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Zheng M, Ai Z, Guo Y, Chen Y, Xie P, An W. Imbalance in ALR ubiquitination accelerates the progression of nonalcoholic steatohepatitis to hepatocellular carcinoma. Oncogene 2023; 42:308-321. [PMID: 36434180 DOI: 10.1038/s41388-022-02549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Accumulating evidence indicates that non-alcoholic steatohepatitis (NASH) is a key predisposing factor for HCC occurrence. However, the precise mechanisms driving NASH transition to HCC remain largely obscure. Augmenter of liver regeneration (ALR) is a sulfhydryl oxidase and cytochrome c reductase that functions as an important regulator of mitochondrial dynamics. In this study, we focused on ALR ubiquitination-mediated degradation and its potential contribution to NASH-driven HCC progression at the mitochondrial level. Hepatic ALR expression in HCC patients was determined using immunohistochemical analysis. Mice with liver-specific deletion of ALR (ALRCKO) and ALRWT mice were fed a western diet (WD) and high-sugar solution for induction of NASH. HCC in animals was induced via peritoneal administration of CCl4. ALR expression was markedly decreased in liver tissues of patients with NASH and HCC compared with non-NASH and non-tumor tissues. Similarly, in ALRWT mice, the ALR level in tumor tissue was reduced relative to that in para-tumor tissue. In the ALRCKO group, mice fed WD plus CCl4 developed HCC starting at week 12 while ALRWT mice fed WD plus CCl4 developed HCC at week 24. Analysis of protein posttranslational modifications revealed ubiquitylation (Ub) and deubiquitination (DUb) of ALR by murine double minute 2 (MDM2) and ubiquitin-specific protease 36 (USP36), respectively. Imbalance between Ub and DUb of ALR resulted in profound ALR degradation, which appeared to be reversibly associated with Edmondson-Steiner tumor grade. Rescue of ALR levels via gene transfection abolished tumor malignant features to a certain extent in vitro. Notably, ALR deletion substantially enhanced mitochondrial fission by activating Drp1 phosphorylation at Ser616, thus disrupting the balance of mitochondrial dynamics between fission and fusion and severely impairing oxidative phosphorylation (OXPHOS) and ATP synthesis, instead enhancing anaerobic metabolism, which might be attributed to steatotic hepatocyte transition into the malignant HCC phenotype. Hepatic ALR depletion via dysregulation of ubiquitination is a critical aggravator of NASH-HCC progression and represents a promising therapeutic target for related liver diseases.
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Affiliation(s)
- Mingzhe Zheng
- Department of Cell Biology, The Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
| | - Ziwei Ai
- Department of Cell Biology, The Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
| | - Yuanyuan Guo
- Department of Cell Biology, The Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China.,China-Japan Friendship Hospital Department of Pathology, Beijing, China
| | - Yujiao Chen
- Department of Cell Biology, The Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
| | - Ping Xie
- Department of Cell Biology, The Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China.
| | - Wei An
- Department of Cell Biology, The Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China.
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Weng J, Han X, Zeng F, Zhang Y, Feng L, Cai L, Liang K, Liu S, Li S, Fu G, Zeng M, Gao Y. Fiber scaffold bioartificial liver therapy relieves acute liver failure and extrahepatic organ injury in pigs. Theranostics 2021; 11:7620-7639. [PMID: 34335954 PMCID: PMC8315066 DOI: 10.7150/thno.58515] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
Rationale: Acute liver failure (ALF) causes severe liver injury and a systemic inflammatory response, leading to multiorgan failure with a high short-term mortality. Bioartificial liver (BAL) therapy is a promising approach that is hampered by the lack of appropriate bioreactors and carriers to retain hepatic cell function and poor understanding of BAL treatment mechanisms in ALF and extrahepatic organ injury. Recently, we used a fiber scaffold bioreactor (FSB) for the high-density, three-dimensional (3D) culture of primary porcine hepatocytes (PPHs) combined with an absorption component to construct a BAL and verified its function in a D-galactosamine (D-gal)-induced ALF porcine model to evaluate its protective effects on the liver and extrahepatic organs. Methods: Male pigs were randomized into standard/supportive therapy (ST), ST+no-cell BAL (ST+Sham BAL) and ST+BAL groups and received treatment 48 h after receiving a D-gal injection. Changes in blood chemistry and clinical symptoms were monitored for 120 h. Tissues and plasma were collected for analysis by pathological examination, immunoblotting, quantitative PCR and immunoassays. Results: PPHs cultured in the FSB obtained sufficient aeration and nutrition for high-density, 3D culture and maintained superior viability and functionality (biosynthesis and detoxification) compared with those cultured in flasks. All the animals developed ALF, acute kidney injury (AKI) and hepatic encephalopathy (HE) 48 h after D-gal infusion and received corresponding therapies. Animals in the BAL group showed markedly improved survival (4/5; 80%) compared with those in the ST+Sham BAL (0/5; p < 0.001) and ST (0/5; p < 0.001) groups. The levels of blood ammonia and biochemical and inflammatory indices were alleviated after BAL treatment. Increased liver regeneration and attenuations in the occurrence and severity of ALF, AKI and HE were observed in the ST+BAL group compared with the ST (p = 0.0009; p = 0.038) and ST+Sham BAL (p = 0.011; p = 0.031) groups. Gut leakage, the plasma endotoxin level, bacterial translocation, and peripheral and neuroinflammation were alleviated in the ST+BAL group compared with those in the other groups. Conclusions: BAL treatment enhanced liver regeneration and alleviated the systemic inflammatory response and extrahepatic organ injury to prolong survival in the ALF model and has potential as a therapeutic approach for ALF patients.
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Affiliation(s)
- Jun Weng
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Xu Han
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Fanhong Zeng
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Yue Zhang
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Lei Feng
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Lei Cai
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Kangyan Liang
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Shusong Liu
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Shao Li
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
| | - Gongbo Fu
- Department of Medical Oncology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, Nanjing 210000, China
| | - Min Zeng
- Guangdong Qianhui Biotechnology Co., Ltd., Guangzhou 510285, China
| | - Yi Gao
- Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China
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Huang J, Xie P, Dong Y, An W. Inhibition of Drp1 SUMOylation by ALR protects the liver from ischemia-reperfusion injury. Cell Death Differ 2021; 28:1174-1192. [PMID: 33110216 PMCID: PMC8027887 DOI: 10.1038/s41418-020-00641-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 01/30/2023] Open
Abstract
Hepatic ischemic reperfusion injury (IRI) is a common complication of liver surgery. Although an imbalance between mitochondrial fission and fusion has been identified as the cause of IRI, the detailed mechanism remains unclear. Augmenter of liver regeneration (ALR) was reported to prevent mitochondrial fission by inhibiting dynamin-related protein 1 (Drp1) phosphorylation, contributing partially to its liver protection. Apart from phosphorylation, Drp1 activity is also regulated by small ubiquitin-like modification (SUMOylation), which accelerates mitochondrial fission. This study aimed to investigate whether ALR-mediated protection from hepatic IRI might be associated with an effect on Drp1 SUMOylation. Liver tissues were harvested from both humans and from heterozygous ALR knockout mice, which underwent IRI. The SUMOylation and phosphorylation of Drp1 and their modulation by ALR were investigated. Hepatic Drp1 SUMOylation was significantly increased in human transplanted livers and IRI-livers of mice. ALR-transfection significantly decreased Drp1 SUMOylation, attenuated the IRI-induced mitochondrial fission and preserved mitochondrial stability and function. This study showed that the binding of transcription factor Yin Yang-1 (YY1) to its downstream target gene UBA2, a subunit of SUMO-E1 enzyme heterodimer, was critical to control Drp1 SUMOylation. By interacting with YY1, ALR inhibits its nuclear import and dramatically decreases the transcriptional level of UBA2. Consequently, mitochondrial fission was significantly reduced, and mitochondrial function was maintained. This study showed that the regulation of Drp1 SUMOylation by ALR protects mitochondria from fission, rescuing hepatocytes from IRI-induced apoptosis. These new findings provide a potential target for clinical intervention to reduce the effects of IRI during hepatic surgery.
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Affiliation(s)
- Jing Huang
- grid.24696.3f0000 0004 0369 153XDepartment of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, China
| | - Ping Xie
- grid.24696.3f0000 0004 0369 153XDepartment of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, China
| | - Yuan Dong
- grid.24696.3f0000 0004 0369 153XDepartment of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, China
| | - Wei An
- grid.24696.3f0000 0004 0369 153XDepartment of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, China
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Sokolov AA, Rey SI, Aleksandrova IV, Popov AV, Gendel LL, Gubanova SN, Marchenkova LV, Sudakov MV. Comparison of selective plasma exchange and plasmadialfiltration with MARS and Prometheus systems in the treatment of liver failure. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2020. [DOI: 10.21292/2078-5658-2020-17-3-39-52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The mortality of patients with hepatic failure remains high. Often the patient's life can be saved only with extracorporeal liver support (ELS). ELS systems – MARS® и Prometheus® have proved their efficacy but their widespread use is constrained by their very high cost. Introduction in clinical practice of new affordable ELS systems is a topical issue. The objective: to compare clinical and laboratory effects of selective plasma exchange (SPE), plasmadialfiltration (PDF) with use of the selective membrane plasma separators EvaclioTM and MARS® and Prometheus® (FPSA) systems in the treatment of liver failure. Subjects and methods: 15 extracorporeal procedures of each type were performed in 52 patients with acute liver failure (14) and acute-on-chronic liver failure (38): MARS, FPSA, PDF, SPE with use of Evaclio ЕС-2C, and ЕС-3C, ЕС-4C. The clinical and laboratory parameters (total, direct and indirect bilirubin, total protein, albumin, creatinine, urea, etc.), severity of the condition according to MELD score were determined before and after the session and the next morning. Changes, side effects and complications of procedures were assessed and compared. Results. Reduction of concentration of direct bilirubin was comparable with FPSA, PDF and SPE on Evaclio ЕС-3C20 и ЕС-4C20 (38-42%), indirect bilirubin – with PDF and SPE on Evaclio ЕС-3C20 и ЕС-4C20 (29-34%). Low-molecular metabolites (urea, creatinine) were better removed with FPSA (35-44%) and PDF (40-42%). The reduction of their concentration with SPE was insignificant. The reduction of albumin level was the highest with FPSA (10.2%) and SPE on Evaclio ЕС-4C20 (14.3%). All investigated ELS methods did not exert a significant influence on the basic parameters of blood coagulation and quantity of blood cells. No side effects and complications were observed. Conclusion: Selective plasma exchange and plasmadiafiltration are generally comparable in clinical and laboratory effects in the treatment of liver failure with MARS and Prometheus system provided significantly lower costs.
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Affiliation(s)
| | - S. I. Rey
- N. V. Sklifosovsky Moscow Research Institute of Emergency;
Research Institute of Health Organization and Medical Management of Moscow Health Department
| | | | | | | | | | - L. V. Marchenkova
- Research Institute of Health Organization and Medical Management of Moscow Health Department
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Song X, Xu T, Yang L, Li Y, Yang Y, Jin L, Zhang J, Zhong R, Sun S, Zhao W, Zhao C. Self-Anticoagulant Nanocomposite Spheres for the Removal of Bilirubin from Whole Blood: A Step toward a Wearable Artificial Liver. Biomacromolecules 2020; 21:1762-1775. [DOI: 10.1021/acs.biomac.9b01686] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Xin Song
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
| | - Tao Xu
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
| | - Li Yang
- Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, People’s Republic of China
| | - Yupei Li
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610225, People’s Republic of China
| | - Ye Yang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
| | - Lunqiang Jin
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
| | - Jue Zhang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
| | - Rui Zhong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Peking Union Medical College, Chengdu 610052, People’s Republic of China
| | - Shudong Sun
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
| | - Weifeng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
- State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 200438, People’s Republic of China
| | - Changsheng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People’s Republic of China
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Liu L, Xie P, Li W, Wu Y, An W. Augmenter of Liver Regeneration Protects against Ethanol-Induced Acute Liver Injury by Promoting Autophagy. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 189:552-567. [PMID: 30553838 DOI: 10.1016/j.ajpath.2018.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
Alcoholic liver disease is associated with high morbidity and mortality, and treatment options are limited to date. Augmenter of liver regeneration (ALR) may protect against hepatic injury from chemical poisons, including ethanol. Autophagy appears to positively influence survival in cases of liver dysfunction, although the mechanisms are poorly understood. Herein, we investigated effects of ALR-induced autophagy in vitro and in vivo in an ethanol-induced model of acute liver injury. Decreased serum levels of alanine aminotransferase and aspartate aminotransferase and reduced histologic lesions revealed that mice overexpressing ALR experienced less liver damage than wild-type. ALR-knockdown mice experienced more severe liver damage than wild-type. ALR-transfected HepG2 cells showed increased survival rates, improved maintenance of mitochondrial membrane potential, and increased ATP levels after ethanol treatment. The observed protection was associated with up-regulation of autophagy-markers, including light chain 3II, beclin-1, and autophagy-related gene 5, and down-regulation of p62 by ALR. Autophagy was inhibited in ALR-knockdown mice and HepG2 cells, and autophagy inhibitor bafilomycin A1 attenuated the protective effects of ALR. Results showed phosphorylated mammalian target of rapamycin (mTOR) was down-regulated when ALR was overexpressed and up-regulated when ALR was knocked down. These data show that ALR is protective against ethanol-induced acute liver injury by promoting autophagy, probably via repressing the mTOR pathway. These results have potential implications for the clinical treatment of alcoholic liver disease patients.
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Affiliation(s)
- Limin Liu
- Department of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, People's Republic of China
| | - Ping Xie
- Department of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, People's Republic of China
| | - Wen Li
- Department of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, People's Republic of China
| | - Yuan Wu
- Department of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, People's Republic of China
| | - Wei An
- Department of Cell Biology, Capital Medical University and the Municipal Key Laboratory for Liver Protection and Regulation of Regeneration, Beijing, People's Republic of China.
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Augmenter of liver regeneration potentiates doxorubicin anticancer efficacy by reducing the expression of ABCB1 and ABCG2 in hepatocellular carcinoma. J Transl Med 2017; 97:1400-1411. [PMID: 28825695 DOI: 10.1038/labinvest.2017.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is highly chemoresistant and therefore challenges both physicians and patients. Augmenter of liver regeneration (ALR), previously also known as 'hepatic stimulator substance', is reported to inhibit the epithelial-mesenchymal transition (EMT) in HCC, one of the frequent events that occur in cancer metastasis, suggesting that ALR is involved in HCC. In this study, we report for the first time that the transfection of ALR enhances the antitumor effect of chemotherapy with doxorubicin, a typical anticancer drug, on HCC in vitro and in vivo. The efflux of doxorubicin from ALR-transfected HCC cells is efficiently suppressed. This implies the intracellular retention of doxorubicin in tumor cells, which is at least partly attributable to the effective inhibition of ABCB1 and ABCG2 transporter expression in ALR-expressing cells. The downregulation of ALR expression by short hairpin RNA diminishes the antitumor effect of ALR. We further demonstrate that ALR inhibits the AKT/Snail signaling pathway, resulting in the downregulation of ABCB1 and ABCG2 expression. In conclusion, our results suggest that ALR is a potential chemotherapeutic agent against HCC.
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Yamamoto H, Nakae H, Uji Y, Maeda K, Tani T, Eguchi Y. Plasma Adiponectin Levels in Acute Liver Failure Patients Treated with Plasma Filtration with Dialysis and Plasma Exchange. Ther Apher Dial 2016; 19:349-54. [PMID: 26386223 DOI: 10.1111/1744-9987.12344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Plasma filtration with dialysis (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside of the hollow fibers. Improvement of hypoadiponectinemia is considered to be a useful therapeutic approach for ameliorating fatal conditions including cardio-metabolic and infectious disease. We investigated the effects of PDF in comparison to PE in terms of plasma adiponectin (APN) changes in patients with acute liver failure. Seventeen patients with liver failure were studied; PDF was performed 55 times and PE 14 times. Plasma APN levels increased significantly after PDF, while decreasing significantly after PE. PDF appears to be among the most useful blood purification therapies in acute liver failure cases in terms of increasing APN levels.
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Affiliation(s)
- Hiroshi Yamamoto
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University School of Medicine, Akita, Japan
| | - Yoshitaka Uji
- Department of Gastroenterological Surgery, Shinkoga Hospital, Fukuoka, Japan
| | - Kazuhisa Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tohru Tani
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yutaka Eguchi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Shiga, Japan
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Yue-Meng W, Yang LH, Yang JH, Xu Y, Yang J, Song GB. The effect of plasma exchange on entecavir-treated chronic hepatitis B patients with hepatic de-compensation and acute-on-chronic liver failure. Hepatol Int 2015; 10:462-9. [PMID: 26482576 DOI: 10.1007/s12072-015-9667-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/30/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Various studies showed that entecavir (ETV) failed to improve the short-term survival in chronic hepatitis B (CHB) patients with severe acute exacerbation (SAE) and hepatic de-compensation or acute-on-chronic liver failure (ACLF). One study concluded that plasma exchange (PE) significantly decreased the short-term mortality of CHB patients with ACLF who were treated with lamivudine (LAM). Our study was designed to examine the effect of PE on CHB patients with ACLF who were treated with ETV. METHODS From August 2010 to January 2015, 38 (PE group) and 120 (control group) consecutive CHB-naïve patients with hepatic de-compensation and ACLF treated with PE plus ETV and ETV, respectively, were recruited. The primary endpoint was liver-related mortality at week 12. Biochemical and virological responses were also studied. RESULTS At baseline, the PE group had higher serum alanine aminotransferase (ALT) levels and model for end-stage liver disease (MELD) scores, and had lower albumin levels than the control group. The cumulative survival rate at week 4 and week 12 in the PE group and control group were, respectively, 37 and 18 %, and 29 and 14 % (p < 0.001, by log rank test). While the bilirubin levels in the PE group were more quickly lowered by PE therapy (p < 0.001), the decrease of ALT levels and virological response were similar in the two groups (p > 0.05). Univariate analysis showed that the control group had a higher liver-related mortality (p = 0.038) at week 12 than the PE group. Multivariate analysis showed that hepatic encephalopathy, ascites, PE treatment, and MELD scores were independent factors for liver-related mortality at week 12. CONCLUSIONS PE significantly improved the short-term survival of CHB patients with hepatic de-compensation and ACLF who were treated with ETV. Hepatic encephalopathy, ascites, PE treatment, and MELD scores were independent factors for liver-related mortality at week 12.
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Affiliation(s)
- Wan Yue-Meng
- Department of Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Li-Hong Yang
- Department of Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Jin-Hui Yang
- Department of Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China.
| | - Ying Xu
- Department of Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Jing Yang
- Department of Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Gui-Bo Song
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
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Xiao W, Ren M, Zhang C, Li S, An W. Amelioration of nonalcoholic fatty liver disease by hepatic stimulator substance via preservation of carnitine palmitoyl transferase-1 activity. Am J Physiol Cell Physiol 2015; 309:C215-27. [DOI: 10.1152/ajpcell.00133.2014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/25/2015] [Indexed: 12/14/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease and so far is supposed to be related with mitochondrial impairment. Hepatic stimulator substance (HSS) has been defined as a liver-protective factor promoting hepatocyte DNA synthesis and hepatic proliferation after liver intoxication. We previously reported that HSS ameliorated hepatocyte death, probably because of its preservation of mitochondria. This study aims to explore whether HSS could protect carnitine palmitoyl transferase-1 (CPT-1), an essential enzyme responsible for β-oxidation of free fatty acids in mitochondria, from lipotoxicity, thus alleviating hepatic lipid deposition. To test this, the HSS gene was delivered into C57BL/6J mice and efficiently expressed in the liver. NASH mice were prepared with high-fat diet or methionine-choline-deficient diet. The results showed that hepatic inflammation and liver functions were alleviated in the HSS-transfected mice; meanwhile, the activity of CPT-1 was obviously protected. Moreover, oleic acid (OA) treatment resulted in remarkable lipid accumulation in HepG2 cells; this deposition was improved by HSS transfection. Simultaneously, the CPT-1 activity, which was impaired by OA treatment, was profoundly rescued in the HSS-expressing cells. CPT-1 activity was more severely impaired if the OA treatment was combined with S15176, a CPT-1 inhibitor. However, this impairment was effectively reduced by the HSS transfection, and the effect was enhanced by C75, a CPT-1 activator. Interestingly, if the cells were transfected with HSS-siRNA, the preservation of CPT-1 provided by HSS was again diminished. In conclusion, HSS reduces lipotoxicity to mitochondria most likely via preservation of CPT-1.
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Affiliation(s)
- Weichun Xiao
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regeneration Regulation, Capital Medical University, Beijing, China
| | - Meng Ren
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regeneration Regulation, Capital Medical University, Beijing, China
| | - Can Zhang
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regeneration Regulation, Capital Medical University, Beijing, China
| | - Shenglan Li
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regeneration Regulation, Capital Medical University, Beijing, China
| | - Wei An
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regeneration Regulation, Capital Medical University, Beijing, China
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Glorioso JM, Mao SA, Rodysill B, Mounajjed T, Kremers WK, Elgilani F, Hickey RD, Haugaa H, Rose CF, Amiot B, Nyberg SL. Pivotal preclinical trial of the spheroid reservoir bioartificial liver. J Hepatol 2015; 63:388-98. [PMID: 25817557 PMCID: PMC4508211 DOI: 10.1016/j.jhep.2015.03.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS The neuroprotective effect of the spheroid reservoir bioartificial liver (SRBAL) was evaluated in a porcine model of drug-overdose acute liver failure (ALF). METHODS Healthy pigs were randomized into three groups (standard therapy (ST) alone, ST+No-cell device, ST+SRBAL device) before placement of an implantable intracranial pressure (ICP) monitor and a tunneled central venous catheter. One week later, pigs received bolus infusion of the hepatotoxin D-galactosamine and were followed for up to 90h. RESULTS At 48h, all animals had developed encephalopathy and biochemical changes confirming ALF; extracorporeal treatment was initiated and pigs were observed up to 90h after drug infusion. Pigs treated with the SRBAL, loaded with porcine hepatocyte spheroids, had improved survival (83%, n=6) compared to ST alone (0%, n=6, p=0.003) and No-cell device therapy (17%, n=6, p=0.02). Ammonia detoxification, peak levels of serum ammonia and peak ICP, and pig survival were influenced by hepatocyte cell dose, membrane pore size and duration of SRBAL treatment. Hepatocyte spheroids remained highly functional with no decline in mean oxygen consumption from initiation to completion of treatment. CONCLUSIONS The SRBAL improved survival in an allogeneic model of drug-overdose ALF. Survival correlated with ammonia detoxification and ICP lowering indicating that hepatocyte spheroids prevented the cerebral manifestations of ALF (brain swelling, herniation, death). Further investigation of SRBAL therapy in a clinical setting is warranted.
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Affiliation(s)
| | - S. A. Mao
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - B. Rodysill
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - T. Mounajjed
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W. K. Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - F. Elgilani
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - R. D. Hickey
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA,Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - H. Haugaa
- Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo
| | - C. F. Rose
- Hepato-Neuro Laboratory, CRCHUM, Universite de Montreal, Quebec, Canada
| | - B. Amiot
- Brami Biomedical, Inc. Minneapolis, MN, USA
| | - S. L. Nyberg
- Department of Surgery, Mayo Clinic, Rochester, MN, USA,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA,Corresponding address: Scott L. Nyberg, MD, PhD, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, 200 First Street, Rochester, MN 55905
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12
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Zhou N, Li J, Zhang Y, Lu J, Chen E, Du W, Wang J, Pan X, Zhu D, Yang Y, Chen Y, Cao H, Li L. Efficacy of coupled low-volume plasma exchange with plasma filtration adsorption in treating pigs with acute liver failure: A randomised study. J Hepatol 2015; 63:378-87. [PMID: 25814048 DOI: 10.1016/j.jhep.2015.03.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Extracorporeal blood purification systems for supportive therapy of liver failure are widely used. We developed a novel blood purification system, named Li's artificial liver system (Li-ALS), which couples low-volume plasma exchange (low-volume PE) with plasma filtration adsorption (PFA). This study aims to evaluate the efficacy of our novel system in pigs with acute liver failure (ALF). METHODS Thirty-two pigs were infused with D-galactosamine (1.3g/kg) to induce ALF. All animals were equally and randomly divided into four groups: the ALF control group received intensive care, the PFA group underwent five hour plasma recycling filtration and adsorption purification, the low-volume PE group received one hour low-volume PE, and the Li-ALS group underwent one hour low-volume PE, followed by five hour PFA. Intervention was initiated 36hours after drug administration. The efficacy of each treatment was assessed by survival time and improvement in hematological, biochemical, and immunohistological parameters. RESULTS Pigs in the Li-ALS group survived longer than those in the other groups (p<0.001, ALF control: 60±2h; PFA group: 74±2h; low-volume PE group: 75±2h; and Li-ALS group: 90±3h). Liver enzyme, bilirubin, bile acid and blood ammonia levels were decreased significantly after Li-ALS treatment, and increases in inflammatory cytokines were ameliorated. A higher hepatocyte regeneration index was also observed in the Li-ALS group. CONCLUSION Our novel Li-ALS could expedite liver regeneration and improve survival time; hence, it could be promising for treating ALF.
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Affiliation(s)
- Ning Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Jianzhou Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Yimin Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Juan Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Ermei Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Weibo Du
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Jie Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Xiaoping Pan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Danhua Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Ying Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Yu Chen
- Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China
| | - Hongcui Cao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, Zhejiang University, Hangzhou, China.
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13
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Shinozaki K, Lampe JW, Wang CH, Yin T, Kim J, Oda S, Hirasawa H, Becker LB. Developing dual hemofiltration plus cardiopulmonary bypass in rodents. J Surg Res 2014; 195:196-203. [PMID: 25555403 DOI: 10.1016/j.jss.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/14/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emerging therapies for prolonged cardiac arrest (CA) include advanced circulatory interventions like emergency cardiopulmonary bypass (ECPB) and continuous venovenous hemofiltration (CVVHF). However, preclinical studies are limited because of the absence of a practical method of using CVVHF along with ECPB in rodents. METHODS We modified a CA model with ECPB resuscitation to include the CVVHF circuit. Adult rats were cannulated via the femoral artery or vein and the jugular vein for the ECPB circuit. A new circuit for CVVHF was added to allow ECPB and CVVHF to be started simultaneously. CVVHF blood flow at 3 mL/min could be controlled with a screw clamp during ECPB. After cessation of ECPB, the CVVHF flow was maintained using a roller pump. The filtration rate was controlled at 40 mL/h/kg in the standard volume of CVVHF and 120 mL/h/kg in the high volume (HV) of CVVHF. The driving force of hemofiltration was evaluated by monitoring transmembrane pressure and filter clearance (FCL). RESULTS Transmembrane pressure in both groups was stable for 6 h throughout CVVHF. FCL of blood urea nitrogen and potassium in the standard volume group was significantly less than the HV group (P < 0.01). FCL of blood urea nitrogen and potassium was stable throughout the CVVHF operation in both groups. CONCLUSIONS We developed a method of CVVHF along with ECPB in rodents after CA. We further demonstrated the ability to regulate both standard and HV filtration rates.
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Affiliation(s)
- Koichiro Shinozaki
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA; Department of Emergency and Critical Care Medicine, Chiba University, Chiba, Japan.
| | - Joshua W Lampe
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chih-Hsien Wang
- Division of Cardiovascular Surgery and Surgical Critical Care, Department of Surgery and Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai Yin
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Junhwan Kim
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Hirasawa
- Department of Emergency and Critical Care Medicine, Chiba University, Chiba, Japan
| | - Lance B Becker
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
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Jiang SJ, Li W, An W. Adenoviral gene transfer of hepatic stimulator substance confers resistance against hepatic ischemia-reperfusion injury by improving mitochondrial function. Hum Gene Ther 2014; 24:443-56. [PMID: 23461564 DOI: 10.1089/hum.2012.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hepatic stimulator substance (HSS) has been suggested to protect liver cells from various toxins. However, the precise role of HSS in hepatic ischemia-reperfusion (I/R) injury remains unknown. This study aims to elucidate whether overexpression of HSS could attenuate hepatic ischemia-reperfusion injury and its possible mechanisms. Both in vivo hepatic I/R injury in mice and in vitro hypoxia-reoxygenation (H/R) in a cell model were used to evaluate the effect of HSS protection after adenoviral gene transfer. Moreover, a possible mitochondrial mechanism of HSS protection was investigated. Efficient transfer of the HSS gene into liver inhibited hepatic I/R injury in mice, as evidenced by improvement in liver function tests, the preservation of hepatic morphology, and a reduction in hepatocyte apoptosis. HSS overexpression also inhibited H/R-induced cell death, as detected by cell viability and cell apoptosis assays. The underlying mechanism of this hepatic protection might involve the attenuation of mitochondrial dysfunction and mitochondrial-dependent cell apoptosis, as shown by the good preservation of mitochondrial ultrastructure, mitochondrial membrane potential, and the inhibition of cytochrome c leakage and caspase activity. Moreover, the suppression of H/R-induced mitochondrial ROS production and the maintenance of mitochondrial respiratory chain complex activities may participate in this mechanism. This new function of HSS expands the possibility of its application for the prevention of I/R injury, such as hepatic resection and liver transplantation in clinical practice.
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Affiliation(s)
- Shu-Jun Jiang
- Department of Cell Biology and Municipal Laboratory of Liver Protection and Regulation of Regeneration, Capital Medical University, 100069 Beijing, China
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Techniques of extracorporeal cytokine removal: a systematic review of the literature on animal experimental studies. Int J Artif Organs 2013; 36:149-58. [PMID: 23446761 DOI: 10.5301/ijao.5000128] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Extracorporeal cytokine removal may be desirable. We sought to assess extracorporeal blood purification (EBP) techniques for cytokine removal in experimental animal studies.
METHODS We conducted a targeted, systematic search and identified 17 articles. We analyzed cytokine clearance, sieving coefficient (SC), ultrafiltrate (UF) concentration, and percentage removal. As this review concerns technical appraisal of EBP techniques, we made no attempts to appraise the methodology of the studies included. Results are in descriptive terms only.
RESULTS Applying predicted clearance for 80 kg human, high volume hemofiltration (HVHF) techniques and plasmafiltration (PF) showed the highest rates of cytokine removal. High cutoff (HCO)/HF and PF techniques showed modest ability to clear cytokines using low to medium flows. Standard hemofiltration had little efficacy. At higher flows, HCO/HF achieved clearances between 30 and 70 ml/min for IL-6 and IL-10. There was essentially no removal of tumor necrosis factor (TNF)-alpha outside of PF.
CONCLUSIONS Experimental animal studies indicate that HVHF (especially with HCO filters) and plasmafiltration have the potential to achieve appreciable IL-6 and IL-10 clearances. However, only PF can remove TNF-alpha reliably.
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16
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Nakae H, Eguchi Y, Yoshioka T, Yoshimura N, Isono M. Plasma Diafiltration Therapy in Patients With Postoperative Liver Failure. Ther Apher Dial 2011; 15:406-10. [DOI: 10.1111/j.1744-9987.2011.00969.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Increased hepatic apoptosis in high-fat diet-induced NASH in rats may be associated with downregulation of hepatic stimulator substance. J Mol Med (Berl) 2011; 89:1207-17. [PMID: 21814826 DOI: 10.1007/s00109-011-0790-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 06/10/2011] [Accepted: 07/07/2011] [Indexed: 02/07/2023]
Abstract
The mechanisms of progression from fatty liver to steatohepatitis and cirrhosis are not well elucidated. Hepatocellular apoptosis could be one of the key factors in the pathogenesis of non-alcoholic steatohepatitis (NASH). Hepatic stimulator substance (HSS) protects liver cells from various toxins. We previously reported that HSS is critically important for the survival of hepatocytes due to its mitochondrial association. This study aims to investigate the relationship between HSS and hepatocellular apoptosis in vivo models of high-fat diet-induced NASH and in vitro models of palmitic acid-induced hepatocyte injury. Sprague-Dawley rats were fed a high-fat diet for 8, 12 and 16 weeks. Hepatic histological lesions, liver function and apoptosis were examined. HSS expression, in association with caspase-3 and cytochrome c leakage, which are both indicators of cell apoptosis, was measured. Results showed that a high-fat diet altered liver function and histology in a manner resembling NASH. Hepatic protein and mRNA HSS expression was decreased as NASH progressed. Meanwhile, cell apoptosis increased as result of caspase-3 activation and cytochrome c release, indicating that HSS might be involved in NASH pathogenesis. Furthermore, in palmitic acid-induced hepatic cell damage, over-expression of HSS decreased cells apoptosis. In contrast, repression of HSS expression by siRNA increased cell apoptosis. In conclusion, these data imply that cell apoptosis contributes to the pathogenesis of NASH, during which HSS expression is downregulated. Increasing HSS expression in hepatocytes may forestall cell apoptosis as result of fatty acid insult.
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Abstract
PURPOSE OF REVIEW Acute-on-chronic liver failure (ACLF), a syndrome precipitated by acute liver injury in patients with advanced cirrhosis, is associated with multiorgan dysfunction and high rates of mortality. Liver support systems have been developed in an attempt to improve survival of patients with ACLF by providing a bridge until recovery of the native liver function. RECENT FINDINGS Nonbiological devices such as molecular adsorbent recirculating system (MARS) and fractionated plasma separation and adsorption (Prometheus) are effective in improving severe hepatic encephalopathy and cholestasis, have good safety and tolerability profiles and are frequently employed in patients with ACLD; however, randomized controlled trials (RCTs) failed to show improvement in survival. Biologic devices that incorporate hepatic cells in bioreactors are also under development. Recent data from pilot studies suggested improvement in survival rates in some groups of patients with ACLF; however, their effect on patient survival in RCT is still unknown. SUMMARY Liver support systems are safe and well tolerated when used in management of patients with ACLF. Their use should continue in controlled clinical trials to explore their role in bridging patients to liver transplantation or recovery in well defined patient groups.
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Thiel K, Schenk M, Etspüler A, Schenk T, Morgalla MH, Königsrainer A, Thiel C. A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia. BMC Gastroenterol 2011; 11:79. [PMID: 21756340 PMCID: PMC3224123 DOI: 10.1186/1471-230x-11-79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/14/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Advances in intensive care support such as therapeutic hypothermia or new liver assist devices have been the mainstay of treatment attempting to bridge the gap from acute liver failure to liver transplantation, but the efficacy of the available devices in reducing mortality has been questioned. To address this issue, the present animal study was aimed to analyze the pure clinical effects of a simple extracorporeal dummy device in an anhepatic porcine model of acute liver failure. METHODS Total hepatectomy was performed in ten female pigs followed by standardized intensive care support until death. Five animals (dummy group, n = 5) underwent additional cyclic connection to an extracorporeal dummy device which consisted of a plasma separation unit. The separated undetoxified plasma was completely returned to the pigs circulation without any plasma substitution or exchange in contrast to animals receiving intensive care support alone (control group, n = 5). All physiological parameters such as vital and ventilation parameters were monitored electronically; laboratory values and endotoxin levels were measured every 8 hours. RESULTS Survival of the dummy device group was 74 ± 6 hours in contrast to 53 ± 5 hours of the control group which was statistically significant (p < 0.05). Body temperature 24 hours after hepatectomy was significantly lower (36.5 ± 0.5°C vs. 38.2 ± 0.7°C) in the dummy device group. Significant lower values were measured for blood lactate (1.9 ± 0.2 vs. 2.5 ± 0.5 mM/L) from 16 hours, creatinine (1.5 ± 0.2 vs. 2.0 ± 0.3 mg/dL) from 40 hours and ammonia (273 ± 122 vs. 1345 ± 700 μg/dL) from 48 hours after hepatectomy until death. A significant rise of endotoxin levels indicated the onset of sepsis at time of death in 60% (3/5) of the dummy device group animals surviving beyond 60 hours from hepatectomy. CONCLUSIONS Episodes of slight hypothermia induced by cyclic connection to the extracorporeal dummy device produced a significant survival benefit of more than 20 hours through organ protection and hemodynamic stabilisation. Animal studies which focus on a survival benefit generated by liver assist devices should especially address the aspect of slight transient hypothermia by extracorporeal cooling.
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Affiliation(s)
- Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany
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Li S, Tang Z, Yu H, Li W, Jiang Y, Wang Y, An W. Administration of naked plasmid encoding hepatic stimulator substance by hydrodynamic tail vein injection protects mice from hepatic failure by suppressing the mitochondrial permeability transition. J Pharmacol Exp Ther 2011; 338:750-7. [PMID: 21613410 DOI: 10.1124/jpet.111.181305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute liver failure is a devastating illness of various causes with considerable mortality. Hepatic stimulator substance (HSS) has been suggested for use as a protective agent against acute hepatic injury induced by chemical poisons because it has a variety of biological activities. However, the mechanism whereby HSS protects against hepatotoxins is poorly understood. In this study, we established a hepatic gene transfer system via hydrodynamic tail vein injection to deliver a naked plasmid containing the human HSS gene (hHSS) and analyzed HSS-mediated protection of the liver during fulminant hepatic failure (FHF) induced by D-galactosamine (D-gal) and lipopolysaccharide (LPS). The results showed that the reporter gene, enhanced green fluorescent protein, was efficiently expressed in the liver of BALB/c mice. Hydrodynamic-based transfection of hHSS yielded a 70% survival rate compared with 36.7% for the control group at 24 h after D-gal/LPS treatment. In addition, hHSS expression preserved liver morphology and function. It is noteworthy that hHSS hydrodynamic-based transfer ameliorated indices of the mitochondrial permeability transition (MPT) resulting from the toxic effects of d-gal/LPS on the liver such as mitochondrial swelling, mitochondrial transmembrane potential disruption, and cytochrome c translocation. Furthermore, mitochondrial morphology and ATP levels were maintained in hHSS-administered mice. HSS-mediated protection was similar to that observed with the MPT inhibitor N-methyl-4-isoleucine-cyclosporin (NIM811), indicating a possible role for HSS in the regulation of MPT. In conclusion, a single dose of hHSS plasmid protected mice from FHF, and this hepatoprotective effect seemed to correlate with the inhibition of MPT.
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Affiliation(s)
- Shenglan Li
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, Beijing, China
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Nakae H, Eguchi Y, Saotome T, Yoshioka T, Yoshimura N, Kishi Y, Naka T, Furuya T. Multicenter study of plasma diafiltration in patients with acute liver failure. Ther Apher Dial 2011; 14:444-50. [PMID: 21175541 DOI: 10.1111/j.1744-9987.2010.00864.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. A prospective, multicenter study was undertaken to evaluate the changes in bilirubin, IL-18, and cystatin C, as well as the 28-day and 90-day survival rates, with the use of PDF according to the level of severity as measured by the Model for End-Stage Liver Disease (MELD) score. Twenty-one patients with liver failure were studied: 10 patients had fulminant hepatitis and PDF therapies were performed 28 times; 11 had acute liver failure with the therapy performed 96 times. Levels of total bilirubin, IL-18, and cystatin C decreased significantly after treatment. The 28-day survival rate was 70.0% and that at 90 days was 16.7%. According to the severity of the MELD score, each of the results compared well with the use of Molecular Adsorbent Recirculating System or Prometheus therapy. In conclusion, PDF appears to be one of the most useful blood purification therapies for use in cases of acute liver failure in terms of medical economics and the removal of water-soluble and albumin-bound toxins.
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Affiliation(s)
- Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University School of Medicine, Hondo, Akita 010-8543, Japan.
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Wong KF, Wo J, Ho D, Poon RT, Casasnovas JM, Luk JM. Prophylactic uses of integrin CD18-βA peptide in a murine polymicrobial peritonitis model. World J Gastroenterol 2010; 16:2648-56. [PMID: 20518087 PMCID: PMC2880778 DOI: 10.3748/wjg.v16.i21.2648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prophylactic properties of integrin CD18-βA peptide in a murine model of abdominal polymicrobial peritonitis and sepsis.
METHODS: Bacterial sepsis was induced in Institute of Cancer Research (ICR) mice by cecal ligation and puncture (CLP) surgery. Inflicted mice were then injected with either sterile saline or CD18-βA peptide intraperitoneally at 2 h after surgery, and were sacrificed at 12 and 24 h after surgery. Blood samples were immediately collected, and analyzed for endotoxin activity and tumor necrosis factor (TNF)-α and interleukin (IL)-6. Lungs and liver were studied for CD45+ leukocyte and CD3 mRNA content. Pulmonary expression of intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM) and E-selectin was also determined.
RESULTS: Intraperitoneal injection of CD18-βA peptide significantly suppressed circulating endotoxin activity (P < 0.01) at 24 h, as well as serum levels of TNF-α (P < 0.05 at 12 and 24 h) and IL-6 (P < 0.01 at 12 h, P < 0.05 at 24 h) in CLP-inflicted mice. CD18-βA peptide also abrogated leukocyte infiltration into liver and lungs as unveiled by reduced CD45+ leukocyte and CD3 mRNA contents. Furthermore, the peptide significantly reduced pulmonary expression of VCAM (P < 0.01 at 12 h, P < 0.001 at 24 h), E-selectin (P < 0.01 at 12 and 24 h), and ICAM-1 (P < 0.01 at 12 h, P < 0.001 at 24 h). These actions of CD18-βA peptide collectively protected septic mice against lethality (P < 0.01).
CONCLUSION: CD18-βA peptide is a potent endotoxin antagonist that can protect surgical patients against sepsis-associated lethality.
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Wu Y, Zhang J, Dong L, Li W, Jia J, An W. Hepatic stimulator substance mitigates hepatic cell injury through suppression of the mitochondrial permeability transition. FEBS J 2010; 277:1297-309. [DOI: 10.1111/j.1742-4658.2010.07560.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
A májelégtelenség – akár korábbi májbetegség fennállása nélkül alakult ki (akut májelégtelenség), akár krónikus májbetegség akut dekompenzációja („akut a krónikuson” májelégtelenség) következménye – magas halálozással jár. A végállapotú májbetegségek következtében kialakult májelégtelenség egyetlen kuratív megoldása ma a májtranszplantáció. Ennek fő gátját a rendelkezésre álló donorszervek hiánya képezi, emiatt sok, várólistán szereplő beteg exitál. A transzplantáció korlátai tették szükségessé olyan májtámogató rendszerek kifejlesztését, amelyek alkalmasak a beteg életben tartására a szervátültetésig vagy a máj regenerációjáig. A korai próbálkozások (hemodialízis, hemoperfúzió, cseretranszfúzió, kereszthemodialízis, keresztkeringés, plazmaferézis stb.) elégtelennek bizonyultak. Napjainkban a májpótló kezelésnek két fő iránya alakult ki: a sejtalapú, úgynevezett bioarteficiális és a nem sejtalapú, úgynevezett arteficiális rendszerek. A bioarteficiális rendszerek élő állati májsejteket vagy emberi májtumorsejteket tartalmaznak. Jellegzetességük, hogy a beteg vérét vagy szeparált plazmáját a májsejteket tartalmazó bioreaktoron áramoltatják át. Elviekben a májműködést ezek a metodikák modellezik a legtökéletesebben, mert a máj szintetizáló- és detoxikálófunkcióját egyaránt pótolják. Jelenlegi formájukban azonban még távol állnak az ideális megoldástól, alkalmazásuk számos immunológiai, infektológiai, onkológiai és financiális problémát vet fel, ezért egyelőre csak kísérleti célra állnak rendelkezésre. Az arteficiális rendszerek a klinikum számára már elérhetőek, bár széles körben még nem terjedtek el. Csak a máj detoxikálófunkcióját pótolják, a szintetikus funkció részben a hiányzó anyagok (plazmaproteinek, alvadási faktorok) szubsztitúciójával pótolható. Idetartozik a hemodiabszorpció, amely az Amerikai Egyesült Államokban terjedt el (liver dialysis unit), valamint a főleg Európában használatos albumindialízis és a legújabban kifejlesztett frakcionált plazmaszeparáció és -adszorpció (FPSA). Az albumindialízis egyszerű módszere a „single pass albumin dialysis” (SPAD), ennek továbbfejlesztett változata a „molecular adsorbent recirculating system” (MARS). Az FPSA high-flux hemodialízissel kiegészített változata a Prometheus-rendszer. Bár a felsorolt módszerek hatásosságát számos kísérleti és klinikai tanulmány támasztja alá, a konzervatív kezeléssel szemben a túlélésre kifejtett előnyös hatásuk bizonyítására még nagy esetszámot felölelő, randomizált, kontrollált vizsgálatok elvégzésére van szükség.
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Affiliation(s)
- Csaba Rikker
- 1 Péterfy Sándor Utcai Kórház-Rendelőintézet és Baleseti Központ Fresenius Medical Care Dialízisközpont Budapest Péterfy Sándor u. 8–20. 1076
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26
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Ichikawa T, Sato H, Kaira K, Oh-I S, Kakizaki S, Sato K, Takagi H, Mori M. Prolonged intrahepatic cholestasis after exposure to loxoprofen. Clin Ther 2008; 30:2402-6. [PMID: 19167598 DOI: 10.1016/j.clinthera.2008.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
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27
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Yu JW, Sun LJ, Zhao YH, Li SC. Prediction value of model for end-stage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment. J Gastroenterol Hepatol 2008; 23:1242-9. [PMID: 18637053 DOI: 10.1111/j.1440-1746.2008.05484.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM We used the model for end-stage liver disease (MELD) scoring system to predict the 3-month prognosis of patients with acute-on-chronic liver failure (ACLF) after plasma exchange (PE) and lamivudine treatment, and studied the predictive factors on the prognosis of patients. METHODS A total of 280 patients treated with lamivudine were randomly divided into PE and control groups. The relationship between mortality and influential factors of patients was studied by univariate and multivariate analysis. RESULTS The mortality (49.4%) of patients in the PE group with a MELD score from 30 to 40 was lower than that (86.1%) of the control group (chi(2) = 24.546, P < 0.01). The total bilirubin (TBIL) rebound rate of the dead group was significantly higher than that of the survival group (P < 0.01). Univariate analysis showed that mortality was significantly related to age (P = 0.003), treatment method (P = 0.000), TBIL (P = 0.010), MELD score (P = 0.001), international normalised ratio (P = 0.014), pretreatment HBV-DNA load (P = 0.000), decline of hepatitis B virus (HBV)-DNA load during therapy (P = 0.013), encephalopathy (P = 0.019), and hepatorenal syndrome (P = 0.026). In multivariate analysis, MELD scores of 30-40, treatment method (P = 0.003), pretreatment HBV-DNA load (P = 0.009), decline of HBV-DNA load during therapy (P = 0.016), and encephalopathy (P = 0.015) were independent predictors of mortality; for MELD scores above 40, only the MELD score (P = 0.012) was an independent predictive. CONCLUSIONS PE significantly decreased the mortality of patients with a MELD score of 30-40. For ACLF patients with a MELD score of 30-40, a low viral load pretreatment and quick decline of HBV-DNA load are good predictors for the survival with PE and lamivudine treatment.
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Affiliation(s)
- Jian-Wu Yu
- Department of Infectious Diseases, Second Affiliated Hospital, Harbin Medical University, Harbin, China
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28
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Li N, Zhou L, Zhang B, Dong P, Lin W, Wang H, Xu R, Ding H. Recombinant human growth hormone increases albumin and prolongs survival in patients with chronic liver failure: a pilot open, randomized, and controlled clinical trial. Dig Liver Dis 2008; 40:554-9. [PMID: 18164672 DOI: 10.1016/j.dld.2007.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/09/2007] [Accepted: 11/14/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of recombinant human growth hormone (rhGH) in the treatment of patients with chronic liver failure. SUBJECTS AND METHODS One hundred and fourteen patients with chronic liver failure were randomly divided into two groups: (1) 56 patients in the rhGH treatment group received 4.5IU of rhGH intramuscularly daily for 4 weeks and (2) 58 patients in the control-treatment group. Fifteen healthy subjects served as normal controls. Symptoms and complications were recorded. The prognosis was analysed by Kaplan-Meier survival analysis. The serum GH, IGF-1, IGFBP-3, and insulin levels were determined using ELISA. RESULTS The efficacy of rhGH treatment was 87.5% (vs. 38.1% in the controls-treatment group, p<0.01). The serum GH, IGF-1, IGFBP-3, and insulin levels in patients with chronic liver failure were significantly different than the levels in the normal controls (5.50+/-4.21 vs. 1.57+/-1.27, 80.45+/-69.99 vs. 172.97+/-78.12, 109.93+/-87.53 vs. 373.41+/-119.07, and 31.99+/-49.87 vs. 6.72+/-1.09, respectively, p<0.05-0.001). The serum IGF-1, IGFBP-3, albumin, proalbumin, and cholesterol levels were significantly increased after rhGH treatment; however, the serum GH and insulin levels were decreased. The survival rate of the rhGH treatment and control-treatment groups after 2 weeks, 1 month, 3 months, and 6 months of treatment was 98.21% vs.75.86%, 91.07% vs.62.07%, 66.07% vs.22.41%, and 55.36% vs.13.79%, respectively. Cox regression analysis showed that rhGH was an independent factor in predicting the survival of patients after 3 and 6 months of treatment with rhGH. CONCLUSIONS rhGH replacement therapy increased albumin and tended to improve survival in adult patients with chronic liver failure.
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Affiliation(s)
- N Li
- Department of GI and Hepatology, Beijing You'an Hospital Affiliated to Capital Medical University, China
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Gong D, Ren B, Ji D, Tao J, Xu B, Liu Z, Li Z. Selective albumin exchange: a novel and simple method to remove bilirubin. Int J Artif Organs 2008; 31:425-30. [PMID: 18609516 DOI: 10.1177/039139880803100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Owing to its non-selectivity, plasma exchange has limited use in the treatment of patients with hepatic failure, although it is effective in removal of protein-bound toxins. This study reports a novel way to perform selective albumin exchange (SAE) by using a secondary plasma separator and aims to study its depurative capacity in the removal of bilirubin. METHOD In ex vivo experiments, the sieving coefficients (SCs) of plasma proteins for two secondary plasma separators, EC20W and EC30W (Asahi Medical, Tokyo, Japan), were measured. The EC20W membrane was chosen for use in clinical treatment because of its higher selectivity in separating albumin from plasma than the EC30W. The SCs of albumin, immunoglobumin G, A and M (IgG, IgA, IgM) for the EC20W were 0.3+/-0.021, 0.017+/-0.012, and 0, respectively. Five inpatients with plasma total bilirubin (TB) more than 200 micromol/L were enrolled in the present study and received a total of 10 SAE therapy sessions. Each session lasted 10 hours. SAE using the EC20W was conducted, making it similar to post-dilution continuous veno-venous hemofiltration (CVVH), with a filtrate rate of 2000 ml/h. Replacement fluid was composed by adding human albumin into conventional CVVH replacement fluid, with a final albumin concentration of 0.6%. During each treatment, the parameters of plasma and filtrate TB, direct bilirubin (DB), indirect bilirubin (IDB), and proteins were dynamically monitored. Hemostasis parameters were measured before and after sessions. RESULTS The reduction ratio of plasma TB, DB, and IDB after a single session was 29.1+/-3.0%, 31.3+/-4.5%, and 18.7+/-10.2%, respectively. The clearance of TB at initiation was 11.1+/-1.3 mL/min and declined to 4.4+/-0.5 ml/min at the end (p<0.01). This decline was accompanied by a reduction in albumin SC from 0.3+/-0.021 to 0.13+/-0.05. The molar ratio of bilirubin to albumin in filtrate was comparable to that in plasma. After a single treatment, plasma protein concentration including total protein, albumin, IgA and IgM remained unaffected, except for globulin and IgG, which were reduced by 11.5+/-7.8% and 11.1+/-2.3%, respectively. An improvement in hemostasis parameters, including plasma fibrinogen, prothrombase time and INR, was found after treatment. No obvious side effects were reported during any of the sessions. CONCLUSION Selective albumin exchange is a simple and effective method to remove bilirubin. However, further studies are required to verify its effects on clinical outcome.
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Affiliation(s)
- D Gong
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing - China.
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Bakos Á, Rikker C, Tóvárosi S, Kárteszi †M. The therapeutical efficiency of the newest extracorporal elimination procedure (Prometheus® treatment) in acute liver failure caused by intoxication. Orv Hetil 2007; 148:1981-8. [DOI: 10.1556/oh.2007.28171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Az akut májelégtelenség mortalitása az intenzív terápia ellenére májtranszplantáció nélkül 60–90%. Az átültethető szervek korlátozott száma miatt azonban a betegek jelentős része a várólistán exitál. A mortalitás csökkentése érdekében számos próbálkozás történt a májelégtelenségben felhalmozódó albuminhoz kötött és vízoldékony méreganyagok eltávolítására, elősegítve ezzel a máj spontán regenerációját, illetve a beteg életben tartását a májtranszplantációig. A Prometheus®-kezelés egy viszonylag új technika, a frakcionált plazmaszeparáció és -adszorpció (FPSA) és egy high-flux dialízis kombinációja. Az eljárás során a beteg saját, szeparált, albuminban gazdag plazmája speciális adszorbereken halad keresztül, lehetővé téve az albuminhoz kötött toxinok eliminációját, miközben a vízoldékony toxinok eltávolítása hemodialízissel történik.
Célkitűzés:
A szerzők szándéka az volt, hogy a Prometheus®-kezelés hatékonyságát igazolják mérgezés okozta akut májelégtelenségben.
Betegek és módszer:
A Prometheus®-kezelést három, konzervatív kezeléssel nem uralható akut májelégtelenségben szenvedő, súlyos, paracetamol-, káliumpermanganát- és Amanita phalloides-mérgezett beteg esetében alkalmazták.
Eredmények:
A három nőbetegnél 10 kezelés történt. Súlyos szövődményt nem észleltek. A kezelések során az albuminhoz kötött (indirekt bilirubin
p
= 0,048; epesav
p
= 0,001) és a vízoldékony (direkt bilirubin
p
= 0,002; kreatinin
p
= 0,007) toxinok szignifikáns csökkenését tapasztalták. Az ammónia, a karbamid, a fibrinogén és az antitrombin III szint szignifikánsan nem változott. Mindhárom beteg májtranszplantáció nélkül meggyógyult.
Következtetés:
A Prometheus®-kezelés hatékonyan távolítja el az akut májelégtelenségben akkumulálódó toxinokat. Biztonságos eljárás. Konzervatív terápiával nem uralható esetekben lehetővé teszi a beteg életben tartását a máj spontán regenerációjáig vagy a májtranszplantációig.
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Affiliation(s)
- Ágnes Bakos
- 1 Péterfy Sándor utcai Kórház és Rendelőintézet Sürgősségi Belgyógyászati és Klinikai Toxikológiai Osztály Budapest Alsóerdősor u. 7. 1074
| | - Csaba Rikker
- 2 Péterfy Sándor utcai Kórház és Rendelőintézet Fresenius Medical Care Dialízis Központ Budapest
| | | | - †Mihály Kárteszi
- 1 Péterfy Sándor utcai Kórház és Rendelőintézet Sürgősségi Belgyógyászati és Klinikai Toxikológiai Osztály Budapest Alsóerdősor u. 7. 1074
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Wu Y, Chen L, Yu H, Liu H, An W. Transfection of hepatic stimulator substance gene desensitizes hepatoma cells to H2O2-induced cell apoptosis via preservation of mitochondria. Arch Biochem Biophys 2007; 464:48-56. [PMID: 17485068 DOI: 10.1016/j.abb.2007.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 03/17/2007] [Accepted: 03/20/2007] [Indexed: 12/19/2022]
Abstract
Hepatic stimulator substance (HSS) protects liver cells from various toxins. However, the mechanism by which HSS protects hepatocytes remains unclear. In this study, we report that the HSS gene, after transfection into BEL-7402 hepatocma cells, is stably expressed in the mitochondria. Hydrogen peroxide (H(2)O(2))-induced cell apoptosis in the HSS-transfected cells is reduced, as shown by morphologic analysis. In the HSS-transfected cells, disruption of mitochondrial transmembrane potential (MTP) and cytochrome c leakage are reduced. The anti-apoptotic gene Bcl-2 is also highly expressed. In addition, ATP levels in the HSS-transfected cells are maintained. In conclusion, in hepatoma cells, HSS gene expression protects cells against H(2)O(2) injury, and this effect is likely to be associated with preservation of mitochondria.
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Affiliation(s)
- Yuan Wu
- Department of Cell Biology and Municipal Laboratory for Liver Protection and Regulation of Regeneration, Capital Medical University, 10 You An Men Wai Xi Tou Tiao, Beijing 100069, China
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Harvie M, Jordan TW, La Flamme AC. Differential liver protein expression during schistosomiasis. Infect Immun 2006; 75:736-44. [PMID: 17101652 PMCID: PMC1828499 DOI: 10.1128/iai.01048-06] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The arrival of eggs in the liver during Schistosoma mansoni infection initiates a protective granulomatous response; however, as the infection progresses, this response results in chronic liver fibrosis. To better understand the impact of schistosomiasis on liver function, we used a proteomic approach to identify proteins whose expression was significantly altered in schistosome-infected mice 8 weeks postinfection. Identification of differentially expressed proteins by mass fingerprinting revealed that schistosome infection markedly reduced the abundance of proteins associated with several normal liver functions (i.e., citric acid cycle, fatty acid cycle, and urea cycle), while proteins associated with stress responses, acute phase reactants, and structural components were all significantly more abundant. The expression patterns of several immunity-related proteins (peroxiredoxin 1, arginase 1, and galectin 1) suggested that different protein forms are associated with schistosome infection. These findings indicate that acute schistosomiasis has a significant impact on specific liver functions and, moreover, that the alterations in specific protein isoforms and upregulation of unique proteins may be valuable as new markers of disease.
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Affiliation(s)
- Marina Harvie
- School of Biological Sciences, Victoria University of Wellington, P.O. Box 600, Wellington, New Zealand
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Mitzner S, Klammt S, Stange J, Schmidt R. Albumin regeneration in liver support-comparison of different methods. Ther Apher Dial 2006; 10:108-17. [PMID: 16684211 DOI: 10.1111/j.1744-9987.2006.00351.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Albumin is the most abundant human plasma protein. Among many other functions it is an important transporter of hydrophobic internal and external substances such as intermediate and end products of metabolism and drugs. In liver failure the albumin binding capacity is decreased because of a disproportion between available albumin molecules caused by decreased hepatic synthesis and hydrophobic toxins because of decreased hepatic clearance. The resulting increase in plasma and tissue concentrations of these substances is associated with multiple organ dysfunctions frequently seen in severe liver failure. The scope of the present article is to compare different liver support strategies with regard to their ability to regenerate the patients albumin pool by removing albumin-bound toxins. Most prominent technique in this group is the molecular adsorbent recirculating system (MARS). It will be compared with single pass albumin dialysis (SPAD), fractionated plasma separation and adsorption system (FPSA, Prometheus), and plasma perfusion/bilirubin adsorption with special regard to efficacy and selectivity.
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Affiliation(s)
- Steffen Mitzner
- Department of Medicine, University of Rostock, Rostock, Germany.
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Rozga J, Umehara Y, Trofimenko A, Sadahiro T, Demetriou AA. A novel plasma filtration therapy for hepatic failure: preclinical studies. Ther Apher Dial 2006; 10:138-44. [PMID: 16684215 DOI: 10.1111/j.1744-9987.2006.00355.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a need to develop artificial means of liver replacement and/or assistance with the aim of either supporting patients with borderline functional liver cell mass until their liver regenerates, or until a donor liver becomes available for transplantation. Selective plasma filtration is a novel approach to blood purification therapy designed to reduce the level of circulating toxins of hepatic and renal failure, mediators of inflammation and inhibitors of hepatic regeneration. The results of preclinical studies indicate that treatment of pigs with experimentally-induced fulminant hepatic failure is safe and effective in extending survival time and arresting brain swelling. In addition, the amount of ammonia, aromatic amino acids, IL6, TNFalpha and C3a removed during the 6-h treatment in the present study was higher by 34% to 175% than the total plasma content of those substances at the start of therapy.
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Affiliation(s)
- Jacek Rozga
- Arbios Systems, Inc, Los Angeles, CA 90048, USA.
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Li LJ, Zhang YM, Liu XL, Du WB, Huang JR, Yang Q, Xu XW, Chen YM. Artificial liver support system in China: a review over the last 30 years. Ther Apher Dial 2006; 10:160-7. [PMID: 16684218 DOI: 10.1111/j.1744-9987.2006.00358.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Severe viral hepatitis with high mortality is the most common cause of liver failure in China. Treatment of severe viral hepatitis by hemoperfusion was initially adopted in the late 1970s and early 1980s. Following 10 years of development in China, a plasma exchange (PE)-centered artificial liver support system (ALSS), principally dependent on PE technology was developed. Based on the condition and symptoms of each patient, PE was given alone, or combined with hemodialysis, hemofiltration, hemodiafiltration, hemoperfusion, or plasma perfusion. In the late 1990s, training courses for ALSS were developed, and ALSS began to be carried out across China. Guidelines for artificial liver therapy were formulated and published by the Artificial Liver and Liver Failure Group of the Chinese Society of Infection. In recent years, new methods have been attempted, including small pore-size plasma separators, a molecular adsorbent-based recirculating system (MARS), and a continuous albumin purification system (CAPS). According to a retrospective analysis published in 2004, ALSS therapy significantly (P < 0.001) improved the survival rate of patients with severe hepatitis compared with patients who received only medicines (43.4%, 157/362 vs. 15.4%, 55/358 in chronic patients and 78.9%, 30/38 vs. 11.9%, 5/42 in acute and subacute patients). Furthermore, ALSS has also proved valuable as a bridge to liver transplantation in the treatment of patients with end-stage severe hepatitis in China. More recently, ALSS has been used in the treatment of drug-induced liver failure, acute fatty liver during pregnancy, and other difficult-to-treat disorders in China.
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Affiliation(s)
- Lan Juan Li
- Key Laboratory of Infectious Diseases, Ministry of Public Health, Department of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Abstract
In the present review, various animal models of acute liver failure are reviewed with respect to their suitability for evaluating liver support systems (LSS) according to envisaged modes of therapy. In order to increase the value of the preclinical testing of LSS, it would be advantageous to include more than one animal model in the evaluation program. It is possible to identify appropriate sets of models, which make a suitable test system for particular clinical applications. A standardization of evaluation methods between testing groups would also be beneficial to the field of liver support.
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Affiliation(s)
- Oleksandr Seleverstov
- Center for Biotechnology and Biomedicine (BBZ), University of Leipzig, Leipzig, Germany.
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Nishimura A, Umehara Y, Umehara M, Hakamada K, Narumi S, Toyoki Y, Yoshihara S, Sasaki M. Plasma Exchange-based Plasma Recycling Dialysis System as a Potential Platform for Artificial Liver Support. Artif Organs 2006; 30:629-33. [PMID: 16911318 DOI: 10.1111/j.1525-1594.2006.00273.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We developed a plasma recycling dialysis (PRD) system based on plasma exchange (PE). In this system, rapid reduction of toxic substances and restitution of deficient essential substances are performed by PE, and subsequent blood purification is performed by dialysis between separated plasma recycled over a purification device and the patient's blood across the membrane of the plasma separator. This study was performed to demonstrate the safety and efficacy of this system. Hyperbilirubinemia was induced by ligating the bile duct in pigs, and 7 days later, only PE for 2 h (group PE) or PE for 2 h followed by PRD for 6 h (group PE + PRD) was performed. The separated plasma was recycled over anion-exchange resin through the extra fiber space of the plasma separator. The safety and efficacy of this system were evaluated based on the values of hemodynamic and laboratory parameters. Transfer from PE to PRD was completed in a few minutes. The hemodynamic status and blood cells counts were stable and hemolysis was not observed during the procedure. In the PE + PRD group, the concentrations of total bile acids continuously decreased (pretreatment, 155.5 +/- 40.6 microM; 2 h [end of PE], 76.1 +/- 14.4 microM; 8 h [end of PRD], 25.8 +/- 9.1 microM) and the value was significantly lower than in the PE group after 6 h. The total bilirubin also continuously decreased during PRD (pretreatment, 55.3 +/- 11.5 microM; 2 h [end of PE], 33.8 +/- 8.4 microM; 8 h [end of PRD], 18.6 +/- 7.7 microM) and was significantly lower than in the PE group after 4 h. No significant change was observed in other laboratory values. This PE-based PRD system allowed a swift transfer from PE to sorbent-based blood purification. The safety of this system was demonstrated and the removal of toxic substances was significant. This study confirmed the clinical utility of this system as a platform for artificial liver support.
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Affiliation(s)
- Akimasa Nishimura
- Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
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Li LJ, Liu XL, Xu XW, Sheng GP, Chen Y, Chen YM, Huang JR, Yang Q. Comparison of Plasma Exchange With Different Membrane Pore Sizes in the Treatment of Severe Viral Hepatitis. Ther Apher Dial 2005; 9:396-401. [PMID: 16202014 DOI: 10.1111/j.1744-9987.2005.00277.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Plasma exchange has become an effective mode of blood purification in patients suffering from liver failure. To assist in patient recovery, we compared two plasma separators to identify a plasma separator with suitable pore sizes to remove toxic substances effectively, and retain important plasma components. The study focused on severe viral hepatitis patients. Of 206 rounds of plasma exchange, 137 were completed with the PS-06 plasma separator (membrane pore size=0.2 microm) and 69 with the EC-4A plasma separator (membrane pore size=0.03 microm). The efficacy of different plasma separators was compared using survival rate, changes in liver biochemistry, immunoglobulin, and complement parameters. The survival rate of patients treated with PS-06 was 43.3% (13 of 30 patients). For patients treated with EC-4A, two patients were bridged to liver transplantation successfully, and 57.9% (11 of 19 patients) survived. In both groups, the levels of total bilirubin, prothrombin time, and bile acid declined significantly. Compared to PS-06, EC-4A could retain significantly larger amounts of immunoglobulin and complements. Our study revealed that plasma exchange implementation with membrane pore size 0.03 microm could remove adequate bilirubin and bile acid, a class of toxins bound to plasma protein in severe viral hepatitis patients, and reduce the loss of essential plasma macromolecules.
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Affiliation(s)
- Lan Juan Li
- Department of Infectious Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Miyazawa M, Torii T, Toshimitsu Y, Koyama I. Effect of Mechanical Stress Imposition on Co-culture of Hepatic Parenchymal and Nonparenchymal Cells: Possibility of Stimulating Production of Regenerating Factor. Transplant Proc 2005; 37:2398-401. [PMID: 15964426 DOI: 10.1016/j.transproceed.2005.03.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Indexed: 12/22/2022]
Abstract
The effect of mechanical stress generated within a three-dimensional bioreactor on the co-culture of hepatic parenchymal cells (PC) and hepatic nonparenchymal cells (NPC) was assessed to develop a bioartificial liver that can produce factors accelerating liver regeneration. A rotating radial flow bioreactor was used to provide mechanical stress to a co-culture of PC and NPC that were isolated from rats. They were co-cultured in the reactor under static or dynamic conditions. Albumin, interleukin-6 (IL-6), hepatocyte growth factor (HGF), and lactate dehydrogenase (LDH) were measured at intervals. Electron microscopy was also performed. LDH was not significantly different between the static and mechanical stress-loaded cultures, while albumin and interleukin-6 levels were higher in the latter at all sampling times. Only the co-cultures loaded with mechanical stress produced HGF in the early stage of culture (hours 3 and 6). Histologically, the cells retained their structure when cultured under dynamic conditions. These results suggested that an appropriate level of mechanical stress enabled co-cultures of PC and NPC to produce IL-6, HGF, and other factors that accelerate liver regeneration.
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Affiliation(s)
- M Miyazawa
- Department of Surgery, Saitama Medical School, 38-Morohongou, Moroyama, Iruma-gun, Saitama 350-0495, Japan
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Ding HG, Shan J, Zhang B, Ma HB, Zhou L, Jin R, Tan YF, He LX. Combined human growth hormone and lactulose for prevention and treatment of multiple organ dysfunction in patients with severe chronic hepatitis B. World J Gastroenterol 2005; 11:2981-3. [PMID: 15902741 PMCID: PMC4305672 DOI: 10.3748/wjg.v11.i19.2981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficiency and safety of combined recombinant human growth hormone (rhGH) and lactulose for treatment and/or prevention of multiple organ dysfunction in patients with chronic severe hepatitis B.
METHODS: Forty-eight inpatients with chronic severe hepatitis B were randomly divided into rhGH group (n = 28) and control group (n = 20). In rhGH group, 4-4.5 IU of rhGH was injected intramuscularly once daily for 2-4 wk, and 100 mL of enema containing 30 mL of lactulose, 2 g of metronidazole and 0.9% saline was administered every 2 d for 2-4 wk. Their symptoms and complications were noted. Liver and kidney functions were analyzed by an Olympus analyzer. Serum GH, IGF-1, IGFBP1 and IGFBP3 were measured by ELISA.
RESULTS: Clinical symptoms of 90% of these patients in rhGH group were obviously improved. The total effectiveness in rhGH group was better than that in control group (75% vs 40%, P<0.05). After 2- and 4-wk treatment of rhGH respectively, serum albumin (26.1±4.1 vs 30.2±5.3, 31.9±5.1 g/L), prealbumin (79.6±28.0 vs 106.6±54.4, 108.4±55.0 g/L), cholesterol (76.3±16.7 vs 85.6±32.3, 96.1±38.7 mg/dL), and IGFBP1 (56.8±47.2 vs 89.7±50.3 ng/mL after 2 wk) were significantly increased compared to control group (P<0.05). However, serum GH was decreased. The increase of serum IGF1 and IGFBP3 after rhGH treatment was also observed.
CONCLUSION: rhGH in combination with lactulose may be beneficial to the prevention and treatment of multiple organ dysfunction in patients with chronic severe hepatitis.
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Affiliation(s)
- Hui-Guo Ding
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital University of Medical Sciences, Beijing 100054, China.
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Abstract
Owing to its powers of regeneration, the liver is capable of in vivo "tissue engineering" which enables complete restoration of liver architecture and re-establishment of the specific functions of the liver after various types of liver injury. Our current understanding of liver regeneration forms the basis of modern liver surgery and is now taken into consideration in the treatment of many liver diseases, in liver transplantation and hepatic tissue engineering. These advances have been achieved primarily by studies of liver regeneration in animal models after partial hepatectomy, attention being focused on the general mechanisms of cell proliferation. In recent years, however, toxin-induced models of liver regeneration have assumed growing importance, and by studying the interaction between cell damage and cell regeneration have made possible an investigation of liver regeneration of greater clinical relevance. However, the mechanisms of liver regeneration in patients with pre-existing chronic liver damage such as liver cirrhosis are still largely unexplored. This review examines and critically appraises the various approaches to the study of liver regeneration in animal models, including both surgical and pharmacological approaches.
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Affiliation(s)
- Daniel Palmes
- Surgical Research, Department of General Surgery, Muenster University Hospital, Waldeyer Str. 1, 48149, Muenster, Germany
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Wang PP, Wang JH, Yan ZP, Hu MY, Lau GK, Fan ST, Luk JM. Expression of hepatocyte-like phenotypes in bone marrow stromal cells after HGF induction. Biochem Biophys Res Commun 2004; 320:712-6. [PMID: 15240106 DOI: 10.1016/j.bbrc.2004.05.213] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Indexed: 01/10/2023]
Abstract
Bone marrow comprises heterogeneous cell populations, of which certain progenitors have demonstrated the ability to differentiate into multiple mesenchymal cell lineages. This study demonstrates the bone marrow stromal cells (BMSCs) with intrinsic plasticity to differentiate into hepatocyte-like phenotypes under in vitro induction of hepatocyte growth factor (HGF). BMSCs isolated from rat femurs and tibias were cultured and passaged 3-4 times in the presence of HGF. Cells were harvested on days 0, 10, and 20 and subjected to examination of any hepatocyte characteristics by flow cytometry, RT-PCR, Western blot, and immunocytochemistry. Expression of albumin and alpha-fetoprotein at both mRNA and protein levels was detectable on day 10. By contrast, c-Met mRNA was significantly decreased in BMSC in the course of HGF induction. Here BMSC was shown to differentiate into hepatocyte-like phenotypes given the HGF induction, as an alternative source for adult stem cell transplantation in liver repair.
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Affiliation(s)
- P Ping Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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He NH, Wang YJ, Wang ZW, Liu J, Li JJ, Liu GD, Wang YM. Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study. World J Gastroenterol 2004; 10:1218-21. [PMID: 15069730 PMCID: PMC4656365 DOI: 10.3748/wjg.v10.i8.1218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: Non-bioartificial liver has been applied to clinic for quite a long time, but the reported efficacy has been very different. The aim of this study was to compare the efficacy and safety of hemoperfusion adsorption, plasma exchange and plasma exchange plus hemoperfusion adsorption in treatment of severe viral hepatitis.
METHODS: Seventy-five patients with severe viral hepatitis were treated with hemoperfusion adsorption therapy (24 cases), plasma exchange therapy (17 cases) and plasma exchange plus hemoperfusion adsorption therapy (34 cases). The data of liver function, renal function, blood routine test, prothrombin time (PT) and prothrombin activity (PTa) pre-and post-therapy were analyzed.
RESULTS: Clinical symptoms of patients improved after treatment. The levels of aminotransferase, total bilirubin, direct bilirubin decreased significantly after 3 therapies (P < 0.05 or P < 0.01). PT, the level of total serum protein decreased significantly and PTa increased significantly after plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy (P < 0.05 or P < 0.01). The side effects were few and mild in all patients.
CONCLUSION: Three therapies were effective in the treatment of severe viral hepatitis. Plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy are better than hemoperfusion adsorption therapy.
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Affiliation(s)
- Nian-Hai He
- Research Institute of Infectious Disease, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Zhengjie, Chongqing 400038, China
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Maruyama M, Totsugawa T, Kunieda T, Okitsu T, Shibata N, Takesue M, Kurabayashi Y, Oshita M, Nakaji S, Kodama M, Tanaka N, Kobayashi N. Hepatocyte isolation and transplantation in the pig. Cell Transplant 2004; 12:593-8. [PMID: 14579927 DOI: 10.3727/000000003108747190] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepatocyte transplantation (HTX) has received great expectation for the treatment of a wide spectrum of liver diseases. Considering the severe shortage of human livers for hepatocyte isolation, porcine hepatocytes are an attractive alternative to normal human hepatocytes. To develop such therapy, establishment of an efficient hepatocyte isolation and transplantation model that enables accurate assessment of safety and efficacy of HTX is extremely important. Porcine hepatocytes were isolated from a surgically removed liver segment with a four-step retrograde perfusion using dispase and collagenase. The resultant hepatocytes of > 84% viability were used for transplantation experiment in a pig model of acute liver failure induced by intravenous administration of D-galactosamine (D-gal) (0.5 mg/kg). Twenty-four hours after D-gal injection, transplantation of freshly isolated porcine hepatocytes (1 x 10(9)) was safely conducted and prolonged the survival of D-gal-treated pigs. We describe an efficient porcine hepatocyte isolation and subsequent cell transplantation in pigs with D-gal-induced liver failure.
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Affiliation(s)
- Masanobu Maruyama
- Department of Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
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Wang YJ, Wang ZW, Luo BW, Liu HL, Wen HW. Assessment of resin perfusion in hepatic failure in vitro and in vivo. World J Gastroenterol 2004; 10:837-40. [PMID: 15040028 PMCID: PMC4727023 DOI: 10.3748/wjg.v10.i6.837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To observe the adsorbent effect of resin on endotoxin, cytokine, bilirubin in plasma of patients with hepatic failure and to determine the resin perfusion as an artificial liver support system in the treatment of hepatic failure.
METHODS: One thousand milliliters of discarded plasma was collected from each of 6 severe hepatitis patients treated with plasma exchange. The plasma was passed through a resin perfusion equipment for 1-2 h via extracorporeal circulation, and then absorbent indicators of transaminase, bilirubin, blood ammonia, endotoxin and cytokines were examined. In the meantime, study of in vivo resin plasma perfusion was performed on 7 severe hepatitis patients to compare the changes of endotoxin and cytokines in blood before and after perfusion.
RESULTS: The levels of total bilirubin, endotoxin, interleukin 1β and TNF-α in plasma were significantly decreased after in vitro resin plasma perfusion. The levels of interleukin 1β, TNF-α and endotoxin in blood were also evidently declined after in vivo resin plasma perfusion. Nevertheless, no obvious changes in IL-6, creatinine (Cr) and urea nitrogen (UN), blood ammonia and electrolytes were found both in vitro and in vivo.
CONCLUSION: Bilirubin, endotoxin and cytokines in plasma of patients with hepatic failure can be effectively adsorbed by resin in vitro. Most cytokines and endotoxin in plasma can also be effectively removed by resin in vivo. It demonstrates that resin perfusion may have good treatment efficacy on hepatic failure and can be expected to slow down the progression of hepatic failure.
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Affiliation(s)
- Ying-Jie Wang
- Institute of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Sizer E, Wendon J, Bernal W. Acute Liver Failure in the ICU. Intensive Care Med 2003. [DOI: 10.1007/978-1-4757-5548-0_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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