Targeting IRE1α improves insulin sensitivity and thermogenesis and suppresses metabolically active adipose tissue macrophages in obesity

Reviewer #1 (Public review):

First, the authors confirm the up-regulation of the main genes involved in the three branches of the Unfolded Protein Response (UPR) system in diet-induced obese mice in AT, observations that have been extensively reported before. Not surprisingly, IRE1a inhibition with STF led to an amelioration of the obesity and insulin resistance of the animals. Moreover, non-alcoholic fatty liver disease was also improved by the treatment. More novel are their results in terms of thermogenesis and energy expenditure, where IRE1a seems to act via activation of brown AT. Finally, mice treated with STF exhibited significantly fewer metabolically active and M1-like macrophages in the AT compared to those under vehicle conditions. Overall, the authors conclude that targeting IRE1a has therapeutical potential for treating obesity and insulin resistance.

The study has some strengths, such as the detailed characterization of the effect of STF in different fat depots and a thorough analysis of macrophage populations. However, the lack of novelty in the findings somewhat limits the study´s impact on the field.

Reviewer #2 (Public review):

The manuscript by Wu et al demonstrated that IRE1a inhibition mitigated insulin resistance and other comorbidities through increased energy expenditure in DIO mice. In this reviewer's opinion, this timely study has high significance in the field of metabolism research for the following reasons.

(1) The authors' findings are significant and may offer a new therapeutic target to treat metabolic diseases, including diabetes, obesity, NAFLD, etc.

(2) The authors carefully profiled the ATMs and examined the changes in gene expression after STF treatment.

(3) The authors presented evidence collected from both systemic indirect calorimetry and individual tissue gene expression to support the notion of increased energy expenditure.

Overall, the authors have presented sufficient background in a clear and logically organized structure, clearly stated the key question to be addressed, used the appropriate methodology, produced significant and innovative main findings, and made a justified conclusion.

Reviewer #3 (Public review):

Summary:

The manuscript by Wu D. et al. explores an innovative approach to immunometabolism and obesity by investigating the potential of targeting macrophage Inositol-requiring enzyme 1α (IRE1α) in cases of overnutrition. Their findings suggest that pharmacological inhibition of IRE1α could influence key aspects such as adipose tissue inflammation, insulin resistance, and thermogenesis. Notable discoveries include the identification of High-Fat Diet (HFD)-induced CD9+ Trem2+ macrophages and the reversal of metabolically active macrophages' activity with IRE1α inhibition using STF. These insights could significantly impact future obesity treatments.

Strengths:

The study's key strengths lie in its identification of specific macrophage subsets and the demonstration that inhibiting IRE1α can reverse the activity of these macrophages. This provides a potential new avenue for developing obesity treatments and contributes valuable knowledge to the field.

Weaknesses:

The research lacks an in-depth exploration of the broader metabolic mechanisms involved in controlling diet-induced obesity (DIO). Addressing this gap would strengthen the understanding of how targeting IRE1α might fit into the larger metabolic landscape.

Impact and Utility:

The findings have the potential to advance the field of obesity treatment by offering a novel target for intervention. However, further research is needed to fully elucidate the metabolic pathways involved and to confirm the long-term efficacy and safety of this approach. The methods and data presented are useful, but additional context and exploration are required for broader application and understanding.

Author response:

Public Reviews:

Reviewer #1 (Public review):

First, the authors confirm the up-regulation of the main genes involved in the three branches of the Unfolded Protein Response (UPR) system in diet-induced obese mice in AT, observations that have been extensively reported before. Not surprisingly, IRE1a inhibition with STF led to an amelioration of the obesity and insulin resistance of the animals. Moreover, non-alcoholic fatty liver disease was also improved by the treatment. More novel are their results in terms of thermogenesis and energy expenditure, where IRE1a seems to act via activation of brown AT. Finally, mice treated with STF exhibited significantly fewer metabolically active and M1-like macrophages in the AT compared to those under vehicle conditions. Overall, the authors conclude that targeting IRE1a has therapeutical potential for treating obesity and insulin resistance.

The study has some strengths, such as the detailed characterization of the effect of STF in different fat depots and a thorough analysis of macrophage populations. However, the lack of novelty in the findings somewhat limits the study´s impact on the field.

We thank the reviewer for the appreciation of our findings and the comments about the novelty. Regarding the novelty, we would emphasize several novelties presented in this manuscript. First, as the reviewer correctly pointed out, we discovered that IRE1 inhibition by STF activates brown AT and promotes thermogenesis and that IRE1 inhibition not only significantly attenuated the newly discovered CD9+ ATMs and the “M1-like” CD11c+ ATMs but also diminished the M2 ATMs for the first time. These discoveries are very important and novel. In obesity, it was originally proposed that ATM undergoes M1/M2 polarization from an anti-inflammatory M2 to a classical pro-inflammatory M1 state. It was further reported that IRE1 deletion improves thermogenesis by boosting M2 population which then synthesize and secrete catecholamines to promote thermogenesis. It is now known that M2 macrophages do not synthesize catecholamines or promote thermogenesis. In this study, we discovered that IRE1 inhibition doesn’t increase (but instead decrease) the M2 population and that IRE1 inhibition promotes thermogenesis likely by suppressing pro-inflammatory macrophage populations including the M1-like ATMs and most importantly the newly identified metabolically active macrophages, given that ATM inflammation has been reported to suppress thermogenesis. Second, this study presented the first characterization of relationship between the more classical M1-like ATMs and the newly discovered metabolically active ATMs, showing that the CD11c+ M1-like ATMs are largely overlapping with but yet non-identical to CD9+ ATMs in the eWAT under HFD. Third, although upregulation of ER stress response genes in the adipose tissues of diet-induced obese mice have been extensively reported, it doesn’t necessarily mean that targeting IRE1a or ER stress can reverse existing insulin resistance and obesity. It is not uncommon that a therapy doesn’t yield the desired effect as expected. For instance, amyloid plaques are a hallmark of Alzheimer's disease (AD), interventions that prevent or reverse beta amyloid deposition have been expected to prevent progression or even reverse cognitive impairment in AD patients. However, clinical trials on such therapies have been disappointing. In essence, experimental demonstration of effectiveness or feasibility for any potential therapeutic targets is a first step for any future clinical implementation.

Reviewer #2 (Public review):

The manuscript by Wu et al demonstrated that IRE1a inhibition mitigated insulin resistance and other comorbidities through increased energy expenditure in DIO mice. In this reviewer's opinion, this timely study has high significance in the field of metabolism research for the following reasons.

(1) The authors' findings are significant and may offer a new therapeutic target to treat metabolic diseases, including diabetes, obesity, NAFLD, etc.

(2) The authors carefully profiled the ATMs and examined the changes in gene expression after STF treatment.

(3) The authors presented evidence collected from both systemic indirect calorimetry and individual tissue gene expression to support the notion of increased energy expenditure.

Overall, the authors have presented sufficient background in a clear and logically organized structure, clearly stated the key question to be addressed, used the appropriate methodology, produced significant and innovative main findings, and made a justified conclusion.

We thank the reviewer for the appreciation of our work.

Reviewer #3 (Public review):

Summary:

The manuscript by Wu D. et al. explores an innovative approach to immunometabolism and obesity by investigating the potential of targeting macrophage Inositol-requiring enzyme 1α (IRE1α) in cases of overnutrition. Their findings suggest that pharmacological inhibition of IRE1α could influence key aspects such as adipose tissue inflammation, insulin resistance, and thermogenesis. Notable discoveries include the identification of High-Fat Diet (HFD)-induced CD9+ Trem2+ macrophages and the reversal of metabolically active macrophages' activity with IRE1α inhibition using STF. These insights could significantly impact future obesity treatments.

Strengths:

The study's key strengths lie in its identification of specific macrophage subsets and the demonstration that inhibiting IRE1α can reverse the activity of these macrophages. This provides a potential new avenue for developing obesity treatments and contributes valuable knowledge to the field.

Weaknesses:

The research lacks an in-depth exploration of the broader metabolic mechanisms involved in controlling diet-induced obesity (DIO). Addressing this gap would strengthen the understanding of how targeting IRE1α might fit into the larger metabolic landscape.

Impact and Utility:

The findings have the potential to advance the field of obesity treatment by offering a novel target for intervention. However, further research is needed to fully elucidate the metabolic pathways involved and to confirm the long-term efficacy and safety of this approach. The methods and data presented are useful, but additional context and exploration are required for broader application and understanding.

We thank the reviewer for the appreciation of strengths in our manuscript. In particular, we appreciate the reviewer’s recommendation on the exploration of broader metabolic landscape, such as the effect of IRE1 inhibition on non-adipose tissue macrophages and metabolism. We agree that achieving these will certainly broaden the therapeutic potential of IRE1 inhibition to larger metabolic disorders and we will pursue these explorations in future studies.