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Abstract 


Infiltration of inflammatory macrophages into adipose tissues with the progression of obesity triggers insulin resistance and obesity-related metabolic diseases. We recently reported that macrophage-derived apoptosis inhibitor of macrophage (AIM) protein is increased in blood in line with obesity progression and is incorporated into adipocytes, thereby inducing lipolysis in adipose tissue. Here we show that such a response is required for the recruitment of adipose tissue macrophages. In vitro, AIM-dependent lipolysis induced an efflux of palmitic and stearic acids from 3T3-L1 adipocytes, thereby stimulating chemokine production in adipocytes via activation of toll-like receptor 4 (TLR4). In vivo administration of recombinant AIM to TLR4-deficient (TLR4(-/-)) mice resulted in induction of lipolysis without chemokine production in adipose tissues. Consistently, mRNA levels for the chemokines that affect macrophages were far lower in AIM-deficient (AIM(-/-)) than in wild-type (AIM(+/+)) obese adipose tissue. This reduction in chemokine production resulted in a marked prevention of inflammatory macrophage infiltration into adipose tissue in obese AIM(-/-) mice, although these mice showed more advanced obesity than AIM(+/+) mice on a high-fat diet. Diminished macrophage infiltration resulted in decreased inflammation locally and systemically in obese AIM(-/-) mice, thereby protecting them from insulin resistance and glucose intolerance. These results indicate that the increase in blood AIM is a critical event for the initiation of macrophage recruitment into adipose tissue, which is followed by insulin resistance. Thus, AIM suppression might be therapeutically applicable for the prevention of obesity-related metabolic disorders.

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Proc Natl Acad Sci U S A. 2011 Jul 19; 108(29): 12072–12077.
Published online 2011 Jul 5. https://doi.org/10.1073/pnas.1101841108
PMCID: PMC3141977
PMID: 21730133

Apoptosis inhibitor of macrophage (AIM) is required for obesity-associated recruitment of inflammatory macrophages into adipose tissue

Associated Data

Supplementary Materials

Abstract

Infiltration of inflammatory macrophages into adipose tissues with the progression of obesity triggers insulin resistance and obesity-related metabolic diseases. We recently reported that macrophage-derived apoptosis inhibitor of macrophage (AIM) protein is increased in blood in line with obesity progression and is incorporated into adipocytes, thereby inducing lipolysis in adipose tissue. Here we show that such a response is required for the recruitment of adipose tissue macrophages. In vitro, AIM-dependent lipolysis induced an efflux of palmitic and stearic acids from 3T3-L1 adipocytes, thereby stimulating chemokine production in adipocytes via activation of toll-like receptor 4 (TLR4). In vivo administration of recombinant AIM to TLR4-deficient (TLR4−/−) mice resulted in induction of lipolysis without chemokine production in adipose tissues. Consistently, mRNA levels for the chemokines that affect macrophages were far lower in AIM-deficient (AIM−/−) than in wild-type (AIM+/+) obese adipose tissue. This reduction in chemokine production resulted in a marked prevention of inflammatory macrophage infiltration into adipose tissue in obese AIM−/− mice, although these mice showed more advanced obesity than AIM+/+ mice on a high-fat diet. Diminished macrophage infiltration resulted in decreased inflammation locally and systemically in obese AIM−/− mice, thereby protecting them from insulin resistance and glucose intolerance. These results indicate that the increase in blood AIM is a critical event for the initiation of macrophage recruitment into adipose tissue, which is followed by insulin resistance. Thus, AIM suppression might be therapeutically applicable for the prevention of obesity-related metabolic disorders.

Keywords: diabetes, fatty acid synthase, CD36, knockout mouse

Chronic, low-grade inflammation observed in adipose tissues is characteristic of obesity. Such a subclinical inflammatory state of adipose tissues is highly associated with insulin resistance both in adipose tissue and systemically and thus contributes to the development of multiple obesity-induced metabolic and cardiovascular diseases (14). Evidence has shown that infiltration of a large number of classically activated inflammatory macrophages (M1 macrophages) into adipose tissue is responsible for obesity-associated inflammation (57). Lean adipose tissue contains a resident population of alternatively activated macrophages (M2 macrophages), which can suppress the inflammation of both adipocytes and macrophages partly via the secretion of interleukin (IL)-10. Hence, obesity induces a switch in macrophage activation state in adipose tissue toward M1 polarization, which leads to inflammation (812). However, the mechanism that promotes infiltration of inflammatory macrophages into obese adipose tissue is as yet unknown.

We recently reported that the apoptosis inhibitor of macrophage (AIM) protein (13) is incorporated into adipocytes via CD36-mediated endocytosis, and induces lipolysis by suppressing the activity of fatty acid synthase (FAS) (14). AIM is a member of the scavenger receptor cysteine-rich superfamily and was initially identified as an apoptosis inhibitor that supports the survival of macrophages against different types of apoptosis-inducing stimuli (13). AIM is a direct target for regulation by nuclear receptor liver X receptor/retinoid X receptor (LXR/RXR) heterodimers (15, 16) and is solely produced by tissue macrophages. As a secreted molecule, AIM is detected in both human and mouse blood at various levels (13, 1619) and increases in blood with the progression of obesity in mice fed a high-fat diet (HFD) (14). The augmented blood AIM induced lipolysis, as evident by the fact that the increase of free fatty acids (FFAs) and glycerol in blood was suppressed in AIM−/− mice (14). Owing to less lipolysis, adipocyte hypertrophy was more advanced and the overall mass of visceral adipose tissues was greater in AIM−/− than in AIM+/+ mice fed a HFD (14). All these observations imply that AIM-induced lipolysis might be responsible for the obesity-associated recruitment of adipose tissue macrophages.

In the present study, we assessed whether AIM affects macrophage accumulation in adipose tissues in obese mice. In addition, we determined the molecular mechanism of how AIM-dependent lipolysis results in the production of chemokines by adipocytes for the effective recruitment of adipose tissue macrophages. Finally, we investigated how the absence of AIM influences the local and systemic inflammatory state and insulin resistance in mice. On the basis of these results, we discuss the putative role of AIM in the initiation of obesity-associated chronic inflammation and subsequent metabolic diseases.

Results and Discussion

Prevention of M1 Macrophage Recruitment into Adipose Tissues in Obese AIM−/− Mice.

In AIM−/− mice, adipocyte hypertrophy was more advanced than in AIM+/+ mice, and the overall mass of visceral fat as well as body weight was markedly greater compared with that of AIM+/+ mice (14). Interestingly, however, far fewer macrophages stained with a pan-macrophage antibody F4/80 were observed in epididymal adipose tissue in AIM−/− mice than in AIM+/+ mice fed a HFD for 12 wk (Fig. 1A). The number of IL-6 stained inflammatory type (M1) macrophages in obese AIM−/− mice was markedly lower than in obese AIM+/+ mice (Fig. 1A). In addition, almost no M1 macrophage clusters forming crown-like structures (CLS) were observed in obese AIM−/− mice (Fig. 1A). In contrast, the number of M2 adipose tissue macrophages stained for mannose receptor (MR) was not increased in AIM+/+ or AIM−/− mice after a 12-wk HFD (Fig. 1B). Furthermore, the stromal-vascular cell fraction (SVF) containing macrophages was isolated from the epididymal fat tissue of lean and obese mice by collagenase treatment and assessed to determine the number of both types of macrophage by flow cytometry after staining for F4/80 and CD11b (macrophage), CD11c (M1 marker), and MR. Consistent with the histological data, the increase in M1 macrophage number was apparent in obese AIM+/+ but not in obese AIM−/− mice (Fig. S1A). The M1/M2 ratio of macrophage number was significantly increased in obese AIM+/+ than in lean AIM+/+ mice, indicating M1 polarization of adipose tissue macrophage (9), whereas this was comparable in lean and obese AIM−/− mice (Fig. S1B). Similarly, quantitative RT-PCR (QPCR) analysis with RNA isolated from epididymal fat showed a remarkable increase in mRNA levels for M1 macrophage marker genes, such as CD11c and iNOS, after a 12-wk HFD in AIM+/+ mice, whereas this was not apparent in AIM−/− mice (Fig. S1C). In addition, expression levels of antiinflammatory (M2) macrophage marker genes, such as CD163, MR, and arginase, were decreased in epididymal fat of AIM+/+ mice fed a HFD, whereas this was not observed in AIM−/− mice (Fig. S1C). The reduction in mRNA levels of M2 markers in obese AIM+/+ mice is consistent with the increase in the M1/M2 ratio of macrophage number in obese AIM+/+ mice (Fig. 1D). The difference in macrophage accumulation in fat in the presence or absence of AIM was not predominantly brought about by the antiapoptotic effect of AIM (13, 20) because the apoptotic state of macrophages (and also of adipocytes) was comparable between obese AIM+/+ and AIM−/− epididymal adipose tissues, as assessed by TUNEL staining (Fig. S2). These results implicate an indispensable role of AIM in the obesity-associated recruitment of adipose tissue macrophages.

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Requirement of AIM for macrophage recruitment into obese adipose tissue. (A and B) Specimens of epididymal fat tissue from lean (0 wk) or obese (fed a HFD for 12 wk) AIM+/+ and AIM−/− mice were costained for F4/80 (pan-macrophage marker; green), IL-6 (red), and Hoechst (blue) for A, and F4/80 (pan-macrophage marker; green), mannose receptor (MR) (red), and Hoechst (blue) for B. (Scale bar, 200 μm.) Quantification of F4/80+ cell number, IL-6+ macrophages, and the number of crown-like structures (CLS) are presented for A, or F4/80+ cell number and MR+ macrophages for B are presented. At least three different areas in three different sections per mouse were analyzed in six to eight mice of each genotype. Results are presented as averages ± SEM.

AIM-Dependent Lipolysis Induces Macrophage Migration.

We then tested whether AIM itself attracts macrophages. However, AIM showed no chemoattractive activity in a macrophage migration assay using RAW264.1 mouse macrophage cells (Fig. 2A, Left). In contrast, conditioned medium from 3T3-L1 adipocytes that had been challenged with rAIM for 72 h (AIM CM) efficiently attracted macrophage cells (Fig. 2A, Left). A comparable effect was observed with conditioned medium from cells treated with C75, a specific FAS inhibitor that also induces lipolysis (14). AIM CM also attracted J774.1 mouse monocyte cells (Fig. S3A). Furthermore, 3T3-L1 adipocytes were treated with rAIM in the presence of a CD36-neutralizing antibody (mouse IgA), which inhibits AIM-dependent lipolysis by disturbing the endocytosis of AIM into adipocytes (14), and the conditioned medium (AIM+αCD36 CM) was assessed in the macrophage migration assay. The AIM+αCD36 CM did not efficiently attract macrophages (Fig. 2A, Right), suggesting that AIM-induced lipolysis in adipocytes appears to be responsible for macrophage recruitment. The CD36-neutralizing antibody itself had no direct effect on the macrophage migration (Fig. S3B).

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AIM-dependent lipolysis induces chemokine production in adipocytes via TLR4 stimulation. (A) Chemotaxis of RAW 264.1 cells in response to specified stimulant. Attractants: rAIM (25 μg/mL), C75 (25 μM), AIM CM/C75 CM: conditioned medium from 3T3-L1 adipocytes treated for 3 d with rAIM (25 μg/mL) or C75 (25 μM), respectively; AIM+αCD36 CM/AIM+IgA CM: conditioned medium from 3T3-L1 adipocytes treated for 3 d with rAIM (25 μg/mL) in the presence of anti-CD36 Ab or mouse IgA (10 μg/mL each), respectively; none CM, control CM: treated without rAIM or C75; and FM: fresh DMEM culture medium containing 10% FBS. Averages from n = 3 ± SEM. MCP-1 (100 ng/mL) was used as a positive control. (B) Degradation of IkBα in 3T3-L1 adipoctytes in response to specified stimulant in the absence (−) or presence (+) of a TIRAP inhibitor (100 μM). LPS (100 ng/mL) was used as a positive control. Representative immunoblotting results are presented. The density of the signal was quantified using National Institutes of Health Image J image analysis software and presented as values relative to those of prestimulation (Lower two panels). n = 3. Error bar: SEM. *, versus the value at prestimulation (0 min). (C) QPCR analysis of mRNA levels for MCP-1, CCL5/RANTES, MCP-2, and MCP-3 using RNA isolated from 3T3-L1 adipocytes treated with specified stimulant for 24 h in the absence (white bars) or presence (black bars) of a TIRAP inhibitor. Values were presented as relative expression to those without stimulation (none). n = 3 for each. Error bar: SEM. (D and E) No degradation of IkBα or expression induction of mRNA for chemokine genes in 3T3-L1 adipoctytes in response to rAIM alone (25 μg/mL) (D) or AIM+αCD36 CM (E).

Fatty Acids Effluxed from Adipocytes in Response to AIM-Dependent Lipolysis Stimulated TLR Signaling Pathway and Induced Chemokine Production in Adipocytes.

Accumulating evidence has demonstrated that saturated fatty acids activate TLR signaling cascade and that this response is tightly associated with obesity-induced inflammation (2125). Thus, it is plausible that an increase in blood AIM may induce vigorous lipolysis in obese adipose tissues, and saturated fatty acids effluxed from adipocytes as a result of lipolysis might activate chemokine production in adipocytes via the stimulation of TLR(s) in a paracrine/autocrine fashion (2628). Indeed, palmitic and stearic acids, the major fatty acids comprising triglyceride droplets (29) and well known as stimulators of TLR4 and TLR2 (21, 25, 30, 31), were identified as the components released by adipocytes in response to lipolysis induced by AIM or C75 when the profile of fatty acids in AIM CM and C75 CM was evaluated by gas-chromatography mass-spectrometry analysis.

Consistent with this result, both AIM CM and C75 CM efficiently stimulated the TLR signaling cascade and chemokine production in 3T3-L1 adipocytes, as assessed by degradation of IkBα (Fig. 2B) and mRNA expression of chemokines such as MCP-1, CCL5/RANTES, MCP-2, and MCP-3, which affects macrophages (Fig. 2C). AIM CM induced substantial levels of protein of these chemokines as assessed by ELISA (Fig. S4A). These responses diminished when adipocytes were treated with AIM CM or C75 CM in the presence of a toll–interleukin-1 receptor domain containing adapter protein (TIRAP) inhibitor, which specifically interferes with the interaction of TLR4 (as well as TLR2) and the adapter protein TIRAP/Mal, resulting in attenuation of TLR signaling (Fig. 2 B and C) (32). Furthermore, we confirmed that similar effects of TLR activation and chemokine production were observed when 3T3-L1 adipocytes were treated with palmitic acid (PA) or stearic acid (SA) and that the responses induced by each fatty acid were reduced when subjected to the TIRAP inhibitor (Fig. S5). Consistent with the results from macrophage migration assay presented in Fig. 2A, neither rAIM alone (Fig. 2D and Fig. S4B) nor AIM+αCD36 CM (Fig. 2E and Fig. S4C) stimulated IkBα degradation or chemokine mRNA and protein expression in adipocytes. These findings clearly indicate the necessity of the lipolytic process in the overall activation of TLR signaling cascade by AIM.

Involvement of TLR4.

As TIRAP is downstream of not only TLR4 but also other TLRs, including TLR2 (32), the precise involvement of TLR4 in macrophage recruitment was further verified. We first suppressed TLR4 expression by siRNA in 3T3-L1 adipocytes and assessed the induction of MCP-1 by AIM CM. As shown in Fig. S6 AC, induction of both mRNA and protein of MCP-1 by AIM CM was significantly reduced in cells transfected with siRNA for TLR4. In addition, we injected rAIM i.v. into wild-type and TLR4−/− mice and thereafter assessed the state of lipolysis and chemokine production in epididymal adipose tissue. In both types of mice, the mRNA levels of FSP27 (also called Cidec), Perilipin, and Adipophilin, coating elements for lipid droplets, were decreased after challenging with rAIM (Fig. 3A), a finding consistent with the progression of lipolysis reported previously (17, 33, 34). Similarly, the increase in blood FFA and glycerol levels was equivalent in TLR4−/− and wild-type mice (Fig. 3B). In contrast, induction of mRNA for chemokines by rAIM injection was significantly less efficient in TLR4−/− than in wild-type mice (Fig. 3C). In line with this, phosphorylation levels of c-Jun N-terminal kinases (JNKs) in epididymal fat, which represent the state of TLR activation, were up-regulated in wild-type mice but not in TLR4−/− mice (Fig. 3D). Furthermore, the rAIM injection increased mRNA levels for M1 macrophage markers in epididymal adipose tissue of wild-type but not TLR4−/− mice, demonstrating that AIM-induced lipolysis could not recruit inflammatory macrophages into adipose tissue in the absence of TLR4 (Fig. 3E). There was no significant change in mRNA levels for M2 macrophage markers in both TLR4−/− and wild-type mice (Fig. 3E). Histological analysis revealed the presence of IL-6 expressing M1 macrophages after the rAIM injection in epididymal adipose tissue of wild-type mice but not of TLR4−/− mice (Fig. S6D).

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Involvement of TLR4 in adipose tissue macrophage recruitment by AIM in vivo. (AE) TLR4−/− and wild-type littermate mice (B6 background) were i.v. injected with rAIM or BSA three times every other day (400 μg in 200 μL PBS per injection). The day after the third injection (day 8 from the first injection), mice were killed, and lipolysis, chemokine expression, and adipose tissue macrophage accumulation were analyzed. n = 5 for each. (A) mRNA levels for FSP27, Perilipin, and Adipophilin were assessed by QPCR using RNA isolated from epididymal fat. Values were presented as relative expression to those of fat tissue injected with BSA. Error bar: SEM. (B) Serum levels for FFA and glycerol. (C) mRNA levels for chemokines. (D) Immunoblotting for total and phosphorylated JNK in epididymal fat. Immunoblot for β-actin is also presented. Results from three mice for each group are presented. Note that comparable results were obtained in five independent mice in each group. (E) mRNA levels for F4/80 pan-macrophage marker, M1 and M2 macrophage markers to assess macrophage recruitment. (F) Immunoblotting for total and phosphorylated JNK using lysates obtained from epididymal fats of AIM+/+ and AIM−/− mice fed a HFD for 12 wk (n = 4–6). Relative values of phosphorylated JNK signals to total JNK are also presented (Lower graph). (G) QPCR analysis of mRNA levels for chemokine genes in epididymal fat tissue and (H) serum MCP-1 concentration in AIM+/+ and AIM−/− mice fed a HFD for 0 (lean) or 12 wk (obese); n = 6–8.

Consistent results were obtained in obese AIM+/+ and AIM−/− mice after 12 wk on a HFD. In epididymal fat, phosphorylation levels of JNKs were decreased in AIM−/− mice compared with AIM+/+ mice (Fig. 3F). In addition, chemokine mRNA levels were also lower in AIM−/− than in AIM+/+ adipose tissue (Fig. 3G). Moreover, the serum level of MCP-1 was lower in AIM−/− than in AIM+/+ mice (Fig. 3H).

It is possible that fatty acids effluxed from adipocytes may stimulate TLR4 expressed not only on adipocytes but also on resident M2 macrophages within adipose tissue in a paracrine fashion and may induce chemokine expression in macrophages. To assess this possibility, we stained epididymal fat from wild-type AIM+/+ mice fed a HFD for 6 wk for MR, a M2 macrophage marker, and MCP-1. As shown in Fig. S7, both adipocytes and M2 macrophages stained positive for MCP-1. As expected, in AIM−/− mice, neither adipocytes nor resident macrophages showed obvious MCP-1 expression. Thus, in summary, AIM-induced lipolysis provoked the efflux of saturated fatty acids, including palmitic and stearic acids, from adipocytes, and these fatty acids stimulated chemokine production in both adipocytes and resident macrophages via TLR4 activation, resulting in M1 macrophage migration.

Prevention of Obesity-Associated Inflammation and Insulin Resistance in AIM−/− Mice.

As a consequence of abolished infiltration of inflammatory macrophages, the progression of obesity-associated inflammation was prevented both locally and systemically in obese AIM−/− mice. In adipose tissue (Fig. 4A) and the liver (Fig. S8), mRNA levels for proinflammatory cytokines, such as TNFα, IL-6, and IL-1β, were significantly lower in AIM−/− than in AIM+/+ mice after a HFD for 12 wk. Consistent with this finding, serum levels of TNFα and IL-6 were lower in AIM−/− mice compared with AIM+/+mice (Fig. 4B).

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Prevented inflammation and normal insulin sensitivity in obese AIM−/− mice. (A) Local inflammation. QPCR analysis of mRNA levels for inflammatory cytokine genes in epididymal fat tissue from AIM+/+ or AIM−/− mice fed a HFD for 0 (lean) or 12 wk (obese). n = 6–8 for each group. Values were presented as relative expression to that in lean AIM+/+ mice. Error bar: SEM. (B) Systemic inflammation. Serum TNFα and IL-6 levels are the same as in A. (C) AIM−/− and AIM+/+ mice fed a HFD for 12 wk (three mice for each) were fasted for 5 h and treated with insulin (10 U/kg body weight) via i.p. injection. Within 15 min, epididymal fat, skeletal muscle (gastrocnemius), and liver were isolated and examined by immunoblotting for phosphorylated AKT (p-AKT), total AKT, phosphorylated GSK3β (p-GSK3β), total GSK3 (α and β), and β-actin. (D) Glucose tolerance test (GTT) and insulin tolerance test (ITT) performed on AIM+/+ and AIM−/− mice fed a HFD for 0 (lean) or 12 wk (obese); n = 6–8 for each group. For ITT, two panels including absolute blood glucose levels (Left) and % of the initial (time 0) glucose level (Right) are presented.

Having observed decreased inflammation in AIM−/− mice, we next assessed insulin sensitivity in AIM−/− and AIM+/+ mice fed a HFD for 12 wk. Activation of the insulin signaling pathway after i.v. injection of insulin was studied in adipose tissue, skeletal muscle (gastrocnemius), and liver. As shown in Fig. 4C, substantial insulin-stimulated phosphorylation of AKT and GSK3β protein kinases was observed in all three tissues in AIM−/− mice in contrast to the markedly diminished phosphorylation levels in AIM+/+ mice. Thus, insulin sensitivity was preserved in obese AIM−/− mice. Consistent with these results, whole-body glucose intolerance and insulin resistance observed in AIM+/+ mice were found to be ameliorated in AIM−/− mice by i.p. glucose and insulin tolerance tests (GTT and ITT, respectively; Fig. 4D). Insulin production in pancreatic β cells in response to glucose was comparable in AIM−/− and AIM+/+ mice, as assessed in vivo (Fig. S8B) and in vitro using isolated pancreatic Langerhans islets (Fig. S8C).

Conclusion

The present results provide unique and important evidence regarding the role of AIM in the initiation of chronic inflammation that connects obesity and insulin resistance. Firstly, macrophage recruitment into obese adipose tissues requires AIM-induced lipolysis. Augmentation of blood AIM levels may induce vigorous lipolysis in obese adipose tissues, increasing local extracellular fatty acid concentration to a level sufficient for the stimulation of TLR4, which triggers chemokine production by adipocytes and macrophage recruitment (summarized in Fig. S9). Although we and others previously reported some related facts underlying this conclusion, which were observed in a number of different physiological and experimental conditions (12, 14, 2133), we would like to emphasize that this study, which focused on AIM, has uniquely linked apparently independent elements to a process that occurs during the progression to obesity.

Secondly, adipocyte hypertrophy is not solely sufficient for the initiation of macrophage infiltration; an increase in blood AIM needs to be accompanied. In AIM−/− mice, although the level of AIM-independent lipolysis increases in line with adipocyte hypertrophy (14), it may not reach a level sufficient for macrophage recruitment (Fig. S9). Thirdly, within adipose tissue, crosstalk between macrophages and adipocytes establishes a vicious cycle that accelerates inflammation; saturated fatty acids brought about by lipolysis activate TLR4 to induce TNFα, which in turn activates the TNFα receptor to produce inflammatory cytokines/adipokines and chemokines (35). The end point of this response is further progression of inflammation, lipolysis, and macrophage recruitment. It is likely that via an increase in lipolysis, AIM may strengthen this crosstalk, further contributing to the progression of inflammation (Fig. S9).

Thus, this study might not only advance our knowledge about the events triggering obesity-associated inflammation, but also open a door to the development of next-generation antimetabolic therapies via suppression of AIM.

Materials and Methods

Mice.

AIM−/− mice (13) had been backcrossed to C57BL/6 (B6) for 13 generations before used for experiments. HFD (HFD32, fat kcal: 60%) was purchased from CREA. TLR4−/− mice (36) were kindly provided from Drs. S. Akira (Osaka University, Osaka, Japan) and K. Miyake (The Institute of Medical Science, University of Tokyo, Tokyo, Japan). All mice were maintained under a specific pathogen free condition.

Statistical Analysis.

A two-tailed Mann-Whitney test was used to calculate P values. ***P < 0.001, **P < 0.01, *P < 0.05. Error bars: SEM.

Please see SI Materials and Methods for further details.

Supplementary Material

Supporting Information:

Acknowledgments

We thank Genostaff Inc. for technical assistance in histology. This work was supported by Grants-in-Aid for Scientific Research (B) (Japan Society for the Promotion of Science), the Global Centers of Excellence (COE) Program (T.M.), Kanae Foundation for the Promotion of Medical Science, the Astellas Foundation for Research on Metabolic Disorders, and the Ono Medical Research Foundation (S.A.).

Footnotes

The authors declare no conflict of interest.

*This Direct Submission article had a prearranged editor.

This article contains supporting information online at www.pnas.org/lookup/suppl/10.1073/pnas.1101841108/-/DCSupplemental.

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