40-42 Lack of adipocytes should result in a deficiency of all fat-derived signals. On the basis of our findings, leptin deficiency appears to be the chief contributor to the metabolic abnormalities associated with lipodystrophy. Thus, severe lipodystrophy may be an important reason to consider leptin-replacement therapy. The optimal dose of recombinant leptin in patients with lipodystrophy, the role of leptin-replacement therapy in treating other insulin-resistance states, and the degree of leptin deficiency that will respond to leptin-replacement therapy remain to be determined.

Supported in part by grants from the NIH (RO1-DK54387 and MO1-RR00633) and from Amgen.

Drs. Wagner and DePaoli are employees of Amgen. Dr. Taylor is now an employee of Eli Lilly.

We are indebted to the following for their contribution to the study: Oksana Gavrilova, Monica Skarulis, Karim Calis, Beverley Adams-Huet, Jerry Payne, Bryan Fox, Nancy Sebring, Patti Riggs, Bernice Marcus-Samuels, Craig Cochran, Angela Osborn, Esther Bergman, nurses and clinical fellows, and the Metabolic Cart Consult Service.

Source Information

From the Diabetes Branch, National Institute of Diabetes and Digestive and Kidney Diseases (E.A.O., E.R., A.A., M.L.R., S.I.T., P.G.), and the Clinical Center (A.P.), National Institutes of Health, Bethesda, Md.; the University of Texas Southwestern Medical Center at Dallas, Dallas (V.S., P.S., A.G.); and Amgen, Thousand Oaks, Calif. (A.J.W., A.M.D.).

Address reprint requests to Dr. Oral at the National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes Branch, Bldg. 10, Rm. 8D20, Bethesda, MD 20892-1770, or at .

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Citing Articles

  1. 1

    Martin G. Myers, Steven B. Heymsfield, Carol Haft, Barbara B. Kahn, Maren Laughlin, Rudolph L. Leibel, Matthias H. Tschöp, Jack A. Yanovski. (2012) Challenges and Opportunities of Defining Clinical Leptin Resistance. Cell Metabolism 15:2, 150-156
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    Andreas Hillenbrand, Manfred Weiss, Uwe Knippschild, Anna Maria Wolf, Markus Huber-Lang. (2012) Sepsis-Induced Adipokine Change with regard to Insulin Resistance. International Journal of Inflammation 2012, 1-7
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    Tusty-Jiuan Hsieh, Pei-Chen Hsieh, Ming-Tsang Wu, Wei-Chiao Chang, Pi-Jung Hsiao, Kun-Der Lin, Pong-Chun Chou, Shyi-Jang Shin. (2011) Betel nut extract and arecoline block insulin signaling and lipid storage in 3T3-L1 adipocytes. Cell Biology and Toxicology 27:6, 397-411
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    Charmaine S Tam, Virgile Lecoultre, Eric Ravussin. (2011) Novel strategy for the use of leptin for obesity therapy. Expert Opinion on Biological Therapy 11:12, 1677-1685
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    Guillaume Bidault, Camille Vatier, Jacqueline Capeau, Corinne Vigouroux, Véronique Béréziat. (2011) LMNA -linked lipodystrophies: from altered fat distribution to cellular alterations. Biochemical Society Transactions 39:6, 1752-1757
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    J. Argente, J.F. Sotos. (2011) Hipercrecimientos con y sin obesidad: fundamentos clínicos y moleculares. Anales de Pediatría
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    John I Gallin. (2011) The NIH Clinical Center and the future of clinical research. Nature Medicine 17:10, 1221-1223
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    Warda Fatima, Adeela Shahid, Muhammad Imran, Jaida Manzoor, Shahida Hasnain, Sobia Rana, Saqib Mahmood. (2011) Leptin deficiency and leptin gene mutations in obese children from Pakistan. International Journal of Pediatric Obesity 6:5-6, 419-427
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    Melissa K. Crocker, Jack A. Yanovski. (2011) Pediatric Obesity: Etiology and Treatment. Pediatric Clinics of North America 58:5, 1217-1240
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    Michael J. Stuart, Bernhard T. Baune. (2011) Depression and type 2 diabetes: Inflammatory mechanisms of a psychoneuroendocrine co-morbidity. Neuroscience & Biobehavioral Reviews
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    Todd T. Brown, Marshall J. Glesby. (2011) Management of the metabolic effects of HIV and HIV drugs. Nature Reviews Endocrinology
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    Irina Kowalska, Monika Karczewska-Kupczewska, Marek Strączkowski. (2011) Adipocytokines, gut hormones and growth factors in anorexia nervosa. Clinica Chimica Acta 412:19-20, 1702-1711
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    Jane M Johnston, Steven J Greco, Ashkan Hamzelou, J Wesson Ashford, Nikolaos Tezapsidis. (2011) Repositioning leptin as a therapy for Alzheimer’s disease. Therapy 8:5, 481-490
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    Elif A Oral. (2011) Leptin for type 1 diabetes: coming onto stage to be (or not?). Pediatric Diabetesno-no
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    B. P. Cummings, A. Bettaieb, J. L. Graham, K. L. Stanhope, R. Dill, G. J. Morton, F. G. Haj, P. J. Havel. (2011) Subcutaneous administration of leptin normalizes fasting plasma glucose in obese type 2 diabetic UCD-T2DM rats. Proceedings of the National Academy of Sciences 108:35, 14670-14675
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    Alberto Chavez, Devjit Tripathy. 2011. Adipokines and Obesity. , 199-213.
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    Suzanne L Quinn, M. Cecilia Lansang, Deanna Mina. (2011) Safety and Effectiveness of U-500 Insulin Therapy in Patients with Insulin-Resistant Type 2 Diabetes Mellitus. Pharmacotherapy 31:7, 695-702
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    Laurent Gautron, Joel K. Elmquist. (2011) Sixteen years and counting: an update on leptin in energy balance. Journal of Clinical Investigation 121:6, 2087-2093
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    Osamu Itani, Yoshitaka Kaneita, Atsushi Murata, Eise Yokoyama, Takashi Ohida. (2011) Association of onset of obesity with sleep duration and shift work among Japanese adults. Sleep Medicine 12:4, 341-345
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    Joseph S. Marino, Yong Xu, Jennifer W. Hill. (2011) Central insulin and leptin-mediated autonomic control of glucose homeostasis. Trends in Endocrinology & Metabolism
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    K. Miehle, M. Stumvoll, M. Fasshauer. (2011) Lipodystrophie. Der Internist 52:4, 362-373
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    Amita Yadav, Pramila jyoti, S. K. Jain, Jayashree Bhattacharjee. (2011) Correlation of Adiponectin and Leptin with Insulin Resistance: A Pilot Study in Healthy North Indian Population. Indian Journal of Clinical Biochemistry 26:2, 193-196
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    2011. References. , 283-360.
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    Christina G. Fiorenza, Sharon H. Chou, Christos S. Mantzoros. (2011) Lipodystrophy: pathophysiology and advances in treatment. Nature Reviews Endocrinology 7:3, 137-150
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    Placido Llaneza, Celestino González, José Fernandez-Iñarrea, Ana Alonso, Fernando Diaz, Ignacio Arnott, Javier Ferrer-Barriendos. (2011) Soy isoflavones, diet and physical exercise modify serum cytokines in healthy obese postmenopausal women. Phytomedicine 18:4, 245-250
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    Noriyuki Ouchi, Jennifer L. Parker, Jesse J. Lugus, Kenneth Walsh. (2011) Adipokines in inflammation and metabolic disease. Nature Reviews Immunology 11:2, 85-97
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    Lisa G. Rider, Carol B. Lindsley, James T. Cassidy. 2011. JUVENILE DERMATOMYOSITIS. , 375-413.
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    Yasumichi Arai, Michiyo Takayama, Yukiko Abe, Nobuyoshi Hirose. (2011) Adipokines and Aging. Journal of Atherosclerosis and Thrombosis 18:7, 545-550
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    Wei Luo, Peter F. Bodary, Yuechun Shen, Kevin J. Wickenheiser, Miina K. Öhman, Chiao Guo, Kristina L. Bahrou, Martin G. Myers, Daniel T. Eitzman. (2011) Leptin receptor-induced STAT3-independent signaling pathways are protective against atherosclerosis in a murine model of obesity and hyperlipidemia. Atherosclerosis 214:1, 81-85
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    Jeffrey M. Friedman. (2011) Leptin and the Regulation of Body Weigh. The Keio Journal of Medicine 60:1, 1-9
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    Aleksandra Rojek, Marek Niedziela. (2011) Insulin receptor and its relationship with different forms of insulin resistance. Advances in Cell Biology 1:-1, 1-32
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    Carmine Zoccali, Francesca Mallamaci. (2011) Adiponectin and Leptin in Chronic Kidney Disease: Causal Factors or Mere Risk Markers?. Journal of Renal Nutrition 21:1, 87-91
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    Hélène De Naeyer, D. Margriet Ouwens, Yves Van Nieuwenhove, Piet Pattyn, Leen M. ‘t Hart, Jean-Marc Kaufman, Henrike Sell, Juergen Eckel, Claude Cuvelier, Youri E. Taes, Johannes B. Ruige. (2011) Combined Gene and Protein Expression of Hormone-Sensitive Lipase and Adipose Triglyceride Lipase, Mitochondrial Content, and Adipocyte Size in Subcutaneous and Visceral Adipose Tissue of Morbidly Obese Men. Obesity Facts 4:5, 407-416
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    Jean L. Chan, Karen Lutz, Elaine Cochran, Wenying Huang, Yvette Peters, Christian Weyer, Phillip Gorden. (2011) Clinical Effects of Long-Term Metreleptin Treatment in Patients with Lipodystrophy. Endocrine Practice 1:-1, 1-31
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    Laura Scolaro, Marco Cassone, Jerzy W Kolaczynski, Laszlo Otvos Jr, Eva Surmacz. (2010) Leptin-based therapeutics. Expert Review of Endocrinology & Metabolism 5:6, 875-889
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    Martin G. Myers, Rudolph L. Leibel, Randy J. Seeley, Michael W. Schwartz. (2010) Obesity and leptin resistance: distinguishing cause from effect. Trends in Endocrinology & Metabolism 21:11, 643-651
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    Yingfeng Deng, Philipp E. Scherer. (2010) Adipokines as novel biomarkers and regulators of the metabolic syndrome. Annals of the New York Academy of Sciences 1212:1, E1-E19
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    T. Fujikawa, J.-C. Chuang, I. Sakata, G. Ramadori, R. Coppari. (2010) Leptin therapy improves insulin-deficient type 1 diabetes by CNS-dependent mechanisms in mice. Proceedings of the National Academy of Sciences 107:40, 17391-17396
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    Ushma S. Neill. (2010) Leaping for leptin: the 2010 Albert Lasker Basic Medical Research Award goes to Douglas Coleman and Jeffrey M. Friedman. Journal of Clinical Investigation 120:10, 3413-3418
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    Konstantinos Lois, Georgios Valsamakis, Georgio Mastorakos, Sudhesh Kumar. (2010) The impact of insulin resistance on woman's health and potential treatment options. Annals of the New York Academy of Sciences 1205:1, 156-165
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    P. Beijer, Th.A.M. Hurk, M.A.M.J. Vroede, R.J. Odink. (2010) Een zuigeling zonder subcutaan vet: berardinelli-seip-syndroom. Tijdschrift voor Kindergeneeskunde 2010:1, 33-36
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    Henry Bohler, Sriprakash Mokshagundam, Stephen J. Winters. (2010) Adipose tissue and reproduction in women. Fertility and Sterility 94:3, 795-825
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    Vladimír Teplan, František Vyhnánek, Robert Gürlich, Martin Haluzík, Jaroslav Racek, Ivana Vyhnankova, Milena Štollová, Vladimír Teplan. (2010) Increased proinflammatory cytokine production in adipose tissue of obese patients with chronic kidney disease. Wiener klinische Wochenschrift 122:15-16, 466-473
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    Angus Jones, Andrew T. Hattersley. 2010. Monogenic Causes of Diabetes. , 243-264.
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    Batya B Davidovici, Naveed Sattar, Prinz C Jörg, Luis Puig, Paul Emery, Jonathan N Barker, Peter van de Kerkhof, Mona Ståhle, Frank O Nestle, Giampiero Girolomoni, James G Krueger. (2010) Psoriasis and Systemic Inflammatory Diseases: Potential Mechanistic Links between Skin Disease and Co-Morbid Conditions. Journal of Investigative Dermatology 130:7, 1785-1796
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    François R. Jornayvaz, Varman T. Samuel, Gerald I. Shulman. (2010) The Role of Muscle Insulin Resistance in the Pathogenesis of Atherogenic Dyslipidemia and Nonalcoholic Fatty Liver Disease Associated with the Metabolic Syndrome. Annual Review of Nutrition 30:1, 273-290
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    Kanakadurga Singer, Massimo Pietropaolo, Ram K Menon. (2010) Improving type 1 diabetes control with leptin - Is this a game-changer?. Pediatric Diabetes 11:4, 216-217
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    Roger H. Unger, Philipp E. Scherer. (2010) Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity. Trends in Endocrinology & Metabolism 21:6, 345-352
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    Thien T. Tran, C. Ronald Kahn. (2010) Transplantation of adipose tissue and stem cells: role in metabolism and disease. Nature Reviews Endocrinology 6:4, 195-213
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    T Fuke, T Yoshizaki, M Kondo, K Morino, T Obata, S Ugi, Y Nishio, S Maeda, A Kashiwagi, H Maegawa. (2010) Transcription factor AP-2β inhibits expression and secretion of leptin, an insulin-sensitizing hormone, in 3T3-L1 adipocytes. International Journal of Obesity 34:4, 670-678
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    James J. Lynch, Eugene W. Shek, Vincent Castagné, Scott W. Mittelstadt. (2010) The proconvulsant effects of leptin on glutamate receptor-mediated seizures in mice. Brain Research Bulletin 82:1-2, 99-103
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    D. H. McGibbon. 2010. Subcutaneous Fat. , 1-49.
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    M.-y. Wang, L. Chen, G. O. Clark, Y. Lee, R. D. Stevens, O. R. Ilkayeva, B. R. Wenner, J. R. Bain, M. J. Charron, C. B. Newgard, R. H. Unger. (2010) From the Cover: Feature Article: Leptin therapy in insulin-deficient type I diabetes. Proceedings of the National Academy of Sciences 107:11, 4813-4819
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    Roger H. Unger, Gregory O. Clark, Philipp E. Scherer, Lelio Orci. (2010) Lipid homeostasis, lipotoxicity and the metabolic syndrome. Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids 1801:3, 209-214
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    Jean L. Chan, Elif A. Oral. (2010) Clinical Classification and Treatment of Congenital and Acquired Lipodystrophy. Endocrine Practice 16:2, 310-323
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    Elif A. Oral, Jean L. Chan. (2010) Rationale for Leptin-Replacement Therapy for Severe Lipodystrophy. Endocrine Practice 16:2, 324-333
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    E J Bak, H G Park, J M Kim, J M Kim, Y-J Yoo, J-H Cha. (2010) Inhibitory effect of evodiamine alone and in combination with rosiglitazone on in vitro adipocyte differentiation and in vivo obesity related to diabetes. International Journal of Obesity 34:2, 250-260
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    Matthias Blüher. (2010) Do adipokines link obesity to its related metabolic and cardiovascular diseases?. Clinical Lipidology 5:1, 95-107
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    L. Herrero, H. Shapiro, A. Nayer, J. Lee, S. E. Shoelson. (2010) Inflammation and adipose tissue macrophages in lipodystrophic mice. Proceedings of the National Academy of Sciences 107:1, 240-245
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    Yoshimaro YANAGAWA, Tadashi MORIMURA, Katsuhiko TSUNEKAWA, Koji SEKI, Takayuki OGIWARA, Nobuo KOTAJIMA, Tetsuo MACHIDA, Shingo MATSUMOTO, Takumi ADACHI, Masami MURAKAMI. (2010) Oxidative Stress Associated with Rapid Weight Reduction Decreases Circulating Adiponectin Concentrations. Endocrine Journal 57:4, 339-345
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    A. Y. Chong, B. C. Lupsa, E. K. Cochran, P. Gorden. (2010) Efficacy of leptin therapy in the different forms of human lipodystrophy. Diabetologia 53:1, 27-35
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    Kristina Hedbacker, Kıvanç Birsoy, Robert W. Wysocki, Esra Asilmaz, Rexford S. Ahima, I. Sadaf Farooqi, Jeffrey M. Friedman. (2010) Antidiabetic Effects of IGFBP2, a Leptin-Regulated Gene. Cell Metabolism 11:1, 11-22
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    D. B. Savage, S. O’Rahilly. (2010) Leptin therapy in lipodystrophy. Diabetologia 53:1, 7-9
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    Zhaoxia Wang, Tomohiro Nakayama. (2010) Inflammation, a Link between Obesity and Cardiovascular Disease. Mediators of Inflammation 2010, 1-17
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    Atsushi Nishiyama, Mariko Yagi, Hiroyuki Awano, Yo Okizuka, Taro Maeda, Shinsaku Yoshida, Yasuhiro Takeshima, Masafumi Matsuo. (2009) Two Japanese infants with congenital generalized lipodystrophy due to BSCL2 mutations. Pediatrics International 51:6, 775-779
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    Sang Hoon Han, Bum Sik Chin, Han Sung Lee, Su Jin Jeong, Hee Kyoung Choi, Chang Oh Kim, Jun Yong Choi, Young Goo Song, Hyun Chul Lee, June Myung Kim. (2009) Serum retinol-binding protein 4 correlates with obesity, insulin resistance, and dyslipidemia in HIV-infected subjects receiving highly active antiretroviral therapy. Metabolism 58:11, 1523-1529
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    Christopher Sinal, Kerry Goralski. 2009. Adipose Tissue as Endocrine Organ. , 23-45.
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    Peter Zahradka, Carla Taylor, Vanessa DeClercq, Ryan Hunt, Maria Baranowski, Danielle Stringer. 2009. Inflammatory Actions of Adiponectin, Leptin, and Resistin. , 167-187.
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    Kazuwa Nakao, Akihiro Yasoda, Ken Ebihara, Kiminori Hosoda, Masashi Mukoyama. (2009) Translational research of novel hormones: lessons from animal models and rare human diseases for common human diseases. Journal of Molecular Medicine 87:10, 1029-1039
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    Satya P. Kalra. (2009) Central leptin gene therapy ameliorates diabetes type 1 and 2 through two independent hypothalamic relays; a benefit beyond weight and appetite regulation. Peptides 30:10, 1957-1963
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    Alexander R. Moschen, Clemens Molnar, Anna Maria Wolf, Helmut Weiss, Ivo Graziadei, Susanne Kaser, Christoph F. Ebenbichler, Sylvia Stadlmann, Patrizia L. Moser, Herbert Tilg. (2009) Effects of weight loss induced by bariatric surgery on hepatic adipocytokine expression. Journal of Hepatology 51:4, 765-777
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    Geoffrey C Farrell. (2009) The liver and the waistline: Fifty years of growth. Journal of Gastroenterology and Hepatology 24, S105-S118
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    Eric Ravussin, Steven R. Smith, Julie A. Mitchell, Reshma Shringarpure, Kevin Shan, Holly Maier, Joy E. Koda, Christian Weyer. (2009) Enhanced Weight Loss With Pramlintide/Metreleptin: An Integrated Neurohormonal Approach to Obesity Pharmacotherapy. Obesity 17:9, 1736-1743
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    Melissa K. Crocker, Jack A. Yanovski. (2009) Pediatric Obesity: Etiology and Treatment. Endocrinology & Metabolism Clinics of North America 38:3, 525-548
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    Biao Wang, Jun Zhu, Khalid Mounzih, Eric F. Chehab, Yaohuang Ke, Farid F. Chehab. (2009) Overexpression of the transcription factor foxo4 is associated with rapid glucose clearance. Molecular and Cellular Endocrinology 307:1-2, 217-223
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    M J Müller, A Bosy-Westphal, W Later, V Haas, M Heller. (2009) Functional body composition: insights into the regulation of energy metabolism and some clinical applications. European Journal of Clinical Nutrition 63:9, 1045-1056
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    Vinaya Simha, Abhimanyu Garg. (2009) Inherited lipodystrophies and hypertriglyceridemia. Current Opinion in Lipidology 20:4, 300-308
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    Tomas Roubicek, Marketa Bartlova, Jana Krajickova, Denisa Haluzikova, Milos Mraz, Zdena Lacinova, Michal Kudla, Vladimir Teplan, Martin Haluzik. (2009) Increased production of proinflammatory cytokines in adipose tissue of patients with end-stage renal disease. Nutrition 25:7-8, 762-768
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    J.-F. Dumas, G. Simard, M. Flamment, P.-H. Ducluzeau, P. Ritz. (2009) Is skeletal muscle mitochondrial dysfunction a cause or an indirect consequence of insulin resistance in humans?. Diabetes & Metabolism 35:3, 159-167
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    T. Kusakabe, H. Tanioka, K. Ebihara, M. Hirata, L. Miyamoto, F. Miyanaga, H. Hige, D. Aotani, T. Fujisawa, H. Masuzaki, K. Hosoda, K. Nakao. (2009) Beneficial effects of leptin on glycaemic and lipid control in a mouse model of type 2 diabetes with increased adiposity induced by streptozotocin and a high-fat diet. Diabetologia 52:4, 675-683
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    Karina Braga Gomes, Victor Cavalcanti Pardini, Ana Paula Fernandes. (2009) Clinical and molecular aspects of Berardinelli–Seip Congenital Lipodystrophy (BSCL). Clinica Chimica Acta 402:1-2, 1-6
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    Ivona Brasnjevic, Harry W.M. Steinbusch, Christoph Schmitz, Pilar Martinez-Martinez. (2009) Delivery of peptide and protein drugs over the blood–brain barrier. Progress in Neurobiology 87:4, 212-251
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    Eugenia Negredo, Jordi Puig, David Aldea, Manuel Medina, Carla Estany, Núria Pérez-Álvarez, Carmina Rodríguez-Fumaz, Jose A. Muñoz-Moreno, Carmen Higueras, Vicente Gonzalez-Mestre, Bonaventura Clotet. (2009) Four-Year Safety with Polyacrylamide Hydrogel to Correct Antiretroviral-Related Facial Lipoatrophy. AIDS Research and Human Retroviruses 25:4, 451-455
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    F. A. J. L. Scheer, M. F. Hilton, C. S. Mantzoros, S. A. Shea. (2009) From the Cover: Adverse metabolic and cardiovascular consequences of circadian misalignment. Proceedings of the National Academy of Sciences 106:11, 4453-4458
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    Martin G. Myers, Heike Münzberg, Gina M. Leinninger, Rebecca L. Leshan. (2009) The Geometry of Leptin Action in the Brain: More Complicated Than a Simple ARC. Cell Metabolism 9:2, 117-123
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    Paolo Calabrò, Enrica Golia, Valeria Maddaloni, Marco Malvezzi, Beniamino Casillo, Carla Marotta, Raffaele Calabrò, Paolo Golino. (2009) Adipose tissue-mediated inflammation: the missing link between obesity and cardiovascular disease?. Internal and Emergency Medicine 4:1, 25-34
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    Melissa A. Lawson. (2009) Lipoatrophic Diabetes: A Case Report with a Brief Review of the Literature. Journal of Adolescent Health 44:1, 94-95
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    R H Eckel. (2008) Obesity research in the next decade. International Journal of Obesity 32, S143-S151
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    Nicole C Kesty, Jonathan D Roth, David Maggs. (2008) Hormone-based therapies in the regulation of fuel metabolism and body weight. Expert Opinion on Biological Therapy 8:11, 1733-1747
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    Y. Arai, M. Takayama, Y. Gondo, H. Inagaki, K. Yamamura, S. Nakazawa, T. Kojima, Y. Ebihara, K. Shimizu, Y. Masui, K. Kitagawa, T. Takebayashi, N. Hirose. (2008) Adipose Endocrine Function, Insulin-Like Growth Factor-1 Axis, and Exceptional Survival Beyond 100 Years of Age. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63:11, 1209-1218
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    Seth S. Martin, Atif Qasim, Muredach P. Reilly. (2008) Leptin Resistance. Journal of the American College of Cardiology 52:15, 1201-1210
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    X. Yu, B.-H. Park, M.-Y. Wang, Z. V. Wang, R. H. Unger. (2008) Making insulin-deficient type 1 diabetic rodents thrive without insulin. Proceedings of the National Academy of Sciences 105:37, 14070-14075
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    R. H. Unger. (2008) Noninvasive tracking of gene expression by reporter transgene imaging. Proceedings of the National Academy of Sciences 105:35, 12641-12642
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    Yo Hotta, Hiroshi Yatsuya, Hideaki Toyoshima, Kunihiro Matsushita, Hirotsugu Mitsuhashi, Seiko Takefuji, Yutaka Oiso, Koji Tamakoshi. (2008) Low leptin but high insulin resistance of smokers in Japanese men. Diabetes Research and Clinical Practice 81:3, 358-364
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    Belinda J. Yauger, Phillip Gorden, Jean Park, Elaine Cochran, Pamela Stratton. (2008) Effect of Depot Medroxyprogesterone Acetate on Glucose Tolerance in Generalized Lipodystrophy. Obstetrics & Gynecology 112:2, Part 2, 445-447
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    Sasha Taleban, Heather T. Carew, Helén L. Dichek, Samir S. Deeb, David Hollenback, David S. Weigle, David E. Cummings, John D. Brunzell. (2008) Energy balance in congenital generalized lipodystrophy type I. Metabolism 57:8, 1155-1161
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    Hansjoerg Heep,, Christian Wedemeyer,, Jie Xu,, Sebastian Hofmeister,, Marius von Knoch,. (2008) No Adaptations in Bone of Leptin-Deficient ob/ob Mice in Response to Loading. BIOmaterialien 9:1-2, 18-25
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    J. E. Mallewa, E. Wilkins, J. Vilar, M. Mallewa, D. Doran, D. Back, M. Pirmohamed. (2008) HIV-associated lipodystrophy: a review of underlying mechanisms and therapeutic options. Journal of Antimicrobial Chemotherapy 62:4, 648-660
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    Rexford S. Ahima. (2008) Revisiting leptin’s role in obesity and weight loss. Journal of Clinical Investigation
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    Funda Kosova, Aylin Sepici-Dincel, Atilla Engin, Leyla Memiş, Cemile Koca, Nilgün Altan. (2008) The thyroid hormone mediated effects of insulin on serum leptin levels of diabetic rats. Endocrine 33:3, 317-322
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    Sarah N Oosman, Ada W Lam, George Harb, Suraj Unniappan, Ni T Lam, Travis Webber, Daniel Bruch, Qiu-Xia Zhang, Gregory S Korbutt, Timothy J Kieffer. (2008) Treatment of Obesity and Diabetes in Mice by Transplant of Gut Cells Engineered to Produce Leptin. Molecular Therapy 16:6, 1138-1145
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    Jeong Soon Lee, Jae Myoung Suh, Hong Gyu Park, Eun Jung Bak, Yun-Jung Yoo, Jeong-Heon Cha. (2008) Heparin-binding epidermal growth factor-like growth factor inhibits adipocyte differentiation at commitment and early induction stages. Differentiation 76:5, 478-487
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    J. D. Roth, B. L. Roland, R. L. Cole, J. L. Trevaskis, C. Weyer, J. E. Koda, C. M. Anderson, D. G. Parkes, A. D. Baron. (2008) Leptin responsiveness restored by amylin agonism in diet-induced obesity: Evidence from nonclinical and clinical studies. Proceedings of the National Academy of Sciences 105:20, 7257-7262
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    Adilson Guilherme, Joseph V. Virbasius, Vishwajeet Puri, Michael P. Czech. (2008) Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nature Reviews Molecular Cell Biology 9:5, 367-377
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    Silvie Timmers, Patrick Schrauwen, Johan de Vogel. (2008) Muscular diacylglycerol metabolism and insulin resistance. Physiology & Behavior 94:2, 242-251
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    Paolo Calabrò, Giuseppe Limongelli, Giuseppe Pacileo, Giovanni Di Salvo, Paolo Golino, Raffaele Calabrò. (2008) The role of adiposity as a determinant of an inflammatory milieu. Journal of Cardiovascular Medicine 9:5, 450-460
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    M. Karmazyn, D. M. Purdham, V. Rajapurohitam, A. Zeidan. (2008) Signalling mechanisms underlying the metabolic and other effects of adipokines on the heart. Cardiovascular Research 79:2, 279-286
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    Jean-Marc Guettier, Jean Y. Park, Elaine K. Cochran, Christine Poitou, Arnaud Basdevant, Muriel Meier, Karine Clément, Jocelyne Magré, Phillip Gorden. (2008) Leptin therapy for partial lipodystrophy linked to a PPAR-γ mutation. Clinical Endocrinology 68:4, 547-554
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