The association between inflammation and endoplasmic reticulum (ER) stress has been observed in many diseases. However, if and how chronic inflammation regulates the unfolded protein response (UPR) and alters ER homeostasis in general, or in the context of chronic disease, remains unknown. Here, we show that, in the setting of obesity, inflammatory input through increased inducible nitric oxide synthase (iNOS) activity causes S-nitrosylation of a key UPR regulator, IRE1α, which leads to a progressive decline in hepatic IRE1α-mediated XBP1 splicing activity in both genetic (ob/ob) and dietary (high-fat diet–induced) models of obesity. Finally, in obese mice with liver-specific IRE1α deficiency, reconstitution of IRE1α expression with a nitrosylation-resistant variant restored IRE1α-mediated XBP1 splicing and improved glucose homeostasis in vivo. Taken together, these data describe a mechanism by which inflammatory pathways compromise UPR function through iNOS-mediated S-nitrosylation of IRE1α, which contributes to defective IRE1α activity, impaired ER function, and prolonged ER stress in obesity.

Insulin-producing β cells become dedifferentiated during diabetes progression. An impaired ability to select substrates for oxidative phosphorylation, or metabolic inflexibility, initiates progression from β-cell dysfunction to β-cell dedifferentiation. The identification of pathways involved in dedifferentiation may provide clues to its reversal. Here we isolate and functionally characterize failing β cells from various experimental models of diabetes and report a striking enrichment in the expression of aldehyde dehydrogenase 1 isoform A3 (ALDH+) as β cells become dedifferentiated. Flow-sorted ALDH+ islet cells demonstrate impaired glucose-induced insulin secretion, are depleted of Foxo1 and MafA, and include a Neurogenin3-positive subset. RNA sequencing analysis demonstrates that ALDH+ cells are characterized by: (i) impaired oxidative phosphorylation and mitochondrial complex I, IV and V; (ii) activated RICTOR; and (iii) progenitor cell markers. We propose that impaired mitochondrial function marks the progression from metabolic inflexibility to dedifferentiation in the natural history of β-cell failure.

Endoplasmic reticulum (ER) plays a critical role in protein, lipid and glucose metabolism, as well as cellular calcium homeostasis and signaling. Perturbation of ER function and chronic ER stress is associated with many pathologies ranging from diabetes to neurodegenerative diseases, cancer and inflammation. While targeting the ER offers therapeutic promise in preclinical models of obesity and other pathologies, the available chemical entities generally lack the specificity and other pharmacological properties required for effective clinical translation. To overcome these challenges and identify new potential therapeutic candidates, we first designed and chemically and genetically validated two high-throughput functional screening systems that independently measure the free chaperone content and the protein folding capacity of ER. With these quantitative platforms, we characterized a small molecule compound, azoromide, that improves ER protein folding ability and activates ER chaperone capacity to protect cells against ER stress in multiple systems. Remarkably, this compound also exhibits potent anti-diabetic efficacy in two independent mouse models of obesity by improving insulin sensitivity and beta cell function. Taken together, these results demonstrate the utility of this functional, phenotypic assay platform for ER-targeted drug discovery, and provide proof-of-principle that specific ER modulators can be potential drug candidates against type 2 diabetes.

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Diabetes is caused by a combination of impaired responsiveness to insulin and reduced production of insulin by the pancreas. Until recently, the decline of insulin production had been ascribed to β‐cell death. But recent research has shown that β‐cells do not die in diabetes, but undergo a silencing process, termed “dedifferentiation.” The main implication of this discovery is that β‐cells can be revived by appropriate treatments. We have shown that mitochondrial abnormalities are a key step in the progression of β‐cell dysfunction towards dedifferentiation. In normal β‐cells, mitochondria generate energy required to sustain insulin production and its finely timed release in response to the body's nutritional status. A normal β‐cell can adapt its mitochondrial fuel source based on substrate availability, a concept known as “metabolic flexibility.” This capability is the first casualty in the progress of β‐cell failure. β‐Cells lose the ability to select the right fuel for mitochondrial energy production. Mitochondria become overloaded, and accumulate by‐products derived from incomplete fuel utilization. Energy production stalls, and insulin production drops, setting the stage for dedifferentiation. The ultimate goal of these investigations is to explore novel treatment paradigms that will benefit people with diabetes.