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Metabolic diseases are closely linked to aberrant synthesis of endogenous fatty acids in the liver, called de novo lipogenesis (DNL), which is mediated by the enzyme fatty acid synthase (FASN). The composition of complex lipids consists of saturated or monosaturated fatty acids, which can be endogenously produced, and polyunsaturated fatty acids (PUFA), which are strictly dietary. Compositional differences between individuals are insufficiently understood and may influence the onset and progression of metabolic and cardiovascular diseases. Here we show that DNL critically determines the use of dietary PUFA. A patient with a hypofunctional heterozygous de novo Arg2177Cys variant in FASN exhibited an elevated composition of PUFA, which was phenocopied by pharmacological inhibition of FASN with TVB-2640 in patients with nonalcoholic steatohepatitis (NASH). In mice, the incorporation rate of supplemented omega-3 PUFA during an obesogenic diet was increased by genetic or pharmacologic reduction of DNL. Mechanistically, we show that the FASN variant exhibited a cysteine-dependent, non-enzymatic acetylation of FASN, which resulted in hyperubiquitinylation and decreased protein stability. The study reveals that PUFA storage is an active, enzymatic process controlled by FASN, DGAT2 and MFSD2A and that combining FASN inhibition and PUFA supplementation exerts additive beneficial metabolic effects. These findings provide evidence that the success of PUFA supplementation may depend on the rate of endogenous DNL and that combined PUFA supplementation and FASN inhibition may be a promising approach in metabolic disease.

Metabolic diseases such as obesity, type 2 diabetes mellitus and non-alcoholic steatohepatitis (NASH) are closely linked to aberrant synthesis of endogenous fatty acids in the liver, called de novo lipogenesis, which is mediated by the enzyme fatty acid synthase (FASN). Endogenously synthesized fatty acids are either saturated or monounsaturated and can adversely affect metabolic health through mechanisms that are not sufficiently understood. Here we show that lipogenesis critically determines the use of food-derived, metabolically beneficial polyunsaturated fatty acids (PUFA). We found a patient with a hypofunctional heterozygous de novo Arg2177Cys mutation in FASN, which resulted in a cysteine-dependent, non-enzymatic acetylation of FASN and decreased protein stability. Remarkably, the patient showed markedly elevated levels of polyunsaturated fatty acids, whereas patients with high FASN expression in the liver showed diminished levels. Moreover, pharmacological intervention with the FASN-inhibitor TVB-2640 in patients with NASH was sufficient to increase the rate of PUFA use in circulating lipids. In line, the incorporation rate of supplemented omega-3 PUFA in obesogenic diet could be dramatically increased by reducing the lipogenesis rate in mice. Mechanistically, we show that fatty acid storage preferences are determined by an active, enzymatic process dependent on FASN and DGAT2. Our results demonstrate that low lipogenesis rates increase the efficiency of PUFA incorporation into complex lipids, whereas high lipogenesis rates lead to low PUFA use. This has critical clinical implications for the prediction of low therapeutic success of omega-3 supplementation in patients with high lipogenesis and provides evidence for the urgent development of combined therapy options targeting lipogenesis and PUFA supplementation.