Abstract P3032: Liver-directed Mitochondrial Uncoupling Attenuates The Progression Of Early And Late-stage Atherosclerosis In Mice

Atherosclerotic cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in people with type 2 diabetes (T2D) and new therapies are urgently needed. We recently developed an orally available, liver-directed controlled-release mitochondrial protonophore (CRMP) and showed that this agent safely reverses hypertriglyceridemia, fatty liver, and T2D in rodent and nonhuman primate models of obesity by promoting a subtle sustained increase in hepatic mitochondrial inefficiency. To determine the effect of CRMP on atherogenesis, we performed intervention studies in which 12-week Western-diet fed Ldlr -/- mice with established atherosclerosis were treated with CRMP (30 mg/kg-day) or vehicle control for an additional 12 weeks. CRMP-treated mice displayed a significant reduction in fasting plasma and hepatic triglyceride content, independently of changes in body weight, fasting plasma glucose, insulin or cholesterol levels. Morphometric analysis of the aortic root and brachiocephalic artery revealed that CRMP treatment significantly reduced total plaque area and neutral lipid accumulation. CRMP treatment also decreased markers of plaque vulnerability, as evidenced by a reduction in necrotic core area and increase in fibrous cap area ( P <0.05 vs veh). To determine the mechanisms by which CRMP attenuated atherosclerosis, we performed progression studies in Ldlr -/- mice fed a Western diet containing CRMP or vehicle control for 12 weeks. Similarly to the intervention studies, CRMP significantly reduced aortic root plaque area, neutral lipid accumulation and necrotic core area. These changes were associated with a reduction in plasma triglyceride content and improvement in whole-body insulin sensitivity as assessed by hyperinsulinemic-euglycemic clamps (all P <0.05 vs veh). Single-cell RNA sequencing of whole aortas from CRMP and vehicle-treated Ldlr -/- mice revealed that CRMP reduced the frequency of inflammatory macrophages compared to vehicle (~19% vs ~2%), consistent with an immune-dampening effect of CRMP. Taken together, these data support an anti-atherogenic role for CRMP and suggest the therapeutic potential of liver-directed mitochondrial uncouplers for the treatment of early and late-stage atherosclerosis.