1. Introduction
Ectopic lipid infiltration and accumulation within the visceral organs are key underlying factors for a heightened risk of metabolic disease [
1]. Collectively, the actions of pancreatic steatosis and non-alcoholic fatty liver disease (NAFLD) are major determinants of cardiometabolic disease (CVD) [
2]. Ectopic lipid accumulation in the pancreas and liver is particularly notable as it has been demonstrated to be a key differentiator for the variation in type 2 diabetes mellitus (T2DM) and CVD risk across differing ethnicities [
3].
Whilst considerable attention is directed towards the impact of NAFLD and its relationship to metabolic disease risk [
2,
4], the importance of pancreatic steatosis as a causal mechanism implicated in pancreatic β-cell dysfunction and apoptosis has also been established [
5]. These impairments in pancreatic function are hallmark features for the loss of insulin secretory function present in T2DM [
6]. Detailed analysis of pancreatic steatosis and its relationship to metabolic disease risk has been an ongoing challenge due to the need to accurately quantify lipid accumulation within this small organ located deep in the retroperitoneal abdominal region [
7]. Recently described magnetic resonance imaging (MRI) and spectroscopy (MRS) methods are yielding advances in the precision of quantification [
8,
9]. However, these techniques remain technically challenging, precluding regular application clinically and experimentally [
10]. Hence, there is a need for suitable informative proxy measures or biomarkers that can be used for preliminary screening or potentially to provide additional insight into the pathogenesis of pancreatic steatosis.
MicroRNAs (miRNAs) are integral molecular negative regulators of transcriptional processes, with evidence that dysregulated circulatory miRNA abundances contribute to pathophysiological processes associated with the onset of metabolic diseases such as pancreatitis, insulin resistance (IR), liver and pancreatic steatosis [
11,
12]. miRNA expression is reported to be tissue specific although there is evidence for bidirectional crosstalk between metabolically active organs such as pancreas and liver [
13,
14]. For example, circulatory miR-375 [
15], an islet-cell enriched miRNA and a critical regulator of β-cell function [
16], has been reported to be involved in the development of non-alcoholic liver steatosis [
17] . Similarly, miR-122 [
18,
19], a liver specific miRNA, has been shown to exhibit significant differences in the blood of severe acute pancreatitis patients compared to healthy controls [
20]. Whilst, such crosstalk exists between several miRNAs, it is expected that the identification of potential-specific biomarkers of miRNAs may help predict or detect the development and progression of steatosis in these organs at an early stage, and therefore allow timely intervention. However, it remains yet to be known if any correlation exists between the abundance of these circulatory miRNAs and the degree of pancreas and liver steatosis as quantified using MRI/MRS techniques.
The aim of the current study was, therefore, to examine in a cohort of women the correlation between the abundances of a subset of circulatory miRNAs that have previously been identified to be associated with pancreatic and lipid steatosis with MRI and MRS-determined pancreatic (MR-%pancreatic) and liver fat (MR-%liver) . We analysed the circulatory miRNA levels in plasma of a cohort of women from the previously described TOFI (
Thin on the
Outside,
Fat on the
Inside) cohort consisting of Asian Chinese and European Caucasian ethnicities, lean and overweight, normoglycaemic and prediabetic [
21].
4. Discussion
The circulating abundances of ten candidate miRNAs implicated in the regulation of insulin production and pancreatitis risk were analysed in relation to MRI-determined pancreas % fat and MRS-determined liver % fat. Of these miRNAs, miR-21-3p and miR-320a exhibited a negative correlation, specifically for MR-%pancreas fat. Further, the abundances of these miRNAs correlated with biomarkers of metabolic disease, which includes circulatory C-peptide, HOMA2-IR, plasma insulin and HbA1c. Moreover, in a multivariate linear regression model involving BMI, FPG and plasma insulin as covariates, miR-21-3p showed a significant negative association with pancreatic steatosis irrespective of ethnicity.
In recent years, studies have shown that compared to the liver, the pancreas might be more sensitive to fat infiltration [
30]. However, there is no globally comparable cut-off for increased %pancreas fat, with evidence suggesting arbitrary values between 4.5%-6.5% in people with mild to morbid obesity [
30]. Based on the previous literature, this study used an arbitrary value of 4.5% as a cut-off for %pancreas fat [
30]. This threshold identified 39% of our cohort (n=25; mean age: 49±12y; BMI: 28.7±4.4 kg/m
2) as above the cut point. Interestingly, an ethnicity-specific relationship was observed between pancreas fat and BMI; Chinese women at a fixed BMI of 20-25 kg/m
2 had ~1% higher predicted pancreas fat than their Caucasian counterparts [
21]. For liver fat, where a cut-off of ≥5.6% can be considered elevated [
31], the mean %liver fat measured across the full cohort of 68 women was below this threshold (mean: 4.2±0.8%,
Table 1), with 22% (n=15; mean age: 50.1±13.0 y; BMI: 28.9±3.6 kg/m
2) of women were identified with elevated liver fat [
21]. Although the average of both %pancreas fat and liver fat were lower than the adopted thresholds, this study observed a significant correlation between %-pancreatic fat and circulatory miRNAs, possibly demonstrating that even small changes in the circulatory miRNAs would likely reflect the early stages of steatosis.
Upregulated expression of miR-21-3p is reported to be a general feature of tissue inflammation and fibrosis [
32]. miR-21-3p is shown to have pro-adipogenic characteristics [
33], with an upregulated expression in subcutaneous adipose tissues of obese human and animal models [
34]. Interestingly, under normal physiological conditions, miR-21-3p is highly expressed in the hepatocytes of mice, although minimally active [
35]. However, upon challenge with a high-fat diet in mice, miR-21-3p promotes metabolic derangements, including glucose intolerance, IR and steatosis [
36]. Furthermore, in rat models of pancreatitis, an upregulation of miR-21-3p expression is reported to aggravate the disease and promote pancreatic injury by activating the transient receptor potential (TRP) signalling pathway [
32]. In contrast, the current study observed a negative association between the measured circulatory abundance of miR-21-3p with that of MR-%pancreas fat. Although understanding the mechanism behind this discrepancy is out of the scope for this study, we assume the possible reason involved could be due to different species and/or different techniques used to quantify the abundance of miRNAs in this current study.
Although little is known about the role of miR-320a and pancreatic steatosis, altered expression of miR-320a has been observed in pancreatic cancer, IR, and pancreatic fibrosis [
37,
38].The observed correlation between miR-320a and pancreatic steatosis in this study might indicate a wide range of pathophysiological events within the pancreas and not specifically the measured steatosis. Clearly, mechanistic analysis is required to confirm the function of these miRNAs in the complex regulation of pancreatic function.
Variation in the deposition of pancreatic fat has been reported in different ethnicities [
39], with additional evidence for ethnicity impacting the expression patterns of miRNAs [
40]. Therefore, to elucidate the effect of different ethnicities of our study participants on the expression of miR-21-3p and miR-320a, a partial correlation of these miRNAs with MR-%pancreas fat while controlling for ethnicity was performed. Interestingly, the expression of these miRNAs still showed an inverse correlation with the MR-%pancreas fat, thus suggesting that miR-21-3p and miR-320a are associated with pancreatic fat independent of ethnicity.
There are some limitations to the findings of this study. There has been evidence of differences in the physiological processes of the pancreas based on the sex of an individual. For example, while analysing the secretin-induced exocrine pancreatic response in healthy men and women above and below the age of 45, it was observed that women over the age limit, compared to the males, secreted significantly less water and bicarbonate [
41]. Moreover, the authors also observed age and sex-dependent variations for lipase secretion, with a decreased secretion in women per mg of pancreatic tissue [
41]. There is no consensus around sex-specific miRNA expression and pancreatic steatosis. The present study was undertaken in females only and further studies examining potential sex-specificity in circulatory miRNA profiles and associations with pancreatic steatosis are required.. In addition, plasma miRNA profiling provides limited insights into tissue-specific exosomal miRNA expression as it cannot conclusively identify the tissue source of these miRNAs[
42]. Therefore, further elucidation of the clinical implications of the altered miRNA abundances on pancreatic steatosis and other metabolically active organs is required to ascertain systemic effects.
This study showed a correlation between MR-%pancreas fat and the abundance of circulating miRNAs. Irrespective of ethnicity, miR-21-3p was negatively correlated with the MR-%pancreas fat but not with MR-%liver fat. A significant correlation of both miRNAs was also observed with biomarkers related to impaired pancreatic endocrine function, including HOMA2-IR, HbA1c, and fasting plasma insulin. These analyses were exploratory and preliminary. Therefore, the clinical utility of these miRNAs as biomarkers of organ steatosis remains uncertain. However, this study highlights important observations that would help bridge the gap in understanding the underlying mechanisms linking miRNAs and the pathophysiology of pancreatic and liver steatosis.