Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease

Background The Fontan operation is the current standard of care for single‐ventricle congenital heart disease. Almost all patients with Fontan operation develop liver fibrosis at a young age, known as Fontan‐associated liver disease (FALD). The pathogenesis and mechanisms underlying FALD remain litt...

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Main Authors: Rasheed Sule, Po Hu, Clarissa Shoffler, Christopher Petucci, Benjamin J. Wilkins, Jack Rychik, Liming Pei
Format: Article
Language:English
Published: Wiley 2025-03-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
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Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.124.039201
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author Rasheed Sule
Po Hu
Clarissa Shoffler
Christopher Petucci
Benjamin J. Wilkins
Jack Rychik
Liming Pei
author_facet Rasheed Sule
Po Hu
Clarissa Shoffler
Christopher Petucci
Benjamin J. Wilkins
Jack Rychik
Liming Pei
author_sort Rasheed Sule
collection DOAJ
description Background The Fontan operation is the current standard of care for single‐ventricle congenital heart disease. Almost all patients with Fontan operation develop liver fibrosis at a young age, known as Fontan‐associated liver disease (FALD). The pathogenesis and mechanisms underlying FALD remain little understood, and there are no effective therapies. We aimed to present a comprehensive multiomic analysis of human FALD, revealing the fundamental biology and pathogenesis of FALD. Methods and Results We recently generated a single‐cell transcriptomic and epigenomic atlas of human FALD using single‐nucleus multiomic RNA sequencing and assay for transposase‐accessible chromatin using sequencing, which uncovered substantial metabolic reprogramming. Here, we applied liquid chromatography–mass spectrometry–based untargeted metabolomics to unveil the metabolomic landscape of human FALD, using liver samples/biopsies from age‐ and sex‐matched donors and patients with FALD (n=12 per group). Results were integrated with liver single‐nucleus multiomic RNA sequencing and assay for transposase‐accessible chromatin using sequencing and serum metabolomics data to present a comprehensive multiomic atlas of FALD.We discovered significant metabolic abnormalities in livers of adolescent patients with Fontan circulation, particularly amino acid metabolism, peroxisomal fatty acid oxidation, cytochrome P450 system, glycolysis, tricarboxylic acid cycle, ketone body metabolism, and bile acid metabolism. Integrated analyses with liver single‐nucleus multiomic RNA sequencing and assay for transposase‐accessible chromatin using sequencing results unveiled potential underlying mechanisms of these metabolic changes. Comparison with serum metabolomics data indicate that liver metabolic reprogramming contributes to circulatory metabolomic changes in FALD. Furthermore, comparison with metabolomics data of human metabolic dysfunction–associated fatty liver disease and metabolic dysfunction–associated steatohepatitis highlighted dysregulated amino acid metabolism as a common metabolic abnormality. Conclusions Our comprehensive multiomic analyses reveal new insights into the fundamental biology and pathogenesis mechanisms of human FALD.
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spelling doaj-art-0cf58a55bbd54c1e89b7e3981cd234f82025-08-20T03:07:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-03-0114610.1161/JAHA.124.039201Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver DiseaseRasheed Sule0Po Hu1Clarissa Shoffler2Christopher Petucci3Benjamin J. Wilkins4Jack Rychik5Liming Pei6Center for Mitochondrial and Epigenomic Medicine Children’s Hospital of Philadelphia Philadelphia PA USACenter for Mitochondrial and Epigenomic Medicine Children’s Hospital of Philadelphia Philadelphia PA USACardiovascular Institute, Perelman School of Medicine University of Pennsylvania Philadelphia PA USACardiovascular Institute, Perelman School of Medicine University of Pennsylvania Philadelphia PA USADepartment of Pathology and Laboratory Medicine Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA USACenter for Mitochondrial and Epigenomic Medicine Children’s Hospital of Philadelphia Philadelphia PA USABackground The Fontan operation is the current standard of care for single‐ventricle congenital heart disease. Almost all patients with Fontan operation develop liver fibrosis at a young age, known as Fontan‐associated liver disease (FALD). The pathogenesis and mechanisms underlying FALD remain little understood, and there are no effective therapies. We aimed to present a comprehensive multiomic analysis of human FALD, revealing the fundamental biology and pathogenesis of FALD. Methods and Results We recently generated a single‐cell transcriptomic and epigenomic atlas of human FALD using single‐nucleus multiomic RNA sequencing and assay for transposase‐accessible chromatin using sequencing, which uncovered substantial metabolic reprogramming. Here, we applied liquid chromatography–mass spectrometry–based untargeted metabolomics to unveil the metabolomic landscape of human FALD, using liver samples/biopsies from age‐ and sex‐matched donors and patients with FALD (n=12 per group). Results were integrated with liver single‐nucleus multiomic RNA sequencing and assay for transposase‐accessible chromatin using sequencing and serum metabolomics data to present a comprehensive multiomic atlas of FALD.We discovered significant metabolic abnormalities in livers of adolescent patients with Fontan circulation, particularly amino acid metabolism, peroxisomal fatty acid oxidation, cytochrome P450 system, glycolysis, tricarboxylic acid cycle, ketone body metabolism, and bile acid metabolism. Integrated analyses with liver single‐nucleus multiomic RNA sequencing and assay for transposase‐accessible chromatin using sequencing results unveiled potential underlying mechanisms of these metabolic changes. Comparison with serum metabolomics data indicate that liver metabolic reprogramming contributes to circulatory metabolomic changes in FALD. Furthermore, comparison with metabolomics data of human metabolic dysfunction–associated fatty liver disease and metabolic dysfunction–associated steatohepatitis highlighted dysregulated amino acid metabolism as a common metabolic abnormality. Conclusions Our comprehensive multiomic analyses reveal new insights into the fundamental biology and pathogenesis mechanisms of human FALD.https://www.ahajournals.org/doi/10.1161/JAHA.124.039201amino acid metabolismFontan‐associated liver disease (FALD)metabolic reprogrammingmetabolomicsmultiomics
spellingShingle Rasheed Sule
Po Hu
Clarissa Shoffler
Christopher Petucci
Benjamin J. Wilkins
Jack Rychik
Liming Pei
Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
amino acid metabolism
Fontan‐associated liver disease (FALD)
metabolic reprogramming
metabolomics
multiomics
title Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease
title_full Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease
title_fullStr Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease
title_full_unstemmed Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease
title_short Comprehensive Multiomic Analysis Reveals Metabolic Reprogramming Underlying Human Fontan‐Associated Liver Disease
title_sort comprehensive multiomic analysis reveals metabolic reprogramming underlying human fontan associated liver disease
topic amino acid metabolism
Fontan‐associated liver disease (FALD)
metabolic reprogramming
metabolomics
multiomics
url https://www.ahajournals.org/doi/10.1161/JAHA.124.039201
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