Insulin and Metformin Regulate Circulating and Adipose Tissue Chemerin

OBJECTIVE

To assess chemerin levels and regulation in sera and adipose tissue from women with polycystic ovary syndrome (PCOS) and matched control subjects.

RESEARCH DESIGN AND METHODS

Real-time RT-PCR and Western blotting were used to assess mRNA and protein expression of chemerin. Serum chemerin was measured by enzyme-linked immunosorbent assay. We investigated the in vivo effects of insulin on serum chemerin levels via a prolonged insulin-glucose infusion. Ex vivo effects of insulin, metformin, and steroid hormones on adipose tissue chemerin protein production and secretion into conditioned media were assessed by Western blotting and enzyme-linked immunosorbent assay, respectively.

RESULTS

Serum chemerin, subcutaneous, and omental adipose tissue chemerin were significantly higher in women with PCOS (n = 14; P < 0.05, P < 0.01). Hyperinsulinemic induction in human subjects significantly increased serum chemerin levels (n = 6; P < 0.05, P < 0.01). In adipose tissue explants, insulin significantly increased (n = 6; P < 0.05, P < 0.01) whereas metformin significantly decreased (n = 6; P < 0.05, P < 0.01) chemerin protein production and secretion into conditioned media, respectively. After 6 months of metformin treatment, there was a significant decrease in serum chemerin (n = 21; P < 0.01). Importantly, changes in homeostasis model assessment–insulin resistance were predictive of changes in serum chemerin (P = 0.046).

CONCLUSIONS

Serum and adipose tissue chemerin levels are increased in women with PCOS and are upregulated by insulin. Metformin treatment decreases serum chemerin in these women.Polycystic ovary syndrome (PCOS), a common endocrinopathy affecting 5–10% of women in the reproductive age, is characterized by menstrual dysfunction and hyperandrogenism and is associated with insulin resistance and pancreatic β-cell dysfunction, impaired glucose tolerance (IGT), type 2 diabetes, dyslipidemia, and visceral obesity (1,2). The consequent hyperinsulinemia is more prevalent in lean and obese women with PCOS when compared with age- and weight-matched normal women (3).The metabolic syndrome is associated with excessive accumulation of central body fat. As well as its role in energy storage, adipose tissue produces several hormones and cytokines termed ‘adipokines’ that have widespread effects on carbohydrate and lipid metabolism. They appear to play an important role in the pathogenesis of insulin resistance, diabetes, and atherosclerosis (4). Furthermore, it is apparent that accumulation of visceral adipose tissue poses a greater cardiometabolic risk than subcutaneous adipose tissue (5) as removal of visceral rather than subcutaneous adipose tissue has been shown to improve insulin sensitivity (6). Moreover, differences in gene expression of adipocyte-secreted molecules (adipokines) suggest that there are inherent adipose tissue depot–specific differences in the endocrine function of adipose tissue. In relation to this, we have published data on the increased levels of vaspin in women with PCOS (7); vaspin is a recently described adipokine mainly formed in human visceral adipose tissue that has insulin-sensitizing effects (8).Recently, Bozaoglu et al. (9) reported chemerin as a novel adipokine, circulating levels of which significantly correlated with BMI, circulating triglycerides, and blood pressure, features of the metabolic syndrome. In addition, chemerin or chemerin receptor knockdown impaired differentiation of 3T3-L1 cells and attenuated the expression of adipocyte genes involved in glucose and lipid homeostasis (10).With the aforementioned in mind and the fact that there is no literature with regards to chemerin in human adipose tissue and its regulation, in study 1, we assessed circulating chemerin as well as mRNA expression and protein levels of chemerin in subcutaneous and omental adipose tissue depots in women with PCOS against age, BMI, and waist-to-hip ratio (WHR) in matched control subjects. Furthermore, we studied the in vivo (study 2) and ex vivo effects of insulin on circulating chemerin levels via a prolonged insulin-glucose infusion in humans and primary adipose tissue explant cultures, respectively. In study 3 we studied the effects of metformin therapy, widely used in the treatment of PCOS in women, on circulating chemerin levels in tandem with associated changes to clinical, hormonal, and metabolic parameters in the same cohort of PCOS in women. Additionally, we studied the ex vivo effects of metformin and steroid hormones in human primary adipose tissue explants.