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Impact of Infliximab on Serum Leptin Levels in Patients with Crohn’s Disease

Laboratory of Experimental Gastroenterology and Department of Gastroenterology (D.F., S.R., T.G., E.Q., M.-C.G., J.D., A.V.G.), Erasme University Hospital, Brussels 1070, Belgium; and Division of Gastroenterology (D.F., Y.T.), Montreal General Hospital, McGill University, Montreal, Quebec, Canada H3A 1A4

Address all correspondence and requests for reprints to: Denis Franchimont, M.D., Ph.D., Division of Gastroenterology, Montreal General Hospital, McGill University, 1650 Cedar Avenue, D7.102, Montreal, Quebec, Canada H3A 1A4. E-mail: denis.franchimont{at}mcgill.ca.

Objectives: In mice, body weight is regulated by adipocyte-derived leptin. TNF is a critical mediator of inflammation-induced cachexia in Crohn’s disease (CD). The regulation of leptin by TNF is poorly understood in CD. Pharmacological neutralization of TNF with infliximab offers a unique opportunity to study TNF-mediated regulation of leptin in CD patients.

Methods: We prospectively followed up CD patients treated with infliximab (n = 20). Body composition was assessed before and after treatment at 1 and 4 wk. Serum leptin, IL-6, soluble TNF receptor type II, and soluble intercellular antiadhesion molecule-1 levels were measured as well as cholesterol levels and free urinary cortisol. Because methylprednisolone (MP) increases leptin production in vivo, CD patients treated with MP (n = 9) were studied separately as a positive control group.

Results: Infliximab induced clinical remission and a significant decrease in C-reactive protein (P < 0.01) and IL-6 (P < 0.05) levels in all CD patients and increased body weight (P = 0.013) at 4 wk. Leptinemia was significantly increased after infliximab administration at 1 wk (P = 0.014) and 4 wk (P < 0.001). This increase in serum leptin occurred early at 1 wk, when no significant weight and fat mass changes could be observed and was associated with the down-regulation of TNF-regulated mediators, soluble TNF receptor type II (P = 0.015), and soluble intercellular antiadhesion molecule-1 (P = 0.007). Moreover, infliximab increased cholesterol levels at 1 wk (P = 0.001). Twenty-four-hour cortisol secretion was not altered by infliximab. Leptinemia increased at 1 wk after MP administration (P = 0.028).

Conclusion: Infliximab increases leptinemia in CD. This study suggests that TNF exerts major inhibitory actions on leptin production in CD patients.

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