Cancer-associated cachexia is a condition defined by a sustained net-negative energy imbalance. Although the different types of adipose tissue – white, beige, and brown – have been implicated in contributing to cancer-associated cachexia, the mechanisms of these maladaptive changes and their impact on whole-body energy expenditure have not been fully elucidated. Using breast cancer as our model, we demonstrate white adipose tissue browning in murine and human breast cancer; furthermore, we demonstrate that this effect is extremely localized and takes place early in tumor progression. We utilized in vitro cell culture techniques and demonstrate that cancer secreted factors and cross-talk with white adipocytes decrease expression of classic white adipose tissue-related genes. We also demonstrate in murine and human culture models that cancer secreted factors reduce white adipocyte lipid droplet size, and cross-talk between cancer cells and adipocytes results in an increase in lipolysis-related gene expression. Interestingly, our results strongly suggest that in mice, neither cancer secreted factors nor cross talk with adipocytes can induce white adipose tissue browning, indicate that this process likely occurs independently of direct cancer interactions with local white adipocytes. We demonstrate that interleukin 6, a cytokine with previous implications in white adipose tissue browning, induces interleukin 6-mediated signaling; however, that signaling alone is not enough to directly induce white adipose tissue browning. We present preliminary data suggesting that immune cell population shifts within the white adipose tissue of mice with breast cancer tumors may be source of white adipose tissue browning. We show that the Virginia Commonwealth University Health System has an identifiable population of patients with cancer with what we hypothesize as maladaptive thermogenic adipose tissue activity, and discuss ongoing experiments aimed at understanding the implications of these changes on whole body energy expenditure in human patients. Lastly, in a case of autoimmune diabetes mellitus in the setting of an extra-adrenal paraganglioma, we demonstrate that the interaction between cancer and whole-body metabolism is multifaceted. Together, these experiments demonstrate that adipose tissue plasticity occurs in breast cancer (and other cancers), and that different drivers for individual changes exist within the tumor microenvironment. We predict that further exploration of the exact mechanisms and translational implications will provide useful information to lead to new therapeutic treatments for patients with cancer-associated cachexia.

<p>Methods for assessment of body composition allow studies of the complex relationships between body composition and the wellbeing of humans. The amount and distribution of adipose tissue is of great importance in these studies. This thesis describes, proposes, and evaluates new methods for assessment of body composition (amount and distribution of adipose tissue) using magnetic resonance imaging (MRI). The thesis focuses on the use of MRI but includes results from computed tomography (CT) and dual energy X-ray absorptiometry (DEXA). The subject data used originates from cohorts recruited solely for the purpose of the included studies and from the “Prospective Investigation of Vasculature in Uppsala Seniors” (PIVUS) and the Sib-pair (within the framework of the Swedish Obese Subjects - SOS study) studies.</p><p>The included studies propose a new acquisition method for whole-body analysis of adipose tissue, a fully automated post processing algorithm for segmentation of visceral and subcutaneous adipose tissue from abdominal MRI data, and anthropometrical measurements for practical estimations of body composition.</p><p>The proposed acquisition method for whole-body adipose tissue analysis simplified the analysis of adipose tissue and the results strongly correlated with the results from CT and DEXA analysis. The fully automated post processing algorithm gave reproducible results with relatively high accuracy. Transverse and sagittal abdominal diameters gave information about subcutaneous and visceral adipose tissue, respectively, and an elliptical approximation was found useful in estimation of total amount of abdominal adipose tissue.</p><p>The methods proposed in this thesis were found useful for assessment of body composition. The methods were developed with clinical practice in mind and all proposed methods have been used in further studies for assessment of body composition.</p>

Methods for assessment of body composition allow studies of the complex relationships between body composition and the wellbeing of humans. The amount and distribution of adipose tissue is of great importance in these studies. This thesis describes, proposes, and evaluates new methods for assessment of body composition (amount and distribution of adipose tissue) using magnetic resonance imaging (MRI). The thesis focuses on the use of MRI but includes results from computed tomography (CT) and dual energy X-ray absorptiometry (DEXA). The subject data used originates from cohorts recruited solely for the purpose of the included studies and from the “Prospective Investigation of Vasculature in Uppsala Seniors” (PIVUS) and the Sib-pair (within the framework of the Swedish Obese Subjects - SOS study) studies. The included studies propose a new acquisition method for whole-body analysis of adipose tissue, a fully automated post processing algorithm for segmentation of visceral and subcutaneous adipose tissue from abdominal MRI data, and anthropometrical measurements for practical estimations of body composition. The proposed acquisition method for whole-body adipose tissue analysis simplified the analysis of adipose tissue and the results strongly correlated with the results from CT and DEXA analysis. The fully automated post processing algorithm gave reproducible results with relatively high accuracy. Transverse and sagittal abdominal diameters gave information about subcutaneous and visceral adipose tissue, respectively, and an elliptical approximation was found useful in estimation of total amount of abdominal adipose tissue. The methods proposed in this thesis were found useful for assessment of body composition. The methods were developed with clinical practice in mind and all proposed methods have been used in further studies for assessment of body composition.

Ο λιπώδης ιστός θεωρείται πλέον ενδοκρινές όργανο που παράγει πληθώρα βιολογικά δραστικών πεπτιδίων, που καλούνται λιποκίνες. Ανάλογα με την ανατομική τους εντόπιση, οι διαφορετικές αποθήκες λίπους έχουν και διαφορετική ικανότητα παραγωγής λιποκινών και επίδρασης σε φυσιολογικές λειτουργίες. Οι λιποκίνες που παράγονται από τον περιαγγειακό λιπώδη ιστό εμπλέκονται στην παθογένεια αγγειακών νόσων, συμπεριλαμβανόμενης της αθηροσκλήρωσης. Είναι γνωστό πως η αντιπονεκτίνη ασκεί αντιαθηρογόνες δράσεις, ενώ ο ρόλος της Τ-καντχερίνης ως υποδοχέα της αντιπονεκτίνης δεν έχει πλήρως διαλευκανθεί. Το απελινεργικό σύστημα, αποτελούμενο από την απελίνη και τον υποδοχέα της APJ, αποτελεί μεσολαβητή ποικίλων καρδιαγγειακών λειτουργιών και ενδέχεται να συμμετέχει και στην αθηροσκληρωτική διαδικασία. Η χεμερίνη είναι λιποκίνη με γνωστό ρόλο στην ανοσία, στη λειτουργία του λιπώδους ιστού και στο μεταβολισμό, δρώντας κυρίως μέσω του υποδοχέα της CMKLR1. Μελετήσαμε την πρωτεϊνική έκφραση της αντιπονεκτίνης και της Τ-καντχερίνης, της απελίνης και του APJ, της χεμερίνης και του CMKLR1 σε ανθρώπινες αορτές, στεφανιαίες αρτηρίες και στον αντίστοιχο περιαγγειακό λιπώδη ιστό και συσχετίσαμε την έκφρασή τους με την παρουσία αθηροσκλήρωσης και με κλινικές παραμέτρους. Εφαρμόστηκε ανοσοϊστοχημική χρώση για την αντιπονεκτίνη, την Τ-καντχερίνη, την απελίνη, τον APJ, τη χεμερίνη και τον CMKLR1 σε δείγματα ανθρώπινων αορτών και στεφανιαίων αρτηριών, περιλαμβανόμενου και του περιαγγειακού λίπους. Οι αορτικές και στεφανιαίες αθηρωματικές βλάβες αξιολογήθηκαν με βάση την κατάταξη του AHA. Ανοσοϊστοχημική χρώση, ποικίλης έντασης, για την αντιπονεκτίνη ανιχνεύθηκε μόνο στα λιποκύτταρα, ενώ η Τ-καντχερίνη εντοπίστηκε στα αγγειακά λεία μυικά κύτταρα (ΑΛΜΚ) και στα ενδοθηλιακά κύτταρα. Ανοσοϊστοχημική χρώση για την απελίνη ανιχνεύθηκε σε λιποκύτταρα, ΑΛΜΚ, ενδοθηλιακά κύτταρα και μακροφάγα-αφρώδη κύτταρα των αθηρωματικών βλαβών, ενώ ο APJ εντοπίστηκε στα ΑΛΜΚ και στο ενδοθήλιο των αγγείων. Ανοσοθετικότητα για τη χεμερίνη παρατηρήθηκε και στις δύο αποθήκες λίπους ,στα ΑΛΜΚ και σε αφρώδη κύτταρα των αθηρωματικών βλαβών. Ο CMKLR1 εκφράστηκε σε ΑΛΜΚ και σε αφρώδη κύτταρα αορτών και στεφανιαίων αγγείων με αθηρωματικές βλάβες. Η έκφραση αντιπονεκτίνης στον περιαγγειακό λιπώδη ιστό και η έκφραση Τ-καντχερίνης στα ΑΛΜΚ συσχετίστηκαν αρνητικά με την αθηροσκλήρωση και στις δύο εντοπίσεις, όπως και η έκφραση απελίνης στα ΑΛΜΚ. Η έκφραση χεμερίνης στις περιαγγειακές αποθήκες λίπους και στα αφρώδη κύτταρα συσχετίστηκε στατιστικά σημαντικά με τη βαρύτητα της αθηροσκλήρωσης και στις δύο εντοπίσεις. Πολλές ακόμα – ειδικές για την εντόπιση – συσχετίσεις παρατηρήθηκαν. Τα αποτελέσματά μας υποδεικνύουν πιθανό ρόλο της Τ-καντχερίνης ως μεσολαβητή των αντιαθηρογόνων δράσεων της αντιπονεκτίνης, ενώ υποστηρίζουν το ενδεχόμενο αντιαθηρογόνο προφίλ της απελίνης και του υποδοχέα της APJ στις ανθρώπινες αρτηρίες. Ενισχύουν, ακόμα, τον υποτιθέμενο ρόλο της χεμερίνης στην εξέλιξη των αθηρωματικών βλαβών, πιθανότατα δρώντας μέσω του CMKLR1 υποδοχέα της. Περαιτέρω έρευνα είναι αναγκαία για να αποσαφηνιστεί ο ρόλος της τοπικά παραγόμενης αντιπονεκτίνης, απελίνης και χεμερίνης και της σηματοδότησης μέσω των αντίστοιχων υποδοχέων τους – T-cadherin, APJ και CMKLR1 – στην παθογένεια της αθηροσκλήρωσης στον άνθρωπο. / Adipose tissue is considered an endocrine organ, producing numerous bioactive peptides, called adipokines. Depending on their anatomical location, different fat depots have a different capacity to produce adipokines and influence physiological functions. Adipokines produced by periadventitial fat have been implicated in the pathogenesis of vascular disease, including atherosclerosis. Adiponectin has established anti-atherogenic actions, while the role of T-cadherin as an adiponectin receptor is not fully elucidated. The apelinergic system, consisting of apelin and its APJ receptor, is a mediator of various cardiovascular functions and may also be involved in the atherosclerotic process. Chemerin is an adipokine with an established role in immunity, adipose tissue function and metabolism, acting, mainly through its CMKLR1 receptor. We investigated the protein expression of adiponectin and T-cadherin, apelin and APJ, chemerin and CMKLR1 in human aortas, coronary vessels and the respective periadventitial adipose tissue and correlated their expression with the presence of atherosclerosis and clinical parameters. Immunohistochemistry for adiponectin, T-cadherin, apelin, APJ, chemerin and CMKLR1 was performed on human aortic and coronary artery samples including the periadventitial adipose tissue. Aortic and coronary atherosclerotic lesions were assessed using the AHA classification. Adiponectin immunostaining, of varied intensity, was detected only in adipocytes, while T-cadherin was localized to vascular smooth muscle cells (VSMCs) and endothelial cells. Apelin immunostaining was detected in adipocytes, VSMCs, endothelial cells and foam cells in atherosclerotic lesions, while APJ was found in VSMCs and endothelia. Chemerin immunopositivity was noticed in both periadventitial fat depots, in VSMCs and foam cells in atherosclerotic lesions. CMKLR1 was expressed in VSMCs and foam cells in aortic and coronary vessels with atherosclerotic lesions. Periadventitial adiponectin and VSMC T-cadherin expression were negatively correlated with atherosclerosis in both sites, as was VSMC apelin expression. Chemerin expression in periadventitial fat depots and foam cells was statistically significantly correlated with the severity of atherosclerosis in both locations. Several other – depot specific – associations were observed. Our results suggest a possible role for T-cadherin as a mediator of anti-atherogenic adiponectin actions, while they support the putative anti-atherogenic profile for apelin and its APJ receptor in human arteries. They also lend some support to a presumable role of chemerin in the progression of atherosclerotic lesions, possibly acting through its CMKLR1 receptor. Further research is necessary to elucidate the role of locally produced adiponectin, apelin and chemerin and signaling through their respective receptors – T-cadherin, APJ and CMKLR1 – in the pathogenesis of human atherosclerosis.

1 Abstrakt Hnědá tuková tkáň je unikátní termoregulační orgán, její funkcí je přeměňovat energii ve formě protonového gradientu na energii tepelnou a zároveň snižovat efektivitu metabolismu. Její funkce se zdá být nadějí v léčbě metabolického syndromu a komplikací s ním spojených. Efekt hnědé tukové tkáně v léčbě MS však stále není objasněn a proto jsme chirurgicky odstranili tuto tkáň u potkanů, kteří trpí metabolickým syndromem, abychom objasnili důsledky extirpace na parametry metabolického syndromu. V této práci jsme sledovali aktivitu interskapulární tukové tkáně na parametry metabolického syndromu. Srovnávali jsme parametry mezi kmeny HHTg potkanů a kontrolním kmenem potkanů Wistar a pozorovali jsme nižší hmotnost potkanů kmene HHTg přes projevy ostatních parametrů metabolického syndromu, jako je dyslipidémie, inzulinová rezistence tukové tkáně, vyšší hodnoty NEMK v krvi. Zjistili jsme, že tito potkani mají významně vyšší aktivitu iBAT, jak v inkorporaci palmitátu do lipidů, tak ve spalování lipidů ve formě CO2 a zejména v nižším věku. Tato zjištění nás vedla k hypotéze, že iBAT by mohla mít zásadní vliv na parametry MS u neobézních potkanů. Extirpací iBAT u mladých potkanů, ani u potkanů v pokročilejším věku však neměla zásadní vliv na metabolismus ani na hmotnost. Dokonce došlo ke zlepšení některých...

Chronic exposure of humans or rodents to high calorie diets leads to hypertriglyceridemia and ectopic lipid deposition throughout the body, resulting in metabolic disease. Cellular lipids are stored in organelles termed lipid droplets (LDs) that are regulated by tissue-specific LD proteins. These proteins are critical for lipid homeostasis, as humans with LD protein mutations manifest metabolic dysfunction. Identification of novel components of the LD machinery could shed light on human disease mechanisms and suggest potential therapeutics for Type 2 Diabetes. Microarray analyses pinpointed the largely unstudied Hypoxia-Inducible Gene 2 (Hig2) as a gene that was highly expressed in obese human adipocytes. Imaging studies demonstrated that Hig2 localized to LDs in mouse hepatocytes and the human SGBS adipocyte cell line. Thus, this work examined the role of Hig2 as a LD protein in liver and adipose tissue. Hig2 deficiency reduced triglyceride deposition in hepatocytes; conversely, ectopic Hig2 expression promoted lipid deposition. Furthermore, liver-specific Hig2-deficient mice displayed improved glucose tolerance and reduced liver triglyceride content. Hig2 deficiency increased lipolysis and -oxidation, accounting for the reduced triglyceride accumulation. Similarly, adipocyte-specific Hig2-deficient mice displayed improved glucose tolerance, reduced adipose tissue weight and brown adipose tissue that was largely cleared of lipids. These improvements were abrogated when the animals were placed in thermoneutral housing and brown adipocyte-specific Hig2-deficient mice also displayed improved glucose tolerance, suggesting that active brown fat largely mediates the metabolic phenotype of Hig2 deletion. Thus, this work demonstrates that Hig2 localizes to LDs in liver and adipose tissue and promotes glucose intolerance.

Adipose tissue is one of the most dynamic tissues in the body and is vital for metabolic homeostasis. In the case of excess nutrient uptake, adipose tissue expands to store excess energy in the form of lipids, and in the case of reduced nutrient intake, adipose tissue can shrink and release this energy. Adipocytes are most functional when the balance between these two processes is intact. To understand the molecular mechanisms that drive insulin resistance or conversely preserve the metabolically healthy state in obese individuals, our laboratory performed a screen for differentially regulated adipocyte genes in insulin resistant versus insulin sensitive subjects who had been matched for BMI. From this screen, we identified the type II transmembrane protein tenomodulin (TNMD), which had been previously implicated in glucose tolerance in gene association studies. TNMD was upregulated in omental fat samples isolated from the insulin resistant patient group compared to insulin sensitive individuals. TNMD was predominantly expressed in primary adipocytes compared to the stromal vascular fraction from this adipose tissue. Furthermore, TNMD expression was greatly increased in human preadipocytes by differentiation, and silencing TNMD blocked adipogenic gene induction and adipogenesis, suggesting its role in adipose tissue expansion. Upon high fat diet feeding, transgenic mice overexpressing Tnmd specifically in adipose tissue developed increased epididymal adipose tissue (eWAT) mass without a difference in mean cell size, consistent with elevated in vitro adipogenesis. Moreover, preadipocytes isolated from transgenic epididymal adipose tissue demonstrated higher BrdU incorporation than control littermates, suggesting elevated preadipocyte proliferation. In TNMD overexpressing mice, lipogenic genes PPARG, FASN, SREBP1c and ACLY were upregulated in eWAT as was UCP-1 in brown fat, while liver triglyceride content was reduced. Transgenic animals displayed improved systemic insulin sensitivity, as demonstrated by decreased inflammation and collagen accumulation and increased Akt phosphorylation in eWAT. Thus, the data we present here suggest that TNMD plays a protective role during visceral adipose tissue expansion by promoting adipogenesis and inhibiting inflammation and tissue fibrosis.

In humans, various dietary and social factors led to the development of increased brain sizes alongside large adipose tissue stores. Complex reciprocal signaling mechanisms allow for a fine-tuned interaction between the two organs to regulate energy homeostasis of the organism. As an endocrine organ, adipose tissue secretes various hormones, cytokines, and metabolites that signal energy availability to the central nervous system (CNS). Vice versa, the CNS is a critical regulator of adipose tissue function through neural networks that integrate information from the periphery and regulate sympathetic nerve outflow. This review discusses the various reciprocal signaling mechanisms in the CNS and adipose tissue to maintain organismal energy homeostasis. We are focusing on the integration of afferent signals from the periphery in neuronal populations of the mediobasal hypothalamus as well as the efferent signals from the CNS to adipose tissue and its implications for adipose tissue function. Furthermore, we are discussing central mechanisms that fine-tune the immune system in adipose tissue depots and contribute to organ homeostasis. Elucidating this complex signaling network that integrates peripheral signals to generate physiological outputs to maintain the optimal energy balance of the organism is crucial for understanding the pathophysiology of obesity and metabolic diseases such as type 2 diabetes.

Obesity develops early in childhood and is accompanied by early signs of adipose tissue (AT) dysfunction and metabolic disease in children. In order to analyse the molecular processes during obesity-related AT accumulation in children, we investigated genome-wide expression profiles in AT samples, isolated adipocytes, and stromal vascular fraction (SVF) cells and assessed their relation to obesity as well as biological and functional AT parameters. We detected alterations in gene expression associated with obesity and related parameters, i.e., BMI SDS, adipocyte size, macrophage infiltration, adiponectin, and/or leptin. While differential gene expression in AT and adipocytes shared an enrichment in metabolic pathways and pathways related to extracellular structural organisation, SVF cells showed an overrepresentation in inflammatory pathways. In adipocytes, we found the strongest positive association for epidermal growth factor-like protein 6 (EGFL6) with adipocyte hypertrophy. EGFL6 was also upregulated during in vitro adipocyte differentiation. In children, EGFL6 expression was positively correlated to parameters of AT dysfunction and metabolic disease such as macrophage infiltration into AT, hs-CRP, leptin levels, and HOMA-IR. In conclusion, we provide evidence for early alterations in AT gene expression related to AT dysfunction in children and identified EGFL6 as potentially being involved in processes underlying the pathogenesis of metabolic disease.

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