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Vol. 63, Issue 4, 908-914, April 2003
CNS Research Department, Sanofi-Synthélabo Recherche, Montpellier, France
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Abstract |
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This study investigates the effects of SR141716, a selective CB1 receptor antagonist that reduces food intake and body weight of rodents, on Acrp30 mRNA expression in adipose tissue. Acrp30, a plasma protein exclusively expressed and secreted by adipose tissue, has been shown to induce free fatty acid oxidation, hyperglycemia and hyperinsulinemia decrease, and body weight reduction. We report that N-(piperidin-1-yl)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboximide hydrochloride (SR141716) treatment once daily (10 mg/kg/d, i.p.) from 2 to 14 days reduced body weight and stimulated Acrp30 mRNA expression in adipose tissue of obese Zucker (fa/fa) rats. In parallel, the hyperinsulinemia associated with this animal model was reduced by SR141716 treatment. In cultured mouse adipocytes (3T3 F442A), SR141716 (25 to 100 nM) also induced an overexpression of Acrp30 mRNA and protein. In addition, in adipose tissue of CB1-receptor knockout mice, SR141716 had no effect on Acrp30 mRNA expression, demonstrating a CB1 receptor mediating effect. Furthermore, RT-PCR analysis revealed that rat adipose tissue and 3T3 F442A adipocytes expressed CB1 receptor mRNA. Relative quantification of this expression revealed an up-regulation (3- to 4-fold) of CB1 receptor mRNA expression in adipose tissue of obese (fa/fa) rats and in differentiated 3T3 F442A adipocytes compared with lean rats and undifferentiated adipocytes, respectively. Western blot analysis revealed the presence of CB1 receptors in 3T3 F442A adipocytes, and their expression was up-regulated in differentiated cells. These results show that SR141716 stimulated Acrp30 mRNA expression in adipose tissue by an effect on adipocytes, and reduced hyperinsulinemia in obese (fa/fa) rats. These hormonal regulations may participate in the body weight reduction induced by SR141716 and suggest a role of metabolic regulation in the antiobesity effect of SR141716.
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Introduction |
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Obesity
is a complex metabolic disorder resulting from an abnormality in the
balance between energy intake and expenditure. This dysregulation may
have genetic and/or behavioral origins, involving the quality and
quantity of food intake and lifestyle (Carpino, 2000
). Obesity is also
commonly associated with insulin resistance and hyperinsulinemia
(Polonsky, 2000
; Weyer et al., 2001
), which increases the risk of
diabetes and cardiovascular diseases (Allison et al., 1999
; Must et
al., 1999
).
The hypothalamus is the principal brain region playing a pivotal role
in the integrated control of feeding, energy homeostasis, and
regulation of body weight (Elmquist et al., 1999
; Kalra et al., 1999
).
This function is mediated in part by the synthesis and release of
several neurotransmitters and neuropeptides involved in the control of
food intake, energy expenditure, and body weight homeostasis. These
include monoamine neurotransmitters, such as serotonin and
noradrenaline (Halford and Blundell, 2000
), orectic neuropeptides, such
as neuropeptide Y, orexins (A and B), and anorectic peptides, such as
cocaine- and amphetamine-regulated transcript and
pro-opiomelanocortin-derived peptides, such as
-MSH (Kalra et al.,
1999
; Proietto et al., 2000
). The hypothalamus is also a target site
for the action of hormones such as insulin and leptin, which have been
largely described to be involved in the regulation of food intake and
body weight (Baskin et al., 1999
; Elmquist et al., 1999
; Kalra et al.,
1999
; Proietto et al., 2000
; Williams et al., 2001
).
Recently, a role for the cannabinoid receptor subtype 1 (CB1-R) in the regulation of appetite and body
weight has been reported (Di Marzo et al., 2001
). There is an elevation
of the level of endocannabinoids in the hypothalamus of obese animal
models, and the CB1 receptor antagonist SR141716
(Rinaldi-Carmona et al., 1994
) reduces food intake and induces weight
loss in mouse and rat (Arnone et al., 1997
; Chaperon et al., 1998
;
Colombo et al., 1998
; Di Marzo et al., 2001
). Furthermore, after an
18-h food restriction period, CB1 receptor
knockout mice eat less than their wild-type littermates, and SR141716
has no effect on weight gain and food intake on
CB1 receptor knockout mice (Di Marzo et al., 2001
). These findings suggest a physiological role for the hypothalamic CB1 receptor in the control of appetite. They
also indicate that endocannabinoids, in the hypothalamus, may tonically
activate CB1 receptors to maintain food intake
and to sustain overeating in obese animals (Colombo et al., 1998
; Di
Marzo et al., 2001
).
The reported loss of body weight induced by SR141716 results in part
from its rapid and strong decrease of food intake during the first days
of treatment (Colombo et al., 1998
; Di Marzo et al., 2001
). This effect
may be mediated by a mechanism involving the regulation of the
expression of hypothalamic neuropeptides (Proietto et al., 2000
).
Furthermore, the long-lasting loss of body weight induced by SR141716
may be independent of food intake and is likely to be related to an
increase in energy expenditure and/or metabolic activities.
The site of action of SR141716 with regard to a potential peripheral
effect could be the adipose tissue, which is the major fat storage
depot. This endocrine organ produces and secretes various
physiologically important proteins, such as leptin, adipsin, lipoprotein lipase, and tumor necrosis factor
, which regulate whole-body energy homeostasis (Dugail et al., 1992
; Fried and Russell,
1998
).
One of these proteins, the 30-kDa adipocyte complement-related protein
(Acrp30) originally identified by four independent groups (Hu et al.,
1996
; Maeda et al., 1996
; Nakano et al., 1996
; Scherer et al., 1995
),
also known as adiponectin, Adipo Q, and ApM1, is exclusively expressed
in the adipose tissue. Acrp30 is a secreted protein, with an N-terminal
collagenous domain and a C-terminal globular domain. The latter domain
carries all the known pharmacological activities of Acrp30, comprising
the induction of free fatty acid oxidation, body weight reduction in
mouse (Fruebis et al., 2001
), hyperglycemia (Berg et al., 2001
; Combs
et al., 2001
), hyperinsulinemia decrease, and insulin resistance
reversion (Yamauchi et al., 2001
) in obese and diabetic animals.
Furthermore, the plasma level of the protein Acrp30 and its mRNA
expression in adipose tissue are decreased in both murine and human
obesity, as well as in subjects with type 2 diabetes (Hu et al., 1996
; Arita et al., 1999
; Fruebis et al., 2001
; Weyer et al., 2001
).
The aim of the present work was to determine whether SR141716 affects the regulation of Acrp30 mRNA expression in adipose tissue and to provide evidence for the implication of peripheral CB1 receptors in the control of body weight.
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Materials and Methods |
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Animals and Adipose Tissue.
Male obese Zucker (fa/fa) rats
and their lean littermates of 8 to 9 weeks of age were purchased from
Harlan (Indianapolis, IN). C57BL/6j mice with deleted
CB1 receptor gene (CB1-R
/
) and wild-type C57BL/6j mice (CB1-R +/+)
were bred as described previously (Robbe et al., 2002
) and used at 9 to
10 weeks of age. All animals were housed in groups of six with food and
water freely available and were maintained at room temperature.
80°C. After the rats were
killed, individual trunk blood was collected for determining plasma
levels of insulin by radioimmunoassay as described in the
manufacturer's protocol (Amersham Biosciences, Les Ulis, France). All
procedures were approved by the Comité d'Experimentation Animale
(Animal Care and Use Committee) of Sanofi-Synthélabo Research.
Cell Culture.
Mouse 3T3 F442A cells (Green and Kehinde,
1973
; Kuri-Harcuch and Green, 1977
) were maintained in Dulbecco's
modified Eagle's medium (DMEM) containing 10% calf serum and
differentiated with DMEM supplemented with 10% fetal calf serum and 5 µg/ml of insulin after reaching subconfluence as described previously
(Hu et al., 1996
). Appropriate differentiation was confirmed by noting
the accumulation of lipid droplets by microscopic observation, 6 to 8 days after the initiation of differentiation.
RNA Preparation and Northern Blot Analysis.
Actin cDNA
probe was purchased from BD Biosciences Clontech (Palo Alto, CA). Rat
and mouse Acrp30 cDNA probes were obtained by RT-PCR on adipose tissue
RNA according to the manufacturer's protocol (Invitrogen, Cergy
Pontoise, France) in the presence of two Acrp30 cDNA-specific
primers (sense primer, 5'-CAG GAT GCT ACT GTT GCA AGC-3'; antisense
primer, 5'-TGC AGT CAG TTG GTA TCA TGG-3') spanning the start and stop
codons, respectively, in the sequence of the mouse Acrp30 cDNA (GenBank
accession number U37222).
actin probes labeled with
[
32P]dCTP, using a random priming kit
(Amersham Bisociences).
Membranes were scanned on a Storm PhosphorImager (Amersham
Biosciences). Northern blot analysis revealed the expression of one and
three Acrp30 transcripts in mouse and rat tissues, respectively, as
reported previously (Hu et al., 1996
actin mRNA
expression and were presented as a percentage of control values.
RT-PCR Analysis of CB1 Receptor Expression.
For
RT-PCR, 2 µg of total RNA from rat adipose tissues and 3T3 F442A
cells were reverse-transcribed using oligo(dT) primer, and PCR
amplification of the first-strand cDNA product was carried out
according to the manufacturer's protocol (Invitrogen) in the presence
of either two CB1 receptor cDNA specific primers
(sense primer, 5'-TCT CTG GAA GGC TCA CAG C-3'; antisense primer,
5'-TGT CTG TGG ACA CAG ACA TG-3') or two
-actin cDNA-specific
primers (sense primer, 5'-GGG TCA CCC ACA CTG TGC-3'; antisense primer, 5'-TGC TTG CTG ATC CAC ATC TG-3'). The following temperature profile was used for PCR amplification: an initial denaturing step at 93°C
for 1 min and 35 cycles consisting of 93°C for 30 s, 55°C for
30 s, and 72°C for 1 min. PCR products were analyzed by Southern blot using a 32P-labeled oligonucleotide probe
specific for CB1 receptor or
actin cDNA. The
relative mRNA expression levels of CB1 receptor and
actin were quantified using the Storm PhosphorImager system. Results were normalized and presented as described above.
Western Blot Analysis.
3T3 F442A adipocyte cellular proteins
were dissolved in the lysis buffer: 50 mM Tris HCl, pH 7.5, 1% SDS, 10 mM EDTA, 100 mM NaCl, and 1%
-mercaptoethanol containing protease
inhibitors (Roche Diagnostics, Mannheim Germany), and centrifuged at
12,000g for 15 min at 4°C. The supernatants were collected
and protein concentrations were determined by bicinchoninic acid
protein assay kit (Pierce, Rockford, IL). Cellular protein extracts
(200 µg) were analyzed on the NOVEX precast 4 to 20%
Tris-glycine-SDS-polyacrylamide gel electrophoresis gels and
transferred on polyvinylidene difluoride membranes as indicated by the
manufacturer (Novex, San Diego, CA). The following steps were performed
at room temperature. The membranes were blocked with TBST (20 mM
Tris-HCl, pH 7.5, 150 mM NaCl, and 0.1% Tween 20) containing 5%
nonfat dry milk for 1 h and then they were incubated for 3 h
with specific antibodies, rabbit anti-mouse Acrp30 or rabbit anti-mouse
CB1 receptor (Affinity Bioreagents, Golden, CO)
in TBST. After three washes for 10 min in TBST, membranes were then
incubated for 30 min with horseradish peroxidase-conjugated,
anti-rabbit antiserum (Sigma, Saint-Quentin Fallavier, France).
Membranes were then washed three times for 10 min in TBST. The
immunoreactivity was revealed with the ECL+ chemiluminescent substrate
(Amersham Biosciences). Membranes were scanned on a Kodak Image Station
440 CF (Eastman Kodak, Rochester, NY) and relative quantification of
Acrp30 and CB1 receptor proteins were performed
with image analysis software (Kodak).
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Results |
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SR141716 Reduced Body Weight of Obese Zucker (fa/fa) Rats.
Obese (fa/fa) rats showed a rapid body weight reduction during the
first 4 days of treatment with SR141716 (10 mg/kg/d). Body weight was
reduced up to 20% on day 4 compared with the initial body weight at
day 0 (Fig. 1). These results agree with
those reported previously (Colombo et al., 1998
). Furthermore, after the fourth day of treatment and throughout the complete treatment period, body weight of SR141716-treated rats continued to be lower than
that of vehicle-treated rats (Fig. 1), whereas food intake of SR141716
treated-fa/fa rats became comparable with that of lean rats (Colombo et
al., 1998
; M. Arnone, L. Millet, M. F. Desclaux, C. Delgorge, P. Keane,
J. P. Maffrand, P. Soubrié, submitted). This suggests a
metabolic and energy expenditure regulation by SR141716 in addition to
its early reduction of food intake.
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SR141716 Increased Acrp30 mRNA Expression in Adipose Tissue of
Obese Zucker (fa/fa) Rats.
The expression of Acrp30 was increased
by 1.33- and 1.37-fold in adipose tissue of obese (fa/fa) rats treated
once a day for 4 days with SR141716 at 3 and 10 mg/kg/d, respectively,
compared with control animals that received vehicle (Fig.
2). The rate of stimulation of Acrp30
expression induced by SR141716 was dependent on the duration of the
treatment. At a dose of SR141716 (10 mg/kg/d), there was a 1.37- and
1.8-fold increase in Acrp30 expression after 4 and 10 days of
treatment, respectively. This level of expression remained constant
until day 14 (Fig. 3A). No effect of
SR141716 was observed before day 4 (data not shown).
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SR141716 Stimulated Acrp30 mRNA and Protein Expression in Cultured
Mouse 3T3 F442A Adipocyte Cells.
The addition of SR141716 (100 nM)
to subconfluent cultures of 3T3 F442A adipocytes, induced a rapid and
strong increase in Acrp30 expression. As shown in Fig.
4A, the stimulation rate of Acrp30 mRNA
expression, compared with that of control cultures, was 1.4- and
1.8-fold after 30 and 60 min of SR141716 incubation, respectively. At
60 min of treatment, SR141716 increased Acrp30 expression in a
concentration-dependent manner from 25 to 200 nM with a maximal effect
at 100 nM (Fig. 4B). In parallel, after 4 days of treatment, SR141716
increased in a concentration-dependent manner (from 50 to 200 nM) the
level of the protein Acrp30 in 3T3 F442A adipocytes, with a maximal
effect at 100 nM (Fig. 4C).
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CB1 Receptor Mediated the SR141716-Stimulation of
Acrp30 Expression in Adipose Tissue.
In adipose tissue of
wild-type mice (CB1-R +/+), SR141716 (10 mg/kg/d)
induced a slight and significant increase of the Acrp30 expression
(1.25-fold) after 10 days of treatment (Table
1). This SR141716 stimulation rate is
comparable with that observed in lean Zucker rats (Fig. 3B). By
contrast, as shown in Table 1, once-daily treatment with SR141716 (10 mg/kg/d) for 4 or 10 days did not induce any effect on Acrp30
expression in adipose tissue of CB1 receptor
knockout mice (CB1-R
/
).
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CB1 Receptor Expression Analysis in Rat Adipose Tissue
and in Mouse 3T3 F442A Adipocyte Cells.
CB1
receptor expression was assessed by RT-PCR analysis, using specific
oligonucleotide primers, on mRNA isolated from rat adipose tissues of
obese (fa/fa) and lean Zucker rats and from undifferentiated and
differentiated 3T3 F442A adipocyte cells in culture. As shown in Fig.
5, A and B, all these tissues and cells
expressed CB1 receptor mRNA. Relative
quantification analysis of this CB1 receptor
expression, normalized against that of
actin, revealed an
up-regulation of the CB1 receptor expression in
adipose tissue of obese rats which was 3.11-fold higher than that
observed in lean rats. Furthermore, in differentiated 3T3 F442A
adipocyte cells, the expression of CB1 receptor
mRNA was 4.35-fold higher than that obtained in undifferentiated
adipocytes. The fact shows that CB1 receptor was present in 3T3 F442A
adipocyte cells and that its level was 4.9 fold higher in
differentiated adipocyte cells compared with the level observed in
undifferentiated cells shown in Fig. 5C.
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SR141716 Decreased Hyperinsulinemia in Obese Zucker (fa/fa)
Rats.
We also investigated the effect of SR141716 on the
hyperinsulinemia characterizing obese Zucker (fa/fa) rats. Once daily
treatment of obese (fa/fa) rats with SR141716 (10 mg/kg/d, i.p.) for 4 days, induced a strong decrease in plasma insulin rate (60%) in
comparison with the insulin rate of control animals that received
vehicle (Fig. 6). In contrast, SR141716
treatment in the same condition had no effect on the plasma insulin
levels of lean Zucker rats (Fig. 6).
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Discussion |
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Recently, it has been reported that SR141716, a selective
CB1-receptor antagonist, reduced body weight of
genetically obese Zucker (fa/fa) rats (M. Arnone, L. Millet, M. F. Desclaux, C. Delgorge, P. Keane, J. P. Maffrand, P. Soubrié,
submitted). This SR141716-induced body weight loss seems to
comprise two phases. The early phase is principally food
intake-regulation-dependent: during the first days of treatment,
SR141716 reduced both food intake and body weight. This
SR141716-induced body weight loss may originate from the decrease of
food intake, which may itself be mediated by a regulation of the
expression and release of hypothalamic neuropeptides involved in both
the control of appetite and body-weight regulation (i.e., a central
effect of SR141716) (Elmquist et al., 1999
; Kalra et al., 1999
;
Proietto et al., 2000
).
The second phase is food intake-regulation-independent: after the
early phase (4 days of treatment) and throughout the entire period of
treatment, SR141716-induced body weight loss was maintained, whereas
food intake returned to a level comparable with that of nonobese (lean)
rats. These results agree with those reported previously (Colombo et
al., 1998
; M. Arnone, L. Millet, M. F. Desclaux, C. Delgorge, P. Keane,
J. P. Maffrand, P. Soubrié, submitted) and suggest a
metabolic and energy expenditure regulation by long term
SR141716-treatment.
Acrp30 is a plasma protein exclusively expressed in adipose
tissue and has been reported to regulate hyperglycemia,
hyperinsulinemia and fatty acid oxidation (Berg et al., 2001
; Combs et
al., 2001
; Fruebis et al., 2001
; Yamauchi et al., 2001
). Intravenous
injection of Acrp30 reduced body weight in obese animals, in a food
intake-independent manner (Fruebis et al., 2001
). Furthermore, both the
plasma levels and adipose tissue mRNA of Acrp30 are decreased in obese
subjects (Hu et al., 1996
; Arita et al., 1999
; Fruebis et al., 2001
;
Weyer et al., 2001
). Therefore, we investigated the effect of SR141716 on Acrp30 mRNA expression in adipose tissue. Our results show that,
after 4 days of treatment, SR141716 stimulated Acrp30 mRNA expression
in adipose tissue of obese Zucker (fa/fa) rats. This stimulation was
also found to occur within 30 min of SR141716 treatment of cultured
mouse 3T3 F442A adipocyte cells. Furthermore, like Acrp30 mRNA,
SR141716 treatment also increased Acrp30 protein levels in mouse 3T3
F442A adipocyte cells.
We also show that in adipose tissue of wild-type mice, SR141716
induced an up-regulation of Acrp30 mRNA expression with a level of
stimulation comparable with that observed in lean Zucker rats. In
contrast, SR141716 had no effect on Acrp30 mRNA expression in adipose
tissue of CB1 knockout mice
(CB1-R
/
). These results demonstrated that
SR141716 regulates Acrp30 expression in adipocytes through a
CB1 receptor-mediated pathway, but the mechanism
involved in this SR141716 effect remains to be fully elucidated.
Using RT-PCR analysis, we provide evidence that adipose tissue of lean and obese rats and cultured mouse 3T3 F442A adipocyte cells express the CB1 receptor and protein. Additionally, CB1 receptor expression is up-regulated in adipose tissue of obese (fa/fa) rats and in differentiated mouse 3T3 F442A adipocyte cells.
Together, these results suggest a role for adipose tissue
CB1 receptors in the control of body weight
homeostasis, as illustrated by the effects of the
CB1 receptor antagonist SR141716, and agree with
those reported previously (Di Marzo et al., 2001
).
Hyperinsulinemia and insulin resistance are commonly associated with
obesity (Allison et al., 1999
; Must et al., 1999
; Polonsky, 2000
) and
with a decrease of Acrp30 plasma levels (Weyer et al., 2001
). In
parallel to the increase of Acrp30 mRNA expression in adipose tissue,
SR141716 treatment decreased the hyperinsulinemia characterizing obese
(fa/fa) rats. This effect may involve a direct action of SR141716 on
plasma insulin levels of obese (fa/fa) rats or may be mediated by the
stimulation of Acrp30, which has been shown to decrease
hyperinsulinemia and reverse insulin resistance (Yamauchi et al.,
2001
). Whatever the mechanism involved in the effects of SR141716, the
decrease of hyperinsulinemia may participate to the overall action of
SR141716 on body weight regulation. This hypothesis agrees with the
proposal that decreasing hyperinsulinemia may be a therapeutic approach
to treat obesity, in particular that associated with type 2 diabetes
(Campfield et al., 1995
).
In summary, SR141716 stimulated Acrp30 mRNA expression in adipose
tissue and decreased hyperinsulinemia in obese Zucker (fa/fa) rats. The
regulation by SR141716 of a protein involved in lipid metabolism
(Acrp30) and of a metabolic hormone (insulin) suggests that these
factors may be among the principal mediators of the metabolic effects
of SR141716 leading to body weight reduction and indicates that
SR141716 may antagonize an endogenous endocannabinoid tone or could
exert this effect by its agonist inverse activity previously described
(Bouaboula et al., 1997
). Other enzymes and hormones may also
participate in these metabolic effects of SR141716.
Finally, our data demonstrate for the first time that SR141716 regulates hormones implicated in lipid and glucose metabolism and clearly underline that SR141716 could exert a metabolic "peripheral" action in addition to its known "central" effect on food intake. The regulation of food intake and body weight by SR141716 may result from these closely related and complementary effects.
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Acknowledgments |
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We thank Ruth LeGué for typing the manuscript, Isabel Lefevre for criticism and helpful comments, and John Alexander for editing the article.
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Footnotes |
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Received September 5, 2002; Accepted January 14, 2002
Address correspondence to: Mohammed Bensaid, Sanofi-Synthélabo Recherche, CNS Research Department, 371 rue du Professeur J. Blayac, F-34184 Montpellier Cédex 04, France. E-mail: mohammed.bensaid{at}sanofi-synthelabo.com
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Abbreviations |
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CB1-R, cannabinoid receptor 1; Acrp30, 30-kDa adipocyte complement-related protein; SR141716, N-(piperidin-1-yl)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboximide hydrochloride; TBST, Tris-buffered saline Tween 20; PCR, polymerase chain reaction; RT, reverse transcriptase.
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M. Bluher, S. Engeli, N. Kloting, J. Berndt, M. Fasshauer, S. Batkai, P. Pacher, M. R. Schon, J. Jordan, and M. Stumvoll Dysregulation of the Peripheral and Adipose Tissue Endocannabinoid System in Human Abdominal Obesity Diabetes, November 1, 2006; 55(11): 3053 - 3060. [Abstract] [Full Text] [PDF] |
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D. Sarnataro, S. Pisanti, A. Santoro, P. Gazzerro, A. M. Malfitano, C. Laezza, and M. Bifulco The Cannabinoid CB1 Receptor Antagonist Rimonabant (SR141716) Inhibits Human Breast Cancer Cell Proliferation through a Lipid Raft-Mediated Mechanism Mol. Pharmacol., October 1, 2006; 70(4): 1298 - 1306. [Abstract] [Full Text] [PDF] |
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P. Pacher, S. Batkai, and G. Kunos The Endocannabinoid System as an Emerging Target of Pharmacotherapy Pharmacol. Rev., September 1, 2006; 58(3): 389 - 462. [Abstract] [Full Text] [PDF] |
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I. Matias, M.-P. Gonthier, P. Orlando, V. Martiadis, L. De Petrocellis, C. Cervino, S. Petrosino, L. Hoareau, F. Festy, R. Pasquali, et al. Regulation, Function, and Dysregulation of Endocannabinoids in Models of Adipose and {beta}-Pancreatic Cells and in Obesity and Hyperglycemia J. Clin. Endocrinol. Metab., August 1, 2006; 91(8): 3171 - 3180. [Abstract] [Full Text] [PDF] |
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E. V. Gelfand and C. P. Cannon Rimonabant: A Cannabinoid Receptor Type 1 Blocker for Management of Multiple Cardiometabolic Risk Factors J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1919 - 1926. [Abstract] [Full Text] [PDF] |
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