Uncoupling protein and nonalcoholic fatty liver disease 1 Xi JIN, 1Zun XIANG, 1Yi Peng CHEN, 2Kui Fen MA, 3Yue Fang YE, 1You Ming LI* 1 Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China 2 Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China 3 Department of Gastroenterology, The Affiliated Hospital, College of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China Running Title: UCP and NAFLD * Correspondence to: You Ming LI Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China No.79 Qing chun Road, Hangzhou, Zhejiang 310003, P.R.China Fax: 86-571-87236611 Tel: 86-571-87236618 Email: [email protected] Abstract Nonalcoholic fatty liver disease (NAFLD) has been widely investigated for its increasing prevalence but unknown pathogenesis. Currently, under the frame of “two hit hypothesis”, accumulating evidences supported the importance of mitochondrial dysfunction, where uncoupling protein (UCP) showed a vital role for uncoupling of oxidative phosphorylation. Therefore, we here summarized the typical concepts, up to date findings and existing controversies of UCP2 in NAFLD. We also presented the novel effect of hepatocellular down regulated mitochondrial carrier protein (HDMCP) in NAFLD and the new concept that any mitochondrial inner membrane carrier protein has, more or less, uncoupling ability. Considering the importance of NAFLD in clinics and UCP in energy metabolism, we believe this review may raise research enthusiasm on the effect of UCP in NAFLD and provide novel mechanism and therapeutic target for NAFLD. Key word nonalcoholic fatty liver disease, uncoupling protein, phosphorylation, hepatocellular down regulated mitochondrial carrier protein Introduction Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease with hepatocellular lipid deposition and/or ensuing inflammation on the basis of precluding other known causes. NAFLD has been considered as hepatic manifestation of metabolic syndrome and consists of progressive stages, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis(1). With social development and lifestyle change, NAFLD has now become one of the major causes of end stage liver diseases (2), with approximate 20% global prevalence. Currently, the mechanism of NAFLD is still unclear. On the basis of “two hit hypothesis” from Day CP(3), accumulating data supported the involvement of mitochondrial dysfunction in NAFLD progress(4), where change of uncoupling protein (UCP) has been intensively investigated. In this review, we summarized the up to date concept of UCP and its role in NAFLD progress. Concept, structure, distribution and biological function of UCP The concept of oxidative phosphorylation was first proposed in 1961 by Dr. Mitchell, P(5). In his theory, electrons produced from metabolism are donated to the electron transport chain (ETC) by nicotinamide adenine dinucleotide-reduced (NADH) and succinate and further pass along ETC to ultimately reduce molecular oxygen to water at cytochrome c oxidase. This reaction provides energy for the outward translocation of protons from the mitochondrial matrix into the inner membrane space to create an electrochemical gradient across the inner membrane. This gradient then drives ATP synthesis through the controlled return of protons into the matrix. However, disconnection of ATP synthesis from mitochondrial respiration exists in various tissues. Such process is termed as uncoupling of oxidative phosphorylation and UCP is named for its uncoupling activity (6). UCP belongs to mitochondrial anion carrier protein family, locates in mitochondrial inner membrane and composes of 6 α-helical type transmembrane units. The C and N termini of UCP are both located at mitochondrial outer membrane. It is presumed that certain amino acids in the termini may form the functional part of UCP(7). Currently, five classical UCPs have been identified in mammals (Table 1), where UCP 1-3 show high similarity in sequence. UCPs exert their function in the form of dimmers, with molecular weight ranging between 31 and 34 kDa. Though UCP1 uncoupled energy is used for heat production in brown fat tissue, the physiological function other UCPs and their regulators are still vague (8) . There are two major hypotheses of UCP1 activation by free fatty acid (FFA)(9-11). One is proton buffering model, where FFA acts as proton complement that helps to present proton to the transportation channel. The other is FFA circulation model. In detail, FFA is only able to pass through mitochondrial inner membrane through UCP1 in mitochondrial matrix. After binding proton, FFA can “flip-flop” back to the matrix and enter the next circulation after releasing proton. Besides, accumulating evidences revealed that ATP, ADP, GTP and GDP can bind to UCP1 with high affinity and reduce its uncoupling velocity(12). In addition, oxidative radical and superoxide may indirectly regulate proton leak through metabolic intermediate Hydroxynonenal (HNE) (13, 14). UCP2 and NAFLD Among UCPs, UCP2 locates close to genes related with energy metabolism and obesity (15) . Previous studies showed a positive correlation between UCP2 and obesity(16). Since NAFLD is also associated with obesity and energy surplus, it is plausible that UCP2 is involved in NAFLD pathogenesis and development. Nowadays, the effect of UCP2 in NAFLD has been widely investigated and we established a model (Figure 1) based on accumulated novel findings as followings: Increased FFA from dietary fat, the adipose tissue and de novo synthesis are available in NAFLD. They can be taken up into mitochondria mainly through carnitine palmitoyltransferase 1 (CPT1) for β-oxidation, yielding ketons, or fully oxidized within the tricarboxylic acid cycle (TCA) as well as providing excess NADH and FADH2 that donate electrons to ETC. UCP2 is then increased and its mediated proton leak also enhanced in fuel surplus in NAFLD, which on one hand, supports ongoing FFA oxidation and decreases triglyceride deposition through ATP depletion. On the other hand, increased UCP2 may decrease △ψm that is the result of proton translocation from mitochondrial matrix into intermembrane space by ETC and consumed through oxidative phosphorylation mediated by ATP synthase and through proton leak mediated by UCP2. The rate of Hydrogen Peroxide (H2O2) production, a vital step in the progress from steatosis to NASH, is also decreased. In the followings, we will describe detailed mechanisms of UCP2 in different stages of NAFLD based on “two hit hypothesis”. Figure 1, Model of UCP2 in NAFLD progress UCP2 and “the first hit” in NAFLD In the process of “the first hit”, hyperlipidemia, insulin resistance and other factors caused hepatic lipid accumulation. The early report on the association between UCP2 and lipid metabolism came from Dr. Fleury, where UCP2 level from white fat tissue of rat fed with high fat diet was 4-6 times higher than that from normal diet(15). Besides, hepatocellular UCP2 expression is undetectable under normal physiological condition but significantly increased in NAFLD, indicating its potential role in disease development(17-20). Interestingly, the composition of fatty acid influence its ability in inducing UCP2 expression, where polyunsaturated fatty acid is higher than oligomeric unsaturated fatty acid(21). Such regulation may be through direct or indirect effect of transcription factor. For instance, high fat diet or fenofibrate is able to increase UCP2 level of rat by activating peroxide proliferator activator receptor α (PPARα)(22) while PPARγ ligand is able to induce UCP2 expression and increase lipid accumulation in fatty liver(23). Further more, resent study showed up-regulation of UCP2 may prevent NAFLD development (24). Though increased UCP2 was found in NAFLD, its real effect is still unclear. On one hand, over produced NADH from mitochondrial FFA β oxidation needs further oxidation by mitochondrial respiration. However, under the status of energy surplus, mitochondrial respiration may be hampered by high proton level while UCP2 induced proton leak is able to decrease mitochondrial membrane potential and thus support FFA oxidation instead of accumulation. On the other hand, FFA enters mitochondrial matrix in the form of Acetyl CoA while insufficient NADH re-oxidation may cause more Acetyl CoA transforming into nonesterifed fatty acid (NEFA). NEFA can’t be further metabolized in matrix and will then be transported to cytoplasm(25-27). It is noticeable that FFA accumulation is more harmful than triglyceride accumulation for inducing cell apoptosis(28). Therefore, UCP2 may also exert as a specific transporter of metabolite to avoid NEFA accumulation caused damage on mitochondrial matrix. The effect of UCP2 is also associated with AMPK, an important protein in phosphorylation and metabolism regulation. In hepatocyte, AMPK alleviates hepatic lipid accumulation and insulin resistance by increasing FFA oxidation and ketone formation as well as inhibiting hepatic glyceride and cholesterol synthesis(29). Further evidence revealed that UCP2 expression was paralleled with AMPK activity(30). Previous research indicated that UCP2 deficiency caused hepatic lipid accumulation in a non-insulin dependent manner(31). Interestingly, another report demonstrated that obesity-related fatty liver is unchanged in mice deficient for mitochondrial UCP2(32). Furthermore, it was indicated that down-regulation of UCP2 can promote the recovery of hepatic steatosis (33). These contradictory findings raised discussion on the real effect of UCP2 on NAFLD. Scientists are eager to know whether UCP2 is protective in hepatic lipid accumulation in NAFLD. In addition, what is the degree of protection if the answer is “Yes”. Moreover, are there any other hepatic mitochondrial proteins having uncoupling activity and involved in NAFLD? UCP2 and “the second hit” in NAFLD In the process of “the second hit”, various factors including TNF-α caused liver inflammatory cell infiltration and abnormal liver function on the basis of hepatic steatosis. In this process, reactive oxygen species (ROS) produced from mitochondrial respiration plays a vital role. Theoretically, UCP is involved in the “second hit” for its ability in regulating mitochondrial respiration. In NAFLD, overloaded FFA in mitochondrion will increase ROS production and provide soil for ensuing oxidative reaction. Therefore, it is plausible that UCP2 expression is increased in lipid accumulated liver to decrease stress from reactive oxidation as an adaptive reaction. Nevertheless, previous reports indicated that oxidative stress is persistent under the status of increased hepatic UCP2 expression in rodents(34, 35). Furthermore, the UCP2 level in NASH patients is still unknown and we postulate that increased hepatic UCP2 is insufficient to control ROS production from fat overloaded hepatocyte. Under normal physiological status, UCP2 is mainly expressed in hepatic kupffer cell and is undetectable in hepatocytes(36). However, this phenomenon is changed under specific metabolic status. For instance, UCP2 level is decreased in peripheral macrophage and mitochondrial ROS production is significantly increased(37). In addition, endotoxin induced UCP2 expression in hepatocyte and kupffer cell is varied in UCP2-/- mice receiving macrophage from UCP2+/+ mice through bone marrow transplantation(38). Therefore, the influence of UCP2 on ROS production in NASH patients may be resulted from its over expression in hepatocyte and down expression in kupffer cell. The negative regulation of UCP2 in hepatic kupffer cell is still vague. Previous research indicated that UCP2 over expression may be caused by site mutation in a conserved segment encoding 36 amino acids of exon 2 of UCP2(39). In addition, novel findings demonstrated that SP1(40), miRNA-15a(41) and PPARα(42) were also able to regulate UCP2 expression, indicating the complexity of UCP2 regulation network. Though decreased UCP2 expression in hepatic kupffer cell may cause mitochondrial ROS production in NASH, the UCP2 over expression in fat accumulated hepatocyte may also lead to ATP depletion and energy insufficiency, resulting in disease progression(43). Therefore, we should consider the cell-specific expression character of UCP2 when concerning it as therapeutic target in NASH. HDMCP, other UCP and NAFLD Since UCP2 expression in NAFLD is still in controversy, searching other candidate UCP has attracted wide attention. In the year of 2004, hepatocellular down-regulated mitochondrial carrier protein (HDMCP) was cloned by Tan MG and colleagues(44). HDMCP has basic characters of mitochondrial carrier protein and is exclusively expressed in liver, with high similarity of protein sequence and gene location among human, rat and mice. It is able to decrease mitochondrial membrane potential and ATP production. Therefore, the authors postulated that HDMCP was one of the hepatic specific UCPs. We further confirmed the GDP insensitive uncoupling ability of HDMCP in yeast expression system. Since HDMCP is exclusively expressed in liver, we postulated that it may be associated with NAFLD development and found increased HDMCP in NAFLD rat model. Furthermore, in NAFLD cell model, we found HDMCP was able to alleviate lipid accumulation in L02 and HepG2 cells by decreasing ATP and H2O2 levels(45). Now, researches on HDMCP function have been carried out in our lab, including: HDMCP level in human; the bilateral effect between HDMCP and UCP2 in NAFLD; the activator and inhibitor of HDMCP; the role of HDMCP in NASH and the effect of targeting it for therapeutic purpose. Liver is the largest metabolic organ in human and the oxygen consumption caused by proton leak is of 20%-30% total oxygen consumption in resting hepatocytes(46). According to our knowledge, UCP1 is exclusively expressed in brown fat while the expression of UCP3-5 in liver has not been reported. Though significantly increased in NAFLD, UCP2 level is very low in hepatocytes under physiologic status. Therefore, there might be other proteins with uncoupling ability, where the newly discovered HDMCP is a good example. Currently, many scientists agreed that any mitochondrial inner membrane carrier protein has, more or less, the uncoupling ability(45), which may expand the extent of UCP. Under this conception, we may focus on other mitochondrial inner membrane carrier protein by testing their uncoupling activity and role in NAFLD. Conclusion NAFLD has been widely investigated for its increasing prevalence but unknown pathogenesis. Currently, under the frame of “two hit hypothesis”, accumulating evidences supported the importance of mitochondrial dysfunction in NAFLD, where UCP showed a vital role for its uncoupling of oxidative phosphorylation. In NAFLD, UCP2 is intensively studied but results are in controversy. For instance, UCP2 level is increased in hepatocyte but decreased in kupffer cell in NAFLD. Nevertheless, UCP2 knockout did not influence lipid accumulation in ob/ob mice. HDMCP is a newly cloned hepatic UCP and a good example for the concept that any mitochondrial inner membrane carrier protein has, more or less, the uncoupling ability. 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The proton leak across the mitochondrial inner membrane. Biochim Biophys Acta 1990; 1018:128-33. 47 Cioffi F, Sense R, de Lange P, Goglia F, Lanni A, Lombardi A. Uncoupling proteins: a complex journey to function discovery. Biofactors.2009; 35: 417-28. Table Table 1, Allocation and Distribution of UCP Gene Allocation Distribution UCP1 mice chromosome 8,human chromosome4q31 Only in brown fat tissue UCP2 ratchromosome 7, human chromosome11q13 various tissue UCP3 ratchromosome 7, human chromosome 11q13 bone and heart tissue UCP4 human chromosome6pl1.2 - q12 brain tissue UCP5 human chromosome Xq24 brain and tonsil
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