脂肪肝と闘うための新しいアプローチ(A novel approach to combat fatty liver disease)

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2024-10-14 スイス連邦工科大学ローザンヌ校(EPFL)

EPFLの研究によると、ACMSD酵素を阻害することで、代謝性肝疾患(MASLD/MASH)による肝臓の損傷を大幅に軽減できることが判明しました。MASLD/MASHは肥満や不健康な食事が原因で脂肪が肝臓に蓄積し、炎症や線維化を引き起こします。研究では、ACMSD阻害により肝臓のNAD+レベルが増加し、炎症やDNA損傷、線維化が軽減されることが確認され、これが新しい治療法となる可能性が示唆されています。

<関連情報>

ACMSD阻害はMASLD/MASHにおける線維化、炎症、DNA損傷を改善する ACMSD inhibition corrects fibrosis, inflammation, and DNA damage in MASLD/MASH

Yasmine J. Liu ∙ Masaki Kimura ∙ Xiaoxu Li∙ … ∙ G. Mani Subramanian ∙ Takanori Takebe, ∙ Johan Auwerx
Journal of Hepatology  Publishede:August 21, 2024
DOI:https://doi.org/10.1016/j.jhep.2024.08.009

Graphical abstract

脂肪肝と闘うための新しいアプローチ(A novel approach to combat fatty liver disease)

Highlights

•ACMSD inhibition enhances NAD+ de novo synthesis and enables genome stability in hepatocytes.
•ACMSD inhibition increases NAD+ levels, reduces DNA damage and prevents MASLD/MASH progression.
•The therapeutic benefits of ACMSD inhibition are recapitulated in human liver organoid models of steatohepatitis.
•Mendelian randomization suggests causality of DNA damage in MASLD/MASH incidence.

Abstract

Background & Aims
Recent findings reveal the importance of tryptophan-initiated de novo nicotinamide adenine dinucleotide (NAD+) synthesis in the liver, a process previously considered secondary to biosynthesis from nicotinamide. The enzyme α-amino-β-carboxymuconate-ε-semialdehyde decarboxylase (ACMSD), primarily expressed in the liver and kidney, acts as a modulator of de novo NAD+ synthesis. Boosting NAD+ levels has previously demonstrated remarkable metabolic benefits in mouse models. In this study, we aimed to investigate the therapeutic implications of ACMSD inhibition in the treatment of metabolic dysfunction-associated steatotic liver disease/steatohepatitis (MASLD/MASH).

Methods
In vitro experiments were conducted in primary rodent hepatocytes, Huh7 human liver carcinoma cells and induced pluripotent stem cell-derived human liver organoids (HLOs). C57BL/6J male mice were fed a western-style diet and housed at thermoneutrality to recapitulate key aspects of MASLD/MASH. Pharmacological ACMSD inhibition was given therapeutically, following disease onset. HLO models of steatohepatitis were used to assess the DNA damage responses to ACMSD inhibition in human contexts.

Results
Inhibiting ACMSD with a novel specific pharmacological inhibitor promotes de novo NAD+ synthesis and reduces DNA damage ex vivo, in vivo, and in HLO models. In mouse models of MASLD/MASH, de novo NAD+ biosynthesis is suppressed, and transcriptomic DNA damage signatures correlate with disease severity; in humans, Mendelian randomization-based genetic analysis suggests a notable impact of genomic stress on liver disease susceptibility. Therapeutic inhibition of ACMSD in mice increases liver NAD+ and reverses MASLD/MASH, mitigating fibrosis, inflammation, and DNA damage, as observed in HLO models of steatohepatitis.

Conclusions
Our findings highlight the benefits of ACMSD inhibition in enhancing hepatic NAD+ levels and enabling genomic protection, underscoring its therapeutic potential in MASLD/MASH.

Impact and implications
Enhancing NAD+ levels has been shown to induce remarkable health benefits in mouse models of metabolic dysfunction-associated steatotic liver disease/steatohepatitis (MASLD/MASH), yet liver-specific NAD+ boosting strategies remain underexplored. Here, we present a novel pharmacological approach to enhance de novo synthesis of NAD+ in the liver by inhibiting α-amino-β-carboxymuconate-ε-semialdehyde decarboxylase (ACMSD), an enzyme highly expressed in the liver. Inhibiting ACMSD increases NAD+ levels, enhances mitochondrial respiration, and maintains genomic stability in hepatocytes ex vivo and in vivo. These molecular benefits prevent disease progression in both mouse and human liver organoid models of steatohepatitis. Our preclinical study identifies ACMSD as a promising target for MASLD/MASH management and lays the groundwork for developing ACMSD inhibitors as a clinical treatment.

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