Leptin replacement improves metabolic control in women with lipodystrophy

NEW YORK (Reuters Health) – Results of a small study, reported in The New England Journal of Medicine for February 21, show that treatment with recombinant leptin improves glycemic control and lowers triglyceride levels in women with severe lipodystrophy.

Dr. Elif Arioglu Oral, from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, and colleagues studied nine women, 15 to 42 years of age, who had lipodystrophy and serum leptin levels less than 4 ng/mL. Of the nine women, eight were diabetic.

The researchers treated these women with escalating subcutaneous doses of recombinant methionyl human leptin, given twice daily, to achieve low, intermediate, and high physiologic replacement levels of leptin. After 4 months, mean serum leptin levels increased from 1.3 ng/mL to 11.1 ng/mL.

Among the eight diabetic patients there was an absolute decrease in mean glycosylated hemoglobin value of 1.9% (p = 0.001), the researchers report. Average triglyceride levels were decreased by 60% during treatment (p < 0.001), as was liver volume (average 28%, p = 0.002), Dr. Oral's group found. These results allowed diabetic therapy to be greatly reduced or discontinued, they add.

Leptin replacement therapy also resulted in self-reported significantly lower daily caloric intake (p = 0.005) and a significantly decreased resting metabolic rate (p = 0.003).

Dr. Oral and colleagues conclude that "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."

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