Hepatic ketogenic insufficiency reprograms hepatic glycogen metabolism and the lipidome

While several molecular targets are under consideration, mechanistic underpinnings of the transition from uncomplicated nonalcoholic fatty liver disease (NAFLD) to nonalcoholic steatohepatitis (NASH) remain unresolved. Here we apply multiscale chemical profiling technologies to mouse models of deranged hepatic ketogenesis to uncover potential NAFLD driver signatures. Use of stable-isotope tracers, quantitatively tracked by nuclear magnetic resonance (NMR) spectroscopy, supported previous observations that livers of wild-type mice maintained long term on a high-fat diet (HFD) exhibit a marked increase in hepatic energy charge. Fed-state ketogenesis rates increased nearly 3-fold in livers of HFD-fed mice, a greater proportionate increase than that observed for tricarboxylic acid (TCA) cycle flux, but both of these contributors to overall hepatic energy homeostasis fueled markedly increased hepatic glucose production (HGP). Thus, to selectively determine the role of the ketogenic conduit on HGP and oxidative hepatic fluxes, we studied a ketogenesis-insufficient mouse model generated by knockdown of the mitochondrial isoform of 3-hydroxymethylglutaryl-CoA synthase (HMGCS2). In response to ketogenic insufficiency, TCA cycle flux in the fed state doubled and HGP increased more than 60%, sourced by a 3-fold increase in glycogenolysis. Finally, high-resolution untargeted metabolomics and shotgun lipidomics performed using ketogenesis-insufficient livers in the fed state revealed accumulation of bis(monoacylglycero)phosphates, which also accumulated in livers of other models commonly used to study NAFLD. In summary, natural and interventional variations in ketogenesis in the fed state strongly influence hepatic energy homeostasis, glucose metabolism, and the lipidome. Importantly, HGP remains tightly linked to overall hepatic energy charge, which includes both terminal fat oxidation through the TCA cycle and partial oxidation via ketogenesis

Ketogenesis prevents diet-induced fatty liver injury and hyperglycemia

Nonalcoholic fatty liver disease (NAFLD) spectrum disorders affect approximately 1 billion individuals worldwide. However, the drivers of progressive steatohepatitis remain incompletely defined. Ketogenesis can dispose of much of the fat that enters the liver, and dysfunction in this pathway could promote the development of NAFLD. Here, we evaluated mice lacking mitochondrial 3-hydroxymethylglutaryl CoA synthase (HMGCS2) to determine the role of ketogenesis in preventing diet-induced steatohepatitis. Antisense oligonucleotide–induced loss of HMGCS2 in chow-fed adult mice caused mild hyperglycemia, increased hepatic gluconeogenesis from pyruvate, and augmented production of hundreds of hepatic metabolites, a suite of which indicated activation of the de novo lipogenesis pathway. High-fat diet feeding of mice with insufficient ketogenesis resulted in extensive hepatocyte injury and inflammation, decreased glycemia, deranged hepatic TCA cycle intermediate concentrations, and impaired hepatic gluconeogenesis due to sequestration of free coenzyme A (CoASH). Supplementation of the CoASH precursors pantothenic acid and cysteine normalized TCA intermediates and gluconeogenesis in the livers of ketogenesis-insufficient animals. Together, these findings indicate that ketogenesis is a critical regulator of hepatic acyl-CoA metabolism, glucose metabolism, and TCA cycle function in the absorptive state and suggest that ketogenesis may modulate fatty liver disease

Hepatic Ketogenesis as a Novel Regulator of Liver Metabolism and Injury

Ketone body metabolism plays the fundamental metabolic role of generating alternative fuel sources, in the form of circulating ketone bodies, derived from breakdown of fatty acids, traditionally during states of carbohydrate depletion. Ketone bodies are produced in the mitochondria of the liver via ketogenesis, a process driven by activity of the fate-committing ketogenic enzyme, mitochondrial 3-hydroxymethylglutaryl-CoA synthase (HMGCS2). Nonalcoholic fatty liver disease (NAFLD) spectrum disorders affect nearly one billion individuals worldwide and approximately 30% of all adults in the United States. NAFLD is defined by pathological lipid accumulation in the liver, is strongly correlated with obesity and the metabolic syndrome, and can progress to the more severe non-alcoholic steatohepatitis (NASH) if left untreated. Despite this, the mechanisms driving hepatic steatosis and steatohepatitis are still unknown, and few therapies exist to address this spectrum of liver disorders. In particular, the role of mitochondrial metabolism, the central organelle in fatty acid oxidation, remains incompletely defined. Ketogenesis is positioned at a pivotal juncture in the hepatic mitochondria, amongst the tricarboxylic acid (TCA) cycle, gluconeogenesis, and fatty acid oxidation. In this dissertation, I utilize novel mouse models, mass spectrometry and nuclear magnetic resonance imaging of 13C-labeled substrate flux in vivo, and measures of mitochondrial morphology and function among other biochemical and systems physiology techniques to demonstrate a critical role for hepatic ketogenesis in regulating mitochondrial metabolism and liver injury in the context of the neonatal period, during feeding and fasting in adulthood, and in overnutrition. Using a novel murine model of HMGCS2-deficiency, I show that ketogenesis insufficient, fasting, adult mice are markedly steatotic with concomitant hyperglycemia. However, upon high-fat diet feeding, an inability to generate ketone bodies from fatty acids instead results in severe liver inflammation and injury, which is associated with a redirection of acetyl-CoA flux towards de novo lipogenesis (DNL) and sequestration of free coenzyme A, further disrupting mitochondrial metabolic pathways. I further demonstrate that this metabolic reprogramming in the ketogenesis insufficient context provokes shifts in the hepatic phospholipidome, as well as mitochondrial morphology and function. These studies implicate a significant role for hepatic ketogenesis in regulating complex metabolic pathways in the liver in a classically non-ketogenic, carbohydrate replete state, and establish it as a compelling target to better understand and address the metabolic dysfunction seen in the livers of obese and diabetic individuals

Molecular epidemiology of quinolon resistant strains of extended spectrum beta-lactamase producing Escherichia coli

Objective: To determine the clonal relationship of ESBL-producing and quinolone resistant E. coil strains and to investigate the risk factors for infections with these microorganisms

Determination of Glutathione Disulfide Levels in Biological Samples Using Thiol-disulfide Exchanging Agent, Dithiothreitol

A reverse-phase HPLC method incorporating dithiothreitol (DTT) reduction for quantitative determination of oxidized glutathione (GSSG) in biological samples is described here. This method is based on our previous enzymatic reduction technique that uses N-1-(pyrenyl) maleimide (NPM) as a derivatizing agent. In our earlier method, glutathione disulfide (GSSG) was measured by first reducing it to GSH with glutathione reductase (GR) in the presence of NADPH. However, this is a very costly and time-consuming technique. The method described here employs a common and inexpensive thiol-disulfide exchanging agent, DTT, for reduction of GSSG to GSH, followed by derivatization with NPM. The calibration curves are linear over a concentration range of 25-1250 nm (r2 \u3e 0.995). The coefficients of variations for intra-run precision and inter-run precision range from 0.49 to 5.10% with an accuracy range of 1.78-6.15%. The percentage of relative recovery ranges from 97.3 to 103.2%. This new method provides a simple, efficient, and cost-effective way of determining glutathione disulfide levels with a 2.5 nm limit of detection per 5 µL injection volume

Genotyping of Nosocomial Methicillin-Resistant Staphylococcus aureus Strains Isolated from Clinical Specimens by rep-PCR

Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with increased cost, mortality and length of hospital stay compared with the other infections. Therefore, controlling the spread of this pathogen by screening patients, personnel and the environment remains as a high priority in infection control programs. The aim of this study was to detect the clonal relationship between nosocomial MRSA strains by using repetitive-sequence-based polymerase chain reaction (rep-PCR) method which has several advantages owing to its speed and ease of use. A total of 100 MRSA stock strains that had been isolated from various clinical samples of hospitalized patients in Erciyes University Medical Faculty Hospitals between September 2008-October 2009, were included in the study. Methicillin resistance of the strains were determined by cefoxitin disc diffusion test according to CLSI guidelines. Rep-PCR (Diversilab, bioMerieux, France) method was performed in the following four steps in order to determine genetic proximity of MRSA strains: (1) Manual DNA extraction (UltraClean Microbial DNA Isolation Kit; MoBio Laboratories, USA), (2) Rep-PCR by using fingerprinting kits in the thermocycler (Diversilab DNA Fingerprinting Kit), (3) Automated microfluidic electrophoresis by bioanalyzer (Diversilab DNA LabChip kit), (4) Analysis and rapid evaluation with the use of web-based DiversiLab software (version 2.1.66). Rep-PCR analysis have shown the presence of a total 11 clones, including 3 major clones [A (4 subtypes), B (2 subtypes) and C (2 subtypes)] and 8 unique clones (D-K). Clone A was found to be the dominant type. Seventy-eight percent of the 100 MRSA isolates belonged to clone A (63 were A1; 9 were A2; 4 were A3, 2 were A4), 11% belonged to clone B (10 were B1, 1 was B2), 3% belonged to clone C (2 were C1, 1 was C2), and one of each belonged to the other clones (D, E, F, G, H, I, J, K). Clone A was isolated from 93.3% (14/15) of the samples sent from internal diseases intensive care unit (ICU), from 66.6% (10/15) of the samples sent from infectious diseases ward and 91% (10/11) of hematology-oncology ward samples. All MRSA strains isolated from anesthesiology and newborn ICU were of clone A. The isolation dates of these strains were in proximity. In conclusion, MRSA strains showed clonal dissemination in our hospital, clone A being the predominant one during the study period. Rep-PCR which is a rapid and reliable method, can easily be applied for molecular epidemiological purposes and aid to infection control measures

Is rapid antibacterial susceptibility testing medium reliable for routine laboratory practices?

Objective: Early detection of antibiotic susceptibility profile of the isolates has critical importance in terms of immediate beginning of the appropriate treatment and increasing of treatment success, such as meningitis, bacteriemia and sepsis. In the present study, it was aimed to compare the antibiotic susceptibility results of Quicolor (Salubris Inc., Massachusetts, USA) and standard disk diffusion method

Investigation of Carbapenemases in Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae Strains Isolated in 2014 in Turkey

Carbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.Wo