Decreased cerebrospinal-fluid/serum leptin ratio in obesity: A possible mechanism for leptin resistance

Background A receptor for leptin has been cloned from the choroid plexus, the site of cerebrospinal-fluid (CSF) production and the location of the blood/cerebrospinal-fluid barrier. Thus, this receptor might serve as a transporter for leptin. We have studied leptin concentrations in serum and (CSF). Methods and findings We demonstrated by radioimmunoassay and western blot the presence of leptin in human CSF. We then measured leptin in CSF and serum in 31 individuals with a wide range of bodyweight. Mean serum leptin was 318% higher in 8 obese (40.2 [SE 8.6] ng/mL) than in 23 lean individuals (9.6 [1.5] ng/mL, p<0 0005). However, the CSF leptin concentration in obese individuals (0.337 [0.04] ng/mL) was only 30% higher than in lean people (0.259 [0.26] ng/mL, p<0.1). Consequently, the leptin CSF/serum ratio in lean individuals (0.047 [0.010] was 4.3-fold higher than that in obese individuals (0.011 [0.002], p<0.05). The relation between CSF leptin and serum leptin was best described by a logarithmic function (r=0.52, p<0.01). Interpretation Our data suggest that leptin enters the brain by a saturable transport system. The capacity of leptin transport is lower in obese individuals, and may provide a mechanism for leptin resistance.