Expression of Inflammatory and Regenerative Genes in a Model of Liver Ischemia/Reperfusion and Partial Hepatectomy

New progress in understanding roles of nitric oxide during hepatic ischemia-reperfusion injury

Hepatic ischemia-reperfusion injury (HIRI) is a major clinical cause of morbidity and mortality in liver surgery and transplantation. Many studies have found that nitric oxide (NO) plays an important role in the HIRI and its increase or decrease can affect the progression and outcome of HIRI. However, the role of NO in HIRI is controversial and complicated. NO derived by endothelial NO synthase (eNOS) shows a protective role in HIRI, while excessive NO derived by inducible NO synthase (iNOS) accelerates inflammation and increases oxidative stress, further aggravating HIRI. Nevertheless, the overexpression of eNOS may exacerbate HIRI and iNOS-derived NO in some cases reduces HIRI. Here we review the new progress in the understanding of the roles of NO during HIRI: (1) NO possesses different roles in HIRI by increasing NO bioavailability, down-regulating leukotriene C4 synthase, inhibiting the activation of the nuclear factorκB (NFκB) pathway, enhancing cell autophagy, and reducing inflammatory cytokines and reactive oxygen species (ROS). And NO has both protective and deleterious effects by regulating apoptotic factors; (2) eNOS promotes NO production and suppresses its own overexpression, exerting a hepatoprotective effect reversely. Its activation is regulated by the PI3K/Akt and KLF2/AMPK pathways; and (3) iNOS derived NO mainly has deteriorating effects on HIRI, while it may have a protective function under some conditions. Their expression should reach a balance to reduce the adverse side and make NO protective in the treatment of HIRI. Thus, it can be inferred that NO modulating drugs may be a new direction in the treatment of HIRI or may be used as an adjunct to mitigate HIRI for the purpose of protecting the liver.

Restored microRNA-326-5p Inhibits Neuronal Apoptosis and Attenuates Mitochondrial Damage via Suppressing STAT3 in Cerebral Ischemia/Reperfusion Injury

Studies have greatly explored the role of microRNAs (miRNAs) in cerebral ischemia/reperfusion injury (CI/RI). But the specific mechanism of miR-326-5p in CI/RI is still elusive. Hence, this study was to unmask the mechanism of miR-326-5p/signal transducer and activator of transcription-3 (STAT3) axis in CI/RI. Two models (oxygen and glucose deprivation [OGD] in primary rat cortical neurons and middle cerebral artery occlusion [MCAO] in Sprague-Dawley rats) were established to mimic CI/RI in vitro and in vivo, respectively. Loss- and gain-of function assays were performed with OGD-treated neurons and with MCAO rats. Afterward, viability, apoptosis, oxidative stress and mitochondrial membrane potential in OGD-treated neurons were tested, as well as pathological changes, apoptosis and mitochondrial membrane potential in brain tissues of MCAO rats. Mitofusin-2 (Mfn2), miR-326-5p and STAT3 expression in OGD-treated neurons and in brain tissues of MCAO rats were detected. Mfn2 and miR-326-5p were reduced, and STAT3 was elevated in OGD-treated neurons and brain tissues of MCAO rats. miR-326-5p targeted and negatively regulated STAT3 expression. Restoring miR-326-5p or reducing STAT3 reinforced viability, inhibited apoptosis and oxidative stress, increased mitochondrial membrane potential and increased Mfn2 expression in OGD-treated neurons. Up-regulating miR-326-5p or down-regulating STAT3 relieved pathological changes, inhibited apoptosis and elevated mitochondrial membrane potential and Mfn2 expression in brain tissues of rats with MCAO. This study elucidates that up-regulated miR-326-5p or down-regulated STAT3 protects against CI/RI by elevating Mfn2 expression.

Desflurane protects against liver ischemia/reperfusion injury via regulating miR-135b-5p

BACKGROUND

A number of anesthetics have protective effect against ischemia-reperfusion (I/R) injury, including desflurane. But the function and molecular mechanism of desflurane in liver I/R injury have not been fully understood. The aim of this study was to investigate the effect of desflurane on liver I/R injury and further investigated the molecular mechanisms involving in miR-135b-5p.

METHODS

The models of liver I/R injury in rats were established, and received desflurane treatment throughout the injury. Serum alanine transaminase (ALT) and aspartate transaminase (AST) were measured and compared between groups. H/R-induced cell model in L02 was established, and were treated with desflurane before hypoxia. Quantitative real-time polymerase chain reaction was performed to determine the expression of miR-135b-5p in different groups. The cell apoptosis was detected using flow cytometry assay. Western blot was used for the measurement of protein levels.

RESULTS

I/R significantly increased serum levels of ALT and AST in rats, which were reversed by desflurane treatment. Desflurane also significantly attenuated the increase of cell apoptosis induced by I/R in both vivo and vitro. MiR-135b-5p significantly reversed the protective effect of desflurane against liver I/R injury. Additionally, Janus protein tyrosine kinase (JAK)2 was shown to be a target gene of miR-135b-5p, and miR-135b-5p overexpression significantly decreased the protein levels of p-JAK2, JAK2, p-STAT3.

CONCLUSION

Desflurane attenuated liver I/R injury through regulating miR-135b-5p, and JAK2 was the target gene of mIR-135b-5p. These findings provide references for further development of therapeutic strategies in liver injury.

Comparative safety and effectiveness of ultrasound-guided radiofrequency ablation combined with preoperative three-dimensional reconstruction versus surgical resection for solitary hepatocellular carcinoma of 3-5 cm

OBJECTIVE

To investigate the safety and effectiveness of ultrasound-guided radiofrequency ablation (RFA) combined with preoperative three-dimensional (3D) reconstruction versus surgical resection for solitary hepatocellular carcinoma of 3-5 cm.

METHODS

The cohort of this retrospective study included 66 consecutive patients who underwent open hepatectomy (Surgery group) between January 2009 and December 2014, as well as 54 consecutive patients who underwent ultrasound-guided RFA combined with preoperative 3D reconstruction (RFA group) during the same period. Preoperative 3D reconstruction was performed using Myrian-XP-Liver software. The image fusion system was used to evaluate the RFA safety margin at 1 month after surgery. Kaplan-Meier analysis and the log-rank test were used to compare the recurrence and overall survival (OS) rates between the two treatment groups.

RESULTS

There were no significant differences in the baseline characteristics of the two groups. The complete ablation rate was 94.4% (51/53). As compared with surgical resection for solitary HCC of 3-5 cm, ultrasound-guided RFA combined with preoperative 3D reconstruction significantly reduced the morbidity of excessive pain, total complications, and infections (p < 0.001). A significant decrease in the duration of the hospital stay after treatment was also observed in the RFA group (t = 10.017, p < 0.001). There was no significant difference in the cumulative recurrence rate between the two groups. Kaplan-Meier analysis and the log-rank test revealed no significant difference in the OS rate between the two groups over a 3-year follow-up period.

CONCLUSION

Ultrasound-guided RFA combined with preoperative 3D reconstruction appears to be a safe and effective therapeutic option for patients with solitary HCC of 3-5 cm.

Ischemic postconditioning decreases iNOS gene expression but ischemic preconditioning ameliorates histological injury in a swine model of extended liver resection

Background

Both pre- and postconditioning have been shown to protect the liver parenchyma from ischemia/reperfusion (I/R) injury during hepatectomy by altering the production of NO. However, to date there is no study to compare their effect on the inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) gene expression, who are the main modulators in the pathway of NO during the acute phase of I/R injury.

Methods

We designed a prospective experimental cohort comprising of three groups (sham group-SG, preconditioning-PrG and postconditioning group-PoG) and consisting of 10 animals per group. All animals underwent extended hepatectomy (70%) under prolonged warm ischemia either after preconditioning or followed by postconditioning or without any protective maneuver (SG). Following reperfusion blood samples and liver biopsies were obtained at the start of reperfusion (0 hours), at 6 and 12 hours post reperfusion. iNOS and eNOS gene expression was assessed on liver tissue by polymerase chain reaction (PCR); in addition, the extent of hepatocellular injury was histologically assessed.

Results

At the beginning of reperfusion iNOS expression was significantly reduced in the PoG in comparison to the SG (Kruskal-Wallis test, P=0.012; Mann-Whitney U test, P<0.0005 Bonferroni correction) and continued to remain at low levels until 6 hours post reperfusion (Kruskal-Wallis test, P=0.01; Mann-Whitney U test, P<0.0005-Bonferroni correction) This difference was eliminated by 12 hours. No significant differences were found in the expression of eNOS between groups and within time measurements. Aspartate aminotransferase (AST) and Alkaline phosphatase (ALP) were found increased at the start of reperfusion; their levels continued to increase by 6 hours in all groups, however only in the PoG the increase attended statistical significance at 12 hours after reperfusion. ALT levels presented only minor alterations during the course of reperfusion. The PrG was found to have more intense hepatocellular injury at the start of reperfusion than the PoG however, that appeared to gradually settle by 12 hours in contrast to PoG where the hepatocellular injury continued to deteriorate.

Conclusions

PoG appeared to decrease iNOS overexpression more effectively than PrG in comparison to animals who have undergone no protective maneuver (SG). However, PrG was more effective than PoG in ameliorating the hepatocellular injury observed at 12 hours after the ischemic insult.

Plasma membrane-bound G protein-coupled bile acid receptor attenuates liver ischemia/reperfusion injury via the inhibition of toll-like receptor 4 signaling in mice

The plasma membrane-bound G protein-coupled bile acid receptor (TGR5) displays varied levels of expression in different tissues. TGR5-induced liver protection has been demonstrated during several liver diseases, except during ischemia/reperfusion injury (IRI). Male adult wild-type and TGR5 knockout (KO) mice were subjected to liver partial warm ischemia/reperfusion. Hepatic injury was evaluated based on serum alanine aminotransferase and serum aspartate aminotransferase. Liver histological injury and inflammatory cell infiltration were evaluated in tissue sections using liver immunohistochemical analysis. We used quantitative real-time polymerase chain reaction to analyze the liver expression of inflammatory cytokines. The toll-like receptor 4 (TLR4) signaling pathway and its related apoptotic molecules were investigated after reperfusion. Moreover, the effect of TGR5 on inflammation was determined with TGR5^+/+ or TGR5^-/- primary bone marrow-derived macrophages in vitro. TGR5 significantly attenuated liver damage after IRI. As demonstrated by in vivo experiments, TGR5 significantly reduced the up-regulation of the TLR4-nuclear factor kappa B (NF-κB) pathway and inhibited caspase 8 activation after IRI. Later experiments showed that TGR5 KO significantly increased the expression of TLR4-NF-κB signaling molecules and promoted hepatocellular apoptosis. In addition, in vitro experiments showed that overexpression of 6alpha-ethyl-23(S)-methylcholic acid (INT-777)-activated TGR5 directly down-regulated tumor necrosis factor α (TNF-α) and interleukin (IL) 6 expression but up-regulated IL10 expression in hypoxia/reoxygenation-induced primary TGR5^+/+ macrophages. Moreover, the expression of TLR4-NF-κB signaling molecules was significantly inhibited by the activation of TGR5. Importantly, these results were completely reversed in primary TGR5^-/- macrophages. This work is the first to provide evidence for a TGR5-inhibited inflammatory response in IRI through suppression of the TLR4-NF-κB pathway, which may be critical in reducing related inflammatory molecules and modulating innate inflammation. Liver Transplantation 23:63-74 2017 AASLD.