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Endocrine Abstracts (2022) 81 P352 | DOI: 10.1530/endoabs.81.P352


1Division of Endocrinology & Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria; 2Medical University of Vienna, Department of Medicine III, Division of Endocrinology & Metabolism, Vienna, Austria; 3Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; 4, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; 5Center for Rare Endocrine Diseases, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany; 6Medical Department – Endocrinology, Nephrology, Rheumatology, Lipodystrophy Center Leipzig, University of Leipzig, Leipzig, Germany; 7Obesity and Lipodystrophy Research Center, Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy; 8Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy; 9High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; 10Institute of Medical Chemistry, Center for Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria


Objective: Treatment with metreleptin ameliorates hepatic steatosis in patients with lipodystrophy. The anti-steatotic effect of metreleptin is partially independent of its anorexic action, which suggests a direct effect of metreleptin on hepatic lipid metabolism. However, this mechanism is unknown. Based on previous findings in rodents, we hypothesized that metreleptin reduces hepatic lipid content by stimulating very-low density lipoprotein triglyceride (VLDL1-TG) secretion, a key mechanism that protects the liver from steatosis.

Methods: In this randomized, placebo-controlled, crossover trial we investigated the effects of a single acute subcutaneous metreleptin injection (0.1 mg/kg body weight) in overnight-fasted patients with lipodystrophy on VLDL1-TG secretion (primary outcome) and hepatocellular lipid content (HCL%, secondary outcome). VLDL1-TG secretion rate was assessed using an intralipid infusion test combined with density gradient ultracentrifugation. Changes in HCL% were measured by H1-magnetic resonance spectroscopy before and 3hrs after metreleptin or placebo injection. Patients previously on metreleptin treatment suspended injections for 14 days prior to the study. A two-sided paired t-test and the Wilcoxon signed rank test were used to analyze the differences after placebo vs. metreleptin injection in VLDL1-TG secretion and HCL%, respectively (statistical significance P<0.05).

Results: We recruited 5 patients with familial partial lipodystrophy: 4 females and 1 male; age range 27.9–58.6yrs; BMI 25.8±2.8 kg/m2 (mean±SD); all Caucasian; LMNA mutations confirmed in 2 cases; 2 previously on metreleptin treatment. An HCL >5% was detected in 3 patients. Hepatic VLDL1-TG secretion rate was higher after metreleptin in 5 out of 5 patients (mean±SD: 366±146 mg/h vs. 588±108 mg/h; placebo vs. metreleptin;P=0.019), whereas no statistically significant difference was observed in HCL% fold change within 3hrs post injection (median[IQR]: 1% [-7%;5%] vs. -6%[-11%;0%]; placebo vs. metreleptin;P=0.23)

Conclusion: Metreleptin markedly increases hepatic VLDL1-TG secretion in patients with lipodystrophy. This effect may play a role in the longterm antisteatotic action of metreleptin.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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