ATP-citrate lyase (ACLY), upregulated in chronic kidney disease (CKD), catalyzes the synthesis of acetyl-coA from citrate. Acetyl-CoA is a vital precursor for lipid/cholesterol synthesis and histone acetylation that regulates gene expression. In renal cells, ACLY regulates fibrogenic, lipogenic and inflammatory gene expression; its inhibition reduced fibrosis in the unilateral ureteral obstruction (UUO) model. The ACLY metabolic by-product malonyl-coA is also an important inhibitor of fatty acid oxidation (FAO), and defective FAO in proximal tubular epithelial cells (PTEC) is now established as a major contributor to fibrosis. Here we tested the efficacy of a novel ACLY inhibitor on reducing fibrosis and its potential role in improving FAO in UUO. 8-week-old male C57BL/6J mice underwent UUO surgery and were treated orally with an ACLY inhibitor (EVT0185, Espervita Therapeutics) for 10 days. Kidneys were assessed by immunohistochemistry, immunoblotting, and RNAseq. Effects of ACLY inhibition were tested on the HK2 PTEC cell line and primary renal fibroblast responses to TGFβ1 (5ng/ml, 48h), a cytokine known to promote fibrosis and reduce FAO. Lipid accumulation was assessed by Oil Red O staining and LC/MS analysis. ACLY inhibition significantly and dose-dependently decreased fibrosis in the UUO model determined by trichrome, PSR, fibronectin, and α-smooth muscle actin (SMA) expression. ACLY inhibition decreased macrophage (F4/80) infiltration including that of the profibrotic M2 phenotype marked by CD206. RNAseq analysis showed upregulation of FAO-related hallmark pathways and reduction in inflammation pathways with ACLY inhibition. Defective FAO is known to result in PTEC apoptosis and lipid accumulation. ACLY inhibition reduced both apoptosis, as assessed by the presence of cleaved caspase 3, as well as lipid accumulation, with a particular decrease in cholesteryl esters. In HK2 cells and renal fibroblasts, TGFβ1-induced fibrotic protein expression was inhibited by ACLY inhibition, and lipid accumulation was reduced in PTECs. ACLY inhibition reduced renal fibrosis, apoptosis, and lipid accumulation in UUO mice. ACLY inhibition also prevented profibrotic responses to TGFβ1 in PTECs and fibroblasts. Current studies are ongoing to confirm beneficial effects on restoring FAO. / Thesis / Master of Science (MSc) / Chronic kidney disease (CKD) is the leading cause of kidney failure in Canada, affecting 4 million Canadians. There is no cure for CKD and current treatments are only able to slow down disease progression. CKD is caused by scarring in the kidney. The kidney requires a lot of energy to do its job filtering our blood and creating urine, and with CKD the ability to create and use energy is reduced. The protein ATP-citrate lyase (ACLY) that is present in the kidney contributes to CKD. Research has shown that people and mice with CKD have higher levels of this protein than healthy individuals. ACLY creates a molecule called acetyl-coA that is likely to cause our kidneys to produce less energy. This study will test if ACLY is causing the kidneys to produce and use less energy. This will be done by using mice with CKD and blocking the activity of ACLY using a drug to see if this will help the kidney create more energy for itself. The kidneys of the mice will be tested to see if the drug worked in increasing energy levels and if it prevented kidney scarring. A type of cell in the kidney, called tubular cells, makes up most of the kidney and requires a lot of energy to function. We performed experiments with tubular cells and gave them stressors, like those found in CKD, and ACLY-blockers to test if the energy levels are restored and if scarring was reduced. This study is important because there is no cure for CKD and many patients will eventually develop end-stage kidney disease, requiring dialysis or transplant. Research needs to be done to create new medications for those suffering from CKD. Current studies are testing ACLY-blocking drugs to treat heart disease. If our study is successful, this drug is well-positioned to be developed into a new treatment for CKD.

The important role of the central intermediary metabolite acetyl-coenzyme A (AcCoA)for several anabolic and catabolic pathways is well characterised. However, the role of AcCoA as the only known donor of acetyl groups for protein acetylation in regulation of enzyme activities, protein complex stability as well as epigenetic status off chromatin, is only recently emerging. Among multiple other pathways, the autophagy pathway has now been shown to be directly regulated by protein acetylation and deacetylation. Therefore, it was reasoned that the availability of AcCoA, via the modulation of AcCoA generating enzymes, may regulate autophagy. This study has focussed on the role of the acetate-mediated route to nuclear-cytosolic AcCoA synthesis, catalysed by AcCoA synthetase 2 (ACSS2), in the regulation of autophagy.

Currently, many patients with early-stage localized prostate cancer (PrCa) (D’Amico: low risk or low-intermediate risk) do not receive immediate therapy but are monitored within systematic AS programs. Prospective trials showed rates of stage reclassification and progression to the treatment of 20–40% over 2–5 years. However, in certain patients, PrCa progresses rapidly to an advanced stage that requires combined modality therapies, which carry increased risk for toxicity and poor outcomes. There is a need to identify biomarkers that can predict the risk for disease progression in this population. Research showed that dysregulation of metabolism is an important hallmark of cancer progression. Here, we pursued a pilot investigation of enzymes of de novo lipogenesis [ATP-citrate lyase (ACLY), Acetyl-CoA Carboxylase (ACC)], lipid oxidation [a-Methylacyl-CoA Racemase (AMACR)], glucose uptake [facilitative glucose transporter 1 (GLUT1)], and folate – glutamate metabolism (PSMA: prostate-specific membrane antigen) as potential biomarkers of PrCa progression in AS patients. With ethics approval from the Hamilton Integrated Research Ethics Board (HiREB), 40 AS patients were accrued prospectively from the Niagara Health System PrCa diagnostic program clinics and were asked to donate their biopsy tissue. 28 patients progressed on repeat biopsies at 12 or 24 months after initial diagnosis and were included in the “Progressed” group, and 12 did not who were included in the “Non-Progressed” group. Baseline diagnostic prostate core biopsy tissues of both groups were evaluated with H&E and immunohistochemistry (IHC) staining for ACLY, ACC, GLUT1, AMACR and PSMA expression (quantified by H-score). H-scores were evaluated in benign and malignant components (epithelial cells) and were compared between the two groups of patients. We observed statistically significant increased GLUT1 expression in malignant epithelial cells of the progressed group compared to the non-progressed group. Also, we found statistically significant increased PSMA expression in the benign epithelial cells of the progressed group compared to the non-progressed group. Further, our results demonstrated a statistically significant increase in ACLY and ACC expression in malignant epithelial cells compared to benign epithelial cells in the progressed group, while AMACR was detected solely in the malignant component. Overall, the results of this pilot study are consistent with the notion of induction of glycolytic metabolism, de novo lipogenesis and increased PSMA expression associated with the risk for PrCa progression. The levels of expression of PSMA within benign epithelial cells and GLUT1 within malignant epithelial cells may have value as predictive markers of risk for PrCa progression in AS patients. Future studies should investigate this concept systematically in larger AS cohorts. / Thesis / Master of Science (MSc) / Currently, many patients with localized prostate cancer do not receive immediate therapy and are monitored within systematic active surveillance (AS) programs. The main aim of AS management is to prevent overtreatment and treatment-related complications in patients who would otherwise have a good quality of life despite dealing with prostate cancer. However, many of these patients, especially those with low intermediate-risk prostate cancer have a significant risk for disease progression and metastasis. Additionally, there is a lack of promising tissue biomarkers to predict the risk for progression in AS patients at the time of initial diagnosis. Research showed that metabolism dysregulation is an essential hallmark of cancer progression, including prostate cancer. In this pilot study, we examined whether the expression of enzymes involved in lipid, glucose and protein metabolism could have value as biomarkers of risk for prostate cancer progression in patients managed with AS. The expression of five metabolic enzymes (ACLY, ACC, GLUT1, AMACR and PSMA) was examined in tumor and benign regions of diagnostic biopsies of the prostate obtained from men managed with AS. Our early results suggest that the expression of enzymes of protein (PSMA) and glucose (GLUT1) metabolism may have value as biomarkers of risk for prostate cancer progression and should be investigated further in systematic studies.

Thesis / Doctor of Philosophy (PhD)