Ubiquitin D as a potential therapeutic target for NASH, HCC and chronic kidney diseases

摘要： 非酒精性脂肪性肝炎(NASH)是非酒精性脂肪性肝病(NAFLD)的一种晚期形式，是 引起肝硬变和肝细胞癌的主要原因。目前还没有批准的治疗方法 NASH和晚期纤维化患者因心血管疾病(CVD)死亡的风险最高。 此外，NAFLD的存在增加了约80%的慢性肾脏疾病(CKD)的风险。它不是 已知NASH和CKD如何相互影响，但它们共同影响CVD和患者死亡率。 因此，可以改善NASH及其相关并发症(如CKD和CVD)的治疗靶点 将在临床上有很大的好处。 我们发现泛素D(UBD)在Nash肝脏(主要是肝细胞)、肝细胞癌中高度上调 CKD小鼠的肿瘤和肾脏。有趣的是，UBD最近被发现是与疾病进展相关的六种疾病之一 这些基因在NAFLD的发展过程中起着至关重要的作用，并与脂肪变性、气球膨胀、 炎症、纤维化和NAS评分。同样，多份报告将肾脏UBD与蛋白尿和肾脏疾病联系起来。 已知UBD参与替代泛素化途径，并与关键细胞蛋白相互作用，如 P53、P62和MAD2，但其在NASH/肝癌和CKD中的确切作用机制尚不清楚。缺席 UBD(在UBD-/-小鼠中)改善了整体代谢健康，延长了小鼠的寿命。尽管有这么多 令人信服的证据是，UBD尚未被测试为NASH和CKD的治疗靶点。在这里，我们建议 目的：应用反义寡核苷酸(ASO)抑制UBD，作为治疗NASH和CKD的一种方法。我们有 已经开发出一种“GalNAc”连接的ASO，它能有效地抑制UBD基因的表达 肝细胞。我们的初步数据表明，抗UBD GalNAc-ASO显著改善NASH和 纤维化症。据我们所知，UBD通路以前没有被研究过其治疗潜力。 也不是目前任何行业或学术界关注的焦点。因此，UBD是一种新的靶点和抗UBD ASOS 提供新的治疗线索，具有改善NASH和CKD的潜力。 我们将利用一种独特的饮食诱导NASH的临床前小鼠模型，该模型也开发出 CKD和CVD与后期死亡率(在本实验室建立)。我们将解决是否反对UBD ASO 可以改善所有这三种疾病的结局以及生存益处。我们将对此模型进行补充 NASH、肝癌和CKD的其他临床前模型。以下两个具体目标将在本报告中阐述 建议：目标1将确定抑制UBD是否可以防止NASH及其进展为肝硬化和 肝细胞癌。此外，我们将使用人类原代细胞来源的3-D球状细胞将我们的发现移植到人类身上 文化。目的2研究抑制UBD对CKD、CVD和生存效益的影响。 NASH和/或CKD的上下文。成功完成拟议的目标将使UBD成为一部小说 NASH和CKD的治疗靶点。

Abstract: Non-alcoholic steatohepatitis (NASH), an advanced form of non-alcoholic fatty liver disease (NAFLD), is one of the major causes of cirrhosis and hepatocellular carcinoma (HCC). There is currently no approved treatment for NASH and patients with advanced fibrosis are at highest risk of mortality due to cardiovascular diseases (CVD). Furthermore, presence of NAFLD increases the risk of chronic kidney disease (CKD) by about 80%. It is not known how NASH and CKD influence each other, but together they can influence CVD and patient mortality. Therefore, a therapeutic target that can improve NASH and its associated co-morbidities such as CKD and CVD will be of great benefit in clinics. We found that Ubiquitin D (UBD) is highly upregulated in NASH livers (primarily in the hepatocytes), HCC tumors and kidneys of CKD mice. Interestingly, UBD was recently found to be one of the six progression-related genes that play a vital role in the progression of NAFLD and positively correlates with steatosis, ballooning, inflammation, fibrosis and NAS score. Similarly, multiple reports link renal UBD to proteinuria and kidney disease. UBD is known to participate in alternative ubiquitination pathway and interact with key cellular proteins such as p53, p62 and MAD2 but the precise mechanism of its role in NASH/HCC and CKD remains unclear. Absence of UBD (in Ubd-/- mice) improved overall metabolic health and extended the mouse lifespan. Despite all the compelling evidences, UBD has not been tested as a therapeutic target for NASH and CKD. Here, we propose to suppress UBD using anti-sense oligos (ASOs) as a therapeutic approach to treat NASH and CKD. We have already developed a “GalNAc” conjugated ASO that is potent in suppressing UBD gene expression in the hepatocytes. Our preliminary data indicates that anti-UBD GalNAc-ASO significantly improved NASH and fibrosis. According to our knowledge, UBD pathway has not been investigated for its therapeutic potential before and also is not a current focus of any industry or academia. Therefore, UBD is a novel target and anti-UBD ASOs provide novel therapeutic leads with a potential to improve both NASH and CKD. We will take advantage of a unique pre-clinical mouse model of diet-induced NASH that also develop CKD and CVD with mortality at later stages (established in our lab). We will address whether anti-UBD ASOs could improve all three disease outcome along with survival benefit. We will supplement this model with additional preclinical models of NASH, HCC and CKD. The following 2 Specific Aims will be addressed in this proposal: Aim 1 will Identify whether UBD suppression prevents NASH and its progression to Cirrhosis and HCC. Additionally, we will translate our findings to human using human primary cell derived 3-D spheroid cell cultures. Aim 2 will investigate the effect of UBD suppression on CKD, CVD and survival benefit either in the context of NASH and/or CKD. Successful completion of the proposed aims will establish UBD as a novel therapeutic target for NASH and CKD.