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Larsen FT, Hansen D, Terkelsen MK, Bendixen SM, Avolio F, Wernberg CW, Lauridsen MM, Grønkjaer LL, Jacobsen BG, Klinggaard EG, Mandrup S, Di Caterino T, Siersbæk MS, Indira Chandran V, Graversen JH, Krag A, Grøntved L, Ravnskjaer K. Stellate cell expression of SPARC-related modular calcium-binding protein 2 is associated with human non-alcoholic fatty liver disease severity. JHEP Rep 2023; 5:100615. [PMID: 36687468 PMCID: PMC9850195 DOI: 10.1016/j.jhepr.2022.100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
Background & Aims Histological assessment of liver biopsies is the gold standard for diagnosis of non-alcoholic steatohepatitis (NASH), the progressive form of non-alcoholic fatty liver disease (NAFLD), despite its well-established limitations. Therefore, non-invasive biomarkers that can offer an integrated view of the liver are needed to improve diagnosis and reduce sampling bias. Hepatic stellate cells (HSCs) are central in the development of hepatic fibrosis, a hallmark of NASH. Secreted HSC-specific proteins may, therefore, reflect disease state in the NASH liver and serve as non-invasive diagnostic biomarkers. Methods We performed RNA-sequencing on liver biopsies from a histologically characterised cohort of obese patients (n = 30, BMI >35 kg/m2) to identify and evaluate HSC-specific genes encoding secreted proteins. Bioinformatics was used to identify potential biomarkers and their expression at single-cell resolution. We validated our findings using single-molecule fluorescence in situ hybridisation (smFISH) and ELISA to detect mRNA in liver tissue and protein levels in plasma, respectively. Results Hepatic expression of SPARC-related modular calcium-binding protein 2 (SMOC2) was increased in NASH compared to no-NAFLD (p.adj <0.001). Single-cell RNA-sequencing data indicated that SMOC2 was primarily expressed by HSCs, which was validated using smFISH. Finally, plasma SMOC2 was elevated in NASH compared to no-NAFLD (p <0.001), with a predictive accuracy of AUROC 0.88. Conclusions Increased SMOC2 in plasma appears to reflect HSC activation, a key cellular event associated with NASH progression, and may serve as a non-invasive biomarker of NASH. Impact and implications Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), are the most common forms of chronic liver diseases. Currently, liver biopsies are the gold standard for diagnosing NAFLD. Blood-based biomarkers to complement liver biopsies for diagnosis of NAFLD are required. We found that activated hepatic stellate cells, a cell type central to NAFLD pathogenesis, upregulate expression of the secreted protein SPARC-related modular calcium-binding protein 2 (SMOC2). SMOC2 was elevated in blood samples from patients with NASH and may hold promise as a blood-based biomarker for the diagnosis of NAFLD.
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Key Words
- AUROC, area under the receiver operating characteristic curve
- ECM, extracellular matrix
- HSC, hepatic stellate cells
- LSM, liver stiffness measurement
- MCP, matricellular protein
- NAFL, non-alcoholic fatty liver
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH
- PCA, principal component analysis
- SAF, steatosis, activity, and fibrosis
- SE, sensitivity
- SMOC2
- SMOC2, SPARC-related modular calcium-binding protein 2
- SP, specificity
- SPARC, secreted protein acidic and cysteine-rich
- VSMCs, vascular smooth muscle cells
- WGCNA, weighted gene co-expression network analysis
- aHSC, activated HSC
- hepatic stellate cells
- non-invasive biomarker
- qHSC, quiescent HSC
- smFISH, single-molecule fluorescence in situ hybridisation
- transcriptomics
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Affiliation(s)
- Frederik T. Larsen
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Daniel Hansen
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Mike K. Terkelsen
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Sofie M. Bendixen
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Fabio Avolio
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Charlotte W. Wernberg
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
- Department of Gastroenterology and Hepatology, University Hospital of
Southern Denmark, Esbjerg, Denmark
- Center for Liver Research (FLASH), Department of Gastroenterology and
Hepatology, Odense University Hospital, Odense, Denmark
| | - Mette M. Lauridsen
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
- Department of Gastroenterology and Hepatology, University Hospital of
Southern Denmark, Esbjerg, Denmark
| | - Lea L. Grønkjaer
- Department of Gastroenterology and Hepatology, University Hospital of
Southern Denmark, Esbjerg, Denmark
| | - Birgitte G. Jacobsen
- Department of Gastroenterology and Hepatology, University Hospital of
Southern Denmark, Esbjerg, Denmark
| | - Ellen G. Klinggaard
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Susanne Mandrup
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Tina Di Caterino
- Department of Pathology, Odense University Hospital, Odense,
Denmark
| | - Majken S. Siersbæk
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Vineesh Indira Chandran
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense,
Denmark
| | - Jonas H. Graversen
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense,
Denmark
| | - Aleksander Krag
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
- Center for Liver Research (FLASH), Department of Gastroenterology and
Hepatology, Odense University Hospital, Odense, Denmark
| | - Lars Grøntved
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
| | - Kim Ravnskjaer
- Department of Biochemistry and Molecular Biology, University of Southern
Denmark, Odense, Denmark
- Center for Functional Genomics and Tissue Plasticity (ATLAS), University of
Southern Denmark, Odense, Denmark
- Corresponding author. Address: Department of Biochemistry and Molecular
Biology, Campusvej 55, 5230 Odense M, Denmark. Tel.: +45 65508906/+45
93979317.
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