The Leptin ParadoxA Treacherous Art in cardiac sequelae of obesity

Leptin is the first identified obese gene product which participates in the regulation of food intake, energy expenditure, glucose and lipid metabolism. Leptin initiates both hypertrophic and antihypertrophic effects on hearts in addition to its cardiac depressant effect. Circulating leptin levels correlate with the body mass index (BMI) and total amount of body fat, which may be associated with changes of cardiac morphology and function. It has been shown that cardiac function is present in both hyperleptinemic (db/db) and hypoleptinemic (ob/ob) mouse models. Leptin replenishment reconciles the compromised myocardial function in ob/ob mice, indicating the premises of leptin on heart function. Interestingly, elevated plasma leptin levels may trigger leptin resistance and serve as an independent risk factor for cardiovascular diseases. Therefore, physiological range of leptin is essential for normal cardiac geometry and function whereas disrupted leptin signaling (hyper-and hypoleptinemia) results in functional and morphological aberrations leading to heart problem. Given that human obesity is a syndrome of leptin resistance, which is unlikely amenable to leptin treatment, the identification of novel parallel signal transduction pathways is of particular therapeutic value for obesityassociated cardiac dysfunction.