Transcriptomics informs design of a planar human enterocyte culture system that reveals metformin enhances fatty acid export

Background & Aims: Absorption, metabolism, and export of dietary lipids occurs in the small intestinal epithelium. Caco-2 and organoids have been used to study these processes but are limited in physiological relevance or preclude simultaneous apical and basal access. Here, we develop a high-throughput planar human absorptive enterocyte (AE) monolayer system for investigating lipid-handling, then evaluate the role of fatty acid oxidation (FAO) in fatty acid (FA) export, using etomoxir, C75, and anti-diabetic drug, metformin. Methods: Single-cell RNA-sequencing (scRNAseq), transcriptomics, and lineage trajectory was performed on primary human jejunum. In vivo AE maturational states informed conditions used to differentiate human intestinal stem cells (ISCs) that mimic in vivo AE maturation. The system was scaled for high-throughput drug screening. Fatty acid oxidation (FAO) was pharmacologically modulated and BODIPYTM (B)-labelled FAs were used to evaluate FA-handling via fluorescence and thin layer chromatography (TLC). Results: scRNAseq shows increasing expression of lipid-handling genes as AEs mature. Culture conditions promote ISC differentiation into confluent AE monolayers. FA-handling gene expression mimics in vivo maturational states. FAO inhibitor, etomoxir, decreased apical-to-basolateral export of medium-chain B-C12 and long-chain B-C16 FAs whereas CPT1 agonist, C75, and antidiabetic drug, metformin, increased apical-to-basolateral export. Short-chain B-C5 was unaffected by FAO inhibition and diffused through AEs. Conclusions: Primary human ISCs in culture undergo programmed maturation. AE monolayers demonstrate in vivo maturational states and lipid-handling gene expression profiles. AEs create strong epithelial barriers in 96-Transwell format. FA export is proportional to FAO. Metformin enhances FAO and increases basolateral FA export, supporting an intestine-specific role. Keywords: Intestinal stem cells, absorptive enterocyte monolayers, fatty acid oxidation, drug screening ### Competing Interest Statement Scott Magness would like to disclose a financial interest in Altis Biosystems Inc., which licenses the ISC monolayer technology used in this study.