Human genetic lipodystrophic syndromes are rare conditions with total or partial body fat loss, severe lipid and glucose alterations and insulin resistance, leading to early diabetes, cardiovascular and hepatic complications. Most generalised forms, recessively inherited, result from mutations in four proteins, mainly 1‐acylglycerol‐3‐phosphate‐O‐acyltransferase‐2 (AGPAT2) involved in triglyceride synthesis, or seipin involved in the adipocyte lipid droplet formation/maintenance but also in caveolin‐1 and cavin‐1/polymerase I and transcript release factor, expressed in caveolae and at the lipid droplet surface. Partial lipodystrophic syndromes, generally dominantly inherited, mainly involve A‐type lamins (
LMNA)
, forming the nuclear lamina, or the adipogenic transcription factor peroxisome proliferator‐activated‐receptor‐gamma. Less frequently Akt2, in the insulin signalling pathway, perilipin and cell‐death‐inducing‐DFF45‐like‐effector‐C, controlling adipocyte triglyceride storage, are affected. Insulin resistance and lipodystrophy can also be present in genetic syndromes of premature ageing as the Hutchinson–Gilford progeria or mandibuloacral dysplasia (
LMNA
or
ZMPSTE24
) and the Werner syndrome (affecting the helicase WRN). Patients’ management is difficult and recombinant human leptin treatment could be helpful.
Key Concepts:
Adipose tissue releases a number of factors and hormones and plays an important physiological role, only recently considered.
Genetic lipodystrophic syndromes are a heterogeneous group of diseases with lipoatrophy either generalised or partial.
The very limited fat expansion seen in lipodystrophies results in severe metabolic alterations and early complications as a result of fat overwhelming by nutriments.
Partial lipodystrophies due to a single gene mutation associate both fat hypertrophy and fat atrophy, stressing for the differential physiology of differently located fat depots.
A number of genetic lipodystrophies affect proteins involved in lipid droplet function, which stresses the underrecognised role of lipid droplet in adipocyte physiology.
The transcription factor PPARγ plays important roles in adipogenesis but also at the level of the vascular wall.
Mutations in the gene encoding lamin A/C result in a wide range of diseases collectively called laminopathies.
Human recombinant leptin can improve the metabolic alterations present in lipodystrophic patients with a low leptin level.