Central Ceramide-Induced Hypothalamic Lipotoxicity and ER Stress Regulate Energy Balance

Summary: Hypothalamic endoplasmic reticulum (ER) stress is a key mechanism leading to obesity. Here, we demonstrate that ceramides induce lipotoxicity and hypothalamic ER stress, leading to sympathetic inhibition, reduced brown adipose tissue (BAT) thermogenesis, and weight gain. Genetic overexpression of the chaperone GRP78/BiP (glucose-regulated protein 78 kDa/binding immunoglobulin protein) in the ventromedial nucleus of the hypothalamus (VMH) abolishes ceramide action by reducing hypothalamic ER stress and increasing BAT thermogenesis, which leads to weight loss and improved glucose homeostasis. The pathophysiological relevance of this mechanism is demonstrated in obese Zucker rats, which show increased hypothalamic ceramide levels and ER stress. Overexpression of GRP78 in the VMH of these animals reduced body weight by increasing BAT thermogenesis as well as decreasing leptin and insulin resistance and hepatic steatosis. Overall, these data identify a triangulated signaling network involving central ceramides, hypothalamic lipotoxicity/ER stress, and BAT thermogenesis as a pathophysiological mechanism of obesity. : The brain senses lipids, such as fatty acids, and modifies energy metabolism accordingly. However, it is unclear whether other lipid species may be involved. Contreras et al. now demonstrate that ceramides regulate energy balance through the induction of hypothalamic lipotoxicity and modulation of endoplasmic reticulum functionality. This leads to changes in sympathetic tone and brown adipose tissue (BAT)-induced thermogenesis, impacting body weight.