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{{protein
{{Primary sources|date=March 2012}}
|Name=hypocretin (orexin) neuropeptide precursor
{{Pfam box
|caption=
| Symbol = Orexin
|image=
| Name = Prepro-orexin
| image = 1R02 crystallography.png
| width =
| caption = Solution phase [[NMR]] structure of orexin A based on the [[Protein Data Bank|PDB]] coordinates {{PDB2|1R02}}.
| Pfam = PF02072
| InterPro = IPR001704
| SMART=
| Prosite =
| SCOP = 1cq0
| TCDB =
| OPM family =154
| OPM protein = 1wso
| PDB= {{PDB3|1cq0}}A:71-97 {{PDB3|1wso}}A:35-66 {{PDB3|1r02}}A:34-66 {{PDB3|1uvq}}C:1-13
}}
{{Infobox protein
|Name=orexin (hypocretin) neuropeptide precursor
|caption=Solution phase NMR structure of orexin B based on the [[Protein Data Bank|PDB]] coordinates {{PDB2|1CQ0}}.
|image=1CQ0 crystallography.png
|width=
|width=
|HGNCid=4847
|HGNCid=4847
|Symbol=HCRT
|Symbol=HCRT
|AltSymbols=
|AltSymbols=PPOX, OX
|EntrezGene=3060
|EntrezGene=3060
|OMIM=602358
|OMIM=602358
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|LocusSupplementaryData=
|LocusSupplementaryData=
}}
}}
{{SI}}


'''Orexin''', also called '''hypocretin''', is a [[neuropeptide]] that regulates [[arousal]], [[wakefulness]], and [[appetite]].<ref name=Davis>{{ cite book | chapter = 24. Orexigenic Hypothalamic Peptides Behavior and Feeding -  24.5 Orexin |  url = https://books.google.com/books?id=KuAEPOPbW6MC&pg=PA361 | pages = 361–2 |vauthors=Davis JF, Choi DL, Benoit SC | title = Handbook of Behavior, Food and Nutrition |veditors=Preedy VR, Watson RR, Martin CR | publisher = Springer | year = 2011 | isbn = 9780387922713 }}</ref> The most common form of [[narcolepsy]], in which the sufferer briefly loses muscle tone ([[cataplexy]]), is caused by a lack of orexin in the brain due to destruction of the cells that produce it.<ref name=Stanford>Stanford Center for Narcolepsy [http://med.stanford.edu/narcolepsy/faq1.html FAQ] (retrieved 27-Mar-2012)</ref>


'''Orexins''', also called '''hypocretins''', are the common names given to a pair of highly excitatory neuropeptide [[hormone]]s that were simultaneously discovered by two groups of researchers in [[rat]] brains.  
There are approximately 70,000&nbsp;orexin-producing [[neurons]] in the human brain that project from the [[lateral hypothalamus]] to neurons and brain regions that modulate wakefulness.<ref name="Davis"/><ref name="Stanford"/> However, the [[axons]] from these neurons extend throughout the entire brain and spinal cord,<ref name=Marcus>{{ cite book | chapter = 3. Orexin Projections and Localization of Orexin Receptors |vauthors=Marcus JN, Elmquist JK | url = https://books.google.com/books?id=OHIu9l7bAmsC&lpg=PA195 | page = 195 | title =  The Orexin/Hypocretin System: Physiology and Pathophysiology |veditors=Nishino S, Sakurai T | publisher = Springer | year = 2006 | isbn = 9781592599509 }}</ref> where there are also receptors for orexin.


The two related peptides (orexin A and B, or hypocretin-1 and -2), with approximately 50% sequence identity, are produced by cleavage of a single precursor protein. Studies suggest that orexin A/hypocretin-1 may be of greater biological importance than orexin B/hypocretin-2. Although these peptides are produced by a very small population of cells in the lateral and posterior [[hypothalamus]], they send projections throughout the brain. The orexin peptides bind to the [[orexin receptor]], a [[G-protein coupled receptor]].
Orexin was discovered in 1998 almost simultaneously by two independent groups of rat-brain researchers.<ref name="pmid9491897">{{cite journal | vauthors = Sakurai T, Amemiya A, Ishii M, Matsuzaki I, Chemelli RM, Tanaka H, Williams SC, Richardson JA, Kozlowski GP, Wilson S, Arch JR, Buckingham RE, Haynes AC, Carr SA, Annan RS, McNulty DE, Liu WS, Terrett JA, Elshourbagy NA, Bergsma DJ, Yanagisawa M | title = Orexins and orexin receptors: a family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior | journal = Cell | volume = 92 | issue = 4 | pages = 573–85 | date = Feb 1998 | pmid = 9491897 | doi = 10.1016/S0092-8674(00)80949-6 }}</ref><ref name="pmid9419374">{{cite journal | vauthors = de Lecea L, Kilduff TS, Peyron C, Gao X, Foye PE, Danielson PE, Fukuhara C, Battenberg EL, Gautvik VT, Bartlett FS, Frankel WN, van den Pol AN, Bloom FE, Gautvik KM, Sutcliffe JG | title = The hypocretins: hypothalamus-specific peptides with neuroexcitatory activity | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 95 | issue = 1 | pages = 322–7 | date = Jan 1998 | pmid = 9419374 | pmc = 18213 | doi = 10.1073/pnas.95.1.322 }}</ref> One group named it '''orexin''', from ''orexis,'' meaning "appetite" in Greek; the other group named it '''hypocretin''', because it is produced in the ''hypo''thalamus and bears a weak resemblance to ''[[secretin]]'', another [[peptide]].<ref name=Stanford/> The use of both terms is now a practical necessity, as hypocretin is used to refer to the genetic products and orexin is used to refer to the protein products.<ref name="pmid22759794">{{cite journal | vauthors = Gotter AL, Webber AL, Coleman PJ, Renger JJ, Winrow CJ | title = International Union of Basic and Clinical Pharmacology. LXXXVI. Orexin receptor function, nomenclature and pharmacology | journal = Pharmacological Reviews | volume = 64 | issue = 3 | pages = 389–420 | date = Jul 2012 | pmid = 22759794 | doi = 10.1124/pr.111.005546 }}</ref>


The orexins/hypocretins are strongly conserved peptides, found in all major classes of vertebrates. The peptides are thought to have arisen early in vertebrate evolution.
== Discovery ==
In 1998, reports of the discovery of orexin/hypocretin were published nearly simultaneously. Luis de Lecea, [[Thomas Kilduff]], and colleagues reported the discovery of the hypocretin system at the same time as Takeshi Sakurai from [[Masashi Yanagisawa]]'s lab at the [[University of Texas Southwestern Medical Center at Dallas]] reported the discovery of the ''orexins'' to reflect the orexigenic (appetite-stimulating) activity of these peptides. In their 1998 paper describing these neuropeptides, they also reported discovery of two orexin receptors, dubbed OX<sub>1</sub>R and OX<sub>2</sub>R.<ref name="pmid9491897"/>.


==Functions==
The two groups also took different approaches towards their discovery. One team was interested in finding new genes that were expressed in the hypothalamus. In 1996, scientists from the [[Scripps Research Institute]] reported the discovery of several genes in the rat brain, including one they dubbed "clone 35." Their work showed that clone 35 expression was limited to the lateral hypothalamus.<ref name="pmid8710940">{{cite journal | vauthors = Gautvik KM, de Lecea L, Gautvik VT, Danielson PE, Tranque P, Dopazo A, Bloom FE, Sutcliffe JG | title = Overview of the most prevalent hypothalamus-specific mRNAs, as identified by directional tag PCR subtraction | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 93 | issue = 16 | pages = 8733–8 | date = Aug 1996 | pmid = 8710940 | pmc = 38742 | doi = 10.1073/pnas.93.16.8733 }}</ref> They extracted selective DNA found in the lateral hypothalamus. They cloned this DNA and studied it using electron microscopy. Neurotransmitters found in this area were oddly similar to the gut hormone, secretin, a member of the [[incretin]] family, so they named hypocretin to stand for a hypothalamic member of the incretin family.<ref>{{cite journal | vauthors = Ebrahim IO, Howard RS, Kopelman MD, Sharief MK, Williams AJ | title = The hypocretin/orexin system | journal = Journal of the Royal Society of Medicine | volume = 95 | issue = 5 | pages = 227–30 | date = May 2002 | pmid = 11983761 | pmc = 1279673 }}</ref> These cells were first thought to reside and work only within the lateral hypothalamus area, but immunocytochemistry tactics revealed the various projections this area truly had to other parts of the brain. A majority of these projections reached the limbic system and structures associated with it (including the amygdala, septum, and basal forebrain area).
The orexin/hypocretin system was initially suggested to be primarily involved in the stimulation of food intake, based on the finding that central administration of orexin A/hypocretin-1 increases food intake. The discovery that orexin/hypocretin dysregulation causes the sleep disorder [[narcolepsy]]<ref>{{cite journal |author=Siegel J |title=Narcolepsy: a key role for hypocretins (orexins) |journal=Cell |volume=98 |issue=4 |pages=409-12 |year=1999 |pmid=10481905}} [http://www.npi.ucla.edu/sleepresearch/Hypocretins.htm full text]</ref> subsequently indicated a major role for this system in sleep regulation. Narcolepsy results in excessive daytime sleepiness, inability to consolidate wakefulness in the day (and sleep at night), and [[cataplexy]] (loss of muscle tone in response to strong, usually positive, emotions). Dogs that lack a functional receptor for orexin/hypocretin have narcolepsy, while animals and people lacking the orexin/hypocretin neuropeptide itself also have narcolepsy. Orexin/hypocretin neurons strongly excite various brain nuclei with important roles in wakefulness including the [[dopamine]], [[norepinephrine]], [[histamine]] and [[acetylcholine]] systems and appear to play an important role in stabilizing wakefulness and sleep.  


Recent studies indicate that a major role of the orexin/hypocretin system is to integrate metabolic, circadian and sleep debt influences to determine whether the animal should be asleep or awake and active. Central administration of orexin A/hypocretin-1 strongly promotes wakefulness, increases body temperature, locomotion and elicits a strong increase in energy expenditure. Sleep deprivation also increases orexin A/hypocretin-1 transmission.  The orexin/hypocretin system may thus be more important in the regulation of energy expenditure than food intake. In fact, orexin/hypocretin-deficient narcoleptic patients have increased obesity rather than decreased [[Body mass index|BMI]], as would be expected if orexin/hypocretin were primarily an appetite stimulating peptide.
On the other hand, Sakurai and colleagues were studying the orexin system as [[orphan receptor]]s. To this end, they used transgenic cell lines that expressed individual orphan receptors and then exposed them to different potential ligands. They found that the orexin peptides activated the cells expressing the orexin receptors and went on find orexin peptide expression specifically in the hypothalamus. Additionally, when either orexin peptide was administered to rats it stimulated feeding, giving rise to the name 'orexin'.<ref name="pmid9491897"/>


[[Leptin]] is a hormone produced by fat cells and acts as a long-term internal measure of energy state. [[Ghrelin]] is a short term factor secreted by the stomach just before an expected meal, and strongly promotes food intake.  
The nomenclature of the orexin/hypocretin system now recognizes the history of its discovery. "Hypocretin" refers to the gene or genetic products and "orexin" refers to the protein, reflecting the differing approaches that resulted in its discovery. The use of both terms is also a practical necessity because "HCRT" is the standard gene symbol in databases like [[GenBank]] and "OX" is used to refer to the pharmacology of the peptide system by the [[International Union of Basic and Clinical Pharmacology]].<ref name="pmid22759794"/>


Orexin-producing cells have recently been shown to be inhibited by glucose but are activated by ghrelin.
== Isoforms ==
There are two types of orexin: [[orexin-A]] and -B (hypocretin-1 and -2). They are excitatory [[neuropeptide]]s with approximately 50% sequence identity, produced by cleavage of a single precursor protein. Orexin-A is 33 amino acid residues long and has two intrachain [[disulfide bond]]s; orexin-B is a linear 28 amino acid residue peptide. Although these peptides are produced by a very small population of cells in the lateral and posterior [[hypothalamus]], they send projections throughout the brain.  The orexin peptides bind to the two [[G-protein coupled receptor|G-protein coupled]] [[orexin receptor]]s, [[Hypocretin (orexin) receptor 1|OX<sub>1</sub>]] and [[Hypocretin (orexin) receptor 2|OX<sub>2</sub>]], with orexin-A binding to both OX<sub>1</sub> and OX<sub>2</sub> with approximately equal affinity while orexin-B binds mainly to OX<sub>2</sub> and is 5&nbsp;times less potent at OX<sub>1</sub>.<ref name="pmid14691055">{{cite journal | vauthors = Langmead CJ, Jerman JC, Brough SJ, Scott C, Porter RA, Herdon HJ | title = Characterisation of the binding of [3H]-SB-674042, a novel nonpeptide antagonist, to the human orexin-1 receptor | journal = British Journal of Pharmacology | volume = 141 | issue = 2 | pages = 340–6 | date = Jan 2004 | pmid = 14691055 | pmc = 1574197 | doi = 10.1038/sj.bjp.0705610 }}</ref>


Hypocretin-producing cells have recently been shown to be inhibited by leptin (by leptin receptors) but are activated by ghrelin and [[hypoglycemia]]. Orexin/hypocretin (as of 2007) is therefore a very important link between metabolism and sleep regulation. Such a relationship has been long suspected based on the observation that long-term sleep deprivation in rodents dramatically increases food intake and energy metabolism, i.e. [[catabolism]], with lethal consequences on a long term basis.
The orexins are strongly conserved peptides, found in all major classes of vertebrates.<ref>{{cite journal|author=Wong, K.K.|author2=Ng, S.Y.|author3=Lee, L.T.|author4=Ng, H.K.|author5=Chow, B.K.|year=2011|title=Orexins and their receptors from fish to mammals: a comparative approach|journal=General and comparative endocrinology|volume=171|issue=2|pages=124–130|pmid=21216246|doi=10.1016/j.ygcen.2011.01.001}}</ref>


The research on orexin/hypocretin is still in an early phase, although many scientists believe that orexin/hypocretin-based drugs could help [[narcolepsy|narcoleptics]] and increase alertness in the brain without the side effects of [[amfetamine|amphetamines]].
== Function ==
{{See also|Orexinergic projection system}}
The orexin system was initially suggested to be primarily involved in the stimulation of food intake, based on the finding that central administration of orexin-A and -B increased food intake. In addition, it stimulates wakefulness, regulates [[energy (psychological)|energy]] expenditure, and modulates visceral function.


Preliminary research has been conducted that shows potential for orexin blockers in the treatment of [[alcoholism]]. [[Brown rat|Lab rat]]s given drugs which targeted the orexin system lost interest in alcohol despite being given free access in experiments.<ref>{{cite news|url=http://www.worldcampaign.net/forum/view.php?id=1707|author=Helen Puttick|title=Hope in fight against alcoholism|date=December 26, 2006|publisher=[[The Herald (Glasgow)|The Herald]]}}</ref>
=== Brown fat activation ===
Obesity in orexin [[knockout mice]] is a result of inability of brown preadipocytes to differentiate into [[brown adipose tissue]] (BAT), which in turn reduces BAT [[thermogenesis]]. BAT differentiation can be restored in these knockout mice through injections of orexin. Deficiency in orexin has also been linked to [[narcolepsy]], a sleep disorder. Furthermore, narcoleptic people are more likely to be obese.  Hence obesity in narcoleptic patients may be due to orexin deficiency leading to impaired thermogenesis and energy expenditure.<ref name="pmid21982708">{{cite journal | vauthors = Sellayah D, Bharaj P, Sikder D | title = Orexin is required for brown adipose tissue development, differentiation, and function | journal = Cell Metabolism | volume = 14 | issue = 4 | pages = 478–90 | date = Oct 2011 | pmid = 21982708 | doi = 10.1016/j.cmet.2011.08.010 | laysummary = http://www.sciencedaily.com/releases/2011/10/111004123554.htm | laysource = ScienceDaily }}</ref>


==History and nomenclature==
=== Wakefulness ===
[[Masashi Yanagisawa]] and colleagues at the [[University of Texas Southwestern Medical Center at Dallas]], coined the term ''orexin'' to reflect the orexigenic (appetite-stimulating) activity of these hormones.  
Orexin seems to promote wakefulness. Recent studies indicate that a major role of the orexin system is to integrate metabolic, circadian and [[sleep debt]] influences to determine whether an animal should be asleep or awake and active. Orexin neurons strongly excite various brain nuclei with important roles in wakefulness including the [[dopamine]], [[norepinephrine]], [[histamine]] and [[acetylcholine]] systems<ref name="pmid9614245">{{cite journal | vauthors = Sherin JE, Elmquist JK, Torrealba F, Saper CB | title = Innervation of histaminergic tuberomammillary neurons by GABAergic and galaninergic neurons in the ventrolateral preoptic nucleus of the rat | journal = The Journal of Neuroscience | volume = 18 | issue = 12 | pages = 4705–21 | date = Jun 1998 | pmid = 9614245 | doi =  | url = http://www.jneurosci.org/cgi/content/full/18/12/4705 }}</ref><ref name="pmid12040064">{{cite journal | vauthors = Lu J, Bjorkum AA, Xu M, Gaus SE, Shiromani PJ, Saper CB | title = Selective activation of the extended ventrolateral preoptic nucleus during rapid eye movement sleep | journal = The Journal of Neuroscience | volume = 22 | issue = 11 | pages = 4568–76 | date = Jun 2002 | pmid = 12040064 | url = http://www.jneurosci.org/cgi/content/full/22/11/4568 }}</ref> and appear to play an important role in stabilizing wakefulness and sleep.


Luis DeLecea, Thomas Kilduff, and colleagues also reported discovery of these same peptides, dubbing them ''hypocretins'' to indicate that they are synthesized in the [[hypothalamus]] and to reflect their similarity to a class of hormones called [[incretin]]s (i.e., ''hypo''thalamic in''cretin'').  
The discovery that an orexin receptor mutation causes the [[sleep disorder]] canine [[narcolepsy]]<ref name="pmid10458611">{{cite journal | vauthors = Lin L, Faraco J, Li R, Kadotani H, Rogers W, Lin X, Qiu X, de Jong PJ, Nishino S, Mignot E | title = The sleep disorder canine narcolepsy is caused by a mutation in the hypocretin (orexin) receptor 2 gene | journal = Cell | volume = 98 | issue = 3 | pages = 365–76 | date = Aug 1999 | pmid = 10458611 | doi = 10.1016/S0092-8674(00)81965-0 }}</ref> in [[Doberman Pinscher]]s  subsequently indicated a major role for this system in [[sleep]] regulation. Genetic knockout mice lacking the gene for orexin were also reported to exhibit narcolepsy.<ref name="pmid10481909">{{cite journal | vauthors = Chemelli RM, Willie JT, Sinton CM, Elmquist JK, Scammell T, Lee C, Richardson JA, Williams SC, Xiong Y, Kisanuki Y, Fitch TE, Nakazato M, Hammer RE, Saper CB, Yanagisawa M | title = Narcolepsy in orexin knockout mice: molecular genetics of sleep regulation | journal = Cell | volume = 98 | issue = 4 | pages = 437–51 | date = Aug 1999 | pmid = 10481909 | doi = 10.1016/S0092-8674(00)81973-X }}</ref> Transitioning frequently and rapidly between sleep and wakefulness, these mice display many of the symptoms of narcolepsy. Researchers are using this animal model of narcolepsy to study the disease.<ref name="pmid15254084">{{cite journal | vauthors = Mochizuki T, Crocker A, McCormack S, Yanagisawa M, Sakurai T, Scammell TE | title = Behavioral state instability in orexin knock-out mice | journal = The Journal of Neuroscience | volume = 24 | issue = 28 | pages = 6291–300 | date = Jul 2004 | pmid = 15254084 | doi = 10.1523/JNEUROSCI.0586-04.2004 }}</ref> Narcolepsy results in [[excessive daytime sleepiness]], inability to consolidate wakefulness in the day (and sleep at night), and [[cataplexy]], which is the loss of muscle tone in response to strong, usually positive, emotions. Dogs that lack a functional receptor for orexin have narcolepsy, while animals and people lacking the orexin neuropeptide itself also have narcolepsy.


The name of this family of peptides is currently in dispute. The name "orexin" has been rejected by some due to evidence that the orexigenic effects of these peptides may be incidental or trivial, while other groups maintain that the name "hypocretin" is awkward, pointing out that many neuropeptides have names that are unrelated to their most important functions. The name "hyporexin" has been suggested as a compromise, but as of yet has not been commonly used. Both "orexin" and "hypocretin" will likely continue to appear in published works until a preferred name has been accepted by the scientific community.
Central administration of orexin-A strongly promotes wakefulness, increases body temperature and locomotion, and elicits a strong increase in energy expenditure. [[Sleep deprivation]] also increases orexin-A transmission.  The orexin system may thus be more important in the regulation of energy expenditure than food intake. In fact, orexin-deficient narcoleptic patients have increased obesity rather than decreased [[Body mass index|BMI]], as would be expected if orexin were primarily an appetite stimulating peptide.  Another indication that deficits of orexin cause narcolepsy is that depriving monkeys of sleep for 30–36&nbsp;hours and then injecting them with the neurochemical alleviates the cognitive deficiencies normally seen with such amount of sleep loss.<ref>{{cite web | url = https://www.wired.com/science/discoveries/news/2007/12/sleep_deprivation | title = Snorting a Brain Chemical Could Replace Sleep |accessdate = 2008-02-05 | author= [[Alexis Madrigal]] | date= 2007-12-28 | publisher = Wired News, Condé Nast  }}</ref><ref name="pmid18160631">{{cite journal | vauthors = Deadwyler SA, Porrino L, Siegel JM, Hampson RE | title = Systemic and nasal delivery of orexin-A (Hypocretin-1) reduces the effects of sleep deprivation on cognitive performance in nonhuman primates | journal = The Journal of Neuroscience | volume = 27 | issue = 52 | pages = 14239–47 | date = Dec 2007 | pmid = 18160631 | doi = 10.1523/JNEUROSCI.3878-07.2007 }}</ref>


==Drugs==
In humans, narcolepsy is associated with a specific variant of the [[human leukocyte antigen]] (HLA) complex.<ref name="pmid10984567">{{cite journal | vauthors = Klein J, Sato A | title = The HLA system. Second of two parts | journal = The New England Journal of Medicine | volume = 343 | issue = 11 | pages = 782–6 | date = Sep 2000 | pmid = 10984567 | doi = 10.1056/NEJM200009143431106 }}</ref> Furthermore, genome-wide analysis shows that, in addition to the HLA variant, narcoleptic humans also exhibit a specific genetic [[mutation]] in the [[T cell|T-cell]] [[T cell receptor|receptor]] alpha locus.<ref name="pmid19412176">{{cite journal | vauthors = Hallmayer J, Faraco J, Lin L, Hesselson S, Winkelmann J, Kawashima M, Mayer G, Plazzi G, Nevsimalova S, Bourgin P, Hong SC, Hong SS, Honda Y, Honda M, Högl B, Longstreth WT, Montplaisir J, Kemlink D, Einen M, Chen J, Musone SL, Akana M, Miyagawa T, Duan J, Desautels A, Erhardt C, Hesla PE, Poli F, Frauscher B, Jeong JH, Lee SP, Ton TG, Kvale M, Kolesar L, Dobrovolná M, Nepom GT, Salomon D, Wichmann HE, Rouleau GA, Gieger C, Levinson DF, Gejman PV, Meitinger T, Young T, Peppard P, Tokunaga K, Kwok PY, Risch N, Mignot E | title = Narcolepsy is strongly associated with the T-cell receptor alpha locus | journal = Nature Genetics | volume = 41 | issue = 6 | pages = 708–11 | date = Jun 2009 | pmid = 19412176 | pmc = 2803042 | doi = 10.1038/ng.372 }}</ref> In conjunction, these genetic anomalies cause the immune system to attack and kill the critical orexin neurons. Hence the absence of orexin-producing [[neuron]]s in narcoleptic humans may be the result of an [[autoimmunity|autoimmune]] disorder.<ref name="url_eurekalert">{{cite web | url = http://www.eurekalert.org/pub_releases/2009-05/sumc-nia042809.php | title = Narcolepsy is an autoimmune disorder, Stanford researcher says | date = 2009-05-03| format = | work = EurekAlert | publisher = American Association for the Advancement of Science | pages = | quote = | accessdate = 2009-05-31}}</ref>
[[SB649868]] is under development by [[GlaxoSmithKline]] for sleep disorders; it is an orexin receptor antagonist. ACT-078573 is a similar compound under development by Actelion.


==References==
=== Food intake ===
<references/>
Orexin increases the craving for food, and correlates with the function of the substances that promote its production. Orexin is also shown to increase meal size by suppressing inhibitory postingestive feedback.<ref>{{cite journal | vauthors = Baird JP, Choe A, Loveland JL, Beck J, Mahoney CE, Lord JS, Grigg LA | title = Orexin-A Hyperphagia: Hindbrain Participation in Consummatory Feeding Responses | journal = Endocrinology | volume = 150 | issue = 3 | pages = 1202–1206 | date = March 2009 | pmid = 19008313 | doi = 10.1210/en.2008-0293 | url = http://press.endocrine.org/doi/10.1210/en.2008-0293?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed | pmc=2654731}}</ref> However, some studies suggest that the stimulatory effects of orexin on feeding may be due to general arousal without necessarily increasing overall food intake.<ref>{{cite journal | vauthors = Ida T, Nakahara K, Katayama T, Murakami N, Nakazato M | title = Effect of lateral cerebroventricular injection of the appetite-stimulating neuropeptide, orexin and neuropeptide Y, on the various behavioral activities of rats | journal = Brain Research | volume = 821 | issue = 2 | pages = 526–529 | date = 1999-03-13 | pmid = 10064841 | doi = 10.1016/S0006-8993(99)01131-2 | url = http://www.sciencedirect.com/science/article/pii/S0006899399011312 }}</ref>


==External links==
[[Leptin]] is a hormone produced by fat cells and acts as a long-term internal measure of energy state. [[Ghrelin]] is a short-term factor secreted by the stomach just before an expected meal, and strongly promotes food intake.
* {{MeshName|orexins}}
 
Orexin-producing cells have recently been shown to be inhibited by leptin (through the leptin receptor pathway), but are activated by ghrelin and [[hypoglycemia]] ([[glucose]] inhibits orexin production). Orexin, as of 2007, is claimed to be a very important link between metabolism and sleep regulation.<ref>{{cite journal | vauthors = Brisbare-Roch C, Dingemanse J, Koberstein R, Hoever P, Aissaoui H, Flores S, Mueller C, Nayler O, van Gerven J, de Haas S, Hess P, Qiu C, Buchmann S, Scherz M, Weller T, Fischli W, Clozel M, Jenck F | title = Promotion of sleep by targeting the orexin system in rats, dogs and humans | journal = Nature Medicine | volume = 13 | issue = 2 | pages = 150–155 | date = 2007-01-28 | pmid = 17259994 | doi = 10.1038/nm1544 | url = http://www.nature.com/nm/journal/v13/n2/full/nm1544.html }}</ref><ref>{{cite journal | vauthors = Sakurai, T | title = The neural circuit of orexin (hypocretin): maintaining sleep and wakefulness | journal = Nature Reviews Neuroscience | volume = 8 | issue = 3 | pages = 171–181 | date = 2007-02-14 | pmid = 17299454 | doi = 10.1038/nrn2092 | url = http://www.nature.com/nrn/journal/v8/n3/full/nrn2092.html }}</ref> Such a relationship has been long suspected, based on the observation that long-term sleep deprivation in rodents dramatically increases food intake and energy metabolism, i.e., [[catabolism]], with lethal consequences on a long-term basis. Sleep deprivation then leads to a lack of energy. In order to make up for this lack of energy, many people use high-carbohydrate and high-fat foods that ultimately can lead to poor health and weight gain. Other dietary nutrients, amino acids, also can activate orexin neurons, and they can suppress the glucose response of orexin neurons at physiological concentration, causing the energy balance that orexin maintains to be thrown off its normal cycle.<ref>{{cite journal | vauthors = Inutsuka A, Yamanaka A | title = The physiological role of orexin/hypocretin neurons in the regulation of sleep/wakefulness and neuroendocrine functions | journal = Frontiers in Endocrinology | volume = 4 | issue = 18 | pages = 18 | date = 2013-03-06 | pmid = 23508038 | doi = 10.3389/fendo.2013.00018 | url = http://journal.frontiersin.org/article/10.3389/fendo.2013.00018/full | pmc=3589707}}</ref>
 
=== Addiction ===
Preliminary research has been conducted that shows potential for orexin blockers in the treatment of [[alcoholism]]. [[Brown rat|Lab rat]]s given drugs which targeted the orexin system lost interest in alcohol despite being given free access in experiments.<ref>{{cite news | url = http://www.worldcampaign.net/forum/view.php?id=1707 | author = Helen Puttick | title = Hope in fight against alcoholism | date = 2006-12-26 | publisher = [[The Herald (Glasgow)|The Herald]] }}</ref><ref name="pmid16751790">{{cite journal | vauthors = Lawrence AJ, Cowen MS, Yang HJ, Chen F, Oldfield B | title = The orexin system regulates alcohol-seeking in rats | journal = British Journal of Pharmacology | volume = 148 | issue = 6 | pages = 752–9 | date = Jul 2006 | pmid = 16751790 | pmc = 1617074 | doi = 10.1038/sj.bjp.0706789 }}</ref>
 
Because orexin-A receptors have been shown to regulate relapse to cocaine seeking, a new study investigated its relation to nicotine by studying rats. By blocking the orexin-A receptor with low doses of the selective [[orexin antagonist]] [[SB-334,867]], nicotine [[self-administration]] decreased and also the motivation to seek and obtain the drug. The study showed that blocking of receptors in the [[Insular cortex|insula]] decreased [[self-administration]], but not blocking of receptors in the adjacent [[somatosensory cortex]]. The greatest decrease in self-administration was found when blocking all orexin-A receptors in the brain as a whole. A rationale for this study was the fact that the insula has been implicated in regulating feelings of craving. The insula contains orexin-A receptors. It has been reported that smokers who sustained damage to the insula lost the desire to smoke.<ref name="urlBlocking A Neuropeptide Receptor Decreases Nicotine Addiction">{{cite web | url = http://www.sciencedaily.com/releases/2008/11/081124174851.htm | title = Blocking A Neuropeptide Receptor Decreases Nicotine Addiction | date = 2008-12-01 | work = | publisher = ScienceDaily LLC | pages = | quote = | accessdate = 2009-02-11}}</ref>
 
=== Lipid metabolism ===
Orexin-A (OXA) has been recently demonstrated to have a direct effect on an aspect of [[lipid]] metabolism. OXA stimulates [[glucose]] uptake in 3T3-L1 [[adipocytes]] and that increased energy uptake is stored as lipids ([[triacylglycerol]]). OXA thus increases [[lipogenesis]]. It also inhibits [[lipolysis]] and stimulates the secretion of [[adiponectin]]. These effects are thought to be mostly conferred via the [[PI3K]] pathway because this pathway inhibitor (LY294002) completely blocks OXA effects in adipocytes.<ref>{{cite journal | vauthors = Skrzypski M, T Le T, Kaczmarek P, Pruszynska-Oszmalek E, Pietrzak P, Szczepankiewicz D, Kolodziejski PA, Sassek M, Arafat A, Wiedenmann B, Nowak KW, Strowski MZ | title = Orexin A stimulates glucose uptake, lipid accumulation and adiponectin secretion from 3T3-L1 adipocytes and isolated primary rat adipocytes | journal = Diabetologia | volume = 54 | issue = 7 | pages = 1841–52 | date = Jul 2011 | pmid = 21505958 | doi = 10.1007/s00125-011-2152-2 }}</ref> The link between OXA and the lipid metabolism is new and currently under more research.
 
Obesity in orexin-[[knockout mice]] is associated with impaired [[brown adipose tissue]] thermogenesis.<ref name="pmid21982708" />
 
=== Mood ===
High levels of orexin-A have been associated with happiness in human subjects, while low levels have been associated with sadness.<ref name="happiness">{{cite journal | vauthors = Blouin AM, Fried I, Wilson CL, Staba RJ, Behnke EJ, Lam HA, Maidment NT, Karlsson KÆ, Lapierre JL, Siegel JM | title = Human hypocretin and melanin-concentrating hormone levels are linked to emotion and social interaction | journal = Nature Communications | volume = 4 | pages = 1547 | year = 2013 | pmid = 23462990 | pmc = 3595130 | doi = 10.1038/ncomms2461 | laysummary = http://www.sciencedaily.com/releases/2013/03/130307145720.htm | laysource = Science Daily }}</ref> The finding suggests that boosting levels of orexin-A could elevate mood in humans, being thus a possible future treatment for disorders like depression.
 
== Orexin neuron neurotransmitters ==
 
Orexinergic neurons have been shown to be sensitive to inputs from Group III [[metabotropic glutamate receptors]],<ref name="pmid15044540">{{cite journal | vauthors = Acuna-Goycolea C, Li Y, Van Den Pol AN | title = Group III metabotropic glutamate receptors maintain tonic inhibition of excitatory synaptic input to hypocretin/orexin neurons | journal = The Journal of Neuroscience | volume = 24 | issue = 12 | pages = 3013–22 | date = Mar 2004 | pmid = 15044540 | doi = 10.1523/JNEUROSCI.5416-03.2004 }}</ref> [[cannabinoid receptor 1]] and {{abbr|CB1–OX1|cannabinoid-1 and orexin-1}} [[GPCR oligomer|receptor heterodimer]]s,<ref name="Cannabinoid-Orexin systemic cross-talk">{{cite journal | vauthors = Flores A, Maldonado R, Berrendero F | title = Cannabinoid-hypocretin cross-talk in the central nervous system: what we know so far | journal = Frontiers in Neuroscience | volume = 7 | issue =  | pages = 256 | year = 2013 | pmid = 24391536 | pmc = 3868890 | doi = 10.3389/fnins.2013.00256 | quote = Direct CB1-HcrtR1 interaction was first proposed in 2003 (Hilairet et al., 2003). Indeed, a 100-fold increase in the potency of hypocretin-1 to activate the ERK signaling was observed when CB1 and HcrtR1 were co-expressed&nbsp;...  In this study, a higher potency of hypocretin-1 to regulate CB1-HcrtR1 heteromer compared with the HcrtR1-HcrtR1 homomer was reported (Ward et al., 2011b). These data provide unambiguous identification of CB1-HcrtR1 heteromerization, which has a substantial functional impact.&nbsp;... The existence of a cross-talk between the hypocretinergic and endocannabinoid systems is strongly supported by their partially overlapping anatomical distribution and common role in several physiological and pathological processes. However, little is known about the mechanisms underlying this interaction. }}<br />{{bull}}[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868890/figure/F1/ Figure 1: Schematic of brain CB1 expression and orexinergic neurons expressing OX1 or OX2]<br />{{bull}}[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868890/figure/F2/ Figure 2: Synaptic signaling mechanisms in cannabinoid and orexin systems]<br />{{bull}}[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868890/figure/F3/ Figure 3: Schematic of brain pathways involved in food intake]</ref><ref name="OX1-CB1 heterodimer review of function">{{cite journal | vauthors = Thompson MD, Xhaard H, Sakurai T, Rainero I, Kukkonen JP | title = OX1 and OX2 orexin/hypocretin receptor pharmacogenetics | journal = Frontiers in Neuroscience | volume = 8 | issue =  | pages = 57 | year = 2014 | pmid = 24834023 | pmc = 4018553 | doi = 10.3389/fnins.2014.00057 | quote = OX1–CB1 dimerization was suggested to strongly potentiate orexin receptor signaling, but a likely explanation for the signal potentiation is, instead, offered by the ability of OX1 receptor signaling to produce 2-arachidonoyl glycerol, a CB1 receptor ligand, and a subsequent co-signaling of the receptors (Haj-Dahmane and Shen, 2005; Turunen et al., 2012; Jäntti et al., 2013). However, this does not preclude dimerization. }}</ref><ref name="Human heterodimers: OX1–OX2 OX1–CB1 OX2–CB1">{{cite journal | vauthors = Jäntti MH, Mandrika I, Kukkonen JP | title = Human orexin/hypocretin receptors form constitutive homo- and heteromeric complexes with each other and with human CB1 cannabinoid receptors | journal = Biochemical and Biophysical Research Communications | volume = 445 | issue = 2 | pages = 486–90 | date = Mar 2014 | pmid = 24530395 | doi = 10.1016/j.bbrc.2014.02.026 | quote = Orexin receptor subtypes readily formed homo- and hetero(di)mers, as suggested by significant BRET signals. CB1 receptors formed homodimers, and they also heterodimerized with both orexin receptors.&nbsp;... In conclusion, orexin receptors have a significant propensity to make homo- and heterodi-/oligomeric complexes. However, it is unclear whether this affects their signaling. As orexin receptors efficiently signal via endocannabinoid production to CB1 receptors, dimerization could be an effective way of forming signal complexes with optimal cannabinoid concentrations available for cannabinoid receptors. }}</ref> [[adenosine A1 receptor|adenosine A<sub>1</sub> receptors]],<ref name="pmid17093123">{{cite journal | vauthors = Liu ZW, Gao XB | title = Adenosine inhibits activity of hypocretin/orexin neurons by the A1 receptor in the lateral hypothalamus: a possible sleep-promoting effect | journal = Journal of Neurophysiology | volume = 97 | issue = 1 | pages = 837–48 | date = Jan 2007 | pmid = 17093123 | pmc = 1783688 | doi = 10.1152/jn.00873.2006 }}</ref> [[Muscarinic acetylcholine receptor M3|muscarinic M<sub>3</sub> receptors]],<ref name="pmid18344611">{{cite journal | vauthors = Ohno K, Hondo M, Sakurai T | title = Cholinergic regulation of orexin/hypocretin neurons through M(3) muscarinic receptor in mice | journal = Journal of Pharmacological Sciences | volume = 106 | issue = 3 | pages = 485–91 | date = Mar 2008 | pmid = 18344611 | doi = 10.1254/jphs.FP0071986 | url = http://joi.jlc.jst.go.jp/JST.JSTAGE/jphs/FP0071986?from=PubMed | archive-url = https://archive.is/20121219051258/http://joi.jlc.jst.go.jp/JST.JSTAGE/jphs/FP0071986?from=PubMed | dead-url = yes | archive-date = 2012-12-19 }}</ref> serotonin [[5-HT1A receptor|5-HT<sub>1A</sub> receptors]],<ref name="pmid15306649">{{cite journal | vauthors = Muraki Y, Yamanaka A, Tsujino N, Kilduff TS, Goto K, Sakurai T | title = Serotonergic regulation of the orexin/hypocretin neurons through the 5-HT1A receptor | journal = The Journal of Neuroscience | volume = 24 | issue = 32 | pages = 7159–66 | date = Aug 2004 | pmid = 15306649 | doi = 10.1523/JNEUROSCI.1027-04.2004 }}</ref> [[neuropeptide Y]] receptors,<ref name="pmid15470140">{{cite journal | vauthors = Fu LY, Acuna-Goycolea C, van den Pol AN | title = Neuropeptide Y inhibits hypocretin/orexin neurons by multiple presynaptic and postsynaptic mechanisms: tonic depression of the hypothalamic arousal system | journal = The Journal of Neuroscience | volume = 24 | issue = 40 | pages = 8741–51 | date = Oct 2004 | pmid = 15470140 | doi = 10.1523/JNEUROSCI.2268-04.2004 }}</ref> [[cholecystokinin A receptor]]s,<ref name="pmid16093397">{{cite journal | vauthors = Tsujino N, Yamanaka A, Ichiki K, Muraki Y, Kilduff TS, Yagami K, Takahashi S, Goto K, Sakurai T | title = Cholecystokinin activates orexin/hypocretin neurons through the cholecystokinin A receptor | journal = The Journal of Neuroscience | volume = 25 | issue = 32 | pages = 7459–69 | date = Aug 2005 | pmid = 16093397 | doi = 10.1523/JNEUROSCI.1193-05.2005 }}</ref> and [[catecholamines]],<ref name="pmid15634779">{{cite journal | vauthors = Li Y, van den Pol AN | title = Direct and indirect inhibition by catecholamines of hypocretin/orexin neurons | journal = The Journal of Neuroscience | volume = 25 | issue = 1 | pages = 173–83 | date = Jan 2005 | pmid = 15634779 | doi = 10.1523/JNEUROSCI.4015-04.2005 }}</ref><ref name="pmid16611835">{{cite journal | vauthors = Yamanaka A, Muraki Y, Ichiki K, Tsujino N, Kilduff TS, Goto K, Sakurai T | title = Orexin neurons are directly and indirectly regulated by catecholamines in a complex manner | journal = Journal of Neurophysiology | volume = 96 | issue = 1 | pages = 284–98 | date = Jul 2006 | pmid = 16611835 | doi = 10.1152/jn.01361.2005 }}</ref> as well as to [[ghrelin]], [[leptin]], and [[glucose]].<ref name="pmid17910982">{{cite journal | vauthors = Ohno K, Sakurai T | title = Orexin neuronal circuitry: role in the regulation of sleep and wakefulness | journal = Frontiers in Neuroendocrinology | volume = 29 | issue = 1 | pages = 70–87 | date = Jan 2008 | pmid = 17910982 | doi = 10.1016/j.yfrne.2007.08.001 }}</ref> Orexinergic neurons themselves regulate release of [[acetylcholine]],<ref name="pmid14622212">{{cite journal | vauthors = Bernard R, Lydic R, Baghdoyan HA | title = Hypocretin-1 causes G protein activation and increases ACh release in rat pons | journal = The European Journal of Neuroscience | volume = 18 | issue = 7 | pages = 1775–85 | date = Oct 2003 | pmid = 14622212 | doi = 10.1046/j.1460-9568.2003.02905.x }}</ref><ref name="pmid17928158">{{cite journal | vauthors = Frederick-Duus D, Guyton MF, Fadel J | title = Food-elicited increases in cortical acetylcholine release require orexin transmission | journal = Neuroscience | volume = 149 | issue = 3 | pages = 499–507 | date = Nov 2007 | pmid = 17928158 | doi = 10.1016/j.neuroscience.2007.07.061 }}</ref> [[serotonin]], and [[noradrenaline]].<ref name="pmid15111023">{{cite journal | vauthors = Soffin EM, Gill CH, Brough SJ, Jerman JC, Davies CH | title = Pharmacological characterisation of the orexin receptor subtype mediating postsynaptic excitation in the rat dorsal raphe nucleus | journal = Neuropharmacology | volume = 46 | issue = 8 | pages = 1168–76 | date = Jun 2004 | pmid = 15111023 | doi = 10.1016/j.neuropharm.2004.02.014 }}</ref>
 
== Clinical Uses ==
 
The orexin/hypocretin system is the target of the insomnia medication [[suvorexant]] (trade name: [[Belsomra]]), which works by blocking both orexin receptors. Suvorexant has undergone three phase III trials and was approved on August 13, 2014 by the [[US Food and Drug Administration]] (FDA) after being denied approval the year before.<ref>{{cite web|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm409950.htm|title=FDA approves new type of sleep drug, Belsomra|work=Food and Drug Administration (FDA)|date=2014-08-31|editor-last=Ventura|editor-first=Jeff|accessdate=2015-10-31}}</ref> It is available as "[[Belsomra]]".<ref>{{cite web|url=http://www.belsomra.com/|title=BELSOMRA® (suvorexant) C-IV |work=Belsomra |accessdate=2015-10-31}}</ref>
 
In 2016, the [[University of Texas Health Science Center]] registered a clinical trial for the use of suvorexant for people with [[cocaine dependence]]. They plan to measure cue reactivity, anxiety and stress.<ref>{{cite web|url=https://clinicaltrials.gov/ct2/show/NCT02785406|title=Role of the Orexin Receptor System in Stress, Sleep and Cocaine Use (NCT02785406) |work=ClinicalTrials.gov |accessdate=2017-07-08}}</ref>
 
=== Other potential uses ===


{{Neuropeptides}}
Intranasal orexin is able to increase cognition in primates, especially under sleep deprived situations,<ref>{{cite journal|last1=Nixon|first1=Joshua P.|last2=Mavanji|first2=Vijayakumar|last3=Butterick|first3=Tammy A.|last4=Billington|first4=Charles J.|last5=Kotz|first5=Catherine M.|last6=Teske|first6=Jennifer A.|title=Sleep disorders, obesity, and aging: the role of orexin|journal=Ageing research reviews|date=24 January 2017|volume=20|pages=63–73|doi=10.1016/j.arr.2014.11.001|pmc=4467809|issn=1568-1637|pmid=25462194}}</ref> which may provide an opportunity for treatment excessive daytime sleepiness.<ref>{{cite journal|last1=Billiard|first1=Michel|title=Narcolepsy: current treatment options and future approaches|journal=Neuropsychiatric Disease and Treatment|date=24 January 2017|volume=4|issue=3|pages=557–566|pmc=2526380|issn=1176-6328|pmid=18830438}}</ref>


[[Category:Endocrinology]]
A study has reported that transplantation of orexin neurons into the pontine [[reticular formation]] in rats is feasible, indicating the development of alternative therapeutic strategies in addition to pharmacological interventions to treat narcolepsy.<ref name="pmid15683135">{{cite journal | vauthors = Arias-Carrión O, Murillo-Rodriguez E, Xu M, Blanco-Centurion C, Drucker-Colín R, Shiromani PJ | title = Transplantation of hypocretin neurons into the pontine reticular formation: preliminary results | journal = Sleep | volume = 27 | issue = 8 | pages = 1465–70 | date = Dec 2004 | pmid = 15683135 | pmc = 1201562 | doi =  | url = http://www.journalsleep.org/Articles/270802.pdf }}</ref>
[[Category:peptide hormones]]
[[Category:neuropeptides]]


== References ==
{{Reflist|30em}}


== External links ==
* {{MeshName|orexins}}
* [https://sleepfoundation.org/sleep-news/compare-different-sleep-aids Compare Different Sleep Aids], ''National Sleep Foundation''
* [https://sleepfoundation.org/sleep-news/orexin-receptor-antagonists-new-class-sleeping-pill Orexin receptor antagonists: A new class of sleeping pill], ''National Sleep Foundation''


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{{Orexigenics}}
[[de:Orexine]]
{{Neuropeptides}}
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{{Neuropeptidergics}}
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Revision as of 15:48, 18 October 2017

Prepro-orexin
File:1R02 crystallography.png
Solution phase NMR structure of orexin A based on the PDB coordinates 1R02​.
Identifiers
SymbolOrexin
PfamPF02072
InterProIPR001704
SCOP1cq0
SUPERFAMILY1cq0
OPM superfamily154
OPM protein1wso
orexin (hypocretin) neuropeptide precursor
File:1CQ0 crystallography.png
Solution phase NMR structure of orexin B based on the PDB coordinates 1CQ0​.
Identifiers
SymbolHCRT
Alt. symbolsPPOX, OX
Entrez3060
HUGO4847
OMIM602358
RefSeqNM_001524
UniProtO43612
Other data
LocusChr. 17 q21

Orexin, also called hypocretin, is a neuropeptide that regulates arousal, wakefulness, and appetite.[1] The most common form of narcolepsy, in which the sufferer briefly loses muscle tone (cataplexy), is caused by a lack of orexin in the brain due to destruction of the cells that produce it.[2]

There are approximately 70,000 orexin-producing neurons in the human brain that project from the lateral hypothalamus to neurons and brain regions that modulate wakefulness.[1][2] However, the axons from these neurons extend throughout the entire brain and spinal cord,[3] where there are also receptors for orexin.

Orexin was discovered in 1998 almost simultaneously by two independent groups of rat-brain researchers.[4][5] One group named it orexin, from orexis, meaning "appetite" in Greek; the other group named it hypocretin, because it is produced in the hypothalamus and bears a weak resemblance to secretin, another peptide.[2] The use of both terms is now a practical necessity, as hypocretin is used to refer to the genetic products and orexin is used to refer to the protein products.[6]

Discovery

In 1998, reports of the discovery of orexin/hypocretin were published nearly simultaneously. Luis de Lecea, Thomas Kilduff, and colleagues reported the discovery of the hypocretin system at the same time as Takeshi Sakurai from Masashi Yanagisawa's lab at the University of Texas Southwestern Medical Center at Dallas reported the discovery of the orexins to reflect the orexigenic (appetite-stimulating) activity of these peptides. In their 1998 paper describing these neuropeptides, they also reported discovery of two orexin receptors, dubbed OX1R and OX2R.[4].

The two groups also took different approaches towards their discovery. One team was interested in finding new genes that were expressed in the hypothalamus. In 1996, scientists from the Scripps Research Institute reported the discovery of several genes in the rat brain, including one they dubbed "clone 35." Their work showed that clone 35 expression was limited to the lateral hypothalamus.[7] They extracted selective DNA found in the lateral hypothalamus. They cloned this DNA and studied it using electron microscopy. Neurotransmitters found in this area were oddly similar to the gut hormone, secretin, a member of the incretin family, so they named hypocretin to stand for a hypothalamic member of the incretin family.[8] These cells were first thought to reside and work only within the lateral hypothalamus area, but immunocytochemistry tactics revealed the various projections this area truly had to other parts of the brain. A majority of these projections reached the limbic system and structures associated with it (including the amygdala, septum, and basal forebrain area).

On the other hand, Sakurai and colleagues were studying the orexin system as orphan receptors. To this end, they used transgenic cell lines that expressed individual orphan receptors and then exposed them to different potential ligands. They found that the orexin peptides activated the cells expressing the orexin receptors and went on find orexin peptide expression specifically in the hypothalamus. Additionally, when either orexin peptide was administered to rats it stimulated feeding, giving rise to the name 'orexin'.[4]

The nomenclature of the orexin/hypocretin system now recognizes the history of its discovery. "Hypocretin" refers to the gene or genetic products and "orexin" refers to the protein, reflecting the differing approaches that resulted in its discovery. The use of both terms is also a practical necessity because "HCRT" is the standard gene symbol in databases like GenBank and "OX" is used to refer to the pharmacology of the peptide system by the International Union of Basic and Clinical Pharmacology.[6]

Isoforms

There are two types of orexin: orexin-A and -B (hypocretin-1 and -2). They are excitatory neuropeptides with approximately 50% sequence identity, produced by cleavage of a single precursor protein. Orexin-A is 33 amino acid residues long and has two intrachain disulfide bonds; orexin-B is a linear 28 amino acid residue peptide. Although these peptides are produced by a very small population of cells in the lateral and posterior hypothalamus, they send projections throughout the brain. The orexin peptides bind to the two G-protein coupled orexin receptors, OX1 and OX2, with orexin-A binding to both OX1 and OX2 with approximately equal affinity while orexin-B binds mainly to OX2 and is 5 times less potent at OX1.[9]

The orexins are strongly conserved peptides, found in all major classes of vertebrates.[10]

Function

The orexin system was initially suggested to be primarily involved in the stimulation of food intake, based on the finding that central administration of orexin-A and -B increased food intake. In addition, it stimulates wakefulness, regulates energy expenditure, and modulates visceral function.

Brown fat activation

Obesity in orexin knockout mice is a result of inability of brown preadipocytes to differentiate into brown adipose tissue (BAT), which in turn reduces BAT thermogenesis. BAT differentiation can be restored in these knockout mice through injections of orexin. Deficiency in orexin has also been linked to narcolepsy, a sleep disorder. Furthermore, narcoleptic people are more likely to be obese. Hence obesity in narcoleptic patients may be due to orexin deficiency leading to impaired thermogenesis and energy expenditure.[11]

Wakefulness

Orexin seems to promote wakefulness. Recent studies indicate that a major role of the orexin system is to integrate metabolic, circadian and sleep debt influences to determine whether an animal should be asleep or awake and active. Orexin neurons strongly excite various brain nuclei with important roles in wakefulness including the dopamine, norepinephrine, histamine and acetylcholine systems[12][13] and appear to play an important role in stabilizing wakefulness and sleep.

The discovery that an orexin receptor mutation causes the sleep disorder canine narcolepsy[14] in Doberman Pinschers subsequently indicated a major role for this system in sleep regulation. Genetic knockout mice lacking the gene for orexin were also reported to exhibit narcolepsy.[15] Transitioning frequently and rapidly between sleep and wakefulness, these mice display many of the symptoms of narcolepsy. Researchers are using this animal model of narcolepsy to study the disease.[16] Narcolepsy results in excessive daytime sleepiness, inability to consolidate wakefulness in the day (and sleep at night), and cataplexy, which is the loss of muscle tone in response to strong, usually positive, emotions. Dogs that lack a functional receptor for orexin have narcolepsy, while animals and people lacking the orexin neuropeptide itself also have narcolepsy.

Central administration of orexin-A strongly promotes wakefulness, increases body temperature and locomotion, and elicits a strong increase in energy expenditure. Sleep deprivation also increases orexin-A transmission. The orexin system may thus be more important in the regulation of energy expenditure than food intake. In fact, orexin-deficient narcoleptic patients have increased obesity rather than decreased BMI, as would be expected if orexin were primarily an appetite stimulating peptide. Another indication that deficits of orexin cause narcolepsy is that depriving monkeys of sleep for 30–36 hours and then injecting them with the neurochemical alleviates the cognitive deficiencies normally seen with such amount of sleep loss.[17][18]

In humans, narcolepsy is associated with a specific variant of the human leukocyte antigen (HLA) complex.[19] Furthermore, genome-wide analysis shows that, in addition to the HLA variant, narcoleptic humans also exhibit a specific genetic mutation in the T-cell receptor alpha locus.[20] In conjunction, these genetic anomalies cause the immune system to attack and kill the critical orexin neurons. Hence the absence of orexin-producing neurons in narcoleptic humans may be the result of an autoimmune disorder.[21]

Food intake

Orexin increases the craving for food, and correlates with the function of the substances that promote its production. Orexin is also shown to increase meal size by suppressing inhibitory postingestive feedback.[22] However, some studies suggest that the stimulatory effects of orexin on feeding may be due to general arousal without necessarily increasing overall food intake.[23]

Leptin is a hormone produced by fat cells and acts as a long-term internal measure of energy state. Ghrelin is a short-term factor secreted by the stomach just before an expected meal, and strongly promotes food intake.

Orexin-producing cells have recently been shown to be inhibited by leptin (through the leptin receptor pathway), but are activated by ghrelin and hypoglycemia (glucose inhibits orexin production). Orexin, as of 2007, is claimed to be a very important link between metabolism and sleep regulation.[24][25] Such a relationship has been long suspected, based on the observation that long-term sleep deprivation in rodents dramatically increases food intake and energy metabolism, i.e., catabolism, with lethal consequences on a long-term basis. Sleep deprivation then leads to a lack of energy. In order to make up for this lack of energy, many people use high-carbohydrate and high-fat foods that ultimately can lead to poor health and weight gain. Other dietary nutrients, amino acids, also can activate orexin neurons, and they can suppress the glucose response of orexin neurons at physiological concentration, causing the energy balance that orexin maintains to be thrown off its normal cycle.[26]

Addiction

Preliminary research has been conducted that shows potential for orexin blockers in the treatment of alcoholism. Lab rats given drugs which targeted the orexin system lost interest in alcohol despite being given free access in experiments.[27][28]

Because orexin-A receptors have been shown to regulate relapse to cocaine seeking, a new study investigated its relation to nicotine by studying rats. By blocking the orexin-A receptor with low doses of the selective orexin antagonist SB-334,867, nicotine self-administration decreased and also the motivation to seek and obtain the drug. The study showed that blocking of receptors in the insula decreased self-administration, but not blocking of receptors in the adjacent somatosensory cortex. The greatest decrease in self-administration was found when blocking all orexin-A receptors in the brain as a whole. A rationale for this study was the fact that the insula has been implicated in regulating feelings of craving. The insula contains orexin-A receptors. It has been reported that smokers who sustained damage to the insula lost the desire to smoke.[29]

Lipid metabolism

Orexin-A (OXA) has been recently demonstrated to have a direct effect on an aspect of lipid metabolism. OXA stimulates glucose uptake in 3T3-L1 adipocytes and that increased energy uptake is stored as lipids (triacylglycerol). OXA thus increases lipogenesis. It also inhibits lipolysis and stimulates the secretion of adiponectin. These effects are thought to be mostly conferred via the PI3K pathway because this pathway inhibitor (LY294002) completely blocks OXA effects in adipocytes.[30] The link between OXA and the lipid metabolism is new and currently under more research.

Obesity in orexin-knockout mice is associated with impaired brown adipose tissue thermogenesis.[11]

Mood

High levels of orexin-A have been associated with happiness in human subjects, while low levels have been associated with sadness.[31] The finding suggests that boosting levels of orexin-A could elevate mood in humans, being thus a possible future treatment for disorders like depression.

Orexin neuron neurotransmitters

Orexinergic neurons have been shown to be sensitive to inputs from Group III metabotropic glutamate receptors,[32] cannabinoid receptor 1 and CB1–OX1 receptor heterodimers,[33][34][35] adenosine A1 receptors,[36] muscarinic M3 receptors,[37] serotonin 5-HT1A receptors,[38] neuropeptide Y receptors,[39] cholecystokinin A receptors,[40] and catecholamines,[41][42] as well as to ghrelin, leptin, and glucose.[43] Orexinergic neurons themselves regulate release of acetylcholine,[44][45] serotonin, and noradrenaline.[46]

Clinical Uses

The orexin/hypocretin system is the target of the insomnia medication suvorexant (trade name: Belsomra), which works by blocking both orexin receptors. Suvorexant has undergone three phase III trials and was approved on August 13, 2014 by the US Food and Drug Administration (FDA) after being denied approval the year before.[47] It is available as "Belsomra".[48]

In 2016, the University of Texas Health Science Center registered a clinical trial for the use of suvorexant for people with cocaine dependence. They plan to measure cue reactivity, anxiety and stress.[49]

Other potential uses

Intranasal orexin is able to increase cognition in primates, especially under sleep deprived situations,[50] which may provide an opportunity for treatment excessive daytime sleepiness.[51]

A study has reported that transplantation of orexin neurons into the pontine reticular formation in rats is feasible, indicating the development of alternative therapeutic strategies in addition to pharmacological interventions to treat narcolepsy.[52]

References

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     • Figure 1: Schematic of brain CB1 expression and orexinergic neurons expressing OX1 or OX2
     • Figure 2: Synaptic signaling mechanisms in cannabinoid and orexin systems
     • Figure 3: Schematic of brain pathways involved in food intake
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