title: Low cerebrospinal fluid hypocretin (Orexin) and altered energy homeostasis in human narcolepsy.
abstract: Hypocretins (orexins) are hypothalamic neuropeptides involved in sleep and energy homeostasis. Hypocretin mutations produce narcolepsy in animal models. In humans, narcolepsy is rarely due to hypocretin mutations, but this system is deficient in the cerebrospinal fluid (CSF) and brain of a small number of patients. A recent study also indicates increased body mass index (BMI) in narcolepsy. The sensitivity of low CSF hypocretin was examined in 38 successive narcolepsy-cataplexy cases [36 human leukocyte antigen (HLA)-DQB1*0602-positive] and 34 matched controls (15 controls and 19 neurological patients). BMI and CSF leptin levels were also measured. Hypocretin-1 was measurable (169 to 376 pg/ml) in all controls. Levels were unaffected by freezing/thawing or prolonged storage and did not display any concentration gradient. Hypocretin-1 was dramatically decreased (<100 pg/ml) in 32 of 38 patients (all HLA-positive). Four patients had normal levels (2 HLA-negative). Two HLA-positive patients had high levels (609 and 637 pg/ml). CSF leptin and adjusted BMI were significantly higher in patients versus controls. We conclude that the hypocretin ligand is deficient in most cases of human narcolepsy, providing possible diagnostic applications. Increased BMI and leptin indicate altered energy homeostasis. Sleep and energy metabolism are likely to be functionally connected through the hypocretin system.
authors.affiliation: Stanford University Center for Narcolepsy, Palo Alto, CA 94304, USA. nishino@stanford.edu
authors.forename: S
authors.initials: S
authors.lastname: Nishino
authors.forename: B
authors.initials: B
authors.lastname: Ripley
authors.forename: S
authors.initials: S
authors.lastname: Overeem
authors.forename: S
authors.initials: S
authors.lastname: Nevsimalova
authors.forename: G J
authors.initials: GJ
authors.lastname: Lammers
authors.forename: J
authors.initials: J
authors.lastname: Vankova
authors.forename: M
authors.initials: M
authors.lastname: Okun
authors.forename: W
authors.initials: W
authors.lastname: Rogers
authors.forename: S
authors.initials: S
authors.lastname: Brooks
authors.forename: E
authors.initials: E
authors.lastname: Mignot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D002352:Carrier Proteins / Q000097:blood / Q000134:cerebrospinal fluid*; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006683:HLA-DQ Antigens / Q000134:cerebrospinal fluid; D006706:Homeostasis; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D020738:Leptin / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D009479:Neuropeptides / Q000097:blood / Q000134:cerebrospinal fluid*; D000068797:Orexins
chemical_list: D002352:Carrier Proteins; C000596229:HCRT protein, human; D006683:HLA-DQ Antigens; D047908:Intracellular Signaling Peptides and Proteins; D020738:Leptin; D009479:Neuropeptides; D000068797:Orexins