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Synchronicity of Frequently Sampled, 24-H Concentrations of Circulating Leptin, Luteinizing Hormone, and Estradiol in Healthy Women

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Synchronicity of Frequently Sampled, 24-H Concentrations of Circulating Leptin, Luteinizing Hormone, and Estradiol in Healthy Women Proc. Natl. Acad. Sci. USA Vol. 95, pp. 2541–2546, March 1998 Medical Sciences Synchronicity of frequently sampled, 24-h concentrations of circulating leptin, luteinizing hormone, and estradiol in healthy women JULIO LICINIO*†,ANDRE´ B. NEGRA˜O*, CHRISTOS MANTZOROS‡,VIRGINIA KAKLAMANI‡,MA-LI WONG*, PETER B. BONGIORNO*, ABEDA MULLA*, LAURA CEARNAL§,JOHANNES D. VELDHUIS¶,JEFFREY S. FLIER‡, i SAMUEL M. MCCANN , AND PHILIP W. GOLD* *Clinical Neuroendocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-1284; ‡Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215; §Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892; ¶Department of Internal Medicine and National Science Foundation Center for Biological Timing, University of Virginia Health Sciences Center, Charlottesville, VA 22908; and iPennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808-4124 Contributed by Samuel M. McCann, December 29, 1997 ABSTRACT Leptin, an adipocyte hormone, is a trophic in uterine cross-sectional area, epithelial height, endometrial factor for the reproductive system; however, it is still unknown area, and glandular areas; in obyob males, 2 weeks of leptin whether there is a dynamic relation between fluctuations in treatment results in a rise in serum levels of follicle-stimulating circulating leptin and hypothalamic—pituitary–ovarian (HPO) hormone, as well as augmentation in the weights of the testes axis hormones. To test the hypothesis that fluctuations in plasma and seminal vesicles, associated with increases in the epithelial leptin concentrations are related to the levels of luteinizing height of the seminal vesicles (10). In humans, increases in hormone (LH) and estradiol, we sampled plasma from six plasma leptin concentrations seem to be associated with the healthy women every 7 min for 24 h during days 8–11 of the onset of puberty in boys. Mantzoros et al. (11) found that leptin menstrual cycle. Cross-correlation analysis throughout the 24-h levels rose by '50% before the onset of puberty in healthy boys cycle revealed a relation between release patterns of leptin and and decreased to baseline values after the initiation of puberty, LH, with a lag of 42–84 min but no significant cross-correlation remaining stable for extended periods; those changes occurred between LH and estradiol. The ultradian fluctuations in leptin despite constantly increasing body mass index (11). In persons levels showed pattern synchrony with those of both LH and with anorexia nervosa, low leptin levels may contribute to the estradiol as determined by cross-approximate entropy (cross- amenorrhea that is characteristic of that disorder (12–14). ApEn). At night, as leptin levels rose to their peak, the pulsatility Leptin acts not only in the hypothalamus (15), where it can profiles of LH changed significantly and became synchronous produce rapid synaptic modulatory effects (16) and increased with those of leptin. LH pulses were fewer, of longer duration, luteinizing hormone-releasing hormone release from medial basal higher amplitude, and larger area than during the day. More- hypothalamic explants (17), but it also has direct actions on the rat over, the synchronicity of LH and leptin occurred late at night, pituitary gland and ovary; in the pituitary, it stimulates luteinizing at which time estradiol and leptin also exhibited significantly hormone (LH) and follicle-stimulating hormone release (17), and stronger pattern coupling than during the day. We propose that in the ovary, it impairs the insulin-like growth factor I-mediated leptin may regulate the minute-to-minute oscillations in the augmentation of follicle-stimulating hormone-stimulated estradi- levels of LH and estradiol, and that the nocturnal rise in leptin ol-17b synthesis by granulosa cells (18). Thus, leptin can affect the may determine the change in nocturnal LH profile in the hypothalamic–pituitary–gonadal axis by direct actions in the hy- mid-to-late follicular phase that precedes ovulation. This may pothalamus, the pituitary gland, and the gonads. explain the disruption of hypothalamic—pituitary–ovarian Even though it is well established that leptin affects reproduc- function that is characteristic of states of low leptin release, such tive function, studies have not yet elucidated whether leptin is only as anorexia nervosa and cachexia. a necessary trophic factor for the reproductive system or whether the minute-to-minute dynamics of leptin concentrations are Leptin, the hormonal product of the OB gene (1), is a signal associated with hypothalamic–pituitary–ovarian (HPO) function. of nutritional status. High leptin levels in mice not only cause Our group and others have demonstrated that leptin concentra- weight loss, by suppressing food intake and increasing motor tions in human plasma have ultradian and circadian fluctuations activity, energy metabolism, oxygen consumption, and body (19–21). Because the hormones of the HPO axis exhibit striking temperature (2–4), but also stimulate reproduction. Admin- pulsatility, we designed a study to examine the hypothesis that istration of exogenous leptin to immature animals accelerates pulsatile release of leptin, LH, and estradiol exhibit pattern the onset of puberty (5, 6). In adult animals, leptin adminis- coupling or synchronicity by measuring plasma concentrations of tration corrects the sterility defect in homozygous obese the three hormones every 7 min throughout the 24 h. female mice (7) and corrects hypogonadism in mice starved for METHODS 2 days, without affecting body weight (8). In ad libitum-fed, but not in food-deprived, animals, leptin facilitates female sexual Clinical Research Protocol. Six healthy women were studied on behavior (9). Leptin treatment of obyob female mice for 2 days 8–11 of the menstrual cycle (mid-to-late follicular phase) weeks causes elevations of serum levels of LH, increases in after giving informed consent for a clinical research protocol ovarian and uterine weights and in total ovarian follicle approved by the National Institute of Mental Health Institutional number as well as primary and Graafian follicles, and increases Review Board. Partial results of leptin, but not LH or estradiol, The publication costs of this article were defrayed in part by page charge Abbreviations: LH, luteinizing hormone; ApEn, approximate entropy; HPO, hypothalamic-pituitary-ovarian; CV, coefficient of variation; payment. This article must therefore be hereby marked ‘‘advertisement’’ in PCOS, polycystic ovary syndrome. accordance with 18 U.S.C. §1734 solely to indicate this fact. †To whom reprint requests should be addressed at: Clinical Neuroendo- © 1998 by The National Academy of Sciences 0027-8424y98y952541-6$2.00y0 crinology Branch, NIMH, NIH, Building 10y2D46, 10 Center Drive, PNAS is available online at http:yywww.pnas.org. MSC 1284, Bethesda, MD 20892-1284. e-mail: [email protected]. 2541 Downloaded by guest on October 2, 2021 2542 Medical Sciences: Licinio et al. Proc. Natl. Acad. Sci. USA 95 (1998) concentrations have been reported (21). Subjects had an average higher leptin levels), we used CLUSTER (24), a computerized pulse age of 25.5 6 1.6 years and an average body mass index (calcu- analysis algorithm to identify statistically significant pulses in lated as the weight in kilograms divided by the square of the relation to measurement error in each hormone time series. The height in meters) of 21.6 6 1.1 kgym2. Women with history of use of this program has been described (21). Measurement error psychiatric or medical illness, obesity, smoking, or substance (within sample variance) for the 207 replicated samples in each abuse were excluded, as reported. For the 30-day period preced- series was modeled as a power function of sample concentration. ing each study, as well as during the study, no subject was taking Significantly increased or decreased hormone concentrations prescribed or over-the-counter medications, hormones, or di- (peak margins) were judged by pooled t statistics, which were etary supplements. applied to moving test nadirs and peak clusters that began with Subjects were acclimated to a research bed in the National the onset of the experimental series and traversed all points. We Institutes of Health Clinical Center for 48 h before the study. We identified the following mean properties of pulsatile hormone collected blood via an indwelling catheter that was inserted during concentrations: pulse frequency (number of significant peaksy24 the previous evening; samples were withdrawn every 7 min for h), interpeak interval (time separating consecutive peak maxi- 1442 min, yielding a total of 207 samples per subject, starting at ma), pulse duration in min, pulse height (maximal hormone 08:00 h. Clinical research protocol and diet are described in ref. concentration in a peak), pulse height as percentage increase over 21. Subjects were exposed to light from 07:00–23:00 h and were preceding baseline (100% corresponds to preceding baseline), studied in bed, in the dark from 23:00–07:00 h, during which time pulse area, and largest increase (increment) above pre-peak basal they slept. Sleep was monitored by the NightCap apparatus or nadir. (Healthdyne Technologies, Marietta, GA) (22, 23). To maintain Cross-Correlation Analysis. Cross-correlation was calculated their level of physical activity at a comparable baseline, on the
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