Tuberculosis, caused by Mycobacterium tuberculosis, still poses a huge global health threat today. During infection, the bacilli are believed to confront with various stresses, including hypoxia. Hypoxia is known to trigger the bacteria to adapt into a nonreplicating dormant state associated with reduced drug susceptibility. In addition to dormancy, mycobacteria, like other bacteria, may switch to sessile biofilm growth that is generally associated with augmented drug and stress tolerance. Bacterial biofilm is physically heterogeneous and may harbor cells displaying distinct metabolic activities. It is therefore likely that some cell populations within an established biofilm are in a nonreplicating dormant state. A better understanding of mycobacterial dormancy establishment and biofilm growth could unveil crucial bacillary survival strategies that will provide insights into a rational design of chemotherapy regimen.The mycobacterial chaperonin 60.1 (Cpn60.1, also known as GroEL1), a probable chaperonin and/or nucleoid associated protein, is necessary for mycobacterial cell wall virulence lipid biosynthesis, which was reported to be enhanced at the early stage of mycobacterial hypoxic adaptation, and for reduced drug susceptibility under aerobic condition. We therefore investigated whether Cpn60.1 was essential for mycobacterial adaptation to hypoxic dormancy using Mycobacterium bovis BCG as the model organism. We found that Cpn60.1, although nonessential for mycobacterial survival, reduced isoniazid (INH) susceptibility under hypoxia. Unexpectedly and interestingly, INH’s bactericidal activity was found to involve electron transport chain perturbation (e.g. enhanced oxygen consumption and increased adenosine triphosphate level) via NADH dehydrogenases, succinate dehydrogenases, cytochrome bc1 and F0F1 ATP synthase. Moreover, respiratory reprogramming to cytochrome bd was observed to protect against INH-induced killing.Intriguingly, we found that Cpn60.1 was required for respiratory and energetic downregulation under excess glycerol as well as in response to drugs (such as Q203 inhibiting cytochrome bc1). Cpn60.1 also played a role in lipidomic adaptation under excess glycerol (e.g. enhanced phthiocerol dimycocerosate and glycerol-based lipids synthesis but repressed trehalose-based lipids synthesis). Defective energetic downregulation in the absence of Cpn60.1 compromised the establishment of the Crabtree effect characterized by respiratory downregulation, glycolytic enhancement and secretion of several metabolites (i.e. pyruvate, succinate, acetate and glutamate). The Crabtree effect was necessary for mycobacterial adaptation to excess glycerol and biofilm growth. Due to a compromised Crabtree effect, a Cpn60.1-deficient Mycobacterium bovis BCG strain, i.e. the Δcpn60.1 strain, suffered from methylglyoxal-induced growth stasis under excess glycerol, leading to the biofilm defect under the standard biofilm medium. Given the essentiality for Cpn60.1 in mycobacterial respiratory adaptation under stresses, it is likely that the enhanced INH susceptibility of the Δcpn60.1 strain under hypoxia was due to a problematic respiratory reprogramming.In summary, Mycobacterium bovis BCG Cpn60.1 is not required for bacillary survival under hypoxic dormancy. However, it participates in various adaptations (e.g. respiratory downregulation) necessary for mycobacterial biofilm growth and for escaping INH’s bactericidal mechanism. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive form of cancer with poor prognosis and limited treatment options. Since many patients present with metastatic disease and are thus ineligible for surgical resection, PDAC is almost ubiquitously fatal; new treatment options are therefore needed to combat this disease. A key hallmark of many cancers, including PDAC, is metabolic reprogramming and a shift towards a high glycolytic rate, known as the Warburg effect. This allows cancer cells to generate ATP in the face of hypoxia and to meet the increased metabolic requirements associated with rapid proliferation. We hypothesised that this shift towards glycolytic metabolism has important implications for the regulation of cytosolic Ca2+ ([Ca2+]i) in PDAC, since the plasma membrane Ca2+ ATPase (PMCA), which is critical for maintaining low [Ca2+]i and thus cell survival, is dependent on ATP to extrude cytosolic Ca2+. The relative contributions of mitochondrial vs glycolytic ATP in fuelling the PMCA in human PDAC cell lines (PANC-1 and MIA PaCa-2) were therefore assessed. Moreover, the effects of numerous mechanistically distinct metabolic inhibitors on key readouts of cell death, [Ca2+]i and ATP were investigated. Treatment with glycolytic inhibitors induced significant ATP depletion, PMCA inhibition, [Ca2+]i overload and cell death in both PANC-1 and MIA PaCa-2 cells, while mitochondrial inhibitors had no effect. Subsequently, these experiments were repeated on PDAC cells cultured in media formulated to "switch" their highly glycolytic phenotype back to one more reliant on mitochondrial metabolism. Culture in nominal glucose-free media supplemented with either galactose (10 mM) or alpha-ketoisocaproate (KIC, 2 mM) resulted in a switch in metabolism in MIA PaCa-2 cells, where proliferation rate and glycolysis were significantly decreased, and in the case of cells cultured in KIC, oxidative phosphorylation rate was preserved (assessed using Seahorse XF technology). Following culture of MIA PaCa-2 cells in either galactose or KIC, glycolytic inhibition failed to recapitulate the profound ATP depletion, PMCA inhibition and [Ca2+]i overload observed in glucose-cultured MIA PaCa-2 cells. These data demonstrate that in PDAC cells exhibiting a high rate of glycolysis, glycolytically-derived ATP is important for fuelling [Ca2+]i homeostasis and thus is critical for survival. Finally, using a cell surface biotinylation assay, the keyglycolytic enzymes LDHA, PFKP, GAPDH, PFKFB3 and PKM2 were all found to associate with the plasma membrane in MIA PaCa-2 cells, possibly in a tyrosine phosphorylation-dependent manner. To investigate whether the dynamic membrane-association of glycolytic enzymes provides a privileged supply of ATP to the PMCA in PDAC, the effects of tyrosine kinase inhibitors was assessed on PMCA activity. However, while these inhibited PMCA activity, this occurred without accompanying global ATP depletion. These data indicate that glycolytic ATP is critical for the regulation of [Ca2+]i by the PMCA in PDAC, and that the glycolytic regulation of the PMCA may be an important therapeutic locus. However, further research is required to determine whether membrane-bound glycolytic enzymes regulate its activity.

Sepsis é uma disfunção de órgãos causada por uma resposta desregulada do hospedeiro em decorrência de uma infecção e que eventualmente leva a morte. A identificação de moléculas que minimizem este processo pode fornecer alvos terapêuticos para prevenir a falência de órgãos durante a sepse. O supressor de sinalização de citocinas 1 (SOCS1) é conhecido por regular negativamente a sinalização de receptores de citocinas e de receptores do tipo Toll (TLRs). No entanto, os alvos celulares e mecanismos moleculares envolvidos nas ações de SOCS1 durante a sepse são desconhecidos. Para determinar o papel de SOCS1 durante a sepse polimicrobiana, camundongos C57BL/6 foram tratados com um peptídeo inibidor do domínio KIR (kinase inhibitor region) do SOCS1 (iKIR) e submetidos à CLP (ligação e perfusão do ceco). O tratamento com iKIR aumentou a mortalidade, a carga bacteriana e a produção de citocinas inflamatórias induzida pela CLP. Além disso, observou-se que animais deficientes de SOCS1 nas células mielóides (SOCS1?myel) também tiveram aumento na carga bacteriana e na produção de citocinas proinflamatórias, quando comparados com camundongos SOCS1fl. O aumento na susceptibilidade a sepse foi acompanhado pelo aumento da via glicolítica nas células peritoneias e no pulmão desses animais. Assim, foi observado aumento da produção de ácido láctico e da expressão de enzimas glicolíticas como hexoquinase-1 (Hk1), lactato desidrogenase A (Ldha) e o transportador de glicose 1 (Glut-1) em camundongos sépticos tratados com iKIR ou SOCS1?myel. A expressão desses genes da via glicolítica foi dependente da via de ativação STAT3/HIF-1?. O tratamento com 2-deoxiglicose (inibidor da via glicolítica) diminuiu a susceptibilidade à sepse em camundongos tratados com iKIR. Estes resultados indicam um papel até agora desconhecido de SOCS1, como um regulador de reprogramação metabólica que reduz a resposta inflamatória exacerbada e o dano de órgãos durante a sepse. / Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Identification of pleiotropic molecular brakes might provide therapeutic targets to prevent organ failure during sepsis. Suppressor of cytokine signaling 1 (SOCS1) is known to negatively regulate signaling by cytokine and Tolllike receptors (TLRs). However, the cellular targets and molecular mechanisms involved in SOCS1 actions during sepsis are unknown. To address this in a cecal ligation puncture (CLP) model of sepsis, we treated C57BL/6 mice with an antagonist peptide (iKIR) that blocks the kinase inhibitory region (KIR) domain of SOCS1 and prevents its actions. iKIR treatment increased mortality, bacterial burden and inflammatory cytokine production induced after CLP. We also found that myeloid cell-specific SOCS1 deletion (SOCS1?myel) rendered mice more susceptible to sepsis, shown by higher bacterial loads and inflammatory cytokines than SOCS1fl littermate control mice. O aumento na susceptibilidade a sepse foi acompanhado pelo aumento da via glicolítica nas células peritoneias e pulmão desses animais. These effects were accompanied by increase of glycolysis function in peritoneal cells and lung of SOCS1?myel. Thus, it was observed increased expression of the glycolytic enzymes, hexoquinase-1 (Hk1), lactate dehydrogenase A (Ldha), and glucose transporter 1 (Glut-1) in iKIR-treated or SOCS1?myel septic mice. These events were dependent on the activation of STAT3/HIF-1? pathway. Blocking glycolysis with 2-deoxyglucose ameliorated the increased susceptibility to sepsis in iKIR-treated CLP mice. Together, we unveiled a heretofore unknown role of SOCS1 as a regulator of metabolic reprograming that reduces overwhelming inflammatory response and organ damage during sepsis.

L’ectoderme embryonnaire devient spécifié en ectoderme non-neural, plaque neurale et bordure neurale à la fin de la gastrulation. Les cellules de bordure neurale sont les progéniteurs de la crête neurale et des placodes. La crête neurale est une population transitoire de cellules multipotentes, qui se forme au cours de la neurulation. Quand les bourrelets neuraux s’élèvent pour former le tube neural, les cellules de la crête neurale subissent une transition épithélio-mésenchymateuse, migrent dans l'ensemble du corps pour atteindre leur destination finale et se différencier. La crête neurale donne naissance à de multiples dérivés tels que les neurones et les cellules gliales du système nerveux périphérique, le cartilage et les os du visage, ou encore les mélanocytes. Des régulations complexes, impliquant de nombreuses signalisations et la transcription de gènes-clé, orchestrent ces événements. Cependant, les premières étapes menant à la formation de la crête neurale et à la spécification précoce de la bordure neurale sont encore peu comprises. Nous avons analysé le transcriptome de la crête neurale d'embryon de l'amphibien Xenopus laevis, à la recherche de nouveaux régulateurs des premières étapes de la formation de la crête neurale. Nous avons constaté que le régulateur de la glycolyse PFKFB4, est exprimé dans l’ectoderme dorsal de la jeune gastrula et dans les cellules de la crête neurale. Ici, nous démontrons que PFKFB4 régule la spécification de l’ectoderme via la voie de signalisation Akt, indépendamment de la glycolyse, démontrant ainsi la première fonction non-glycolytique des enzymes PFKFB. En outre, cette régulation est essentielle pour permettre aux progéniteurs de l'ectoderme d’être spécifiés en plaque neurale, crête neurale, placodes ou ectoderme non neural, mettant en évidence un nouveau point de contrôle de développement. De plus, nous démontrons que PFKFB4 régule des étapes ultérieures de la formation de la crête neurale. Notre travail met en évidence que les régulateurs du métabolisme cellulaire possèdent des fonctions non-métaboliques pour contrôler des étapes de développement au cours du développement embryonnaire. / Embryonic ectoderm becomes specified into non-neural ectoderm, neural plate and neural border at the end of gastrulation. Neural border cells are the progenitors of the neural crest and placodes. The neural crest is a transient population of multipotent cells, which forms during neurulation. As the neural border elevates to form the neural tube, neural crest cells undergo an epithelial to mesenchymal transition, migrate extensively into the whole body to reach their final destinations and differentiate. Neural crest gives rise to multiple derivatives such as neurons and glia, facial cartilage, bones, melanocytes and sympatho-adrenal cells. A complex interplay of signaling and transcriptional regulations orchestrates these early patterning events. However, the first steps leading to NC formation and early specification at the NB are less understood. We analysed the NC transcriptome of frog embryos, to look for novel regulators of the early steps of NC formation. We found that the well-known glycolysis regulator PFKFB4, is expressed in early gastrula dorsal ectoderm, and in neurula neural crest cells. Here, we demonstrate that PFKFB4 regulates ectoderm specification via Akt signaling independently of glycolysis, thus demonstrating the first non-glycolytic function of PFKFB enzymes. Moreover, this regulation is essential to allow ectoderm embryonic progenitors to be patterned into neural plate, neural crest, placodes and definitive ectoderm, highlighting a novel developmental checkpoint. Moreover, we also demonstrate that PFKFB4 regulates later steps of neural crest formation. Our work highlights that regulators of cell metabolism accumulate non-metabolic related functions to control developmental steps during embryonic development.

L’homéostasie énergétique ou ‘balance énergétique’ est l’équilibre qui s’établit chez l’Homme et l’animal adulte entre la prise quotidienne de nutriments sous la forme de glucides, de lipides ou de protéines et leur oxydation pour ne produire que la quantité énergétique strictement nécessaire. Pour maintenir cette balance l’organisme doit recueillir en permanence des signaux nerveux, métaboliques ou hormonaux de la part de cellules spécifiques. Ces senseurs des besoins énergétiques transmettent alors à des centres régulateurs leurs informations qui en retour, par voie hormonale ou nerveuse, informent les organes effecteurs des mesures à prendre pour stocker, produire ou consommer l’énergie. Les trois principaux centres de cette balance sont 1/ le cerveau, centre intégrateur de l’information ; 2/ un groupe d’organes effecteurs parmi lesquels le foie, le tissu adipeux, les muscles squelettiques, le pancréas et 3/ un centre senseur de la qualité et de la quantité des aliments, le tractus gastrointestinal (Migrenne 2006). En plus d’être la source d’énergie nécessaire à la vie des cellules, les nutriments tels que les acides gras, le cholestérol ou encore le glucose sont aussi des molécules de signalisation cellulaire à la fois par leur fixation à des récepteurs membranaires mais aussi via des récepteurs nucléaires. Un déséquilibre dans l’homéostasie énergétique dû à une alimentation déséquilibrée, à un manque d’exercice physique ou à des facteurs génétiques est une caractéristique de l’obésité et de complications telles que le diabète de type 2 et les maladies cardiovasculaires (Hill, 2006). Au cours de ma thèse je me suis intéressé à l’intestin pour son rôle de régulateur de l’homéostasie énergétique dans un contexte physiologique ou physiopathologique d’obésité via sa capacité à sécréter l’incrétine Glucagon-Like Peptide-1 (GLP-1) en réponse au glucose et aux acides biliaires. J’ai étudié plus particulièrement le rôle du récepteur nucléaire en tant que senseurs moléculaires des acides biliaires FXR dans les cellules sécrétrices de cette incrétine car à l’heure actuelle rien n’était connu quant à son rôle ni même quant à son expression dans la cellule L. Pour cela, j’ai utilisé des lignées cellulaires murines et humaines où j’ai mis au point les conditions expérimentales pour répondre aux questions posées. Grâce à des ARN d’intestins issus de différents modèles de souris la relevance chez le rongeur a été testée. La relevance de ces résultats sur des biopsies intestinales humaine a également été testée. Grâce à ces outils, j'ai pu montré que FXR dans les cellules L était fonctionnel et que son activation interférait avec la voie de la glycolyse entrainant moins de synthèse et de sécrétion de GLP-1. Cela nous a permis de proposer un nouveau mécanisme moléculaire par lequel les séquestrants des acides biliaires exercent leur effets bénéfiques chez des patients atteints de diabète de type 2. / Originally identified as dietary lipid detergents, bile acids (BA) are now recognized as signaling molecules which bind to the transmembrane receptor TGR5 and the nuclear receptor FXR (Farnesoid X Receptor). Upon binding to TGR5 at the surface of enteroendocrine L cells, bile acids (BA) promote the secretion of the incretin GLP-1 which potentiates the glucose-induced insulin secretion by pancreatic beta-cells. More than 50% of the insulin secretion in response to glucose is mediated by GLP-1 and the other incretin Glucose-dependent Insulinotropic Polypeptide (GIP). Once secreted, GLP-1 is rapidly (2-3 minutes) degraded by the endothelial enzyme Dipeptydil Peptidase 4 (DPP4). GLP-1 analogues and DPP4 inhibitors are successfully used for the treatment of T2D. FXR is a ligand-activated nuclear receptor highly expressed in the liver and in the distal intestine. FXR controls BA, lipid and glucose metabolism. Whether FXR is expressed, functional in intestinal enteroendocrine L cells and in which extend its activation affects GLP-1 production are not yet reported. Encouraging data were obtained during my M2 training course. The aim of my thesis was thus to assess whether FXR in enteroendocrines cells could participate in the control of the deregulation of glucose homeostasis. Multiple in vitro, ex vivo and in vivo human and murine models allowed us to show that FXR is present and functional in L cells. FXR activation decreases GLP-1 production and secretion in L cells by inhibiting glycolysis pathway through an interference with the carbohydrate responsive transcription factor ChREBP. Finally, I identified an additional mechanism of action of the bile acid sequestrant Colesevelam, a molecule currently successfully used in USA for treating type 2 diabetic patients.

L'exposition à la lumière des solutions de nutrition parentérale (NP) génère des peroxydes tels que l'H2O2 et l'ascorbylperoxyde (AscOOH). Cette absence de photo-protection provoque une augmentation des triglycérides (TG) plasmatique chez les enfants prématurés et chez un modèle animal, ayant un stress oxydatif et une stéatose hépatique indépendante de l’exposition au H2O2. Nous pensons que l'AscOOH est l'agent actif conduisant à l'élévation des TG. Le but est d'investiguer le rôle de l'AscOOH sur les métabolismes du glucose et des lipides à l'aide d'un modèle animal néonatal de NP. / The light exposure of parenteral nutritive solutions generates peroxides such as H2O2 and ascorbylperoxide. This absence of photo-protection is associated with higher plasma triacylglycerol concentration (TG) in premature infants and, in animals, with oxidative stress and a H2O2 independent hepatic steatosis. We hypothesized that ascorbylperoxide is the active agent leading to high TG. The aim was to investigate the role of ascorbylperoxide on glucose and lipid metabolism in an animal model of neonatal parenteral nutrition.

Altered glucose metabolism is the underlying factor in many metabolic disorders, including diabetes. A novel protein recently linked to diabetes through animal and clinical studies is Sarcolemmal Membrane Associated Protein (SLMAP) but its role in metabolism remains undefined. The data here reveals a novel role for SLMAP isoform1 in glucose metabolism within the myocardium. Neonatal cardiomyocytes (NCMs) harvested from hearts of transgenic mice expressing SLMAP1, presented with increased glucose uptake, glycolytic rate, as well as glucose transporter 4 (GLUT4) expressions with minimal impact on lipid metabolism. SLMAP1 expression markedly increased the machinery required for endosomal trafficking of GLUT4 to the membrane within NCMs, accounting for the observed effects on glucose metabolism. The data here indicates SLMAP1 as a unique regulator of glucose metabolism through endosomal regulation of GLUT4 trafficking and suggests it may uniquely serve as a target to limit cardiovascular disease in metabolic disorders such as diabetes.

Le paludisme est un problème de santé public dans de nombreux pays. Cinq espèces infectent l'homme : P. falciparum, responsable de la grande majorité des décès, et P. vivax, P. ovale, P. malariae et P. knowlesi qui provoquent des formes bénignes de la maladie. Le diagnostic qui fait partie des moyens de lutte, est une urgence médicale. Les tests de diagnostic rapides (TDRs) dont l'usage est recommandés par l'OMS, sont donc de plus en plus employés. Cependant, la détection et l'identification des espèces non P. falciparum par ces tests est insuffisante. Le besoin en nouveaux couples « antigènes-anticorps » est une nécessité pour améliorer les TDRs. Au cours de ce travail, de nouveaux anticorps anti LDH de P.malariae ont été produits.Une recherche de nouveaux antigènes a également été entreprise. Pour cela, certaines enzymes de la voie de la glycolyse ont été étudiées. Pour la première fois des séquences des enzymes de cette voie ont été obtenues pour P. ovale et P. malariae. Elles ont permis de déterminer de nombreux épitopes cibles potentiels spécifiques et ceux communs à toutes les espèces. Dans un deuxième temps, une recherche en protéomique a été menée pour identifier des biomarqueurs parasitaires. L'étude du culot globulaire et du plasma de patients infectés a permis la sélection de 8 protéines cibles originales. Ces travaux préparent la fabrication et la commercialisation par la société Whidiag d'une nouvelle génération de TDRs pour le paludisme. / Malaria is a public health problem in many countries. Five species infect humans: P. falciparum, responsible for the vast majority of deaths, and P. vivax, P. ovale, P. malariae and P. knowlesi causing mild forms of the disease. The diagnostic is a means of control and a medical emergency. The rapid diagnostic tests (RDT) whose are recommended by WHO, are increasingly used. However, the detection and identification of not P. falciparum species is insufficient. New "antigen-antibody" couples are a need to improve the RDTs performance. In this work, new anti LDH antibodies from P. malariae were produced. A search for new antigens was also undertaken. For this purpose, some enzyme of glycolysis pathway were studied. For the first time the sequences of the enzymes from this pathway were obtained for P. ovale and P. malariae. We identified many potential target epitopes specific and common to all those species. In a second step, a proteomics approches has been conducted to identify parasites biomarkers. The study of red blood cells and plasma of infected patients has led to the selection of 8 original target proteins. This work prepares the manufacturing and marketing of a new generation of RDTs for malaria by the company Whidiag

Cardiac energy metabolism is the one of the most complex system in the body. To sustain life, but also to respond quickly to any sudden changes (e.g. running, emotional stress), the heart has developed a unique ability and has become a metabolic "omnivore". At physiological conditions, long chain fatty acids (LCFAs) present the major energetic source for the adult myocardium. However, the cardiac energy metabolism may be compromised during pathophysiological states. One of the most dangerous is, undoubtedly, ischaemia-reperfusion injury with its acute form, myocardial infarction. However, the adaptation to chronic hypoxia has been known for decades for its cardioprotective effect against I/R. Changes of cardiac energy metabolism induced by the adaptation have not been fully explored and the system conceals still too many secrets. This thesis has aimed to determine how adaptation to chronic hypoxia affects the cardiac metabolism of the rat LVs in the following set-ups: 1. The effect of chronic normobaric hypoxia (CNH; 3 weeks, 5500m) during a brief I/R protocol in vitro on the protein kinase B/hexokinase (Akt/HK) pathway, including the expression and phosphorylation of Akt, the expression and localization of HK, the expression of mitochondrial creatine kinase (mtCKS), and the level of Bcl-2 family...

Chronic hypoxia is a state of oxygen limitation that is common in many aquatic and terrestrial environments. Metabolic suppression is an essential strategy that is used by hypoxia-tolerant champions such as goldfish and naked mole-rats to cope with prolonged low oxygen. This thesis examines the physiological processes used by goldfish and naked mole-rats to survive in low oxygen environments. It proposes a novel mechanism - the remodeling of membrane lipids - to reduce ATP use and production. Temperature (homeoviscous adaptation), diet (natural doping in migrant birds) and body mass (membrane pacemaker of metabolism) have an impact on the lipid composition of membranes that, in turn, modulates metabolism. In chapters 2 and 3 of this thesis, I demonstrate that vertebrate champions of hypoxia tolerance undergo extensive changes in membrane lipid composition upon in vivo exposure to low oxygen. These changes and those observed in hibernating mammals can promote the downregulation of Na⁺/K⁺-ATPase (major ATP consumers), mitochondrial respiration capacity [OXPHOS (phosphorylating conditions), proton leak (non-phosphorylating conditions), cytochrome c oxidase], and energy metabolism (β-oxidation and glycolysis) as discussed in chapters 3 and 4. A common membrane signal regulating the joint inhibition of ion pumps and channels could be an exquisite way to preserve the balance between ATP supply and demand in hypometabolic states. In chapter 5, I show that the reduction in ATP turnover is also orchestrated by mechanisms that involve post-translational and post-transcriptional modifications and epigenetic changes. Membrane remodeling, together with these more traditional molecular mechanisms, could work in concert to cause metabolic suppression.