title: Leptin responsiveness restored by amylin agonism in diet-induced obesity: evidence from nonclinical and clinical studies.
abstract: Body weight is regulated by complex neurohormonal interactions between endocrine signals of long-term adiposity (e.g., leptin, a hypothalamic signal) and short-term satiety (e.g., amylin, a hindbrain signal). We report that concurrent peripheral administration of amylin and leptin elicits synergistic, fat-specific weight loss in leptin-resistant, diet-induced obese rats. Weight loss synergy was specific to amylin treatment, compared with other anorexigenic peptides, and dissociable from amylin's effect on food intake. The addition of leptin after amylin pretreatment elicited further weight loss, compared with either monotherapy condition. In a 24-week randomized, double-blind, clinical proof-of-concept study in overweight/obese subjects, coadministration of recombinant human leptin and the amylin analog pramlintide elicited 12.7% mean weight loss, significantly more than was observed with either treatment alone (P < 0.01). In obese rats, amylin pretreatment partially restored hypothalamic leptin signaling (pSTAT3 immunoreactivity) within the ventromedial, but not the arcuate nucleus and up-regulated basal and leptin-stimulated signaling in the hindbrain area postrema. These findings provide both nonclinical and clinical evidence that amylin agonism restored leptin responsiveness in diet-induced obesity, suggesting that integrated neurohormonal approaches to obesity pharmacotherapy may facilitate greater weight loss by harnessing naturally occurring synergies.
authors.affiliation: Amylin Pharmaceuticals, Inc., San Diego, CA 92121, USA. jonathan.roth@amylin.com
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Roth
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Roland
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Cole
authors.forename: James L
authors.initials: JL
authors.lastname: Trevaskis
authors.forename: Christian
authors.initials: C
authors.lastname: Weyer
authors.forename: Joy E
authors.initials: JE
authors.lastname: Koda
authors.forename: Christen M
authors.initials: CM
authors.lastname: Anderson
authors.forename: David G
authors.initials: DG
authors.lastname: Parkes
authors.forename: Alain D
authors.initials: AD
authors.lastname: Baron
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism; D000682:Amyloid / Q000819:agonists* / Q000737:chemistry* / Q000378:metabolism / Q000494:pharmacology; D000818:Animals; D001835:Body Weight; D031204:Caloric Restriction; D004195:Disease Models, Animal; D006728:Hormones / Q000378:metabolism; D007031:Hypothalamus / Q000378:metabolism; D058228:Islet Amyloid Polypeptide; D020738:Leptin / Q000031:analogs & derivatives / Q000378:metabolism* / Q000494:pharmacology; D008954:Models, Biological; D009765:Obesity / Q000235:genetics / Q000628:therapy; D010101:Oxygen Consumption; D051381:Rats
chemical_list: D000682:Amyloid; D006728:Hormones; D058228:Islet Amyloid Polypeptide; D020738:Leptin; C105254:pramlintide; C415771:metreleptin