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Diabetes Section, National Institute on Aging, National Institutes of Health (B.-J.K., O.D.C., H.-J.J., C.B., J.M.E.), Baltimore, Maryland 21224; and Department of Surgery, University of Massachusetts (D.E.), Worcester, Massachusetts 01655
Address all correspondence and requests for reprints to: Dr. Josephine M. Egan, Diabetes Section, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, Maryland 21224. E-mail: eganj{at}grc.nia.nih.gov.
| Abstract |
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Objective: Our objective was to investigate whether plasma PYY levels were correlated with sex and body mass index (BMI).
Design, Setting, and Patients: We conducted a cross-sectional study of 151 normal volunteers (1990 yr of age) in the Baltimore Longitudinal Study of Aging.
Interventions: All subjects had an oral glucose tolerance test (75 g) performed.
Main Outcome Measures: Immunostaining of human duodenum, BMI, hemoglobin A1c, plasma glucose, insulin, PYY, glucagon like peptide-1 (GLP-1), ghrelin, and leptin were the main outcome measures.
Results: PYY and GLP-1 colocalized in the same cells in human duodenum. Both hormones reached peak plasma levels by 20 min and had similar secretory patterns. The incremental increases in PYY and GLP-1 during that first 20 min were significantly correlated (r2 = 0.388; P < 0.0001). The areas under the curve from 0120 min for PYY and GLP-1 were similar in both obese and lean participants. Female participants across the range of BMI had significantly higher PYY area under the curve (17,464 ± 1,240 vs. 14,120 ± 806 pmol/liter·min, female vs. male; P < 0.05) compared with male participants.
Conclusions: Our findings show that PYY and GLP-1 are colocalized and cosecreted from L cells and that total secretion of PYY is higher in females than in males, but fasting PYY levels and PYY secretion in response to oral glucose were not in any way correlated with BMI.
| Introduction |
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Peripheral PYY infusions have been reported to decrease food intake in both rodents (6) and humans (16) and to decrease body weight gain in rodents (6), although the findings in rodents have not been universally replicated (17). Most interestingly, fasting levels of PYY were found to be lower in obese compared with lean humans, with a negative correlation between PYY levels and body mass index (BMI), implicating PYY deficiency in the pathogenesis of obesity. Secretion of PYY after a meal was also lower in obese subjects than in lean subjects (16).
Because the relationship between PYY and GLP-1 secretion is not clear in humans, we examined their secretion after an oral glucose tolerance test with multiple blood samplings. We also examined human duodenum by immunofluorescent staining to look for colocalization of the two hormones.
| Subjects and Methods |
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We screened the Baltimore Longitudinal Study on Aging (BLSA) participants from 2001 forward who were not taking glucose-lowering medications and who had an oral glucose tolerance testing with the standard 75-g glucose load during their most recent visit. From those, we analyzed all 151 (mean age, 57.1 ± 17.0 yr; 93 women and 58 men; BMI, 28.4 ± 5.5 kg/m2) with normal fasting and 2-h glucose levels [fasting plasma glucose, <100 mg/dl (5.6 mmol/liter); 2-h plasma glucose after 75 g oral glucose, <140 mg/dl (7.8 mmol/liter)]). The committee on human investigation of Medstar Research Institute approved the study. All volunteers were informed about the nature of the study, and all provided written informed consent in accordance with the Helsinki II Declaration.
Modified oral glucose tolerance test in BLSA participants
Participants fasted overnight. Blood was obtained for hemoglobin A1c (HbA1c) as well as for fasting plasma glucose, insulin, GLP-1, PYY, ghrelin, and leptin measurements (time zero). Participants then drank 75 g glucose (SunDex, Fisherbrand, Pittsburgh, PA), and nine more blood samples were subsequently drawn at 5, 10, 15, 20, 40, 60, 80, 100, and 120 min for plasma glucose, insulin, GLP-1, and PYY determinations. Blood was collected into EDTA-coated tubes (1.5 µg/ml blood), containing aprotinin (40 µl/ml blood; Trasylol, Serological Proteins, Kankakee, IL) and an inhibitor of dipeptidyl-peptidase IV (DDP4; 10 µl/ml blood; Linco Research, Inc., St. Charles, MO). The body weights and heights of participants were measured manually using a medical scale (SECA Corp., Hanover, MD), and BMI was calculated as body weight in kilograms divided by the square of the height in meters.
Plasma hormone and biochemical assays
We measured plasma glucose levels with a glucose analyzer (Beckman Instruments, Brea, CA). We assayed plasma samples for insulin by ELISA (ALPCO Diagnostics, Windham, NH) with a detection limit of 1 µU/ml. The cross-reactivity of the insulin antibody for C peptide and vice versa were less than 0.1%. We measured active GLP-1 by ELISA (Linco Research, Inc.) with a detection limit of 5 pmol/liter. We assayed PYY using an RIA (Linco Research, Inc.). The PYY antibody recognizes both 136 and 336 forms of human PYY. The limit of sensitivity and the limit of linearity of the PYY assay are 10 and 1280 pg/ml, respectively (100 µl plasma). Quality control specimens (QC1, 38.479.7 pg/ml; QC2, 156.0324.1 pg/ml; interassay variation, <5%) were always run with each standard curve, and their results were within the levels of expectation. In addition, we checked the cross-reactivity of the PYY antibody with pancreatic polypeptide (PP) and neuropeptide Y (NPY) by assay of serial dilutions of PYY-(136), PP, and NPY synthetic peptides (Bachem Bioscience, Inc., King of Prussia, PA; 2.5, 5, 10, 20, 40, 80, 160, 320, and 640 pmol/liter) in human plasma with the same kit and did not find any cross-reactivity between PYY and either PP or NPY. We measured plasma leptin levels by ELISA (Linco Research, Inc.), plasma ghrelin levels by RIA (Phoenix Pharmaceuticals, Inc., Belmont, CA), and HbA1c with an automated DiaSTAT analyzer (Bio-Rad Laboratories, Hercules, CA).
Immunofluorescent staining
Antibodies used were to GLP-1 (goat antihuman GLP-1 C-terminal antibody; Santa Cruz Biotechnology, Inc., Santa Cruz, CA; 1:200) antibody, PYY (rabbit polyclonal antihuman PYY antibody; gift from Dr. Gordon Ohning, Cure/Digestive Disease Research Center, University of California, Los Angeles, CA; 1:200) (18) and chromogranin A (mouse monoclonal antihuman chromogranin antibody; Abcam, Inc., Cambridge, MA; 1:200). The GLP-1 and PYY antibodies were preincubated with their respective antigens to block staining and then were also preincubated with one another as well as with chromogranin A. Human paraffin-embedded duodenal sections (anonymous postmortem samples from a woman, aged 28 yr, and a man, aged 64 yr) were obtained from Histology Control Systems. After deparaffinization with xylene, human duodenal sections were permeabilized in Triton X (0.1%) on ice and blocked for 1 h at room temperature in 5% BSA and 0.1% Tween in PBS. For triple-immunofluorescent staining, sections were incubated overnight at 4 C with primary antibodies, washed, incubated with secondary antibodies (Alexa 568 donkey antigoat antibody for GLP-1, Alexa 488 donkey antirabbit antibody for PYY, and Alexa 633 goat antimouse antibody for chromogranin A) for 1 h, washed, and mounted with fluorescence mounting medium (Vector Laboratories, Inc., Burlingame, CA). Immunofluorescent control sections were stained using isotype controls, with omission of primary antibodies and primary antibodies had been blocked with their respective antigens. After single staining (to prove the blocking), we performed triple-indirect immunofluorescent staining, and we made photomicrograph images using a confocal microscope (LSM-410, Carl Zeiss, Inc., New York, NY). We also made images using filters only at the correct wavelengths (without antibodies added) to exclude autofluorescence in enteroendocrine cells.
Statistical analysis
All values are expressed as the mean ± SEM. To estimate the incremental changes in plasma glucose, insulin, PYY, and GLP-1 levels between 0 and 120 min after challenge, we calculated the area under the curve (AUC) for the plasma hormone concentrations vs. time by the trapezoidal rule. Unpaired Students t tests were used to compare mean values of glucose and hormone levels, the homeostasis model assessment of insulin resistance (HOMAIR) (19), BMI, HbA1c, incremental changes in hormones (020 min after oral glucose tolerance test for plasma GLP-1 and PYY), and total AUC of plasma hormone levels among the participants. All data were normally distributed (Kolmogorov and Smirnov test). Simple Pearson correlation was performed between BMI and hormone levels. All significance tests for the comparisons were two-sided, and P < 0.05 was regarded as indicating statistical significance.
| Results |
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Omission of primary antibodies (PYY, GLP-1, and chromogranin A), the use of isotype controls, and the use of filters at the wavelengths of the three secondary antibodies revealed no positive staining and no autofluorescence in enteroendocrine cells (Fig. 1A
). Triple-immunofluorescent staining of human duodenal sections generally showed PYY (green), GLP-1 (red), and chromogranin A (blue) to be colocalized (white) in human intestinal mucosa with just an occasional granule containing either PYY or GLP-1 (Fig. 1B
). All duodenal L cells from the female specimen, having examined over 1000 cells, contained both hormones. In the male specimen there was an occasional L cell, which contained only GLP-1. There were no PYY-positive only cells in either specimen. After the glucose load, both hormones peaked at 20 min and returned toward the fasting level during the next 2 h (Fig. 2A
). We calculated the incremental rise during the first 20 min of PYY (
PYY) and GLP-1 (
GLP-1).
PYY was positively correlated with
GLP-1 (r2 = 0.3381; P < 0.0001; Fig. 2B
). We did not find any correlation between fasting PYY and GLP-1 levels and total PYY (PYYAUC (0120 min), 3831 ± 1422 pmol/liter·min) and GLP-1 (GLP-1AUC (0120 min), 1133 ± 797 pmol/liter·min) secretion (Fig. 2
, C and D).
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We found no correlation between either fasting PYY (r2 = 0.00002; P = 0.568) or GLP-1 (r2 = 0.0007; P = 0.909) levels across the range of BMI (1947 kg/m2) of participants (Fig. 3
, A and B). Sorting our participants by age (
50 yr or >50 yr) also did not alter the finding (data not shown). Fasting ghrelin and leptin levels have been shown in previous studies to be correlated with BMI (20, 21). This study confirmed those findings, because fasting ghrelin (r2 = 0.089; P < 0.0001) and leptin (r2 = 0.2726; P < 0.0001) levels correlated with BMI (Fig. 3
, C and D) in our participants.
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We analyzed the secretory profiles of PYY as well as GLP-1 and insulin in obese participants with BMI of 30 kg/m2 or higher (n = 19; BMI, 31.6 ± 1.6 kg/m2) and in lean participants with BMI less than 25 kg/m2 (n = 19; BMI, 22.8 ± 1.7 kg/m2), who were aged-matched (50.6 ± 18.5 vs. 57.8 ± 16.3 yr, lean vs. obese; P = 0.211). The glucose profile, total AUC of glucose [glucoseAUC (0120 min); Fig. 4A
] and HbA1c (5.2 ± 0.4 vs. 5.2 ± 0.3%, lean vs. obese; P = 0.755) were similar in the two groups. Total insulin secretion was significantly higher in obese participants [insulinAUC (0120 min), 7660 ± 1400 vs. 3917 ± 403 µU/ml·min, obese vs. lean; P = 0.011; Fig. 4
, B and F]. As expected, obese participants were more insulin resistant than lean participants, as quantified by HOMAIR (2.21 ± 0.99 vs. 1.35 ± 0.68 mmol/liter·µU/ml, obese vs. lean; P = 0.004; Fig. 4F
). However, total secretion of GLP-1 [GLP-1AUC (0120 min)] and that of PYY [PYYAUC (0120 min)] were similar in obese and lean participants (Fig. 4
, CE).
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| Discussion |
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Infusions of PYY to animals and humans are reported to regulate appetite and cause a decrease in food intake (6, 16). Its anorectic effect appears to be through the Y2 receptor in the arcuate nucleus of the hypothalamus in rodents (31). Several NPY receptor subtypes (Y1, Y2, Y4, and Y5) exist in brain, and PYY is thought to be a ligand of the Y2 receptor (32). However, the effects of PYY infusions on food intake, leading to decreases in body weight in rodents, have not been universally replicated (17). Of importance to elucidating the pathogenesis of obesity and diabetes, fasting levels of PYY were found to be lower in obese compared with lean humans, with a negative correlation between PYY levels and BMI (16). We found no correlation between BMI and GLP-1 levels, in agreement with previous reports (16), but, in contrast, we did not find a correlation between BMI and PYY levels. The original report (16) was based on 24 participants with an age range of 1850 yr. In an attempt to evaluate a similar population in this report, analyses of age-matched participants (1950 yr) were performed; however, this subset of our data still did not reveal any correlation. Similarly, our data serve to confirm a recent report that did not find any correlation between fasting PYY and BMI in obese, control, and anorectic adolescents (33). The PYY profiles of the BLSA participants after oral glucose loading are slightly blunted compared with the profiles reported by Stock et al. (33). This difference is probably due to the 20% fat content in liquid mixed meal that they used as a stimulus for PYY secretion. Also, the time to peak PYY and GLP-1 plasma levels of BLSA participants is quicker then generally reported (16, 33), and again, this is probably due to a slowing of the transit time of nutrients due to the fat in the mixed meals. As generally reported, we found that fasting ghrelin and leptin levels were negatively and positively correlated, respectively, with BMI in our study population.
It has also been reported that PYY secretion is lower in obese than in lean participants (16). However, PYY secretion after oral glucose was similar in our obese and lean participants. The design of the Batterham et al. study (16) was different, in that they examined the PYY response to a mixed meal, not glucose. Recently, it has been clearly shown that fat components directly stimulate L cell secretion through activation of gpr120 receptors (34). It is possible that in obesity, grp120 receptors are down-regulated to fat stimulation, and as a consequence, pro-PYY expression and secretion are decreased in response to fats, but that glucose-stimulated hormone secretion is not altered, which would explain why obese and lean participants respond similarly to glucose, but not to a mixed meal. In this regard, it has been shown that the PYY response was blunted after a mixed meal in obese adolescents (33), which seems to be in agreement with the findings of Batterham et al. (16). However, in the adolescents, PYY levels were decreased only at the 180-min point after their mixed meal, whereas in the obese subjects reported by Batterham et al. (16), PYY levels were decreased at all time points studied after their mixed meal. Obese BLSA participants displayed the expected changes in insulin secretion and insulin resistance, again demonstrating that they conform to known metabolic consequences of their obesity.
Plasma levels of some hormones show sex differences. It has been reported in 24 subjects (13 males and 11 females) that fasting plasma levels of ghrelin, a potent GH secretagogue that plays a role in feeding behavior, are higher in females than in males (35).
Our findings were not consistent with that report, which had a much smaller sample size. Leptin (22, 23) and agouti signal protein (36), expressed in adipose tissue, are reported to be higher in females than in males, and our findings confirm this observation.
Although the time to peak PYY concentration was similar in male and females, in that they both attained peak levels by 20 min, females reached significantly higher levels, and the total PYY AUC remained higher in females. Delayed GI motility (37), decreased gall bladder contraction (38), and increased colonic transit and gastric emptying time (39) in women have all been reported. Also, females sense gastric fullness earlier than males (40). Slow movement of foods through the GI tract may provide more contact time for the food material with intestinal mucosa, which might lead to increased PYY secretion and synthesis. PYY decreases GI motility and inhibits pancreatic exocrine secretion through inhibition of cholecystokinin- and secretin-modulated pathways in the area postrema of the brain (41, 42), which might, in turn, modulate its own secretion.
We conclude that PYY and GLP-1 are colocalized and cosecreted from L cells in response to physiological stimuli. Fasting PYY levels and PYY secretion in response to oral glucose were not correlated with BMI. Interestingly, the total secretion of PYY was higher in females than in males. Although PYY analogs are under development as therapeutic targets for obesity because of reports that PYY deficiency is involved in the pathogenesis of obesity, our findings do not support their development.
| Footnotes |
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First Published Online September 20, 2005
Abbreviations: AUC, Area under the curve; BLSA, Baltimore Longitudinal Study on Aging; BMI, body mass index;
, incremental rise; GI, gastrointestinal; GLP-1, glucagon like peptide-1; HbA1c, glycosylated hemoglobin; HOMAIR, homeostasis model assessment of insulin resistance; IAPP, islet amyloid polypeptide; NPY, neuropeptide Y; PP, pancreatic polypeptide; PYY, peptide YY.
Received February 24, 2005.
Accepted September 13, 2005.
| References |
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