Faculty of Pure and Applied Sciences, University of Tsukuba, Tennoudai 1-1-1, Tsukuba, Ibaraki, 305-8573, Japan.
Department of Pathology, Asahikawa Medical University, 1 Chome-1-1, Midorigaoka, Higashi 2 Jo, Asahikawa, Hokkaido, 078-8510, Japan.
Biomaterials. 2023 Apr;295:122047. doi: 10.1016/j.biomaterials.2023.122047. Epub 2023 Feb 17.
With the preponderance of a high-calorie diet and sedentary lifestyle, the prevalence of non-alcoholic steatohepatitis (NASH), a state of abnormally elevated lipid accumulation in the liver with chronic inflammation, is increasing at an alarming rate worldwide. Hence, cost-effective therapeutic interventions are required to manage this disease at an early stage. Numerous reports have suggested a link between gut microbial dysbiosis, particularly a decrease in the abundance of short-chain fatty acids (SCFA)-producing microbiota and NASH pathogenesis. Considering these low molecular weight (LMW) SCFAs such as acetic, propionic, and butyric acids have been used to inhibit hepatic steatosis in mouse models. However, the poor pharmacokinetic (PK) profile of SCFAs, caused due to their LMW, renders them therapeutically ineffective. Thus, to improve the PK characteristic-based therapeutic efficacy of LMW SCFAs, we designed SCFA-based prodrugs that possess self-assembling characteristics in aqueous media. The designed SCFA prodrugs consist of enzyme-metabolizable amphiphilic block copolymers, [poly(ethylene glycol)-b-poly(vinyl ester)s] conjugated to propionic acid (PA) or butyric acid (BA) by an ester linkage, which self-assemble into stable nanosized micelles several tens of nanometers in diameter (Nano and Nano). Via pharmacological analysis, we confirmed that, after oral administration, LMW BA decreased to a physiological level within 24 h in the liver, whereas BA liberated from Nano was observed until 72 h post-administration, implying a sustained release profile. Here, we evaluated the therapeutic efficacy of Nano in a choline-deficient, L-amino acid-defined high-fat diet (CDAHFD)-induced NASH and liver fibrosis mouse model by ad libitum drinking. Nano, particularly Nano, exhibited the remarkable potential to ameliorate the phenotypic features of fatty liver disease by reducing hepatic lipogenesis and fibrosis, with negligible adverse effects. In contrast, conventional LMW SCFAs failed to prevent the pathogenesis of fatty liver disease, which plausibly can be explained by their rapid clearance and discernible adverse effects. Mechanistic studies revealed that Nano restored the nuclear expression of PPARα, a transcriptional factor regulating mitochondrial fatty acid oxidation, in the periportal hepatocytes and decreased the CPT1A expression level in the hepatic tissues, reflecting the therapeutic effects of Nano. Taken together, we confirmed that our Nano potentially improved the PK properties of SCFAs, and it consequently alleviated NASH symptoms and fibrotic liver compared to LMW SCFAs. Our study establishes Nano as a suitable nano-assembled prodrug for NASH treatment.
随着高热量饮食和久坐生活方式的盛行,非酒精性脂肪性肝炎(NASH)的患病率——一种肝脏内脂质异常堆积并伴有慢性炎症的状态——正在全球范围内以惊人的速度增长。因此,需要进行具有成本效益的治疗干预措施,以便在早期阶段对这种疾病进行管理。大量报告表明,肠道微生物群落失调,特别是产生短链脂肪酸(SCFA)的微生物丰度降低,与 NASH 的发病机制有关。考虑到这些低分子量 (LMW) 的 SCFAs,如乙酸、丙酸和丁酸,已被用于抑制小鼠模型中的肝脂肪变性。然而,由于其 LMW,SCFAs 的药代动力学(PK)特性较差,导致它们在治疗上无效。因此,为了提高 LMW SCFAs 的基于 PK 特征的治疗效果,我们设计了具有自组装特性的基于 SCFA 的前药,这些前药由在水性介质中可酶代谢的两亲嵌段共聚物组成,[聚(乙二醇)-b-聚(乙烯酯)] 通过酯键与丙酸(PA)或丁酸(BA)连接,自组装成数十纳米直径的稳定纳米级胶束(Nano 和 Nano)。通过药理学分析,我们证实,经口服给药后,LMW BA 在 24 小时内在肝脏内降至生理水平,而从 Nano 中释放的 BA 可观察到 72 小时后给药,表明具有持续释放的特征。在这里,我们通过自由饮用评估了 Nano 在胆碱缺乏、L-氨基酸定义的高脂肪饮食(CDAHFD)诱导的 NASH 和肝纤维化小鼠模型中的治疗效果。Nano,特别是 Nano,具有通过减少肝内脂质生成和纤维化来改善脂肪肝疾病表型特征的巨大潜力,且副作用极小。相比之下,传统的 LMW SCFAs 未能预防脂肪肝疾病的发病机制,这可能是由于它们的快速清除和明显的副作用。机制研究表明,Nano 恢复了核内过氧化物酶体增殖物激活受体α(PPARα)的核表达,PPARα 是调节线粒体脂肪酸氧化的转录因子,并降低了肝组织中 CPT1A 的表达水平,反映了 Nano 的治疗效果。综上所述,我们证实,与 LMW SCFAs 相比,我们的 Nano 可能改善了 SCFA 的 PK 特性,从而缓解了 NASH 症状和纤维化的肝脏。我们的研究确立了 Nano 作为一种合适的用于治疗 NASH 的纳米组装前药。
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