Obesity may be viewed as a state of chronic low-grade inflammation that participates in the development of the metabolic syndrome. Nonalcoholic steatohepatitis (NASH) is considered a hepatic phenotype of the metabolic syndrome and a high risk for progression to cirrhosis and hepatocellular carcinoma. Although the "two hit" hypothesis suggests involvement of excessive hepatic lipid accumulation and chronic inflammation, the molecular mechanisms underlying the development of NASH remain unclear, in part because of lack of appropriate animal models. Herein we report that melanocortin 4 receptor-deficient mice (MC4R-KO) develop steatohepatitis when fed a high-fat diet, which is associated with obesity, insulin resistance, and dyslipidemia. Histologic analysis reveals inflammatory cell infiltration, hepatocyte ballooning, and pericellular fibrosis in the liver in MC4R-KO mice. Of note, all of the MC4R-KO mice examined developed well-differentiated hepatocellular carcinoma after being fed a high-fat diet for 1 year. They also demonstrated enhanced adipose tissue inflammation, ie, increased macrophage infiltration and fibrotic changes, which may contribute to excessive lipid accumulation and enhanced fibrosis in the liver. Thus, MC4R-KO mice provide a novel mouse model of NASH with which to investigate the sequence of events that make up diet-induced hepatic steatosis, liver fibrosis, and hepatocellular carcinoma and to aid in understanding the pathogenesis of NASH, pursuing specific biomarkers, and evaluating Nonalcoholic fatty liver disease (NAFLD) is characterized by increased accumulation of lipids in the liver without a history of excessive alcohol consumption or known liver disease.1 NAFLD often occurs with the metabolic syndrome, a constellation of visceral fat obesity, impaired glucose metabolism, atherogenic dyslipidemia, and elevated blood pressure, and is considered the hepatic manifestation of the metabolic syndrome.2 Patients with nonalcoholic steatohepatitis (NASH), a subset of NAFLD, are at high risk for progression to cirrhosis and hepatocellular carcinoma (HCC). However, the molecular mechanisms involved in disease progression from simple steatosis to NASH to HCC are currently unclear. This is in part because there are no appropriate animal models that reflect a liver condition of human NASH, although many attempts have been made to generate animal NASH models via genetic, dietary, and pharmacologic approaches. 3The pathogenesis of NASH is thought to involve a multistep process in which the first step is excessive accumulation of lipids in the liver. According to the "two hit" hypothesis, the development of NASH requires the presence of additional pathogenic factors such as oxidative stress, endotoxins, cytokines, chemokines, and lipotoxicity. 4 -6 Because NASH is often associated with visceral fat obesity, there should be a mechanistic link

Abstract-Obese adipose tissue is markedly infiltrated by macrophages, suggesting that they may participate in the inflammatory pathways that are activated in obese adipose tissue. Evidence has suggested that saturated fatty acids released via adipocyte lipolysis serve as a naturally occurring ligand that stimulates Toll-like receptor (TLR)4 signaling, thereby inducing the inflammatory responses in macrophages in obese adipose tissue. Through a combination of cDNA microarray analyses of saturated fatty acid-stimulated macrophages in vitro and obese adipose tissue in vivo, here we identified activating transcription factor (ATF)3, a member of the ATF/cAMP response element-binding protein family of basic leucine zipper-type transcription factors, as a target gene of saturated fatty acids/TLR4 signaling in macrophages in obese adipose tissue. Importantly, ATF3, when induced by saturated fatty acids, can transcriptionally repress tumor necrosis factor-␣ production in macrophages in vitro. Chromatin immunoprecipitation assay revealed that ATF3 is recruited to the region containing the activator protein-1 site of the endogenous tumor necrosis factor-␣ promoter. Furthermore, transgenic overexpression of ATF3 specifically in macrophages results in the marked attenuation of proinflammatory M1 macrophage activation in the adipose tissue from genetically obese KKA y mice fed high-fat diet. This study provides evidence that ATF3, which is induced in obese adipose tissue, acts as a transcriptional repressor of saturated fatty acids/TLR4 signaling, thereby revealing the negative feedback mechanism that attenuates obesity-induced macrophage activation. Our data also suggest that activation of ATF3 in macrophages offers a novel therapeutic strategy to prevent or treat obesity-induced adipose tissue inflammation. (Circ Res. 2009;105:25-32.) Key Words: adipocytes Ⅲ ATF3 Ⅲ fatty acids Ⅲ inflammation Ⅲ macrophages Ⅲ TLR4 K nown as the metabolic syndrome, the cluster of wellestablished risk factors for cardiovascular disease (visceral fat obesity, impaired glucose metabolism, atherogenic dyslipidemia, and blood pressure elevation), is an increasing health problem worldwide. [1][2][3] The pathophysiology underlying the metabolic syndrome is not fully understood and visceral fat obesity appears to be an important component. 4 There is considerable evidence that obesity is a state of chronic low-grade inflammation, which may play a critical role in the pathophysiology of the metabolic syndrome. [1][2][3] Obese adipose tissue is markedly infiltrated by macrophages, suggesting that they may participate in the inflammatory pathways that are activated in obese adipose tissue. 5 Using an in vitro coculture system composed of adipocytes and macrophages, we have provided evidence that a paracrine loop involving saturated fatty acids and tumor necrosis factor (TNF)␣ derived from adipocytes and macrophages, respectively, establishes a vicious cycle that augment the inflammatory change in obese adipose tissue. 6 Recent studies have also poin...

Many attempts have been made to find novel therapeutic strategies for non-alcoholic steatohepatitis (NASH), while their clinical efficacy is unclear. We have recently reported a novel rodent model of NASH using melanocortin 4 receptor-deficient (MC4R-KO) mice, which exhibit the sequence of events that comprise hepatic steatosis, liver fibrosis, and hepatocellular carcinoma with obesity-related phenotypes. In the liver of MC4R-KO mice, there is a unique histological feature termed hepatic crown-like structures (hCLS), where macrophages interact with dead hepatocytes and fibrogenic cells, thereby accelerating inflammation and fibrosis. In this study, we employed MC4R-KO mice to examine the effect of highly purified eicosapentaenoic acid (EPA), a clinically available n-3 polyunsaturated fatty acid, on the development of NASH. EPA treatment markedly prevented the development of hepatocyte injury, hCLS formation and liver fibrosis along with lipid accumulation. EPA treatment was also effective even after MC4R-KO mice developed NASH. Intriguingly, improvement of liver fibrosis was accompanied by the reduction of hCLS formation and plasma kallikrein-mediated transforming growth factor-β activation. Moreover, EPA treatment increased the otherwise reduced serum concentrations of adiponectin, an adipocytokine with anti-inflammatory and anti-fibrotic properties. Collectively, EPA treatment effectively prevents the development and progression of NASH in MC4R-KO mice along with amelioration of hepatic steatosis. This study unravels a novel anti-fibrotic mechanism of EPA, thereby suggesting a clinical implication for the treatment of NASH.

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