r.j. fasenmyer annual lectureship metabolic control of ... 2... · r.j. fasenmyer annual...
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RJ Fasenmyer Annual Lectureship Metabolic Control of Innate Immunity and Inflammation ndash The Rediscovered Frontier
Luke OrsquoNeill PhD Director Trinity Biomedical Sciences Institute School of Biochemistry and Immunology Trinity College Dublin Dublin Ireland
A RHEUMATOID JOINT IMAGED WITH 2-DEOXYGLUCOSE
- Where wersquove come from - What has 28 years of effort taught us about the mechanistic basis of inflammatory diseases
-Where we are now - what therapies have emerged
- Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
INNATE IMMUNITY
WHERE WErsquoVE COME FROM
PUBLISHED 1914
The diet ought to be as rich as can be digested ndash considerable amounts of meat good sound wine or stout and extracts of malt The best drug is syrup of the iodide of iron Sea sand should be heated in a tin and poured over the affected joint as hot as can be borne
TREATMENT FOR RHEUMATOID ARTHRITIS 1914 The Modern Family Doctor A Guide to Perfect Health Hygieia London 1914 p510
Another method which frequently does wonders consists in the application of large blisters over the spine these blisters being kept open for a week or ten days It is usual to give some opiate during the cure but the results are so gratifying in many cases as to warrant a trial even in seemingly hopeless cases
Without basic research there can be no applications After all electricity and the electric lightbulb were not invented by incremental improvements in the candle
THE NEED FOR BASIC RESEARCH
Without basic research there can be no applications After all anti-TNF medicines were not invented by incremental improvements in aspirin
INFLAMMATION
INFLAMMATORY DISEASES
PROSTAGLANDINS
1985
Cytokines IL-1 TNF IL6
Inflammatory gene expression
INFLAMMATION
INFLAMMATORY DISEASES
1990
More and more Cytokines
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
NFkappaB p38 JAKs
Mid 90s
DCT cell interactions
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
- Where wersquove come from - What has 28 years of effort taught us about the mechanistic basis of inflammatory diseases
-Where we are now - what therapies have emerged
- Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
INNATE IMMUNITY
WHERE WErsquoVE COME FROM
PUBLISHED 1914
The diet ought to be as rich as can be digested ndash considerable amounts of meat good sound wine or stout and extracts of malt The best drug is syrup of the iodide of iron Sea sand should be heated in a tin and poured over the affected joint as hot as can be borne
TREATMENT FOR RHEUMATOID ARTHRITIS 1914 The Modern Family Doctor A Guide to Perfect Health Hygieia London 1914 p510
Another method which frequently does wonders consists in the application of large blisters over the spine these blisters being kept open for a week or ten days It is usual to give some opiate during the cure but the results are so gratifying in many cases as to warrant a trial even in seemingly hopeless cases
Without basic research there can be no applications After all electricity and the electric lightbulb were not invented by incremental improvements in the candle
THE NEED FOR BASIC RESEARCH
Without basic research there can be no applications After all anti-TNF medicines were not invented by incremental improvements in aspirin
INFLAMMATION
INFLAMMATORY DISEASES
PROSTAGLANDINS
1985
Cytokines IL-1 TNF IL6
Inflammatory gene expression
INFLAMMATION
INFLAMMATORY DISEASES
1990
More and more Cytokines
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
NFkappaB p38 JAKs
Mid 90s
DCT cell interactions
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
PUBLISHED 1914
The diet ought to be as rich as can be digested ndash considerable amounts of meat good sound wine or stout and extracts of malt The best drug is syrup of the iodide of iron Sea sand should be heated in a tin and poured over the affected joint as hot as can be borne
TREATMENT FOR RHEUMATOID ARTHRITIS 1914 The Modern Family Doctor A Guide to Perfect Health Hygieia London 1914 p510
Another method which frequently does wonders consists in the application of large blisters over the spine these blisters being kept open for a week or ten days It is usual to give some opiate during the cure but the results are so gratifying in many cases as to warrant a trial even in seemingly hopeless cases
Without basic research there can be no applications After all electricity and the electric lightbulb were not invented by incremental improvements in the candle
THE NEED FOR BASIC RESEARCH
Without basic research there can be no applications After all anti-TNF medicines were not invented by incremental improvements in aspirin
INFLAMMATION
INFLAMMATORY DISEASES
PROSTAGLANDINS
1985
Cytokines IL-1 TNF IL6
Inflammatory gene expression
INFLAMMATION
INFLAMMATORY DISEASES
1990
More and more Cytokines
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
NFkappaB p38 JAKs
Mid 90s
DCT cell interactions
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Another method which frequently does wonders consists in the application of large blisters over the spine these blisters being kept open for a week or ten days It is usual to give some opiate during the cure but the results are so gratifying in many cases as to warrant a trial even in seemingly hopeless cases
Without basic research there can be no applications After all electricity and the electric lightbulb were not invented by incremental improvements in the candle
THE NEED FOR BASIC RESEARCH
Without basic research there can be no applications After all anti-TNF medicines were not invented by incremental improvements in aspirin
INFLAMMATION
INFLAMMATORY DISEASES
PROSTAGLANDINS
1985
Cytokines IL-1 TNF IL6
Inflammatory gene expression
INFLAMMATION
INFLAMMATORY DISEASES
1990
More and more Cytokines
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
NFkappaB p38 JAKs
Mid 90s
DCT cell interactions
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Without basic research there can be no applications After all anti-TNF medicines were not invented by incremental improvements in aspirin
INFLAMMATION
INFLAMMATORY DISEASES
PROSTAGLANDINS
1985
Cytokines IL-1 TNF IL6
Inflammatory gene expression
INFLAMMATION
INFLAMMATORY DISEASES
1990
More and more Cytokines
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
NFkappaB p38 JAKs
Mid 90s
DCT cell interactions
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Cytokines IL-1 TNF IL6
Inflammatory gene expression
INFLAMMATION
INFLAMMATORY DISEASES
1990
More and more Cytokines
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
NFkappaB p38 JAKs
Mid 90s
DCT cell interactions
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Late 90s ndash 2000s
DCT cell interactions
NFkappaB p38 JAKs
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
WHERE WE ARE NOW THERAPIES
CYTOKINES AS KEY THERAPEUTIC TARGETS
Inaugural conference of the International Cytokine and Interferon Society (ICIS)
Sept 29th ndash Oct 3rd
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
ANTI-CYTOKINE THERAPIES 2013
Rheumatoid arthritis Anti-TNF Infliximab Adalimumab Etanercept Certolizumab Golimumab Anti-IL-1 Anakinra Anti-IL-6R Tocilizumab Psoriasis Anti-IL-1223 Ustekinumab Anti-TNF Crohnrsquos disease Anti-IL-6R Tocilizumab Anti-TNF Infliximab Adalimumab Phase III efficacy Anti-IL-1223 in Psoriasis Crohnrsquos disease and ulcerative colitis Anti-TNF in ulcerative colitis Anti-IL-17 in ulcerative colitis
WHAT ABOUT SIGNALS
- Tofacitinib (JAK inhibitor) approved in USA and Japan but not EU for rheumatoid arthritis in methotrexate non-responders
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
T
DAMPs and PAMPs
Cytokines IL-1 TNF IL6
Inflammatory gene expression (COX2 iNOS CAMs chemokines etc)
INFLAMMATION
INFLAMMATORY DISEASES
INNATE IMMUNE RECEPTORS
Today
DCT cell interactions
NFkappaB p38 JAKs
Tregs Microbiome
Endogenous ligands for TLR4 in RA
Hsp22 hsp60 hsp70 Biglycan Fibronectin HA fragments Tenascin-C Fibrinogen (Fibrinogen globe region) Citrullinated Fibrinogen (10X)
TLR4
TNF IL-6 etc
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
RA Synovial Tissue
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
1000
2000
3000
4000
5000
6000
7000
Plt001
Plt001
Plt005
IL-6
pg
mlm
g o
f b
iop
sy
gm
l)
Isotype (10
gm
l)
Humira (10
gm
l)
OPN-301
(10
gm
l)
OPN-301
(05
0
10
20
30
40
50
60Plt001
Plt001
Pgt005
TN
F-
pg
ml
23 Doug Veale and colleagues St Vincentrsquos Hospital
Blocking TLR2 prevents cytokine production in
The discovery of inflammasomes has stimulated renewed interest in IL-1
as a target
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
INFLAMMASOMES
Park H et al (2012) Lighting the fires within the cell biology of autoinflammatory diseases Nat Rev Immunol 12 570-580
TYPE I DIABETES
AIRE Foxp3
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Muckle Wells disease
-100 0 100 200
0
100
200
300
400
500
600
Days from infusion
SA
A m
gL
-100 0 100 2000
20
40
60
80
100
120
Days from infusion
CR
P m
gL
Immediately pre first treatment 24 hours post treatment
A Cure Canakinumab (Anti-IL1beta) induced a complete clinical and biochemical response
in all cases
Helen Lachman
Atherosclerosis Cholesterol
crystals
Nlrp3 in disease
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
The Nlrp3 inflammasome may be especially relevant to crystal arthropathies -Best data so far is in osteoarthritis ndash hydroxyapatite crystals
-Role in Gout less clear - inhibiting IL-1beta is efficacious ndash approved in the EU
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Needles Rods
Cartilage integrity
Hydroxyapatite Nlrp3
IL-1
Joint inflammation
OA
NFkappaB JNK
2013
COX2 aggrecanases
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
-Where we are going - a re-discovered frontier ndash the role of metabolism in innate immunity and inflammation
TYPE 2 DIABETES AND IL-1
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
1990 2010 OBESITY
Type 2 diabetes
WHY CORN SYRUP
OBESITY AND TYPE 2 DIABETES
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
IRONY
IRONY
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
IL1 in T2D
IL1b
Beta cell proliferation Beta cell death
Hypoglycemia Insulin resistance
Appetite suppression
Inhibiting IL-1beta has shown benefits in the treatment of T2D 9 separate clinical trials
What induces IL-1beta in T2D
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
IAPP deposits in human pancreas
Production of IL-1b by IAPP requires Nlrp3
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
FAT TISSUE PANCREAS Lipids Insulin + IAPP (palmitate ceramide) Adipocytes and macrophages Macrophages in the pancreas Nlrp3 Caspase-1 activation Nlrp3 Caspase-1 activation IL-1beta IL-1beta Decreased fat oxidation obesity Beta cell death Insulin resistance Insulin resistance
A model for the pathogenesis of T2D Adipose tissue the pancreas Nlrp3 and T2D
IAPP (initial insulin resistence)
Nlrp3
IL-1
Further insulin resistance
Beta cell death
Type 2 diabetes
NFkappaB JNK
2011
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
GLUCOSE MUSCLE LIVER
INSULIN
+
NORMAL
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD INFLAMMATION CAUSE INSULIN RESISTENCE
MACROPHAGE ACTIVATION (not resistant) HOST DEFENSE REPAIR
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
WHAT ROLE DOES GLUCOSE PLAY IN IL-1beta PRODUCTION
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPS
rela
tive I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
2DG blocks LPS-induced IL-1beta in vivo
Glucose 2-deoxyglucose
ONE OXYGEN MAKES ALL THE DIFFERENCE
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
BIOLOGY AT ITrsquoS SIMPLEST
Control 18h LPS treated 18h
LPS THE WARBURG EFFECT
CONTROL LPS LPS and 2-DG
4 8 16 240
5
10
15 unstimulated
LPS
Time (h)
Glu
co
se
util
isa
tio
nG
lyco
lysis
O
xp
ho
s
LPS increases flux through glycolyis and decreases mitochondrial respirations
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
0
2
4
6
unstimulated LPS
NA
DN
AD
H ra
tio p
mo
l10
6 c
ells
LPS decreases NAD production
Otto Warburg
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
The Warburg Effect Aerobic glycolysis
Otto Warburgrsquos grant application
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
lsquoThe lsquocancer metabolismrsquo of normal white blood cells is an artefact of mechanical and chemical damagersquo
Th17
Treg
HIF is required for RORgt
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Nature (2013) 493 346-354
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Pro-inflammatory versus anti-inflammatory cells and metabolism
WARBURG EFFECT M1 macrophages activated dendritic cells activated fibroblasts Th17 cells OXIDATIVE PHOSPHORYLATION M2 macrophages (Sedoheptulose Kinase) Treg cells CD8+ memory cells
Glycolysis Oxidative Phosphorylation
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
First observation ndash Dingle JT and Page-Thomas DP (1956) Brit J of Exp Pathology 37 318-323
Enzymes in glycolysis are autoantigens in RA Glucose phosphate isomerase Enolase and aldolase Enolase is citrullinated
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
METBOLISM MEETS IMMUNOLOGY
Infection Injury Inflammation Immunity Restore Homeostasis
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
METBOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Metabolism Immunity Restore Maintain Homeostasis Homeostasis
EXTERNAL STRESSORS
METBOLISM MEETS IMMUNOLOGY
Infection Injury Over-Nutrition Inflammation Altered Metabolism Immunity Metabolic diseases
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
METBOLISM MEETS IMMUNOLOGY
Infection Injury Genetics Inflammation Altered Metabolism Immunity Inflammatory diseases
What are the precise molecular pathways that link the 2 systems
of immunity and metabolism
KEY QUESTION
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
METBOLISM MEETS IMMUNOLOGY TYPE 2 DIABETES
Infection Injury Over-Nutrition Nlrp3 Altered Metabolism IL-1beta Metabolic diseases
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Colchicine works in gout because if prevents tubulin polymerisation
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
So in gout the decrease in NAD promotes Nlrp3 activation Another example inflammation inceases succinate to promote IL-1beta
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
2DG decreases IL-1beta but not TNF expression at 24h in human
0
05
1
15
2
25
3
0 LPS
TN
Fa (
ng
ml)
LPS
LPS + 2DG
IL-1beta
TNFalpha
0
50
100
150
200
250
300
350
400
0 LPSre
lati
ve I
L-1
beta
exp
ressio
n
LPS
LPS + 2DG
Two questions 1 What do the metabolic changes induced by LPS in macrophages mean for macrophage function 2 What is the mechanism by which they occur
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
WHAT ROLE DOES GLUCOSE PLAY IN ALL THIS CAN WE TREAT INFLAMMATION (INCLUDING TYPE 2 DIABETES) BY STARVING MACROPHAGES
-Anti-inflammatory agents might work in part by making a macrophage think itrsquos starvinghellippseudostarvation
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Metabolomic Analysis
bull 2-DG inhibits glycolysis
bull LPS appears to promote glycolysis
bull What can we learn from the metabolome
in LPS activated macrophages
Profound metabolic changes in LPS-treated macrophages
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
THE GABA SHUNT
2-DG inhibits the LPS-induced increase in succinate
0
2times1006
4times1006
6times1006
su
ccin
ate
(p
ea
k a
rea
)
LPS
unstimulated
- 1 5 10
2DG (mM)
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
LPS induces succinate in part from glutamine being metabolised by thre
GABA shunt acetyl-CoA
citrate
a-ketoglutarate
succinate
fumarate
malate
oxaloacetateGlu [13C515N2]-Gln
12C
13C
14N
15NGABA
SinglepassofTCAcycle
What would inhibiting the GABA shunt with vigabatrin do to IL-1beta
production
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
IL-1beta
LPS LPS + sabril PBS sabril0
200
400
600
800
1000
IL-1b
eta (
pgm
l)IL-6
LPS LPS + sabril PBS sabril0
10
20
30
40IL-
6 (ng
ml)
TNFalpha
LPS LPS + sabril PBS sabril0
1
2
3
TNFa
(ngm
l)
Blocking the GABA shunt with Vigabatrin in vivo reduces LPS-induced IL-1b
Inhibition of the GABA shunt protects mice from LPS lethality
0 20 40 60 80 0
50
100
150 Co n t r o l
Vi g a + L PS
LP S
Ho u r s p o s t L P S
P e r c
e n
t s u r v
i v a l
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
At this stage
- LPS increases glycolysis and the GABA shunt in macrophages leading to an
increase in succinate
-What is the succinate doing
2DG inhibits LPS-induced IL-1beta promoter-driven luciferase activity
Increasing amounts of IL-1b luc +LPS +- 2DG
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Could inhibition of HIF-1alpha explain why 2-DG blocks transcription of IL-1beta but not TNF
TNF promoter lacks sites for PU1 Spi1 and HIF-1alpha
LPS stabilises HIF1alpha in macrophages at 24h
WB HIF1α WB actin
LPS
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
2-DG
LPS - + - + - + - + HIF1 IL-1b B-actin
LPS-induced HIF1α protein is
inhibited by 2DG
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Is Succinate involved in HIF-1 stabilisation in inflammation
-50
0
50
100
150
200
250
300
350
400
PGL3 IL-1 promoter IL-1 -HIF promoter
unstim
LPS
LPS plus 2DG
Mutating the HIF-1alpha site in the IL-1beta promoter abolishes LPS responsiveness
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Effect of manipulation of HIF1a on IL-1 β expression
- LPS - LPS0
2000
4000
6000
8000
rela
tive I
L-1
b e
xp
ressio
n
+ succinate
0 LPS 0 LPS0
20000
40000
60000
rela
tive I
L-1
b e
xp
ressio
n
+ butylmalonate
EXOGENOUS SUCCINATE BOOSTS BLOCKING SUCCINATE METABOLISM BOOSTS
Succinate KG and HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Succinate will inhibit PHDs and stablise HIF1
HIF-1 HIF-1 stablised
PHD
KG Succinate
-
KG will antagonise the effect of succinate on PHD and destablise HIF1
HIF-1 HIF-1 hydroxylation and degradation
PHD
KG Succinate
KG
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
012
h
12h+αK
G24
h
24h+αK
G
00
05
10
Rela
tive E
nri
ch
men
t
0 LPS 0 LPS0
10000
20000
30000
rela
tiv
e IL
-1b
ex
pre
ss
ion
+ aKG
Alpha ketoglutarate ndash competes with succinate to degrade HIF1-alpha and inhibits IL-1beta induction
WBIL-1β
WBHIF-1α
- +LPSαKG αKG
WBβ-ac n
Summary
bull LPS promotes glycolysis and other metabolic processes (purine biosynthesis)
bull TCA cycle is limited and GABA shunt is activated ndash
succinate builds up bull Succinate is transported from the mitochondria and
stabilises HIF-1-alpha by inhibiting Prolyl Hydroxylase bull HIF-1-alpha promotes the transcription of IL-1beta and other proteins
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Comparison to Cytochrome C Succinate as a mitochondrial signal for inflammation
Infectious Inflammatory signals
succinate
PHD
HIF-1 IL-1beta Inflammation
Multiple targets for succinate in innate immunity
Succinylation of target Proteins GPR91 synergy with TLR signaling
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
LPS increases protein succinylation in macrophages
2DG2DG
-LPS+LPS
WBsuccinyllysine
WBIL-1βWBβ-ac n
unstimulated LPS00
01
02
03
04
me
an
em
PA
I va
lue
LPS decreases expression of the desuccinylase Sirt5
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Protein succinylation
bull We identified several metabolic enzymes that underwent succinylation
bull Notable example- bull malate dehydrogenase
bull GAPDH
bull Triose phosphate isomerase
bull PKM12
Succinylation is predicted to cause a major conformational change
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Key finding
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha that drives the inflammatory process forward
METABOLISM MEETS IMMUNOLOGY GOUT
Misawa T et al Nat Immunol 14 454-460 (2013)
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -decreased NAD -decreased SIRT2 (deaceylase) - acetylated tubulin - Nlrp3 activation IL-1beta and inflammation
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
METABOLISM MEETS IMMUNOLOGY
Infection Injury Nutrition Inflammation Altered Metabolism Immunity -increased succinate -PHD inhibition - increased HIF1alpha - increased IL-1beta and other genes inflammation
THE IMMUNE SYSTEM AS A TURBO-CHARGED HYBRID CAR
When resting ndash battery (electricity) (Oxidative Phosphorylation) To activate ndash petrol (Glycolysis) Turbo charge Succinate from Glutamine
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
2-DG makes an activated macrophage think itrsquos starving
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
GLUCOSE BUILDS UP
MUSCLE LIVER
INSULIN
RESISTENCE
INFLAMMATION
WHY WOULD A STARVING MACROPHAGE BE TURNED OFF
MACROPHAGE ACTIVATION HOST DEFENSE REPAIR
LOW GLUCOSE MACROPHAGE TURNED OFF GLUCOSE SPARED FOR VITAL ORGANS
LOW GLUCOSE
Starving Macrophage AMP kinase activation- less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
The role of AMP kinase in promoting oxidative phosphorylation and limiting glycolysis in conserved in yeast
Low glucose
SNF2
YEAST MACROPHAGE
Low glucose 2DG
AMP kinase
Ox Phos Glycolysis Ethanol
Ox Phos Glycolysis Inflammation (HIF1alpha IL-1beta)
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
GLUCOSE
Anti-Diabetic drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
(mM)
IL-1β qPCR
(mM)
Metformin inhibits transcription of IL-1beta but not TNF
Int Immunopharmacol 2013 Apr 116(1)85-92 doi 101016jintimp201303020 [Epub ahead of print] Metformin downregulates Th17 cells differentiation and attenuates murine autoimmune arthritis Kang KY Kim YK Yi H Kim J Jung HR Kim IJ Cho JH Park SH Kim HY Ju JH
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
GLUCOSE
Anti-inflammatory drugs on a macrophage less inflamed
ENERGY
TCA
ADP
ATP C02
H2O
mitochondria
STORED FATS
AMP KINASE
METFORMIN SALICYLATES METHOTREXATE RESVERATROL
Do anti-inflammatory drugs cause Pseudo-starvation in a macrophage
turning it off
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Succinate might be a very important signal- a driver
of innate immunity and inflammation
The take home messages
bull Inflammation promotes major metabolic changes ndash glycolysis succinate and HIF-1alpha
bull Pseudo-starvation might limit inflammation
via AMP kinase
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Does inflammation lie at the heart of most diseases because it puts the body under metabolic stress This deprives tissues of nutrients ignoring the usual integrated cues that control metabolism leading to morbidity and shortening of life span
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
Genetic variation as the tipping point into disease
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
Infection
TLRs Nlrp3
NFkB
Cytokines (IL1 TNF IL6 IL12 IL17 IL23)
INFLAMMATION
Tissue Injury
DAMPs
PAMPs Antigen
Autoantigen
Autoantibodies
T cell B cell
+
+
Abatacept Rituximab
Anti-cytokine
p38
Anti-JAK
HIF1
Metabolic shift NAD down succinate up
Genetic variation as the tipping point into disease
Metformin Salicylates
INNATE IMMUNITY AUTOINFLAMMATION AND AUTOIMMUNITY
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
LUKE OrsquoNEILL
Rebecca Coll Beth Kelly
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
OrsquoNEILL LAB
Rebecca Coll Sinead Corr Annie Curtis Niamh Foley Anne McGettrick Claire McCoy Eva Palsson McDermott Gillian Tannahill Seth Masters (WEHI) Mustafa Alam Nick Bernard Moritz Haneklaus Beth Kelly Evanna Mills Sue Quinn Mirjam van den Bosch Paulina Wochal Kathy Banahan Cait Donoghue
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Acknowledgment
Juraj Adamik Mike Murphy Phil Auron
University of Duquesne MRC Mitochondrial Biology Unit Cambridge
Univeristy College Dublin
Eoin Cummins Cormac Taylor
Beatson Institute for Cancer Research
Christian Frezza Eyal Gottlieb
Mass General HarvardMIT Broad Ramnik Xavier Clary Clish
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
IL4 Caloric restriction Nampt1 STAT6 NAD+ PGC-1b SIRT1
b-oxidation Mitochondrial biosynthesis
Metabolic Regulation of M2 macrophages and Th17 cells (a) M2 macrophages
CARKL
IL6 TORC1 STAT3 HIF1 Glycolysis
RORgt pVHL E3L Foxp3 degradation IL-17
(b) Th17 cells
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
COMPARING SIGNATURE METABOLIC PROCESSES IN TUMORS AND INFLAMMATORY CELLS
TARGETING TLRs AGONISTS AND ANTAGONISTS
ONLY PUBLISHED ANTAGONIST IS ERITORAN (ANTI-TLR4) WHICH FAILED IN SEPSIS
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Diethylfumarate (BG12) and MS
A natural metabolite in the TCA cycle Similar effect to AMP kinase activators ndash induces IL4 and IL10 (M2 macrophages) Approved by the FDA 27th March 2013 for relapsing remitting MS
210 binding site Human - UUUUCGCACAAU Mouse - UUUUCCCACCGU
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
Potential role of miR210 4th yr data
N=2
N=2
081211 bmdm SS
Ctl LPS (24 hr)0
1
2
3
4
Re
lative
miR
21
0 e
xp
ressio
n
181111 j774
Ctl LPS (24 hr)00
05
10
15
20
25
Re
lativ
e m
iR2
10
exp
ressio
n
310112 Bmdm ss 48h
Ctl LPS (48 hr)0
1
2
3
4
5
Re
lative
miR
21
0 e
xp
ressio
n
N=2
J774s
BMDM BMDM
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Confirmation that LPS-increases miR-210
080413 210
Ctl LPS Ctl LPS Ctl LPS00
05
10
15
20
0 MCSF2 FCS
2 MCSF2 FCS
10 MCSF10 FCS
Re
lativ
e m
iR-2
10
exp
ressio
n
27328140413 pooled 24h no SS n=8
Ctl LPS00
05
10
15
20
Re
lative
miR
-21
0 e
xp
ressio
n
N=8 N=3
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
LPS decreases SDHD expression- through miR210
25030208160413 sdhd n=10
Ctl LPS00
05
10
15
Re
lative
sd
hd
exp
ressio
n
N=10
miR210 SDHD succinate
LPS
HIF-1α IL-1β
Hypothesis
Anti-miR210 may prevent LPS-induced decrease in SDHD and decreases IL-1β production
miR210 SDHD succinate
anti-miR210
HIF-1α IL-1β
n=1
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B
00
05
10
15
20
25
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e S
DH
D e
xp
ressio
n
0
2000
4000
6000
8000
10000
anti-miR210 (10nM)
anti-miR210 (50nM)
NT NC
Unstimulated
LPS (1 ngml)
Re
lativ
e IL
-1b
exp
ressio
n
A
B