Asprosin Neutralizing Antibodies as a Treatment for Metabolic Syndrome
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Summary: Mishra et al. present data characterizing the effect of asprosin neutralizing antibodies on the parameters of metabolic syndrome (weight, glucose, lipids, etc). This group were the initial discoverers and characterized asprosin as a hormone that increases blood sugar and stimulates appetite. In their Nature Medicine 2017 article they also present data on a neutralizing antibody. In this follow-up manuscript the group characterizes the impact of neutralizing monoclonal antibodies on metabolic parameters of three mouse models of obesity (DIO, NASH diet and Leptin receptor knockout). The translational focus of the manuscript is potential use of monoclonal antibodies against aprosin as a treatment of metabolic syndrome.
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Abstract
Recently, we discovered a new glucogenic and centrally-acting orexigenic hormone – asprosin. Asprosin is elevated in metabolic syndrome (MS) patients, and importantly, its genetic loss results in reduced appetite, leanness and robust insulin sensitivity, leading to protection from MS. Here we demonstrate that anti-asprosin monoclonal antibodies (mAbs) are a dual-effect pharmacologic therapy that targets the two key pillars of MS – over-nutrition and the blood glucose burden. Anti-asprosin mAbs from three distinct species lowered appetite and body weight, and improved blood glucose in a dose-dependent and epitope-agnostic fashion in three independent MS mouse models, with an IC 50 of ∼1.5 mg/kg. In addition, mAb treatment ameliorated MS associated dyslipidemia and hepatic dysfunction. The mAbs displayed half-life of over 3 days in vivo, with equilibrium dissociation-constants in picomolar to low nanomolar range. This evidence paves the way for further development towards an investigational new drug application and subsequent human trials for treatment of MS, a defining physical ailment of our time.
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Reviewer #3:
Three different anti-asprosin mAbs were produced and tested in different metabolic syndrome animal models. Beneficial effects were noted on body weight, food intake and blood glucose and insulin levels. The effects were modest, but seemed to be relevant to elevated aprosin levels, as the AB blocked the effects of adenoviral overexpression of the hormone. Some issues require attention:
Additional characterization of the aprosin neutralizing effect of the AB is required.. It will be helpful to show the endogenous free asprosin levels at different time points after a single or repeated mAb injection. This result is also important to tell whether this mAb will cause other immune responses and side effects that might confound interpretation of the results.
In Figure 3 (a, e, j) and Figure 4 (a, e, I, m). please show body weight …
Reviewer #3:
Three different anti-asprosin mAbs were produced and tested in different metabolic syndrome animal models. Beneficial effects were noted on body weight, food intake and blood glucose and insulin levels. The effects were modest, but seemed to be relevant to elevated aprosin levels, as the AB blocked the effects of adenoviral overexpression of the hormone. Some issues require attention:
Additional characterization of the aprosin neutralizing effect of the AB is required.. It will be helpful to show the endogenous free asprosin levels at different time points after a single or repeated mAb injection. This result is also important to tell whether this mAb will cause other immune responses and side effects that might confound interpretation of the results.
In Figure 3 (a, e, j) and Figure 4 (a, e, I, m). please show body weight to rule out the stress or side effects caused by virus injection. For DIO mice, 14 days IgG injection also caused weight loss; for db/db mice, IgG injection increased body weight. Please discuss.
Although adenovirus and AAV are widely used for in vivo protein overexpression, it is important to show here that endogenous asprosin levels were increased after virus injection and decreased after antibody neutralization.
In Figure 5, more data on liver weight, histology, etc. is required to support their conclusion on liver health. The current data from three different mice models are very contradictory, this can be caused by the side effect or off-target effect of this mAb.
In Figure 6, it is important to demonstrate the neutralizing effect of the mAbs.
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Reviewer #2:
Asprosin, as identified by the authors' group, is reported to stimulate glucose release from the liver and also centrally act as an orexigenic hormone. The present study developed monoclonal antibodies for asprosin and demonstrated that antibody-based asprosin depletion lowered food intake, prevented diet-induced body weight gain, and lowered blood glucose levels in mice. Overall the data are supportive of the conclusion; however, several concerns were identified as follows:
One of the central issues is the specificity of the antibody action. The authors should demonstrate if the effect of the asprosin antibodies is blunted in mice that lack either asporosin or its receptor OR4M1.
Previous studies from the authors' group show that asprosin acts on hepatocytes and triggers cAMP signaling. The authors should examine if the …
Reviewer #2:
Asprosin, as identified by the authors' group, is reported to stimulate glucose release from the liver and also centrally act as an orexigenic hormone. The present study developed monoclonal antibodies for asprosin and demonstrated that antibody-based asprosin depletion lowered food intake, prevented diet-induced body weight gain, and lowered blood glucose levels in mice. Overall the data are supportive of the conclusion; however, several concerns were identified as follows:
One of the central issues is the specificity of the antibody action. The authors should demonstrate if the effect of the asprosin antibodies is blunted in mice that lack either asporosin or its receptor OR4M1.
Previous studies from the authors' group show that asprosin acts on hepatocytes and triggers cAMP signaling. The authors should examine if the neutral antibodies blunt the cAMP signaling in DIO mice.
Similarly, asprosin was shown to stimulate AgRP+ neurons. The authors need to demonstrate the effect of asprosin antibodies on AgRP+ neuronal activity.
A recent paper (von Herrath et al. Cell Metabolism 2019) challenged the author's observation of the metabolic action of asprosin. The authors claim that this is due to "due to use of poor quality recombinant asprosin". However, no scientific evidence was presented. This study needs a more rigorous assessment of data reproducibility.
Most of the bodyweight data are presented as "body-weight change". However, the authors should present them as whole-body weight.
Some of the data points and stat analyses require further clarification. e.g.) lack of SE in Fig.1c, statistical analysis of Fig.3, Sup Fig.1
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Reviewer #1:
The study is interesting and does have potential translational relevance. There are some concerns however: (1) in Figure 1 the blood glucose drops independent of food intake is this all related to decreased hepatic glucose output or are there any effects on urine. Was urinary glucose measured? Is there increased glycosuria?; (2) In previous papers you discuss the increased lean body mass when aprosin is not present. There is no body composition data in this study. Was there any body composition differences with the antibody among the different mouse models (e.g DIO vs Nash diet)?; (3) were any changes in lean body mass with the antibodies associated with increases in strength?; (4) several mouse ages are discussed in the Methods section: 12 weeks, 16 weeks, 12 week of high fat diet or 24 week of NASH diet. Not clear from …
Reviewer #1:
The study is interesting and does have potential translational relevance. There are some concerns however: (1) in Figure 1 the blood glucose drops independent of food intake is this all related to decreased hepatic glucose output or are there any effects on urine. Was urinary glucose measured? Is there increased glycosuria?; (2) In previous papers you discuss the increased lean body mass when aprosin is not present. There is no body composition data in this study. Was there any body composition differences with the antibody among the different mouse models (e.g DIO vs Nash diet)?; (3) were any changes in lean body mass with the antibodies associated with increases in strength?; (4) several mouse ages are discussed in the Methods section: 12 weeks, 16 weeks, 12 week of high fat diet or 24 week of NASH diet. Not clear from description if mice were matched for age. Please clarify; (5) In Figure 5 there are a number of inflammatory markers which can vary according to the model. What about anti inflammatory markers (cortisol, IL-10 etc) would be helpful to get a better picture of physiologic changes.
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Summary: Mishra et al. present data characterizing the effect of asprosin neutralizing antibodies on the parameters of metabolic syndrome (weight, glucose, lipids, etc). This group were the initial discoverers and characterized asprosin as a hormone that increases blood sugar and stimulates appetite. In their Nature Medicine 2017 article they also present data on a neutralizing antibody. In this follow-up manuscript the group characterizes the impact of neutralizing monoclonal antibodies on metabolic parameters of three mouse models of obesity (DIO, NASH diet and Leptin receptor knockout). The translational focus of the manuscript is potential use of monoclonal antibodies against aprosin as a treatment of metabolic syndrome.
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