The Pharmaceutical Journal
Vol 268 No 7187 p274-79
2 March 2002

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The New England Journal of Medicine (content.nejm.org)

Leptin replacement therapy stabilises glycaemia in disordered fat metabolism

Leptin replacement therapy in patients with lipodystrophy improves glycaemic control, according to American researchers.

The researchers explain that severe lipodystrophy, a fat metabolism disorder, is caused by a deficiency or destruction of adipose cells and is characterised by low levels of the adipocyte hormone leptin, as well as hypertriglyceridemia and severe insulin resistance, which is usually accompanied by diabetes mellitus. Patients with a complete deficiency of leptin are morbidly obese from infancy.

Dr Elif Oral, National Institute of Diabetes and Digestive and Kidney Diseases, Maryland, and colleagues examined whether twice daily administration of recombinant leptin for four months improved insulin resistance, diabetes and hypertriglyceridaemia in nine patients with lipodystrophy and leptin deficiency.

They say that both plasma glucose levels and triglyceride levels decreased at the end of four months of therapy and food intake was also reduced. They add that "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". However, they say that the optimal dose of recombinant leptin in patients with lipodystrophy and the role of leptin replacement therapy in other insulin resistance states still need to be determined (New England Journal of Medicine 2002;346:570).