Rapid improvement of hepatic steatosis after initiation of leptin substitution in a leptin-deficient girl.

BACKGROUND: Leptin deficiency is associated with severe obesity and metabolic disturbances. Increased liver fat content has been reported in only one case beforehand, even though hepatic steatosis is a typical comorbidity of common obesity. It is also frequent in patients with lipodystrophy where it resolves under leptin therapy. SUBJECT AND METHODS: In 2010, we reported a leptin-deficient patient with a novel homozygous mutation in the leptin gene and severe hepatic steatosis. We have now studied serum changes and changes in liver fat content during the substitution with recombinant methionyl human leptin. RESULTS: After 23 weeks of leptin substitution, elevated transaminases, total cholesterol and low-density lipoprotein levels normalized. After 62 weeks, homeostasis model assessment of insulin resistance improved from 10.7 to 6.0 and body fat mass dropped from 50.2 to 37.8%. Liver fat content was drastically reduced from 49.7 to 9.4%. The first changes in liver fat content were detectable after 3 days of therapy. CONCLUSION: Our patient showed a remarkable reduction of liver fat content during the treatment with recombinant methionyl human leptin. These changes occurred rapidly after initiation of the substitution, which implies that leptin has a direct effect on hepatic lipid metabolism in humans as it is seen in rodents.

Leptin substitution results in the induction of menstrual cycles in an adolescent with leptin deficiency and hypogonadotropic hypogonadism.

BACKGROUND: Leptin deficiency leads to midluteal-phase defect or reduced testicular volume in adults, despite normal gonadotropin levels. All children documented to date with leptin deficiency were prepubertal with physiologically low gonadotropins prior to therapy. A direct effect of leptin on pubertal development in a leptin-naive adolescent has not yet been shown. METHODS: In 2010, we reported the first connatal leptin-deficient adolescent girl with clinically and chemically proven hypogonadotropic hypogonadism. In this study, we evaluated the effect of recombinant methionyl human leptin substitution. RESULTS: Initially, the patient had prepubertal basal and stimulated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, low growth hormone and insulin-like growth factor 1 (IGF1) levels and no pulsatile secretion of LH and FSH. After 11 weeks of therapy, basal and stimulated LH and FSH levels rose to pubertal values and nocturnal pulsatility was initiated. After 76 weeks of therapy, menstruation occurred at the age of 16.3 years. Pulsatile nocturnal growth hormone secretion, stimulated growth hormone secretion and IGF1 values also normalized. CONCLUSION: We describe here the first adolescent with hypogonadotropic hypogonadism due to connatal leptin deficiency. Leptin substitution led to a rapid induction of gonadotropin secretion and menarche. These data are further proof of the concept that leptin is needed for a timely maturation of the hypothalamic/pituitary/gonadal axis.

Effect of formic acid or formaldehyde treatment of alfalfa silage on nutrient utilization by dairy cows.

Third-cutting alfalfa with 37% DM was ensiled untreated or treated with either 2.8 g of formic acid/100 g of DM or .31 g of formaldehyde/100 g of DM and fed to lactating dairy cows in two experiments. Silage treated with formic acid had the lowest pH and concentrations of NPN, NH3, and total free AA. Both treatments decreased rumen in vitro protein degradability but did not affect in vitro rumen plus pepsin digestibility. In trial 1, part 1, 22 Holstein cows received a standard diet for 18 d postpartum and then were fed for 6 wk one of three diets containing 98% alfalfa silage DM. Although DMI was comparable, yields of milk, SCM, fat, protein, lactose, and SNF were higher when treated silages were fed. Plasma concentrations of branched-chain, essential, and total AA increased when formic acid-treated silage was fed. Rumen pH and concentrations of NH3 and VFA were similar for all diets. Rumen escape protein, estimated using 15N as a microbial protein marker, was increased more by formic acid than by formaldehyde treatment. In trial 1, part 2, supplementation with 4.8% fish meal increased concentration of milk protein and yields of milk, protein, lactose, and SNF. Milk urea concentration was higher on the untreated silage diet. Total tract apparent DM and N digestibilities were not affected by silage treatment, although fish meal decreased apparent DM digestibility. In trial 2, 80:20 alfalfa silage:ground corn diets were fed to 12 midlactation cows in a 3 x 3 Latin square study. Milk production was unaffected, but milk protein concentration and DMI were higher when treated silages were fed. Feeding treated silages increased plasma concentrations of branched-chain AA, essential AA, and total AA. Formaldehyde and especially formic acid treatment effectively improved utilization of nutrients in alfalfa silage by lactating dairy cows.