Regulation of Brown Adipose Tissue Thermogenesis and Bile Acid Metabolism by a β3-Adrenergic Receptor Agonist

Diabetes. 2018 Oct;67(10):2113-2125

Alison S. Baskin, Joyce D. Linderman, Robert J. Brychta, Suzanne McGehee, Esti Anflick-Chames, Cheryl Cero, James W. Johnson, Alana E. O’Mara, Laura A. Fletcher, Brooks P. Leitner, Courtney J. Duckworth, Shan Huang, Hongyi Cai, H. Martin Garraffo, Corina M. Millo3, William Dieckmann3, Vladimir Tolstikov4, Emily Y Chen4, Fei Gao, Niven R Narain,Michael A Kiebish, Peter J. Walter, Peter Herscovitch, Kong Y. Chen, Aaron M. Cypess

β3-adrenergic receptor (AR) agonists are approved to treat only overactive bladder. However, rodent studies suggest that these drugs could have other beneficial effects on human metabolism. We performed tissue receptor profiling and showed that the human β3-AR mRNA is also highly expressed in gallbladder and brown adipose tissue (BAT). We next studied the clinical implications of this distribution in twelve healthy men given one-time randomized doses of placebo; the approved dose of 50 mg; and 200 mg of the β3-AR agonist mirabegron. There was a more-than-dose proportional increase in BAT metabolic activity as measured by 18 F-FDG PET/CT (medians 0.0 vs. 18.2 vs. 305.6 mL*SUVmean*g/mL). Only the 200 mg dose elevated both non-esterified fatty acids (+68%) and resting energy expenditure (+5.8%). Previously undescribed increases in gallbladder size (+35%) and reductions in conjugated bile acids were also discovered. Therefore, besides urinary bladder relaxation, the human β3-AR contributes to WAT lipolysis, BAT thermogenesis, gallbladder relaxation, and bile acid metabolism. This physiology should be considered in the development of more selective β3-AR agonists to treat obesity-related complications.

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