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Peroxisome
Proliferator
Activated
Receptor
s:
Volume 18
The titles published in this series are listed at the end of this volume.
Peroxisome
Proliferator
Activated
Receptor
s:
From Basic Science to Clinical Applications
Edited by
J.-C. Fruchart
Institut Pasteur de Lille, Universite de Lille II, Faculte des SciencesPharmaceutiques et
Biologiques, Inserm U 545, Dept. Atherosclerose, Lille, France
A . M . Gotto, Jr.
Weill Medical College of Cornell University, New York, New York, USA
R. Paoletti
Department of Pharmacological Sciences,University of Milan, Milan, Italy
B. Staels
University of Lille II, Department of Atherosclerosis, Pasteur Institute,
Inserm U 545, Lille, France
and
A.L . Catapano
*
Department of Pharmacological Sciences,University of Milan, Milan, Italy
616'.042-dc21 2002074104
I S B N 978-1-4613-5427-7
Preface
List of Contributors
Less than one decade after the cloning of the first peroxisome proliferator-activated
receptor, PPARs attract great attention in light of the wide spectrum of genes of biological
and medical relevance identified as under their control. As a consequence, our knowledge
of the role of these receptors in physiology and pathology continues to grow at a fast pace,
and PPARs have become an interesting target for the treatment of many pathological
conditions, including diabetes and atherosclerosis.
Within this framework the First International Symposium on P PARs: From Basic
Science to Clinical Applications was held in Florence on April 4-7, 200 I, promoted and
organized by the GIOVANNI LORENZINI MEDICAL FOUNDATION (Milan, Italy and Houston,
Texas, U.S.A.). The aim of the Symposium was to provide the participants with an update
on the latest aspects of basic research and of clinical applications ofPPAR ligands, as well
as to offer an authoritative review of the field.
Attention was focused on the understanding of the molecular mechanisms involved
in PPAR activation and on the interaction with other nuclear factors/cofactors. On the
clinical side, the meeting succeeded in assessing the potential of the most recently
developed drugs in the areas of pathology and therapy, such as diabetes and atherosclerosis.
A selection of lectures presented at the Symposium is included in this volume of
Proceedings and we envision the volume as a means of readily available access to current
knowledge through the publication of critical opinions from leading clinical and scientific
experts.
The Editors would like to thank the personnel of the GIOVANNI LORENZINI
MEDICAL FOUNDATION and the sponsors for having made the Symposium and this volume
possible.
The Editors
LIST OF CONTRIBUTORS
Paul Baker, University of Adelaide and Hanson Centre for Cancer Research, Adelaide,
Australia
Yaacov Barak, The Jackson Laboratory, 600 Main Street, Bar Harbor, Maine 04609, U.S.A.
Philip Barter, University of Adelaide and Hanson Centre for Cancer Research, Adelaide,
Australia
Ajay Chawla, The Salk Institutefor Biological Studies, Howard Hughes Medical Institute, La
Jolla, California 90237, U.S.A.
Gregory J. Cooney, Garvan Institute of Medical Research, 384 Vistoria Street, Darlinghurst,
Sydney, NSW 2010 Australia
Patrick Duriez, Unite de Recherche sur les Lipoproteines et I'Athirosclerose, Inserm U545,
Institut Pasteur and Universite de Lille 2 - Faculte de Pharmacie, Lille, France
Ronald M. Evans, The Salk Institute for Biological Studies, Howard Hughes Medical Institute,
Xll
Maria Febbraio, Weill Medical College ofCornell University, 1300 York Avenue, New York, New
York 10021, U.S.A.
Stuart M. Furler, Garvan Institute of Medical Research, 384 Vistoria Streel, Darlinghurst,
Sydney, NSW 2010 Australia
Jennifer Gamble, University ofAdelaide and Hanson Centre for Cancer Research, Adelaide,
Australia
Frank J. Gonzalez, Building 37, Room 3E-24, National Institutes ofHealth, Bethesda, Maryland
20892, U.S.A.
Antonio M. Gotto, Jr., Weill Medical College of Cornell University, 1300 York Avenue, New
York. New York 10021, U.S.A.
David P. Hajjar, Weill Medical College of Cornell University, 1300 York Avenue, New York, New
York 10021. U.S.A.
Anders Hamsten, King GustafV Research Institute, Karolinska Hospital, S-l71 76 Stockholm,
Sweden
Jihong Han, Weill Medical College ofCornell University, 1300 York Avenue, New York, New York
10021, US.A.
Barbara Hansen, Obesity and Diabetes Research Center, University of Maryland School of
Medicine, Baltimore, Maryland 21201, U.S.A.
Edward S. Horton, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts,
U.S.A.
Hitoshi Ikeda, Pharmaceutical Research Division, Takeda Chemical Industries, Ltd., Osaka,
Japan
Sander Kersten, Nutrition, Metabolism and Genomics Group, Wageningen University, PO Box
8129, 6700 EV Wageningen, The Netherlands
Steven Kliewer, GlaxoSmithKline Research and Development, Five Moore Dr., Research
Triangle Park, North Carolina 27709, U.S.A.
Edward W. Kraegen, Garvan Institute ofMedical Research, 384 Vistoria Street, Darlinghurst,
Sydney, NSW 2010 Australia
Millard H. Lambert, Nuclear Receptor Discovery Research, GlaxoSmithKline, Five Moore Drive,
Research Triangle Park, North Carolina 27709-3398, US.A.
Chih-Hao Lee, The Salk Institute for Biological Studies, Howard Hughes Medical Institute,
La Jolla, California 90237, U.S.A.
Debbie Liao, The Salk Institute for Biological Studies, Howard Hughes Medical Institute, La
Jolla, California 90237, U.S.A.
Nikolaus Marx, Department ofInternal Medicine II- Cardiology, University of Ulm, Robert-Koch-
Str. 8, D-89081 Ulm, Germany
Marthe Moldes, Department of Biochemistry, Boston University School of Medicine, 715 Albany
Street, Boston, Massachusetts, U.SA.
Yu Momose, Pharmaceutical Research Division, Takeda Chemical Industries, Ltd., Osaka, Japan
Shinji Moriyama, Pharmaceutical Discovery Research Division, Takeda Chemical Industries,
Ltd., Osaka, Japan
Ron F. Morrison, Department ofBiochemistry, Boston University School ofMedicine, 715 Albany
Street, Boston, Massachusetts, U.SA.
Andrew C. Nicholson, Weill Medical College of Cornell University, i300 York Avenue, New
York, New York 10021, U.SA.
Hiroyuki Odaka, Pharmaceutical Research Division, Takeda Chemical industries, Ltd., Osaka,
Japan
William Oliver, Jr., GlaxoSmithKline Research Triangle Park, North Carolina 27709, U.S.A.
Jorge Plutzky, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical
School, 211 LongwoodAve., Boston, Massachusetts 20115, U.SA.
Eugene A. Podrez, Cleveland Clinic Foundation, Cleveland, Ohio, U.SA.
Kerry-Anne Rye, University ofAdelaide and Hanson Centre for Cancer Research, Adelaide,
Australia
Kavita Shanna, Weill Medical College of Cornell University, 1300 York Avenue, New York, New
York 10021, U.SA.
Roy L. Silverstein, Weill Medical College of Cornell University, 1300 York Avenue, New York,
New York 10021, U.SA.
Jonathan D. Smith, The Rockefeller University, New York, New York, U.SA.
Dan Sternbach, GlaxoSmithKline Research Triangle Park 27709, North Carolina, U.S.A.
Yasuo Sugiyama, Pharmaceutical Research Division, Takeda Chemical Industries, Ltd., Osaka,
xvi
Japan
Aristidis Veves, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts, U.S.A.
Mathew Vadas, University ofAdelaide and Hanson Centre for Cancer Research, Adelaide,
Australia
Gary D. Wu, 600 Clinical Research Building, 415 Curie Boulevard, Philadelphia,
Pennsylvania 19104-6144, U.S.A.
H. Eric Xu, Nuclear Receptor Discovery Research, GlaxoSmithKline, Five Moore Drive, Research
Triangle Park, North Carolina 27709-3398, U.S.A.
Jiming Ye, Garvan Institute of Medical Research, 384 Vistoria Street, Darlinghurst, Sydney,
NSW 2010 Australia
PEROXISOME PROLIFERATOR ACTIVATED RECEPTOR ALPHA COORDINATES
INTERMEDIARY METABOLISM DURING FASTING
Introduction
In response to repeated and long-lasting food shortages during evolution, humans have
evolved with an intricate metabolic control system that allows them to survive prolonged
period of food deprivation. One hallmark of this adaptive system is the ability to store large
amounts of energy in the form of fat in times of plenty and mobilize this energy under
conditions of food shortage such as fasting.
The liver plays a central role in the coordination of energy metabolism during
fasting. For instance, fatty acids are oxidized to form ketone bodies, which are used by
peripheral tissues for energy. In addition, to maintain plasma glucose levels during fasting,
the liver breaks down glycogen and synthesizes glucose from gluconeogenic precursors
such as lactate and glycerol. The metabolic function of the liver is controlled by numerous
transcription factors that regulate the expression of enzymes, binding proteins, transporters,
and many other genes. Indeed, micro-array experiments have revealed the dramatic impact
offasting on hepatic gene expression (Kersten and Wahli, unpublished data). One of these
transcription factors that mediate the hepatic response to fasting is the peroxisome
proliferator activated receptor alpha (PPARa).
PP ARa is one of three different PP AR isotypes that are known to date [1]. The
PPARs are members of the nuclear hormone receptor superfamily. They can be activated
by certain ligands and influence DNA transcription by binding to specific nucleotide
sequences in the promoter region of target genes. The PPARa isotype is mostly expressed
in liver and is the cellular target of fibrate drugs. Fibrates, which include gemfibrozil,
bezafibrate, and fenofibrate, are potent hypolipidemic drugs widely used in the treatment
of cardiovascular disease. It is now evident that one ofthe main functions ofPPARa is to
stimulate the expression of genes involved in fatty acid metabolism in liver, which includes
fatty acid uptake through membranes, fatty acid binding in cells, fatty acid oxidation
(mitochondrial, peroxisomal, and microsomal), and lipoprotein assembly and transport [1].
Clues that PP ARa may be implicated in the hepatic response to fasting were
twofold: first, the expression ofPP ARa follows a circadian rhythm with lowest expression
levels achieved during the nocturnal part, when mice tend to eat [2]. Second, PP ARa
increases the expression of numerous genes involved in hepatic fatty acid oxidation, a
2
process which is known to be activated during fasting [3]. To study the role ofPPARa in
the hepatic response to fasting, we used mice in which the PP ARa gene had been
inactivated. Careful analysis of these mice revealed that they had defects at the level of
lipid, carbohydrate, as well as amino acid metabolism. These effects are elaborated on
below.
Lipid Metabolism
Fasting is normally associated with a dramatic rise in plasma ketone body concentration,
reflecting the accelerated rate of hepatic fatty acid oxidation. However, in mice in which
the PPARa gene has been inactivated, plasma ketone body levels hardly rise, indicating a
marked impairment in fatty acid oxidation and ketogenesis [4,5]. Micro-array and Northern
blot analysis revealed that this was due to reduced mRNA expression of numerous genes
involved in fatty acid oxidation, including acyl-CoA dehydrogenases and HMG-CoA
synthase [4-6]. In contrast to ketone bodies, plasma free fatty acid levels were increased in
fasted PPARa null mice [4]. This probably reflects the diminished capacity for fatty acid
binding and uptake in PP ARa null mice, due to lowered expression of fatty acid
transporters and binding proteins. Fasting ofPP ARa null mice was also associated with the
development of a mild steatosis (fatty liver) phenotype, which indicates the impaired ability
of the liver to properly dispose offatty acids [4].
Carbohydrate Metabolism
During fasting, the plasma glucose level declines, reaching a stable level that is supported
by gluconeogenesis. Interestingly, in PPARa null mice, the drop in plasma glucose is much
more dramatic, causing severe hypoglycemia after a 24-hour fast. Two possible
mechanisms may explain this phenotype. First, the impaired oxidation offatty acids may
compromise gluconeogenesis via interference in allosteric regulation and by causing a
hepatic energy shortage [4]. Second, gluconeogenesis may be reduced because ofdecreased
expression levels of gluconeogenic enzymes in PPARa null mice (Escher and Kersten,
unpublished data). This does not include phosphoenolpyruvate carboxykinase (PEPCK)
whose expression is unaltered in fasted PP ARa null mice compared to wild-type mice [4].
Amino acids are an important energy source for the liver. Indeed, in the fed state, they
probably contribute the major share of energy for liver function. Except for the branched
chain amino acids, most of the amino acids are metabolized in the liver, yielding urea,
which harbors the nitrogen portion of the amino acid molecule, and a diverse array of
carbon-based end products. During fasting, hepatic amino acid metabolism slows down,
resulting in decreased urea production by the liver. Our results suggest that PP ARa
probably plays a role in this process by causing a decrease in the expression of genes
involved. Using subtractive hybridization, micro-array, and Northern blot we find that the
3
expression of numerous genes involved in transamination, deamination, and the urea cycle
is increased in PP ARu null mice. In contrast, the expression of these genes is reduced by
the synthetic PPARu activator WY14643, suggesting that PPARu is directly involved in
the regulation of amino acid metabolism. This is clearly shown by arginino succinate lyase,
an enzyme of the urea cycle whose expression is increased in fasted PPARu null mice and
decreased by WY14643 (Figure 1).
+/+ -/-
fasted
+/+ -/- WY WY
arginino succinate
lyase
Conclusion
Together, these results demonstrate that PPARu plays a central role in intermediary
metabolism during fasting. The overall picture indicates that, during fasting, PPARu
coordinately regulates lipid, carbohydrate, and amino acid metabolism in order to maintain
liver and whole body homeostasis (see Figure 2). As fatty acids serve as ligands for
PPARu, these results also raise the interesting possibility that the fatty acids that are
liberated from the adipose tissue during fasting serve as some kind of hormonal signal that
regulates the activity of a whole repertoire of metabolic reactions via PP ARu.
fat tissue
liver
fatty aci ds •
!I
PPARa + fatty acid oxidation!
:.----~ ketogenesis
+
References
1. Kersten S, Desvergne B, Wahli W. Roles ofPPARs in health and disease. Nature 2000;
405 :421-24.
2. Lemberger T, Saladin R, Vazquez M, et al. Expression of the peroxisome proliferator-
activated receptor alpha gene is stimulated by stress and follows a diurnal rhythm. J BioI
Chern 1996;271:1764-69.
3. Aoyama T, Peters JM, Iritani N, et al. Altered constitutive expression "Of fatty acid-
metabolizing enzymes in mice lacking the peroxisome proliferator-activated receptor alpha
(PPARalpha). J BioI Chern 1998;273:5678-84.
4. Kersten S, Seydoux J, Peters 1M, Gonzalez FJ, Desvergne B, Wahli W. Peroxisome
proliferator-activated receptor alpha mediates the adaptive response to fasting. J Clin
Invest 1999; 103: 1489-98.
5. Leone TC, Weinheimer CJ, Kelly DP A critical role for the peroxisome proliferator-
activated receptor alpha (PP ARalpha) in the cellular fasting response: The PPARalpha-null
mouse as a model of fatty acid oxidation disorders. Proc Nat! Acad Sci USA 1999;96:
7473-78.
6. Le May C, Pineau T, Bigot K, Kohl C, Girard J, Pegorier J-P. Reduced hepatic fatty acid
oxidation in fasting PP ARa null mice is due to impaired mitochondrial
hydroxymethylglutaryl-CoA synthase gene expression. FEBS Letters 2000;475: 163-66.
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