Human obesity and insulin resistance: lessons from experiments of nature.

The past decade or so has seen the adipocyte catapulted from a position of relative obscurity onto the centre stage of biomedical science. Having long been viewed largely as a passive storage depot for energy in times of plenty and a fuel reservoir called upon in times of need, the discovery that the adipocyte is an active participant in the control mechanisms for both energy balance and intermediary metabolism represents one of the most stunning paradigm shifts in modern mammalian biology. The normal control of energy homeostasis is now known to be highly dependent on the adipocyte-secreted hormone, leptin. Defects in the leptin signalling pathway, both inherited and acquired, are now known to contribute to the important clinical problem of obesity. Dysfunction of adipocytes, in both obesity and lipodystrophies, is now considered to be critically involved in the pathogenesis of insulin resistance, the metabolic syndrome and type 2 diabetes. The range of metabolites, steroids and bioactive peptides now known to be actively produced by adipocytes and influencing organs as diverse as brain, muscle, liver and pancreatic islet has increased dramatically. Our understanding of how these are co-ordinated to regulate normal metabolism and are dysregulated in metabolic disease is still in its infancy. However what is clear is that the adipocyte, until recently the 'Cinderella Cell' of metabolism, has rapidly become the 'Belle of the Ball'.