Orchestrated regulation of immune inflammation with cell therapy in pediatric acute liver injury

Dual therapy for amanita phalloides-induced acute liver failure in mice: A combination of etanercept and alpha-1 antitrypsin

BACKGROUND

The toxin α-amanitin from Amanita phalloides induces hepatocyte death and disrupts local and systemic immune responses, key drivers of acute liver failure (ALF). Although TNF-α plays a central role in ALF, TNF-α-targeted therapies alone have shown limited efficacy.

METHODS

Serum alpha1-globulin levels were measured retrospectively in a cohort of patients with amanita-induced ALF. Additionally, a murine interventional study was conducted, incorporating flow cytometry (FACS)-based immunophenotyping to analyze immune cell populations in the liver and lung to assess systemic versus liver-specific immune effects.

RESULTS

We observed a correlation between lower serum alpha1-globulin levels-primarily comprising α1-antitrypsin (AAT)-and increased disease severity in patients with amanita-induced ALF. In a murine interventional study aiming to evaluate the therapeutic potential of alpha1-antitrypsin and TNF-α inhibition-alone and in combination-, the combined administration of etanercept (Enbrel®), a TNF-α scavenger, and recombinant AAT (recAAT) produced in CHO cells significantly improved survival rates in mice with amanita-induced ALF. Reduced liver damage markers, including lower cleaved caspase-3 levels, and decreased activation of liver CD4+ T cells and natural killer (NK) cells, accompanied this protective effect. Additionally, there was an increase in liver dendritic cells and IL-6+ TNF-α + macrophages, suggesting their potential role in mitigating liver injury. Immune changes in the lung were less pronounced and showed only modest reductions in CD4+ and NK1.1+ cells, with no significant shifts in innate immune populations.

CONCLUSIONS

Our findings from the mouse model suggest a promising approach for treating ALF caused by α-amanitin from Amanita phalloides: the combined use of AAT (broad-spectrum protease inhibitor) and a TNF-α inhibitor. This dual therapy offers a novel and potentially effective treatment strategy for ALF patients.

Identifying KLF14 as a potential regulatory factor in liver regeneration trough transcriptomic and metabolomic

Liver regeneration is a complex process crucial for recovery after partial hepatectomy (PH) or ex-vivo liver resection and autotransplantation (ELRA). This study aimed to explore the molecular mechanisms involved in liver regeneration by analyzing peripheral blood samples from three patients with alveolar echinococcosis undergoing PH and ELRA. Peripheral blood samples were collected from three patients undergoing PH and three patients undergoing ELRA at three time points: pre-operation, postoperative day 1, and postoperative day 5, as well as three healthy controls. Transcriptomic analysis was performed to identify differentially expressed genes (DEGs) using RNA sequencing, while metabolomic analysis was conducted using untargeted liquid chromatography-mass spectrometry (LC-MS). Key findings were validated through real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot analysis. Transcriptomic analysis revealed 3574 DEGs on post-operative day 1 compared to pre-operation in the ELRA group, and 3269 DEGs on post-operative day 5 compared to day 1. In the PH group, 1619 DEGs were identified on post-operative day 1 compared to pre-operation, and 896 DEGs were found on post-operative day 5 compared to day 1. Among these, 36 common genes were shared between both groups, primarily enriched in metabolic pathways. Integration of common genes, co-expression network analysis and Mfuzz clustering identified KLF14 as a gene correlated with liver regeneration processes, with its association with the PI3K-AKT pathway. Metabolomic analysis highlighted differentially expressed metabolites associated with lipid, amino acid, and energy metabolism. This study provides new insights into the molecular regulation of liver regeneration, identifying KLF14 and associated metabolic processes. These findings offer potential therapeutic targets for enhancing liver repair.

Zebrafish as a model for human epithelial pathology

Zebrafish (Danio rerio) have emerged as an influential model for studying human epithelial pathology, particularly because of their genetic similarity to humans and their unique physiological traits. This review explores the structural and functional homology between zebrafish and human epithelial tissues in organs, such as the gastrointestinal system, liver, and kidneys. Zebrafish possess significant cellular and functional homology with mammals, which facilitates the investigation of various diseases, including inflammatory bowel disease, nonalcoholic fatty liver disease, and polycystic kidney disease. The advantages of using zebrafish as a model organism include rapid external development, ease of genetic manipulation, and advanced imaging capabilities, allowing for the real-time observation of disease processes. However, limitations exist, particularly concerning the lack of organs in zebrafish and the potential for incomplete phenocopy of human conditions. Despite these challenges, ongoing research in adult zebrafish promises to enhance our understanding of the disease mechanisms and regenerative processes. By revealing the similarities and differences in epithelial cell function and disease pathways, this review highlights the value of zebrafish as a translational model for advancing our knowledge of human health and developing targeted therapies.

Emerging Roles of High-mobility Group Box-1 in Liver Disease

High-mobility group box-1 (HMGB1) is an architectural chromosomal protein with various roles depending on its cellular localization. Extracellular HMGB1 functions as a prototypical damage-associated molecular pattern that triggers inflammation and adaptive immune responses, mediated by specific cell surface receptors, including receptors for advanced glycation end products and toll-like receptors. Post-translational modifications of HMGB1 significantly impact various cellular processes that contribute to the pathogenesis of liver diseases. Recent studies have highlighted the close relationship between HMGB1 and the pathogenesis of acute liver injuries, including acetaminophen-induced liver injury, hepatic ischemia-reperfusion injury, and acute liver failure. In chronic liver diseases, HMGB1 plays a role in nonalcoholic fatty liver disease, alcohol-associated liver disease, liver fibrosis, and hepatocellular carcinoma. Targeting HMGB1 as a therapeutic approach, either by inhibiting its release or blocking its extracellular function, is a promising strategy for treating liver diseases. This review aimed to summarize the available evidence on HMGB1's role in liver disease, focusing on its multifaceted signaling pathways, impact on disease progression, and the translation of these findings into clinical interventions.