Retinoid metabolism in the small intestine during development of liver cirrhosis

Intestinal involvement during 3,5-diethoxycarbonyl-1,4-dihydrocollidine-induced chronic liver injury in a mouse model

PURPOSE

Although a physiologic relationship between intestinal mucosal integrity and hepatic function has been previously described, the effect of primary liver disease on intestinal mucosal homeostasis has not been previously well documented. In the current study, we studied the effects of chronic liver injury as a primary injury on enterocyte turnover (proliferation and apoptosis) in a mouse model.

METHODS

The liver toxin 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC)-enriched diet was used to induce chronic cholestatic liver injury in mice. Livers and intestine were harvested after 3 weeks of dietary treatment of histologic analysis and a determination of cell proliferation (immunohistochemistry for Ki67), or apoptosis (immunohistochemistry for caspase-3), as well as a determination of Wnt/β-catenin signaling activity.

RESULTS

All DDC-fed animals exhibited histologic evidence of liver damage that was associated with the expansion of atypical ductal proliferation near the periportal areas and increased oxidative stress. In the intestine, DDC-induced liver damage was associated with decreased villus height, decreased enterocyte proliferation, and increased cell apoptosis compared with control animals. There was also evidence for decreased β-catenin expression by immunostaining in crypt and villus cells of DDC-fed mice compared with control animals.

CONCLUSION

Primary liver injury and cholestasis is associated with intestinal mucosal hypoplasia. Decreased cell proliferation and increased cell apoptosis may be responsible for decreased intestinal epithelial cell mass. The observed decrease in cell turnover is accompanied by an alteration in Wnt/β-catenin signaling.

The effectiveness of relative dose response to retinol intake as an evaluation of vitamin A status of cirrhotic patients

BACKGROUND

The liver is the main organ involved in homeostasis, metabolism and the storage of retinol. During the fibrotic process, hepatic stellate cells lose their lipid drops, and retinol reserves may deplete. Thus, the present study aimed to evaluate serum retinol levels (RL), hepatic retinol storage and dietary vitamin A intake in cirrhotic patients.

METHODS

RL were measured by high-performance liquid chromatography in fifty-eight cirrhotic patients. Fasting RL <1.05 μmol L⁻¹ indicates vitamin A deficiency (VAD). A relative dose response (RDR) to oral retinol ≥20% indicates an inadequate hepatic retinol reserve (positive test). Severe malnutrition was defined as a mid-arm muscle circumference (MAMC) and/or triceps skinfold thickness (TSF) below the 5th percentile and moderate malnutrition as MAMC and/or TSF below the 10th percentile. Vitamin A daily intake was estimated by a specific questionnaire. The Child-Pugh classification of liver disease severity and the Model for End-Stage Liver Disease were used.

RESULTS

Low RL were found in 60% of the patients. Twenty-three cirrhotic patients had adequate fasting RL (RL = 1.34; 1.05-2.12 μmol L⁻¹) and negative RDR, indicating efficient liver stores. Among thirty-five cirrhotic patients with low RL, 43% had negative RDR (RL = 0.42; 0.06-0.82 μmol L⁻¹) and 57% had positive RDR (RL = 0.45; 0.09-0.93 μmol L⁻¹). Malnutrition (36%) and inadequate vitamin A intake (55%) were not associated with fasting RL or RDR.

CONCLUSIONS

VAD was highly prevalent in cirrhotic patients. However, in those with low serum RL and negative RDR, factors other than inadequate vitamin A intake, such as impaired hepatic vitamin A mobilization and intestinal vitamin A malabsorption, which were not examined in the present study, could have influenced the negative results obtained by the RDR method.

The histopathalogical effects of retinoic acid on the tissues

The aim of this study is to sum up the important information that has emerged from the last 10 years of experimental investigations over the effects of retinoic acid (RA) on embryonic structure and adult tissues. Administration of exogenous RA can affect the connective tissues including enhancement of myeloid compartment and suppression of erythroid cells and conversion of hematopoietic stem cells to erythroid progenitors. Also, it is able to induce osteogenic differentiation of stem cells derived from adipose tissues and etc. Examining the neural tissue highlighted that disruption of RA signaling in the adult leads to degeneration of motor neurons and development of some diseases. In vitro administration of All-Trans Retinoic Acid (ATRA) increased dendritic growth and synaptophysin puncta intensity and increased expressions of neuronal nuclei, neuron specific enolase, synaptophysin. RA also promotes expression of a marker of mature astrocytes. On muscular tissue, it can inhibit proliferation of smooth muscle cells (SMC) while promoting differentiation of SMC in vitro instead. The ATRA stimulates skeletal myogenesis while inhibiting cardiomyogenesis and hypertrophy and proliferation of cultured neonatal cardiomyocytes and cardiofibroblasts. In addition, differences in levels of embryonic RA may contribute to variability in great artery anomalies. In epithelial tissue, the squamous epithelium exposed to ATRA showed the columnar differentiation independent to proliferation. Also RA seems able to rescue the regeneration process of injured gut and revealing a better wound healing of the intestine undergone intra-operative radiotherapy. It can interrupt the process of progressive fibrosis, enhancements of the langerhans islets, exocrine pancreas, modulate the health of the mammary glands and repairs the lung cell. Thus, differences in levels of endogenous RA in embryonic and adult tissues may contribute to anomalies and pathogenesis of disease, furthermore RA has paradoxical effects on the parts forming the connective and muscles tissue in equal conditions.

Genetic analysis of expression profile involved in retinoid metabolism in non-alcoholic fatty liver disease

AIM

The patients with non-alcoholic fatty liver disease (NAFLD) have been reported to be at greater risk for progression to chronic liver disease including liver cirrhosis (LC). To examine the mechanisms for the progression of NAFLD, a genetic analysis of hepatic expression profile in retinoid metabolism in NAFLD was performed since the loss of retinoid signaling is associated with the progression of liver disease via reactive oxygen species (ROS) generation.

METHODS

Fifty-one genes, which are associated with retinoid metabolism and action, were examined in thirty six subjects including 17 patients with simple steatosis, 11 with non-alcoholic steatohepatitis (NASH) and eight controls were examined by real-time reverse transcriptase polymerase chain reaction. Immunohistochemical study was also done by 3 kinds of antibodies.

RESULTS

Higher expression of CRBP1 LRAT, DGT1/2 and CES1 in NAFLD suggests that mutual conversion between retinyl ester and retinal occurs actively. Expression of ADH1/2/3, RDH5/10/11, DHRS3 and RALDH1/3 was increased in NAFLD, suggesting that oxidation process from retinol to all-trans retinoic acid (ATRA) was enhanced. Importantly, greater expression of CYP26A1 indicated that degradation of ATRA was enhanced in NAFLD. Further, expression of SOD1/2, catalase, thioredoxin and uncoupling protein 2 was also enhanced.

CONCLUSION

Hyperdynamic state of retinoid metabolism is present in the liver tissues with NAFLD, which may be a putative mechanism by which NAFLD progresses to chronic liver disease including LC.