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Mavila N, Siraganahalli Eshwaraiah M, Kennedy J. Ductular Reactions in Liver Injury, Regeneration, and Disease Progression-An Overview. Cells 2024; 13:579. [PMID: 38607018 PMCID: PMC11011399 DOI: 10.3390/cells13070579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
Ductular reaction (DR) is a complex cellular response that occurs in the liver during chronic injuries. DR mainly consists of hyper-proliferative or reactive cholangiocytes and, to a lesser extent, de-differentiated hepatocytes and liver progenitors presenting a close spatial interaction with periportal mesenchyme and immune cells. The underlying pathology of DRs leads to extensive tissue remodeling in chronic liver diseases. DR initiates as a tissue-regeneration mechanism in the liver; however, its close association with progressive fibrosis and inflammation in many chronic liver diseases makes it a more complicated pathological response than a simple regenerative process. An in-depth understanding of the cellular physiology of DRs and their contribution to tissue repair, inflammation, and progressive fibrosis can help scientists develop cell-type specific targeted therapies to manage liver fibrosis and chronic liver diseases effectively.
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Affiliation(s)
- Nirmala Mavila
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.S.E.); (J.K.)
- Division of Applied Cell Biology and Physiology, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mallikarjuna Siraganahalli Eshwaraiah
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.S.E.); (J.K.)
| | - Jaquelene Kennedy
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.S.E.); (J.K.)
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Zhong A, Short C, Xu J, Fernandez GE, Malkoff N, Noriega N, Yeo T, Wang L, Mavila N, Asahina K, Wang KS. Prominin-1 promotes restitution of the murine extrahepatic biliary luminal epithelium following cholestatic liver injury. Hepatol Commun 2023; 7:e0018. [PMID: 36662671 PMCID: PMC10019165 DOI: 10.1097/hc9.0000000000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/22/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIMS Restitution of the extrahepatic biliary luminal epithelium in cholangiopathies is poorly understood. Prominin-1 (Prom1) is a key component of epithelial ciliary body of stem/progenitor cells. Given that intrahepatic Prom1-expressing progenitor cells undergo cholangiocyte differentiation, we hypothesized that Prom1 may promote restitution of the extrahepatic bile duct (EHBD) epithelium following injury. APPROACH AND RESULTS Utilizing various murine biliary injury models, we identified Prom1-expressing cells in the peribiliary glands of the EHBD. These Prom1-expressing cells are progenitor cells which give rise to cholangiocytes as part of the normal maintenance of the EHBD epithelium. Following injury, these cells proliferate significantly more rapidly to re-populate the biliary luminal epithelium. Null mutation of Prom1 leads to significantly >10-fold dilated peribiliary glands following rhesus rotavirus-mediated biliary injury. Cultured organoids derived from Prom1 knockout mice are comprised of biliary progenitor cells with altered apical-basal cellular polarity, significantly fewer and shorter cilia, and decreased organoid proliferation dynamics consistent with impaired cell motility. CONCLUSIONS We, therefore, conclude that Prom1 is involved in biliary epithelial restitution following biliary injury in part through its role in supporting cell polarity.
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Affiliation(s)
- Allen Zhong
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Celia Short
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Jiabo Xu
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - G. Esteban Fernandez
- Cellular Imaging Core, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Nicolas Malkoff
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Nicolas Noriega
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Theresa Yeo
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Larry Wang
- Department of Pathology, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Nirmala Mavila
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Kinji Asahina
- Central Research Laboratory, Shiga University of Medical Science, Ōtsu, Shiga Prefecture, Japan
| | - Kasper S. Wang
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
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3
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Short C, Zhong A, Xu J, Mahdi E, Glazier A, Malkoff N, Noriega N, Yeo T, Asahina K, Wang KS. TWEAK/FN14 promotes profibrogenic pathway activation in Prominin-1-expressing hepatic progenitor cells in biliary atresia. Hepatology 2023; 77:1639-1653. [PMID: 36626628 DOI: 10.1097/hep.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/01/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Biliary atresia (BA), a congenital cholestatic liver disease, commonly culminates in end-stage liver disease. We previously demonstrated in BA that Prominin-1 ( Prom1 )-expressing hepatic progenitor cells (HPCs) expand within regions of developing fibrosis, giving rise to cholangiocytes within biliary ductular reactions. Null mutation of Prom1 or ablation of cells expressing Prom1 significantly diminishes fibrogenesis. FN14, the receptor for TNF-like weak inducer of apoptosis (TWEAK), is expressed by HPCs. TWEAK/FN14 signaling promotes fibrosis in multiple organ systems. Therefore, we hypothesized that TWEAK/FN14 signaling mediates Prom1 -expressing HPC proliferation leading to profibrogenic ductular reactions in BA. APPROACH AND RESULTS The experimental mouse model of BA mediated by perinatal rhesus rotavirus (RRV) infection resulted in increased co-expression of Fn14 in Prom1 -expressing HPCs within regions of ductular reactions. FN14 antagonist L524-0366 decreased ductular reactions, biliary fibrosis and periportal fibroblast activation in RRV injury. L524-0366 inhibition also demonstrated loss of downstream noncanonical NF-kB signaling expression in RRV injury. Murine HPC organoids demonstrated accelerated organoid growth and proliferation when treated with recombinant TWEAK. Increased organoid proliferation with recombinant TWEAK was lost when also treated with L524-0366. Analysis of a large publicly available RNA sequencing database of BA and normal control patients revealed significant increases in expression of PROM1 , FN14 , and genes downstream of TNF signaling and noncanonical NF-κB signaling pathways in BA infants. Infants who failed to achieve bile drainage after hepatoportoenterostomy had higher relative levels of FN14 expression. CONCLUSION TWEAK/FN14 signaling activation in Prom1 -expressing HPCs contributes to proliferation of profibrogenic ductular reactions in BA.
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Affiliation(s)
- Celia Short
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Allen Zhong
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Jiabo Xu
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Elaa Mahdi
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Alison Glazier
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Nicolas Malkoff
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Nicolas Noriega
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Theresa Yeo
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Kinji Asahina
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Central Research Laboratory, Shiga University of Medical Science, Ōtsu, Shiga Prefecture, Japan
| | - Kasper S Wang
- Developmental Biology, Regenerative Medicine, and Stem Cell Program, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA
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Oh HT, Heo W, Yoo GD, Kim KM, Hwang JH, Hwang ES, Ko J, Ko YG, Hong JH. CD133-Src-TAZ signaling stimulates ductal fibrosis following DDC diet-induced liver injury. J Cell Physiol 2022; 237:4504-4516. [PMID: 36250997 DOI: 10.1002/jcp.30899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Chronic liver injury follows inflammation and liver fibrosis; however, the molecular mechanism underlying fibrosis has not been fully elucidated. In this study, the role of ductal WW domain-containing transcription regulator 1 (WWTR1)/transcriptional coactivator with PDZ-binding motif (TAZ) was investigated after liver injury. Ductal TAZ-knockout (DKO) mice showed decreased liver fibrosis following a Diethyl 1,4-dihydro-2,4,6-trimethyl-3,5-pyridinedicarboxylate (DDC) diet compared to wild-type (WT) mice, as evidenced by decreased expression levels of fibrosis inducers, including connective tissue growth factor (Ctgf)/cellular communication network factor 2 (CCN2), cysteine-rich angiogenic inducer 61 (Cyr61/CCN1), and transforming growth factor beta 1 (Tgfb1), in DKO mice. Similarly, TAZ-knockout (KO) cholangiocyte organoids showed decreased expression of fibrosis inducers. Additionally, the culture supernatant of TAZ-KO cholangiocyte organoids decreased the fibrogenic gene expression in liver stellate cells. Further studies revealed that prominin 1 (PROM1/CD133) stimulated TAZ for fibrosis. After the administration of DDC diet, fibrosis was decreased in CD133-KO (CD133-KO) mice compared to that in WT mice. Similarly, CD133-KO cholangiocyte organoids showed decreased Ctgf, Cyr61, and Tgfb1 expression levels compared to WT cholangiocyte organoids. Mechanistically, CD133 stabilized TAZ via Src activation. Inhibition of Src decreased TAZ levels. Similarly, CD133-knockdown HCT116 cells showed decreased TAZ levels, but reintroduction of active Src recovered the TAZ levels. Taken together, our results suggest that TAZ facilitates liver fibrosis after a DDC diet via the CD133-Src-TAZ axis.
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Affiliation(s)
- Ho Taek Oh
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Woong Heo
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Gi Don Yoo
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Kyung Min Kim
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Jun-Ha Hwang
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Eun Sook Hwang
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Jesang Ko
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Young-Gyu Ko
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Jeong-Ho Hong
- Division of Life Sciences, Korea University, Seoul, Republic of Korea
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5
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Lee H, Yu DM, Bahn MS, Kwon YJ, Um MJ, Yoon SY, Kim KT, Lee MW, Jo SJ, Lee S, Koo SH, Jung KH, Lee JS, Ko YG. Hepatocyte-specific Prominin-1 protects against liver injury-induced fibrosis by stabilizing SMAD7. EXPERIMENTAL & MOLECULAR MEDICINE 2022; 54:1277-1289. [PMID: 36038590 PMCID: PMC9440255 DOI: 10.1038/s12276-022-00831-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/09/2022]
Abstract
Prominin-1 (PROM1), also known as CD133, is expressed in hepatic progenitor cells (HPCs) and cholangiocytes of the fibrotic liver. In this study, we show that PROM1 is upregulated in the plasma membrane of fibrotic hepatocytes. Hepatocellular expression of PROM1 was also demonstrated in mice (Prom1CreER; R26TdTom) in which cells expressed TdTom under control of the Prom1 promoter. To understand the role of hepatocellular PROM1 in liver fibrosis, global and liver-specific Prom1-deficient mice were analyzed after bile duct ligation (BDL). BDL-induced liver fibrosis was aggravated with increased phosphorylation of SMAD2/3 and decreased levels of SMAD7 by global or liver-specific Prom1 deficiency but not by cholangiocyte-specific Prom1 deficiency. Indeed, PROM1 prevented SMURF2-induced SMAD7 ubiquitination and degradation by interfering with the molecular association of SMAD7 with SMURF2. We also demonstrated that hepatocyte-specific overexpression of SMAD7 ameliorated BDL-induced liver fibrosis in liver-specific Prom1-deficient mice. Thus, we conclude that PROM1 is necessary for the negative regulation of TGFβ signaling during liver fibrosis.
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Affiliation(s)
- Hyun Lee
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Dong-Min Yu
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Myeong-Suk Bahn
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Young-Jae Kwon
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Min Jee Um
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Seo Yeon Yoon
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Ki-Tae Kim
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Myoung-Woo Lee
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Sung-Je Jo
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Sungsoo Lee
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Seung-Hoi Koo
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea.,Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - Ki Hoon Jung
- Department of Surgery, Dongguk University College of Medicine, Gyeongju, 38067, Korea
| | - Jae-Seon Lee
- Research Center for Controlling Intercellular Communication, College of Medicine, Inha University, Incheon, 22212, Korea
| | - Young-Gyu Ko
- Tunneling Nanotube Research Center, Korea University, Seoul, 02841, Korea. .,Division of Life Sciences, Korea University, Seoul, 02841, Korea.
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6
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Urea-based amino sugar agent clears murine liver and preserves protein fluorescence and lipophilic dyes. Biotechniques 2021; 70:72-80. [PMID: 33467918 PMCID: PMC7983039 DOI: 10.2144/btn-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Five established clearing protocols were compared with a modified and simplified method to determine an optimal clearing reagent for three-dimensionally visualizing fluorophores in the murine liver, a challenging organ to clear. We report successful clearing of whole liver lobes by modification of an established protocol (UbasM) using only Ub-1, a urea-based amino sugar reagent, in a simpler protocol that requires only a 24-h processing time. With Ub-1 alone, we observed sufficiently preserved liver tissue structure in three dimensions along with excellent preservation of fluorophore emissions from endogenous protein reporters and lipophilic tracer dyes. This streamlined technique can be used for 3D cell lineage tracing and fluoroprobe-based reporter gene expression to compare various experimental conditions. This study presents a simplified protocol for optically clearing murine liver tissue in only 24 h using one simple urea-based amino sugar solution and a single incubation. This method preserves fluorescence of transgenically expressed proteins and lipophilic tracer dyes within the context of native spatial morphology.
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7
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Lee H, Yu D, Park JS, Lee H, Kim J, Kim HL, Koo S, Lee J, Lee S, Ko Y. Prominin-1-Radixin axis controls hepatic gluconeogenesis by regulating PKA activity. EMBO Rep 2020; 21:e49416. [PMID: 33030802 PMCID: PMC7645247 DOI: 10.15252/embr.201949416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022] Open
Abstract
Prominin-1 (Prom1) is a major cell surface marker of cancer stem cells, but its physiological functions in the liver have not been elucidated. We analyzed the levels of mRNA transcripts in serum-starved primary WT (Prom1+/+ ) and KO (Prom1-/- ) mouse hepatocytes using RNA sequencing (RNA-seq) data, and found that CREB target genes were downregulated. This initial observation led us to determine that Prom1 deficiency inhibited cAMP response element-binding protein (CREB) activation and gluconeogenesis, but not cyclic AMP (cAMP) accumulation, in glucagon-, epinephrine-, or forskolin-treated liver tissues and primary hepatocytes, and mitigated glucagon-induced hyperglycemia. Because Prom1 interacted with radixin, Prom1 deficiency prevented radixin from localizing to the plasma membrane. Moreover, systemic adenoviral knockdown of radixin inhibited CREB activation and gluconeogenesis in glucagon-treated liver tissues and primary hepatocytes, and mitigated glucagon-elicited hyperglycemia. Based on these results, we conclude that Prom1 regulates hepatic PKA signaling via radixin functioning as an A kinase-anchored protein (AKAP).
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Affiliation(s)
- Hyun Lee
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Dong‐Min Yu
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Jun Sub Park
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Hwayeon Lee
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Jun‐Seok Kim
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Hong Lim Kim
- Laboratory of Electron MicroscopeIntegrative Research Support CenterCollege of MedicineThe Catholic University of KoreaSeoulKorea
| | - Seung‐Hoi Koo
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Jae‐Seon Lee
- Department of Molecular MedicineInha University College of MedicineIncheonKorea
- Hypoxia‐related Disease Research CenterInha University College of MedicineIncheonKorea
| | - Sungsoo Lee
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
| | - Young‐Gyu Ko
- Tunneling Nanotube Research CenterKorea UniversitySeoulKorea
- Division of Life SciencesKorea UniversitySeoulKorea
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Fenlon M, Short C, Xu J, Malkoff N, Mahdi E, Hough M, Glazier A, Lee C, Asahina K, Wang KS. Prominin-1-expressing hepatic progenitor cells induce fibrogenesis in murine cholestatic liver injury. Physiol Rep 2020; 8:e14508. [PMID: 32686913 PMCID: PMC7370750 DOI: 10.14814/phy2.14508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/13/2023] Open
Abstract
Cholestatic liver injury is associated with intrahepatic biliary fibrosis, which can progress to cirrhosis. Resident hepatic progenitor cells (HPCs) expressing Prominin-1 (Prom1 or CD133) become activated and participate in the expansion of cholangiocytes known as the ductular reaction. Previously, we demonstrated that in biliary atresia, Prom1(+) HPCs are present within developing fibrosis and that null mutation of Prom1 significantly abrogates fibrogenesis. Here, we hypothesized that these activated Prom1-expressing HPCs promote fibrogenesis in cholestatic liver injury. Using Prom1CreERT2-nLacZ/+ ;Rosa26Lsl-GFP/+ mice, we traced the fate of Prom1-expressing HPCs in the growth of the neonatal and adult livers and in biliary fibrosis induced by bile duct ligation (BDL). Prom1-expressing cell lineage labeling with Green Fluorescent Protein (GFP) on postnatal day 1 exhibited an expanded population as well as bipotent differentiation potential toward both hepatocytes and cholangiocytes at postnatal day 35. However, in the adult liver, they lost hepatocyte differentiation potential. Upon cholestatic liver injury, adult Prom1-expressing HPCs gave rise to both PROM1(+) and PROM1(-) cholangiocytes contributing to ductular reaction without hepatocyte or myofibroblast differentiation. RNA-sequencing analysis of GFP(+) Prom1-expressing HPC lineage revealed a persistent cholangiocyte phenotype and evidence of Transforming Growth Factor-β pathway activation. When Prom1-expressing cells were ablated with induced Diphtheria toxin in Prom1CreERT-nLacZ/+ ;Rosa26DTA/+ mice, we observed a decrease in ductular reactions and biliary fibrosis typically present in BDL as well as decreased expression of numerous fibrogenic gene markers. Our data indicate that Prom1-expressing HPCs promote biliary fibrosis associated with activation of myofibroblasts in cholestatic liver injury.
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Affiliation(s)
- Michael Fenlon
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Celia Short
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Jiabo Xu
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Nicolas Malkoff
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Elaa Mahdi
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Michelle Hough
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Alison Glazier
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Calvin Lee
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
| | - Kinji Asahina
- Southern California Research Center for ALPD & CirrhosisDepartment of PathologyKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Kasper S. Wang
- Developmental Biology, Regenerative Medicine, and Stem Cell ProgramThe Saban Research InstituteChildren’s Hospital of Los AngelesLos AngelesCAUSA
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9
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Zagory JA, Fenlon M, Dietz W, Zhao M, Nguyen MV, Trinh P, Adoumie M, Park A, Xu J, Mahdi E, Glazier A, Malkoff N, Mavila N, Wang KS. Prominin-1 Promotes Biliary Fibrosis Associated With Biliary Atresia. Hepatology 2019; 69:2586-2597. [PMID: 30723921 PMCID: PMC6541523 DOI: 10.1002/hep.30550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/29/2019] [Indexed: 01/09/2023]
Abstract
In patients with biliary atresia (BA), the extent of intrahepatic biliary fibrosis negatively correlates with successful surgical bypass of the congenital cholangiopathy as well as subsequent transplant-free survival. We recently linked the expansion of a population of prominin-1 (Prom1)-expressing hepatic progenitor cells to biliary fibrogenesis. Herein, we hypothesized that Prom1-expressing progenitor cells play a role in BA-associated fibrosis. Rhesus rotavirus (RRV)-mediated experimental BA was induced in newborn mice homozygous for the transgene Prom1cre-ert2-nlacz , which was knocked in to the Prom1 gene locus, thus creating functional Prom1 knockout (KO) mice, and their wildtype (WT) littermates. Clinical data and tissue samples from BA infants from the Childhood Liver Disease Research Consortium were analyzed. Extrahepatic biliary obliteration was present in both WT and KO mice; there was no difference in serum total bilirubin (TBili) levels. The intrahepatic periportal expansion of the PROM1pos cell population, typically observed in RRV-induced BA, was absent in KO mice. RRV-treated KO mice demonstrated significantly fewer cytokeratin-19 (CK19)-positive ductular reactions (P = 0.0004) and significantly less periportal collagen deposition (P = 0.0001) compared with WT. RRV-treated KO mice expressed significantly less integrin-β6, which encodes a key biliary-specific subunit of a transforming growth factor (TGF) β activator (P = 0.0004). Infants with successful biliary drainage (Tbili ≤1.5 mg/dL within 3 months postoperatively), which is highly predictive of increased transplant-free survival, expressed significantly less hepatic PROM1, CK19, and COLLAGEN-1α compared with those with TBili >1.5 (P < 0.05). Conclusion: Prom1 plays an important role in biliary fibrogenesis, in part through integrin-mediated TGF pathway activation.
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Affiliation(s)
| | - Michael Fenlon
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - William Dietz
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Menghan Zhao
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Marie V. Nguyen
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Pavin Trinh
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Maeva Adoumie
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Alex Park
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Jiabo Xu
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Elaa Mahdi
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Alison Glazier
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Nicolas Malkoff
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
| | - Nirmala Mavila
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA,Cedars-Sinai Medical Center, Gastroenterology, Los Angeles, CA, USA
| | - Kasper S. Wang
- Children’s Hospital Los Angeles, Surgery, Los Angeles, CA, USA
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Davenport M. Adjuvant therapy in biliary atresia: hopelessly optimistic or potential for change? Pediatr Surg Int 2017; 33:1263-1273. [PMID: 28940004 DOI: 10.1007/s00383-017-4157-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Abstract
Given that the aetiology of biliary atresia (BA) is complex and that there is a multiplicity of possible pathogenic mechanisms then it is perhaps not surprising that the evidence for effect of a number of different agents is contradictory. Post-operative cholangitis for instance is common, bacterial in origin and various antibiotic regimens have been tested (although none in a randomized trial) but continuation beyond the early post-operative period does not appear to offer any greater protection. There is an inflammatory reaction in about 25-35% of cases of BA illustrated by abnormal expression of class II antigen and upregulation of ICAM, VCAM and E-selectin with an infiltrate of immune-activated T cells (predominantly CD4 + Th1 and Th17) and NK cells and a systemic surge in inflammatory cytokines (e.g. TNF-α, IL-2, IL-12). This has potential as a therapeutic target and is the main hypothesis behind the rationale use of steroids. The first report of steroids was published in 1985 by Karrer and Lilly as "blast" therapy to treat recalcitrant cholangitis, followed by a multiplicity of small-scale uncontrolled studies suggesting benefit. To date there has been one randomized placebo-controlled study with a low-dose (prednisolone 2 mg/kg/day) regimen (2007); one with a high-dose (IV prednisolone 4 mg/kg/day regimen) (2014); two prospective high-dose open-label studies (2013); a prospective comparison of low- and high-dose regimen and a large (380 infants) retrospective comparison. The most recent meta-analysis (2016) identified a significant difference in clearance of jaundice at 6 months (OR 1.59, 95% CI 1.03-2.45, P = 0.04), in patients treated with high-dose steroids, particularly if < 70 days at surgery. Ursodeoxycholic acid (UDCA) may increase choleresis or change the ratio of endogenous bile acids to a less hydrophobic and, therefore, less toxic millieu. UDCA may protect cholangiocyte membranes against damage and perhaps reduce the tendency to fibrogenesis. Biochemical benefit has been shown in a single crossover trial in older BA children who had cleared their jaundice. Other potential adjuvant therapies include immunoglobulin therapy, anti-viral agents and Chinese herbs although real evidence of benefit is lacking.
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Affiliation(s)
- Mark Davenport
- Department of Paediatric Surgery, King's College Hospital, London, SE5 9RS, UK.
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Abstract
Despite advances in our understanding of the pathogenesis of biliary atresia (BA), BA remains the most common cause of end-stage liver disease in children and the leading indication for pediatric liver transplantation. Age at time of Kasai portoenterostomy (KPE), performed to provide bile drainage, strongly correlates with transplant-free survival, mostly due to progression of intrahepatic fibrosis to cirrhosis. Unfortunately, challenges remain in recognizing that a jaundiced infant may have BA. To better diagnose infants with BA at an earlier age, population-based screening programs in countries such as Taiwan, Japan, and China have utilized stool color cards. Early results have been promising demonstrating earlier diagnosis, earlier KPE, and, hence, improved outcomes. Cost-effectiveness studies focused on stool color card screening in North America where the incidence of BA is much lower also project improved transplant-free survival rate with a savings in terms of healthcare expenditure. There is also evidence that postnatal serum bilirubin levels may also be effective as a screening tool given that all infants with BA exhibit hyperbilirubinemia at birth. The American Academy of Pediatrics (AAP) recently advocated studying the implementation of newborn screening for BA in the United States. Further efforts and analyses within the United States are ongoing, but current evidence is supportive of screening for BA even in low incidence countries.
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Treatment Policy and Liver Histopathology Predict Biliary Atresia Outcomes: Results after National Centralization and Protocol Biopsies. J Am Coll Surg 2017; 226:46-57.e1. [PMID: 28958913 DOI: 10.1016/j.jamcollsurg.2017.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/28/2017] [Accepted: 09/07/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Different treatment policies can influence biliary atresia outcomes, but the pathophysiology of expanding fibrosis occurring even after successful portoenterostomy remains unclear. STUDY DESIGN Clearance of jaundice (COJ) (bilirubin <20 μmol/L), native liver survival, and overall survival rates of biliary atresia patients were analyzed before and after national centralization of management, as well as in relation to native liver histopathology of protocol biopsies. RESULTS Of the 59 patients, 35 were managed after centralization and received standardized postoperative adjuvant therapy, including corticosteroids. After centralization, age at portoenterostomy decreased from 73 days to 54 days (p = 0.014) and COJ rate increased from 42% to 80% (p = 0.005), 5-year native liver survival increased from 38% to 70% (p = 0.014), and 5-year overall survival increased from 68% to 94% (p = 0.007). High-grade portal inflammation at portoenterostomy predicted COJ (odds ratio 3.66; p = 0.011) and slower fibrosis progression (β = -0.74; p = 0.005). Native liver survival was extended in patients with high-grade portal inflammation (p = 0.002) and in patients whose bilirubin normalized within 3 months (p < 0.001). Portal inflammation and cholestasis reduced only after COJ (p < 0.001), and persisting ductal reaction, reflected by cytokeratin 7-positive proliferating bile ductules and periportal hepatocytes, correlated with follow-up fibrosis (r = 0.454 to 0.763; p < 0.001 to 0.003). Cytokeratin 7 immunopositivity of periportal hepatocytes increased after COJ (p = 0.015) and was the only predictor of follow-up liver fibrosis (β = 0.36; p = 0.002) in multiple regression. CONCLUSIONS Biliary atresia outcomes improved significantly after centralization and standardized management. Resolution of cholestasis and reduction of high-grade portal inflammation postoperatively predict slower fibrosis progression and improved native liver survival, and persisting ductal reaction parallels progressive native liver fibrosis despite COJ.
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Zagory JA, Dietz W, Park A, Fenlon M, Xu J, Utley S, Mavila N, Wang KS. Notch signaling promotes ductular reactions in biliary atresia. J Surg Res 2017; 215:250-256. [DOI: 10.1016/j.jss.2017.03.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 12/29/2022]
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