British Journal of Nutrition

Horizons in Nutritional Science

Hypoxia in adipose tissue: a basis for the dysregulation of tissue function in obesity?

Paul Trayhurna1 c1, Bohan Wanga1 and I. Stuart Wooda1

a1 Obesity Biology Unit, School of Clinical Sciences, University of Liverpool, University Clinical Departments, Duncan Building, Liverpool L69 3GA, UK


White adipose tissue is a key endocrine and secretory organ, releasing multiple adipokines, many of which are linked to inflammation and immunity. During the expansion of adipose tissue mass in obesity there is a major inflammatory response in the tissue with increased expression and release of inflammation-related adipokines, including IL-6, leptin, monocyte chemoattractant protein-1 and TNF-α, together with decreased adiponectin production. We proposed in 2004 (Trayhurn & Wood, Br J Nutr 92, 347–355) that inflammation in adipose tissue in obesity is a response to hypoxia in enlarged adipocytes distant from the vasculature. Hypoxia has now been directly demonstrated in adipose tissue of several obese mouse models (ob/ob, KKAy, diet-induced) and molecular studies indicate that the level of the hypoxia-inducible transcription factor, hypoxia-inducible factor-1α, is increased, as is expression of the hypoxia-sensitive marker gene, GLUT1. Cell- culture studies on murine and human adipocytes show that hypoxia (induced by low O2 or chemically) leads to stimulation of the expression and secretion of a number of inflammation-related adipokines, including angiopoietin-like protein 4, IL-6, leptin, macrophage migration inhibitory factor and vascular endothelial growth factor. Hypoxia also stimulates the inflammatory response of macrophages and inhibits adipocyte differentiation from preadipocytes. GLUT1 gene expression, protein level and glucose transport by human adipocytes are markedly increased by hypoxia, indicating that low O2 tension stimulates glucose utilisation. It is suggested that hypoxia has a pervasive effect on adipocyte metabolism and on overall adipose tissue function, underpinning the inflammatory response in the tissue in obesity and the subsequent development of obesity-associated diseases, particularly type 2 diabetes and the metabolic syndrome.

(Received November 23 2007)

(Revised January 11 2008)

(Accepted January 14 2008)

(Online publication April 09 2008)


c1 Corresponding author: Professor Paul Trayhurn, fax +44 151 706 5802, email


Abbreviations: HIF, hypoxia-inducible factor; MIF, macrophage migration inhibitory factor; MT, metallothionein; PAI-1, plasminogen activator inhibitor-1; VEGF, vascular endothelial growth factor; WAT, white adipose tissue