Journal Article

FGF21 gene therapy as treatment for obesity and insulin resistance

Ruberte, Jesus, Garcia, Miquel, Ribera, Albert, Motas, Sandra, Mulero, Francisca, Ferré, Tura, Navarro, Marc, Casana, Estefania, Muñoz, Sergio, Casellas, Alba, Marcó, Sara, Elias, Gemma, Elias, Ivet, Grass, Ignasi, Jambrina, Claudia, Mallol, Cristina, Haurigot, Virginia, Rodó, Jordi, Darriba, Sara, León, Xavier, Bosch, Fatima, Sacristan, Victor, Jimenez, Veronica, Franckhauser, Sylvie

2018

Overview

Prevalence of type 2 diabetes (T2D) and obesity is increasing worldwide. Currently available therapies are not suited for all patients in the heterogeneous obese/T2D population, hence the need for novel treatments. Fibroblast growth factor 21 (FGF21) is considered a promising therapeutic agent for T2D/obesity. Native FGF21 has, however, poor pharmacokinetic properties, making gene therapy an attractive strategy to achieve sustained circulating levels of this protein. Here, adeno‐associated viral vectors (AAV) were used to genetically engineer liver, adipose tissue, or skeletal muscle to secrete FGF21. Treatment of animals under long‐term high‐fat diet feeding or of ob/ob mice resulted in marked reductions in body weight, adipose tissue hypertrophy and inflammation, hepatic steatosis, inflammation and fibrosis, and insulin resistance for > 1 year. This therapeutic effect was achieved in the absence of side effects despite continuously elevated serum FGF21. Furthermore, FGF21 overproduction in healthy animals fed a standard diet prevented the increase in weight and insulin resistance associated with aging. Our study underscores the potential of FGF21 gene therapy to treat obesity, insulin resistance, and T2D. Synopsis This study describes the use of adeno‐associated viral (AAV) vectors to achieve long‐term production of fibroblast growth factor 21 (FGF21) to treat obesity and insulin resistance. AAV‐FGF21 gene transfer to healthy animals also prevented age‐associated weight gain and insulin resistance. A one‐time administration of an AAV vector encoding FGF21 counteract obesity and insulin resistance for more than a year. The approach works in two different animal models of obesity, induced either by diet or genetic mutations. Administration of AAV‐FGF21 to healthy animals promotes healthy aging. AAV‐FGF21 pharmacological effects are demonstrated after genetic engineering of 3 different tissues (liver, adipose tissue and skeletal muscle). FGF21 gene therapy holds great translational potential in the fight against insulin resistance, T2D, obesity and related comorbidities. Graphical Abstract This study describes the use of adeno‐associated viral (AAV) vectors to achieve long‐term production of fibroblast growth factor 21 (FGF21) to treat obesity and insulin resistance. AAV‐FGF21 gene transfer to healthy animals also prevented age‐associated weight gain and insulin resistance.

• Publisher: Nature Publishing Group UK,EMBO Press,John Wiley and Sons Inc,Springer Nature
• Subject: AAV gene therapy / Adipose tissue / Aging / Animal models / Animals / Body weight / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / EMBO16 / EMBO21 / Fatty liver / FGF21 / Fibroblast growth factors / Fibroblasts / Fibrosis / Gene therapy / Genetic engineering / Growth factors / High fat diet / Hypertrophy / Insulin / Insulin resistance / Liver / Musculoskeletal system / Obesity / Research Article / Skeletal muscle / Steatosis / Tissue engineering / type 2 diabetes