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Browning of White Adipose Tissue As a Therapeutic Tool in the Fight Against Atherosclerosis

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Browning of White Adipose Tissue As a Therapeutic Tool in the Fight Against Atherosclerosis H OH metabolites OH Review Browning of White Adipose Tissue as a Therapeutic Tool in the Fight against Atherosclerosis Christel L. Roth, Filippo Molica * and Brenda R. Kwak Department of Pathology and Immunology, University of Geneva, CH-1211 Geneva, Switzerland; [email protected] (C.L.R.); [email protected] (B.R.K.) * Correspondence: fi[email protected] Abstract: Despite continuous medical advances, atherosclerosis remains the prime cause of mortality worldwide. Emerging findings on brown and beige adipocytes highlighted that these fat cells share the specific ability of non-shivering thermogenesis due to the expression of uncoupling protein 1. Brown fat is established during embryogenesis, and beige cells emerge from white adipose tissue exposed to specific stimuli like cold exposure into a process called browning. The consecutive energy expenditure of both thermogenic adipose tissues has shown therapeutic potential in metabolic disorders like obesity and diabetes. The latest data suggest promising effects on atherosclerosis development as well. Upon cold exposure, mice and humans have a physiological increase in brown adipose tissue activation and browning of white adipocytes is promoted. The use of drugs like β3-adrenergic agonists in murine models induces similar effects. With respect to atheroprotection, thermogenic adipose tissue activation has beneficial outcomes in mice by decreasing plasma triglyc- erides, total cholesterol and low-density lipoproteins, by increasing high-density lipoproteins, and by inducing secretion of atheroprotective adipokines. Atheroprotective effects involve an unaffected Citation: Roth, C.L.; Molica, F.; hepatic clearance. Latest clinical data tend to find thinner atherosclerotic lesions in patients with Kwak, B.R. Browning of White higher brown adipose tissue activity. Strategies for preserving healthy arteries are a major concern Adipose Tissue as a Therapeutic Tool for public health. in the Fight against Atherosclerosis. Metabolites 2021, 11, 319. https:// Keywords: white adipose tissue; brown adipose tissue; adipocytes; browning; non-shivering ther- doi.org/10.3390/metabo11050319 mogenesis; β3-adrenergic stimulation; cold exposure; atherosclerosis; atheroprotection Academic Editors: Gloria Alvarez-Llamas and Marta Martin-Lorenzo 1. Introduction Received: 14 April 2021 In the past few years, adipose tissue (AT) understanding evolved from an inert fat Accepted: 13 May 2021 storage tissue to a complex organ interacting with the whole body [1]. It plays a leading Published: 14 May 2021 physiological role in metabolic and energy homeostasis. Conversely, AT dysregulation is implicated in the metabolic syndrome leading to metabolic disorders like obesity, type Publisher’s Note: MDPI stays neutral II diabetes and cardiovascular diseases, including atherosclerosis. Mammals have two with regard to jurisdictional claims in distinctive types of AT: white (WAT) and brown (BAT), classified by their cells, colors, published maps and institutional affil- locations, precursors, vascularization, innervation and antagonist activities. iations. WAT, the central body fat mass extensively distributed in several visceral and sub- cutaneous depots, has two physiological functions [2]. It acts as energy storage; its white adipocytes store droplets of triglycerides in times of plethora and hydrolyze them in times of lacking. WAT is also a specialized organ that secretes several active compounds, Copyright: © 2021 by the authors. adipokines, as auto-, para-, and endocrine signals [3]. In relation to other organs, these Licensee MDPI, Basel, Switzerland. adipokines are the main actors in energy homeostasis and immunity, endothelial and blood This article is an open access article pressure maintenance [4–7]. WAT dysregulation is associated with obesity, especially the distributed under the terms and expansion of visceral AT depots, and is characterized by an altered adipokine secretion. conditions of the Creative Commons The latter conducts adipocyte hypertrophy and hyperplasia, and modifications in AT’s Attribution (CC BY) license (https:// structural cells, such as vascular and immune cells, lead to the pro-inflammatory state creativecommons.org/licenses/by/ associated with the metabolic syndrome [8]. 4.0/). Metabolites 2021, 11, 319. https://doi.org/10.3390/metabo11050319 https://www.mdpi.com/journal/metabolites Metabolites 2021, 11, 319 2 of 20 Metabolites 2021, 11, 319 2 of 20 modifications in AT’s structural cells, such as vascular and immune cells, lead to the pro- inflammatory state associated with the metabolic syndrome [8]. BAT is a high metabolic tissue with a primary thermogenic function. The high BAT is a high metabolic tissue with a primary thermogenic function. The high amount amount of mitochondria and vascularization results in the distinct brown color of BAT of mitochondria and vascularization results in the distinct brown color of BAT [9]. In [9]. In humans, BAT is located in the cervical, axillar, perirenal, adrenal, mediastinal, humans, BAT is located in the cervical, axillar, perirenal, adrenal, mediastinal, paraver- paravertebral and upper abdominal regions along large blood vessels, trachea and tebral and upper abdominal regions along large blood vessels, trachea and intercostal intercostal arteries [10,11]. Brown adipocytes specifically express uncoupling protein 1 arteries [10,11]. Brown adipocytes specifically express uncoupling protein 1 (UCP1), a (UCP1), a mitochondrial protein. UCP1 dissipates energy in the form of heat rather than mitochondrial protein. UCP1 dissipates energy in the form of heat rather than ATP produc- ATPtion [12production]. Thus, BAT [12] limits. Thus, WAT BAT storage limits and WAT decreases storage hyperlipidemia and decreases by hyperlipidemia increasing energy by increasingexpenditure energy [13]. Besides,expenditure WAT [13] dysfunction. Besides, WAT and accumulationdysfunction and reduce accumulation BAT activity, reduce the BATwhite activity, fat percentage the white being fat inverselypercentage related being to inversely it [14]. The related hypothesis to it [14] of. usingThe hypothesis BAT activity of usingto induce BAT calory activity burning to induce via fatty calory acid burning oxidation via was fatty proposed acid oxidation more than was a proposed decade ago more [15]. thanSeveral a decade studies ago in humans [15]. Several have identifiedstudies in BAT humans activation have asidentified a potential BAT therapeutic activation target as a potentialfor increasing therapeutic fat loss target [14,16 ].for increasing fat loss [14,16]. More recently, the induction of UCP1 expression in white adipocytes has been shown inin response to various stimuli stimuli [17] [17].. The The thermogenic thermogenic cell cell differentiation differentiation in in WAT WAT is called browning ( (FigureFigure 11).). WAT-derivedWAT-derived brown-likebrown-like ATAT (wBAT)(wBAT) has has similar similarcharacteristics characteristics asas BAT, likelike aa large large number number of of mitochondria mitochondria and and high high metabolic metabolic activity. activity. Still, BATStill, andBAT wBAT and wBATare two are distinctive two distinctive tissues with tissues their with own morphology,their own morphology, gene expression gene and expression embryogenic and embryogenicprecursors, suggesting precursors, different suggesting regulatory different signals regulatory [17]. β3-adrenergic signals [17] receptor. β3-adrenergic activation receptoris a main activation browning stimulationis a main browning pathway, initiallystimulation identified pathway, by the initially density identified of noradrenergic by the densityfibers in of wBAT noradrenergic [18]. In response fibers in to wBAT cold exposure, [18]. In response insulin and to coldβ3agonists, exposure, increased insulin and wBAT β3 agonists,and resistance increased to obesity wBAT have and beenresistance reported to obesity in mice have [18]. Researchbeen reported in humans in mice reveals [18]. Researchpromising in results humans for reveals inducing promising browning results of WAT for [inducing19–21]. browning of WAT [19–21]. Figure 1.1. Cold exposureexposure physiologicallyphysiologically inducesinduces thethe browning browning process process by by sympathetic sympathetic fiber fiber in- innervnervationation via via a aβ β33-adrenergic-adrenergic stimulation stimulation ofof whitewhite adiposeadipose tissuetissue (WAT). TheThe beige phenotype, enriched with with mitochondria, mitochondria, allows allows for for non non-shivering-shivering thermogenesis thermogenesis like like brown brown adipocytes adipocytes due due to theto the expression expression of UCP1. of UCP1. Photographs Photographs represent represent hematoxylin hematoxylin and eosin and (H eosinE) staining (HE) staining of WAT, of WAT WAT,- derivedWAT-derived brown brown-like-like adipose adipose tissuetissue (wBAT) (wBAT) and brown and brown adipose adipose tissue tissue (BAT) (BAT) in mice. in mice. InIn thethe presentpresent review, review, the the potential potential benefits benefits of BATof BAT activation activation and WAT-to-BATand WAT-to trans--BAT transdifferentiation-differentiation will be will discussed be discussed in the context in the ofcontext atherosclerosis, of atherosclerosi focusings, onfocusing the therapeu- on the therapeutictic targets. targets. Metabolites 2021, 11, 319 3 of 20 2. Thermogenic Adipose Tissue Adaptive thermogenesis defines the body temperature regulation in response to cold exposure. The stimuli-induced
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