Tadalafil ameliorates metabolic syndrome induced alterations in visceral adipose tissue: an experimental study in the rabbit Mario Maggi Sexual

Transcription

1 Tadalafil ameliorates metabolic syndrome induced alterations in visceral adipose tissue: an experimental study in the rabbit Mario Maggi Sexual Medicine and Andrology Unit Dept. Experimental and Clinical Biomedical Sciences University of Florence Italy

2 Sexual Medicine & Andrology Unit Dept. «Mario Serio» University of Florence Linda Vignozzi Anatomy and Histology Units Department of Experimental and Clinical Medicine Prof.Daniele Bani Prof. Barbara Vannelli Dr. Annamaria Morelli, Dr. Erica Sarchielli Ilaria Cellai Paolo Comeglio Francesca Corcetto Chiara Cornio Sandra Filippi Elena Maneschi Gastroenterology Unit Department «Mario Serio» Dr. Tommaso Mello Prof. Andrea Galli

3 High triglycerides Low HDL cholesterol Hypertension Hyperglycemia Visceral obesity Metabolic syndrome (MetS)

4 BAT dissipates energy in the form of heat, by metabolizing fatty acids

5 Inhibition of PDE5 RhoA/ROCK

6 Aim of the Study: to investigate the effect of a PDE5 inhibitor, Tadalafil, on metabolic features in a rabbit model of MetS MetS Hyperglycaemia Reduced glucose tolerance (OGTT) Hypercholesterolemia Hypertriglyceridemia Hypertension Increased visceral fat mass Dysfunctional VAT NASH 0 Standard diet: control High fat diet: HFD 0.5% cholesterol and 4% peanuts oil weeks Hypogonadotropic hypogonadism o testosterone level ( FSH and LH level) o prostate, seminal vesicles weight Filippi S et al., J Sex Med 2009, 6(12): Vignozzi et al., Mol cell Endocrinol ;384: Vignozzi L et al., J Sex Med Jan;8(1):57-77 Vignozzi et al.,.j of Endocrinol 2012 Jan;212(1):71-84 Morelli et al., Prostate Sep 19. Morelli et al., J Steroid Biochem Mol Biol ;132:80. Maneschi et al., J Endocrinol Dec;215(3):

7 Rabbit model of Metabolic Syndrome MetS Hyperglycaemia Reduced glucose tolerance (OGTT) Hypercholesterolemia Hypertriglyceridemia Hypertension Increased visceral fat mass Dysfunctional VAT NASH 0 Standard diet: control High fat diet: HFD weeks 0.5% cholesterol and 4% peanuts oil Tadalafil (2mg/kg/day) Hypogonadotropic hypogonadism o testosterone level ( FSH and LH level) o prostate, seminal vesicles weight High fat diet + acute Tadalafil: HFD + 1 week Tad Vignozzi et al., Mol cell Endocrinol ;384: Vignozzi et al.,.j of Endocrinol 2012 Jan;212(1):71-84 Morelli et al., Prostate Sep 19. Morelli et al., J Steroid Biochem Mol Biol ;132:80. Maneschi et al., J Endocrinol Dec;215(3): Vignozzi L et al., J Sex Med Jan;8(1):57-77 Filippi S et al., J Sex Med 2009, 6(12):

8 Tadalafil significantly reduced HFD induced increase in triglycerides P< P=0.02 MetS Triglycerides (mg/dl) Hyperglycaemia Reduced glucose tolerance (OGTT) Hypercholesterolemia Hypertriglyceridemia Hypertension Increased visceral fat mass Dysfunctional VAT NASH RD HFD HFD+Tad1week Morelli et al., 2013, Prostate. 73(4): Vignozzi et al., unpublished 2014

9 Tadalafil significantly reduced HFD induced increase in VAT weigth P=0.004 P=0.011 MetS VAT (% of body weight) Hyperglycaemia Reduced glucose tolerance (OGTT) Hypercholesterolemia Hypertriglyceridemia Hypertension Increased visceral fat mass Dysfunctional VAT NASH RD HFD HFD+Tad1week Morelli et al., 2013, Prostate. 73(4): Vignozzi et al., unpublished 2014

10 VAT expresses high level of both PDE5 and PDE11 Vignozzi et al., unpublished 2014

11 HFD induced adipocyte hypertrophy and hypoxia were reduced by Tadalafil d. Adipocytediameter (μm) Control RD HFD HFD+Tadalafil h. Hypoxyprobepositivity (% of control) Control RD HFD HFD+Tadalafil HFD+tadalafil Maneschi et al. J of Endocrinol , 1-17 Maneschi et al., J of Endocrinol 218(2): Vignozzi et al., unpublished 2014

12 HFD induced reduction of GLUT4 translocation to plasma membrane was normalized by Tadalafil 120,00 mglut4/cglut4 % 100,00 80,00 60,00 40,00 20,00 0,00 Control RD HFD Diet HFD+Tadalafil Diet+Tad A mglut4 cglut4 STAT1 P<0.01 vs. all the other groups Maneschi et al. J of Endocrinol , 1-17 Maneschi et al., J of Endocrinol 218(2): Vignozzi et al., unpublished 2014

13 UCP1 immunolocalization in rabbit VAT 10x

14 Isolation of rpads from visceral fat RD rpad RD HFD rpad HFD HFD+TAD rpad HFD+TAD Maneschi et al., J Endocrinol Jul 6;218(2): Maneschi et al., J Endocrinol Dec;215(3):

15 Isolation of rpads from visceral fat RD NT DMEM with 4,5 g/l Glucose, P/S, L Glutamine FETAL BOVINE SERUM 5% rpad RD 10 days RD NT10 HFD rpad HFD 10 days HFD NT10 HFD+TAD rpad HFD+TAD 10 days HFD+Tad NT10 Vignozzi et al., unpublished 2014

16 Pre-adipocytes expresses very high level of PDE5 (similar to smooth muscle of corpora cavernosa) Vignozzi et al., unpublished 2014

17 A. RD B. HFD C. HFD+tadalafil D. E.

18 TFAM NRF1 CS SLC25A12 NDUFB5 NDUFB3 NDUFS1 SDHB GCb1 GCa1 PKG1 ROCK2 ROCK1 RhoA HOXC9 RB1 PPARγ PPARϒC 1β PPARϒC 1α BMP4 CD137 TMEM26 UCP1 CIDEA Mitochondrial biogenesis GC/PKG pathway White adipocyte markers p<0,0001, p<0,001, p<0,01, p<0,05 vs HFD mrna expression in HFD+Tadalafil (% of HFD) Brown/Brite adipocyte markers

19 Mitochondrial network morphology and dynamics by using a mitochondria specific probe (MitoTracker) RD HFD HFD+TADALAFIL

20 Mitochondrial ultrastructure by using TEM a. RD b. HFD c. HFD+ tadalafil d. Total Mitochondrial cristae surface/ outer membrane surface p< p< RD HFD HFD+Tadalafil

21 Superoxide production by using dihydroethidium (DHE) a. RD b. HFD c. HFD+tadalafil d.

22 In vitro treatment with tadalafil 100 nm in rpads from HFD rabbits Untreated 10 days HFD +Tadalafil rpad HFD +Tadalafil +KT5823 +KT5823 BAY : a selective sgc activator Tadalafil (inhibits cgmp degradation) +8Br cgmp +BAY KT5823: a selective inhibitor of PKG - 8Br cgmp: a PDE-resistant cgmp analog

23 In vitro treatment with tadalafil 100 nm in rpads from HFD rabbits a. RD b. HFD c. HFD+ tadalafil d. e. f rpad RD rpad HFD rpad HFD + tadalafil 3 H-glucose uptake (%) Insulin (M) Mean number of lipid droplets in rpad Mean volume (μm 3 ) of lipid droplets in rpad

24 Figure 10 a. RD rpad c. b. Untreated HFD rpad d. P< Mitochondrial lenght (µm) P< RD rpad HFD rpad +100nM tadalafil Untreated 100nMtadalafil HFD rpad

25 a. b. c. d. e. f. 140 Total mithoncondrialcristae surface / outer membrane surface P< P< P<0.05 P< Untreated RD RD rpad Untreated HFD +100nM Tadalafil tadalafil + KT KT nM KT+Tadalafil tadalafil+kt5823 HFD rpad

26 In vitro treatment with tadalafil 100 nm in rpads from HFD rabbits Tadalafil stimulates Brown-like phenotype mrna/18s UCP1 # TMEM26 # 0 0 control Tadalafil KT5823 Tadlf+KT 8BrcGMP BR5381 Untreated tadalafil KT 5823 tadalafil+kt Br-cGMP BAY HFD rpad control Untreated Tadalafil tadalafil KT KT5823 tadalafil+kt5823 Tadlf+KT 8-Br-cGMP 8BrcGMP BAY BR HFD rpad CD CIDEA mrna/18s # # Untreated tadalafil tadalafil+kt Br-cGMP BAY NT10 Tadalafil KT5823 Tadlf+KT 8BrcGMP BR5381 HFD rpad 0 control Tadalafil KT5823 Tadlf+KT 8BrcGMP BAY Untreated tadalafil KT 5823 tadalafil+kt Br-cGMP BAY

27 Antonio Aversa Davide Francomano Andrea Lenzi Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Viale Regina Elena 324, Rome, Italy Open label, single-arm, uncontrolled, single center, clinical trial, on 10 male patients aged 18 years, referring to an outpatient facility for the treatment of sexual dysfunction. Primary objective: to determine the potential effects of chronic tadalafil administration (2.5 mg/daily) on body composition in male subjects with erectile dysfunction. The primary outcomes was the variation of abdominal fat mass, measured with a whole body dual-energy X-ray absorptiometry (DXA- HOLOGIC QDR-1000), Further outcomes included body mass index (BMI) and other measures of fat distribution (waist circumference) and body composition (total fat mass with DXA)

28 Antonio Aversa Davide Francomano Andrea Lenzi Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Viale Regina Elena 324, Rome, Italy All patients were treated with tadalafil 2.5mg daily, in the early morning, for 8 weeks; the treatment was then stopped, and further follow-up evaluation was performed at week weeks 16 weeks Tadalafil 2.5mg daily Stop treatment Washout

29 Antonio Aversa Davide Francomano Andrea Lenzi Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, Viale Regina Elena 324, Rome, Italy Open label, single-arm, uncontrolled, single center, clinical trial, on 10 male patients aged 18 years, referring to our outpatient facility for the treatment of sexual dysfunction.

30 a. b Fat (kg) Lean (kg) Total mass (kg) c. p<0.01 Baseline vs 8 weeks 8 weeks vs 16 weeks

31 conclusions: in an animal model of MetS (diet-induced) and in human subjects, in vivo tadalafil administration is able to decrease visceral adipose tissue (VAT), after short-term exposure (1 and 8 weeks, respectively). in vivo and in vitro studies demonstrated that tadalafil, via PKG activation in VAT, up-regulates browning-specific genes, including UCP1, and counteracts HFD-associated mitochondrial alterations, suggesting VAT browning