SlideShare a Scribd company logo
1 of 11
Download to read offline
Enhanced brown adipose tissue differentiation in PTP1B knockout
samples analyzed with Oil Red O staining
Aroldo M. Trejo
ABSTRACT
Background: PTP1B has been associated with inhibitory effects on insulin signaling and brown
adipose tissue (BAT) differentiation.
Objective: The objective of our study was to determine whether a lack of PTP1B would enhance
BAT differentiation. We hypothesized that the knockout treatment (hPTP1B KO) and the
catalytically impaired treatment (hPTP1B D/A) would display greater differentiability compared
to the WT treatment (hPTP1B WT).
Design: PTP1B in BAT was knocked out in rats and various treatments of human PTP1B were
reconstituted in the cells, resulting in hPTP1B WT, hPTP1B D/A, and hPTP1B KO conditions.
After eight days of differentiation, differentiated cells for each treatments (n=2) were stained
with Oil Red O. The Oil Red O was eluted and quantified using spectrophotometry, using
triglyceride (TG) quantification as a marker of differentiation. Differentiated and
undifferentiated cells of each conditioned were lysed and immunoblotted for determination of
PTP1B presence.
Results: The hPTP1B KO and hPTP1B D/A treatments yielded greater differentiation (152%
and 154% respectively) compared to the hPTP1B WT condition (136%). However, there was no
significant difference in differentiation patterns among the three treatments (p>0.05).
Conclusion: PTP1B plays a crucial role in inhibiting BAT differentiation. The results from our
study add to the growing evidence that PTP1B inhibition can play an important role in the
management of the obesity and diabetes epidemic, providing a foreground for PTP1B-targeted
therapeutic advancements in the near future.
Trejo 2
	
  
INTRODUCTION
Protein tyrosine phosphatase 1B (PTP1B) is an inhibitory protein that has been analyzed
for its mediatory role in brown adipose tissue (BAT) differentiation (1, 2). BAT has been
characterized by increased mitochondrial concentration and increased energy expenditure
compared to white adipose tissue (WAT) (3), making it an interest in PTP1B studies. Studies
have found that PTP1B can be knocked out in mice BAT, and human PTP1B (hPTP1B) can be
reconstituted into the knockouts for research on how PTP1B innervates BAT differentiation (1,
2). The targets of PTP1B can be analyzed utilizing a substrate-trapping PTP1B (hPTP1B D/A),
which acts similar to the KO due to its catalytic inactivation (1, 2). PTP1B differentiation can be
studied using Oil Red O stain in order to stain triglycerides (TG) and quantify the amount of
differentiation in the cells (1, 4). Presence for hPTP1B presence in reconstituted cells can be
determined utilizing SDS-PAGE protein separation and immunoblotting utilizing a PTP1B
antibody (5).
Previous studies have determined PTP1B’s role in inhibiting BAT differentiation and
decreasing energy expenditure in rat models (6). It has also been determined that a lack a PTP1B
improves insulin signaling, providing a gateway for treatment against insulin resistance (7). The
objective of our study was to add to the growing evidence that PTP1B is a crucial inhibitory
protein in BAT differentiation in order to provide a foreground for possible therapeutic studies
targeting PTP1B, thus providing and effective treatment against obesity and diabetes. We studied
this using three treatments of reconstituted PTP1B: hPTP1B knockout (KO), a substrate-binding
hPTP1B (D/A), and a wild type hPTP1B (WT). We hypothesized that hPTP1B KO and D/A
treatments would yield enhanced BAT differentiation compared to hPTP1B WT cells.
Trejo 3
	
  
METHODS
Oil Red O Staining of Cultured Cells
Intrascapular BAT cells were obtained from PTP1B knockout mice and immortalized.
The immortalized cells were transfected with either human PTP1B (hPTP1B WT), hPTP1B -/-
(hPTP1B KO), or substrate-trapping hPTP1B D/A. Six samples of each condition were cultured
in respective 35mm plates, three samples from each treatment were differentiated for eight days.
Each sample was subject to Oil Red O staining. The plates were washed with 2.0 mL of
PBS, followed by a 2.0mL formalin wash (27.0mL 37% Merck Cat# K36658003 + 63.0mL
ddH20 + 10.0mL 10xPBS), and a 15.0 minute incubation period at room temperature. After
removal of formalin solution, each sample was washed twice with 2.0 mL ddH20, followed by a
5.0 minute washing period with 60% isopropanol (Merck Cat# K36543834). The cells were then
dried for 15.0 minutes, followed by a 15.0 minute incubation at room temperature with working
Oil Red O Solution (Sigma (Cat# O-0625) 0.35g/100mL isopropanol + 4.0mL ddH20). Cells
were washed immediately four times with 2.0mL ddH20, followed by a 5.0 minute drying period.
The Oil Red O was eluted with 1.0mL of 100% isopropanol for 10.0 minutes. The resulting
solution was pipetted into a 1.5mL eppendorf tube and measured with a spectrophotometer at
500nm with a 100% isopropanol blank.
Standard Calibration Curve Preparation
The standard calibration curve was prepared by diluting the standard TG stock solution to
the following concentrations: 1.00, 0.20, 0.10, 0.05, and 0.02 mg/mL. The stock solutions were
measured at 500nm with a spectrophotometer with a 100% isopropanol blank.
Cell Lysis and Protein Extraction
One undifferentiated and one differentiated sample of each treatment was washed with
2.0 mL PBS solution. 1.0 mL of RIPA buffer was added to each plate, cells were scraped into the
Trejo 4
	
  
buffer and transferred to a small centrifuge tube. Samples were iced for 20.0 minutes and
vortexed every 3.0 minutes. Samples were centrifuged in Sorvall machine (SS3 4 rotor, 1700
rpm) for 10.0 minutes. The supernatant was used for protein assays, ran with SDS-PAGE, and
transferred to a cellulose sheet for western blot with an hPTP1B antibody as described in
previous protocols (1).
Statistical Analysis
Averages, standard deviations, and two sample paired t-test significant values were
calculated with Microsoft Excel formulas.
RESULTS
Standard Calibration Curve
A standard calibration curve created by averaging the absorption of various TG dilution
standards from the subgroups is depicted in Figure 1. TG concentrations of 0.02, 0.05, 0.10,
0.20, and 1.00 mg/ml yielded average absorption values of 0.04, 0.08, 0.14, 0.34, and 1.60
respectively. The five point calibration curve yielded an R2
value of 0.9996 and a correlation
equation of y=1.5998x.
Figure 1. Five-point standard calibration curve using the average absorption values of various
TG dilutions obtained from the six treatment groups. 	
  	
  
y	
  =	
  1.5998x	
  
R²	
  =	
  0.9996	
  
0.00	
  
0.20	
  
0.40	
  
0.60	
  
0.80	
  
1.00	
  
1.20	
  
1.40	
  
1.60	
  
1.80	
  
0.00	
   0.20	
   0.40	
   0.60	
   0.80	
   1.00	
   1.20	
  
Absorp'on	
  
Amount	
  of	
  TG	
  (mg/mL)	
  
Standard	
  Calibra'on	
  Curve	
  
Trejo 5
	
  
Figure 2. hPTP1B protein
western blot detection of hPTP1B
wildtype (WT), knockout (KO),
and substrate (D/A) treatments.
Cell Lysis and hPTP1B Western Blot
Cell lysis and western blot analysis of hPTP1B KO,
hPTP1B D/A, and two hPTP1B WT conditions with the hPTP1B
protein are depicted in Figure 2. The hPTP1B WT and
hPTP1B D/A treatments displayed expression for the hPTP1B
protein, while the hPTP1B KO treatment did not.
hPTP1B WT, KO, & D/A TG Quantification
The hPTP1B KO treatment conditions yielded the highest average differentiated and
undifferentiated cell TG quantifications (1.36 +/- 0.34 and 0.53 +/- 0.09 mg/ml respectively).
The hPTP1B WT condition yielded the least amount of TG compared to all treatments for
differentiated and undifferentiated cells (0.39 +/- 0.07 and 0.19 +/- 0.11 mg/ml respectively).
The hPTP1B D/A treatment yielded an average TG quantification of 0.73 +/- 0.12 and 0.29 +/-
0.06 mg/ml for differentiated and undifferentiated cells respectively.
Table 1. Undifferentiated/differentiated cells absorbance values and triglyceride quantifications
for PTP1B wild type (hPTP1B WT), knockout (hPTP1B), and substrate-trapped (hPTP1B D/A)
treatments. There was no significant difference between differentiated and undifferentiated TG
quantifications in all treatments (p>0.05).
Treatment
Undifferentiated
Cells Absorbance
Undifferentiated
Cells TG (mg/ml)
Average
TG
(mg/ml)
Differentiated
Cells
Absorbance
Differentiated
Cells TG
(mg/ml)
Average
TG
(mg/ml)
P-Value
(Diff. vs.
Undiff.)
hPTP1B
KO
0.958 0.60 0.53 +/-
0.09
2.56 1.60 1.36 +/-
0.34 0.130.753 0.47 1.79 1.12
hPTP1B
WT
0.439 0.27 0.19 +/-
0.11
0.704 0.44 0.39 +/-
0.07 0.100.179 0.11 0.549 0.34
hPTP1B
D/A
0.403 0.25 0.29 +/-
0.06
1.034 0.65 0.73 +/-
0.12 0.070.533 0.33 1.314 0.82
* Indicates significance at alpha=0.05
Trejo 6
	
  
A visual representation comparing the undifferentiated and differentiated TG
quantifications for the three treatment groups is depicted in Figure 3. The hPTP1B KO and
hPTP1B D/A treatments yielded greater BAT proliferation (152% and 154% respectively)
compared to the hPTP1B WT condition (136%). There was no significant difference between
differentiated and undifferentiated TG quantifications in all treatments (p>0.05). No significant
differences were found between hPTP1B KO and hPTP1B WT (p=0.88), hPTP1B KO and
hPTP1B D/A (p=0.87), or PTP1B WT and hPTP1B D/A BAT proliferation (p=0.86) at an alpha
level of 0.05.
Figure 3. Average undifferentiated vs. differentiated cells triglyceride quantifications for PTP1B
wild type (hPTP1B WT), knockout (hPTP1B), and substrate-trapped (hPTP1B D/A) treatments.
DISCUSSION
Cell Lysis and hPTP1B Western Blot
Cell lysis utilizing the RIPA buffer allowed for the degradation of the cellular membranes
of the triglycerides and the ability to access the proteins in each cell (Figure 2) (8). SDS-page
and western blot allowed us to separate the proteins by size and analyze the presence of hPTP1B
0	
  
0.5	
  
1	
  
1.5	
  
hPTP1B	
  KO	
  (n=2)	
   hPTP1B	
  WT	
  (n=2)	
   hPTP1B	
  D/A	
  (n=2)	
  
Amount	
  of	
  TG	
  (mg/ml)	
  
Treatment	
  
TG	
  Quan'fica'on:	
  Undifferen'ated	
  
vs.	
  Differen'ated	
  Cells	
  
UndifferenCated	
  Cells	
  	
   DifferenCated	
  Cells	
  	
  
Trejo 7
	
  
proteins in all three treatments by running an antibody for hPTP1B on the resulting blots (5).
After visualization of the antibody presence, we determined the hPTP1B protein was present in
the WT, but not the KO. This result indicates that successful incorporation of human PTP1B in
the WT conditions, allowing us to allocate the differences observed in our study to the lack of
PTP1B. The hPTP1B D/A condition yielded a positive presence for the hPTP1B, as expected and
shown in previous studies (1). However, the glutamic acid residue in the protein was exchanged
for alanine, yielding a protein that allows for binding of the substrate, but is catalytically
impaired (1, 9). Thus, this allowed us to quantify the effects of the inactive protein, further
allowing us to allocate differences between the conditions to a lack of functioning PTP1B.
BAT Differentiation among Treatments
In all three conditions, differentiated cells yielded higher absorbance values than their
respective undifferentiated cells (Table 1). Elution of Oil Red O from the stained TG in each
condition allowed us to quantify TG concentrations via absorption capability (1, 4); the increased
absorption values in our study correlate with increased TG presence, ultimately depicting
successful differentiation among the treatment groups. The data indicates a large standard
deviation for the average absorption values of hPTP1B WT undifferentiated cells. This may have
been due to experimental error; the Oil Red O strain was not completely eluted in the 100%
isopropanol solution in one sample, ultimately resulting in a decreased absorption value. This
consequently decreased the average differentiation observed in the hPTP1B WT treatment.
Nonetheless, our study yielded no significant differences in differentiation among the
three PTP1B treatment groups (p=0.88 WT vs. KO, p=0.87 KO vs. D/A, p=0.86 WT vs. D/A).
The results of our study fall in line with the results of a previous study conducted by Matsuo et
al., which found an insignificant trend among hPTP1B KO and D/A treatments compared to the
Trejo 8
	
  
WT control (1). However, the lack of significance among the treatments groups observed in our
study may also be due to the small sample size utilized for each treatment. Furthermore,
differentiation among the KO and D/A conditions were almost identical in our study (152% and
154% respectively), indicating similar differentiation patterns between both conditions. This
result falls in line with our hypothesis; in both conditions PTP1B was either not present or
catalytically inactive, thus similar differentiation patterns were expected.
The results from our study indicate increased differentiation patterns among the hPTP1B
KO treatment groups compared to the WT (Figure 3). Previous studies have depicted PTP1B’s
role in differentiation among BAT; a study conducted by Matsuo et al., found enhanced
differentiation among hPTP1B KO and D/A conditions, but a substantial decrease in
differentiation among sumoylation-resistant hPTP1B (1). Another study conducted by Song et al.
determined that adipocytes with an overexpressed version of PTP1B yielded a blunt decrease in
differentiation by 70%, while adipocytes with a knocked out version of PTP1B depicted higher
absorbance of Oil Red O in comparison to the control, indicating greater differentiation (10). The
results from these studies agree with the results determined in our study; PTP1B acts as a
negative regulator of adipocyte differentiation. A proposed mechanism for this observation was
determined in a study conducted by Soledad et al., which found that a lack of PTP1B acts as a
protective mechanism to decrease apoptosis in the induction phase of adipogenesis, ultimately
resulting in greater BAT differentiation (2).
Increased BAT proliferation has metabolically favorable effects, indicating possible
health benefits associated with inhibited PTP1B. BAT is characterized by increased
mitochondria and less TG storage compared to WAT; this morphology induces greater energy
expenditure among BAT in comparison to WAT (3). An analysis of 3,640 BAT compositions in
Trejo 9
	
  
humans found an inverse association between increased BAT and BMI, ultimately providing a
possible mechanism to control human metabolism (11). PTP1B KO studies in mice fed a high fat
diet found that the KO produced leaner mice with greater energy expenditure and decreased fat
stores (6); this depicts the health benefits of increased BAT differentiation and provides a
foreground for future research in human models. This research can be applied to humans in order
to increase BAT differentiation, increase energy expenditure, and increase weight loss- providing
a possible mechanism to combat obesity in the population.
hPTP1B: Possible Therapeutic Target
In addition to the previously described health benefits of PTP1B inhibition, the lack of
PTP1B has also been associated with increased induction of the insulin signaling pathway via
decreased inhibition of IR and IRS-1 (1). PTP1B inhibition has also been associated with
increased leptin sensitivity, providing a possible mechanism for increased energy expenditure.
(7). Thus, the exploitation of this pathway can possibly provide benefits for those suffering from
obesity and type II diabetes, making it a probable target for future therapeutic drugs. A problem
in the production of PTP1B inhibitory drugs lies in selectivity, as all PTP active sites are similar
in structure, thus making it difficult to specifically target PTP1B (7). Advancements have been
made in determining alternate binding mechanisms and increasing the potency of proposed
PTP1B inhibitors, solidifying the development of PTP1B inhibitors in the near future (7). Thus,
the results from our study solidify the findings that PTP1B acts as an inhibitor of BAT
differentiation, propagating future research in exploiting its pathways in order to create a market
for PTP1B inhibitors.
CONCLUSION
The results of our study indicate an increase in BAT differentiation among those cells
treated with hPTP1B KO and D/A treatments, as supported by previous studies. This supports
Trejo 10
	
  
our initial hypothesis that PTP1B plays a crucial role in inhibiting BAT differentiation. The
results from our study add to the growing evidence that PTP1B inhibition can play an important
role in the management of the obesity and diabetes epidemic in the population, however research
in human models needs to be conducted in order to gain validation. A weakness of our study
includes the small samples size utilized and the lack of analysis of PTP1B metabolic pathways;
we simply quantified TG in order to determine differentiation efficiency. This research has
propagated future studies that look into the effects of PTP1B in humans, in an attempt to further
clarify possible PTP1B therapeutic targets and provide a possible treatment for diabetes and
obesity.
REFERENCES
1. Matsuo K, Bettaieb A, Nagata N, Matsuo I, Keilhack H, Haj FG. Regulation of brown fat
adipogenesis by protein tyrosine phosphatase 1B. PLoS One 2011;6(1):e16446. doi:
10.1371/journal.pone.0016446.
2. Miranda S, González-Rodríguez Á, Revuelta-Cervantes J, Rondinone CM, Valverde ÁM.
Beneficial effects of PTP1B deficiency on brown adipocyte differentiation and protection
against apoptosis induced by pro- and anti-inflammatory stimuli. Cell Signal
2010;22(4):645-59. doi: http://dx.doi.org/10.1016/j.cellsig.2009.11.019.
3. Cannon B, Nedergaard J. Brown Adipose Tissue: Function and Physiological
Significance, 2004.
4. Koopman R, Schaart G, Hesselink M. Optimisation of oil red O staining permits
combination with immunofluorescence and automated quantification of lipids. Histochem
Cell Biol 2001;116(1):63-8. doi: 10.1007/s004180100297.
5. Bendickson L, Nilsen-Hamilton M. Western Blots and Other Applications. Edtion ed.
Making and Using Antibodies: CRC Press, 2013:275-301.
6. Klaman LD, Boss O, Peroni OD, Kim JK, Martino JL, Zabolotny JM, Moghal N, Lubkin
M, Kim Y-B, Sharpe AH, et al. Increased Energy Expenditure, Decreased Adiposity, and
Tissue-Specific Insulin Sensitivity in Protein-Tyrosine Phosphatase 1B-Deficient Mice.
Mol Cell Biol 2000;20(15):5479-89. doi: 10.1128/mcb.20.15.5479-5489.2000.
7. Zhang S, Zhang Z-Y. PTP1B as a drug target: recent developments in PTP1B inhibitor
discovery. Drug Discov Today 2007;12(9–10):373-81. doi:
http://dx.doi.org/10.1016/j.drudis.2007.03.011.
8. Reddi AH. Experimental Protocols. Edtion ed. Articular Cartilage: CRC Press, 2013:309-
78.
9. Flint AJ, Tiganis T, Barford D, Tonks NK. Development of “substrate-trapping” mutants
to identify physiological substrates of protein tyrosine  phosphatases. Proceedings of the
National Academy of Sciences 1997;94(5):1680-5.
Trejo 11
	
  
10. Song DD, Chen Y, Li ZY, Guan YF, Zou DJ, Miao CY. Protein tyrosine phosphatase 1B
inhibits adipocyte differentiation and mediates TNFalpha action in obesity. Biochim
Biophys Acta 2013;1831(8):1368-76. doi: 10.1016/j.bbalip.2013.05.006.
11. Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, Kuo FC, Palmer
EL, Tseng Y-H, Doria A, et al. Identification and Importance of Brown Adipose Tissue
in Adult Humans. New Engl J Med 2009;360(15):1509-17. doi:
doi:10.1056/NEJMoa0810780.

More Related Content

What's hot

Springer_CurrentMicrobiol_Mukherjee_2006
Springer_CurrentMicrobiol_Mukherjee_2006Springer_CurrentMicrobiol_Mukherjee_2006
Springer_CurrentMicrobiol_Mukherjee_2006
Dr.Gunjan Mukherjee
 
Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...
Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...
Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...
Federal University of Bahia
 
Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...
Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...
Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...
PerkinElmer, Inc.
 
DANSTAN MOGIRE senior paper
DANSTAN MOGIRE senior paperDANSTAN MOGIRE senior paper
DANSTAN MOGIRE senior paper
Danstan Arasa
 
Biotechniques v30p662 SNP
Biotechniques v30p662 SNPBiotechniques v30p662 SNP
Biotechniques v30p662 SNP
Michael Weiner
 
Proteome-wide covalent ligand discovery in native biological systems
Proteome-wide covalent ligand discovery in native biological systemsProteome-wide covalent ligand discovery in native biological systems
Proteome-wide covalent ligand discovery in native biological systems
Megha Majumder
 
housman_mini_4_5 foot PPT poster template 50 percent
housman_mini_4_5 foot PPT poster template 50 percenthousman_mini_4_5 foot PPT poster template 50 percent
housman_mini_4_5 foot PPT poster template 50 percent
Jonathan Oyler
 
Research Symposium Poster (Spring - April 2014)
Research Symposium Poster (Spring - April 2014)Research Symposium Poster (Spring - April 2014)
Research Symposium Poster (Spring - April 2014)
William Parker
 
OPG ELISA Assay Publication
OPG ELISA Assay PublicationOPG ELISA Assay Publication
OPG ELISA Assay Publication
Nihal Sarikaya
 
44-150724PST_Peptalk_2013_AlphaLISA_immunoassays
44-150724PST_Peptalk_2013_AlphaLISA_immunoassays44-150724PST_Peptalk_2013_AlphaLISA_immunoassays
44-150724PST_Peptalk_2013_AlphaLISA_immunoassays
Michael A. Lomotan
 
J. Lipid Res.-2011-Blade-237-44
J. Lipid Res.-2011-Blade-237-44J. Lipid Res.-2011-Blade-237-44
J. Lipid Res.-2011-Blade-237-44
Anna Blade Griffis
 

What's hot (20)

Springer_CurrentMicrobiol_Mukherjee_2006
Springer_CurrentMicrobiol_Mukherjee_2006Springer_CurrentMicrobiol_Mukherjee_2006
Springer_CurrentMicrobiol_Mukherjee_2006
 
Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...
Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...
Rho Kinase Promotes Alloimmune Responses by Regulating the Proliferation and ...
 
Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...
Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...
Non Invasive Label-Free Studies of Receptor Activation in Lonza® Primary Mese...
 
DANSTAN MOGIRE senior paper
DANSTAN MOGIRE senior paperDANSTAN MOGIRE senior paper
DANSTAN MOGIRE senior paper
 
nihms653583
nihms653583nihms653583
nihms653583
 
New Perspectives in GI Malignancies
New Perspectives in GI Malignancies New Perspectives in GI Malignancies
New Perspectives in GI Malignancies
 
Biotechniques v30p662 SNP
Biotechniques v30p662 SNPBiotechniques v30p662 SNP
Biotechniques v30p662 SNP
 
Proteome-wide covalent ligand discovery in native biological systems
Proteome-wide covalent ligand discovery in native biological systemsProteome-wide covalent ligand discovery in native biological systems
Proteome-wide covalent ligand discovery in native biological systems
 
housman_mini_4_5 foot PPT poster template 50 percent
housman_mini_4_5 foot PPT poster template 50 percenthousman_mini_4_5 foot PPT poster template 50 percent
housman_mini_4_5 foot PPT poster template 50 percent
 
Research Symposium Poster (Spring - April 2014)
Research Symposium Poster (Spring - April 2014)Research Symposium Poster (Spring - April 2014)
Research Symposium Poster (Spring - April 2014)
 
JMMB1_1
JMMB1_1JMMB1_1
JMMB1_1
 
OPG ELISA Assay Publication
OPG ELISA Assay PublicationOPG ELISA Assay Publication
OPG ELISA Assay Publication
 
ASMSPoster_2015
ASMSPoster_2015ASMSPoster_2015
ASMSPoster_2015
 
ASMS_Poster_TSG
ASMS_Poster_TSGASMS_Poster_TSG
ASMS_Poster_TSG
 
44-150724PST_Peptalk_2013_AlphaLISA_immunoassays
44-150724PST_Peptalk_2013_AlphaLISA_immunoassays44-150724PST_Peptalk_2013_AlphaLISA_immunoassays
44-150724PST_Peptalk_2013_AlphaLISA_immunoassays
 
ADME Model Presentation, September 2011
ADME Model Presentation, September 2011ADME Model Presentation, September 2011
ADME Model Presentation, September 2011
 
USRTP Poster
USRTP PosterUSRTP Poster
USRTP Poster
 
Strategies for bioanalysis of proteins using LC-MS
Strategies for bioanalysis of proteins using LC-MSStrategies for bioanalysis of proteins using LC-MS
Strategies for bioanalysis of proteins using LC-MS
 
Eur J Physiol 436 1998
Eur J Physiol 436 1998Eur J Physiol 436 1998
Eur J Physiol 436 1998
 
J. Lipid Res.-2011-Blade-237-44
J. Lipid Res.-2011-Blade-237-44J. Lipid Res.-2011-Blade-237-44
J. Lipid Res.-2011-Blade-237-44
 

Similar to Nutrition Reseach - Enhanced brown adipose tissue differentiation in PTP1B knockout samples

Discovery of Novel Shp2 inhibitors
Discovery of Novel Shp2 inhibitorsDiscovery of Novel Shp2 inhibitors
Discovery of Novel Shp2 inhibitors
Liwei Chen
 
special project cyp2e1 report
special project cyp2e1 reportspecial project cyp2e1 report
special project cyp2e1 report
Kemal Asik
 
Expression and Purification of His-tag β-galactosidase Enzyme from E.coli
 Expression and Purification of His-tag β-galactosidase Enzyme from E.coli Expression and Purification of His-tag β-galactosidase Enzyme from E.coli
Expression and Purification of His-tag β-galactosidase Enzyme from E.coli
Surayya Sana
 
Immune homeostasis
Immune homeostasisImmune homeostasis
Immune homeostasis
Springer
 

Similar to Nutrition Reseach - Enhanced brown adipose tissue differentiation in PTP1B knockout samples (20)

project work
project workproject work
project work
 
Corylin reduces obesity and insulin resistance and promotes adipose tissue ...
Corylin reduces obesity and insulin resistance  and  promotes adipose tissue ...Corylin reduces obesity and insulin resistance  and  promotes adipose tissue ...
Corylin reduces obesity and insulin resistance and promotes adipose tissue ...
 
Recombinant protein
Recombinant protein Recombinant protein
Recombinant protein
 
The Effects of Ibrutinib on Anti Apoptotic Proteins in PTLD
The Effects of Ibrutinib on Anti Apoptotic Proteins in PTLDThe Effects of Ibrutinib on Anti Apoptotic Proteins in PTLD
The Effects of Ibrutinib on Anti Apoptotic Proteins in PTLD
 
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassayExpt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
 
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassayExpt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
 
Purification of the T lymphocyte growth factor Interleukin-2 from cultured me...
Purification of the T lymphocyte growth factor Interleukin-2 from cultured me...Purification of the T lymphocyte growth factor Interleukin-2 from cultured me...
Purification of the T lymphocyte growth factor Interleukin-2 from cultured me...
 
Discovery of Novel Shp2 inhibitors
Discovery of Novel Shp2 inhibitorsDiscovery of Novel Shp2 inhibitors
Discovery of Novel Shp2 inhibitors
 
Expression Purification and Immunodetection of a fusion protein Glutathione S...
Expression Purification and Immunodetection of a fusion protein Glutathione S...Expression Purification and Immunodetection of a fusion protein Glutathione S...
Expression Purification and Immunodetection of a fusion protein Glutathione S...
 
Expression Purification and Immunodetection of a fusion protein Glutathione S...
Expression Purification and Immunodetection of a fusion protein Glutathione S...Expression Purification and Immunodetection of a fusion protein Glutathione S...
Expression Purification and Immunodetection of a fusion protein Glutathione S...
 
In vitro models of hepatotoxicity
In vitro models of hepatotoxicityIn vitro models of hepatotoxicity
In vitro models of hepatotoxicity
 
Tumor proteins
Tumor proteinsTumor proteins
Tumor proteins
 
Carbohydrate, isolation and purification techniques. A complete view.
Carbohydrate, isolation and purification techniques. A complete view.Carbohydrate, isolation and purification techniques. A complete view.
Carbohydrate, isolation and purification techniques. A complete view.
 
13506129.2012.668500
13506129.2012.66850013506129.2012.668500
13506129.2012.668500
 
Screening of anticholinesterases
Screening of anticholinesterasesScreening of anticholinesterases
Screening of anticholinesterases
 
special project cyp2e1 report
special project cyp2e1 reportspecial project cyp2e1 report
special project cyp2e1 report
 
In vitro models of hepatotoxicity
In vitro models of hepatotoxicityIn vitro models of hepatotoxicity
In vitro models of hepatotoxicity
 
Expression and Purification of His-tag β-galactosidase Enzyme from E.coli
 Expression and Purification of His-tag β-galactosidase Enzyme from E.coli Expression and Purification of His-tag β-galactosidase Enzyme from E.coli
Expression and Purification of His-tag β-galactosidase Enzyme from E.coli
 
Immune homeostasis
Immune homeostasisImmune homeostasis
Immune homeostasis
 
cancer biology(ppt)
 cancer biology(ppt) cancer biology(ppt)
cancer biology(ppt)
 

Nutrition Reseach - Enhanced brown adipose tissue differentiation in PTP1B knockout samples

  • 1. Enhanced brown adipose tissue differentiation in PTP1B knockout samples analyzed with Oil Red O staining Aroldo M. Trejo ABSTRACT Background: PTP1B has been associated with inhibitory effects on insulin signaling and brown adipose tissue (BAT) differentiation. Objective: The objective of our study was to determine whether a lack of PTP1B would enhance BAT differentiation. We hypothesized that the knockout treatment (hPTP1B KO) and the catalytically impaired treatment (hPTP1B D/A) would display greater differentiability compared to the WT treatment (hPTP1B WT). Design: PTP1B in BAT was knocked out in rats and various treatments of human PTP1B were reconstituted in the cells, resulting in hPTP1B WT, hPTP1B D/A, and hPTP1B KO conditions. After eight days of differentiation, differentiated cells for each treatments (n=2) were stained with Oil Red O. The Oil Red O was eluted and quantified using spectrophotometry, using triglyceride (TG) quantification as a marker of differentiation. Differentiated and undifferentiated cells of each conditioned were lysed and immunoblotted for determination of PTP1B presence. Results: The hPTP1B KO and hPTP1B D/A treatments yielded greater differentiation (152% and 154% respectively) compared to the hPTP1B WT condition (136%). However, there was no significant difference in differentiation patterns among the three treatments (p>0.05). Conclusion: PTP1B plays a crucial role in inhibiting BAT differentiation. The results from our study add to the growing evidence that PTP1B inhibition can play an important role in the management of the obesity and diabetes epidemic, providing a foreground for PTP1B-targeted therapeutic advancements in the near future.
  • 2. Trejo 2   INTRODUCTION Protein tyrosine phosphatase 1B (PTP1B) is an inhibitory protein that has been analyzed for its mediatory role in brown adipose tissue (BAT) differentiation (1, 2). BAT has been characterized by increased mitochondrial concentration and increased energy expenditure compared to white adipose tissue (WAT) (3), making it an interest in PTP1B studies. Studies have found that PTP1B can be knocked out in mice BAT, and human PTP1B (hPTP1B) can be reconstituted into the knockouts for research on how PTP1B innervates BAT differentiation (1, 2). The targets of PTP1B can be analyzed utilizing a substrate-trapping PTP1B (hPTP1B D/A), which acts similar to the KO due to its catalytic inactivation (1, 2). PTP1B differentiation can be studied using Oil Red O stain in order to stain triglycerides (TG) and quantify the amount of differentiation in the cells (1, 4). Presence for hPTP1B presence in reconstituted cells can be determined utilizing SDS-PAGE protein separation and immunoblotting utilizing a PTP1B antibody (5). Previous studies have determined PTP1B’s role in inhibiting BAT differentiation and decreasing energy expenditure in rat models (6). It has also been determined that a lack a PTP1B improves insulin signaling, providing a gateway for treatment against insulin resistance (7). The objective of our study was to add to the growing evidence that PTP1B is a crucial inhibitory protein in BAT differentiation in order to provide a foreground for possible therapeutic studies targeting PTP1B, thus providing and effective treatment against obesity and diabetes. We studied this using three treatments of reconstituted PTP1B: hPTP1B knockout (KO), a substrate-binding hPTP1B (D/A), and a wild type hPTP1B (WT). We hypothesized that hPTP1B KO and D/A treatments would yield enhanced BAT differentiation compared to hPTP1B WT cells.
  • 3. Trejo 3   METHODS Oil Red O Staining of Cultured Cells Intrascapular BAT cells were obtained from PTP1B knockout mice and immortalized. The immortalized cells were transfected with either human PTP1B (hPTP1B WT), hPTP1B -/- (hPTP1B KO), or substrate-trapping hPTP1B D/A. Six samples of each condition were cultured in respective 35mm plates, three samples from each treatment were differentiated for eight days. Each sample was subject to Oil Red O staining. The plates were washed with 2.0 mL of PBS, followed by a 2.0mL formalin wash (27.0mL 37% Merck Cat# K36658003 + 63.0mL ddH20 + 10.0mL 10xPBS), and a 15.0 minute incubation period at room temperature. After removal of formalin solution, each sample was washed twice with 2.0 mL ddH20, followed by a 5.0 minute washing period with 60% isopropanol (Merck Cat# K36543834). The cells were then dried for 15.0 minutes, followed by a 15.0 minute incubation at room temperature with working Oil Red O Solution (Sigma (Cat# O-0625) 0.35g/100mL isopropanol + 4.0mL ddH20). Cells were washed immediately four times with 2.0mL ddH20, followed by a 5.0 minute drying period. The Oil Red O was eluted with 1.0mL of 100% isopropanol for 10.0 minutes. The resulting solution was pipetted into a 1.5mL eppendorf tube and measured with a spectrophotometer at 500nm with a 100% isopropanol blank. Standard Calibration Curve Preparation The standard calibration curve was prepared by diluting the standard TG stock solution to the following concentrations: 1.00, 0.20, 0.10, 0.05, and 0.02 mg/mL. The stock solutions were measured at 500nm with a spectrophotometer with a 100% isopropanol blank. Cell Lysis and Protein Extraction One undifferentiated and one differentiated sample of each treatment was washed with 2.0 mL PBS solution. 1.0 mL of RIPA buffer was added to each plate, cells were scraped into the
  • 4. Trejo 4   buffer and transferred to a small centrifuge tube. Samples were iced for 20.0 minutes and vortexed every 3.0 minutes. Samples were centrifuged in Sorvall machine (SS3 4 rotor, 1700 rpm) for 10.0 minutes. The supernatant was used for protein assays, ran with SDS-PAGE, and transferred to a cellulose sheet for western blot with an hPTP1B antibody as described in previous protocols (1). Statistical Analysis Averages, standard deviations, and two sample paired t-test significant values were calculated with Microsoft Excel formulas. RESULTS Standard Calibration Curve A standard calibration curve created by averaging the absorption of various TG dilution standards from the subgroups is depicted in Figure 1. TG concentrations of 0.02, 0.05, 0.10, 0.20, and 1.00 mg/ml yielded average absorption values of 0.04, 0.08, 0.14, 0.34, and 1.60 respectively. The five point calibration curve yielded an R2 value of 0.9996 and a correlation equation of y=1.5998x. Figure 1. Five-point standard calibration curve using the average absorption values of various TG dilutions obtained from the six treatment groups.     y  =  1.5998x   R²  =  0.9996   0.00   0.20   0.40   0.60   0.80   1.00   1.20   1.40   1.60   1.80   0.00   0.20   0.40   0.60   0.80   1.00   1.20   Absorp'on   Amount  of  TG  (mg/mL)   Standard  Calibra'on  Curve  
  • 5. Trejo 5   Figure 2. hPTP1B protein western blot detection of hPTP1B wildtype (WT), knockout (KO), and substrate (D/A) treatments. Cell Lysis and hPTP1B Western Blot Cell lysis and western blot analysis of hPTP1B KO, hPTP1B D/A, and two hPTP1B WT conditions with the hPTP1B protein are depicted in Figure 2. The hPTP1B WT and hPTP1B D/A treatments displayed expression for the hPTP1B protein, while the hPTP1B KO treatment did not. hPTP1B WT, KO, & D/A TG Quantification The hPTP1B KO treatment conditions yielded the highest average differentiated and undifferentiated cell TG quantifications (1.36 +/- 0.34 and 0.53 +/- 0.09 mg/ml respectively). The hPTP1B WT condition yielded the least amount of TG compared to all treatments for differentiated and undifferentiated cells (0.39 +/- 0.07 and 0.19 +/- 0.11 mg/ml respectively). The hPTP1B D/A treatment yielded an average TG quantification of 0.73 +/- 0.12 and 0.29 +/- 0.06 mg/ml for differentiated and undifferentiated cells respectively. Table 1. Undifferentiated/differentiated cells absorbance values and triglyceride quantifications for PTP1B wild type (hPTP1B WT), knockout (hPTP1B), and substrate-trapped (hPTP1B D/A) treatments. There was no significant difference between differentiated and undifferentiated TG quantifications in all treatments (p>0.05). Treatment Undifferentiated Cells Absorbance Undifferentiated Cells TG (mg/ml) Average TG (mg/ml) Differentiated Cells Absorbance Differentiated Cells TG (mg/ml) Average TG (mg/ml) P-Value (Diff. vs. Undiff.) hPTP1B KO 0.958 0.60 0.53 +/- 0.09 2.56 1.60 1.36 +/- 0.34 0.130.753 0.47 1.79 1.12 hPTP1B WT 0.439 0.27 0.19 +/- 0.11 0.704 0.44 0.39 +/- 0.07 0.100.179 0.11 0.549 0.34 hPTP1B D/A 0.403 0.25 0.29 +/- 0.06 1.034 0.65 0.73 +/- 0.12 0.070.533 0.33 1.314 0.82 * Indicates significance at alpha=0.05
  • 6. Trejo 6   A visual representation comparing the undifferentiated and differentiated TG quantifications for the three treatment groups is depicted in Figure 3. The hPTP1B KO and hPTP1B D/A treatments yielded greater BAT proliferation (152% and 154% respectively) compared to the hPTP1B WT condition (136%). There was no significant difference between differentiated and undifferentiated TG quantifications in all treatments (p>0.05). No significant differences were found between hPTP1B KO and hPTP1B WT (p=0.88), hPTP1B KO and hPTP1B D/A (p=0.87), or PTP1B WT and hPTP1B D/A BAT proliferation (p=0.86) at an alpha level of 0.05. Figure 3. Average undifferentiated vs. differentiated cells triglyceride quantifications for PTP1B wild type (hPTP1B WT), knockout (hPTP1B), and substrate-trapped (hPTP1B D/A) treatments. DISCUSSION Cell Lysis and hPTP1B Western Blot Cell lysis utilizing the RIPA buffer allowed for the degradation of the cellular membranes of the triglycerides and the ability to access the proteins in each cell (Figure 2) (8). SDS-page and western blot allowed us to separate the proteins by size and analyze the presence of hPTP1B 0   0.5   1   1.5   hPTP1B  KO  (n=2)   hPTP1B  WT  (n=2)   hPTP1B  D/A  (n=2)   Amount  of  TG  (mg/ml)   Treatment   TG  Quan'fica'on:  Undifferen'ated   vs.  Differen'ated  Cells   UndifferenCated  Cells     DifferenCated  Cells    
  • 7. Trejo 7   proteins in all three treatments by running an antibody for hPTP1B on the resulting blots (5). After visualization of the antibody presence, we determined the hPTP1B protein was present in the WT, but not the KO. This result indicates that successful incorporation of human PTP1B in the WT conditions, allowing us to allocate the differences observed in our study to the lack of PTP1B. The hPTP1B D/A condition yielded a positive presence for the hPTP1B, as expected and shown in previous studies (1). However, the glutamic acid residue in the protein was exchanged for alanine, yielding a protein that allows for binding of the substrate, but is catalytically impaired (1, 9). Thus, this allowed us to quantify the effects of the inactive protein, further allowing us to allocate differences between the conditions to a lack of functioning PTP1B. BAT Differentiation among Treatments In all three conditions, differentiated cells yielded higher absorbance values than their respective undifferentiated cells (Table 1). Elution of Oil Red O from the stained TG in each condition allowed us to quantify TG concentrations via absorption capability (1, 4); the increased absorption values in our study correlate with increased TG presence, ultimately depicting successful differentiation among the treatment groups. The data indicates a large standard deviation for the average absorption values of hPTP1B WT undifferentiated cells. This may have been due to experimental error; the Oil Red O strain was not completely eluted in the 100% isopropanol solution in one sample, ultimately resulting in a decreased absorption value. This consequently decreased the average differentiation observed in the hPTP1B WT treatment. Nonetheless, our study yielded no significant differences in differentiation among the three PTP1B treatment groups (p=0.88 WT vs. KO, p=0.87 KO vs. D/A, p=0.86 WT vs. D/A). The results of our study fall in line with the results of a previous study conducted by Matsuo et al., which found an insignificant trend among hPTP1B KO and D/A treatments compared to the
  • 8. Trejo 8   WT control (1). However, the lack of significance among the treatments groups observed in our study may also be due to the small sample size utilized for each treatment. Furthermore, differentiation among the KO and D/A conditions were almost identical in our study (152% and 154% respectively), indicating similar differentiation patterns between both conditions. This result falls in line with our hypothesis; in both conditions PTP1B was either not present or catalytically inactive, thus similar differentiation patterns were expected. The results from our study indicate increased differentiation patterns among the hPTP1B KO treatment groups compared to the WT (Figure 3). Previous studies have depicted PTP1B’s role in differentiation among BAT; a study conducted by Matsuo et al., found enhanced differentiation among hPTP1B KO and D/A conditions, but a substantial decrease in differentiation among sumoylation-resistant hPTP1B (1). Another study conducted by Song et al. determined that adipocytes with an overexpressed version of PTP1B yielded a blunt decrease in differentiation by 70%, while adipocytes with a knocked out version of PTP1B depicted higher absorbance of Oil Red O in comparison to the control, indicating greater differentiation (10). The results from these studies agree with the results determined in our study; PTP1B acts as a negative regulator of adipocyte differentiation. A proposed mechanism for this observation was determined in a study conducted by Soledad et al., which found that a lack of PTP1B acts as a protective mechanism to decrease apoptosis in the induction phase of adipogenesis, ultimately resulting in greater BAT differentiation (2). Increased BAT proliferation has metabolically favorable effects, indicating possible health benefits associated with inhibited PTP1B. BAT is characterized by increased mitochondria and less TG storage compared to WAT; this morphology induces greater energy expenditure among BAT in comparison to WAT (3). An analysis of 3,640 BAT compositions in
  • 9. Trejo 9   humans found an inverse association between increased BAT and BMI, ultimately providing a possible mechanism to control human metabolism (11). PTP1B KO studies in mice fed a high fat diet found that the KO produced leaner mice with greater energy expenditure and decreased fat stores (6); this depicts the health benefits of increased BAT differentiation and provides a foreground for future research in human models. This research can be applied to humans in order to increase BAT differentiation, increase energy expenditure, and increase weight loss- providing a possible mechanism to combat obesity in the population. hPTP1B: Possible Therapeutic Target In addition to the previously described health benefits of PTP1B inhibition, the lack of PTP1B has also been associated with increased induction of the insulin signaling pathway via decreased inhibition of IR and IRS-1 (1). PTP1B inhibition has also been associated with increased leptin sensitivity, providing a possible mechanism for increased energy expenditure. (7). Thus, the exploitation of this pathway can possibly provide benefits for those suffering from obesity and type II diabetes, making it a probable target for future therapeutic drugs. A problem in the production of PTP1B inhibitory drugs lies in selectivity, as all PTP active sites are similar in structure, thus making it difficult to specifically target PTP1B (7). Advancements have been made in determining alternate binding mechanisms and increasing the potency of proposed PTP1B inhibitors, solidifying the development of PTP1B inhibitors in the near future (7). Thus, the results from our study solidify the findings that PTP1B acts as an inhibitor of BAT differentiation, propagating future research in exploiting its pathways in order to create a market for PTP1B inhibitors. CONCLUSION The results of our study indicate an increase in BAT differentiation among those cells treated with hPTP1B KO and D/A treatments, as supported by previous studies. This supports
  • 10. Trejo 10   our initial hypothesis that PTP1B plays a crucial role in inhibiting BAT differentiation. The results from our study add to the growing evidence that PTP1B inhibition can play an important role in the management of the obesity and diabetes epidemic in the population, however research in human models needs to be conducted in order to gain validation. A weakness of our study includes the small samples size utilized and the lack of analysis of PTP1B metabolic pathways; we simply quantified TG in order to determine differentiation efficiency. This research has propagated future studies that look into the effects of PTP1B in humans, in an attempt to further clarify possible PTP1B therapeutic targets and provide a possible treatment for diabetes and obesity. REFERENCES 1. Matsuo K, Bettaieb A, Nagata N, Matsuo I, Keilhack H, Haj FG. Regulation of brown fat adipogenesis by protein tyrosine phosphatase 1B. PLoS One 2011;6(1):e16446. doi: 10.1371/journal.pone.0016446. 2. Miranda S, González-Rodríguez Á, Revuelta-Cervantes J, Rondinone CM, Valverde ÁM. Beneficial effects of PTP1B deficiency on brown adipocyte differentiation and protection against apoptosis induced by pro- and anti-inflammatory stimuli. Cell Signal 2010;22(4):645-59. doi: http://dx.doi.org/10.1016/j.cellsig.2009.11.019. 3. Cannon B, Nedergaard J. Brown Adipose Tissue: Function and Physiological Significance, 2004. 4. Koopman R, Schaart G, Hesselink M. Optimisation of oil red O staining permits combination with immunofluorescence and automated quantification of lipids. Histochem Cell Biol 2001;116(1):63-8. doi: 10.1007/s004180100297. 5. Bendickson L, Nilsen-Hamilton M. Western Blots and Other Applications. Edtion ed. Making and Using Antibodies: CRC Press, 2013:275-301. 6. Klaman LD, Boss O, Peroni OD, Kim JK, Martino JL, Zabolotny JM, Moghal N, Lubkin M, Kim Y-B, Sharpe AH, et al. Increased Energy Expenditure, Decreased Adiposity, and Tissue-Specific Insulin Sensitivity in Protein-Tyrosine Phosphatase 1B-Deficient Mice. Mol Cell Biol 2000;20(15):5479-89. doi: 10.1128/mcb.20.15.5479-5489.2000. 7. Zhang S, Zhang Z-Y. PTP1B as a drug target: recent developments in PTP1B inhibitor discovery. Drug Discov Today 2007;12(9–10):373-81. doi: http://dx.doi.org/10.1016/j.drudis.2007.03.011. 8. Reddi AH. Experimental Protocols. Edtion ed. Articular Cartilage: CRC Press, 2013:309- 78. 9. Flint AJ, Tiganis T, Barford D, Tonks NK. Development of “substrate-trapping” mutants to identify physiological substrates of protein tyrosine  phosphatases. Proceedings of the National Academy of Sciences 1997;94(5):1680-5.
  • 11. Trejo 11   10. Song DD, Chen Y, Li ZY, Guan YF, Zou DJ, Miao CY. Protein tyrosine phosphatase 1B inhibits adipocyte differentiation and mediates TNFalpha action in obesity. Biochim Biophys Acta 2013;1831(8):1368-76. doi: 10.1016/j.bbalip.2013.05.006. 11. Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, Kuo FC, Palmer EL, Tseng Y-H, Doria A, et al. Identification and Importance of Brown Adipose Tissue in Adult Humans. New Engl J Med 2009;360(15):1509-17. doi: doi:10.1056/NEJMoa0810780.