Patient-specific modeling identifies metabolic interventions for reversing glucose use reprogramming in alcohol-associated hepatitis.

Alcoholic hepatitis (AH) is an acute form of alcohol-associated liver disease with very few treatment options. Recent studies highlighted liver metabolic reprogramming in AH as an indicator of severity. We aim at identifying new intervention points to reverse liver metabolic dysregulation across varying degrees of AH. We develop 89 personalized genome-scale metabolic models by integrating a generic human cellular metabolic model with liver transcriptomics data from AH patients with varying disease severity and healthy controls. We grade the AH patients based on the model-predicted level of glycolysis reprogramming and validate the results using published metabolomics data. We test in silico gene knockdown interventions to reverse the aberrant metabolic reprogramming in AH. Knockdown of two glycolytic genes, Hkdc1 and Pkm, significantly rebalance the metabolic fluxes toward a healthy liver metabolic phenotype. We use machine learning on the glycolysis fluxes to develop a quantitative glucose use reprogramming score, which correlates with AH severity and patient-specific responses to in silico gene knockdown interventions. The score was independently validated using a published AH liver transcriptomics dataset. We propose a cellular metabolism-based therapy targeting Hkdc1 and Pkm in the glycolysis pathway as a potential treatment for reversing the aberrant glucose metabolism in AH.