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Adipocytokines and the Metabolic Complications of Obesity

The Central Arkansas Veterans Healthcare System (N.R.), and the Department of Medicine, Division of Endocrinology, University of Arkansas for Medical Sciences (N.R., P.A.K.), Little Rock, Arkansas 72205

Address all correspondence and requests for reprints to: Philip A. Kern, M.D., Slot 718, University of Arkansas for Medical Sciences, 4301 Markham Street, Little Rock, Arkansas 72205. E-mail: KernPhilipA{at}uams.edu.

Context: Adipose tissue is increasingly recognized as an active endocrine organ with many secretory products and part of the innate immune system. With obesity, macrophages infiltrate adipose tissue, and numerous adipocytokines are released by both macrophages and adipocytes. Adipocytokines play important roles in the pathogenesis of insulin resistance and associated metabolic complications such as dyslipidemia, hypertension, and premature heart disease.

Evidence Acquisition: Published literature was analyzed with the intent of addressing the role of the major adipose secretory proteins in human obesity, insulin resistance, and type 2 diabetes.

Evidence Synthesis: This review analyzes the characteristics of different adipocytokines, including leptin, adiponectin, pro-inflammatory cytokines, resistin, retinol binding protein 4, visfatin, and others, and their roles in the pathogenesis of insulin resistance.

Conclusions: Inflamed fat in obesity secretes an array of proteins implicated in the impairment of insulin signaling. Further studies are needed to understand the triggers that initiate inflammation in adipose tissue and the role of each adipokine in the pathogenesis of insulin resistance.