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'''Zerona''' is a low-level laser device developed by Erchonia Corp. for non-invasive body slimming of the waist, hips, and thighs. It has been shown to disrupt [[adipocyte]], or fat cell, membranes causing the release of stored [[lipids]] and fatty material, in turn, promoting adipocyte collapse. The device was first introduced to the market in 2008 as an [[off-label use]] device (contracted; show full)zed, double-blind, multi-centered clinical study was performed to evaluate the clinical utility of this application as an adjunct to liposuction and found that laser therapy decreased operating room times, increased the volume of fat extracted, less force was required by the physician to breakup fat, and the recovery for patients was significantly improved.<ref name=pmc2790317/> Based on the findings of this study the FDA cleared the EML device in 2001 for use as an adjunctive therapy to liposuction.
{{Citation needed|date=July 2011}}

The next logical transition was to evaluate the body’s capacity to remove the liberated fatty material, in turn, positioning this technology as a non-invasive body slimming application.{{Citation needed|date=July 2011}}<ref>http://www.accessdata.fda.gov/cdrh_docs/pdf7/K072206.pdf</ref>

== Mechanism of action ==
The exact mechanism of action for the Zerona is not fully understood. As a low-level laser device the theory of action is defined as bioorganic [[photochemistry]], a discipline that explores the interaction between [[photons]] and biochemical pathways within cells.  Like many other science principles, bioorganic photochemistry is defined by laws, and the first law of [[photochemistry]] states that a photoabsorbing structure must be present to yield a clinical outcome. [[Cytochrome c oxidase]], a terminal enzyme found within the [[electron transport chain]] of the [[mitochondria]], has been reported{{By whom|date=July 2011}} by Karu et al. (2010) to function as a photoabsorbing complex within eukaryotic cells ([[eukaryote]]).{{Citation needed|date=July 2011}} <ref>http://www.isan.troitsk.ru/dls/publ3/344.pdf</ref> This enzyme is responsible for facilitating the transport of electrons across the [[inner mitochondrial membrane]] to reduce oxygen and generate a proton [[electrochemical gradient]]. Cytochrome c oxidase serves an important role in the metabolic process known as [[oxidative phosphorylation]], which is the production of the high energy molecule [[adenosine triphosphate]] (ATP).<ref>{{cite book |first1=Reginald |last1=Garrett |first2=Charles M. |last2=Grisham |chapter=Electron Transport and Oxidative (contracted; show full)molecule participates in numerous pathways within a cell. However, as the concentration of ROS elevates a process known as [[lipid peroxidation]] can occur where ROS reacts with lipids found within cell membranes temporarily damaging them.<ref name=pmid16248161/><ref name=pmid8570716/> It has been hypothesized that the Zerona, as a low-level laser device, modulates cell metabolism resulting in a transient rise of ROS which temporarily degrades the membrane creating transitory pores or openings.
 Presently, studies are on-going to fully elucidate the underlying mechanism of action.{{Citation needed|date=July 2011}}

== Clinical trial ==
In 2008, the clinical trial to investigate the efficacy of Zerona commenced. The trial enrolled 67 subjects, 35 of which were randomly assigned to receive active treatment with 32 randomly assigned to the control group. Both groups were asked to sign an affidavit stating that during the clinical trial they would make no changes to their lifestyle and would not participate in any other program or consume any supplements that would promote slimming. Furthermore, patients were asked to t(contracted; show full)ty |volume=275 |issue=6 Pt 2 |pages=R1898–908 |journal=The American journal of physiology}}</ref> During periods of limited food intake fat tissue rapidly transitions to an abundant provider of non-esterfied free fatty acids which upon their release into the circulatory system can undergo beta-oxidation to supply energy.  The storage capacity of adipocytes remains a key component of its function but has been shown to modulate the synthesis of bioactive peptides, specifically adipose-derived hormones.
<ref>>{{Ccitation needed|date=July 2011}}e journal |pages=69–78 |doi=10.1016/j.mce.2009.11.011 |title=The autocrine and paracrine roles of adipokines |year=2010 |last1=Karastergiou |first1=Kalypso |last2=Mohamed-Ali |first2=Vidya |journal=Molecular and Cellular Endocrinology |volume=318 |pmid=19948207 |issue=1–2}}</ref><ref name=pmid18334583>{{</ref>

Studies have revealed a correlation between deregulated adipose tissue function and excessive fat mass having deleterious effects on the endocrine and immune systems.<ref name=pmid19948207>{{cite journal |pages=69–78 |doi=10.1016/j.mce.2009.11.011 |title=The autocrine and paracrine roles of adipokines |year=2010 |last1=Karastergiou |first1=Kalypso |last2=Mohamed-Ali |first2=Vidya |journal=Molecular and Cellular Endocrinology |volume=318 |pmid=19948207 |issue=1–2}}</ref><ref name=pmid1833458(contracted; show full)cu |first4=A |last5=Atmaca |first5=S |last6=Arikan |first6=S |title=The correlation between adiposity and adiponectin, tumor necrosis factor alpha, interleukin-6 and high sensitivity C-reactive protein levels. Is adipocyte size associated with inflammation in adults? |volume=30 |issue=3 |pages=210–4 |journal=Journal of endocrinological investigation}}</ref> A rise in pro-inflammatory [[adipokines]] coupled with cytokine production may promote the onset of metabolic disorders like [[atherosclerosis]].
{{Citation needed|date=July 2011}} <ref>http://www.erchonia.com/files/pdf/Adipose_Tissue_Endocrine_Organ_2010.pdf</ref>

Positively correlated with increased adipose tissue size are pro-inflammatory factors: [[tumor necrosis factor-α]] (TNF-α), [[interleukin-6]] (IL-6), and [[C-reactive protein]]. Participating in [[paracrine]] and [[autocrine]] signaling, adipocyte impairment may account for metabolic dysfunction as adipose tissue communicates with multiple body systems including nervous, immune, skeletal, cardiovascular, and gastrointestinal.<ref name=pmid17021375/> Positive caloric intake can result in adipocyte [[hypertrophy]] modulating adipose tissue function and increasing a patient’s risk of developing serious metabolic disorders.{{Citation needed|date=July 2011}} <ref>http://www.erchonia.com/files/pdf/Adipose_Tissue_Endocrine_Organ_2010.pdf</ref>

Directly associated with enlarged fat mass is the chronic disease [[diabetes]]. [[Adiponectin]], a hormone solely produced by adipocytes, has demonstrated insulin sensitive effects promoting anti-diabetic characteristics.<ref name=pmid16642957>{{cite journal |pages=9S–15S |doi=10.1038/oby.2006.276 |title=Metabolic Actions of Adipocyte Hormones: Focus on Adiponectin |year=2006 |last1=Ahima |first1=Rexford S. |journal=Obesity |volume=14 |issue=2S}}</ref> As a plasma protein, adiponectin has been reported to regulate insulin sensitivity via the activation of AMPK and reduction of mTOR/S6 kinase activity consequentially reducing insulin receptor substrate 1 inhibitory serine phosphorylation in several tissues.<ref name=pmid17021375/><ref name=pmid16642957/> The synthesis of adiponectin is tightly coupled with adipose tissue fat mass, demonstrating a negative relationship with larger masses. <ref>http://www.erchonia.com/files/pdf/Adipose_Tissue_Endocrine_Organ_2010.pdf</ref> Individuals who are classified as obese display a lower plasma adiponectin concentration when compared to non-obese groups. Furthermore, a direct correlation between low adiponectin levels and the onset of type-2 diabetes has been reported. Adiponectin modulation is reflective of the deleterious outcome that manifests when the adipocyte accumulates tremendous volume.{{Citation needed|date=July 2011}} <ref>http://www.erchonia.com/files/pdf/Adipose_Tissue_Endocrine_Organ_2010.pdf</ref>

Studies have demonstrated the physiological importance of adipocytes.  [[Lipoatrophy]], a condition in which the total number of adipocytes are reduced, reveals an association with [[insulin resistance]], [[hyperglycemia]], and liver [[steatosis]].<ref>{{cite journal |pages=271–8 |doi=10.1172/JCI7901 |title=Surgical implantation of adipose tissue reverses diabetes in lipoatrophic mice |year=2000 |last1=Gavrilova |first1=Oksana |last2=Marcus-Samuels |first2=Bernice |last3=Graham |first3=David |last4=(contracted; show full)erapies to promote insulin sensitivity and reduce the risk of diabetes.  The Zerona, based on histological evidence, has proven to reduce adipose tissue fat mass of the waist, hips, and thighs while preventing fat cell death. The formation of the transitory pore within the adipocyte membrane results in adipocyte cell collapse and its return to a lean state.  Reduced fat mass is associated with the synthesis of beneficial hormones like adiponectin which promotes insulin sensitivity within numerous tissues. 
On-going clinical trials are evaluating Zerona for potential acute and long-term medical benefits.{{Citation needed|date=July 2011}}

An article published in the American Journal of Cosmetic Surgery in 2010 demonstrated a statistically significant reduction in both serum triglyceride and total cholesterol levels following a standard two-week, six treatment Zerona administration.<ref>{{cite journal |first1=Robert F. |last1=Jackson |first2=Greg C. |last2=Roche |first3=Kevin |last3=Wisler |year=2010 |title=Reduction in Cholesterol and Triglyceride Serum Levels Following Low-Level Laser Irradiation: A Noncontrolled, Nonrandomized Pilot Study |journal=The American Journal of Cosmetic Surgery |volume=27 |issue=4 |pages=177–84 |url=http://www.erchonia.com/files/uploads/1/file/Jackson_Reduction%20in%20Cholesterol%20and%20Triglyceride%20Serum%20Levels%20Following%203LT_AJCS_2010.pdf}}</ref> Presently, clinical studies are on-going to elucidate the potential utility of this application.{{Citation needed|date=July 2011}}

==External links==
*[http://www.erchonia.com/ Erchonia Corp., Official Website]

== References ==
{{reflist}}

[[Category:Laser medicine]]
[[Category:Management of obesity]]