Scientists at the Joslin Diabetes Center say they have developed a proof of concept for a novel cell-based therapy against obesity. The potential therapy for obesity would transplant HUMBLE (human brown-like) fat cells, human white fat cells that have been genetically modified to become similar to heat-generating brown fat cells, said Yu-Hua Tseng, PhD, a senior investigator in Joslin’s Section on Integrative Physiology and Metabolism.

Brown fat cells burn energy instead of storing energy as white fat cells do, noted Tseng, senior author on the paper, “CRISPR-engineered human brown-like adipocytes prevent diet-induced obesity and ameliorate metabolic syndrome in mice,” that was recently published in Science Translational Medicine. In the process, brown fat can lower excessive levels of glucose and lipids in the blood that are linked to metabolic diseases such as diabetes.

However, people who are overweight or obese tend to have less of this beneficial brown fat—a barrier that HUMBLE cells are designed to overcome, according to Tseng.

She and her colleagues created the cells from human white fat cells in a progenitor stage. The investigators used a variant of the CRISPR-Cas9 genome editing system to boost expression of a gene called UCP1, which triggers white fat cell progenitors to develop into brown fat-like cells.

Transplanted into mice lacking an immune system, the HUMBLE progenitor cells developed into cells that functioned very much like the mice’s own brown fat cells, continued Tseng, who is also a professor of medicine at Harvard Medical School.

Her team compared transplants of these cells versus the original white fat cells in mice who were put on a high fat diet. Mice given the HUMBLE transplants displayed much greater sensitivity to insulin and ability to clear glucose from the blood (two key factors that are impaired in type 2 diabetes).

Additionally, the mice receiving HUMBLE transplants put on less weight than mice with transplanted white fat cells, remaining in the same range as animals who received brown fat cells.

Perhaps surprisingly, the Joslin scientists demonstrated that these benefits were mostly due to signals from the transplanted cells to endogenous brown fat cells in the mice.

“Brown and brown-like beige/brite adipocytes dissipate energy and have been proposed as therapeutic targets to combat metabolic disorders. However, the therapeutic effects of cell-based therapy in humans remain unclear. Here, we created human brown-like (HUMBLE) cells by engineering human white preadipocytes using CRISPR-Cas9–SAM–gRNA to activate endogenous uncoupling protein 1 expression. Obese mice that received HUMBLE cell transplants showed a sustained improvement in glucose tolerance and insulin sensitivity, as well as increased energy expenditure,” the investigators wrote.

“Mechanistically, increased arginine/nitric oxide (NO) metabolism in HUMBLE adipocytes promoted the production of NO that was carried by S-nitrosothiols and nitrite in red blood cells to activate endogenous brown fat and improved glucose homeostasis in recipient animals. Together, these data demonstrate the utility of using CRISPR-Cas9 technology to engineer human white adipocytes to display brown fat-like phenotypes and may open up cell-based therapeutic opportunities to combat obesity and diabetes.”

“Cells in different tissues communicate with each other,” Tseng explained. “In this case, we found that our transplanted HUMBLE cells secrete a molecule called nitric oxide, which is carried by red blood cells to the endogenous brown cells and activates those cells.”

Microscopic images of the various types of fat tissues
Microscopic images of the various types of fat tissues developed in mice after transplantation. Top panels show the fat tissue’s general morphology, and the bottom panels are the tissue sections stained with hUCP1 (red color), which is unique for brown fat cells. These images show that while the HUMBLE fat cells are morphologically similar to the white fat cells, they express the brown fat specific hUCP1 protein. [Joslin Diabetes Center]

If the HUMBLE technique continues to prove out in preclinical research, it might eventually be possible to generate this type of cell for individual patients, Tseng suggested. Such a procedure would remove a tiny amount of a patient’s white fat cells, isolate the progenitor cells, modify those cells to boost expression of UCP1, and then return the resulting HUMBLE cells to the patient.

However, that individualized approach would be complicated and expensive, so the Tseng lab is pursuing two alternative routes that may be more practical for clinical use.

One is to use cells that are not personalized but instead are encapsulated via biomaterials that protect the cells from rejection by a patient’s immune system. (Joslin researchers and their collaborators have long studied such materials for cell transplants for type 1 diabetes.) The other option is gene therapies that directly express the UCP1 gene in white fat progenitor cells in the body, so that those cells acquire HUMBLE-like properties.

Tseng emphasized that this research is moving ahead despite the Covid-19 pandemic, which puts people with diabetes at much higher risk of serious outcomes if they are infected.

“Employing cell-based or gene therapies to treat obesity or type 2 diabetes used to be science fiction,” she said. “Now scientific advances, such as CRISPR gene-editing technologies, will help us to improve the metabolism, the body weight, the quality of life, and the overall health of people with obesity and diabetes.”

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