The wide range of phenotypic abnormalities seen in the leptin-deficient ob/ob mouse and their reversibility by leptin administration provide compelling evidence for the existence of multiple physiological functions of this hormone in rodents. In contrast, information regarding the roles of this hormone in humans is limited. Three morbidly obese children, who were congenitally deficient in leptin, were treated with daily subcutaneous injections of recombinant human leptin for up to 4 years with sustained, beneficial effects on appetite, fat mass, hyperinsulinemia, and hyperlipidemia. Leptin therapy resulted in a rapid and sustained increase in plasma thyroid hormone levels and, through its age-dependent effects on gonadotropin secretion, facilitated appropriately timed pubertal development. Leptin deficiency was associated with reduced numbers of circulating CD4(+) T cells and impaired T cell proliferation and cytokine release, all of which were reversed by recombinant human leptin administration. The subcutaneous administration of recombinant human leptin has major and sustained beneficial effects on the multiple phenotypic abnormalities associated with congenital human leptin deficiency.

BACKGROUND-A single family has been described in which obesity results from a mutation in the leptin-receptor gene (LEPR), but the prevalence of such mutations in severe, early-onset obesity has not been systematically examined.

The wide range of phenotypic abnormalities seen in the leptin-deficient ob/ob mouse and their reversibility by leptin administration provide compelling evidence for the existence of multiple physiological functions of this hormone in rodents. In contrast, information regarding the roles of this hormone in humans is limited. Three morbidly obese children, who were congenitally deficient in leptin, were treated with daily subcutaneous injections of recombinant human leptin for up to 4 years with sustained, beneficial effects on appetite, fat mass, hyperinsulinemia, and hyperlipidemia. Leptin therapy resulted in a rapid and sustained increase in plasma thyroid hormone levels and, through its age-dependent effects on gonadotropin secretion, facilitated appropriately timed pubertal development. Leptin deficiency was associated with reduced numbers of circulating CD4 + T cells and impaired T cell proliferation and cytokine release, all of which were reversed by recombinant human leptin administration. The subcutaneous administration of recombinant human leptin has major and sustained beneficial effects on the multiple phenotypic abnormalities associated with congenital human leptin deficiency. Nonstandard abbreviations used: recombinant human leptin (r-metHuLeptin); lean body weight (LBW); dual-energy x-ray absorptiometry (DXA); basal metabolic rate (BMR); folliclestimulating hormone (FSH); luteinizing hormone (LH); murine IL-3 (mIL-3); phytohemagglutinin (PHA); total energy expenditure (TEE); SD score (SDS); bone mineral content (BMC); bone mineral density (BMD); free tri-iodothyronine (fT3); free thyroxine (fT4); thyrotropin (TSH); tuberculin purified protein derivitive (PPD).

autoimmunity ͉ tolerance ͉ metabolism ͉ hormones I t has recently been shown that leptin, a cytokine-like hormone mainly secreted by adipocytes, can play a significant role in the pathogenesis of several autoimmune diseases, such as experimental autoimmune encephalomyelitis (EAE), antigen-induced arthritis, and experimentally induced colitis (1-6). EAE is an animal model for the human demyelinating disease multiple sclerosis (MS) (7,8). EAE can be induced in susceptible strains of mice through immunization with myelin antigens or by adoptive transfer of myelinspecific T helper 1 (Th-1) cells (7,8). Genetically leptin-deficient (ob͞ob) mice are resistant to the induction and progression of EAE, and WT EAE-susceptible mice show an increase in serum leptin preceding the clinical onset of the disease that correlates with inflammatory anorexia and disease susceptibility (2, 3). In addition, pathogenic Th-1 cells and macrophages in active EAE brain lesions secrete consistent amounts of leptin (3). These data account for an involvement of leptin in CNS autoimmunity, at least in the EAE model. Despite this finding, in humans, the role of leptin in the pathogenesis of MS is not yet fully elucidated. In this study, we analyzed the secretion of leptin in the cerebrospinal fluid (CSF) and serum of naïve-to-treatment relapsing-remitting MS (RRMS) patients and leptin's interaction with the CD4 ϩ CD25 ϩ regulatory T cells (T Regs ). T Regs are known to dampen autoreactive responses mediated by CD4 ϩ CD25 Ϫ T cells and may influence the onset and progression of autoimmunity (9). In mice, depletion of T Regs is associated with autoimmunity, and defects of T Regs have been described in nonobese diabetic mice and in humans with type 1 diabetes (9, 10). Also, reduced frequency of T Regs and͞or defective suppressor function have been observed in humans with systemic lupus erythematosus, juvenile idiopathic arthritis, autoimmune polyglandular syndrome type II, and RRMS (11-15). T Regs are anergic in vitro but can expand in vivo (9). Although the mechanisms operated by T Regs in suppression are not fully delineated, the forkhead transcription factor FoxP-3 seems to be required for suppression to occur (9).Here, we report increased leptin levels in CSF and serum of naïve-to-therapy RRMS patients and an inverse correlation with T Regs frequency. These findings may be relevant in better understanding the disease pathogenesis and may have therapeutic implications. Materials and MethodsSubjects. All MS patients and controls were recruited at the Università di Napoli ''Federico II.'' For serum and CSF leptin measurement, we included in the study 126 individuals (Table 1) with MS defined according to the criteria of McDonald et al. (16) and 117 age-, gender-, and body mass index (BMI)-matched controls with other noninf lammatory neurologic disorders (NIND). All MS patients had RRMS and an expanded disability status scale score of Յ3.5 and were naïve to treatment. The inclusion criteria for RRMS patients were (i) onset of relapse within 4 w...