Role of heme arginate in modulation of inflammation and type 2 diabetes
Choudhary, Abhijeet Kumar
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Heme oxygenase (HO) is an enzyme that facilitates the oxidative breakdown of free heme into equi-molar concentrations of carbon monoxide (CO), the bile pigment biliverdin IX and free iron. These products have immuno-modulatory and antioxidative properties, which may be useful in the treatment of diseases characterised by low-grade inflammation and oxidative stress, such as insulin resistance and hyperglycaemia in type 2 diabetes. In fact, HO-1 protein levels and carbon monoxide generation are down-regulated in murine models of obesity and type 2 diabetes. Two independent research teams have reported that pharmacological induction of HO activity by protoporphyrin-based compounds, such as hemin and cobalt (III) protoporphyrin IX chloride (CoPP), exerts anti-diabetic effects, including protection from weight gain, systemic inflammation and peripheral insulin resistance, in various experimental models of type 2 diabetes. However, the relative insolubility and instability of hemin in solution and the multiple side-effects of CoPP, including weight loss, preclude their use for the treatment of patients in clinic. Heme arginate (HA) is a stable and soluble composition of hemin and L-arginine (LA) in a solution containing propylene glycol, ethanol and water. Furthermore, HA is licensed for the treatment of acute porphyria in several European countries. Therefore, HA may potentially be used in clinical trials. The current PhD thesis tests the hypothesis that the heme component of HA ameliorates hyperglycaemia via induction of HO activity in the leptin receptor deficient db/db (db/db) mouse model of type 2 diabetes. A preliminary in vivo study demonstrates that the heme but not the LA component of HA exerts an anti-hyperglycaemic effect in db/db mice. In a separate in vivo study, concomitant treatment of HA with stannous (IV) mesoporphyrin IX dichloride (SM), an inhibitor of HO activity, further improves the glycaemic control despite complete abrogation of the HA-mediated increase in HO activity in db/db mice. This result is in contrast to the above stated hypothesis, and demonstrates that the antihyperglycaemic effect of HA is due to a HO activity independent mechanism. Furthermore, the ameliorative effect of HA and HA+SM treatment on hyperglycaemia in db/db mice coincides with a gain in body and visceral fat weight, a reduction in islet β-cell inflammation and the preservation of islet β-cell function. Subsequent in vitro experiments demonstrate that HA exerts anti-inflammatory effects by a HO activity independent mechanism in pro-inflammatory in vitro models such as in cytokine mix-stimulated MIN6 β-cells and in classically activated bone marrow derived macrophages (BMDMs). In conclusion, the current thesis demonstrates the novel finding that the heme component of HA can exert anti-inflammatory and anti-diabetic effects via a HO activity independent mechanism. Future work should focus on studies to test the hypothesis that the interaction of heme with the nuclear receptor Rev-erb-α is responsible for the anti-inflammatory and anti-diabetic effects of HA.