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09-16-2016 | Dyslipidemia | Review | Article

PPARs in obesity-induced T2DM, dyslipidaemia and NAFLD

Barbara Gross, Michal Pawlak, Philippe Lefebvre, Bart Staels


Obesity is a worldwide epidemic that predisposes individuals to cardiometabolic complications, such as type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD), which are all related to inappropriate ectopic lipid deposition. Identification of the pathogenic molecular mechanisms and effective therapeutic approaches are highly needed. The peroxisome proliferator-activated receptors (PPARs) modulate several biological processes that are perturbed in obesity, including inflammation, lipid and glucose metabolism and overall energy homeostasis. Here, we review how PPARs regulate the functions of adipose tissues, such as adipogenesis, lipid storage and adaptive thermogenesis, under healthy and pathological conditions. We also discuss the clinical use and mechanism of PPAR agonists in the treatment of obesity comorbidities such as dyslipidaemia, T2DM and NAFLD. First generation PPAR agonists, primarily those acting on PPARγ, are associated with adverse effects that outweigh their clinical benefits, which led to the discontinuation of their development. An improved understanding of the physiological roles of PPARs might, therefore, enable the development of safe, new PPAR agonists with improved therapeutic potential.

Nat Rev Endocrinol 2017; 13: 36–49. doi: 10.1038/nrendo.2016.135

Approximately 13% of the adult population worldwide has obesity, consequently, this disease is the most prevalent chronic metabolic disorder and one of the most important global public-health challenges1. Obesity is the result of an imbalance between energy intake and expenditure. Excess calories are initially stored in subcutaneous fat; however, when this storage capacity is overwhelmed, the altered endocrine functions of adipose tissues and the ensuing ectopic fat accumulation lead to a lipotoxic metabolic stress, which promotes low-grade inflammation and metabolic dysfunction in organs such as the liver or skeletal muscle, thereby promoting insulin resistance. The metabolic abnormalities associated with obesity predispose patients to cardiometabolic complications such as dyslipidaemia, type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD), which put them at risk of developing cardiovascular diseases (CVD)2.

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