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Benbow JH, Elam AD, Bossi KL, Massengill DL, Brandon-Warner E, Anderson WE, Culberson CR, Russo MW, deLemos AS, Schrum LW. Analysis of Plasma Tenascin-C in Post-HCV Cirrhosis: A Prospective Study. Dig Dis Sci 2018; 63:653-664. [PMID: 29330728 DOI: 10.1007/s10620-017-4860-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Hepatitis C virus (HCV)-related cirrhosis, one of the most common etiologies of liver cirrhosis in the Western world, is a risk factor for hepatocellular carcinoma. To confirm and improve current effectiveness of screening and prognosis of patients with established cirrhosis, a credible, simple plasma biomarker is needed. Hepatic stellate cell activation, a pivotal event in cirrhosis development, results in increased secretion of extracellular matrix proteins, including tenascin-C (TnC). Herein, we tested TnC as a simple biomarker to identify cirrhotic patients with active HCV infection from those with HCV eradication. METHODS A prospective study of subjects with HCV-related cirrhosis, stratified into two groups, HCV or virologic cure, was conducted. Plasma TnC expression was measured by ELISA and Western blots. TnC values were correlated with markers of liver injury and ROC analyses performed between groups. RESULTS The HCV cirrhotic cohort, consisting mostly of men (56%), Caucasians (76%), and genotype 1a or 1b (84%), was compared to healthy controls (HCs). Plasma TnC was significantly higher in HCV cirrhotic patients with active infection compared to HCs (P < 0.0001) and virologic cure (P < 0.0001). TnC concentrations in virologic cure subjects were not statistically different from HCs. TnC levels correlated with AST, platelets, MELD, APRI, FIB-4, and Child-Pugh score. TnC and AST together were significantly better indicators of cirrhosis in patients with active HCV infection than other markers tested. CONCLUSIONS TnC and AST provided the best model for discriminating HCV cirrhotics with active infection from HC and virologic cure cohorts over current liver injury markers, suggesting TnC as a potential indicator of ongoing hepatic injury and inflammation.
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Affiliation(s)
- Jennifer H Benbow
- Liver Pathobiology Laboratory, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - April D Elam
- Liver Pathobiology Laboratory, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA.,Center for Liver Diseases and Liver Transplant, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Krista L Bossi
- Center for Liver Diseases and Liver Transplant, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Danae L Massengill
- Liver Pathobiology Laboratory, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA.,Center for Liver Diseases and Liver Transplant, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Elizabeth Brandon-Warner
- Liver Pathobiology Laboratory, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - William E Anderson
- Center for Outcomes Research and Evaluation, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Catherine R Culberson
- Liver Pathobiology Laboratory, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Mark W Russo
- Center for Liver Diseases and Liver Transplant, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Andrew S deLemos
- Center for Liver Diseases and Liver Transplant, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA
| | - Laura W Schrum
- Liver Pathobiology Laboratory, Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, 28203, USA.
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Benbow JH, Thompson KJ, Cope HL, Brandon-Warner E, Culberson CR, Bossi KL, Li T, Russo MW, Gersin KS, McKillop IH, deLemos AS, Schrum LW. Diet-Induced Obesity Enhances Progression of Hepatocellular Carcinoma through Tenascin-C/Toll-Like Receptor 4 Signaling. Am J Pathol 2015; 186:145-58. [PMID: 26603137 DOI: 10.1016/j.ajpath.2015.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/12/2015] [Accepted: 09/10/2015] [Indexed: 02/06/2023]
Abstract
Obesity is an independent risk factor for the development of liver fibrosis/cirrhosis and hepatocellular carcinoma (HCC). Tenascin-C (TnC), an extracellular matrix protein, is transiently expressed during tissue injury and plays a role in fibrogenesis and tumorigenesis. However, the mechanistic role of TnC signaling in the development of HCC remains unknown. We developed a diet-induced obesity HCC mouse model and examined TnC expression and liver injury. To determine the cellular mechanism of TnC signaling in promoting inflammation and hepatocyte epithelial-mesenchymal transition and migration, we used primary hepatocytes and hepatoma and macrophage cell lines. Further, to determine whether elevated TnC expression correlated with obesity-associated HCC, we measured plasma TnC in obese patients with various levels of liver injury. Increased tissue inflammation accompanied with elevated hepatic stellate cell-derived TnC and Toll-like receptor 4 expression was observed in the diet-induced obesity HCC animal model. In vitro studies found enhanced Toll-like receptor 4 signaling activated by TnC, promoting an increased inflammatory response, hepatocyte transformation, and migration. Further, obese patients with cirrhosis alone and in combination with HCC showed significant increases in plasma TnC compared with healthy volunteers and patients with less severe liver injury. Overall, these studies suggest TnC/Toll-like receptor 4 signaling as an important regulator in HCC; inhibiting this signaling axis may be a viable therapeutic target for impeding HCC.
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Affiliation(s)
- Jennifer H Benbow
- Department of Internal Medicine, Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, North Carolina
| | - Kyle J Thompson
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Heidi L Cope
- Department of Internal Medicine, Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, North Carolina
| | - Elizabeth Brandon-Warner
- Department of Internal Medicine, Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, North Carolina
| | - Catherine R Culberson
- Department of Internal Medicine, Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, North Carolina
| | - Krista L Bossi
- Center for Liver Diseases and Liver Transplant, Carolinas Medical Center, Charlotte, North Carolina
| | - Ting Li
- Department of Internal Medicine, Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, North Carolina
| | - Mark W Russo
- Center for Liver Diseases and Liver Transplant, Carolinas Medical Center, Charlotte, North Carolina
| | - Keith S Gersin
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Iain H McKillop
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Andrew S deLemos
- Center for Liver Diseases and Liver Transplant, Carolinas Medical Center, Charlotte, North Carolina
| | - Laura W Schrum
- Department of Internal Medicine, Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, North Carolina.
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