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[The role of serotonin in normal appetite regulation and in the pathogenesis of anorexia/bulimia].

Evidence accumulated over the past two decades indicates the existence of several neurochemical systems that influence feeding behavior. The central region regulating appetite is thought to be in the hypothalamus, where different monoaminergic systems are localized. It has been suggested that altered function in these systems is taking part in the pathogenesis of anorexia and bulimia nervosa. According to these theoretical principles and to the development of specific monoaminergic and anti-monoaminergic drugs, the pharmacological treatment of eating disorders can become more successful in the future. This article discusses the role of serotonin in appetite regulation and presents new evidence that a dysfunction in hypothalamic serotonergic pathways can be an important part of the pathogenesis of anorexia and bulimia nervosa.

Anorexia Nervosa

Quantification of appetite-regulating hormones in children with hypothalamic and common obesity.

CONTEXT: The pathophysiology of hypothalamic obesity (HyOb) remains incompletely understood with no effective treatments. OBJECTIVE: We examined differences in appetite-regulating hormone concentrations between patients with HyOb, common obesity, and lean controls. DESIGN: Multiway cross-sectional case-control study of patients aged 2 through 19 years. SETTING: Two tertiary pediatric endocrinology centers. PATIENTS: Cases were obese (body mass index [BMI] > +2 SD score [SDS], "HyOb") and lean ("HyLean") patients with congenital (septo-optic dysplasia) or acquired (suprasellar brain tumor) hypothalamic disorders. Controls had common obesity ("Ob") or nonhypothalamic disorders and normal BMI ("Lean"). MAIN OUTCOME MEASURES: Relationships between the Dykens' Hyperphagia Questionnaire Score (DHQS), plasma or serum concentrations of leptin, insulin, α-melanocyte stimulating hormone (αMSH), brain-derived neurotrophic factor, oxytocin, acylated ghrelin, agouti-related peptide and copeptin, and BMI SDS. RESULTS: Dykens' Hyperphagia Questionnaire Score did not differ between HyOb and Ob patients (24 [17-34] vs 24 [18-31]) but correlated with BMI SDS in patients with hypothalamic disorders (P = 0.02). HyOb and Ob patients exhibited similarly increased anorexigens (insulin, leptin) and decreased orexigens (ghrelin, agouti-related peptide) compared to HyLean and Lean patients. The rate of BMI increase was independently associated with lower αMSH (β = -0.23 [-0.36 to -0.11], P = .0007) and ghrelin (β=-0.004 [-0.01 to 0.00], P = .001) concentrations, suggesting that αMSH replacement may be a therapeutic target for HyOb. HyLean patients demonstrated intermediate insulin responses to glucose compared to other subcohorts. CONCLUSION: In our cohort, patients with HyOb appeared indistinguishable from Ob in terms of their appetite and appetite-regulating neuroendocrine circuitry. Higher αMSH concentrations are associated with reduced weight gain and may be a target for therapeutic intervention.

alpha-MSH

Appetite regulation by gut peptides.

A number of gastrointestinal hormones that are released from the gut in response to intraluminal food stuffs have been shown to play a role in producing satiety. Some of these hormones apparently activate ascending vagal fibers that send messages to the nucleus tractus solitarius, and perhaps from there messages are sent to the paraventricular nucleus of the hypothalamus. Not only do gastrointestinal hormones play a role in the termination of a meal but they also appear to modulate energy metabolism (at least in rodents) through the activation of brown adipose tissue.

Animals

A possible physiological function of pancreatic pro-colipase activation peptide in appetite regulation.

Pancreatic pro-colipase activation peptide, a pentapeptide with the sequence VPDPR was found to significantly suppress food intake of 20 h fasted Sprague-Dawley rats in a dose-dependent way. A rat treated with pro-colipase-enriched pellets for 26 days showed decreased daily food intake and retarded growth, which were restored during a following period of regular feeding. Genetically obese Zucker rats (fa/fa) were found to contain a reduced content of pancreatic pro-colipase (60% reduction), whereas the pancreatic lipase content was normal. A physiological function of pancreatic pro-colipase activation peptide as an endogenous satiety signal is suggested.

Animals

[Central nervous appetite regulation: mechanisms and significance for the development of obesity].

This review focuses on neurotransmitter and neuropeptide actions on food ingestion, as well as on some of the mechanisms that may lead to the development and maintenance of obesity. In particular, the role of hypothalamic amines (catecholamines, serotonin) in appetite control is described. Thus, hypothalamic noradrenaline appears to stimulate food intake, while an enhanced brain serotonergic neurotransmission leads to a suppression of food ingestion, preferentially of carbohydrate intake. The involvement of brain serotonin neurons in appetite control is most attractive, since serotonin synthesis and release is readily affected by either precursor loading (i.e., 1-tryptophan) or pharmacological manipulation (e.g., drugs such as fenfluramine or fluoxetine). Recent data now suggest that at least a subgroup of obese patients is characterized by a disturbed serotonergic neurotransmission, thus exhibiting behaviors such as carbohydrate craving. Among neuropeptides involved in appetite control, the most attractive candidate appears to be corticotropin-releasing hormone which is released by neurons of the paraventricular nucleus and produces a stress-like activation of the organism, and has a strong appetite-suppressant effect.

Appetite