Background: Observational evidence regarding the role of leptin in Alzheimer disease (AD) is conflicting. We sought to determine the causal role of circulating leptin and soluble plasma leptin receptor (sOB-R) levels in AD using a separate-sample Mendelian randomization study. Methods: Single nucleotide polymorphisms (SNPs) independently and solely predictive of log-transformed leptin (rs10487505 [LEP], rs780093 [GCKR], rs900400 [CCNL1], rs6071166 [SLC32A1], and rs6738627 [COBLL1]) and of sOB-R (rs1137101 [LEPR], rs2767485 [LEPR], and rs1751492 [LEPR]) levels (ng/mL) were obtained from 2 previously reported genome-wide association studies. We obtained associations of leptin and sOB-R levels with AD using inverse variance weighting with fixed effects by combining Wald estimates for each SNP. Sensitivity analyses included using weighted median and MR-Egger methods and repeating the analyses using only SNPs of genome-wide significance. Results: Using inverse variance weighting, genetically predicted circulating leptin levels were not associated with AD, albeit with wide confidence intervals (CIs): odds ratio (OR) 0.99 per log-transformed ng/mL; 95% CI 0.55-1.78. Similarly, the association of sOB-R with AD was null using inverse variance weighting (OR 1.08 per log-transformed ng/mL; 95% CI 0.83-1.41). Results from our sensitivity analyses confirmed our findings. Conclusions: In this first Mendelian randomization study estimating the causal effect of leptin on AD, we did not find an effect of genetically predicted circulating leptin and sOB-R levels on AD. As such, this study suggests that leptin is unlikely to be a major contributor to AD, although the wide CIs preclude a definitive assessment.

1.
Cummings JL, Morstorf T, Zhong K: Alzheimer's disease drug-development pipeline: few candidates, frequent failures. Alzheimers Res Ther 2014;6:37.
2.
Johnston JM, Greco SJ, Hamzelou A, et al: Repositioning leptin as a therapy for Alzheimer's disease. Therapy 2011;8:481-490.
3.
Lieb W, Beiser AS, Vasan RS, et al: Association of plasma leptin levels with incident Alzheimer disease and MRI measures of brain aging. JAMA 2009;302:2565-2572.
4.
Khemka VK, Bagchi D, Bandyopadhyay K, et al: Altered serum levels of adipokines and insulin in probable Alzheimer's disease. J Alzheimers Dis 2014;41:525-533.
5.
Baranowska-Bik A, Bik W, Styczynska M, et al: Plasma leptin levels and free leptin index in women with Alzheimer's disease. Neuropeptides 2015;52:73-78.
6.
Johnston JM, Hu WT, Fardo DW, et al: Low plasma leptin in cognitively impaired ADNI subjects: gender differences and diagnostic and therapeutic potential. Curr Alzheimer Res 2014;11:165-174.
7.
Power DA, Noel J, Collins R, O'Neill D: Circulating leptin levels and weight loss in Alzheimer's disease patients. Dement Geriatr Cogn Disord 2001;12:167-170.
8.
Ma J, Zhang W, Wang HF, et al: Peripheral blood adipokines and insulin levels in patients with Alzheimer's disease: a replication study and meta-analysis. Curr Alzheimer Res 2016;13:223-233.
9.
Bigalke B, Schreitmuller B, Sopova K, et al: Adipocytokines and CD34 progenitor cells in Alzheimer's disease. PLoS One 2011;6:e20286.
10.
Zhou R, Deng J, Zhang M, et al: Association between bone mineral density and the risk of Alzheimer's disease. J Alzheimers Dis 2011;24:101-108.
11.
Niedowicz DM, Studzinski CM, Weidner AM, et al: Leptin regulates amyloid β production via the γ-secretase complex. Biochim Biophys Acta 2013;1832:439-444.
12.
Martins I, Gomes S, Costa RO, et al: Leptin and ghrelin prevent hippocampal dysfunction induced by Aβ oligomers. Neuroscience 2013;241:41-51.
13.
Li XL, Aou S, Oomura Y, et al: Impairment of long-term potentiation and spatial memory in leptin receptor-deficient rodents. Neuroscience 2002;113:607-615.
14.
Oomura Y, Hori N, Shiraishi T, et al: Leptin facilitates learning and memory performance and enhances hippocampal CA1 long-term potentiation and CaMK II phosphorylation in rats. Peptides 2006;27:2738-2749.
15.
Teunissen CE, van der Flier WM, Scheltens P, et al: Serum leptin is not altered nor related to cognitive decline in Alzheimer's disease. J Alzheimers Dis 2015;44:809-813.
16.
Oania R, McEvoy LK: Plasma leptin levels are not predictive of dementia in patients with mild cognitive impairment. Age Ageing 2015;44:53-58.
17.
Gustafson DR, Backman K, Lissner L, et al: Leptin and dementia over 32 years - The Prospective Population Study of Women. Alzheimers Dement 2012;8:272-277.
18.
Warren MW, Hynan LS, Weiner MF: Lipids and adipokines as risk factors for Alzheimer's disease. J Alzheimers Dis 2012;29:151-157.
19.
Theodoropoulou A, Metallinos IC, Psyrogiannis A, et al: Ghrelin and leptin secretion in patients with moderate Alzheimer's disease. J Nutr Health Aging 2012;16:472-477.
20.
Prasad V, Jorgenson J, Ioannidis JP, Cifu A: Observational studies often make clinical practice recommendations: an empirical evaluation of authors' attitudes. J Clin Epidemiol 2013;66:361-366.
21.
Neurotez, Inc. Pipeline. http://neurotez.com/pipeline/ (accessed November 23, 2016).
22.
Burgess S, Scott RA, Timpson NJ, et al: Using published data in Mendelian randomization: a blueprint for efficient identification of causal risk factors. Eur J Epidemiol 2015;30:543-552.
23.
Davey Smith G, Paternoster L, Relton C: When will Mendelian randomization become relevant for clinical practice and public health? JAMA 2017;317:589-591.
24.
Kilpelainen TO, Carli JF, Skowronski AA, et al: Genome-wide meta-analysis uncovers novel loci influencing circulating leptin levels. Nat Commun 2016;7:10494.
25.
Sun Q, Cornelis MC, Kraft P, et al: Genome-wide association study identifies polymorphisms in LEPR as determinants of plasma soluble leptin receptor levels. Hum Mol Genet 2010;19:1846-1855.
26.
Lambert JC, Ibrahim-Verbaas CA, Harold D, et al: Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer's disease. Nat Genet 2013;45:1452-1458.
27.
Fieller EC: Some problems in interval estimation. J R Stat Soc Series B 1954;16:175-185.
28.
Bowden J, Davey Smith G, Haycock PC, Burgess S: Consistent estimation in Mendelian randomization with some invalid instruments using a weighted median estimator. Genet Epidemiol 2016;40:304-314.
29.
Bowden J, Davey Smith G, Burgess S: Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol 2015;44:512-525.
30.
Li MX, Gui HS, Kwan JS, Sham PC: GATES: a rapid and powerful gene-based association test using extended Simes procedure. Am J Hum Genet 2011;88:283-293.
31.
Lammert A, Kiess W, Bottner A, et al: Soluble leptin receptor represents the main leptin binding activity in human blood. Biochem Biophys Res Commun 2001;283:982-988.
32.
Chan JL, Bluher S, Yiannakouris N, et al: Regulation of circulating soluble leptin receptor levels by gender, adiposity, sex steroids, and leptin: observational and interventional studies in humans. Diabetes 2002;51:2105-2112.
33.
Hellström L, Wahrenberg H, Hruska K, et al: Mechanisms behind gender differences in circulating leptin levels. J Intern Med 2000;247:457-462.
34.
Rice T, Chagnon YC, Borecki IB, et al: Familial resemblance for plasma leptin: sample homogeneity across adiposity and ethnic groups. Obes Res 2002;10:351-360.
35.
Mishra S, Harris TB, Hsueh WC, et al: The association of serum leptin with mortality in older adults. PLoS One 2015;10:e0140763.
36.
Batsis JA, Sahakyan KR, Singh P, et al: Leptin, adiposity, and mortality: results from the National Health and Nutrition Examination Survey III, 1988 to 1994. Mayo Clin Proc 2015;90:481-491.
37.
Brion MJ, Shakhbazov K, Visscher PM: Calculating statistical power in Mendelian randomization studies. Int J Epidemiol 2013;42:1497-1501.
38.
Shimizu H, Shimomura Y, Hayashi R, et al: Serum leptin concentration is associated with total body fat mass, but not abdominal fat distribution. Int J Obes Relat Metab Disord 1997;21:536-541.
39.
Liuzzi A, Savia G, Tagliaferri M, et al: Serum leptin concentration in moderate and severe obesity: relationship with clinical, anthropometric and metabolic factors. Int J Obes Relat Metab Disord 1999;23:1066-1073.
40.
Lee JH, Reed DR, Price RA: Leptin resistance is associated with extreme obesity and aggregates in families. Int J Obes Relat Metab Disord 2001;25:1471-1473.
41.
Tolppanen AM, Ngandu T, Kåreholt I, et al: Midlife and late-life body mass index and late-life dementia: results from a prospective population-based cohort. J Alzheimers Dis 2014;38:201-209.
42.
Mukherjee S, Walter S, Kauwe JS, et al: Genetically predicted body mass index and Alzheimer's disease-related phenotypes in three large samples: Mendelian randomization analyses. Alzheimers Dement 2015;11:1439-1451.
43.
White H, Pieper C, Schmader K: The association of weight change in Alzheimer's disease with severity of disease and mortality: a longitudinal analysis. J Am Geriatr Soc 1998;46:1223-1227.
44.
Johnson DK, Wilkins CH, Morris JC: Accelerated weight loss may precede diagnosis in Alzheimer disease. Arch Neurol 2006;63:1312-1317.
45.
Isidori AM, Strollo F, Morè M, et al: Leptin and aging: correlation with endocrine changes in male and female healthy adult populations of different body weights. J Clin Endocrinol Metab 2000;85:1954-1962.
46.
Lambrinoudaki I, Christodoulakos G, Panoulis C, et al: Determinants of serum leptin levels in healthy postmenopausal women. J Endocrinol Invest 2003;26:1225-1230.
47.
Gannagé-Yared MH, Khalife S, Semaan M, et al: Serum adiponectin and leptin levels in relation to the metabolic syndrome, androgenic profile and somatotropic axis in healthy non-diabetic elderly men. Eur J Endocrinol 2006;155:167-176.
48.
Fatima W, Shahid A, Imran M, et al: Leptin deficiency and leptin gene mutations in obese children from Pakistan. Int J Pediatr Obes 2011;6:419-427.
49.
Farooqi IS, Wangensteen T, Collins S, et al: Clinical and molecular genetic spectrum of congenital deficiency of the leptin receptor. N Engl J Med 2007;356:237-247.
50.
Paz-Filho GJ, Babikian T, Asarnow R, et al: Leptin replacement improves cognitive development. PLoS One 2008;3:e3098.
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