# Therapeutic Potential of Estrogen-Regulated Metabolism and Cardiovascular Risk

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2024 · $403,338

## Abstract

Obesity impairs glucose and lipid metabolism and increases the risk of coronary heart disease (CHD). Women
with obesity have ~1/2 the risk of CHD as obese men. The risk of CHD goes up with menopause, but by
mechanisms distinct from obese men. The protection conferred by estrogen signaling in females is lost with
diabetes due to undefined mechanisms. The liver plays an important part in estrogen-regulated metabolism. Our
goal is to therapeutically target the beneficial hepatic actions of estrogens in males and females and discover
the mechanisms by which diabetes interacts with liver estrogen signaling to put females at high CHD risk.
 In the last funding cycle of this project, we used mouse models and metabolic tracers to discover that estrogen
signaling through hepatic estrogen receptor alpha (ERa) protects against several key aspects of obesity-
associated metabolic disease. We showed that, 1) whole body and liver insulin sensitivity are improved; 2) fatty
liver is diminished by increasing fatty acid oxidation and increasing liver VLDL output; 3) atherosclerosis is
reduced by improving HDL’s cholesterol efflux and anti-inflammatory properties, and by increasing liver
cholesterol delivery (reverse cholesterol transport). While examining the pathways by which hepatic ERa confers
protection for females, we made the surprising observation that it has protective effects in obese males also.
Hepatic ERa in males, 1) decreases liver fat; 2) improves liver and whole-body insulin sensitivity; 3) improves
HDL cholesterol efflux capacity. The goal of AIM1 is to amplify the beneficial effects of the hepatic ERa in male
and female mice by defining approaches to therapeutically target estrogen signaling in the liver.
 Diabetic women have the same elevated CHD risk as diabetic men. We found that hyperglycemia induces
hepatic stress, negating the benefit of hepatic estrogen signaling. Whether hyperglycemia or some aspect of
glycemic control is the mechanism by which diabetes negates the protective effect of being female remains to
be determined. We will explore mechanisms for this important biology in AIM2. Our overarching hypothesis is
that targeted hepatic estrogen signaling will benefit glucose metabolism, fatty liver, HDL function, and
atherosclerosis in obese males and females. In contrast, hyperglycemia leads to accumulation of liver glucose
metabolites that activate Carbohydrate Response Element Binding Protein and counters the benefits of ERa.
 Our hypothesis is innovative because we propose that targeting ERa in hepatocytes will limit many aspects
of obesity-associated disease in both females and males without unfavorable estrogen actions on other tissues.
We will also define a critical mechanism for the sex-specific impact of diabetes on CHD risk factors in females.
 Our techniques are innovative because we are applying isotopic tracers and tissue-targeted, sex-based,
therapeutics to distinguish estradiol action and glucose metabolism at the liver fr...

## Key facts

- **NIH application ID:** 10831428
- **Project number:** 5R01DK109102-10
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** John Michael Stafford
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $403,338
- **Award type:** 5
- **Project period:** 2016-03-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10831428

## Citation

> US National Institutes of Health, RePORTER application 10831428, Therapeutic Potential of Estrogen-Regulated Metabolism and Cardiovascular Risk (5R01DK109102-10). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10831428. Licensed CC0.

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