Our results demonstrate that succinate release from adipose tissue is induced under metabolically disturbed conditions, including hyperglycaemia and hypoxia. Moreover, we find that the succinate signalling pathway is involved in the migration of macrophages towards adipose tissue, a crucial step in the development of obesity-induced adipose tissue inflammation leading to systemic glucose intolerance.
SUCNR1 activation mediates adipose tissue macrophage infiltration and glucose intolerance in obesity
SUCNR1 only needs a twofold increase in plasma or urinary succinate concentrations for a half-maximal response [
6,
9]. The effects of SUCNR1 signalling in adipose tissue were largely unknown, yet our results suggest a prominent role for SUCNR1 in the migration of macrophages towards obese adipose tissue. High levels of SUCNR1 expression by dendritic cells and macrophages have been reported previously [
22] and likely contribute to the SUCNR1 expression observed within the SVF of adipose tissue. In mice, SUCNR1 expression within the SVF appeared low compared with adipocytes. SUCNR1 may nevertheless have an important signalling function, especially during obesity-induced macrophage infiltration in adipose tissue; this is supported by our in vitro data showing enhanced SUCNR1 expression in murine macrophages exposed to adipose tissue explants. Remarkably, explants from obese mice did not increase SUCNR1 expression more than explants from lean mice, while HFD feeding enhanced SUCNR1 expression within the SVF of adipose tissue. Apparently, factors secreted by adipose tissue induce expression of
Sucnr1 in macrophages in vitro, while in vivo other factors in adipose tissue in HFD mice further enhance expression of
Sucnr1. Future research should evaluate whether SUCNR1 expression in the SVF is similarly increased in people with type 2 diabetes compared with controls, especially as our data revealed higher
SUCNR1 mRNA levels in the SVF vs adipocytes in humans.
Succinate has previously been identified as a chemoattractant for dendritic cells, with signalling via the SUCNR1 [
22]. Despite substantial SUCNR1 expression on macrophages [
22], we were unable to show any chemoattractant potential for succinate alone. In line with this, despite the migration observed with medium from apoptotic/hypoxic cells, the succinate concentration in medium from 3T3 cells was low and the difference in concentration was greater between medium from healthy 3T3 cells and control medium than between medium from stressed vs healthy cells. Importantly, the migration of U937 cells towards succinate previously published [
22] was very modest (8% of input cells) at a nearly saturating concentration of succinate (150 μmol/l). We and others found that the E
max (concentration of succinate at which all SUCNR1 receptors are bound and activated) is around 200 μmol/l. For dendritic cells, only 10% and 35% of input cells responded to E
max (225 μmol/l) and supra E
max (450 μmol/l) succinate concentrations, respectively. Moreover, another study showed that around E
50 succinate concentrations (corresponding to 50% E
max; ~100 μmol/l) did not affect migration of peritoneal macrophages [
25], in line with our observations in BMDMs. Thus, although a macrophage cell line has previously shown migration towards succinate, we and others could not confirm this using primary macrophages. This suggests that other factors secreted by apoptotic/hypoxic adipocytes, known to be present in enlarged adipose tissue in obesity [
26,
27], induce macrophage migration and that release of succinate from macrophages and auto/paracrine activation of macrophage SUCNR1 synergises with the initial factor to stimulate macrophage migration towards lipid-rich particles. A similar mechanism has been proposed for microglial cell accumulation in age-related macular degeneration, as SUCNR1-deficient microglial cells show impaired migration towards oxidised LDL (and are unresponsive to succinate) [
25]. Alternatively, SUCNR1 activation by succinate may induce cytoskeletal changes and polarisation of immune cells facilitating their migration.
Although Sucnr1
−/− BMDMs showed reduced expression of chemokine (C-C motif) receptor 1 (CCR1), we propose that the reduced migration of Sucnr1
−/− BMDMs is most likely not caused by reduced expression of CCR1 alone. Notably, migration per se towards ZAS as chemoattractant was not altered in BMDMs lacking SUCNR1. However, specific migration to conditioned adipocyte medium was affected in the absence of SUCNR1.
SUCNR1 deficiency does not affect pro- and anti-inflammatory markers in adipose tissue derived from HFD-fed mice or cytokine production in response to succinate and/or LPS in vitro. In dendritic cells, previous studies showed that succinate acts in synergy with toll-like receptor (TLR) ligands to potentiate the production of proinflammatory cytokines, at least partly via SUCNR1 [
22]. Our results suggest that succinate does not have similar effects on (adipose tissue) macrophages. The improvement of the adipose tissue inflammatory trait in the absence of the SUCNR1, as evidenced by our microarray analysis, can therefore most likely be explained by other mechanisms, including a reduction in the absolute number of macrophages.
We show that
Sucnr1
−/− mice display enhanced glucose tolerance on HFD feeding, despite having body weight similar to WT mice. This enables the study of the role of SUCNR1 in obesity-induced inflammation and metabolic disturbances independent of changes in body weight or adipose tissue weight. A recent study showed that
Sucnr1
−/− mice have increased body weight, with concurrent hyperglycaemia and impaired glucose tolerance [
28], in contrast to our observations. Strikingly, the results of this group varied with the type and length of HFD feeding. Only a prolonged dietary HFD intervention of 20 weeks caused metabolic disturbances, while chow-fed
Sucnr1
−/− mice had reduced adipose tissue weight. Moreover, even HFD feeding for only 11 weeks reduced body weight and tended to improve glucose tolerance [
28]. The dichotomous effects of SUCNR1 on the development of obesity in their experiments could possibly result from the specific Cre model used to generate their
Sucnr1
−/− mouse or the different diets/intervention periods [
28]. The authors suggest that the glucose intolerance likely concurs with the increased white adipose tissue weight after prolonged HFD feeding. The improvement in glucose tolerance in
Sucnr1
−/− mice can be the result of improved insulin sensitivity and/or reduced insulin secretion, something we cannot distinguish using our data. In addition, as we used total
Sucnr1
−/− mice, we cannot distinguish the effects of SUCNR1 deficiency in individual cell types, such as adipocytes vs macrophages. Future studies are needed to disentangle these effects.
Overall, our results have identified succinate and its receptor as a driver of obesity-induced inflammation and an important contributor to the migration of macrophages into adipose tissue, leading to the systemic glucose intolerance in obesity-induced type 2 diabetes. As such, our data put forward SUCNR1 as a promising therapeutic target to combat obesity-induced diabetes.