Reviewer #2 (Public Review):
In this work, Ball et al. investigated the possibility to generate a novel set of HepG2 liver cell lines to generate "mitochondrial DNA-personalized" models as novel tools to study idiosyncratic drug-induced liver injury related to mitochondrial variation. This work represents the generation of a comprehensive collection of n=10 HepG2 lines, half reflecting haplogroup H and half reflecting haplogroup J. The authors then assessed their impact on basic mitochondrial function in liver cells. Interestingly, they find a greater respiratory complex activity driven by complex I and II of the haplogroup J lines relative to haplogroup H. Finally, the authors make an attempt at using this novel set of lines to probe the consequential effects of mitochondrial genotype on drug-induced liver toxicity. This work provides an interesting proof-of-concept study and is a starting point towards studying and predicting idiosyncratic drug-induced liver injury in a personalized manner. This technique may be broadly extrapolated to other commonly used liver cell models within the toxicology field.
Strengths:
1) This work presents an exciting initiative to study interindividual variability in idiosyncratic drug-induced liver injury focusing on mitochondrial haplotypes. In further follow-ups, this work could be extended to also represent other different haplogroups to establish a thorough "biobank". The established lines allow for future in-depth characterization and testing of many putative hepatotoxic compounds through a variety of toxicity measures that could shed further light on the impact of mitochondrial DNA variation on (idiosyncratic) drug-induced liver injury.
2) This technique may be broadly extrapolated to other commonly used liver cell lines within the toxicology field (e.g. HepaRG cells or iPSC-derived cells) that are potentially also more metabolically competent. A short discussion on this could be added to the current manuscript.
Weaknesses:
1) The major weakness of the current manuscript is the rather large variation across sample measurements regarding the proof-of-concept experiments to study drug effects (fig. 3-6). This makes much of the data rather hard to interpret and to infer conclusions. As an example, proton leak (fig. 3f/4f) seems to 2-fold increase in the J group even under basal conditions (0 uM flutamide/metabolite), while this is not observed in fig. 2a and this effect seems to be also absent under 0 uM tolcapone (fig. 5f). Unfortunately, the current data do not allow to draw confident conclusions about whether the tested drugs have effects on the mitochondrial respiration of the different haplogroups. This may well be linked to the methods used for measuring mitochondrial activity, but since this is the predominant method needed in the current paper, either increasing the number of experiments (across more lines) or identifying a more rigorous methodological manner to obtain consistencies of experiments would help the authors to make more confident claims about their data.
2) The data on the effects of inhibition of complex I/II activity are not sufficiently convincing to support the claim that haplogroup J is more susceptible to flutamide/metabolite (fig. 6). Both seem to respond rather identical to flutamide or its metabolite, i.e. at higher concentrations complex I/II activity decreases, but with the sole difference that the haplogroups represent different basal activity (not influenced by the drug). Estimating fold changes, for example, for both haplogroups, complex I and II activity decreases ca. 2-fold at the highest concentration of the metabolite (fig. 6c-d), therefore concluding that there is no difference between haplogroup susceptibility unlike the authors claim. It is furthermore unclear what the statistical significance currently represents: it should represent whether at different/increasing concentrations the activity of the complexes significantly differs vs. the previous/basal conditions from the same haplogroup. If it represents (which it seems to be) the significance of the haplogroup J vs. the haplogroup H, it is non-informative as it is obvious that haplogroup J presents with a higher baseline.
3) It would help to mention how many lines per haplogroup H/J were used in the analyses across all figures. This should be clarified, as the error bars for most experiments are rather high and therefore statistical significance is lacking, making data interpretation complex. It could be helpful if the authors present at least for some analyses single plots of data obtained across different lines from the same haplogroup to evaluate the consistency of the effects of the genotypes as supplementary figures. If only 1-2 lines were used per group, it would help to perform additional experiments to assess consistencies across groups.