Mitochondrial Stress and Metabolic Dysfunction in the Liver: a Role for the Unfolded Protein

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Mitochondrial Stress and Metabolic Dysfunction in the Liver: a Role for the Unfolded Protein MITOCHONDRIAL STRESS AND METABOLIC DYSFUNCTION IN THE LIVER: A ROLE FOR THE UNFOLDED PROTEIN RESPONSE Viktoria Ntouma BSc (Honours), MSc Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy August 2019 Department of Medicine (Austin Health) Faculty of Medicine, Dentistry and Health Science Abstract ABSTRACT Liver dysfunction and fat accumulation in liver correlates with metabolic syndrome, also increases the risk of development of type 2 diabetes, advanced liver disease and several other complications. There are no simple or widely effective medical solutions to these conditions and further studies are required for clarification of mechanisms involved. Mitochondria are the powerhouses of the cell, responsible for cellular energy production and help maintain the cellular environment through complex procedures. Thus, it is fundamental for the mitochondria to function properly. Mitochondrial dysfunction is known to be associated with metabolic diseases including NASH and Type 2 diabetes where it has been implicated in hepatic fat accumulation and hepatic insulin resistance. Various enzymes and proteins are required to make mitochondria function properly. Mitochondrial dysfunction can be caused by build-up of reactive-oxygen-species which leads to the activation of a stress response known as the mitochondrial-unfolded-protein-response (UPRmt). Failure of these responses to adapt to or repair damage from stress results in mitochondrial dysfunction and may lead to apoptosis and eventually death. Ubiquitin-like- 5 (UBL5) is a protein that was first discovered in the obese Israeli sand rat, associated with weight gain. Studies in C. elegans have shown that UBL5 is involved in the activation of the mitochondrial unfolded protein response (UPRmt) to ensure that chaperone proteins are transcribed to relieve the ensuing stress. This pathway upregulates mitochondrial proteases and chaperone proteins to alleviate proteostatic stress. To further explore how mitochondrial stress through the mitochondrial unfolded protein response lead to liver dysfunction, we generated a tamoxifen-inducible, liver-specific UBL5 knockout mouse. In earlier studies, we performed systematic assessments of the role of UBL5 in mitochondrial function and energy metabolism. We found that mice with complete deletion of UBL5 in liver are glucose intolerant and present with features of liver i Abstract failure (gross steatosis, apoptosis and significantly increased hepatic enzymes). Furthermore, these mice present with oxidative stress reduced mitochondrial respiration, increased ROS levels and decreased UPRmt gene expression (CHOP, ClpP, ClpX, Lonp1, HSP10, HSP70, ATF-5) while mtHSP70 was upregulated. PGC1a mitochondrial biogenesis gene was also downregulated. Our heterozygous mice (50% UBL5 reduction), however, did not present with any defects when on a chow diet. Therefore, our aim was to determine whether exposing the heterozygous mice to high-fat diet rich in cholesterol (HFD) would make them more susceptible to liver stress. We found that following 2 months of HFD feeding, the heterozygous mice were healthier than the wildtype controls. They displayed better glucose tolerance, liver enzyme levels and histology. Furthermore, gene expression of UPRmt were significantly higher in the HFD heterozygous mice compared to the HFD fed wildtype controls. The UBL5 KO mice were then treated with pioglitazone, or an ACE2-containing virus to determine if such treatments provide benefit. Liver enzymes and fat accumulation showed significant improvement after treatment with both pioglitazone & ACE2. Which had UPRmt upregulated in pioglitazone treated group and normalized in ACE2 treated UBL5 KO mice. The current dissertation demonstrated that a liver-specific deletion of the mitochondrial stress response gene UBL5 in adult mice leads to reduced UPRmt, mitochondrial dysfunction / hepatic failure and early death. We have generated a model that develops severe fatty liver disease and have shown that both genetic & pharmacological therapies may diminish this disease process. This study provides the first evidence for a critical role for UBL5 and UPRmt in hepatic function. However, the main reason of liver failure remains unknown and further study is required. In lower species the homeostatic nature of the UPRmt it is well-known. If this pathway is sustained in mammals, controlling this stress response might help to establish a therapeutic strategy to cure disease characterized by mitochondrial disruption. ii Declaration DECLARATION This is to certify that: i. The dissertation comprises only my original work towards the PhD, except where indicated in the Preface, ii. Acknowledgement has been made in the text to all other material used, iii. The thesis is less than 100,000 words in length, exclusive of tables, maps, bibliographies and appendices. ………………………………………. Viktoria Ntouma August 2019 iii Preface PREFACE Ozgene (Bentley DC, WA, Australia) designed and produced the targeting construct for the generation of UBL5 knockout mice. Plasma concentrations of cholesterol and triglycerides were measured by Jennifer Horvath, Clinical Trials Department, Austin Pathology, Austin Health. We obtained the virus recombinant adeno-associated viral vector serotype 2/8 with ACE2 (rAAV2/8-ACE2) and the vehicle vector (rAAV2/8+ Human serum albumin (HAS)) from our collaborator Dr. Chandana Herath (Angus group) (The University of Melbourne, Austin Health) (Mak et al., 2015a). The human liver samples were received by the Victorian Cancer Biobank (Austin Health) with the help from A/Prof. Elif I Einchi. In addition, all the training I received at the start of the current PhD project were carried out by Dr. Benjamin Lamont, Dr. Barbara Fam, Dr. Salvatore Mangiafico and A/Prof Sofianos Andrikopoulos. I, Viktoria Ntouma, contributed in a major fashion to all the design, organization, conduction of the experiments, analyses of the datasets and writing of the scientific papers that are currently in writing progress. Mr. Christian Haralambous assisted in experiments such as oral glucose tolerance and mitochondrial respirometer (oroboros). iv Publications PUBLICATIONS Published Abstracts and Conference Presentations: Ntouma V. Haralambous C, Fam BC. Andrikopoulos S. Mitochondrial Stress and Metabolic Dysfunction in the Liver – A Role For The Unfolded Protein Response. 2019 August. Australian Diabetes Congress. (Poster presentation) Ntouma V. Haralambous C, Andrikopoulos S. Liver-Specific Deletion of the Mitochondrial Stress UBL-5 Gene Leads to Fatty Liver That Is Rescued by Pioglitazone Administration or ACE2 Overexpression. American Diabetes Association, July 2018 Ntouma V. Haralambous C. Lamont B. Ekinci E. Liver-Specific deletion of UBL-5 associated mitochondrial stress is associated with liver failure that is improved by ACE2 expression or pioglitazone administration. August 2017- Australian Diabetes Society Oral presentation, elected for Pincus Taft young Investigator, Finalist Ntouma V. Lamont B. Haralambous C. Mangiafico S. Andrikopoulos S. Liver-Specific Deletion of The Mitochondrial Stress Gene UBL-5 Leads To Liver Failure. August 2016 – Australian Diabetes Society. Oral presentation, elected for Pincus Taft young Investigator, Finalist v Publications Manuscripts in progress: Impaired liver function and morphology in liver-specific deletion of the mitochondrial gene UBL5 Viktoria Ntouma, Christian Haralambous, Barbara Fam, Sofianos Andrikopoulos Rescue of UBL5 KO mice by ACE2 and/or pioglitazone therapies (survival and outcome) Viktoria Ntouma, Christian Haralambous, Barbara Fam, Chandana Herath, Sofianos Andrikopoulos Induced fatty liver in heterozygous UBL5 mice versus controls using 21% fat, 2% cholesterol diet Viktoria Ntouma, Christian Haralambous, Barbara fam, Sofianos Andrikopoulos vi Acknowledgments ACKNOWLEDGMENTS I would like to acknowledge my primary supervisor Associate Professor Sofianos Andrikopoulos, to whom I am incredibly thankful for giving to me this great opportunity to work on this fabulous project. I was looking for a project for a long time, it almost felt like impossible and that I would never do a PhD. Then it was when my dearest friend Chrisa introduced me to Sof and he suggested me to “give it a shot” one more time. I immediately felt like home in his laboratory and decided to apply for PhD again with the University of Melbourne. Sof I will always be grateful for your mentorship and guidance toward my PhD journey. You have given to me multiple chances to attend scientific meetings in Australia and overseas, which greatly benefits me in my career. I will never forget the knowledge and mentorship you have shared with me. I also would like to thank my secondary supervisor Associate Professor Elif I Ekinchi for her advice and encouragement to broaden my horizons in research. Thank you Elif for your optimism, enthusiasm about research and the positive energy you always have and project to others. Also, I would like to thank Professor Joseph Proietto that always provided me with inspiration and motivation. Jo your passion for research and your innovative ideas will always guide me in the future. I would also like to sincerely thank Dr. Barbara Fam who helped me through my entire PhD and assisted me greatly with my thesis writing and with all my presentations and posters. Barbara, thank you for your constant guidance, mentorship and support, you were always there in my best and my worst, you always managed to handle all my stress and all my
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