LIVER DISEASE

REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application No.

62/348, 189 filed on June 10, 2016, which is hereby incorporated by reference for all purposes as if fully set forth herein.

INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED

ELECTRONICALLY

The instant application contains a Sequence Listing which has been submitted in ASCII format via EFS-Web and is hereby incorporated by reference in its entirety. Said ASCII copy, created on June 6, 2017, is named P14197-02_SL.txt and is 19,906 bytes in size.

STATEMENT OF GOVERNMENTAL INTEREST

This invention was made with government support under grant no. DK084171 , awarded by the National Institutes of Health. The government has certain rights in the invention.

BACKGROUND OF THE INVENTION

Fatty liver is the accumulation of triglycerides and other fats in the liver cells. The amount of fatty acid in the liver depends on the balance between the processes of delivery and removal. In some patients, fatty liver may be accompanied by hepatic inflammation and liver cell death (steatohepatitis). Potential pathophysiologic mechanisms for fatty liver include the following: decreased mitochondrial fatty acid beta-oxidation, increased endogenous fatty acid synthesis or enhanced delivery of fatty acids to the liver, and deficient incorporation or export of triglycerides as very low-density lipoprotein (VLDL). The mechanism involved in the formation of fatty liver must be identified to enable the creation of therapeutic agents able to prevent or treat disease.

SUMMARY OF THE INVENTION

One embodiment of the present invention is a method for the treatment or prevention of fatty liver disease in a subject comprising administering to the subject an effective amount of an agent that changes the amount of CTRP1 in a subject. When a subject is on a low fat diet it is preferred that the subject is given an agent that increases the amount of CTRP1 in the subject compared to the amount of CTRP1 in the subject before the agent is given. A suitable agent could be chemical, protein, peptide, antibody, CTRP1 or a functional part thereof as examples.

Another embodiment of the present invention is a method for the treatment or prevention of obesity in a subject comprising administering to the subject an effective amount of an agent that changes the amount of CTRP1 in the subject compared to the subject before the agent is given. When a subject is on a high fat diet it is preferred that the subject is given an agent that decreases the amount of CTRP1 in the subject compared to the amount of CTRP1 in the subject before the agent is given. Suitable agents may inhibit the expression or activity of CTRP1 . Another embodiment of the present invention is a mouse comprising a null allele for Ctrpl comprising a deleted functional region of the Ctrpl gene that spans exon 4 replaced with a reporter and a drug resistant cassette. A suitable functional region comprises a 679-bp of the Ctrpl gene that spans exon 4, a suitable drug resistant cassette is a neomycin resistance cassette, and a suitable reporter is a lacZ reporter.

The term "activity" refers to the ability of a gene to perform its function such as ZnT8 (a zinc transporter) being able to transport zinc.

The term "CTRP1 " refers to the C1 q/TNF-Related Protein-1 and an example of a protein sequence of CTRP1 includes Accession number: NP_699203.1 Gl: 388453007 (SEQ ID NO: 1 ):

1 mgsrgqglll ayclllafas glvlsrvphv qgeqqewegt eelpsppdha eraeeqheky 61 rpsqdqglpa srclrccdpg tsmypatavp qinitilkge kgdrgdrglq gkygktgsag 121 arghtgpkgq kgsmgapger ckshyaafsv grkkpmhsnh yyqtvifdte fvnlydhfnm 181 ftgkfycyvp glyffslnvh twnqketylh imkneeewi lfaqygdrsi mqsqslmlel

241 reqdqywvrl ykgerenaif seeldtyitf sgylvkhate p

The term "express" refers to the ability of a gene to express the gene product including for example its corresponding mRNA or protein sequence (s).

The term "reference" refers to a standard or control conditions such as a sample (human cells for example) or subject free, or substantially free, of agent.

The term "reporter gene" or "reporter" refers to a gene that researchers attach to a regulatory sequence of another gene of interest in bacteria, cell culture, animals or plants. Certain genes are chosen as reporters because the characteristics they confer on organisms expressing them are easily identified and measured, or because they are selectable markers. Reporter genes are often used as an indication of whether a certain gene has been taken up by or expressed in the cell or organism population. Commonly used reporter genes that induce visually identifiable characteristics usually involve fluorescent and luminescent proteins. Examples include the gene that encodes jellyfish green fluorescent protein (GFP), which causes cells that express it to glow green under blue light, the enzyme luciferase, which catalyzes a reaction with luciferin to produce light, and the red fluorescent protein from the gene dsRed

As used herein, the term "steatosis" also called "fatty change", "fatty degeneration", or "adipose degeneration" is the process describing the abnormal retention of lipids within a cell. It reflects an impairment of the normal processes of synthesis and elimination of triglyceride fat. Excess lipid accumulates in vesicles that displace the cytoplasm. When the vesicles are large enough to distort the nucleus, the condition is known as macrovesicular steatosis; otherwise, the condition is known as microvesicular steatosis. While not particularly detrimental to the cell in mild cases, large accumulations can disrupt cell constituents, and in severe cases the cell may even burst.

As used herein, the term "subject" is intended to refer to any individual or patient to which the method described herein is performed. Generally the subject is human, although as will be appreciated by those in the art, the subject may be an animal. Thus other animals, including mammals such as rodents (including mice, rats, hamsters and guinea pigs), cats, dogs, rabbits, farm animals including cows, horses, goats, sheep, pigs, etc., and primates (including monkeys, chimpanzees, orangutans and gorillas) are included within the definition of subject.

Glossary

ACC Acetyl CoA carboxylase

ACOX Acyl-coenzyme A oxidase

ACADM acyl-CoA dehydrogenase, C-4 to C-12 straight chain

ACADL Acyl-coenzyme A dehydrogenase, long chain

AdipoQ Adiponectin

AG PAT Acylglycerolphosphate acyltransferase

CPT2 carnitine palmitoyltransferase 2

CTRP C1 q/TNF-related protein

DGAT Diacylglycerol acyltransferases

DIO Diet-induced obese

G6Pc Glucose 6-phosphatase

GPAT Glycerol-3-phosphate acyltransferase

GTT Glucose tolerance test

HDL High-density lipoprotein

HFD High-fat diet

HOMA-IR Homeostatic model assessment of insulin resistance

ITT Insulin tolerance test

IL-1 β Interleukin 1 β

IL-6 lnterleukin-6

LDL Low-density lipoprotein

LEP Leptin

LFD Low-fat diet

MCP-1 Macrophage chemotactic protein 1

NEFA Non-esterified free fatty acid

NMR Nuclear magnetic resonance

PBS Phosphate buffered saline

RER Respiratory exchange ratio

RETN Resistin

RPLP0 Ribosomal phosphoprotein P0

TAG Triglyceride

TGF-β Transforming growth factor β

TNF-a Tumor necrosis factor-alpha

VLDL Very low-density lipoprotein

VC-2 Volume of oxygen consumption

VCC-2 Volume of carbon dioxide produced

WT Wild-type BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 A-1 D illustrates the generation of a Ctrpl KO mouse model.

FIG. 2A-2H illustrates metabolic parameters of WT and Ctrpl -KO mice fed a low-fat diet.

FIG. 3A-3F illustrates reduced expression of GLUT4 and AMPK in skeletal muscle of Ctrpl -KO male mice fed an LFD.

FIG. 4A-4U illustrates the impact of CTRP1 deficiency on the adipose tissue of LFD-fed male mice.

FIG. 5A-5H illustrates LFD-fed Ctrp1 -KO male mice develop liver steatosis FIG. 6A-6G illustrates quantitative real-time PCR analyses were performed to assess possible changes in the expression of hepatic lipid metabolism genes in LFD- fed-KO male mice.

FIG. 7A-7I illustrates enhanced lipid tolerance in LFD-fed Ctrpl -KO mice. FIG. 8A-8K illustrates reduced body weight gain in CTRP1 -KO mice fed a high-fat diet.

FIG. 9A-9S illustrates the reduced adipose expression of lipid synthesis and fibrotic genes in HFD-fed Ctrpl -KO mice.

FIG. 10A-10O illustrates hepatic and circulating lipid levels are reduced in HFD-fed Ctrpl -KO male mice.

FIG. 1 1 A-1 1 J illustrates CTRP-KO mice fed a low-fat diet (Cohort 6) with overnight fast. These mice were 52 weeks old and on a low-fat diet for 47 weeks.

FIG. 12A-12J illustrates CTRP1 KO HFD Male Mice (Cohort 2) with overnight fast. These mice were 62 weeks; WT is 8; HFD is 56 weeks; and KO is 17. FIG. 13A-13F illustrates expression of fat oxidation genes in the liver were significantly down-regulated in overnight CTRP1 deficient animals and genes involved in lipid synthesis were up-regulated in CTRP1 KO mice.

DETAILED DESCRIPTION OF THE I NVENTION

Secreted hormones control energy metabolism via inter-organ crosstalk, and their circulating levels are frequently dysregulated in the pathophysiological states of obesity and diabetes. In an effort to uncover novel metabolic regulators, we have characterized the C1 q/TNF- related proteins (CTRP1 -15), a highly conserved family of secreted proteins. Distinct and notable metabolic, cardiovascular, and

inflammatory functions have been demonstrated for several members of this protein family based on in vivo functional studies. In vitro studies have also highlighted CTRP1 1 's involvement in adipogenesis and CTRP13's role in antagonizing lipid- induced insulin resistance. Similar to many CTRP family members, CTRP1 has a distinct expression profile, with the highest expression levels seen in adipose tissue. Adipose expression of CTRP1 and its circulating levels are modulated by the metabolic and inflammatory states of animals. Its expression is upregulated by the anti-diabetic drug, rosiglitazone, as well as in animals lacking the insulin-sensitizing hormone, adiponectin. Consistent with a metabolic role, administration of recombinant CTRP1 to wild-type mice acutely lowers blood glucose, and chronic overexpression of CTRP1 in transgenic mice enhances AMP-activated protein kinase (AMPK) activation and skeletal muscle fat oxidation, while attenuating insulin resistance induced by high-fat feeding.

The physiologic relevance of CTRP1 in the context of disease is highlighted by recent studies in humans with metabolic disorders. Circulating levels of CTRP1 are elevated in patients with type 2 diabetes and metabolic syndrome, as well as in patients with coronary artery disease and hypertension. Whether the observed upregulation of plasma CTRP1 seen in humans is a cause or a consequence of the disease remains to be established. In support of the notion that CTRP1 upregulation represents physiologic compensation, mice lacking CTRP1 protein have increased myocardial infarct size, cardiomyocyte apoptosis, and proinflammatory gene expression induced by ischemia/reperfusion injury, whereas systemic delivery of CTRP1 attenuated myocardial damage. In contrast, in an apolipoprotein E-deficient mouse model, CTRP1 appears to play an adverse role in promoting atherosclerosis and its deficiency attenuates disease severity. While earlier studies have

demonstrated a positive metabolic role for CTRP1 , the physiologic consequence of its deficiency on glucose and lipid metabolism has not been described. Given the significant caveats and limitations associated with previous recombinant protein infusion and transgenic overexpression studies, the present invention provides genetic evidence, using a knockout (KO) mouse model, that CTRP1 is indeed required for metabolic homeostasis and can be used as a therapeutic agent to treat or prevent disease such as liver steatosis (fatty liver). Using a loss-of -function mouse model, the present invention provides critical genetic evidence that CTRP1 is required for metabolic homeostasis. Notably, though, the contributions of CTRP1 to energy metabolism depend on metabolic and dietary contexts. When mice are fed a low-fat diet, comparable to standard chow, loss of CTRP1 did not appear to affect body weight or metabolic rate (VO2). Its deficiency, however, promoted insulin resistance independent of adiposity. Mice lacking CTRP1 exhibited elevated hepatic gluconeogenic gene expression, as well as elevated fasting insulin levels, and reduced rates of glucose disposal in response to glucose and insulin challenge compared to WT littermate controls (Fig. 2). In the absence of CTRP1 , we also observed a reduction in the steady-state protein levels of AMPK and GLUT4 in the skeletal muscle relative to WT controls. Further, relative phosphorylated AMPKa (a metric of AMPK activation) was also reduced in the skeletal muscle of Ctrp1-KO animals (Fig. 3). Given that both AMPK and the glucose transporter GLUT4 are known to play important roles in skeletal muscle glucose uptake, the reduction in protein levels, along with decreased insulin action, likely contributes to reduced glucose disposal in response to glucose and insulin injection. In contrast to skeletal muscle, loss of CTRP1 did not alter steady-state AMPKa protein levels or relative phosphorylated AMPKa protein levels in adipose tissue (Fig. 4). One of the most striking phenotypes revealed by this study was the

enlargement of the liver and the development of prominent steatosis in Ctrp1-KO mice fed an LFD (Fig. 5). Several mechanisms could account for the accumulation of liver triglycerides in the Ctrp1-KO animals: 1 ) Decreased hepatic fat oxidation; 2) Increased hepatic triglyceride synthesis; 3) Decreased triglyceride export from the liver in the form of VLDL-triglyceride particles; 4) Increased lipid flux into the liver. We examined which of these pathways might be altered in the absence of CTRP1 . With regard to hepatic fat oxidation, we did not observe any differences in the expression of hepatic fat oxidation genes (Fig. 6), nor did we observe changes in serum ketones (β-hydroxybutyrate acids) levels, a surrogate indicator of hepatic fat oxidation. Further, the respiratory exchange ratio (RER) did not indicate any differences in fat oxidation between WT and KO mice. In the liver, triglyceride is synthesized via the glycerol phosphate pathway (1 ) through the sequential acylation of glycerol-3 phosphate, lysophosphatidic acid, and diacylglycerol by multiple isoforms of GPAT, AGPAT, and DGAT enzymes. With the exception of increased Agpatl expression, the expression of genes involved triglyceride synthesis or de novo lipogenesis was not found to be different between genotypes. The use of a lipoprotein lipase inhibitor (poloxamer 407) to block triglyceride hydrolysis and uptake into peripheral tissues allowed us to measure the accumulation of serum triglycerides due to hepatic VLDL-triglyceride export and no differences in the rate of triglyceride export were observed between WT and Ctrp1-KO mice (Fig. 7). Finally, we performed lipid tolerance tests to determine whether CTRP1 deficiency alters the clearance rate of ingested lipids. Interestingly, loss of CTRP1 enhanced lipid clearance relative to WT controls (Fig. 7). Ingested lipids (triglycerides and free fatty acids) are normally delivered to the liver from the intestine via the lymphatic system, in the form of chylomicrons, to be repackaged into VLDL-triglyceride particles before being exported out to peripheral tissues. Thus, an increased rate of lipid clearance, without changes in hepatic VLDL-thglycehde export, likely contributes to the accumulation of triglycerides seen in the liver of Ctrp1-KO mice fed an LFD.

In our recent description of the CTRP1 transgenic mouse model, we illustrated that the protective role of CTRP1 was only revealed when mice were challenged with HFD to induce obesity and insulin resistance. We subjected the Ctrp1-KO animals to a HFD to determine whether the loss of Ctrpl might amplify the effects of the HFD. Given that CTRP1 overexpression attenuates metabolic dysfunction induced by HFD and that Ctrp1-KO mice develop insulin resistance and fatty liver on a LFD, we expected the KO animals to develop pronounced glucose intolerance and an even greater degree of liver steatosis when challenged with a HFD. Surprisingly, we observed the opposite. Ctrp1-KO mice consuming a HFD were leaner, with reduced body weight and adiposity compared to WT littermate controls (Fig. 8). Glucose and insulin tolerance were not significantly different between genotypes, suggesting that the HFD-fed Ctrp1-KO animals were not more insulin resistant than their WT counterparts. An unexpected finding was that Ctrpl - KO mice were significantly more active, during both the light and dark phases of the photocycle when compared to HFD-fed WT littermate controls. The activity levels of HFD-fed Ctrp1-KO mice were comparable to KO animals fed a LFD (Table 3); in contrast, HFD-fed WT mice had significantly lower physical activity levels compared to LFD-fed WT animals. Food intake, however, was not different between genotypes on HFD. How the loss of CTRP1 enhances physical activity in the context of HFD is presently unknown. Increased physical activity without changes in caloric intake likely contributed, at least in part, to the lower weight gain and adiposity seen in

HFD-fed Ctrpl -KO animals relative to WT controls.

TABLE 3

Male Female

WT(n=12) KO (n=9) p-value WT (n=13) KO (n=10) p-value

Low-fat diet

Food intake (g) 4.690 + 0.1986 4.551 + 0.2407 ns 4.691 + 0.2746 4.808 + 0.2631 ns

V0 ₂ (mL/kg-LM/hr) 4544 + 72.35 4786 + 114.9 ns 5537 + 116.9 5488 + 142.6 ns

VC0 ₂ (mL/kg-LM/hr) 4309 + 84.02 4484 + 95.31 ns 5252 + 105.5 5252 + 153.2 ns

Respiratory exchange ratio (RER) 0.9484 + 0.01153 0.9376 + 0.008531 ns 0.9498 + 0.01204 0.9575 + 0.01583 ns

Energy expanditure (kcal/kg-LM/hr) 22.64 + 0.3630 23.78 + 0.5492 ns 27.59 + 0.5587 27.41 + 0.7088 ns

Physical activity (beam breaks) 42724 + 3313 39886 + 2106 ns 75971 + 4388 82086 + 6942 ns

Male Female

WT(n=ll) KO (n=ll) p-value WT (n=13) KO (n=10) p-value

High-fat diet

Food intake (g) 2.722 + 0.1088 2.865 + 0.08533 ns 2.388 + 0.09373 2.305 + 0.08192 ns

V0 ₂ (mL/kg-LM/hr) 4860 + 75.24 4758 + 58.97 ns 5382 + 90.54 5343 + 99.06 ns

VC0 ₂ (mL/kg-LM/hr) 3701 + 56.74 3610 + 47.73 ns 4330 + 61.52 4302 + 73.03 ns

Respiratory exchange ratio (RER) 0.7616 + 0.002731 0.7587 + 0.002106 ns 0.8050 + 0.003875 0.8055 + 0.004440 ns

Energy expanditure (kcal/kg-LM/hr) 23.10 + 0.3555 22.60 + 0.2828 ns 25.87 + 0.4191 25.68 + 0.4646 ns

Physical activity (beam breaks) 27449 + 1736 37192 + 2563 ** 43631 + 3942 57716 + 5570 * In contrast to the LFD-fed Ctrp1-KO mice that developed fatty liver, KO

animals consuming a HFD unexpectedly had reduced hepatic steatosis compared to

WT controls (Fig. 10). Both hepatic and serum triglyceride levels were reduced in

HFD-fed Ctrp1-KO mice. Unlike the LFD-fed KO mice, lipid tolerance testing did not reveal any differences in the rate of triglyceride and free fatty acid clearance

between HFD-fed WT and KO animals. Reduced body weight and adiposity likely contributed, in part, to decreased liver steatosis seen in the HFD-fed Ctrp1-KO animals. Other factors contributing to this phenotype are likely related to the reduced hepatic expression of lipid synthesis genes (Srebp-1c and Scd1) and an increase in the relative phosphorylation and activation of AMPK (Fig. 10), both of which could contribute to the lower hepatic lipid content observed in the Ctrp1-KO animals.

Although less adiposity, a healthier liver, and improved serum lipid levels frequently associate with an improved systemic metabolic profile, the observed reduction in adiposity, hepatic steatosis, and serum lipid levels seen in Ctrp1-KO mice (Fig. 8 and 10) did not appear to affect systemic glucose metabolism, as indicated by lack of differences in glucose and insulin tolerance tests between genotypes (Fig.8). Adipose tissue inflammation and fibrosis, particularly in the context of obesity, are known to alter the expression and secretion of adipokines; this in turn has systemic effects on energy metabolism and insulin sensitivity. Given that CTRP1 is abundantly expressed in adipose tissue, we assessed the impact of CTRP1 deficiency on the expression of genes involved in lipid uptake and synthesis, inflammation, macrophage polarization, and tissue fibrosis. With the exception of reduced fibrotic collagen gene expression, loss of CTRP1 had a relatively minor impact on adipose tissue function when mice were fed an LFD (Fig. 4). In the context of HFD-induced metabolic stress, however, the expression of multiple lipid metabolism genes (Scd1, Cd36, Ppar-y) was significantly reduced in the adipose tissue of Ctrp1-KO mice (Fig. 9). The adipose expression and circulating levels of pro-fibrotic TGF-β were also reduced in Ctrp1-KO animals. Since TGF-β is a potent inducer of fibrotic collagen gene expression, its reduction in mRNA and circulating levels likely contributed to the decreased expression of Co/3 and Co/6. While adipose mass and fibrosis are known to impact systemic metabolism, their reductions in Ctrp1-KO mice were likely insufficient to alter systemic insulin action (Fig. 10).

Adiponectin is a widely studied insulin-sensitizing adipokine with pleiotropic metabolic function. Interestingly, serum adiponectin levels were lower in both LFD and HFD-fed Ctrp1-KO mice compared to WT controls. Although serum adiponectin levels were reduced in LFD-fed Ctrp1-KO mice (Fig. 4), these changes are unlikely to account for the insulin resistance and fatty liver phenotypes observed in our study. Three independent adiponectin KO mouse lines, when fed a chow diet comparable to LFD, are largely indistinguishable from WT controls, with minimum or no detectable metabolic abnormalities. When challenged with a HFD, different adiponectin KO mouse lines develop variable, and relatively mild, degrees of insulin resistance compared to WT controls. In our study, insulin sensitivity was not different between HFD-fed WT and Ctrp1-KO mice despite reduced serum levels of adiponectin (Fig. 8 and 9).

Given the increasing appreciation of sex-dependent differences in metabolic disease phenotypes and severity (31 , 49), we included female WT and KO animals in our studies. Unlike male mice, Ctrp1-KO female mice consuming a control LFD did not develop insulin resistance, glucose intolerance, or fatty liver. When challenged with a HFD, the metabolic phenotypes (body weight, adiposity, energy expenditure, physical activity, and glucose and insulin tolerance) of Ctrp1-KO female mice were indistinguishable from female WT littermate controls (Table 2). Thus, loss of CTRP1 likely contributes to dysregulated metabolism in a sex-dependent manner. Given the myriad physiological roles of sex hormones, this is neither unexpected nor surprising as the metabolic phenotypes of many I oss-of-fu notion mouse models are often manifested in male, but not female, animals.

TABLE 2

Male Female

WT KO p-Value WT KO p-Value i Low-fat diet (LFD) n=12 n=8 n=17 n=8

;Body weight (g) 38.2825+0.694 36.92125 +0.840 ns 29.01 +0.780 29.72 + 1.210 ns iGonadal fat mass (g) 0.955+0.025 0.77875 + 0.036 0.5159+0.04220 0.4400+0.05910 ns iGonadal fat mass/body weight 0.0249 + 0.0005604 0.02104 + 0.0006512 0.01739+0.0010% 0.01442 + 0.001489 ns

: Ingu inal fat mass (g) 0.739 + 0.052 0.645 + 0.035 ns 0.3441+0.02919 0.3750+0.03423 ns

: Inguinal fat mass/body weight 0.01926+0.001213 0.01746 + 0.0008242 ns 0.01160 + 0.0007863 0.01248+0.0008185 ns i Liver weight (g) 1.983 + 0.1271 2.445 + 0.1696 * 1.405 + 0.07098 1.653 + 0.1524 ns

; Liver weight/body weight 0.05155 + 0.002590 0.06592 + 0.003748 ** 0.04801+0.001372 0.05501 + 0.003409 *

;Gastrocnemius muscle (g) 0.121+0.005 0.116+0.005 ns ND ND NA i Gastrocnemius muscle/body weight 0.003163 + 0.0001215 0.003148 + 0.0001273 ns ND ND NA i Heart (g) 0.169+0.009 0.158 + 0.007 ns 0.1488 + 0.005871 0.1475 + 0.0075 ns

: Heart/tibia length 0.009313 + 0.0004806 0.008790 + 0.0003024 ns 0.008234 + 0.0003175 0.008154 + 0.0004050 ns

; Fasting blood glucose (mg/dL) 192.083 + 4.914 182 + 6.059 ns 158.0 + 4.263 155.4+8.181 ns

;Ti bia length (mm) 18.147+0.190 17.890+0.181 ns 18.07+0.09276 18.09 + 0.2816 ns

WT KO p-Value WT KO p-Value i High-fat diet (HFD) n=ll n=10 n=15 n= 10

: Body weight (g) 55.04+1.089 48.85 + 0.4851 53.53 + 1.816 50.20+1.278, n=10 ns iGonadal fat mass (g) 0.6082+0.05129 0.600 + 0.6703 ns 2.199+0.097% 1.916+0.1258 ns iGonadal fat mass/body weight 0.01104 + 0.0009028 0.01229+0.001357 ns 0.04107 + 0.001234 0.03798 + 0.001984 ns

; Ingu inal fat mass (g) 1.256 + 0.04535 0.9150 + 0.03198 1.202+0.04528 1.112 + 0.06734 ns

: Inguinal fat mass/body weight 0.02281 + 0.0006551 0.01874 + 0.0006571 0.02258 + 0.0007765 0.02222 + 0.001315 ns i Liver weight (g) 3.810+0.1604 3.892+0.2103 ns 2.149+0.2036 2.174 + 0.1756 ns i Liver weight/body weight 0.06920 + 0.002455 0.07957 + 0.004000 * 0.03911+0.002605 0.04286 + 0.002777 ns i Heart (g) 0.2291 ± 0.009672 0.2190+0.01602 ns 0.1540 + 0.007091 0.1470+0.002134 ns

: Heart/tibia length 0.01279 + 0.0004742 0.01223+0.0008627 ns 0.008605 + 0.0003912 0.008196 + 0.0001319 ns

: Fasti ng blood glucose (mg/dL) 175.7 + 4.357 176.5 +9.165 ns 183.0+4.508 194.6+7.162 ns iTibia length (mm) 17.90 + 0.2372 17.89+0.08167 ns 17.89+0.1206 17.95 + 0.1503 ns

In summary, our results support an important role for CTRP1 in metabolic homeostasis. The contribution of CTRP1 to systemic glucose and lipid metabolism is sex-dependent and relies on the specific metabolic and dietary context. When fed an LFD, loss of CTRP1 impaired hepatic lipid metabolism (resulting in fatty liver) and systemic insulin sensitivity. In the context of HFD, CTRP1 deficiency attenuated diet- induced obesity and fatty liver. Our study underscores the complex regulation of whole-body metabolism by secreted regulators of the CTRP family.

Regarding the in vivo function of CTRP1 , especially as it relates to lipid metabolism in liver using a genetic mouse model in which the Ctrpl gene was deleted, the inventors made the following discovery. Specifically, CTRP1 knockout (KO) mice, were fed a control low-fat diet and fasted overnight. Observed was a dramatic and striking increase in liver weight, whether it was liver mass (Fig. 1 1 G) or the ratio of liver mass to body weight (Fig. 1 1 H). Other tissues, however, were not different in weight; these include total body weight (Fig. 1 1 A), gonadal (gWAT) and subcutaneous (sWAT) white adipose tissue (Fig. 1 1 C-F), and kidney weight (Fig. 1 1 I, J). The liver phenotypes were even more striking when the CTRP1 -KO mice were fed a high-fat diet to induce obesity. In this case, overnight fasted CTRP1 deficient mice also have a pronounced liver enlargement (Fig. 12G-H). In contrast to the liver, we observed a modest reduction in total body weight (Fig. 12A) and decreased iguinal (subcutaneous) fat depot (iWAT, Fig. 12E-F).

During the overnight fast, the inventors believe lipids from the adipose tissue get mobilized and shunted to the liver for oxidation. Energy derived from fat oxidation enables liver to make glucose during fasting to maintain normal blood glucose levels. One possible mechanism that can account for the enlargement of liver in response to the overnight fast is the reduction in fat oxidation. Indeed, expression of many of the fat oxidation genes in liver were significantly down- regulated in overnight fasted CTRP1 deficient animals (Fig. 13D). In contrast, the expression of genes involved in lipid synthesis was up-regulated in CTRP1 KO mice (Fig. 13A-B).

The inventors believe, based on genetic mouse model data, there is an important role for CTRPI hormone in regulating hepatic lipid metabolism and the therapeutic potential of using recombinant CTRP1 protein to reduce lipid

accumulation in liver in the context of non-alcoholic fatty liver disease (NAFLD).

EXAMPLES/METHODS

The following Examples have been included to provide guidance to one of ordinary skill in the art for practicing representative embodiments of the presently disclosed subject matter. In light of the present disclosure and the general level of skill in the art, those of skill can appreciate that the following Examples are intended to be exemplary only and that numerous changes, modifications, and alterations can be employed without departing from the scope of the presently disclosed subject matter. The following Examples are offered by way of illustration and not by way of limitation.

Animals

The Ctrpl KO (-/-) mouse strain used for this research project (B6; 129S5- C1 qtnf1 ^{tm1 Lex} /Mmucd, identification number 032164-UCD) was obtained from the Mutant Mouse Regional Resource Center (MMRRC), an NCRR-NIH funded strain repository, and was donated to the MMRRC by Genentech, Inc. The Ctrpl gene is located on mouse chromosome 1 1 and comprises 4 exons. The largest exon, exon 4 (which codes for 61 % of the full-length protein), was targeted by homologous recombination. A total of 679 bp, spanning the coding region of exon 4 and a portion (162 bp) of the 3'UTR, was deleted. Heterozygous mice were recovered from cryo- preserved embryos. Since the ES cells were derived from the 129S5/Sv mouse strain, we backcrossed Ctrpl KO mice to the C57BL/6J genetic background for >6 generations. The Ctrpl KO mice were viable and fertile. Genotyping primers for the Ctrpl wild-type (WT) allele were as follows: forward (DNA063-1 ), 5'- GGTTCTACAGGTCC CAGGG-3' (SEQ ID NO: 2); and reverse (DNA063-2), 5'- GTGATGTAGGTGTCGAACTCG-3' (SEQ ID NO: 3). The expected size of the WT amplification product was 458 bp. Genotyping primers for the Ctrpl -KO allele were as follows: forward (Neo-3a), 5'-GCAGCGCATCGCCTTCTATCG-3' (SEQ ID NO: 4) and reverse (DNA063-31 ) 5'-GGAAGTCCCTCTCACGTGTC-3' (SEQ ID NO: 5). The expected size of the KO amplification product was 1 100 bp. To confirm the presence or absence of Ctrpl mRNA in the adipose tissue of WT and KO mice, we performed semi-quantitative PCR analysis using the following primer pair: forward, 5'- GTGAGGACCTCCCCACTTCT-3' (SEQ ID NO: 6) and reverse, 5'- GACCAGGTAGCCA CTGAAGG-3' (SEQ ID NO: 7). The expected size of the amplification product was 632 bp. All Ctrp1-KO (-/-) and WT (+/+) littermate controls used in this study were generated by intercrossing Ctrpl heterozygous (+/-) mice. Male and female Ctrpl KO mice and WT littermate controls were housed in polycarbonate cages on a 12-h light-dark photocycle with ad libitum access to water and food. Mice were fed a high-fat diet (HFD; 60% kcal derived from fat, Research diets; D12492) or a matched control low-fat diet (LFD; 10% kcal derived from fat, Research diets; D12450B). Diet was provided for a period of 24 weeks, beginning at 6 weeks of age. All animal protocols were approved by the Institutional Animal Care and Use Committee of The Johns Hopkins University School of Medicine.

CTRP1 ELISA

An ELISA specific for mouse CTRP1 was obtained from BioVendor R&D, Czech Republic. The assay was carried out according to manufacturer's instructions. Body Composition Analysis

Body composition analyses for fat and lean mass were performed on mice at

19-24 weeks using Echo-MRI-100 (Echo Medical Systems, Waco, TX) at The Johns Hopkins University School of Medicine mouse phenotyping core facility. Lean mass was used to normalize the indirect calorimetry data.

Indirect Calohmetry

LFD-fed and HFD-fed WT and Ctrpl -KO mice at 19-24 weeks of age were used for simultaneous assessments of daily body weight change, food intake

(corrected for spillage), physical activity, and whole-body metabolic profile in the Comprehensive Laboratory Animal Monitoring System (CLAMS) system (Columbus Instruments). Data were collected for 3-4 days to confirm that mice were acclimated to the calorimetry chambers (indicated by stable body weights, food intake, and diurnal metabolic patterns), and data were analyzed from the fourth day. Rates of oxygen consumption (VO2; normalized to mL ^» lean kg ^{~1 »} h ^~1 ) and carbon dioxide production (VCO2; mL ^» lean kg ^{~1 »} h ^~1 ) in each chamber were measured every 24 min throughout the studies. Respiratory exchange ratio (RER = VCO2/VO2) was calculated by CLAMS software (version 4.02) to estimate relative oxidation of carbohydrates (RER = 1 .0) vs. fats (RER ~ 0.7), not accounting for protein oxidation. Energy expenditure (EE) was calculated as EE = V02 [3.815 + (1.232 RER)] (29) and normalized for lean body mass (kcaMean kg ^{~1 »} h ^{~ 1} ) as recommended (2). Physical activities were measured by infrared beam breaks in the metabolic chamber. Average metabolic values were calculated per mouse and averaged across mice for statistical analysis by Student's t-test.

Intraperitoneal Glucose and Insulin Tolerance Test

Mice were fasted for 6 h before glucose injection. Glucose was injected intraperitoneally (i.p.) into mice at a dose of 1 mg/g body weight. Blood glucose was measured at 0, 15, 30, 60, and 120 min post glucose injection using a glucometer (BD Pharmingen, Franklin Lakes, NJ). Fasting serum insulin levels were measured using an ELISA kit (Millipore, Billerica, MA). For insulin tolerance tests, food was removed 2 h before insulin injection. Insulin was injected i.p. at a dose of 0.75 U/kg body weight for LFD-fed mice and 1 or 1 .5 U/kg body weight for HFD-fed mice, and blood glucose was measured at 0, 15, 30, 60, and 90 min post insulin injection as described above. The homeostatic model assessment of insulin resistance (HOMA- IR) was calculated based on fasting glucose and insulin concentrations as HOMA- IR= (fasting glucose [mM] χ fasting insulin [microunits/mL])/22.5 (27). This surrogate index provides a reasonable approximation of the degree of insulin resistance and has been validated against the reference standard glucose clamp for rats (5) and mice (21 ). Lipid Tolerance Test

For lipid tolerance tests (LTT), mice were fasted for 12 h and then gavaged with 20% emulsified Intralipid (soybean oil; Sigma; 10 μί/g of body weight). Sera were collected via tail bleed using a Microvette® CB 300 (Sarstedt) at 0, 1 , 2, 3, and 4 h post-injection. Serum levels of non-esterified free fatty acids (NEFA) and triglycerides were quantified using kits from Wako Diagnostics and Infinity

Triglycerides (Thermo Scientific), respectively.

Hepatic VLDL-Triglvceride Quantification

To measure the hepatic VLDL-triglyceride production rate, a separate cohort of LFD-fed WT and Ctrp1-KO mice were given an intraperitoneal injection of 1000 mg/kg poloxamer 407 (Sigma) in saline ~4 h into the light cycle, as described by

Millar et al. (30) and our previous study (37). Poloxamer 407 inhibits lipoprotein lipase activity and blocks triglyceride hydrolysis, thus allowing VLDL-triglycerides to accumulate over time and enables the calculation of hepatic VLDL-triglyceride secretion rates (30). Serum samples were collected at 0, 1 , 2, 4, and 8 h and analyzed for triglyceride concentration. Serum levels of triglycerides were quantified using the Infinity Triglycerides kit (Thermo Scientific).

Tissue Collection

Liver, white adipose tissue (perigonadal/visceral and inguinal/subcutaneous), and skeletal muscle samples were immediately harvested from euthanized mice and flash-frozen into liquid nitrogen. Homogenized tissue lysates were prepared in RIPA lysis buffer (50 mM Tris-HCI pH 7.4, 150 mM NaCI, 1 mM EDTA, 1 % Triton x 100, and 0.25% deoxycholate) containing protease inhibitors (Complete Mini, Roche) and phosphatase inhibitors (PhosSTOP, Roche). Tissue lysates were centrifuged at 10, 000 rpm for 20 minutes at 4°C for 20 minutes. Supernatants were collected and protein content was quantified using the Pierce BCA Protein Assay Kit (Thermo Scientific).

Histology

WT and Ctrp1-KO mouse tissues were fixed overnight in 10% formalin at 4°C. Fixed tissues were embedded in paraffin, sectioned, and stained with hematoxylin and eosin (H & E) at the Histology Reference Laboratory at The Johns Hopkins University School of Medicine.

Serum and Blood Chemistry Analysis

Mouse serum was harvested by retro-orbital bleeding at the time of euthanasia. Samples were separated using a microvette® CB 300 (Sarstedt, Numbrecht, Germany) and centrifuged at 10,000 x g for 5 min. Glucose

concentrations were determined at the time of collection with a glucometer (BD Pharmingen). Serum lipid levels were measured by the Mouse Pathology and Phenotyping Core at The Johns Hopkins University School of Medicine. Insulin, adiponectin, leptin, TNF-a, MCP-1 , I L- 1 β , and IL-6 were measured using Millipore kits. Serum TGF β-1 was measured using an Abeam kit and CTRP1 was measured using a kit from BioVendor R&D.

Lipid Extraction From Liver Tissue

Lipid extraction was performed as previously described (37). In brief, liver (50 mg) was homogenized in 500 μί of distilled water. 200 μί of the homogenate was collected for lipid extraction, mixed with 1 ml_ of choloroform:methanol (2: 1 ), and centrifuged at 1700 rpm for 5 min at 4°C, and the chloroform phase was collected and dried in a vacuum. Samples were re-suspended in tert-butanol:MeOH:Triton- X100 (3: 1 : 1 ) before determining triacylglycerol and cholesterol content using commercially available colorimetric kits (Thermo Scientific).

Western Blot Analysis

Western blot analyses were carried out and quantified as previously described (41 ), using antibodies specific to GLUT4, AMPKa, AKT, phospho-AKT (Ser-473), and phospho-AMPKa (Thr-172) (Cell Signaling Technology). PGC1 a antibody was obtained from Abeam (cat # ab54481 ).

Quantitative Real-Time PCR Analysis

Total RNA was isolated from tissues using Trizol® (Thermo Scientific) and reverse transcribed using the GoScript Reverse transcription system (Promega). Real-time PCR primers for gluconeogenic genes (G6Pc, Pck1) (39), triglyceride synthesis genes (Gpat, Agpat, Dgat) (37), de novo lipogenesis, fat oxidation and adipokine genes (Acd, Fasn, Srebpl, Acoxl, Cpt1, Cpt2, Lead, Mead, Adipoq, Lep) (55), fibrotic genes (Coll, Co/3, Co/6) (22), and inflammatory genes (11-1 β, 11-6, Tgf-β) have been previously published. Other primer sequences used in this study are listed in Table 1 . Quantitative real-time PCR analyses were performed on a CFX Connect system (Bio-Rad Laboratories, Hercules, CA). Samples were analyzed in 20 μΙ_ reactions with SyBR® Green PCR Master Mix (Applied Biosystems,

Invitrogen) per the manufacturer's directions. Data were normalized to 36B4 (adipose tissue), 18S rRNA (skeletal muscle), and β-actin (liver) and expressed as relative mRNA levels using the AACt method (23).

Table 1

Gene Forward primer Reverse primer

AG ATTCG G G ATATG CTGTTG G C (SEQ TCGGGTCCTAGACCAGTGTTC (SEQ I D

I D NO: 8) NO: 9)

CTTGTG G A ATG CCTTGTG ATTG (SEQ AGCCGAAGCAG C AC ATG AT (SEQ I D

I D NO: 10) NO: 11)

ATA AG A A ATG CG G G G ATGTC AC (SEQ ATATCCGAGAAGGCAGCGAAC (SEQ

I D NO: 12) I D NO: 13)

GCTGCAGGAATCCAGAGAAT (SEQ I D C ATG C AC A AG GTCCTG AG A A (SEQ I D

NO: 14) NO: 15)

AG GTTCCG G CTTG ATG AG AA (SEQ I D AGTGGGTTGGCAGGCTTTAT (SEQ I D

NO: 16) NO: 17)

CTG AC AG G ATG CCTAG CCG (SEQ I D CGCAGGTAATCCCAGAAGC (SEQ I D

NO: 18) NO: 19)

GAG CCCCTG AAG G A ATG CC (SEQ I D CCTATA ACTAG GTCTTTG C AG ATATG G

NO: 20) (SEQ I D NO: 21)

ATGGGCTGTGATCGGAACTG (SEQ I D AGCCAGGACTGCACCAATAAC (SEQ I D

NO: 22) NO: 23)

CGACACTCACCCACCTCTTC (SEQ I D TTGTTCAG CCG G ATCTTGTC (SEQ I D

NO: 24) NO: 25)

AGCGGATTCCAGGTGAGG (SEQ I D TTGTTCAGGCGG ATCTTGTC (SEQ I D

NO: 26) NO: 27)

ATG A ACTTCTCCG G C A AGTACC (SEQ GGTCCTCGGGCAGACCTAT (SEQ I D

I D NO: 28) NO: 29)

GTTCTCCCGTCCAAGACCATT (SEQ I D G CTCCGTACAG AGTGTAG CAAG (SEQ

NO: 30) I D NO: 31)

G CTTG ATGTG CTAC A A A AG CTG (SEQ CGTGGTGATGGTTGAATGTCC (SEQ ID

I D NO: 32) NO: 33)

AGGAGTGTCGACTTCCGCAAA (SEQ ID CTCTTCTTG CCG CTTCAGTTT (SEQ ID

NO: 34) NO: 35)

ATAGTGGGTCACGAAGCAGC (SEQ I D AGGGCAACAGAGTCGGAGAC (SEQ I D

NO: 36) NO: 37)

CCCAGTCGTACACGTCATTTT (SEQ I D C ATCATTCTC ATG GTCCTG CT (SEQ I D

NO: 38) NO: 39)

CTCG G G ACCTTCCTC ATA A AG AG A GAATAGTTCGTTCCTCCCATGCTC (SEQ (SEQ I D NO: 40) I D NO: 41)

ATG G G A A ATCCCCTCC A A ATCT (SEQ GTGCTGAGGTCTGAGACGA (SEQ ID I D NO: 42) NO: 43) CCCTG A AG AC AC AG CTG AG G (SEQ I D GGCTGTACCCTAAGAGGTGG (SEQ I D

NO: 44) NO: 45)

TTA A A A ACCTG G ATCG G A ACC A A (SEQ G C ATTAG CTTC AG ATTTACG G GT (SEQ

I D NO: 46) I D NO: 47)

CCAGAGTCTGCTGATCTGCG (SEQ I D G CC ACCTCTTTG CTCTG CTC (SEQ I D

NO: 48) NO: 49)

TGTGGCCTCATTCCTCCTAC (SEQ I D TCGTGGATGTTGGTGGAGCT (SEQ I D

NO: 50) NO: 51)

G CTG G G CTGTC A AG C ACTGT (SEQ I D GTAACTGGGTAGGCTGCCAT (SEQ I D

NO: 52) NO: 53)

TGT ACG AGT CGG TGT GCT TC (SEQ GGT AGG TAT CCG TCA TGG TCT TG

I D NO: 54) (SEQ I D NO: 55)

TTCTCTGTACCATGACACTCTGC (SEQ CGTGGAATCTTCCGGCTGTAG (SEQ I D

I D NO: 56) NO: 57)

TTCCTGCTGTTTCTCTTACACCT (SEQ CTGTCTGCCTCTTTTGGTCAG (SEQ I D

I D NO: 58) NO: 59)

GTTCTCAG CCCAACA ATACAAG A (SEQ GTGGACGGGTCGATGTCAC (SEQ I D

I D NO: 60) NO: 61)

CCCCAGTGTCCTTACAGAGTG (SEQ I D GTGCCCAGAGTGGATGTCT (SEQ I D

NO: 62) NO: 63)

GCATGAAGGCAGCTGCTATTGGTT TAG G CCC ATCC AG CTA AG C AC ATT

(SEQ I D NO: 64) (SEQ I D NO: 65)

CTCTGTTCAG CTATTG G ACG C (SEQ ID CGG A ATTTCTG G G ATTC AG CTTC (SEQ

NO: 66) I D NO: 67)

GCTCTTACTGACTGGCATGAG (SEQ I D CG C AG CTCTAG GAG C ATGTG (SEQ I D

NO: 68) NO: 69)

CTCC AAG CCAAAGTCCTTAG AG (SEQ AG G AG CTGTC ATTAG G G AC ATC (SEQ

I D NO: 70) I D NO: 71)

TTCTGCTGTGGAAATGCAAG (SEQ ID C A ATG ATG AG AG G C AG C A AG (SEQ I D

NO: 72) NO: 73)

CC A ATCC AG CTA ACTATCCCTCC (SEQ ACCCAGTAGCAGTCATCCCA (SEQ I D

I D NO: 74) NO: 75)

GTGCCCAGAGTGGATGTCT (SEQ I D CCCCG CTTTTGTCATATTCCG (SEQ I D

NO: 76) NO: 77)

Statistical Analysis

Comparisons between two groups of data were performed using two-tailed Student's t-tests with 95% confidence intervals and ANOVA tests were used to make comparisons involving more than two groups. Values were considered to be statistically significant at p<0.05. For all data, * represents p<0.05, ** represents p<0.01 , and *** represents p<0.005. All data are presented as mean ± standard error of the mean (SEM).

All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.

The use of the terms "a" and "an" and "the" and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms "comprising," "having," "including," and "containing" are to be construed as open-ended terms (i.e., meaning "including, but not limited to,") unless otherwise noted. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., "such as") provided herein, is intended merely to better illuminate the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the

specification should be construed as indicating any non-claimed element as essential to the practice of the invention. Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.