Bile acids are signaling molecules that coordinately regulate metabolism and inflammation via the nuclear farnesoid X receptor (FXR) and the Takeda G protein-coupled receptor 5 (TGR5). These receptors activate transcriptional networks and signaling cascades controlling the expression and activity of genes involved in bile acid, lipid and carbohydrate metabolism, energy expenditure, and inflammation by acting predominantly in enterohepatic tissues, but also in peripheral organs. In this review, we discuss the most recent findings on the inter-organ signaling and interplay with the gut microbiota of bile acids and their receptors in meta-inflammation, with a focus on their pathophysiologic roles in obesity, type 2 diabetes, dyslipidemia, and nonalcoholic steatohepatitis, and their potential therapeutic applications.

؊/؊ mice have improved glucose tolerance. These data suggest that 11␤-HSD-1 deficiency produces an improved lipid profile, hepatic insulin sensitization, and a potentially atheroprotective phenotype.

The malignant progression of pancreatic ductal adenocarcinoma (PDAC) is accompanied by a profound desmoplasia, which forces proliferating tumor cells to metabolically adapt to this new microenvironment. We established the PDAC metabolic signature to highlight the main activated tumor metabolic pathways. Comparative transcriptomic analysis identified lipid-related metabolic pathways as being the most highly enriched in PDAC, compared with a normal pancreas. Our study revealed that lipoprotein metabolic processes, in particular cholesterol uptake, are drastically activated in the tumor. This process results in an increase in the amount of cholesterol and an overexpression of the low-density lipoprotein receptor (LDLR) in pancreatic tumor cells. These findings identify LDLR as a novel metabolic target to limit PDAC progression. Here, we demonstrate that shRNA silencing of LDLR, in pancreatic tumor cells, profoundly reduces uptake of cholesterol and alters its distribution, decreases tumor cell proliferation, and limits activation of ERK1/2 survival pathway. Moreover, blocking cholesterol uptake sensitizes cells to chemotherapeutic drugs and potentiates the effect of chemotherapy on PDAC regression. Clinically, high PDAC Ldlr expression is not restricted to a specific tumor stage but is correlated to a higher risk of disease recurrence. This study provides a precise overview of lipid metabolic pathways that are disturbed in PDAC. We also highlight the high dependence of pancreatic cancer cells upon cholesterol uptake, and identify LDLR as a promising metabolic target for combined therapy, to limit PDAC progression and disease patient relapse.is one of the deadliest cancers, rated as the fourth leading cause of cancerrelated death in the United States and Europe, with a 5-y survival rate of about 4% and a median survival of less than 6 mo (1). In the absence of early warning signs, only 15% of patients with localized PDAC can be cured by surgical resection. For the remaining patients diagnosed with late-stage pancreatic cancer with metastatic disease, the current chemotherapy with gemcitabine (GEM) is mainly palliative and remains the standard treatment despite limited benefits (5.6-mo survival) (2). Recent advances in treatment, such as combined regimens using fluorouracil, leucovorin, irinotecan, and oxaliplatin, or Nab-paclitaxel plus GEM, conferred a survival advantage compared with GEM alone (2).The low response rate to chemotherapy is a result, in part, to the presence of a dense stroma, characterized by fibrillar networks around tumoral cells that compress vasculature and limit oxygen, nutrient, and drug delivery to the cells. A fundamental feature of tumoral cells is that they undergo metabolic reprogramming in response to these environmental constraints. Advances in tumor metabolism research reveal that PDAC cells primarily rely on glucose and glutamine catabolism to fulfill bioenergetic need and provide macromolecules required for growth and proliferation (3-5). However, metabolic reprogramming is a complex...

Rationale: A crucial step in atherogenesis is the infiltration of the subendothelial space of large arteries by monocytes where they differentiate into macrophages and transform into lipid-loaded foam cells. Macrophages are heterogeneous cells that adapt their response to environmental cytokines. Th1 cytokines promote monocyte differentiation into M1 macrophages, whereas Th2 cytokines trigger an "alternative" M2 phenotype. Objective: We previously reported the presence of CD68؉ mannose receptor (MR) ؉ M2 macrophages in human atherosclerotic plaques. However, the function of these plaque CD68 ؉ MR؉ macrophages is still unknown. Methods and Results: Histological analysis revealed that CD68؉ MR ؉ macrophages locate far from the lipid core of the plaque and contain smaller lipid droplets compared to CD68؉ MR ؊ macrophages. Interleukin (IL)-4 -polarized CD68؉ MR ؉ macrophages display a reduced capacity to handle and efflux cellular cholesterol because of low expression levels of the nuclear receptor liver x receptor (LXR)␣ and its target genes, ABCA1 and apolipoprotein E, attributable to the high 15-lipoxygenase activity in CD68؉ MR ؉ macrophages. By contrast, CD68 ؉ MR؉ macrophages highly express opsonins and receptors involved in phagocytosis, resulting in high phagocytic activity. In M2 macrophages, peroxisome proliferator-activated receptor (PPAR)␥ activation enhances the phagocytic but not the cholesterol trafficking pathways. Key Words: atherosclerosis Ⅲ macrophages Ⅲ nuclear receptors Ⅲ cholesterol A crucial step in atherogenesis is the infiltration of monocytes within the subendothelial space of large arteries and their differentiation into macrophages. In early plaques, recruited macrophages play reparatory roles via the phagocytosis of oxidized lipids and apoptotic cells. However, during atherosclerosis progression, macrophages contribute to foam cell formation, lesion growth, plaque rupture and thrombosis by secreting immune-inflammatory factors, growth factors, proteolytic enzymes and tissue factor. 1 One of the most important functions of macrophages in the context of atherosclerosis is the handling of lipids, especially cholesterol. The maintenance of macrophage cholesterol homeostasis is of critical importance in the pathogenesis of atherosclerosis, because an imbalance between cholesterol influx and efflux leads to an excessive accumulation of cholesterol in macrophages and their transformation into foam cells. 2,3 Macrophage scavenger receptors, including scavenger receptor (SR)-A, CD36, and lectin-like oxidized low-density lipoprotein (LDL) receptor (LOX)-1, mediate the uptake of modified LDL lipoproteins, including oxidized LDL. Within the macrophages, modified LDL-derived cholesteryl esters are hydrolyzed in lysosomes by the lysosomal acid lipase (LAL). The released unesterified cholesterol traffics to and integrates in the plasma membrane. The excess Original received October 1, 2010; revision received February 15, 2011; accepted February 17, 2011. In January 2011, the average time from submissi...

The interest in brown adipose tissue (BAT) as a target to combat metabolic disease has recently been renewed with the discovery of functional BAT in humans. In rodents, BAT can be activated by bile acids, which activate type 2 iodothyronine deiodinase (D2) in BAT via the G-coupled protein receptor TGR5, resulting in increased oxygen consumption and energy expenditure. Here we examined the effects of oral supplementation of the bile acid chenodeoxycholic acid (CDCA) on human BAT activity. Treatment of 12 healthy female subjects with CDCA for 2 days resulted in increased BAT activity. Whole-body energy expenditure was also increased upon CDCA treatment. In vitro treatment of primary human brown adipocytes derived with CDCA or specific TGR5 agonists increased mitochondrial uncoupling and D2 expression, an effect that was absent in human primary white adipocytes. These findings identify bile acids as a target to activate BAT in humans.

Bile acids (BA) are signalling molecules which activate the transmembrane receptor TGR5 and the nuclear receptor FXR. BA sequestrants (BAS) complex BA in the intestinal lumen and decrease intestinal FXR activity. The BAS-BA complex also induces Glucagon-Like Peptide-1 (GLP-1) production by L-cells which potentiates β-cell glucose-induced insulin secretion. Whether FXR is expressed in L-cells and controls GLP-1 production is unknown. Here we show that FXR activation in L-cells decreases proglucagon expression by interfering with the glucose-responsive factor Carbohydrate-Responsive Element Binding Protein (ChREBP) and GLP-1 secretion by inhibiting glycolysis. In vivo, FXR-deficiency increases GLP-1 gene expression and secretion in response to glucose hence improving glucose metabolism. Moreover, treatment of ob/ob mice with the BAS colesevelam increases intestinal proglucagon gene expression and improves glycemia in a FXR-dependent manner. These findings identify the FXR/GLP-1 pathway as a new mechanism of BA control of glucose metabolism and a pharmacological target for type 2 diabetes.

Nonalcoholic fatty liver disease (NAFLD) covers a spectrum of liver damage ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. To date, no pharmacological treatment is approved for NAFLD/NASH. Here, we report on preclinical and clinical data with GFT505, a novel dual peroxisome proliferator‐activated receptor alpha/delta (PPAR‐α/δ) agonist. In the rat, GFT505 concentrated in the liver with limited extrahepatic exposure and underwent extensive enterohepatic cycling. The efficacy of GFT505 was assessed in animal models of NAFLD/NASH and liver fibrosis (Western diet [WD]‐fed human apolipoprotein E2 [hApoE2] transgenic mice, methionine‐ and choline‐deficient diet‐fed db/db mice, and CCl4‐induced fibrosis in rats). GFT505 demonstrated liver‐protective effects on steatosis, inflammation, and fibrosis. In addition, GFT505 improved liver dysfunction markers, decreased hepatic lipid accumulation, and inhibited proinflammatory (interleukin‐1 beta, tumor necrosis factor alpha, and F4/80) and profibrotic (transforming growth factor beta, tissue inhibitor of metalloproteinase 2, collagen type I, alpha 1, and collagen type I, alpha 2) gene expression. To determine the role of PPAR‐α‐independent mechanisms, the effect of GFT505 was assessed in hApoE2 knock‐in/PPAR‐α knockout mice. In these mice, GFT505 also prevented WD‐induced liver steatosis and inflammation, indicating a contribution of PPAR‐α‐independent mechanisms. Finally, the effect of GFT505 on liver dysfunction markers was assessed in a combined analysis of four phase II clinical studies in metabolic syndrome patients. GFT505 treatment decreased plasma concentrations of alanine aminotransferase, gamma‐glutamyl transpeptidase, and alkaline phosphatase. Conclusion: The dual PPAR‐α/δ agonist, GFT505, is a promising liver‐targeted drug for treatment of NAFLD/NASH. In animals, its protective effects are mediated by both PPAR‐α‐dependent and ‐independent mechanisms. (Hepatology 2013; 58:1941–1952)

No abstract