Soluble TREM2 levels reflect the recruitment and expansion of TREM2+ macrophages that localize to fibrotic areas and limit NASH

BACKGROUND & AIMS

Previous single-cell RNA-sequencing analyses have shown that Trem2-expressing macrophages are present in the liver during obesity, non-alcoholic steatohepatitis (NASH) and cirrhosis. Herein, we aimed to functionally characterize the role of bone marrow-derived TREM2-expressing macrophage populations in NASH.

METHODS

We used bulk RNA sequencing to assess the hepatic molecular response to lipid-dependent dietary intervention in mice. Spatial mapping, bone marrow transplantation in two complementary murine models and single-cell sequencing were applied to functionally characterize the role of TREM2⁺ macrophage populations in NASH.

RESULTS

We found that the hepatic transcriptomic profile during steatohepatitis mirrors the dynamics of recruited bone marrow-derived monocytes that already acquire increased expression of Trem2 in the circulation. Increased Trem2 expression was reflected by elevated levels of systemic soluble TREM2 in mice and humans with NASH. In addition, soluble TREM2 levels were superior to traditionally used laboratory parameters for distinguishing between different fatty liver disease stages in two separate clinical cohorts. Spatial transcriptomics revealed that TREM2⁺ macrophages localize to sites of hepatocellular damage, inflammation and fibrosis in the steatotic liver. Finally, using multiple murine models and in vitro experiments, we demonstrate that hematopoietic Trem2 deficiency causes defective lipid handling and extracellular matrix remodeling, resulting in exacerbated steatohepatitis, cell death and fibrosis.

CONCLUSIONS

Our study highlights the functional properties of bone marrow-derived TREM2⁺ macrophages and implies the clinical relevance of systemic soluble TREM2 levels in the context of NASH.

LAY SUMMARY

Our study defines the origin and function of macrophages (a type of immune cell) that are present in the liver and express a specific protein called TREM2. We find that these cells have an important role in protecting against non-alcoholic steatohepatitis (a progressive form of fatty liver disease). We also show that the levels of soluble TREM2 in the blood could serve as a circulating marker of non-alcoholic fatty liver disease.

TNF-related apoptosis-inducing ligand, interferon gamma-induced protein 10, and C-reactive protein in predicting the progression of SARS-CoV-2 infection: a prospective cohort study

BACKGROUND

Early prognostication of COVID-19 severity will potentially improve patient care. Biomarkers, such as TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), and C-reactive protein (CRP), might represent possible tools for point-of-care testing and severity prediction.

METHODS

In this prospective cohort study, we analyzed serum levels of TRAIL, IP-10, and CRP in patients with COVID-19, compared them with control subjects, and investigated the association with disease severity.

RESULTS

A total of 899 measurements were performed in 132 patients (mean age 64 years, 40.2% females). Among patients with COVID-19, TRAIL levels were lower (49.5 vs 87 pg/ml, P = 0.0142), whereas IP-10 and CRP showed higher levels (667.5 vs 127 pg/ml, P <0.001; 75.3 vs 1.6 mg/l, P <0.001) than healthy controls. TRAIL yielded an inverse correlation with length of hospital and intensive care unit (ICU) stay, Simplified Acute Physiology Score II, and National Early Warning Score, and IP-10 showed a positive correlation with disease severity. Multivariable regression revealed that obesity (adjusted odds ratio [aOR] 5.434, 95% confidence interval [CI] 1.005-29.38), CRP (aOR 1.014, 95% CI 1.002-1.027), and peak IP-10 (aOR 1.001, 95% CI 1.00-1.002) were independent predictors of in-ICU mortality.

CONCLUSIONS

We demonstrated a correlation between COVID-19 severity and TRAIL, IP-10, and CRP. Multivariable regression showed a role for IP-10 in predicting unfavourable outcomes, such as in-ICU mortality.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04655521.

rs641738C>T near MBOAT7 is associated with liver fat, ALT and fibrosis in NAFLD: A meta-analysis

BACKGROUND & AIMS

A common genetic variant near MBOAT7 (rs641738C>T) has been previously associated with hepatic fat and advanced histology in NAFLD; however, these findings have not been consistently replicated in the literature. We aimed to establish whether rs641738C>T is a risk factor across the spectrum of NAFLD and to characterise its role in the regulation of related metabolic phenotypes through a meta-analysis.

METHODS

We performed a meta-analysis of studies with data on the association between rs641738C>T genotype and liver fat, NAFLD histology, and serum alanine aminotransferase (ALT), lipids or insulin. These included directly genotyped studies and population-level data from genome-wide association studies (GWAS). We performed a random effects meta-analysis using recessive, additive and dominant genetic models.

RESULTS

Data from 1,066,175 participants (9,688 with liver biopsies) across 42 studies were included in the meta-analysis. rs641738C>T was associated with higher liver fat on CT/MRI (+0.03 standard deviations [95% CI 0.02-0.05], p_z = 4.8×10^-5) and diagnosis of NAFLD (odds ratio [OR] 1.17 [95% CI 1.05-1.3], p_z = 0.003) in Caucasian adults. The variant was also positively associated with presence of advanced fibrosis (OR 1.22 [95% CI 1.03-1.45], p_z = 0.021) in Caucasian adults using a recessive model of inheritance (CC + CT vs. TT). Meta-analysis of data from previous GWAS found the variant to be associated with higher ALT (p_z = 0.002) and lower serum triglycerides (p_z = 1.5×10^-4). rs641738C>T was not associated with fasting insulin and no effect was observed in children with NAFLD.

CONCLUSIONS

Our study validates rs641738C>T near MBOAT7 as a risk factor for the presence and severity of NAFLD in individuals of European descent.

LAY SUMMARY

Fatty liver disease is a common condition where fat builds up in the liver, which can cause liver inflammation and scarring (including 'cirrhosis'). It is closely linked to obesity and diabetes, but some genes are also thought to be important. We did this study to see whether one specific change ('variant') in one gene ('MBOAT7') was linked to fatty liver disease. We took data from over 40 published studies and found that this variant near MBOAT7 is linked to more severe fatty liver disease. This means that drugs designed to work on MBOAT7 could be useful for treating fatty liver disease.

On-line coupling of microdialysis sampling with liquid chromatography for the determination of peptide and non-peptide leukotrienes

An automated on-line sampling method was developed using microdialysis as the simultaneous sampling and sample pre-treatment technique. The extraction fraction values of microdialysis probes sampling different eicosanoids were investigated. The impact of cyclodextrins in the perfusion liquid used for sampling hydrophobic eicosanoids in biological systems was also studied. The total time for one analysis was 7.6 min allowing seven measurements per hour for monitoring kinetic changes in biological systems.

Simultaneous determination of cross-reactive leukotrienes in biological matrices using on-line liquid chromatography immunochemical detection

Sulfidopeptide leukotrienes, which are important biomarkers for several diseases, are commonly measured by microtiter plate immunoassays. These immunoassays, however, cannot distinguish between several structurally similar leukotrienes and their cross-reactive metabolites and, therefore, need extensive sample handling and fractionation by means of liquid chromatography (LC). This paper describes the development and automation of a continuous-flow immunochemical detection (ICD) system and its subsequent on-line coupling to LC. The on-line LC-ICD system based on fluorescence-labeled leukotriene E4 (LTE4) was used to determine sulfidopeptide leukotrienes and their cross-reactive metabolites in a single run. Furthermore, biological matrices, e.g., urine and human cell extracts, were analyzed, the only sample pretreatment being on-line solid-phase extraction (SPE) on a novel RP-C4 restricted-access support. The determination limit of LTE4 in urine was 0.2 ng/mL (800 fmol; injection volume, 2000 microL; signal-to-noise ratio, 10). The system was linear from 0.2 to 1.0 ng/mL LTE4. Using nonlinear curve-fitting, the range could be expanded to 2.5 ng/mL. It is shown that, besides quantitation of known analytes, on-line LC-ICD is useful in the discovery of cross-reactive LTE4 metabolites.

An efficient way to do the wrong thing

Britain's national health system (NHS) has been embattled since Thatcherism undertook to privatize it. This Britannic version of the new medicine is a hybrid of a neglected, underfunded shadow of the NHS and robust free-market capitalism. The NHS that the Tory government administers is aptly described as topless, bulging in the middle, and suffering chronic battle fatigue at the bottom. The quality of leadership in the NHS has plummeted at the same time thousands of middle managers have been added to prod the frontline caregivers.

Toxic effects of some xanthine derivatives with special emphasis on adverse effects on rat testes

Testicular toxicity and effects on thymus and body weights of 4 xanthine derivatives (D4026: 1,8-dimethyl-3-phenylxanthine, D4152: 8-methyl-3-phenylxanthine, D4160: 1,8-dimethyl-3-(2-methylbutyl)-xanthine, D4173: 8-methyl-3-(2-methylbutyl)-xanthine) were studied in Sprague-Dawley rats and cellular toxicity in human embryonal cells. The effect on toxicity by variation of substituent at positions 1 and 3 was tested. The compounds were administered orally to the rats once a day for 1 month. Mortalities were noted only with D4160. Dose related decreases in body weight gain were found for all substances, but only marginally with D4152. A significant decrease in thymus weight relative to control was observed with all substances, D4152 being the least potent. No effects on testes weights were found with any treatment but histological examination disclosed degeneration of germ producing epithelium of all rats given 100 mumol/kg of D4026 but not at 25 mumol/kg. One rat out of 5 showed testicular damage at 400 mumol/kg of D4173 or D4152. Plasma analysis for unchanged compounds showed significantly higher plasma concentrations at the high dose compared with the low dose with the exception for D4152 showing unexpectedly low levels. In the cellular toxicity test, D4160 was the most potent while D4152 was the least potent. D4026 had a steeper dose-response curve than the others but was less potent than D4160. The 1-methylated xanthine derivatives seemed to be more toxic than the two in position 1 unsubstituted analogues. Mechanisms for testicular toxicity of xanthine derivatives in the rat and clinical relevance of animal data are discussed.

Absorption of sustained-release theophylline tablets

Three different sustained-release tablets of theophylline (Theo-Dur, Phyllocontin continus, Euphyllin Retard) and an oral elixir of aminophylline were administered to 12 healthy volunteers according to a crossover scheme. Plasma concentration of theophylline was monitored for 33 h after each administration using an HPLC reversed-phase method. The mean values and SD for total body clearance (0.054 +/- 0.010 l/[h X kg]), elimination half-life (6.0 +/- 1.2 h), and volume of distribution (0.455 +/- 0.046 l/kg) were calculated from the plasma concentration curves after the administration of elixir. The mean bioavailability of Theo-Dur was 94%, Phyllocontin continus 88%, and Euphyllin Retard 84%. The absorption was faster from Phyllocontin continus than from Theo-Dur or Euphyllin Retard. The time of peak concentration varied considerably after Euphyllin Retard but was less fluctuating among the subjects after Phyllocontin continus or Theo-Dur. In some subjects an extremely delayed peak (up to 24 h after administration) was observed after Euphyllin Retard.