Membrane Bound O-Acyltransferase 7 (MBOAT7) Shapes Lysosomal Lipid Homeostasis and Function to Control Alcohol-Associated Liver Injury

Reviewer #1 (Public Review):

Summary:
The authors provide mechanistic insights into how the loss of function of MBOAT7 promotes alcohol-associated liver disease. They showed that hepatocyte-specific genetic deletion of Mboat7 enhances ethanol-induced hepatic steatosis and increased ALT levels in a murine model of ethanol-induced liver disease. Through lipidomic profiling, they showed that mice with Mboat7 deletion demonstrated augmented ethanol-induced endosomal and lysosomal lipids, together with impaired transcription factor EB (TFEB)-mediated lysosomal biogenesis and accumulation of
autophagosomes.

Strengths:
-Alcohol-induced liver disease (ALD) and metabolic-associated steatotic liver disease (MASLD) are major global health problems, and polymorphism near the gene encoding MBOAT7 has been associated with these conditions. This paper is timely as it is important to gain insights on how loss of MBOAT function contributes to liver disease as this may eventually lead to therapeutic strategies.
-The conclusions of the paper are mostly well supported by data.

Weaknesses:

1. In regards to circulating levels of MBOAT7 products, a comparison of heavy drinkers with ALD versus heavy drinkers without ALD would be more clinically relevant.
2. A few typos need to be addressed. For Figure 1 - figure supplement 1, should the second column heading be "Heavy drinkers" instead of "Healthy drinkers"? Also, in the same figure, it is unclear what the "healthy" subcategory under MELD means.
3. Some of the data in the tables need to be addressed/discussed. For instance, the white blood cell count (WBC) in Figure 1 - figure supplement 1 for "healthy controls" is 34, compared to 13.51 for drinkers. A WBC of 34 is not at all healthy and should be explained. The vast difference between BMI and also between racial distribution within the two cohorts should also be explained. Is it possible that some of these differences contributed to the different levels of circulating MBOAT7 products that were measured?
4. The representation of the statistical difference between the bars in the results figures by using alphabets is a bit confusing. For instance, in figure 2C, does that mean all the bars labelled A are significantly different from B? The solid black bar seems to be very similar to the open red bar; please double check.

Reviewer #2 (Public Review):

Summary:
The work by Varadharajan et. al. explored a previously known genetic variant and its pathophysiology in the development of alcohol-associated liver injury. It provides a plausible mechanism for how varying levels of MBOAT7 could impact the lipid metabolomics of the cell, leading to a deleterious phenotype in MBOAT7 knockout. The authors further characterized the impact of the lipidomic changes and raised lysosomal biogenesis and autophagic flux as mechanisms of how MBOAT7 deletion causes the progression of ALD.

Strengths:
Connecting the GWAS data on MBOAT7 variants with plausible pathophysiology greatly enhances the translational relevance of these findings. The global lipidomic profiling of ALD mice is also very informative and may lead to other discoveries related to lipid handling pathways.

Weaknesses:
The rationale of why MBOAT7 metabolites are lower in heavy drinkers than in normal individuals is not well explained. MBOAT7 loss of function drives ALD, but unclear if MBOAT7 deletion also drives preference for alcohol or if alcohol inhibits MBOAT7 function. Presuming most individuals studied here were WT and expressed an appropriate level of MBOAT7?
Also, the discussion of mechanisms of MBOAT7-induced dysregulation of lysosomal biogenesis/autophagy, while very interesting, seems incomplete. It is not clear how MBOAT7 an enzyme involved in membrane phospholipid remodeling increases mTOR which leads to decreased TFEB target gene transcription. Furthermore, given the significant disturbances of global lipidomic profiling in MBOAT7 knockout, many pathways are potentially affected by this deletion. Further in vivo modeling that specifically addresses these pathways (TFEB targeting, mTOR inhibitor) would help strengthen the conclusions of this paper.