Investigation of Gut Hormone Physiology in the Regulation of Appetite
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Investigation of gut hormone physiology in the regulation of appetite A thesis submitted for the degree of the Doctor of Philosophy in Imperial College London Sagen Elizabeth Kanissaril Zac-Varghese BSc (hons), MBChB, MRCP 2011 Department of Medicine, Imperial College London 1 Abstract Peptide tyrosine tyrosine (PYY) and glucagon like peptide-1 (GLP-1) are endogenous, anorectic gut hormones released from entero-endocrine L cells. The aims of this thesis were to: investigate the breakdown of PYY using peptide analogues in vitro and in vivo, determine the stimuli for release of PYY and GLP-1 from L cells in vitro and finally to attempt to stimulate the endogenous secretion of PYY and GLP-1 and so suppress appetite in man. The breakdown of PYY was studied using specially designed PYY analogues with changes to known enzyme cleavage sites. Degradation of the analogues was studied by incubation with proteolytic enzymes. Receptor binding assays were carried out to confirm that changes to the PYY structure had not altered binding to the endogenous PYY receptors. In vivo studies in rodents previously confirmed an extended pharmacological profile of these analogues. In order to study the various stimulants for PYY and GLP-1 release, a primary L cell model was developed. This was used to study the effect of various nutrients: glucose, amino acids and short chain fatty acids (SCFA) on PYY and GLP-1 release. In mouse and human primary L cell cultures the SCFA propionate increased PYY release significantly compared to basal levels, indicating that propionate is a potent stimulus of PYY release. To further investigate the results of the in vitro work, a randomised, double blind, crossover study was carried out in human volunteers to evaluate the effect of propionate on appetite. Administration of propionate ester over six days reduced energy intake at a buffet meal by 18.8% compared to control (P < 0.05, n = 20). However, there was no significant change in plasma GLP-1 or PYY levels between the groups, possibly suggesting an alternative explanation for the reduction in appetite seen. This may provide an interesting avenue for future studies. These studies of the physiological mechanisms underlying release and degradation of PYY and GLP-1 may contribute towards the development of an anti-obesity therapy based around L cell stimulation. 2 Declaration of contributors All of the work in this thesis was carried out by the author unless stated otherwise. All collaborations are listed below. Chapter 2: Development of the PYY analogue was by Professor Stephen Bloom. Testing of the analogues in animal studies was carried out by the PYY analogue team, Imperial College (Dr. Tricia Tan, Dr. Ben Field, Dr. James Minnion, Ms. Joyceline Shillito, Dr. Jordan Baxter, Dr. Melisande Addison, Dr. Mohammed Hankir, Dr. Samar Ghourab, Ms. Klara Hostomska, Ms. Jennifer Parker, Mr. James Plumer, Dr. Katherine Simpson and Dr. Victoria Salem). The clinical studies were carried out in collaboration with Dr. Victoria Salem, Dr. Tricia Tan and Dr. Ben Field. Dr. James Gardiner and Dr. Emily Thompson assisted in setting up the hY1 and hY5 receptor over-expressing cell lines. Ms. Joyceline Shillito assisted in the receptor binding assays and enzyme degradation studies. Chapter 3: Dr. Fiona Gribble, Cambridge, kindly taught me the method of primary cell culture. Dr. Jelena Anastasvoska, Dr. Benjamin Jones and Ms. Arianna Psichas assisted with these studies. Human colon biopsies were obtained by Dr. Julian Walters, Dr. Jonathan Nolan and Dr. Ian Johnston. Dr. Roger White and Dr. Jimmy Bell assisted by providing primary cell culture facilities. Chapter 4: The human study was performed in collaboration with Ms. Norlida Matt Daud. Dr. Douglas Morrison, Glasgow, provided all of the test reagents used in the study. All human studies were carried out at the Sir McMichael Centre, the Clinical Investigations Unit, Hammersmith Hospital. Dr. Michael Patterson provided assistance and advice for all of the in house radioimmunoassays carried out. Professor Mohammad Ghatei established and maintained all of the radioimmunoassays. 3 Acknowledgements I would like to thank Professor Stephen Bloom for his constant support and encouragement. I am extremely grateful to Professor Gary Frost for his enthusiasm and guidance and to Dr. Niamh Martin who has been a constant, stable and reassuring presence. I would also like to thank Dr. Tricia Tan for her integrity, support and friendship. Special thanks to Professor Mohammad Ghatei, Dr. Michael Patterson, Dr. James Minnion, Ms. Joyceline Shillito, Dr. Waljit Dhillo, Dr. Jelena Anastasvoska, Ms. Arianna Psichas and Mr. Nima Khandan-nia. I am extremely grateful to Dr. Fiona Gribble for generously teaching me the technique of primary L cell culture, a technique that had taken her four years to establish. I would like to thank the Wellcome Trust for funding my research. I am grateful to the subjects who kindly volunteered for the studies, without whose participation much of this work would have been impossible. 4 for my father and mother 5 Abbreviations AcN Acetonitrile ACTH Adrenocorticotrophic hormone AgRP Agouti related protein AMP Adenosine monophosphate AP Area postrema ARC Arcuate nucleus BMI Body mass index BSA Bovine serum albumin cAMP Cyclic adenosine monophosphate CART Cocaine- and amphetamine-regulated transcript CCK Cholecystokinin CNS Central nervous system CO2 Carbon dioxide CRH Corticotrophin-releasing hormone CSF Cerebrospinal fluid DEBQ Dutch Eating Behaviour Questionnaire DMEM Dulbecco’s Modified Eagle’s Medium DMH Dorsomedial hypothalamus DNA Deoxyribonucleic acid DPP IV Dipeptidyl peptidase IV ECG Electrocardiogram EDTA Ethylene diamine tetra-acetic acid ELISA Enzyme linked immunosorbent assay Ex-4 Exendin 4 Fmoc Fluorenyl Methoxy-Carbonyl KO Knockout GCG Glucagon 6 GDW Glass distilled water GI Gastrointestinal GIP Glucose-dependent insulinotropic peptide GLP-1 Glucagon-like peptide-1 GLP-1R Glucagon-like peptide-1 receptor GLP-2 Glucagon-like peptide-2 GRPP Glicentin-related pancreatic polypeptide GTE Glucose tris EDTA HEPES N-(2-hydroxyethyl)piperazine-N’-(2-ethanesulfonic acid); 4-(2- hydroxyethyl)-1-piperazineethanesulfonic acid HPLC High performance liquid chromatography HPT Hypothalamo-pituitary-thyroid ICV Intracerebroventricular IP Intraperitoneal KBB Kidney brush borders LB Lysogeny broth LHA Lateral hypothalamic area MALDI-ToF Matrix-assisted laser desoption/ionization-time of flight MCH Melanin-concentrating hormone MCR Melanocortin receptor MCR2 Melanocortin-2 receptor MCR3 Melanocortin-3 receptor MCR4 Melanocortin-4 receptor MPGH Major proglucagon fragment MSH Melanocyte-stimulating hormone NDC Non digestible carbohydrate NEP Neprilysin NHS National health service 7 NPY Neuropeptide Y NTS Nucleus of the solitary tract OXM Oxyntomodulin PBS Phosphate buffered saline PEG Polyethylene glycol PEI Polyethylenimine PMSF Phenylmethylsulphonylfluoride POMC Proopiomelanocortin PP Pancreatic polypeptide PVN Paraventricular nucleus PYY Peptide tyrosine tyrosine RBA Receptor binding assay RIA Radioimmunoassay RNA Ribonucleic acid SC Subcutaneous SCFA Short chain fatty acid SDS Sodium dodecyl sulphate SP Spacer peptide SPPS Solid phase peptide synthesis TAE Tris, acetic acid, EDTA TFA Trifluoroacetic acid TRH Thyrotrophin releasing hormone TSH Thyroid stimulating hormone VAS Visual analogue scales VMH Ventromedial hypothalamus 8 Table of Contents Abstract 2 Declaration of contributors 3 Acknowledgements 4 Dedication 5 Abbreviations 6 Table of contents 9 List of figures 17 List of tables 21 1. General introduction 22 1.1 Obesity 22 1.2 Prevalence and economic cost of obesity 23 1.3 Aetiology of obesity 24 1.4 Consequences of obesity 25 1.5 Treatment of obesity 26 1.5.1 Diets 26 1.5.2 Medical treatment 28 1.5.3 Bariatric surgery 30 1.6 The hypothalamus and appetite circuits 33 1.6.1 The Arcuate nucleus (ARC) 34 1.6.2 The Paraventricular Nucleus (PVN) 35 1.6.3 The Dorsomedial Nucleus (DMN) 35 1.6.4 The Ventromedial Nucleus (VMN) 36 1.6.5 The Lateral Hypothalamic Area (LHA) 36 1.7 The brainstem, vagal nerve and appetite circuit 37 1.8 Neuropeptides and neurotransmitters involved in appetite regulation 40 1.8.1 Neuropeptide Y (NPY) 40 9 1.8.2 The melanocortin system 40 1.8.3 Cocaine and amphetamine regulated transcript (CART) 43 1.9 Peripheral adiposity hormones involved in appetite regulation 43 1.9.1 Insulin 43 1.9.2 Leptin 44 1.10 Peripheral gut hormones involved in appetite regulation 45 1.10.1 Cholecystokinin (CCK) 47 1.10.2 Glucagon-like peptide- 1 (GLP-1) 47 1.10.3 Oxyntomodulin (OXM) 51 1.10.4 Pancreatic polypeptide (PP) 51 1.10.5 Peptide YY (PYY) 52 1.10.6 Ghrelin 54 1.14 Summary 55 1.15 Hypotheses 56 1.16 Aims 57 2. Investigation into the physiological degradation of PYY3-36, using PYY analogues 2.1 Introduction 58 2.1.1 PYY degradation 59 2.1.2 Dipeptidyl peptidase IV (DPP IV) 60 2.1.3 Meprins 60 2.1.4 Neprilysin (NEP) 61 2.1.5 Design of Stable PYY analogues 61 2.1.6 NPY receptors 62 2.1.7 Y1 receptor 65 10 2.1.8 Y2 receptor 65 2.1.9 Y4 receptor 66 2.1.10 Y5 receptor 66 2.2 Aims and hypothesis 68 2.2.1 Hypothesis 68 2.2.2 Aims 68 2.3 Materials and Methods 69 2.3.1 PYY analogue - PYYα synthesis 69 2.3.2 Safety testing of PYYα 69 2.3.3 Proteolytic degradation of peptides 70 2.3.4 KBB degradation assay 70 2.3.5 Neprilysin (NEP) protease assay 71 2.3.6 Matrix- assisted laser desorption/ ionisation- Time of flight analysis (MALDI- ToF) of KBB hydrolysates 71 2.3.7 Receptor binding studies- production of hY1 and hY5 receptor