Ahmad Farooq, M.D Medical Resident, University at Buffalo, Catholic Health System.

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1 Aspartate a New Treatment Modality in the treatment of Acute Liver Failure and Acute Pancreatitis Ahmad Farooq, M.D Medical Resident, University at Buffalo, Catholic Health System.

2 Tissue Injury Triggers Innate Immune Responses Injured Parenchymal Cell DAMP Sensing Cell Neighboring Cell Pro-IL-1 Pro-IL-18 IL-1 IL-18 Signal 1 TLRs Nlrp3 DAMPs Caspase-1 IL-1 IL-18 independent components ASC ProCaspase-1

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10 What About Amino Acids and Fatty acids?

11 Activation of the N methyl d aspartate receptor by aspartic acid downregulates inflammasome activity and liver inflammation via a b arrestin 2 pathway

12 LPS TLR4 plasma membrane NMDA? ASP Step 1: Gene Transcription of pro-il-1, Nlrp3, CASP1 Step 2: Cleavage of CASP1 and IL-1b release

13 Aspartate downregulates inflammasome components and IL 1b in mouse macrophages A 8 4 Pro IL 1 LPS LPS+ Asp 1mMLPS+ Asp 5mM LPS+ Asp 15mM LPS+ Asp 25mM B LPS+ Asp 5mM LPS Nlrp3 C LPS+ Asp 15mM LPS Pro caspase 1 LPS+ Asp 15mM D E 4 Supernatant IL 1 LPS+ATP LPS+ATP+Asp Unt pg/ml 2 Caspase1 P1 Beta-actin Untreated LPS LPS+ 15mM Asp

14 Mouse Kupffer cells A Pro IL 1 LPS B LPS+ Asp15mM 5 3 Nlrp3 LPS 2 75 LPS+ Asp 15mM C Pro caspase LPS LPS+Asp 15mM D pg/ml 15 Supernatant IL 1 Untreated LPS LPS + AA15mM Human Peripheral Blood Mononuclear cells E 4 2 Pro IL 1 LPS LPS+ Asp 15mM F 5 3 Nlrp3 LPS LPS+ Asp 15mM G Pro caspase LPS LPS+ Asp 15mM

15 In vivo aspartate supplementation reduces hepatic inflammasome levels and protects from acute inflammatory liver injury. 2 Serum Aspartic Acid 3 Serum IL 1 mm 1 pg/ml 15 Untreated Asp Untreated LPS/Gal+ DPBS LPS/Gal+ Asp Pro IL 1 Nlrp3 Pro caspase LPS/Gal+ DPBS LPS/Gal+ Asp 4 LPS/Gal+ LPS/Gal+ DPBS Asp 5 LPS/Gal+ DPBS LPS/Gal+ Asp

16 LPS/Gal + DPBS LPS/Gal + Asp 1x 1x Hemorrhage Serum ALT , Histology Score 1.8 LPS/Gal+ DPBS LPS/Gal +Asp IU/L 1, 5, LPS/Gal+ DPBS LPS/Gal+ Asp

17 In vivo aspartate supplementation reduces pancreas inflammasome levels and protects from caerulein induced pancreatitis 15 Serum Amylase 5 Pro IL 1 U/L Amylase 75 Untreated LPS/Cer + DPBS LPS/Cer + Asp 25 LPS/Cer +DPBS LPS/Cer+ Asp 1 5 Nlrp3 LPS/Cer +DPBS LPS/Cer+ Asp 1 5 Pro caspase 1 LPS/Cer +DPBS LPS/Cer+ Asp

18 1x LPS/CER+ DPBS LPS/CER + Asp 1x 3 Inflammation 3 Necrosis 4 Edema LPS/Cer +DPBS LPS/Cer+ Asp LPS/Cer +DPBS LPS/Cer+ Asp LPS/Cer +DPBS LPS/Cer+ Asp

19 In vivo aspartate supplementation reduces liver inflammasome levels and protects from acetaminophen induced liver failure. 1 5 Pro IL 1 APAP+ DPBS APAP+ Asp 5 3 Nlrp3 APAP+ DPBS APAP+ Asp Pro caspase-1 Serum ALT APAP+ DPBS APAP+ Asp IU/L 8 APAP+ DPBS APAP+Asp

20 1x APAP+ DPBS APAP + Asp 1x 4 Hemorrhage 3 Necrosis Histology Score APAP+ DPBS APAP+ Asp 1.5 APAP+ DPBS APAP+ Asp

21 A 3 15 Aspartate mediated suppression of TLR4 signaling requires the plasma membrane receptor NMDA, and ARRB2 Nr2a Expression B Nr2a Expression SiRNA Scramble SiRNA NR2 C 7 35 LPS SiRNA Scramble LPS+Asp 15mM Pro IL 1 SiRNA NR2a NS Untreated LPS LPS+Asp 15mM Untreated D 3 2 Arrb2 Expression SiRNA Scramble SiRNA Arrb2 E SiRNA Scramble LPS LPS+Asp 15mM Pro IL 1 SiRNA Arrb2 NS Untreated LPS LPS+Asp 15mM Untreated F P Ikk actin LPS LPS+Asp Untreated G

22 A C arrestin 2 induced immune regulation is providing a significant degree of down regulation of the inflammatory response,and supplementation with aspartate acid can further increase this protective effect Arrb2 Expression Kuffer Cells Stellate Cells Hepatocytes Pro IL 1 SiRNA Scramble SiRNA Arrb2 NS B D Pg/mL Arrb2 Expression SiRNA Scramble SiRNA Arrb2 Serum IL 1 SiRNA Scramble SiRNA Arrb2 NS E sirna Scramble LPS/Gal+ DPBS LPS/Gal +Asp F sirna ArrB2 IU/mL Serum ALT NS

23 Conclusion Therapeutic potential of aspartate mediated NMDA signaling in limiting TLR4 driven inflammation in acute pancreatitis. NMDA as a novel target and highlight selective NMDA agonists and antagonist in clinical use in the treatment of acute inflammation Ethanol has been proposed to be a non competitive antagonist of the NMDA receptor in neuron. If the same effect is present in macrophages it will result in loss of NMDA induced down regulation of inflammasome activity and may provide another mechanism of the hepatic immune dysregulation induced by ethanol in alcoholic pancreatitis. In addition use of TPN enriched with glutamate and aspartate has been shown to be associated with reduced inflammation in inflammatory bowel disease. Of great interest is the further possibility that the general immunosuppression seen with TPN may be due to activation of this pathway.

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26 Thank you Dr H Woodman Dr Khalid Qazi Dr Mehal Dr Gorelick Dr Hoque

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28 LPS