The pathogenesis of non-alcoholic fatty liver disease (NAFLD) is connected to genetic susceptibility and metabolic dysfunction, and the disease spectrum includes hepatic steatosis, nonalcoholic steatohepatitis, hepatocirrhosis and hepatocarcinogen[1]. The prevalence of NAFLD worldwide was 32.4% with an increasing prevalence over time (25.5% before 2005 and 37.8% after 2016). (25.5% before 2005 and 37.8% after 2016). The prevalence of male (39.7%) was higher than that of female (25.6%)[2]. Common risk factors for NAFLD include diabetes, insulin resistance, obesity, genetic factors, high fat diet, sarcopenia and sedentary lifestyle[3]. Studies have shown that NAFLD is present in 47.3%-63.7% of patients with diabetes and 80% of obese individuals[4]. As a chronic hepatic disease, in NAFLD early stages, it is associated with disorders of energy metabolism, especially lipid metabolism[5]. In normal conditions, lipid uptake and output in the liver are balanced, which is regulated by four major pathways: fatty acid oxidation (FAO), Very low density lipoproteins (VLDL) transport endogenous triglycerides, fatty acid uptake and de novo lipogenesis (DNL). However, in pathological conditions, excess energy entering the liver accumulates as triglycerides in hepatocytes, ultimately causing NAFLD[6]. In NAFLD, hepatic DNL and fatty acid uptake are increased, whereas compensatory enhanced FAO is insufficient to normalize lipid balance and may potentially contribute to cell damage and disease progression through the induction of oxidative stress[7]. To date, intervention-mediated weight loss has been the primary recommended treatment for NAFLD[8]. Hence, the identification of effective therapeutic methods is urgently required.
Uncarboxylated osteocalcin (GluOC) is a non-collagenous acid glycoprotein composed of 46–50 amino acids[9]. It functions as a vitamin K-dependent calcium-binding protein[10]. GluOC is primarily synthesized by osteoblasts and odontoblasts, with additional production by proliferating chondrocytes and it plays a crucial role bone calcium metabolism and regulates glucose and lipid metabolism[11–14]. GluOC has been shown to have an important regulatory effect on lipid metabolism, and in vivo experiments have shown that intermittent oral GluOC can decrease the white adipocytes size of mice[15]. Another animal experiment also demonstrated that GluOC was injected intraperitoneally into mice for 14 weeks, improving insulin sensitivity as well as glucose tolerance, and reversing hepatic steatosis[16]. Previous studies in our laboratory have demonstrated that GluOC effectively suppresses DNL by activating AMPK in OA/PA-induced hepatocytes[17]. Although numerous studies have indicated that GluOC might be a potential drug, current understanding of GluOC in hepatic lipid metabolism remains at an exploratory stage, there is a lack of research on the regulation of GluOC on FAO and the underlying mechanisms of GluOC in alleviating NAFLD still need to be more deeply studied.
The mediation of SIRT1 in lipid metabolism of livers has been demonstrated in recent studies, and SIRT1 expression negatively correlates with developing NAFLD[18, 19]. SIRT1 as NAD-dependent sirtuin-1 or nicotinamide adenine dinucleotide (NAD+) deacetylase, is highly conserved and involved in key processes related to hepatic fatty acid oxidation and synthesis[20, 21]. One study has shown that obese patients with hepatic steatosis had lower serum SIRT1 levels than mild steatosis, in addition to, the steatosis patients in both groups had lower serum SIRT1 levels than lean individuals[18]. The expression of SIRT1 protein exhibited a significant decrease in rats, mice, and in cultures hepatocytes by a high-fat induced diet[22, 23]. Furthermore, knockout of the liver-specific SIRT1 gene in mice resulted in enhanced inflammation, endoplasmic reticulum stress and hepatic steatosis[24], which confirming the important involvement of SIRT1 in improving lipid metabolism of hepatic. However, further studies are essential to resolve whether SIRT1 mediates the mechanism of GluOC-regulated lipid metabolism.
AMP-activated protein kinase (AMPK) participates in numerous metabolic processes in the body, maintains systemic energy balance under various stress conditions and regulating hepatic lipid metabolism[25]. Its phosphorylation at Thr172 is necessary to regulate lipid metabolism[26]. A study has shown that AMPK regulates acetyl-CoA carboxylase (ACC) and fatty acid synthetase (FASN) expression in DNL through sterol regulatory element binding protein-1c (SREBP-1c)[27]. Another study has shown that AMPK can also directly phosphorylate ACC and regulate its activity[28]. Some studies have shown that SIRT1 has benefits for lipid metabolism through reducing fatty acid chain synthesis via SIRT1/AMPK pathway in hepatocytes[20, 22–24, 29]. However, it has not been shown whether the SIRT1/AMPK pathway mediates mechanisms of GluOC-regulated lipid metabolism.
Peroxisome proliferator activated receptor γ coactivator-1 α (PGC-1α) is a direct downstream target of SIRT1 that enhances FAO[30, 31]. And as a transcriptional coactivator, PGC-1α promotes the target genes expression of mitochondrial oxidative metabolism, which include medium-chain acyl-CoA dehydrogenase (MCAD) and long-chain acyl-CoA dehydrogenase (LCAD) expression, which are the major enzymes involved in FAO[32–37]. The latest studies have demonstrated that SIRT1 activation facilitates PGC-1α deacetylation, promotes gene transcription that regulates mitochondrial biogenesis and FAO to maintain energy metabolic homeostasis[38–40]. Under high fat conditions, SIRT1 can modulate various intracellular homeostasis via modulation of mitochondrial function and lipid autophagy through PGC-1α[41]. These evidences suggest that SIRT1/PGC-1α pathway is critical in regulating NAFLD. However, it has not been shown whether the SIRT1/PGC-1α pathway mediates the lipid metabolism mechanisms regulated by GluOC.
In this study, a series of experiments were designed to comprehensively describe the potential involvement of SIRT1 mediates the mechanism of GluOC-regulated lipid metabolism and to investigate the mechanism underlying GluOC supplementation to improve lipid metabolism. This study first demonstrated that SIRT1 mediates the GluOC mechanism in alleviating hepatocyte lipid accumulation. GluOC inhibits DNL via SIRT1-AMPK pathway and promotes FAO via SIRT1-PGC-1α pathway.