Peripheral neural targets in obesity

Authors

  • Amanda J Page,

    1. Nerve-Gut Research Laboratory, Discipline of Medicine, South Australia, Australia
    2. Discipline of Physiology, University of Adelaide, Adelaide, South Australia, Australia
    3. Royal Adelaide Hospital, South Australia, Australia
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  • Erin Symonds,

    1. Royal Adelaide Hospital, South Australia, Australia
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  • Madusha Peiris,

    1. Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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  • L Ashley Blackshaw,

    Corresponding author
    1. Nerve-Gut Research Laboratory, Discipline of Medicine, South Australia, Australia
    2. Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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  • Richard L Young

    1. Nerve-Gut Research Laboratory, Discipline of Medicine, South Australia, Australia
    2. Discipline of Physiology, University of Adelaide, Adelaide, South Australia, Australia
    3. Royal Adelaide Hospital, South Australia, Australia
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Professor L. Ashley Blackshaw, Wingate Institute, 26 Ashfield St, London E1 2AJ, UK. E-mail: a.blackshaw@qmul.ac.uk

Abstract

Interest in pharmacological treatments for obesity that act in the brain to reduce appetite has increased exponentially over recent years, but failures of clinical trials and withdrawals due to adverse effects have so far precluded any success. Treatments that do not act within the brain are, in contrast, a neglected area of research and development. This is despite the fact that a vast wealth of molecular mechanisms exists within the gut epithelium and vagal afferent system that could be manipulated to increase satiety. Here we discuss mechano- and chemosensory pathways from the gut involved in appetite suppression, and distinguish between gastric and intestinal vagal afferent pathways in terms of their basic physiology and activation by enteroendocrine factors. Gastric bypass surgery makes use of this system by exposing areas of the intestine to greater nutrient loads resulting in greater satiety hormone release and reduced food intake. A non-surgical approach to this system is preferable for many reasons. This review details where the opportunities may lie for such approaches by describing nutrient-sensing mechanisms throughout the gastrointestinal tract.

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