- Reviewing EditorChristoph BuettnerRutgers Robert Wood Johnson Medical School, United States of America
- Senior EditorPramod MistryYale University, United States of America
Reviewer #1 (Public Review):
The authors investigate the roles of ACOT12/8 in the production of acetate by the liver. They observe that acetate concentration parallels ketone concentrations during fasting and T1DM. They show that acetate is produced from fatty acids in hepatocytes, but though described as a novel "ketone body", this acetate is not a product of ketogenesis or acetoacetate. They also provide serum acetate data from human subjects who were classified as either "healthy" or "diabetic,". These subjects are noted as T2DM patients, but there is no other characterization or description, making it difficult to ascertain the context in which they were studied or their relevance to the mouse studies. Although the function of ACOT12/8 is reported in the literature, they are not widely studied, and there also remains surprising uncertainties regarding the mechanism of acetate production by the liver. In this regard, the manuscript provides some important insight. The authors use ShACOT12/8 and ACOT12/8 knockout mice to demonstrate that these acetyl-CoA hydrolases are largely necessary for acetate production. Using a 3H-palmitate assay, the authors then find that loss of these ACOTs inhibit fatty acid oxidation and propose that the mechanism involves scavenging CoA, analogous to the canonical role of ketogenesis. The idea is plausible but not proven. A related finding is that loss of these ACOTs inhibit ketogenesis, which the authors attribute to the loss of function of HMGC2S, partially through acetylation. These mechanisms suffer some limitations based on the cytosolic and mitochondrial compartmentation of the two processes, but the observations appear sound. Interestingly, the loss of the ACOTs have a more profound effect on lowering ketones than acetate, which may have parallel effects but they are not investigated. Finally, the authors try to demonstrate that hepatic ACOT-mediated acetate production is necessary for normal motor function in STZ treated mice, ostensibly as compensation for impaired glucose utilization by the CNS. Injections of 13C acetate and 13C enrichment in downstream metabolites of brain are used to support the importance of acetate metabolism, but the experiment was not performed in loss of function models. In addition, the resulting 13C enrichment data is reported generically as "relative intensity" without further elaboration on how this data was generated and should not be taken at face value by the reader. Conceptually, one may also be skeptical of the rather dramatic loss of motor function in the context of a relatively minor circulating nutrient. Nevertheless, this finding may be important if more supporting evidence with proper controls for ketone concentrations can be provided. Overall, there are important data in the manuscript, but the reader may find it difficult to navigate the 20+ figure panels. The most important findings are that ACOT12/8 are critical for hepatic acetate production in mice, which will be helpful for the field, but the ramifications require more rigorous investigation.
Reviewer #2 (Public Review):
Catabolic conditions lead to increased formation of ketone bodies in the liver, which under these conditions play an important role in supplying energy to metabolically active organs. In this manuscript, the authors explore the concept of whether and to what extent hepatic formation of acetate might contribute to energy supply under metabolic stress conditions. The authors show that patients with diabetes have increased acetate levels, which is explained as a consequence of the increased fatty acid flux from adipose tissue to the liver. This is confirmed in a preclinical model for type 1 diabetes, where acetate concentrations are in a similar range to ketone bodies. Acetate concentrations also increase under physiological conditions of fasting. Using stable isotopes, the authors show that palmitate is used as the primary source for acetate production in primary hepatocytes. Using cell culture studies and adenoviral-mediated knockdown in mice, it can be shown that the conversion of acetyl-CoA to acetate is catalyzed in peroxisomes by acyl-CoA thioesterase8 (ACOT8) and after transport of citrate from mitochondria and subsequent conversion to acetyl-CoA in the cytosol by ACOT12. Remarkably, ACOT8/12 not only regulates the formation of acetate but plays a crucial role in the maintenance of cellular CoA concentration. Accordingly, depletion of ACOT8/12 activity leads to a reduction of other CoA derivatives such as HMG-CoA, which resulted in the inhibition of ketone body synthesis. In diabetic mice, ACOT 8 or ACOT12 knockdown appears to lead to some limitations in strength and behavior.
In summary, the authors clearly demonstrate that hepatic release-mediated by ACOT8 and ACOT12-determines the plasma concentration of acetate. This is a very remarkable observation since most studies assume that short-chain fatty acids in plasma are primarily generated by fermentation of dietary fiber by intestinal bacteria. The authors demonstrate in very well performed studies the metabolic changes that result from impaired thiolysis. On the other hand, the ACOT12 phenotype has been demonstrated in a recently published study (PMID: 34285335). In this study, ACOT12 deficiency caused NAFLD, thus it would be worth determining whether deficiency of ACOT12 and/or ACOT8 promotes de novo lipogenesis under the conditions of the present study. As a further limitation, it should be noted that the relevance of acetate production for the energy supply of peripheral organs including the central nervous system could not be clearly demonstrated. For instance, impaired ketone body production due to impaired CoA availability could affect the metabolic activity of various organs. Moreover, the human cohort is not very well described, e.g. it is unclear whether the patients have type 1 or type 2 diabetes.
Reviewer #3 (Public Review):
Wang et al. investigated the role of acetate production, a byproduct of fatty acid oxidation, in the context of metabolic stressors, including diabetes mellitus and prolonged fasting. Mechanistically, they show the importance of the liver enzymes ACOT8 (peroxisome) and ACOT12 (cytoplasm) in converting FFA-derived acetyl-CoA into acetate and CoA. The regeneration of CoA allows for subsequent fatty acid oxidation. Inhibiting the generation of acetate has negative motor consequences in streptozocin-treated mice, which are mitigated with acetate injection.
This paper's strengths include using multiple mouse models, metabolic stressors (db/db-/-, streptozocin, and prolonged starvation), numerous cell lines, precise knockout and rescue experiments, and complimentary use of mass spectrometry and nuclear magnetic resonance analytical platforms. The presented data support the conclusions of this paper and highlight the role of acetate in energy stress conditions.
In clinical medicine, common ketones that are measured are acetoacetate, beta-hydroxybutyrate, and acetone which can help determine the severity of illness. However, the data presented here suggest the potential importance of measuring acetate as another biomarker when patients present with ketoacidosis in uncontrolled diabetes or starvation. This requires further investigation.