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Metabolic decompensation in children with type 1 diabetes mellitus associated with increased serum levels of the soluble leptin receptor

¹ Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics and ² Hospital for Children and Adolescents, University of Leipzig, Paul-List-Str, 13-15, D-04103 Leipzig, Germany and ³ Children’s Hospital, University of Erlangen, Erlangen, Germany

(Correspondence should be addressed to J Kratzsch; Email: kraj{at}medizin.uni-leipzig.de)

Objective: Type 1 diabetes mellitus (T1DM) leads to increased serum levels of the soluble leptin receptor (sOB-R) by an as yet unknown cellular mechanism. The aim of our study was to investigate potential metabolic factors that may be associated with the induction of the sOB-R release from its membrane receptor.

Materials and methods: Twenty-five children (aged between 1.5 and 17.0 years) were studied at the onset of T1DM. Blood samples were collected before (n = 25), during the first 18 h (mean ± S.D. 11.1 ± 4.3 h, n = 16) and 92 h (47.5 ± 22.5 h; n = 14) after beginning insulin therapy. Serum sOB-R and leptin levels were determined by in-house immunoassays.

Results: The sOBR-level and the molar sOB-R/leptin ratio were significantly higher before than after starting insulin treatment (P < 0.05). In contrast, leptin levels were significantly lower (P < 0.05) before insulin therapy. The correlation between sOB-R and blood glucose (r = 0.49; P < 0.05), as well as sOB-R with parameters of ketoacidosis, such as pH (r = –0.72), base excess (r = –0.70), and bicarbonate (r = –0.69) (P < 0.0001) at diagnosis of T1DM remained significant during the first 18 h of insulin treatment. Multiple regression analysis revealed that base excess predicted 41.0% (P < 0.001), age 16.4% (P < 0.05), and height SDS 13.9% (P < 0.01) of the sOB-R variance.

Conclusions: Metabolic decompensation in children with new onset T1DM is associated with dramatic changes of the leptin axis; serum levels of sOB-R are elevated and of leptin are reduced. The molar excess of sOB-R over leptin (median 11.3) in this condition may contribute to leptin insensitivity. Upregulation of the soluble leptin receptor appears to be a basic mechanism to compensate for intracellular substrate deficiency and energy-deprivation state.

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				S. E. Cohen, E. Kokkotou, S. B. Biddinger, T. Kondo, R. Gebhardt, J. Kratzsch, C. S. Mantzoros, and C. R. Kahn High Circulating Leptin Receptors with Normal Leptin Sensitivity in Liver-specific Insulin Receptor Knock-out (LIRKO) Mice J. Biol. Chem., August 10, 2007; 282(32): 23672 - 23678. [Abstract] [Full Text] [PDF]