Treatment, prevention, and reversal of alcohol-induced liver disease
09717719 · 2017-08-01
Assignee
Inventors
Cpc classification
A61P25/18
HUMAN NECESSITIES
A61P1/16
HUMAN NECESSITIES
International classification
Abstract
This invention relates to methods for treating, preventing, or reversing liver disease or damage produced by chronic alcohol intake by administering at least one peroxisome proliferator activated receptor (PPAR) agonist.
Claims
1. A method for decreasing insulin resistance in the liver of a human diagnosed with alcohol-induced liver disease or alcohol induced liver damage comprising administering to said human at least one peroxisome proliferator activated receptor-δ (PPAR-δ) selective agonist in a therapeutically effective amount, wherein said PPAR-δ agonist is selected from the group consisting of GW-501516, GW-0742, L-165041, carbaprostacyclin, and RWJ-800025.
2. The method of claim 1, wherein said liver damage is produced by chronic alcohol intake in said human.
3. The method of claim 1, wherein two or more PPAR agonists are administered.
4. The method of claim 1, wherein, said liver disease is steatosis, alcoholic hepatitis, or alcoholic cirrhosis.
5. The method of claim 2, wherein said chronic alcohol intake is at least about 0.1 g pure alcohol/kg body weight/day on average.
6. The method of claim 2, wherein said chronic alcohol intake is at least about 0.5 g pure alcohol/kg body weight/day on average.
7. The method of claim 2, wherein said chronic alcohol intake is at least about 1 g pure alcohol/kg body weight/day on average.
8. The method of claim 1, wherein said PPAR-δ selective agonist comprises L-165,041.
9. The method of claim 2, wherein alcohol intake constitutes at least 37% by caloric content for at least 6 weeks.
10. The method of claim 1, wherein said insulin resistance is determined by measuring insulin binding to the insulin receptor, glucose tolerance tests, or expression of insulin-responsive genes.
Description
BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES
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DETAILED DESCRIPTION OF THE INVENTION
(18) The present invention relates to the important role played by increased insulin resistance in the occurrence of alcohol-induced liver damage and disease and the ability of PPAR agonists to prevent or treat the liver damage and restore hepatic regeneration response. Administration of PPAR agonists to animals that chronically ingest alcohol blocks the liver damage that occurs in response to the alcohol intake, including damage due to oxidative stress (e.g., lipid peroxidation) and DNA damage. Further, the administration of PPAR agonists reverses the inhibition of hepatic regeneration response that occurs during chronic alcohol intake. Therefore, the invention relates to methods for treating, preventing, or reversing alcohol-induced liver disease in an animal, comprising administering to said animal a therapeutically effective amount of at least one PPAR agonist.
(19) Another aspect of the invention is directed to methods for treating, preventing, or reversing liver damage produced by chronic alcohol intake in an animal, comprising administering to said animal a therapeutically effective amount of at least one PPAR agonist.
(20) In one embodiment, the invention relates to methods for treating, preventing, or reversing insulin resistance in the liver of an animal produced by chronic alcohol intake, comprising administering to said animal a therapeutically effective amount of at least one PPAR agonist.
(21) In a further embodiment, the invention relates to methods for stimulating or restoring hepatic regenerative response in an animal with chronic alcohol intake, comprising administering to said animal a therapeutically effective amount of at least one PPAR agonist.
(22) In one embodiment of the invention, at least two different PPAR agonists are administered. In another embodiment, at least three different PPAR agonists are administered. In one embodiment, the PPAR agonists that are administered bind to at least two different subtypes of PPAR receptors, e.g., α and δ, α and γ, or δ and γ. In a further embodiment, the PPAR agonists that are administered bind to all three subtypes of PPAR receptors. The PPAR agonists administered may include compounds that selectively bind to one PPAR receptor subtype and/or compounds that bind to more than PPAR receptor subtype.
(23) The term “Alcoholic Liver Disease (ALD),” as used herein, refers to the spectrum of clinical pathologic changes in the liver caused by ethanol intake. ALD pathologies include fatty liver (steatosis), alcoholic hepatitis, and alcoholic cirrhosis.
(24) The term “chronic alcohol intake,” as used herein, refers to the consumption by an animal of at least about 0.1 g pure alcohol (ethanol) per kg body weight per day on average, e.g., at least about 0.2, 0.3, 0.4, 0.5, 1, 2, 3, 4, or 5 g/kg/day on average. For a human, chronic alcohol intake is considered to be at least about 10 g pure alcohol per day on average, e.g., at least about 20, 30, 40, 50, 60, 70, 80, 90, or 100 g/day on average.
(25) The term “therapeutically effective amount,” as used herein, refers to that amount of the therapeutic agent sufficient to result in amelioration of one or more symptoms of a disorder, or prevent advancement of a disorder, or cause regression of the disorder. For example, with respect to the treatment of liver disease, in one embodiment, a therapeutically effective amount will refer to the amount of a therapeutic agent that decreases the number of damaged hepatocytes, slows the rate of increase in the number of damaged hepatocytes, increases the rate of liver regeneration, or increases survival time by at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or at least 100%. In a further embodiment, a therapeutically effective amount will refer to the amount of a therapeutic agent that increases a biological function of the liver by at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or at least 100%. Liver function can be measured using assays that are routine in clinical medicine, including without limitation measurement of transaminases (e.g., alanine aminotransferase (ALT), aspartate aminotransferase (AST)), γ-glutamyl transpeptidase (GGT), mean corpuscular volume (MCV), prothrombin time, platelet count, bilirubin, albumin, and/or alkaline phosphatase. In an additional embodiment, a therapeutically effective amount will refer to the amount of a therapeutic agent that decreases insulin resistance in the liver by at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or at least 100%. Insulin resistance can be measured using assays that are routine in the art and those that are discussed herein, including without limitation measurement of insulin binding to the insulin receptor, glucose tolerance tests, and expression of insulin-responsive genes.
(26) The terms “prevent,” “preventing,” and “prevention,” as used herein, refer to a decrease in the occurrence of pathological cells (e.g., damaged hepatocytes) in an animal. The prevention may be complete, e.g. the total absence of pathological cells in a subject. The prevention may also be partial, such that the occurrence of pathological cells in a subject is less than that which would have occurred without the present invention.
(27) In one aspect of the invention, methods for treating, preventing, or reversing alcohol-induced liver disease in an animal are provided. In certain embodiments, the methods comprise the administration to the animal of a therapeutically effective amount of at least one PPAR agonist. The PPAR agonist may be administered prior to or after the onset of physical or histological symptoms of liver disease. In one embodiment, the liver disease is steatosis, alcoholic hepatitis, or alcoholic cirrhosis.
(28) Another aspect of the invention is directed to methods for treating, preventing, or reversing liver damage produced by chronic alcohol intake in an animal. In certain embodiments, the methods comprise the administration to the animal of a therapeutically effective amount of at least one PPAR agonist. The PPAR agonist may be administered prior to or after the onset of physical or histological symptoms of liver damage. Liver damage may be any type of cellular or tissue damage associated with alcohol intake. For example, the damage may be associated with oxidative stress (e.g., lipid peroxidation) or DNA damage. The term “associated with,” as used herein, means that the alcohol-induced liver damage is evidenced by physical (e.g., histological, serological) signs of a condition (e.g., oxidative stress or DNA damnage).
(29) In one embodiment, the invention relates to methods for treating, preventing, or reversing insulin resistance in the liver of an animal produced by chronic alcohol intake. In certain embodiments, the methods comprise the administration to the animal of a therapeutically effective amount of at least one PPAR agonist. The PPAR agonist may be administered prior to or after the onset of insulin resistance. Insulin resistance may be due to alcohol-induced alterations anywhere along the insulin/IGF signaling pathways, e.g., decreased binding of insulin to the insulin receptor, decreased IGF-I expression, increased IGF-II expression, increased expression of receptors for IGF-I and IGF-II, or decreased expression of insulin-responsive genes such as AAH.
(30) Insulin resistance may be measured by detecting an alteration in the level or function of at least one factor in the insulin/IGF signaling pathway. In one embodiment, the detection of an alteration is carried out in vivo. For example, imaging techniques (e.g., magnetic resonance imaging, computed axial tomography, single photon emission computed tomography, positron emission tomography, X-ray, ultrasound) may be used in combination with detectably labeled antibodies, ligands, enzymes substrates, etc., to determine the level or function of at least one factor in the insulin/IGF signaling pathway in a subject. Examples of detectable labels include, but are not limited to, radioactive, fluorescent, paramagnetic, and superparamagnetic labels. Any suitable in vivo imaging techniques known in the art may be used in the present invention. Examples of imaging techniques are disclosed in U.S. Pat. Nos. 6,737,247, 6,676,926, 6,083,486, 5,989,520, 5,958,371, 5,780,010, 5,690,907, 5,620,675, 5,525,338, 5,482,698, and 5,223,242.
(31) In another embodiment, the detection of an alteration is carried out in vitro, e.g., using a biological sample. A biological sample may be any tissue or fluid from a subject that is suitable for detecting the level or function of at least one factor in the insulin/IGF signaling pathway. Examples of useful samples include, but are not limited to, biopsied hepatic tissues, blood, plasma, serous fluid, cerebrospinal fluid, saliva, urine, and lymph.
(32) Factors in the insulin/IGF signaling pathway that may be detected and measured include, but are not limited to, insulin, insulin-like growth factor-I (IGF-I), IGF-II, insulin receptor, IGF-I receptor, IGF-II receptor, tyrosine phosphorylated insulin receptor, tyrosine phosphorylated IGF-I receptor, tyrosine phosphorylated IGF-II receptor, insulin receptor substrate-1 (IRS-1), IRS-2, IRS-4, tyrosine phosphorylated IRS-1, tyrosine phosphorylated IRS-2, tyrosine phosphorylated IRS-4, phosphatidylinositol 3-kinase (PI3 kinase), the p85 subunit of PI3 kinase, Akt, phospho-Akt, glycogen synthase kinase-3β (GSK-3β), and phospho-GSK-3β. Functions that may be measured include, but are not limited to, ligand binding capacity of the insulin receptor, IGF-I receptor, or IGF-II receptor, kinase activity of the insulin receptor, IGF-I receptor, or IGF-II receptor, interaction of the p85 subunit of PI3 kinase with phosphorylated IRS-1, IRS-2, or IRS-4, binding of phosphorylated IRS-1, IRS-2, or IRS-4 to growth factor receptor-bound protein 2 (Grb2), SHPTP-2 protein tyrosine phosphatase, or the p85 subunit of PI3 kinase, the enzymatic activity of mitogen-activated protein kinase kinase (MAPKK), Erk MAPK, Akt/Protein kinase B, GSK-3β.
(33) The levels of factors in the insulin/IGF signaling pathway may be measured at the protein or RNA (e.g., mRNA) levels. Any method known in the art for quantitating specific proteins in a biological sample may be used in the present methods. Examples include, but are not limited to, immunoassays, Western blotting, immunoprecipitation, inmnunohistochemistry, gel electrophoresis, capillary electrophoresis, column chromatography, ligand binding assays, and enzymatic assays. See, e.g., Harlow et al., Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y., (1988); Ausubel et al., Current Protocols in Molecular Biology, John Wiley & Sons, New York 3rd Edition, (1995).
(34) To measure the level of a specific RNA, any assay known in the art for the detection of nucleic acids may be used in the invention. Examples include, but are not limited to, reverse transcription and amplification assays, hybridization assays, Northern blotting, dot blotting, in situ hybridization, gel electrophoresis, capillary electrophoresis, and column chromatography. See, e.g., Ausubel et al., Current Protocols in Molecular Biology, John Wiley & Sons, New York 3rd ed., (1995); Sambrook et al., Molecular Cloning—A Laboratory Manual, 2nd ed., Vol. 1-3 (1989). The assay can detect the RNA itself or a cDNA produced by reverse transcription of the RNA. Assays can be performed directly on biological samples or on nucleic acids isolated from the samples.
(35) In a further embodiment, the invention relates to methods for stimulating or restoring hepatic regenerative response in an animal. In certain embodiments, the methods comprise the administration to the animal of a therapeutically effective amount of at least one PPAR agonist. The PPAR agonist may be administered prior to or after the reduction in hepatic regenerative response. The increase in regenerative response induced by a PPAR agonist may be at least about 10% greater than the regenerative response seen in the absence of the PPAR agonist, e.g., at least about 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% greater. Measurement of hepatic regenerative response may be carried out by any technique known in the art, such as measurement of DNA synthesis rates.
(36) The methods of the invention may be carried out on animals displaying pathology resulting from liver damage or disease, animals suspected of displaying pathology resulting from liver damage or disease, and animals at risk of displaying pathology resulting from liver damage or disease. For example, those that have a genetic predisposition to alcoholism or who are moderate drinkers but already have liver damage for other reasons (e.g., viral hepatitis) can be treated prophylactically.
(37) PPAR agonists that may be used in the present invention include selective agonists of PPAR-α, PPAR-γ, and PPAR-δ, as disclosed in U.S. Pat. Nos. 6,713,514, 6,677,298, 6,462,046, 5,925,657, and 5,326,770 and in Combs et al., J. Neurosci. 20:558 (2000), as well as compounds that are agonists of multiple PPAR subtypes. The term selective is used to describe agents having greater than 10-fold, preferably greater than 100-fold, and most preferably greater than 1,000-fold activity at one PPAR receptor subtype than at another PPAR receptor subtype. Characterization of receptor affinities and functional activities for agents at PPAR receptor subtypes can be determined using methodology as described in WO 2005049572. The use of PPAR-δ agonists in liver disease patients may have an added advantage of increasing the number of type I muscle fibers, which may confer resistance to obesity and improve metabolic profiles, even in the absence of exercise (Wang et al., PLoS Biol. 2:3294 (2004)).
(38) Useful PPAR-α selective agonists include without limitation clofibrate, bezafibrate, ciprofibrate, 2-bromohexadecanoic acid, etomoxir sodium hydrate, N-oleoylethanolamine, GW-9578, GW-7647, WY-14643, and compounds disclosed in U.S. Pat. Nos. 7,091,225, 7,091,230, 7,049,342, 6,987,118, 6,750,236, 6,699,904, 6,548,538, 6,506,797, 6,306,854, 6,060,515, and 6,028,109.
(39) Useful PPAR-γ selective agonists include without limitation ciglitazone, rosiglitazone, pioglitazone, troglitazone, GW-1929, F-L-Leu, JTT-501, GI-262570, and compounds disclosed in U.S. Pat. Nos. 7,090,874, 7,060,530, 6,908,908, 6,897,235, 6,852,738, 6,787,651, 6,787,556, 6,713,514, 6,673,823, 6,646,008, 6,605,627, 6,599,899, 6,579,893, 6,555,536, 6,541,492, 6,525,083, 6,462,046, 6,413,994, 6,376,512, 6,294,580, 6,294,559, 6,242,196, 6,214,850, 6,207,690, 6,200,995, 6,022,897, 5,994,554, 5,939,442, and 5,902,726.
(40) Useful PPAR-δ selective agonists include without limitation GW-501516, GW-0742, L-165041, and carbaprostacyclin, which are structurally defined below:
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(42) Other useful PPAR-δ agonists include without limitation RWJ-800025, L-160043 and compounds disclosed in U.S. Pat. Nos. 7,091,245, 7,015,329, 6,869,967, 6,787,552, 6,723,740, 6,710,053, and 6,300,364 and in EP 1586573, US 20050245589, and WO 2005049572.
(43) Useful mixed PPAR-α/γ agonists include without limitation GW-1556, AVE-8042, AVE-8134, AVE-0847, DRF-2519, and compounds disclosed in U.S. Pat. Nos. 7,091,230, 6,949,259, 6,713,508, 6,645,997, 6,569,879, 6,468,996, 6,465,497, and 6,380,191.
(44) Useful compounds that act as agonists at all PPAR receptors include without limitation LY-171883 and pseudolaric acid B.
(45) Some embodiments of the present invention provide methods for administering a therapeutically effective amount of a PPAR agonist in combination with an additional agent known in the art to be useful for the treatment, prevention, or reversal of alcohol-induced liver disease or damage. Examples of additional agents include without limitation glucocorticoids (e.g., prednisone, prednisolone), pentoxifylline, ursodeoxycholic acid, colchicine, and diuretics (e.g., amiloride, furosemide).
(46) In some embodiments of the invention, a PPAR agonist and an additional agent are administered to an animal separately, e.g. as two separate compositions. In other embodiments a PPAR agonist and an additional agent are administered as a part of a single composition.
(47) In some embodiments of the present invention, a PPAR agonist and an additional agent are administered to an animal under one or more of the following conditions: at different periodicities, at different durations, at different concentrations, by different administration routes, etc. In some embodiments, a PPAR agonist is administered prior to an additional agent, e.g., 0.5, 1, 2, 3, 4, 5, 10, 12, or 18 hours, 1, 2, 3, 4, 5, or 6 days, or 1, 2, 3, or 4 weeks prior to the administration of an additional agent. In some embodiments, a PPAR agonist is administered after an additional agent, e.g., 0.5, 1, 2, 3, 4, 5, 10, 12, or 18 hours, 1, 2, 3, 4, 5, or 6 days, or 1, 2, 3, or 4 weeks after the administration of an additional agent. In some embodiments, a PPAR agonist and an additional agent are administered concurrently but on different schedules, e.g., a PPAR agonist is administered daily while an additional agent is administered once a week, once every two weeks, once every three weeks, or once every four weeks. In other embodiments, a PPAR agonist is administered once a week while an additional agent is administered daily, once a week, once every two weeks, once every three weeks, or once every four weeks.
(48) The administration of a PPAR agonist may be continued concurrently with the administration of an additional agent. Additionally, the administration of a PPAR agonist may be continued beyond the administration of an additional agent or vice versa.
(49) In certain embodiments of the invention, the method of administering a PPAR agonist in combination with an additional agent may be repeated at least once. The method may be repeated as many times as necessary to achieve or maintain a therapeutic response, e.g., from one to about 10 times or more. With each repetition of the method the PPAR agonist and the additional agent may be the same or different from that used in the previous repetition. Additionally, the time period of administration of the PPAR agonist and the additional agent and the manner in which they are administered can vary from repetition to repetition.
(50) The agents of the present invention may be linked to a carrier molecule to enhance the cellular uptake of the compounds. Examples of such carrier molecules include carrier peptides such as those described by Fulda et al., Nature Med. 8:808 (2002), Arnt et al., J. Biol. Chem. 277:44236 (2002), and Yang et al., Cancer Res. 63:831 (2003), fusogenic peptides (see, e.g., U.S. Pat. No. 5,965,404), and viruses and parts of viruses such as empty capsids and virus hemagglutinin (see, e.g., U.S. Pat. No. 5,547,932). Other carrier molecules include ligands for cell surface receptor such as asialoglycoprotein (which binds to the asialoglycoprotein receptor; see U.S. Pat. No. 5,166,320) and antibodies to cell surface receptors such as antibodies specific for T-cells, e.g., anti-CD4 antibodies (see U.S. Pat. No. 5,693,509).
(51) Compositions within the scope of this invention include all compositions wherein the agents of the present invention are contained in an amount which is effective to achieve its intended purpose. While individual needs vary, determination of optimal ranges of effective amounts of each component is within the skill of the art. The actual dosage and treatment regimen can be readily determined by the ordinary skilled physician, taking into account the route of administration, age, weight, and health of the subject, as well as the stage of liver disease, and, of course, any side effects of the agents, efficacy of the agents, and in accordance with customary medical procedures and practices. Typically, the agents may be administered to animals, e.g. humans, orally at a dose of 0.0025 to 50 mg/kg, or an equivalent amount of the pharmaceutically acceptable salt thereof, per day of the body weight of the animal being treated for liver damage or disease. Preferably, about 0.01 to about 10 mg/kg is orally administered to treat, prevent, or reverse liver damage or disease. For intramuscular injection, the dose is generally about one-half of the oral dose. For example, a suitable intramuscular dose would be about 0.0025 to about 25 mg/kg, and most preferably, from about 0.01 to about 5 mg/kg.
(52) The unit oral dose may comprise from about 0.01 to about 50 mg, preferably about 0.1 to about 10 mg of each agent. The unit dose may be administered one or more times daily as one or more tablets or capsules each containing from about 0.1 to about 10, conveniently about 0.25 to 50 mg of the agents.
(53) In addition to administering agents as raw chemicals, the agents of the invention may be administered as part of a pharmaceutical preparation containing suitable pharmaceutically acceptable carriers comprising excipients and auxiliaries which facilitate processing of the compounds into preparations which can be used pharmaceutically. Preferably, the preparations, particularly those preparations which can be administered orally or topically and which can be used for the preferred type of administration, such as tablets, dragees, slow release lozenges and capsules, mouth rinses and mouth washes, gels, liquid suspensions, hair rinses, hair gels, shampoos and also preparations which can be administered rectally, such as suppositories, as well as suitable solutions for administration by injection, topically or orally, contain from about 0.01 to 99 percent, preferably from about 0.25 to 75 percent of active compound(s), together with the excipient.
(54) The pharmaceutical compositions of the invention may be administered to any subject which may experience the beneficial effects of the compounds of the invention. Foremost among such subjects are mammals, e.g., humans, although the invention is not intended to be so limited. Other animals include veterinary animals (cows, sheep, pigs, horses, dogs, cats and the like).
(55) The compounds and pharmaceutical compositions thereof may be administered by any means that achieve their intended purpose. For example, administration may be by parenteral, subcutaneous, intravenous, intramuscular, intraperitoneal, transdermal, buccal, intrathecal, intracranial, intranasal, or topical routes. Alternatively, or concurrently, administration may be by the oral route. The dosage administered will be dependent upon the age, health, and weight of the recipient, kind of concurrent treatment, if any, frequency of treatment, and the nature of the effect desired.
(56) The pharmaceutical preparations of the present invention are manufactured in a manner which is itself known, for example, by means of conventional mixing, granulating, dragee-making, dissolving, or lyophilizing processes. Thus, pharmaceutical preparations for oral use can be obtained by combining the active compounds with solid excipients, optionally grinding the resulting mixture and processing the mixture of granules, after adding suitable auxiliaries, if desired or necessary, to obtain tablets or dragee cores.
(57) Suitable excipients are, in particular, fillers such as saccharides, for example lactose or sucrose, mannitol or sorbitol, cellulose preparations and/or calcium phosphates, for example tricalcium phosphate or calcium hydrogen phosphate, as well as binders such as starch paste, using, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, tragacanth, methyl cellulose, hydroxypropylmethylcellulose, sodium carboxymethylcellulose, and/or polyvinyl pyrrolidone. If desired, disintegrating agents may be added such as the above-mentioned starches and also carboxymethyl-starch, cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof, such as sodium alginate. Auxiliaries are, above all, flow-regulating agents and lubricants, for example, silica, talc, stearic acid or salts thereof, such as magnesium stearate or calcium stearate, and/or polyethylene glycol. Dragee cores are provided with suitable coatings which, if desired, are resistant to gastric juices. For this purpose, concentrated saccharide solutions may be used, which may optionally contain gum arabic, talc, polyvinyl pyrrolidone, polyethylene glycol and/or titanium dioxide, lacquer solutions and suitable organic solvents or solvent mixtures. In order to produce coatings resistant to gastric juices, solutions of suitable cellulose preparations such as acetylcellulose phthalate or hydroxypropylmethyl-cellulose phthalate, are used. Dye stuffs or pigments may be added to the tablets or dragee coatings, for example, for identification or in order to characterize combinations of active compound doses.
(58) Other pharmaceutical preparations which can be used orally include push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer such as glycerol or sorbitol. The push-fit capsules can contain the active compounds in the form of granules which may be mixed with fillers such as lactose, binders such as starches, and/or lubricants such as talc or magnesium stearate and, optionally, stabilizers. In soft capsules, the active compounds are preferably dissolved or suspended in suitable liquids, such as fatty oils, or liquid paraffin. In addition, stabilizers may be added.
(59) Possible pharmaceutical preparations which can be used rectally include, for example, suppositories, which consist of a combination of one or more of the active compounds with a suppository base. Suitable suppository bases are, for example, natural or synthetic triglycerides, or paraffin hydrocarbons. In addition, it is also possible to use gelatin rectal capsules which consist of a combination of the active compounds with a base. Possible base materials include, for example, liquid triglycerides, polyethylene glycols, or paraffin hydrocarbons.
(60) Suitable formulations for parenteral administration include aqueous solutions of the active compounds in water-soluble form, for example, water-soluble salts and alkaline solutions. In addition, suspensions of the active compounds as appropriate oily injection suspensions may be administered. Suitable lipophilic solvents or vehicles include fatty oils, for example, sesame oil, or synthetic fatty acid esters, for example, ethyl oleate or triglycerides or polyethylene glycol-400. Aqueous injection suspensions may contain substances which increase the viscosity of the suspension include, for example, sodium carboxymethyl cellulose, sorbitol, and/or dextran. Optionally, the suspension may also contain stabilizers.
(61) The invention further provides an animal model of alcohol-induced liver damage and disease produced by chronically feeding ethanol to Long-Evans rats. Surprisingly, it has been discovered that Long-Evans rats exhibit a robust response to ethanol feeding compared to other rat strains that make the rats ideally suited for the study of the effects of chronic alcohol intake. In one embodiment, ethanol is included in the daily diet of Long-Evans rats. For example, ethanol may comprise about 0%, 2%, 4.5%, 6.5%, 9.25% (v/v) (equivalent to 0%, 8%, 18%, 26%, or 37% of the caloric content) or more of the daily diet. In one embodiment, ethanol comprises about 37% of the caloric content of the daily diet. Ethanol feeding may continue for as long as desired, e.g., from as little as two days to as long as six months or more. In one embodiment, ethanol feeding is continued until liver damage and/or reduction in hepatic regeneration response is induced, e.g., for 1, 2, 3, 4, 5, or 6 weeks or more, followed by the administration of agents or other treatments to determine their effect on the liver damage or hepatic regeneration response. In another embodiment, agents or treatments are administered prior to or concurrently with ethanol feeding to determine if liver damage or the reduction in hepatic regeneration response can be prevented or slowed.
(62) The invention further relates to a method for screening for an agent that is potentially useful for the treatment, prevention or reversal of alcohol-induced liver damage or disease, comprising administering an agent to the animal model produced by chronically feeding ethanol to Long-Evans rats and determining the level of liver damage, insulin resistance, and/or hepatic regeneration response relative to the level in a control animal that has not had the agent administered, wherein an improvement in the level of liver damage, insulin resistance, and/or hepatic regeneration response relative to the level in a control animal that has not had the agent administered indicates that the agent is potentially useful for the treatment, prevention or reversal of alcohol-induced liver damage or disease.
(63) Agents that may be screened include proteins, polypeptides, peptides, antibodies, nucleic acids, organic molecules, natural products, chemical libraries, and the like.
(64) The invention additionally provides a method for testing a potential treatment for treatment, prevention or reversal of alcohol-induced liver damage or disease, comprising administering the potential treatment to the animal model produced by chronically feeding ethanol to Long-Evans rats and determining the level of liver damage, insulin resistance, and/or hepatic regeneration response relative to the level in a control animal that has not had the potential treatment administered, wherein an improvement in the level of liver damage, insulin resistance, and/or hepatic regeneration response relative to the level in a control animal that has not had the potential treatment administered indicates that the treatment is potentially useful for the treatment, prevention or reversal of alcohol-induced liver damage or disease.
(65) The following examples are illustrative, but not limiting, of the method and compositions of the present invention. Other suitable modifications and adaptations of the variety of conditions and parameters normally encountered in clinical therapy and which are obvious to those skilled in the art are within the spirit and scope of the invention.
Example 1
(66) General Methods
(67) Experimental Design
(68) In these studies, Long-Evans male rats were fed a 37% ethanol liquid diet for 6 weeks. An isocaloric (sucrose substituted for ethanol) diet was administered to pair fed control animals. After three weeks, both groups of rats were injected with either PPAR-α, γ, or δ agonists or saline as a control. The PPAR-α (GW7647), PPAR-γ (F-L-Leu) and PPAR-δ (L-165,041) activators were obtained from CalBiochem (Carlsbad, Calif.) and administered intraperitoneal (IP) at concentrations of 25 μg/kg, 20 μg/kg and 2 μg/kg respectively. The mice were given IP injections twice a week. At 6 weeks, the animals underwent 2/3 partial hepatectomy. The removed liver was used for histology, measurement of lipid peroxidation, DNA damage and insulin/IGF signaling as described below. Following ⅔ hepatectomy, the liver remnants were harvested 18, 24, 30 and 48 hours later to assess the regenerative response. To do this, animals were injected IP with BrdU 2 hours before harvest to measure its incorporation into hepatic nuclei as an index of DNA synthesis. Liver regeneration as measured by BrdU or .sup.3H-thymidine incorporation is maximal 24 hours after partial hepatectomy in this animal model (Wands et al., Gastroenterology 77:528 (1979)).
(69) Liver tissue from chronic ethanol fed rats and isocaloric pair fed controls were obtained following sacrifice after 6 weeks on these diets. Formalin fixed paraffin-embedded sections of liver regions were stained with hematoxylin and eosin dyes and examined by light microscopy. Adjacent histological sections were subjected to immunohistochemical staining. Fresh, snap-frozen blocks of tissue from the same regions were used to measure mRNA expression and receptor binding.
(70) Histological Studies:
(71) Paraffin sections (8 μm thick) were immunostained with monoclonal antibodies to 8-hydroxy-deoxyguanosine (8-OHdG) (Oxis Research) or 4-hydroxynonenol (HNE) (Chemicon International, Temecula, Calif.), to detect DNA damage and lipid peroxidation, respectively. Prior to immunostaining, the deparaffinized, re-hydrated sections were treated with 0.1 mg/ml saponin in phosphate buffered saline (10 mM sodium phosphate, 0.9% NaCl, pH 7.4; PBS) for 20 minutes at room temperature, followed by 3% hydrogen peroxide in methanol for 10 minutes to quench endogenous peroxidase activity, and then a 30-minute incubation in SuperBlock-TBS (Pierce Chemical Co., Rockford, Ill.) to block non-specific binding sites. The tissue sections were then incubated overnight at 4° C. with 0.5-1 μg/ml of primary antibody. Immunoreactivity was detected with biotinylated secondary antibody, avidin biotin horseradish peroxidase complex (ABC) reagents, and diaminobenzidine as the chromogen (Vector Laboratories, Burlingame, Calif.) (Lam et al., J. Biol. Chem. 269:20648 (1994)). The tissue sections were counterstained with hematoxylin, preserved under coverglass, and examined by light microscopy.
(72) Real Time Quantitative Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Assays:
(73) Total RNA was isolated from liver tissue using TRIzol reagent (Invitrogen, Carlsbad, Calif.) according to the manufacturer's protocol. RNA concentrations and purity were determined from the absorbances measured at 260 nm and 280 nm. RNA (2 μg) was reverse transcribed using the AMV First Strand cDNA synthesis kit (Roche Diagnostics Corporation, Indianapolis, Ind.) and random oligodeoxynucleotide primers. Real time quantitative RT-PCR was used to measure mRNA levels of insulin, IGF-I, and IGF-II growth factors, their corresponding receptors, insulin receptor substrate (IRS) types 1, 2, and 4, and AAH, a downstream insulin/IGF-I responsive gene involved in cell motility and migration. Ribosomal 18S RNA levels measured in parallel reactions were used to calculate relative abundance of the mRNA transcripts (Myers et al., Proc. Natl. Acad Sci. USA 89:10350 (1992); Baltensperger et al., Science 260:1950 (1993); Yeon et al., Hepatology 38:703 (2003); Pares et al., Hepatology 12:1295 (1990)). PCR amplifications were performed in 25 μl reactions containing cDNA generated from 2.5 ng of original RNA template, 300 nM each of gene specific forward and reverse primer (Table 1), and 12.5 μl of 2× QuantiTect SYBR Green PCR Mix (Qiagen Inc., Valencia, Calif.). The amplified signals were detected continuously with the BIO-RAD iCycler iQ Multi-Color RealTime PCR Detection System (Bio-Rad, Hercules, Calif.). The amplification protocol used was as follows: initial 15-minutes denaturation and enzyme activation at 95° C., 45 cycles of 95° C.×15 sec, 55°-60° C.×30 sec, and 72° C.×30 sec. Annealing temperatures were optimized using the temperature gradient program provided with the iCycler software.
(74) TABLE-US-00001 TABLE 1 Primer pairs for real time quantitative RT-PCR* Amplicon Position Size Primer Direction Sequence (5′.fwdarw.3′) (mRNA) (bp) 18S rRNA For GGA CAC GGA CAG 1278 50 GAT TGA CA (SEQ ID NO: 1) 18S rRNA Rev ACC CAC GGA ATC 1327 GAG AAA GA (SEQ ID NO: 2) Insulin For TTC TAC ACA CCC 145 135 AAG TCC CGT C (SEQ ID NO: 3) Insulin Rev ATC CAC AAT GCC 279 ACG CTT CTG C (SEQ ID NO: 4) Insulin For TGA CAA TGA GGA 875 129 Receptor ATG TGG GGA C (SEQ ID NO: 5) Insulin Rev GGG CAA ACT TTC 1003 Receptor TGA CAA TGA CTG (SEQ ID NO: 6) IGF-1 For GAC CAA GGG GCT 65 127 TTT ACT TCA AC (SEQ ID NO: 7) IGF-I Rev TTT GTA GGC TTC 191 AGC GGA GCA C (SEQ ID NO: 8) IGF-I For GAA GTC TGC GGT 2138 113 Receptor GGT GAT AAA GG (SEQ ID NO: 9) IGF-I Rev TCT GGG CAC AAA 2250 Receptor GAT GGA GTT G (SEQ ID NO: 10) IGF-II For CCA AGA AGA AAG 763 95 GAA GGG GAC C (SEQ ID NO: 11) IGF-II Rev GGC GGC TAT TGT 857 TGT TCA CAG C (SEQ ID NO: 12) IGF-II For TTG CTA TTG ACC 1066 91 Receptor TTA GTC CCT TGG (SEQ ID NO: 13) IGF-II Rev AGA GTG AGA CCT 1156 Receptor TTG TGT CCC CAC (SEQ ID NO: 14)
(75) In preliminary studies, SYBR Green-labeled PCR products were evaluated by agarose gel electrophoresis, and the authenticity of each amplicon was verified by nucleic acid sequencing. The complementary (c) DNAs were cloned into the PCRII vector (Invitrogen, Carlsbad, Calif.). Serial dilutions of known quantities of recombinant plasmid DNA containing the specific target sequences were used as standards in the PCR reactions, and the regression lines generated from the C.sub.t values of the standards were used to calculate mRNA abundance. Relative mRNA abundance was determined from the ng ratios of specific mRNA to 18S measured in the same samples (Myers et al., Proc. Natl. Acad Sci. USA 89:10350 (1992); Baltensperger et al., Science 260:1950 (1993)). Results were normalized to 18S because 18S is highly abundant and the levels were essentially invariant among the samples, whereas housekeeping genes were modulated with disease state. Inter-group statistical comparisons were made using the calculated mRNA/18S ratios. Control studies included real-time quantitative PCR analysis of: 1) template-free reactions; 2) RNA that had not been reverse transcribed; 3) RNA samples that were pre-treated with DNAse I; 4) samples treated with RNAse A prior to reverse transcriptase reaction; and 5) genomic DNA.
(76) Receptor Binding Assays:
(77) Fresh frozen tissue (˜100 mg) was homogenized in 5 volumes of NP-40 lysis buffer (50 mM Tris-HCl, pH 7.5, 1% NP-40, 150 mM NaCl, 1 mM EDTA, 2 mM EGTA) containing protease inhibitors (1 mM PMSF, 0.1 mM TPCK, 1 μg/ml aprotinin, 1 μg/ml pepstatin A, 0.5 μg/ml leupeptin, 1 mM NaF, 1 mM Na.sub.4P.sub.2O.sub.7). Protein concentrations were determined using the bicinchoninic acid (BCA) assay (Pierce, Rockford, Ill.). Exploratory studies determined the amounts of protein and concentrations of radiolabeled ligand required to achieve 20% specific binding. Insulin receptor binding assays were performed using 100 μg protein. IGF-I binding assays required 25 μg protein per sample, and IGF-II receptor binding assays were optimized using 10 μg protein. Competitive equilibrium binding assays were used to assess growth factor binding in relation to ethanol exposure. For total binding, duplicate individual protein samples were incubated in 100 μl reactions containing binding buffer (100 mM HEPES, pH 8.0, 118 mM NaCl, 1.2 mM MgSO.sub.4, 8.8 mM dextrose, 5 mM KCl, 1% bovine serum albumin) and 100 nCi/ml of [.sup.125I] (2000 Ci/mmol; 50 pM) insulin, IGF-I, or IGF-II. To measure non-specific binding, replicate samples were identically prepared but with the addition of 0.1 μM unlabeled (cold) ligand.
(78) All reactions were performed in 1.5 ml Eppendorff tubes, and the incubations were performed at 4° C. for 16 hours with gentle platform agitation. Bound radiolabeled tracer was then precipitated by adding 500 μl of 0.15% bovine gamma globulin (prepared in 100 mM Tris-HCl, pH 8.0) followed by 400 μl 37.5% polyethylene glycol 8000 (PEG-8000; prepared in 100 mM Tris-HCl, pH 8.0) to each tube. The samples were thoroughly mixed by vortexing, and then incubated on ice for at least 2 hours. The precipitates were collected by centrifuging the samples at 15,000×g for 5 minutes at room temperature. The supernatant fraction, which contained unbound (free) ligand, was transferred in its entirety to a Gamma counting tube (Sarstedt, Newton, N.C.). The Eppendorff tube tip containing the pellet was cut and released directly into a separate Gamma counting tube. The samples were counted for 1 minute in an LKB CompuGamma CS Gamma counter. Specific binding was calculated by subtracting fmol of non-specific binding, i.e., amount bound in the presence of cold ligand, from the total fmol bound (absence of unlabeled competitive ligand). The results were analyzed and plotted using the GraphPad Prism 4 software (GraphPad Software, Inc., San Diego, Calif.).
(79) Source of Reagents:
(80) Human recombinant [.sup.125I] Insulin, IGF-I, and IGF-II were purchased from Amersham Biosciences (Piscataway, N.J.). Unlabeled human insulin was purchased from Sigma-Aldrich (St. Louis, Mo.). Recombinant IGF-I and IGF-II were obtained from Bachem (King of Prussia, Pa.). Monoclonal antibodies to 8-OHdG and HNE were purchased from Oxis Scientific. All other fine chemicals and reagents were purchased from CalBiochem (Carlsbad, Calif.) or Sigma-Aldrich (St. Louis, Mo.).
(81) Statistical Analysis:
(82) Experiments were conducted using 9 rats per group. Data are depicted as means±S.E.M. in the graphs. Inter-group comparisons were made using Student T-tests. Statistical analyses were performed using the Number Cruncher Statistical System (Kaysville, Utah). P-values corresponding to significant differences and trends are indicated over the graphs.
(83) Effects of Chronic Alcohol Feeding on Liver Structure and Gene Expression
(84) Chronic ethanol feeding produced striking alterations in liver-histology as shown in
(85) The ethanol effects on insulin signaling in the liver were determined by real time PCR as shown in
(86) Effect of Chronic Alcohol Feeding on Liver Regeneration
(87)
(88) Taken together, these studies demonstrate that chronic ethanol consumption leads to hepatocyte injury and inflammation as well as oxidative stress and DNA damage to the liver. The capacity of the liver to regenerate is substantially impaired. These PPAR agonists have also been examined to determine if they rescue injury from lipid peroxidation as shown in
Example 2
(89) General Methods
(90) Chronic Ethanol Exposure Model:
(91) Adult male (˜200-250 g) Long Evans rats (Harlan Sprague Dawley, Inc., Indianapolis, Ind.) were pair-fed with isocaloric liquid diets (BioServ, Frenchtown, N.J.) containing 0% (control) or 37% ethanol by caloric content (9.2% v/v) for 8 weeks. During the week prior to initiating the experiment, rats were adapted to the ethanol-containing diets by sequentially feeding them for two days each with diets containing 8%, 17%, 24%, and then 37% ethanol. Chow fed control rats were also studied. Rats were monitored daily to ensure equivalent food consumption and maintenance of body weight. During the last 3 weeks of the experiment while being maintained on either the 0% or 37% ethanol-containing liquid diets, rats in both groups were administered twice weekly (Mondays and Thursdays) intra-peritoneal (i.p.) injections of vehicle (saline), a PPAR-α (GW7647; 25 μg/kg), PPAR δ (L-165,041; 2 μg/kg), or PPAR-γ (F-L-Leu; 20 μg/kg) agonist (CalBiochem, Carlsbad, Calif.). At the conclusion of the experiment, rats were anesthetized with vaporized isofluorane (SurgiVet, Inc. Waukesha, Wis.), and liver and blood were harvested for analysis. Liver tissue samples were immersion fixed in Histochoice (Amresco Corp., Solon, Ohio) and embedded in paraffin. Adjacent histological sections were stained with Hematoxylin and Eosin or Gomori's Trichrome and examined under code. In addition, liver tissue samples were snap-frozen in a dry ice methanol bath and then stored at −80° C. for later mRNA and protein studies. Throughout the experiment, rats were housed under humane conditions and kept on a 12-hour light/dark cycle with free access to food. All experiments were performed in accordance with protocols that conform to guidelines established by the National Institutes of Health and were approved by Institutional Animal Care and Use Committee at the Lifespan-Rhode Island Hospital.
(92) Analysis of mRNA:
(93) Total RNA was extracted from liver tissue using TRIzol® reagent (Invitrogen, Carlsbad, Calif.) according to the manufacturer's protocol. RNA concentrations and purity were determined from the absorbances measured at 260 nm and 280 nm. RNA (2 μg) was reverse transcribed using the AMV First Strand cDNA synthesis kit (Roche Diagnostics Corporation, Indianapolis, Ind.) and random oligodeoxynucleotide primers. Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assays were used to measure steady-state levels of specific mRNA transcripts. PCR amplifications were performed in 20 μl reactions containing cDNA generated from 2.5 ng of original RNA template, 300 nM each of gene specific forward and reverse primer (Table 2), and 10 μl of 2× QuantiTect SYBR Green PCR Mix (Qiagen Inc, Valencia, Calif.). The amplified signals were detected continuously with the Mastercycler ep realplex instrument and software (Eppendorf AG, Hamburg, Germany). The amplification protocol used was as follows: initial 15-minutes denaturation and enzyme activation at 95° C., 45 cycles of 95° C.×15 sec, 55°-60° C.×30 sec, and 72° C.×30 sec. Annealing temperatures were optimized using the temperature gradient program provided with the Mastercycler ep realplex software.
(94) TABLE-US-00002 TABLE 2 Primer pairs for quantitative PCR* Position Amplicon Size Primer Direction Sequence (5′.fwdarw.3′) (mRNA) (bp) Albumin For CTT CAA AGC CTG GGC 702 188 AGT AG (SEQ ID NO: 15) Albumin Rev TGG AGA TAG TGG CCT 889 GGT TC (SEQ ID NO: 16) ASBT For GCA TTG GCA TTT CTC 598 181 TGG TT (SEQ ID NO: 17) ASBT Rev GGT TCA ATG ATC CAG 778 GCA CT (SEQ ID NO: 18) KCR For TCA CAA ATG CTG TGG 1427 161 ACC AT (SEQ ID NO: 19) KCR Rev GTC TTC ACG CTC TCC 1587 GTT TC (SEQ ID NO: 20) GFAP For GGT GGA GAG GGA CAA 433 215 TCT CA (SEQ ID NO: 21) GFAP Rev CTC GAA CTT CCT CCT 647 CAT GG (SEQ ID NO: 22) Desmin For ACC TGC GAG ATT GAT 1069 206 GCT CT (SEQ ID NO: 23) Desmin Rev ACA TCC AAG GCC ATC 1274 TTC A (SEQ ID NO: 24) Colla2 For ACC TCA GGG TGT TCA 1623 222 (Collagen) AGG TG (SEQ ID NO: 25) Colla2 Rev CGG ATT CCA ATA GGA 1844 (Collagen) CCA GA (SEQ ID NO: 26) Insulin For TTC TAC ACA CCC AAG 145 135 TCC CGT C (SEQ ID NO: 3) Insulin Rev ATC CAC AAT GCC ACG 279 CTT CTG C (SEQ ID NO: 4) Insulin For TGA CAA TGA GGA ATG 875 129 Receptor TGG GGA C (SEQ ID NO: 5) Insulin Rev GGG CAA ACT TTC TGA 1003 Receptor CAA TGA CTG (SEQ ID NO: 6) IGF-I For GAC CAA GGG GCT TTT 65 127 ACT TCA AC (SEQ ID NO: 7) IGF-I Rev TTT GTA GGC TTC AGC 191 GGA GCA C (SEQ ID NO: 8) IGF-I For GAA GTC TGC GGT GGT 2138 113 Receptor GAT AAA GG (SEQ ID NO: 9) IGF-I Rev TCT GGG CAC AAA GAT 2250 Receptor GGA GTT G (SEQ ID NO: 10) IGF-II For CCA AGA AGA AAG GAA 763 95 GGG GAC C (SEQ ID NO: 11) IGF-II Rev GGC GGC TAT TGT TGT 857 TCA CAG C (SEQ ID NO: 12) IGF-II For TTG CTA TTG ACC TTA 1066 91 Receptor GTC CCT TGG (SEQ ID NO: 13) IGF-II Rev AGA GTG AGA CCT TTG 1156 Receptor TGT CCC CAC (SEQ ID NO: 14) IRS-1 For GAT ACC GAT GGC TTC 604 134 TCA GAC G (SEQ ID NO: 27) IRS-1 Rev TCG TTC TCA TAA TAC 737 TCC AGG CG (SEQ ID NO: 28) IRS-2 For CAA CAT TGA CTT TGG 255 109 TGA AGG GG (SEQ ID NO: 29) IRS-2 Rev TGA AGC AGG ACT ACT 363 GGC TGA GAG (SEQ ID NO: 30) IRS-4 For ACC TGA AGA TAA GGG 2409 132 GTC GTC TGC (SEQ ID NO: 31) IRS-4 Rev TGT GTG GGG TTT AGT 2540 GGT CTG G (SEQ ID NO: 32) GAPDH For AGT GGG CAT CAA TGG 306 241 ATT TGG (SEQ ID NO: 33) GAPDH Rev GGG GAT TTC CTT AGG 546 TTC TTT GC (SEQ ID NO: 34) AAH For TGC CTG CTC GTC TTG 666 118 TTT GTG (SEQ ID NO: 35) AAH Rev ATC CGT TCT GTA ACC 783 CGT TGG (SEQ ID NO: 36)
(95) In preliminary studies, SYBR Green-labeled PCR products were evaluated by agarose gel electrophoresis, and authenticity was verified by nucleic acid sequencing. Complementary (c) DNAs were cloned into PCR-II vectors (Invitrogen, Carlsbad, Calif.). In addition, melt-curve analyses demonstrated the presence of a single PCR product without formation of primer-dimer peaks. Serial dilutions of recombinant plasmid DNA containing target sequences were used as standards in PCR reactions, and regression lines generated from the C.sub.t values of the standards were used to calculate mRNA abundance. Relative mRNA expression was expressed as the ng ratio of specific mRNA to ribosomal (r) 18S measured in the same samples because 18S is highly abundant and the levels are not modulated with disease state. Statistical comparisons were made using the calculated mRNA/18S ratios. Control studies included analysis of: 1) template-free reactions; 2) RNA that had not been reverse transcribed; 3) RNA samples that were pre-treated with DNAse I; 4) samples treated with RNAse A prior to the reverse transcriptase reaction; and 5) genomic DNA.
(96) Receptor Binding Assays:
(97) Saturation binding studies were used to determine if the PPAR agonist treatments improved ethanol-impaired insulin and IGF receptor binding in liver. Fresh frozen liver tissue was homogenized in 5 volumes of lysis buffer containing 50 mM Tris-HCl, pH 7.5, 1% NP-40, 150 mM NaCl, 1 mM EDTA, 2 mM EGTA, plus protease (1 mM PMSF, 0.1 mM TPCK, 1 μg/ml aprotinin, 1 μg/ml pepstatin A, 0.5 μg/ml leupeptin, 1 mM NaF, 1 mM Na.sub.4P.sub.2O.sub.7) and phosphatase (2 mM Na.sub.3VO.sub.4) inhibitors. Protein concentration was determined using the bicinchoninic acid (BCA) assay (Pierce, Rockford, Ill.). Exploratory studies determined the optimum amounts of protein and concentrations of radiolabeled ligand required to achieve 20% specific binding. Insulin receptor binding was measured using 100 μg protein per assay tube. IGF-I binding assays required 25 μg protein per sample, and IGF-II receptor binding assays required 10 μg protein per reaction.
(98) To generate the binding curse, samples from 8 rats per group were pooled in equivalent ratios and protein concentrations were adjusted to be identical for each group. For total binding, duplicate samples were incubated in 100 μl reactions containing binding buffer (100 mM HEPES, pH 8.0, 118 mM NaCl, 1.2 mM MgSO.sub.4, 8.8 mM dextrose, 5 mM KCl, 1% bovine serum albumin) and 0.0031 to 1 μCi/ml of [.sup.125I] (2000 Ci/mmol) insulin, IGF-I, or IGF-II. For non-specific binding, duplicate samples were identically prepared but with the addition of 0.1 μM unlabeled (cold) ligand. Incubations were carried out for 16 hours at 4° C. in non-binding 96 well plates (Corning Incorporated Life Science, Lowell, Mass.). Reactions were vacuum harvested (Corning, Lowell, Mass.) onto 96-well GF/C filter plates that had been presoaked for 30 minutes in 0.33% polyethyleneimine (PEI) solution. The filters were washed 5 times with buffer containing 50 mM buffer [4-2-hydroxyethyl)-1-piperazine-ethanesulfonic acid (HEPES), pH 7.4, 500 mM NaCl, and 0.1% BSA. After drying, 50 μl Microscint-20 (Packard Instrument Company, Meriden, Conn.) was added to each well and the levels of bound [.sup.125I] insulin, IGF-I, or IGF-II were measured in a TopCount machine (Packard Instrument Company, Meriden, Conn.). Specific binding was calculated by subtracting fmol/mg of non-specifically bound isotope, i.e., amount bound in the presence of cold ligand, from the total fmol/mg bound isotope. The data were analyzed and graphed using GraphPad Prism 5 software (GraphPad Software, Inc., San Diego, Calif.).
(99) Protein Studies:
(100) Protein expression was examined by Western blot analysis or enzyme-linked immunosorbant assay (ELISA). Western blot analysis was used to measure AAH and GAPDH expression. In addition, immunoreactivity corresponding to the p85 subunit of PI3 kinase was measured as a negative (loading) control. For Western blot analysis, liver tissue was homogenized in 5 volumes of radio-immunoprecipitation assay (RIPA) buffer (50 mM Tris-HCl, pH 7.5, 1% NP40, 0.25% Na-deoxycholate, 150 mM NaCl, 1 mM EDTA, 2 mM EGTA) containing protease (1 mM PMSF, 0.1 mM TPCK, 1 mg/ml aprotinin, 1 mg/ml pepstatin A, 0.5 mg/ml leupeptin, 1 mM NaF, 1 mM Na.sub.4P.sub.2O.sub.7) and phosphatase (2 mM Na.sub.3VO.sub.4) inhibitors. Protein concentrations were determined using the BCA assay (Pierce, Rockford, Ill.). Samples containing 20 μg of protein were fractionated by SDS-PAGE and transferred to PVDF membranes. Non-specific binding sites were blocked with SuperBlock-TBS (Pierce, Rockford, Ill.), and membranes were incubated with primary antibody (0.5-1 μg/ml) overnight at 4° C. with gentle platform agitation. Immunoreactivity was detected with horseradish peroxidase (HRP) conjugated secondary antibody, enhanced chemiluminescence (ECL) reagents (Pierce, Rockford, Ill.), and the Kodak Digital Science Imaging Station (NEN Life Sciences, Boston, Mass.).
(101) ELISAs were used to measure immunoreactivity corresponding to AAH, GAPDH and β-actin (negative control). ELISAs were performed in 96-well opaque polystyrene plates (Nalge Nunc International, Rochester, N.Y.). RIPA protein extracts diluted in TBS (40 ng/100 μl) were adsorbed to the bottoms of the wells by overnight incubation at 4° C. After rinsing in TBS, the wells were blocked for 4 hours with 250 μl/well of 2% BSA in TBS. The proteins were then incubated with primary antibody (0.01-0.1 μg/ml) for 1 hour at room temperature. Immunoreactivity was detected with HRP-conjugated secondary antibody (1:10000; Pierce) and the Amplex Red soluble fluorophore (Molecular Probes). Amplex Red fluorescence was measured (Ex 530/Em 595) in an M-5 machine (fluorescence light units; FLU). Binding specificity was determined from parallel negative control incubations with non-relevant antibodies, or with the primary or secondary antibody omitted. The mean levels of specific AAH, GAPDH, and β-actin immunoreactivity were used for inter-group statistical comparisons.
(102) Source of Reagents:
(103) The PPAR agonists, GW7647 (PPAR-α), L165, 041 (PPAR-δ), and Fmoc-Leu (PPAR-γ) were purchased from Calbiochem (Tecumsula, Calif.). Human recombinant [.sup.125I] Insulin, IGF-I, and IGF-II were purchased from Amersham Biosciences (Boston, Mass.). Unlabeled human insulin, recombinant IGF-I, and recombinant IGF-II were purchased from Bachem (Torrance, Calif.). QuantiTect SYBR Green PCR Mix was obtained from Qiagen Inc (Valencia, Calif.). Monoclonal antibodies to GAPDH and β-actin were purchased from Chemicon (Tecumsula, Calif.). The A85G6 mouse monoclonal antibody used to detect AAH was generated with purified recombinant human protein. All other fine chemicals were purchased from CalBiochem (Carlsbad, Calif.) or Sigma-Aldrich (St. Louis, Mo.).
(104) Statistical Analysis:
(105) Data depicted in graphs represent the mean±S.E.M. or mean±95% C.I.L. for each group. Inter-group comparisons were made using repeated measures analysis of variance (ANOVA) and the post-hoc Tukey-Kramer test for significance. Statistical analyses were performed using GraphPad Prism 5 software (GraphPad Software, Inc., San Diego, Calif.).
(106) PPAR Agonists Reverse Ethanol-Induced Liver Pathology:
(107) Livers from rats fed with either control liquid diet or chow showed the expected well-organized lobular architecture with minimal evidence of steatosis, variation in nuclear size, or hepatocyte drop-out (
(108) General Comments Regarding qRT-PCR Studies:
(109) The use of qRT-PCR enabled all samples to be analyzed simultaneously and with sufficient replicates to demonstrate consistency of results. With the techniques employed, the quality of cDNA generated from tissue was judged to be excellent based on the similar 18S C.sub.t values and consistent 28S:18S ratios obtained for livers of control ethanol-fed rats, irrespective of PPAR agonist treatment. The use of qRT-PCR was ideally suited for rigorous analysis of gene expression because the amplicons were small (mainly <150 bp), thereby circumventing potential problems related to partial RNA degradation, e.g., nicking, which often occurs with chronic ethanol exposure and oxidative stress. Specificity of the amplified products was verified by direct nucleic acid sequencing. Control studies in which cDNA templates were excluded, RNA was not reverse transcribed, RNA samples were pre-treated with RNAse A prior to the RT step, or genomic DNA was used in reactions, produced no detectable amplified products as demonstrated by qPCR analysis and agarose gel electrophoresis. Treatment of RNA samples with DNAse I prior to the RT step had no effect on the detection levels of amplified gene products.
(110) PPAR Agonist Treatments Alter Cell Population Profiles in Liver:
(111) Liver mRNA levels of albumin, apical sodium-dependent bile transporter protein (ASBT), glial fibrillary acidic protein (GFAP), Kupffer cell receptor (KCR), desmin, and collagen were measured by qRT-PCR. Albumin expression was used as an index of hepatocyte abundance/function. ASBT reflects bile duct epithelium. GFAP is an early marker of stellate cell activation and desmin marks transdifferentiation of hepatic stellate cells into myofibroblasts. KCR is a maker of Kupffer cells and increased expression could reflect an intra-hepatic response to injury. Collagen gene expression corresponds to fibrogenic potential or active fibrogenesis. Altogether, these assessments of gene expression in liver, which we have termed “cell profiling,” enabled us to quantify ethanol and PPAR agonist associated relative shifts in liver cell type and function.
(112) Livers of vehicle-treated control rats had significantly higher mean levels of albumin mRNA compared with livers from vehicle-treated ethanol-exposed rats (
(113) ASBT expression was highest in vehicle-treated control livers, and each of the PPAR-agonist treated control livers had a significantly lower mean level of ASBT compared with the vehicle-treated controls (
(114) KCR expression was lowest in vehicle-treated control and ethanol-exposed livers. Treatment with the PPAR-α, PPAR-δ, or PPAR-γ agonists increased the mean levels of KCR mRNA in both control and ethanol-exposed livers; however, the differences from corresponding vehicle-treatment were only statistically significant for ethanol-fed rats (
(115) GFAP is an early marker of stellate cell activation. GFAP mRNA levels were significantly higher in livers from vehicle-treated controls compared with vehicle-treated ethanol-exposed rats. GFAP expression was significantly increased by PPAR-α treatment in both control and ethanol-exposed rats (
(116) Desmin is an intermediate filament expressed in stellate cells during transdifferentiation into myofibroblast-like cells. The mean levels of desmin mRNA were similar in vehicle-treated control and ethanol-exposed livers (
(117) Collagen gene expression reflects fibrogenesis. Collagen mRNA expression was lowest in vehicle-treated control livers (
(118) Effects of Ethanol and PPAR Agonists on Hepatic Expression of Insulin and IGF Polypeptides, their Receptors, and IRS Molecules:
(119) QRT-PCR studies demonstrated expression of insulin, IGF-I, IGF-II polypeptide genes, their corresponding receptors, and IRS-1, IRS-2, and IRS-4 in livers of both control and ethanol-fed rats (
(120) IGF-II receptor mRNA transcripts were most abundant (
(121) In both control and ethanol-exposed livers, IRS-1 mRNA levels were highest (
(122) Effects of Ethanol and PPAR Agonist Treatments on Insulin and IGF Receptor Binding:
(123) Saturation binding assays were used to demonstrate the effects of ethanol and PPAR agonist treatments on insulin, IGF-I and IGF-II receptor binding. The studies were performed with pooled liver tissue samples from 8 rats (equal proportions by protein content) within each subgroup. Binding curves±95% C.I.L., computations of Kd (dissociation constant; affinity) and BMAX (top-level binding), and inter-group statistical comparisons were generated with Prism Graphics 5 software. In all experimental conditions, a single-site model produced the highest R.sup.2, i.e., best fit. Chronic ethanol feeding significantly reduced the BMAX, but had no significant effect on the Kd for insulin receptor binding (
(124) TABLE-US-00003 TABLE 3 BMAX ± 95% C.I.- 95% C.I.- Group S.E.M. BMAX KD ± S.E.M KD R.sup.2 Insulin receptor binding Control + 7.23 ± 2.66 1.83-12.63 165.5 ± 73 16.6-314.5 0.929 Vehicle Control + 1.03 ± 0.16*** 0.69-1.36 34.0 ± 9.4*** 14.93-53.14 0.884 PPAR-α Control + 4.93 ± 1.99 0.89-8.97 165.7 ± 80.7 2.23-329.1 0.920 PPAR-δ Control + 8.06 ± 10.73 −13.78-29.91 300.6 ± 448.5 −612.4-1214 0.778 PPAR-γ Ethanol + 2.59 ± 0.61** 1.36-3.82 51.38 ± 18.63*** 13.62-89.15 0.84 Vehicle Ethanol + 2.04 ± 0.35*** 1.33-2.75 8.45 ± 4.06*** 0.21-16.69 0.57 PPAR-α Ethanol + 3.21 ± 0.45** 2.29-4.12 43.85 ± 9.91** 23.76-63.94 0.92 PPAR-δ Ethanol + 2.08 ± 0.42*** 1.22-2.93 23.26 ± 9.33** 4.3-42.22 0.746 PPAR-γ IGF-I receptor binding Control + 3.62 ± 0.77 2.04-5.21 131.9 ± 49.7 30.64-233.1 0.79 Vehicle Control + 2.52 ± 0.31** 1.87-3.16 63.3 ± 16.2** 30.2-95.4 0.84 PPAR-α Control + 1.64 ± 0.37** 0.88-2.39 57.2 ± 27.1 0.88-2.4 0.48 PPAR-δ Control + 6.43 ± 2.00* 2.32-10.63 425.7 ± 178.1** 80.9-790.4 0.91 PPAR-γ Ethanol + 2.66 ± 0.38* 1.88-3.45 43.57 ± 13.71** 15.49-71.68 0.78 Vehicle Ethanol + 4.21 ± 0.88 2.42-6.00 127.3 ± 45.86 32.2-222.4 0.76 PPAR-α Ethanol + 3.81 ± 0.89 1.99-5.62 120.6 ± 52.1 14.4-226.8 0.71 PPAR-δ Ethanol + 2.74 ± 0.91 0.87-4.60 100.1 ± 63.2 −28.9-229.0 0.48 PPAR-γ IGF-II receptor binding Control + 40.12 ± 3.04 33.96-46.27 29.3 ± 5.8 17.6-40.9 0.92 Vehicle Control + 40.27 ± 3.28 33.62-46.9 31.4 ± 6.4 18.3-44.5 0.91 PPAR-α Control + 29.01 ± 1.99*** 24.99-33.04 21.5 ± 4.3 12.6-29.9 0.91 PPAR-δ Control + 25.20 ± 2.04*** 21.06-29.34 14.6 ± 3.9** 6.6-22.6 0.83 PPAR-γ Ethanol + 22.63 ± 5.25* 12.00-33.25 32.4 ± 18.7 −5.5-70.4 0.53 Vehicle Ethanol + 28.88 ± 6.20 16.31-41.44 40.5 ± 20.0 16.3-41.4 0.59 PPAR-α Ethanol + 51.50 ± 13.53 24.11-78.90 75.6 ± 37.1 0.52-150.8 0.60 PPAR-δ Ethanol + 22.56 ± 4.43* 13.60-31.53 32.3 ± 15.8 0.26-64.38 0.60 PPAR-γ *P < 0.05; **P < 0.001; ***P < 0.0001 relative to Control + Vehicle
(125) Chronic ethanol feeding significantly reduced IGF-I BMAX and Kd. In control-fed rats, PPAR-α treatment reduced the IGF-I BMAX, while PPAR-δ and PPAR-γ treatments significantly increased the IGF-I BMAX (
(126) Effects of Ethanol and PPAR Agonist Treatments on Insulin/IGF Responsive Gene Expression Related to Energy Metabolism and Tissue Remodeling:
(127) AAH expression increases with insulin, IGF-I, or IGF-II stimulation and has positive effects on hepatocellular growth and motility (Cantarini et al., Hepatology 44:446 (2006); de la Monte et al., J. Hepatol. 44:971 (2006)). GAPDH is an insulin-responsive gene that has an important role in glucose metabolism. Western blot analysis detected AAH and GAPDH immunoreactivities in all liver samples (
(128) ELISAs also demonstrated significantly lower mean levels of AAH (
(129) This study was designed to determine if chronic ALD produced in the Long Evans rat model was associated with hepatic insulin resistance, and at the same time, explored the hypothesis that insulin sensitizer agents could be used to restore liver histology in the clinical setting of continued ethanol consumption. To conduct these studies, rats were treated with a PPAR-α, PPAR-δ, or PPAR-γ agonist. This approach was taken because exploratory studies demonstrated that all three receptors are expressed in liver yet there was no definitive data indicating which class of PPAR agonist would be most suitable for restoring hepatic structure and function in ALD.
(130) The chronic ethanol feeding produced histopathological changes that resemble ALD in humans, including prominent architectural disarray with variation in nuclear size and hepatocyte drop-out, yet there was no evidence of interlobular or bridging fibrosis, cirrhosis, regenerative nodule formation, or neoplastic transformation. Treatment with a PPAR-α, PPAR-δ, or PPAR-γ agonist produced no detectable effects on liver histology in controls, but they strikingly reduced the ethanol-associated architectural disarray and steatosis, despite continued ethanol exposure. The PPAR-δ and PPAR-γ agonists were more effective than the PPAR-α agonist in restoring hepatic architecture. These effects of the PPAR agonists correspond with their known anti-inflammatory actions, in addition to their insulin sensitizer properties.
(131) To more objectively quantify the effects of the PPAR agonist treatments on liver histology, a method of evaluating relative expression of specific genes corresponding to different cell types, i.e., liver cell profiling, was used. These analyses demonstrated that chronic ethanol exposure significantly reduced albumin and ASBT expression, suggesting that chronic ethanol feeding significantly reduced hepatocyte and bile duct epithelial cell abundance and/or function. Overall, the PPAR agonist treatments increased albumin and ASBT expression in both control and ethanol-exposed livers; however the effects differed with respect to which subtype of PPAR agonist was most effective and the magnitude of the responses. In this regard, PPAR-α and PPAR-δ agonists normalized albumin and ASBT expression in ethanol-exposed livers, whereas PPAR-δ and PPAR-γ agonists significantly increased albumin and decreased ASBT expression in control livers. These findings suggest that PPAR agonist treatments may have beneficial effects on hepatocyte and biliary epithelial cell survival and function. The increased expression of KCR observed in ethanol-exposed, PPAR agonist treated livers is of uncertain significance. One possible interpretation is that, in correlation with the improvements in liver histology, increased Kuppfer cell function is needed to manage the repair process.
(132) GFAP and desmin are markers of stellate cell activation and proneness toward a fibrogenic response. Collagen gene expression was used as an index of active fibrogenesis. The results demonstrated that expression levels of both GFAP and collagen were increased by PPAR-α treatment in control and ethanol-fed rats, suggesting that PPAR-α agonists may activate stellate cells and ultimately promote fibrogenesis, an effect that may be worse in the setting of ALD. In contrast, treatment with the PPAR-δ agonist reduced collagen gene expression in ethanol-fed rats, but increased it in control rats, and PPAR-γ agonist treatment only increased desmin expression in ethanol-exposed livers. Although these results are complex, one potential interpretation is that certain degrees of stellate cell and fibrogenic response may be required for liver repair in the context of chronic ethanol-induced liver injury.
(133) QRT-PCR analysis was used to assess the integrity of “machinery” required for insulin and IGF signaling. The studies demonstrated that the expression levels of the insulin, IGF-I and IGF-II polypeptides, the corresponding receptors, and IRS molecules were relatively preserved in chronic ethanol-exposed livers, indicating that impairments in insulin or IGF signaling caused by chronic ethanol exposure could not be attributed to local growth factor deficiencies, down-regulation or loss of receptors, or impaired expression of major docking molecules that transmit downstream signals. Of note was that treatment with the PPAR-δ or PPAR-γ agonist significantly increased insulin and IGF-I expression in control livers, but either inhibited or had no significant effect on trophic factor gene expression in ethanol-exposed livers. Similarly, insulin, IGF-I, and IGF-II receptors, and IRS-1, IRS-2, and IRS-4 expression levels were not modulated by PPAR agonist treatments. Therefore, any improvements in liver histology associated with PPAR agonist treatment in ethanol-fed rats were not due to increased expression of local growth factors, growth factor receptors, or IRS genes.
(134) Effective ligand binding is critical to the signaling cascade, and many of the downstream effects of impaired insulin signaling that have been reported in ethanol-exposed livers, including reduced cell survival, could be mediated by inhibition of insulin binding to its receptor. Given the fact that signaling through IGF-I or IGF-II activates IRS pathways either directly or via cross-talk, it was of interest to also measure IGF-I and IGF-II receptor binding in these models. The studies using competitive saturation binding assays demonstrated that chronic ethanol exposure significantly impairs ligand binding to the insulin, IGF-I, and IGF-II receptors as manifested by the reduced BMAX (top-level binding) and increased Kd (reduced affinity). The PPAR-δ, and in some instances PPAR-γ agonist treatments significantly increased insulin, IGF-I, and/or IGF-II receptor binding resulting in higher, i.e., normalized BMAX values in ethanol-exposed livers. Although the mechanism of increased receptor binding has not yet been determined, this effect could have been mediated by corrections in membrane lipid composition since in previous studies, it has been demonstrated that ligand binding to the insulin and IGF receptors was impaired due to membrane cholesterol depletion, and restored by membrane cholesterol repletion. Regardless of mechanism, it is likely that the PPAR agonist associated increases in insulin and IGF receptor binding had critical roles in restoring liver structure and function, including insulin/IGF responsive gene expression, despite continued ethanol exposure.
(135) To examine the consequences of PPAR agonist-mediated increases in insulin and IGF receptor binding in ethanol-exposed livers, insulin and IGF responsive gene expression was assessed by Western blot analysis and ELISA. As expected, the ethanol-exposed livers of vehicle-treated rats had significantly reduced levels of GAPDH and AAH, which respectively mediate energy metabolism and cell motility required for regeneration and remodeling of tissue Treatment with a PPAR-δ or PPAR-γ agonist significantly increased GAPDH expression, resulting in normalization of levels relative to vehicle-treated controls. Therefore, the downstream consequences of increased ligand-receptor binding were increased insulin/IGF responsive gene expression and/or improved liver histology, despite continued ethanol exposure. Importantly, increased levels of GAPDH may be an important factor in the reduction of steatosis due to improved energy metabolism and ATP production, whereas increased AAH expression could have aided in liver remodeling and repair, thereby helping to maintain relatively normal liver histology. Together, the results suggest that PPAR agonist treatments may be helpful for reversing some of the adverse effects of chronic ALD, particularly with respect to the restoration of liver structure and function.
(136) Having now fully described the invention, it will be understood by those of skill in the art that the same can be performed within a wide and equivalent range of conditions, formulations, and other parameters without affecting the scope of the invention or any embodiment thereof. All patents, patent applications and publications cited herein are fully incorporated by reference herein in their entirety.