The balance/imbalance of DNA Damage inhibitor an adipose tissue “mediator cocktail” may profoundly affect not only the situation in the adipose tissue but especially in important target organs such as the liver (Fig. 1). Adiponectin is an anti-inflammatory adipocytokine that signals through two receptors.54-56 Obesity is associated with hypoadiponectinemia, and adiponectin levels increase after weight loss.55

Adiponectin induces extracellular Ca2+ influx by adiponectin receptor 1, which is necessary for activation of adenosine monophosphate–activated protein kinase (AMPK) and Sirtuin 1 (Sirt1).57 Hepatocyte-specific deletion of Sirt1 leads not only to hepatic steatosis but also to ER stress and liver inflammation.58 Genetically obese leptin-deficient ob/ob mice exhibit a reversal of the diabetic phenotype with normalization of glucose and insulin levels upon transgenic overexpression of the full-length isoform of adiponectin, despite Olaparib datasheet retaining the obese phenotype.59 This report convincingly demonstrates that, despite massive expansion of subcutaneous adipose tissue, high-level expression of adipose tissue adiponectin reduces liver fat content

and improves insulin resistance. Therefore, also in humans, a sufficient production of adiponectin might play a central role in establishing a balance where local and systemic/liver inflammation is prevented.60 In the

hierarchy of processes in the adipose tissue, soluble mediators such as adiponectin Org 27569 might be the “big players. Because adipocytes expand with triglycerides, leptin secretion increases proportionally.61 Hyperleptinemia reduces fat content in peripheral organs. Because leptin stimulates fatty acid oxidation, adipocytes would be oxidizing, rather than storing fat if the endogenous leptin they synthesize acts on them.62, 63 Such an autocrine/paracrine relationship between leptin and its secreting cell, the adipocyte, is prevented by a progressive decline of adipocyte leptin receptor expression. It is assumed that leptin’s capacity to oxidize lipids is fully operative in the liver, thereby minimizing ectopic lipid accumulation, at least temporarily. Whether such a mechanism is operative in NAFLD is not known. Expression of IL-6 and TNFα, two important proinflammatory cytokines, is profoundly increased in human fat cells from obese subjects and patients with insulin resistance.64 IL-6 serum levels are elevated in obese patients and weight loss results in decreased IL-6 serum levels.65, 66 Enhanced TNFα expression in adipose tissue of obese subjects decreases following weight loss.67 Insulin resistance is an important feature of NAFLD and is caused by a variety of factors, including soluble mediators derived from immune cells and/or adipose tissue.