There is a critical medical need to develop effective strategies
for long-term weight loss and weight maintenance although it is
unlikely that any single therapy will yield maximal efficacy.
Currently, the few therapies actually shown to be effective for
weight loss include lifestyle modifications (diet and exercise),
bariatric surgery, and pharmacological targets that modulate
central pathways that regulate food intake [
41]. PPARs are
known to modulate enzymes involved in lipid metabolism and are
expressed in many, if not all, metabolically active tissues
including liver, heart, kidney, skeletal muscle, intestine,
pancreas, and adipose tissue [
42,
43]. This suggests that
PPARs play a key role in energy metabolism and homeostasis that
may ultimately affect body weight and body mass. In this report,
we present data showing that potent and selective agonists of all
three PPAR isoforms serve to modulate food intake and energy
balance in DIO AKR/J mice.
Selective activators of PPAR
γ, such as glitazones, have
been successfully used to treat T2DM for nearly a decade.
Treatment with rosiglitazone and pioglitazone induce body weight
gain in mice [
45,
46,
49], rats [
44,
47–
50],
nonhuman primates [
51,
52], and humans [
53–
55].
Weight gain is manifested as increased adiposity, total body water
and plasma volume. In this report, mice treated with a potent and
selective PPAR
γ activator gained more weight than obese
vehicle controls and the weight gain could be completely accounted
for by increased fat mass which was equivalent to the increase in
caloric intake. In addition to stimulation of food consumption,
activation of PPAR
γ promotes triglyceride accumulation
by increasing expression of genes modulating adipogenesis
[
56–
58], lipid transport [
58,
59], storage
[
46,
60], and glucose homeostasis [
61]. We also observed
that GW7845 had no effect on FAO in mouse liver. In summary,
PPAR
γ agonism induces food consumption and energy
storage without an effect on energy utilization resulting in net
weight gain.
A number of studies have suggested that PPAR
δ agonists
regulate food intake, body weight, insulin sensitivity, and
adiposity [
8,
62–
68]. Transgenic mice in
which constitutively active PPAR
δ is expressed in
muscle are highly resistant to high-fat, diet-induced obesity
[
15]. Administration of GW501516, a selective
PPAR
δ agonist, promotes FAO and utilization, depleting
lipid accumulation in adipocytes, skeletal muscle, and liver in
DIO, ob/ob [
68], and db/db mice [
67].
Similarly, there are numerous studies that suggest that
PPAR
α can regulate food intake, body weight, and
adiposity in rodents [
69–
74].
PPAR
α has been shown to modulate target genes involved
in uptake, activation, and degradation of fatty acids maintaining
lipid homeostasis in liver, heart, and oxidative muscles [
33,
75,
76]. It is possible that the combination of these mechanisms
could result in reduction of body weight. Djouadi et al. [
76]
and Muoio et al. [
33] have shown that the body weight of
PPAR
α-KO mice was greater than WT littermates, and that
they became obese when fed a high fat diet, confirming the role of
PPAR
α receptors in modulating energy utilization and BW
in rodents. In humans, fibrate treatment has not been associated
with body weight loss (73), thus, the role of PPAR
α
agonism in human body weight regulation is unclear.
Neither PPARα nor PPARδ agonists had a
sustained effect on body weight. While the increase in liver
weights observed with both treatments counterbalanced the initial
weight loss induced by these compounds, this change did not
completely explain the rebound.
GW0742, the PPARδ agonist, had a transient stimulatory
effect on food intake from days 12–17 and it was during this time
that the rebound increase in weight occurred. There was a
significant increase in liver FAO induced by GW0742 after chronic
dosing. The increase in food intake may have occurred in response
to elevated energy expenditure, thus, an agent that only modulates
energy expenditure did not induce significant weight loss in this
model.
After 10 days of treatment with GW9578, the PPAR
α
agonist, a significant suppression of food intake was observed
that persisted throughout the rest of the study. The timing of
this effect coincided with the timing of the rebound in weight
gain. Currently, we do not have an explanation for this
phenomenon, yet it appears that chronic PPAR
α agonism
induces a metabolic compensation resulting in weight regain and
the food intake suppression could be a counteracting mechanism.
The effect on food consumption could be regulated centrally as
PPAR
α is expressed in low but detectable levels in
mouse hypothalamus, a major center of appetite and satiety
regulation. PPAR
α could also modulate peripheral
mechanisms that affect appetite or central response to lipid
levels resulting from changes in FAO [
12,
75]. While several
reports have shown that PPAR
α increased FAO, the
measurement of this parameter at the end of the study indicated
that there was only a modest alteration. We did observe weight
loss during the first 10 days of the study without a change in
food intake thus it is possible that there could have been
induction of FAO during this time.
A combination study of PPARα and PPARδ
agonists was performed to determine if greater weight loss could
be achieved together than with either compound alone. After 2
weeks of dosing with either single agent, addition of the second
agent further reduced body weight and fat mass, suggesting a
synergistic effect of the two agents. Combination dosing of both
agents for the entire 4 weeks of the study produced even greater
reduction in body weight and fat mass. Interestingly, the
suppression of food intake after addition of GW9578 to GW0742 and
with the straight combination dosing occurred immediately as
opposed to the 10-day delay observed with GW9578 alone. The
immediate effect on food intake through PPARα, increase
in liver FAO from PPARδ, and the initial induction of
weight loss by PPARα through a nonfood intake mechanism
all account for the greater efficacy observed with the combination
dosing from day 1 of treatment.
PPARpan agonists are a class of compounds that activate all three
PPAR receptor subtypes and are currently being evaluated as
antidiabetic agents. Compared to selective PPAR agonists, PPARpan
ligands are expected to display unique characteristics as a result
of ligand-activation profiles combining features of all three PPAR
receptor subtypes, however, the effects are not simply the sum of
the activities, but reflect a careful balance of lipid handling
and energy. Both compounds used in this study are potent
activators of all three isoforms but the potency ratio across the
isoforms is different. GW4148 is an extremely potent agonist of
murine PPARδ (9 nM) and is 4-fold selective over
PPARα or PPARγ receptors. In contrast,
GW9135 is a potent agonist of murine PPARα (13 nM) and
is 18-fold and 50-fold selective over PPARγ and
PPARδ, respectively. Other factors such as cofactor
affinities contribute to the physiological behavior of each
molecule.
GW9135 had little effect on overall weight loss, a pattern not
different from PPARα agonist treatment alone, where
there was an initial decrease in weight followed by regain. This
effect can be explained by the greater potency of the molecule at
PPARα and its weaker potency on PPARδ. In
contrast, GW4148, which is most potent at the PPARα and
PPARδ receptors, behaved similarly to combination
dosing of GW9578 and GW0742 producing significant weight loss at
10/mg/kg.
Contrary to the differential effects on body weight, both PPARpan
agonists produced similar metabolic effects. Each compound reduced
TG, NEFA, and circulating insulin levels, and elevated HDL-c and
bHBA. A similar pattern was noted with the combination of GW9578
and GW0742, however, these two agents alone did not have
significant effects on any parameter except insulin. The
combination of PPARα and PPARδ activation
results in a synergistic effect on serum chemistry parameters.
In summary, these studies demonstrate that PPARs are integrally
involved in energy maintenance. The PPARα and
PPARδ receptors are responsible for induction of weight
loss in AKR/J mice through suppression of food intake and
increased energy expenditure. Activation of PPARα and
PPARδ receptors by PPARpan compounds may be expected to
induce weight loss or provide weight maintenance while combining
the beneficial insulin sensitization effects of a PPARγ
agonist.