Sarah F. Leibowitz

Neurochemical-neuroendocrine systems in the brain controlling macronutrient intake and metabolism

Appetite, energy balance and body weight gain are modulated by diverse neurochemical and neuroendocrine signals from different organs in the body and diverse regions in the brain. The hypothalamus plays an important integrative function in this process, acting through a variety of systems that involve a close interaction between nutrients, amines, neuropeptides and hormones. These systems underlie normal nutrient intake and metabolism and are thought to be responsible for shifts in feeding behavior across the circadian cycle and fluctuations relating to gender and age in both rats and humans. Moreover, alterations in these normal neurochemical-neuroendocrine systems may be associated with abnormal eating patterns, such as anorexia nervosa, bulimia and obesity. Understanding the systems that control eating behavior might provide a foundation for the treatment and possible prevention of such disorders.

The role of serotonin in eating disorders.

SummaryRecent pharmacological studies have more precisely characterised the nature of the inhibitory effect of brain serotonin (5-hydroxytryptamine) on feeding behaviour. Thus, the brain sites and receptors involved have been identified, and a possible physiological role of endogenous serotonin in controlling natural patterns of eating and nutrient selection has been defined. The medial hypothalamus is believed to be a critical location in the mediation of serotonin’s action. Specifically, the paraventricular and ventromedial nuclei are known to be involved in controlling energy balance, while the suprachiasmatic nucleus determines circadian patterns of eating. Serotonergic stimulation of these 3 nuclei with exogenous serotonin or drugs that release endogenous serotonin, preferentially reduces carbohydrate intake in naturally feeding animals through satiety mechanisms involved in the termination of feeding. This phenomenon is mediated by serotonin and possibly serotonin receptors, in contrast to serotonin autoreceptors which potentiate feeding possibly by inhibiting serotonin release. The activity of serotonergic function in the medial hypothalamus exhibits a circadian rhythm which is characterised by a peak at the beginning of the active cycle when the motivation to eat is strongest and is triggered by deficits in energy stores. At this time, carbohydrate is found to be the naturally preferred macronutrient, and it appears that serotonin becomes most activated under these conditions to terminate the carbohydrate-rich meal, possibly by activating satiety neurons localised in the medial hypothalamus. In this process, serotonin may interact antagonistically with noradrenaline (norepinephrine) and its α2-noradrenergic receptors that normally function to enhance carbohydrate intake at the onset of the natural feeding cycle. Moreover, while inducing satiety for carbohydrate, serotonin may also play a role in switching the animal’s preference towards protein. The regulation of this macronutrient is closely linked to that of carbohydrate, and it is normally preferred in the second meal of the natural feeding cycle.Most of the pharmacological evidence to date generally supports the hypothesis that disturbances in serotonin function occur in eating disorders. Decreases in plasma tryptophan, urinary 5-hydroxyindoleacetic acid (5-HIAA), platelet serotonin binding and basal cerebrospinal fluid 5-HIAA in anorexia nervosa normalise upon weight restoration and appear to be starvation effects. These alterations in serotonergic function may however perpetuate the symptomatology of anorexia nervosa once the illness is set in motion. Some drugs which in part affect serotonergic function facilitate weight gain in conjunction with an integrated psychotherapeutic and behavioural programme. Patients with bulimia nervosa, regardless of the presence of anorexia nervosa or major depression, who have been relatively weight stable and free of binge/vomit episodes for at least 3 weeks, have significantly blunted prolactin responses to the serotonin agonists. These findings indicate that post-synaptic responsiveness in hypothalamic-pituitary serotonergic pathways is reduced in bulimia. Similar alterations in other serotonin pathways at or above the level of the hypothalamus may contribute to binge eating and other behavioural symptoms in bulimic patients. The clinical response to several psychotropic agents known to potentiate serotonergic transmission further substantiates a serotonin dysregulation hypothesis of bulimia nervosa. Serotonergic function is subject to seasonal alterations and may also be implicated in changes of mood and eating behaviour which accompany the seasonal affective disorder. Serotonin agonists such as dexfenfluramine are effective in suppressing excessive caloric intake in carbohydrate cravers.

Brain neuropeptide Y: An integrator of endocrine, metabolic and behavioral processes

Neuropeptide Y (NPY), acting through various medial hypothalamic nuclei, is found to have potent effects on a variety of endocrine, physiological and behavioral systems that modulate energy balance. This peptide affects the release of various hormones, such as corticosterone, insulin, aldosterone and vasopressin, which modulate energy metabolism, as well as food intake. It also has direct impact on energy metabolism through an effect on substrate utilization and lipogenesis. Finally, NPY has a remarkably potent stimulatory effect on feeding behavior, which is characterized by a selective increase in carbohydrate ingestion that is strongest at the beginning of the active feeding cycle and is dependent upon circulating levels of corticosterone. This evidence has led to the proposal that NPY exerts anabolic effects to restore energy balance at specific times of energy depletion. Increased NPY activity may occur at the beginning of the active cycle or after a period of food deprivation. Further evidence, that chronic NPY stimulation produces profound hyperphagia and obesity and that endogenous NPY concentration is increased in genetically obese animals, strongly suggests that hypothalamic NPY may contribute to the development of eating disorders and obesity.

Medial hypothalamic serotonin: role in circadian patterns of feeding and macronutrient selection.

Hypothalamic serotonin (5-HT) is believed to have an inhibitory effect on food intake in a variety of species. To define more precisely the nature of this effect, this study investigated the effects of medial hypothalamic 5-HT injection on natural patterns of macronutrient intake in freely feeding rats. Serotonin (5-20 nmol) was injected directly into the paraventricular nucleus (PVN) of brain-cannulated rats maintained ad libitum on pure macronutrient diets, protein, carbohydrate and fat, and measurements of nutrient intake were taken one hour later. To assess whether the action of 5-HT on macronutrient intake varies across the light-dark cycle, these tests were conducted at 3 different times in the nocturnal feeding period, during hours 1, 6 and 11 after lights out. The results demonstrate that the suppressive effect of PVN 5-HT on food intake is dose dependent, nutrient selective, as well as time dependent. Specifically, PVN injection of 5-HT, at all doses tested, was effective at only one time of the nocturnal cycle, namely, at the onset of the active, dark period. While no behavioral effect of 5-HT was detected in the middle and late phases of the dark, a strong, dose-dependent reduction of nutrient intake was revealed immediately after lights out. This suppressive effect was characterized by a highly selective decrease in carbohydrate intake, along with a significant enhancement in preference for protein, as well as for fat, and little change in total caloric intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Noradrenergic innervation of the paraventricular nucleus: Specific role in control of carbohydrate ingestion

Acute injections of norepinephrine (NE) into the hypothalamic paraventricular nucleus (PVN) have been shown to elicit eating in satiated rats. The present report examines the effects of acute and chronic PVN infusion of NE on intake of various liquid and mixed solid diets and on selection of the pure macronutrients, carbohydrate, protein, and fat. The results demonstrate that noradrenergic stimulation of the PVN (40 nmoles of NE) reliably enhances ingestion of pure sucrose diets (liquid and solid) and also of sweet and non-sweet milk solutions. Saccharin intake, in contrast, is unaffected. In preference tests, rats injected with NE show a greater increase in consumption of sucrose cubes compared with lab chow pellets, but exhibit an equivalent preference for sweet and non-sweet carbohydrate-rich diets. Tests with the three pure macronutrients simultaneously available reveal, after NE injection, a strong and selective increase in consumption of carbohydrate, with little or no change in intake of fat and, in some cases, a suppression of protein intake. This clear preference for carbohydrate can be seen with chronic NE infusion (5 nmoles every 30 min over a 14-day period), as well as after acute NE injection (40 nmoles), and also with long-term (24-hr) as well as short-term (1-hr) food intake measurements. This and other evidence suggests that the PVN noradrenergic system may play a specific and unique role in the control of carbohydrate ingestion.

Norepinephrine, clonidine, and tricyclic antidepressants selectively stimulate carbohydrate ingestion through noradrenergic system of the paraventricular nucleus

Using a self-selection feeding procedure, the present experiments examined the impact of central and peripheral injection of the alpha-adrenergic agonist clonidine (CLON) and the tricyclic antidepressant drugs amitriptyline (AMIT) and chlorimipramine (CIMIP) on nutrient selection in the adult male rat. In tests with mixed diets or with separate sources of the 3 macronutrients (carbohydrate, protein, and fat) simultaneously available, the following results were obtained: Peripheral and paraventricular nucleus (PVN) injection of CLON stimulated total food intake and preferentially increased ingestion of carbohydrate. Little or no change in protein or fat intake was observed. This pattern of response is similar to that observed with norepinephrine. PVN injection of AMIT and peripheral injection of CIMIP also selectively enhanced carbohydrate intake. These drug effects on carbohydrate selection occurred under a variety of conditions, including with mixed diets and pure dietary nutrients; under ad lib and restricted feeding conditions; in short (1 hr) as well as long (6 hr) test intervals; and in the absence or presence of a change in total calorie intake. Based on this and other evidence, it is proposed that noradrenergic neurons innervating the PVN in the rat play a role in regulating carbohydrate selection, and that this neurochemical system mediates the stimulating action of CLON and antidepressants on carbohydrate ingestion.

Morphine-stimulated feeding: analysis of macronutrient selection and paraventricular nucleus lesions.

The hypothalamic paraventricular nucleus (PVN) has been found to be sensitive to the feeding stimulatory effects of opiates. The present experiments investigated the effect of systemic morphine (2 mg/kg) on macronutrient selection in freely-feeding and food-restricted rats and assessed the impact of PVN electrolytic and 6-hydroxydopamine lesions on the rats ability to respond to peripheral morphine injection. In satiated rats, maintained ad lib on pure macronutrient diets, morphine increased food intake. This effect was associated with a preferential increase in protein ingestion; carbohydrate consumption, compared with fat and protein intake, was least affected. In food-restricted rats, permitted to eat for 6 hr, morphine instead produced a particular preference for fat, with no significant enhancement of total calorie intake. While PVN 6-hydroxydopamine lesions, which depleted PVN catecholamine levels by 70%, failed to alter morphine-stimulated feeding, electrolytic lesions of the PVN significantly attenuated this response, particularly protein and fat ingestion. This suggests that opiate-induced feeding may, in part, be mediated through the PVN, which is known to have an important function in the control of food ingestion.

PVN steroid implants: Effect on feeding patterns and macronutrient selection

The glucocorticoid corticosterone (CORT) plays a major role in feeding behavior, body weight regulation and metabolism. Recent work has demonstrated an interaction between circulating CORT and the alpha 2-noradrenergic feeding system of the hypothalamic paraventricular nucleus (PVN) and the existence of two different subtypes of glucocorticoid receptors in this nucleus. To examine the function of these specific PVN receptors, crystalline CORT and other steroid hormones were implanted directly into the PVN, and feeding patterns and macronutrient selection, of freely feeding adrenalectomized (ADX) and sham rats, were monitored at the beginning and end of the nocturnal feeding cycle. Results indicate that PVN CORT implants stimulate carbohydrate intake in ADX rats, at the onset of the dark cycle when the feeding-suppressive effects of ADX are strongest. Corticosterone was ineffective in sham rats and was also ineffective in potentiating food intake in ADX rats at the end of the dark phase. In contrast, implants of the mineralocorticoid aldosterone (ALDO) stimulated the ingestion of the fat diet, in both sham and ADX rats and during both the early and the late dark periods. Implants of ALDO also enhanced carbohydrate intake, but only in ADX rats and at dark onset. While the synthetic glucocorticoid, dexamethasone, had a small carbohydrate stimulatory effect similar to CORT, other steroids (deoxycorticosterone, progesterone and estrogen) were without effect. These results indicate a central site of action for the adrenal hormones in modulating nutrient intake. Based on a variety of evidence, it is suggested that the stimulatory effects of ALDO and CORT on macronutrient intake may be differentially mediated by Type 1 and Type 2 steroid receptor subtypes within the brain.

Morphine-elicited feeding: diurnal rhythm, circulating corticosterone and macronutrient selection.

The present study examined the feeding response elicited by morphine, injected either intraperitoneally (IP), or into the paraventricular nucleus (PVN), as a function of diurnal cycle and also in adrenalectomized rats with or without peripheral corticosterone replacement. In animals maintained on a single diet of chow, milk and sugar, a diurnal rhythm in both the peripheral and central morphine-induced feeding responses was observed, with a stronger eating effect occurring in the early dark hours compared with the responses obtained in the early light period. Adrenalectomy significantly reduced the feeding induced by morphine injected IP or into the PVN, and acute corticosterone replacement restored the response. Rats maintained on a self-selection feeding paradigm, with carbohydrate, protein and fat simultaneously available, exhibited a significant increase in total caloric intake after morphine injected IP, along with a preferential increase in the consumption of protein and fat. Adrenalectomy nearly abolished this stimulatory effect of morphine on total intake and altered the diet preference pattern. These findings underscore the importance of corticosterone in the feeding response of morphine injected peripherally or specifically into the PVN. The present findings suggest that corticosterone plays an important role in determining the diurnal rhythm of opiate-induced feeding and the function of endogenous opioids in the regulation of energy balance.

Changes in extracellular PVN monoamines and macronutrient intake after idazoxan or fluoxetine injection

Norepinephrine (NE) and serotonin (5-HT) in the paraventricular nucleus (PVN) have opposite effects on feeding, with NE stimulating carbohydrate intake through alpha 2 noradrenergic receptors and 5-HT inhibiting carbohydrate intake. This study examined the action of drugs that affect brain monoaminergic systems, in terms of their impact on nutrient intake and on PVN monoamines measured using microdialysis. The drugs studied were idazoxan, a blocker of alpha 2 receptors, or fluoxetine, a 5-HT reuptake blocker. In rats maintained on pure macronutrient diets, idazoxan (1 mg/kg) and fluoxetine (10 mg/kg), 120 min after injection both reduced total food intake, and specifically carbohydrate intake. In dialysis experiments, successive 20-min dialysate samples were taken, three samples before and seven samples after intraperitoneal injection of idazoxan (5 and 20 mg/kg), fluoxetine (10 mg/kg), or vehicle. Idazoxan increased NE, homovanillic acid, and dihydroxyphenylacetic acid in the PVN. Fluoxetine induced a significant increment of 5-HT in PVN, while producing a smaller increase in NE, dopamine, and homovanillic acid. These results support the conclusion that the impact of these drugs on macronutrient intake may be a consequence of their action on endogenous monoamine systems in the PVN. Thus, in this nucleus, the blockade of alpha 2-noradrenergic receptors, like stimulation of 5-HT receptors, attenuates normal ingestion of carbohydrate.