Advances in gene therapy of liver cirrhosis: a review

From Pathophysiology to Practice: Evolving Pharmacological Therapies, Clinical Complications, and Pharmacogenetic Considerations in Portal Hypertension

Background: Portal hypertension is a major complication of chronic liver diseases, leading to serious issues such as esophageal variceal bleeding. The increase in portal vein pressure is driven by both an organic component and a functional component, including tonic contraction of hepatic stellate cells. These processes result in a pathological rise in intrahepatic vascular resistance, stemming from partial impairment of hepatic microcirculation, which is further exacerbated by abnormalities in extrahepatic vessels, including increased portal blood flow. Objectives: This review aims to provide a comprehensive overview of the evolving pharmacological therapies for portal hypertension, with consideration and discussion of pathophysiological mechanisms, clinical complications, and pharmacogenetic considerations, highlighting potential directions for future research. Methods: A review of recent literature was performed to evaluate current knowledge and potential therapeutic strategies in portal hypertension. Results: For over 35 years, non-selective beta-blockers have been the cornerstone therapy for portal hypertension by reducing portal vein inflow as an extrahepatic target, effectively preventing decompensation and variceal hemorrhages. However, since not all patients exhibit an adequate response to non-selective beta-blockers (NSBBs), and some may not tolerate NSBBs, alternative or adjunctive therapies that enhance the effects of NSBBs on portal pressure are being investigated in preclinical and early clinical studies. Conclusions: A better understanding of pharmacogenetic factors and pathophysiological mechanisms could lead to more individualized and effective treatments for portal hypertension. These insights highlight potential directions for future research.

Sexual Dimorphism in Interstitial Lung Disease

Interstitial lung diseases (ILD) are a group of heterogeneous progressive pulmonary disorders, characterised by tissue remodelling and/or fibrotic scarring of the lung parenchyma. ILD patients experience lung function decline with progressive symptoms, poor response to treatment, reduced quality of life and high mortality. ILD can be idiopathic or associated with systemic or connective tissue diseases (CTD) but idiopathic pulmonary fibrosis (IPF) is the most common form. While IPF has a male predominance, women are affected more greatly by CTD and therefore associated ILDs. The mechanisms behind biological sex differences in these progressive lung diseases remain unclear. However, differences in environmental exposures, variable expression of X-chromosome related inflammatory genes and sex hormones play a role. Here, we will outline sex-related differences in the incidence, progression and mechanisms of action of these diseases and discuss existing and novel cellular and pre-clinical studies. Furthermore, we will highlight how sex-differences are not adequately considered in pre-clinical disease models, how gender bias exists in clinical diagnosis and how women are underrepresented in clinical trials. Future action on these observations will hopefully shed light on the role of biological sex in disease development, identify potential targets for intervention and increase female participant numbers in clinical trials.

Pathophysiology and Management of Variceal Bleeding

Cirrhosis is the fifth leading cause of death in adults. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. If portal pressure exceeds a certain threshold, the patient is at risk of developing life-threatening bleeding from varices. Variceal bleeding has a high incidence among patients with liver cirrhosis and carries a high risk of mortality and morbidity. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiologic interventions. In terms of management, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. We describe the pathophysiology of cirrhosis and PH to contextualize the formation of gastric and esophageal varices. We also discuss the currently available treatments and compare how they fare in each stage of clinical management, with a special focus on drugs that can prevent bleeding or assist in achieving hemostasis.

Paeoniflorin mitigates PBC-induced liver fibrosis by repressing NLRP3 formation

Purpose:

To delve into the influence of paeoniflorin (PA) on abating primary biliary cholangitis (PBC)-induced liver fibrosis and its causative role.

Methods:

Our team allocated the mice to control group, PA group, PBC group and PBC+PA group. We recorded the weight change of mice in each group. We used Masson staining for determining liver fibrosis, immunofluorescence staining for measuring tumor necrosis factor-α (TNF-α) expression, quantitative real-time polymerase chain reaction (qRT-PCR) for assaying related gene expression, as well as Western blot for testing related protein expression.

Results:

The weight of PBC model mice declined. Twenty-four weeks after modeling, the positive rate of anti-mitochondrial antibody-M2 (AMA-M2) in PBC mice reached 100%. Alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hydroxyproline (HYP), laminin (LN), procollagen type III (PC III), and malondialdehyde (MDA) contents saliently waxed (p<0.01). Meanwhile, superoxide dismutase (SOD) and glutathione peroxidase (GSH-px) activity patently waned (p<0.01). Liver fibrosis levels were flagrantly higher (p<0.01), and TNF-α, NOD-like receptor protein 3 (NLRP3), caspase-1, interleukin-18 (IL-18), and interleukin-1β (IL-1β) protein or gene expression were manifestly up-regulated (p<0.01). PA could restore the weight of PBC mice, strikingly restrain the positive expression of AMA-M2, and down-regulate serum ALP, ALT, AST, HYP, LN, PC III, MDA in PBC mice (p<0.01). PA could also significantly up-regulate SOD and GSH-px levels (p<0.01), down-regulate IL-1β, IL-18, caspase-1, NLRP3, and TNF-α protein or gene expression in PBC mice (p<0.01) and inhibit liver fibrosis levels (p<0.01).

Conclusions:

PA can reduce PBC-induced liver fibrosis in mice and may function by curbing the formation of NLRP3.

Artemisia capillaris extract protects against bile duct ligation-induced liver fibrosis in rats

Artemisia capillaris has been widely used as a traditional herbal medicine in the treatment of liver diseases. However, no previous study has investigated whether A. capillaries alone is effective in treating pathological conditions associated with cholestatic liver injury. In the present study, we evaluated the anti-hepatofibrotic effects of A. capillaris (aqueous extract, WAC) in a bile duct ligation (BDL)-induced cholestatic fibrosis model. After BDL, rats were given WAC (25 or 50 mg/kg) or urosodeoxycholic acid (UDCA, 25 mg/kg) orally for 2 weeks (once per day). The serum cholestatic markers, malondialdehyde, and liver hydroxyproline levels were drastically increased in the BDL group, while administering WAC significantly reduced these alterations. Administering WAC also restored the BDL-induced depletion of glutathione content and glutathione peroxidase activity. Cholestatic liver injury and collagen deposition were markedly attenuated by WAC treatment, and these changes were paralleled by the significantly suppressed expression of fibrogenic factors, including hepatic alpha-smooth muscle actin (α-SMA), platelet-derived growth factor (PDGF), and transforming growth factor beta (TGF-β). The beneficial effects of WAC administration are associated with antifibrotic properties via both upregulation of antioxidant activities and downregulation of ECM protein production in the rat BDL model.

Meta-analysis of the clinical value of danshen injection and huangqi injection in liver cirrhosis

Objective. To evaluate the clinical value of Danshen injection and Huangqi injection for the treatment of liver cirrhosis. Methods. The Chinese Biomedical Literature Database (CBM), Chinese Scientific Journals Full-Text Database (VIP), Wanfang Database, China National Knowledge Infrastructure (CNKI), PubMed, and EMBASE database were searched to collect the literatures about the randomized controlled trials involving the treatment of liver cirrhosis with Danshen injection combined with Huangqi injection, and the data analyses were performed using RevMan 4.2 software. Results. A total of 11 studies involving 1086 patients (trials group: 554 cases, control group: 532 cases) were included in this study. Compared with those in control group, the meta-analysis showed-that the total effectiveness rate and the level of serum albumin increased, while serum total bilirubin, alanine transmninase, type III procollagen, hyaluronic acid, laminin, and type-IV collagen decreased in trials group. The Jadad score ranged from 1 to 2 and the funnel plot analysis suggests that publication bias may occur. Conclusions. Danshen injection combined with Huangqi injection may promote the curative efficacy of liver cirrhosis, which is a promising novel treatment approach. The exact outcome needs to perform rigorously designed, multicenter, and large randomized controlled trials.

Expression of angiotensinogen during hepatic fibrogenesis and its effect on hepatic stellate cells

BACKGROUND

The liver renin-angiotensin system (RAS) plays an important role in promoting the development of hepatic fibrogenesis. Angiotensinogen (AGT) is an important precursor in tissue RAS. This study aimed to investigate the expression and cellular source of AGT in hepatic fibrogenesis and its effect on proliferation and collagen metabolism of hepatic stellate cells.

MATERIAL/METHODS

In a rat carbon tetrachloride (CCl4)-induced liver fibrosis model the mRNA expression of AGT was determined by real-time PCR and the cellular source of AGT was determined by immunohistochemical staining. In vitro HSC-T6 cells were transfected with AGT, and the expression plasmid, AGT shRNA plasmid and negative shRNA plasmid were constructed. Real-time PCR and ELISA were applied to determine the mRNA expressions and contents of TIMP-1, TGF-β1, type I collagen and type III collagen of the cells or in the supernatants.

RESULTS

Compared to normal liver, the AGT and α-SMA mRNA expressions increased at the early stage of hepatic fibrosis and decreased in hepatic cirrhosis. The expressions of AGT and α-SMA mRNA were correlated with the hepatic fibrosis (r=0.915, P=0.03). Immunohistochemistry demonstrated the activated HSCs were the main source of AGT due to colocalization of AGT and α-SMA expressions. The mRNA and protein of TGF-β1, TIMP-1, type I collagen and type III collagen were markedly up-regulated.

CONCLUSIONS

ACEI and angiotensin II type 1 receptor antagonist (AT1RA) could attenuate the progression of hepatic fibrosis in the early stage. Direct inhibition of AGT from aHSCs may become an effective antifibrotic anti-liver fibrosis strategy.

Adenovirus-mediated inhibition of SPARC attenuates liver fibrosis in rats

BACKGROUND

The interaction between fibrogenic cells and extracellular matrix plays a role in liver fibrosis, yet the mechanisms are largely unknown. Secreted protein, acidic and rich in cysteine (SPARC) is a matricellular glycoprotein that is expressed by hepatic stellate cells and is overexpressed in fibrotic livers. We investigated the in vivo role of SPARC in experimentally induced liver fibrosis in rats.

METHODS

A recombinant adenovirus carrying antisense SPARC was constructed (AdasSPARC). Advanced liver fibrosis was induced in Sprague-Dawley rats by prolonged intraperitoneal administration of thioacetamide. Animals received injections of AdasSPARC or Ad beta gal (control adenovirus) via the tail vein and directly into the liver 1 week after the first dose. The pathological changes in liver tissues and indices of fibrosis were assessed at eight weeks. Expression of SPARC, transforming growth factor (TGF)-beta and alpha-smooth muscle actin were evaluated by quantitative real-time polymerase chain reaction, western blotting, enzyme-linked immunosorbent assay and immunohistochemistry.

RESULTS

Hepatic SPARC expression significantly increased during the development of liver fibrosis. AdasSPARC markedly attenuated the development of hepatic fibrosis in rats treated with thiocetamide, as assessed by decreased collagen deposition, lower hepatic content of hydroxyproline and less advanced morphometric stage of fibrosis. AdasSPARC treatment reduced inflammatory activity (Knodell score) and suppressed transdifferentiation of hepatic stellate cell to the myofibroblasts like phenotype in vivo. Furthermore, in vitro inhibition of SPARC on hepatic stellate cells decreases the production of TGF-beta.

CONCLUSIONS

This is the first study to demonstrate that knockdown of hepatic SPARC expression ameliorates thioacetamide-induced liver fibrosis in rats with chronic liver injury. SPARC is a potential target for gene therapy in liver fibrosis.

Pharmacodynamics of pentoxifylline and/or praziquantel in murine schistosomiasis mansoni

Pentoxifylline (PTX) was proved to exert both anti-inflammatory and anti-fibrotic effects, and was used therapeutically in this experimental model to investigate its role alone or with praziquantel (PZQ) in Schistosoma mansoni-infected mice, and to explore its impact on the tissue expression of transforming growth factor-beta1 (TGF-beta1). S. mansoni-infected mice were divided into seven groups: Control untreated (I), treated with curative dose of PZQ, 500 mg/kg/day for 2 consecutive days (II), or subcurative dose, 100 mg/kg/day for 2 consecutive days (III), treated with PTX (10 mg/kg/day for 5 days/wk) alone for 4 weeks (IV) or in addition to subcurative dose of PZQ (V), and treated with PTX alone for 8 weeks (VI) or in addition to subcurative dose of PZQ (VII). All animals were killed 10 weeks post infection. Parasitological assessment of worm burden, tissue egg load and oogram pattern was carried out. The degree of granulomatous fibrosis and eosinophilic cell population was quantified in Sirius-red-stained sections and tissue transforming growth factor beta-1 expression was estimated immunohistochemically. Serum ALAT and GGT, as well as hepatic content of reduced GSH, were measured. The results revealed the highest percent of worm reduction and dead ova in groups (II) and (VII) accompanied by significant diminution in granulomatous parameters, collagen content and TGF-beta1 tissue expression. Moreover, treatments with PTX and/or PZQ ameliorated the liver functions. In conclusion, prolonged treatment with PTX has a potent anti-fibrogenic role especially when used in the early stages of infection, with limited toxic effects on schistosome worms and eggs. Thus, PTX can be used as an adjuvant therapeutic tool with anti-helminthic drugs in the treatment of human schistosomiasis.

Relationship between transforming growth factor β1 and anti-fibrotic effect of interleukin-10

AIM: To study the effect of interleukin-10 (IL-10) on the expression of transforming growth factor β1 (TGF-β1) in hepatic fibrosis rats and the anti-fibrotic role of exo-genous IL-10.

METHODS: Hepatic fibrosis was induced by carbon tetrachloride administered (CCl₄) intraperitoneally. The experiment was performed in two stages. In the first stage, 60 SD rats were divided randomly into normal control group 1(GN₁, n = 8), hepatic fibrosis group(GC, n = 28)and IL-10 intervened group(GI, n = 24). At the beginning of the 7^th and 11^th wk, hepatic stellate cells (HSCs) were isolated, reverse transcription-polymerase chain reation (RT-PCR) and immunocytochemistry were performed to detect the expression of TGF-β1 in HSCs. Histological examination was used to determine the degree of hepatic fibrosis. In the second stage, 47 SD rats were divided randomly into normal control group 2(GN₂, n = 6)and CCl₄ group(GZ, n = 41). At the end of the 9th week, rats in GZ group were allocated randomly into model group(GM, n = 9), IL-10 treatment group(GT, n = 9)and recovered group(GR, n = 9). At the end of the 12^th week, all rats were sacrificed. RT-PCR and immunohistochemistry were performed to detect the expression of TGF-β1 in liver tissue. ELISA was used to assay serum TGF-β1 levels.

RESULTS: Hepatic fibrosis developed in rats with the increase of the injection frequency of CCl₄. In the first stage, hepatic fibrosis developed and HSCs were isolated successfully. At the 7^th and 11^th week, TGF-β1 mRNA in GC group increased significantly compared with that in GN₁(P = 0.001/0.042)and GI groups(P = 0.001/0.007), whereas there was no significant difference between the two groups. The levels of TGF-β1 at the beginning of the 7^th wk was higher than that of the 11^th wk(P = 0.049). Immunocytochemistry results of TGF-β1 were consistent with the above findings. In the second stage, TGF-β1 increased significantly in GM group compared to GN₂. After treatment with IL-10, TGF-β1 declined obviously. The expression of TGF-β1 decreased in GR group but was still higher than that in GT group.

CONCLUSION: The levels of TGF-β1 are increased in hepatic fibrosis rats and decreased after treatment with exogenous IL-10. IL-10 may play an anti-fibrotic role by suppressing TGF-β1 expression.

Effects of total glucosides of peony on immunological hepatic fibrosis in rats

AIM

To study the effects of total glucosides of peony (TGP) on immunological hepatic fibrosis induced by human albumin in rats.

METHODS

Sixty adult male Sprague-Dawley rats were randomly divided into: Normal group, model group, TGP (60 and 120 mg/kg) treatment groups and colchicines (0.1 mg/kg) treatment group. On the day before the rats were killed, those in TGP or colchicine groups received TGP or colchicine as above from the first day of tail vein injection of human albumin. The rats in normal and model groups were only administered with the same volume of vehicle. At the end of the 16th wk, rats in each group were killed. Blood and tissue specimens were taken. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), nitric oxide (NO), content of malondialdehyde (MDA), activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-px), were measured by biochemical methods. Serum procollagen type III (PC III) and laminin (LN) were determined by radioimmunoassay. Liver collagen level was determined by measuring hydroxyproline content in fresh liver samples. Hepatic tissue sections were stained with hematoxylin-eosin and examined under a light microscope.

RESULTS

Histological results showed that TGP improved the human albumin-induced alterations in the liver structure, alleviated lobular necrosis and significantly lowered collagen content. The antifibrotic effect of TGP was also confirmed by decreased serum content of LN and PCIII in TGP-treated group. Moreover, the treatment with TGP effectively reduced the hydroxyproline content in liver homogenates. However, the level of ALT and AST increased in fibrotic rat but had no significance compared with normal control, whereas the ratio of A/G decreased without significance. TGP had no effect on level of ALT, AST and the ratio of A/G. Furthermore, TGP treatment significantly blocked the increase in MDA and NO, associated with a partial elevation in liver total antioxidant capacity including SOD and GSH-px.

CONCLUSION

TGP has beneficial effects on hepatic fibrosis in rats by inhibition of collagen synthesis and decreasing oxidative stress.

Prevention of critical telomere shortening by oestradiol in human normal hepatic cultured cells and carbon tetrachloride induced rat liver fibrosis

BACKGROUND AND AIM

Significant telomere shortening of hepatocytes is associated with replicative senescence and a non-dividing state in chronic liver disease, resulting in end stage liver failure and/or development of hepatocellular carcinoma. To prevent critical telomere shortening in hepatocytes, we have focused on oestrogen dependent transactivation of the human telomerase reverse transcriptase (hTERT) gene as a form of telomerase therapy in chronic liver disease.

METHODS

We examined expression of hTERT mRNA and its protein, and telomerase activity (TA) in three human normal hepatic cell lines (Hc-cells, h-Nheps, and WRL-68) before and after treatment with 17beta-oestradiol. The effects of exogenous oestradiol administration were examined in a carbon tetrachloride (CCl(4)) induced model of liver fibrosis in rats.

RESULTS

Expression of hTERT mRNA and its protein was upregulated by oestradiol treatment. Telomere length decreased in Hc-cells and h-Nheps with accumulated passages whereas with long term oestradiol exposure it was greater than without oestradiol. The incidence of beta-galactosidase positive cells, indicating a state of senescence, decreased significantly in oestradiol treated cells in comparison with non-treated cells (p<0.05). TA in both male and female rats with CCl(4) induced liver fibrosis was significantly higher with oestradiol administration than without (p<0.05). Long term oestradiol administration markedly rescued the hepatic telomere from extensive shortening in both male and female rats.

CONCLUSION

These results suggest that oestradiol acts as a positive modulator of the hTERT gene in the liver. Oestrogen dependent transactivation of the hTERT gene is a new strategy for slowing the progression of chronic liver disease.

Gene expression profiles in liver cirrhosis and normal liver tissues

AIM: To describe liver specific gene expression profiles and to identify genes with differential expression between liver cirrhotic tissues and normal liver tissues.

METHODS: The cDNA probes which were labeled with α-³²P dATP were synthesized from total RNAs of liver cirrhosis and normal liver tissues and hybridized to two identical Atlas human cDNA expression arrays membranes containing 588 known genes respectively.

RESULTS: Autoradiographic results were analyzed by specific AtlasImage^TM (version1.01a) software. Among the 588 genes analyzed, 17 genes were found up-regulated in cirrhosis, including integrin beta 7 and collagen type XVIII, and 98 genes were down-regulated in cirrhosis, including TFDP2, BAK and ABL. Expression of the genes was associated with the regulation of cell proliferation, apoptosis, differen-tiation, cell-cell interaction, invasion regulators and cytokines altered.

CONCLUSION: The results obtained from Atlas microarray provide a comprehensive liver cirrhosis specific expression profile. These results may be helpful for identification of target genes for diagnosis and designing rational therapeutic strategies.

Relationship between clinical and pathologic findings in patients with chronic liver diseases

AIM: To explore the relationship between clinical findings of patients with chronic liver diseases and the pathologic grading and staging of liver tissues.

METHODS: The inflammatory activity and fibrosis of consecutive liver biopsies from 200 patients were determined according to the diagnosis criteria of chronic hepatitis in China established in 1995. A comparative analysis was carried out for 200 patients with chronic liver diseases by comparing their clinical manifestations, serum biochemical markers with the grading and staging of liver tissues.

RESULTS: It was revealed that age, index of clinical symptoms and physical signs were obviously relevant to the pathologic grading and staging of liver tissues (P < 0.05). Blood platelet, red blood cells, aspartate aminotransferase (AST), N-terminal procollagen III (PIII NP) were apparently correlated with the degree of inflammation. PGA (prothrombin time, GGT, apoprotein A1) index, PGAA (PGA + △2-macroglobublin) index, albumin and albumin/globulin were relevant to both inflammation and fibrosis. Hyaluronic acid (HA) was an accurate variable for the severity of hepatic inflammation and fibrosis. The combination of serum markers for fibrosis could increase the diagnostic accuracy. It was notable that viral replication markers were not relevant to the degree of inflammation and fibrosis.

CONCLUSION: There is a good correlation between clinical findings and the pathologic grading and staging of liver tissues, which may give aid to the noninvasive diagnosis of liver fibrosis.

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Effects of estradiol on type I, III collagens and TGF β1 in hepatic fibrosis in rats

AIM

To study the effects of estradiol on the production of collagen I, III and transforming growth factor β₁ (TGF β₁) in experimental fibrosis in rats induced by carbon tetrachloride (CCL4), and to investigate the suppressive effects of estrogen on liver fibrosis.

METHODS

Rats were randomly allocated into a normal control group, a model control group, a therapy control group and an estradiol group. Liver fibrosis was induced by CCL₄ administration. The estradiol group, apart from the administration of CCL₄, was treated subcutaneously with estradiol (benzoic estradiol) 1 mg/kg twice weekly. At the end of week 8, all the rats were sacrificed. Liver inflammation and collagen deposition were observed with HE and Masson's collagen stains, analyzed with scoring and staging systems. Type I, III collagens and TGF β₁ were observed with immunohistochemical method.

RESULTS

CCL₄ group had the typical liver fibrosis compared with normal control group. The fibrous septa were formed in CCL₄ group rats, and collagens were accumulated and deposited in the sinusoids and liver lobules. The expression of type I , III collagens (0.58±0.26 vs 6.34±2.24, 1.07±0.49 vs 5.28±1.28, P<0.001) and TGF β₁ was significantly increased. Estradiol significantly attenuated collagen accumulation (P<0.05) in the fibrotic livers, and decreased type I , III collagens (2.47±0.76 vs 6.34±2.24, 3.02±1.20 vs 5.28±1.28, P<0.05) and TGF β₁ expression in the liver.

CONCLUSION

Estradiol treatment reduces the synthesis of hepatic type I , III collagens and TGF β₁ in the fibrotic liver induced by CCL₄ administration, and attenuates hepatic fibrosis.

Effects of heparin on liver fibrosis in patients with chronic hepatitis B

AIM: To evaluate the effects of heparin on liver fibrosis in patients with chronic hepatitis B.

METHODS: Fifty-two cases under study were divided into two groups, group A and group B. The two groups were given regular treatment and heparin/low molecular weight heparin (LMWH) treatment respectively. Hepatic functions, serum hyaluronic acid (HA) and type IV collagen levels were measured before and after the treatment, and six cases were taken liver biopsy twice.

RESULTS: After treatment, hepatic functions became significantly better in both groups. Serum HA and type IV collagen levels in group B compared with group A, decreased significantly after treatment. Collagen proliferation also decreased in group B after treatment.

CONCLUSION: Heparin/LMWH can inhibit collagen proliferation in liver tissues with hepatitis B.

Expression of local renin and angiotensinogen mRNA in cirrhotic portal hypertensive patient

AIM

To investigate the expression of local renin and angiotensinogen mRNA in cirrhotic portal hypertensive patients.

METHODS

The expression of local renin and angiotensinogen mRNA in the liver, splenic artery and vein of PH patients was detected by RT-PCR analysis.

RESULTS

Expression of local renin mRNA in the liver of control group was (0.19+/-0.11), significantly lower than that in splenic artery (0.45+/-0.17) or splenic vein(0.39+/-0.12) respectively, (P<0.05). Expression of local angiotensinogen mRNA in the liver was (0.64+/-0.21), significantly higher than that in splenic artery(0.41+/-0.15) or in splenic vein (0.35+/-0.18) respectively, (P<0.05). Expression of local renin mRNA in the liver, splenic artery and vein of PH group was (0.78+/-0.28), (0.86+/-0.35) and (0.81+/-0.22) respectively, significantly higher than that in the control group, (P<0.05). Expression of local angiotensinogen mRNA in the liver, splenic artery and vein of PH group was (0.96+/-0.25), (0.83+/-0.18) and (0.79+/-0.23) respectively, significantly higher than that in the control group, (P<0.05). There was no significant difference between the liver, splenic artery and vein in the expression of local renin or local angiotensinogen mRNA in PH group, (P<0.05).

CONCLUSION

In normal subjects the expression of local renin and angiotensinogen mRNA was organ specific, but with increase of the expression of LRAS, the organ-specificity became lost in cirrhotic patients. LRAS may contribute to increased resistance of portal vein with liver and formation of splanchnic vasculopathy.

Experimental study of effect of Ganyanping on fibrosis in rat livers

AIM: To observe the effects of Ganyanping on CCl₄-induced hepatic fibrosis in rats.

METHODS: The rats were separated randomly into five groups. Groups A to group D, each consisting of 15 rats, were for different tests, while 8 rats were used as normal controls (N). For group D, CCl₄ was injected subcutaneously, at a dosage of 3 mL/kg for 9 wk. For group A, Ganyanping was administered via gastric tube at a dosage of 10 mL/kg. For group B, the treatment with Ganyanping was started 4 wk after CCl₄ administration. In group C, Ganyanping was administered 8 wk after the intoxication, and treatment lasted for 4 wk. Liver tissues were fixed in 10% formalin and embedded in paraffin. Pathologic changes, particularly fibrosis, were evaluated on the HE and V-G-stained sections. Ten middle-power fields were randomly selected for assessment of collagen deposition.

RESULTS: Loss of normal hepatic architecture, some with pseudo-lobule formation, was observed in group D, while hepatocytes steatosis and fibrosis were less pronounced in the animals treated with Ganyanping. Pseudo-lobule formation was not evident in the latter groups. The total collagen area and ratio were 840.23 ± 81.65 and 7.0 ± 0.9, respectively in group D, the ratio being reduced greatly in the Ganyanping-treated groups (148.73 ± 45.89 and 1.16 ± 0.33, respectively). The activities of MAO and ACP were elevated and that of SDH in group D decreased in the hepatic tissue as compared to the control group. The treatment with Ganyanping abrogated these enzymatic changes.

CONCLUSION: Our data approved that Ganyanping could improve the microcirculation in the liver, reduce oxygen-derived free radicals, and enhance the cellular metabolism and immune function, all resulting in an anti-fibrotic effect. Hence, Ganyanping can protect the liver from fibrosis. It may be a safe and effective preparation for patient with fibrosis.

Construction of replication-deficient recombinant adenoviral vector carrying HBV S and C region gene by homologous recombination in bacteria and its expression in vitro

AIM

To construct recombinant adenoviral vector carrying HBV S and C region gene by homologous recombination in bacteria and to detect its expression in vitro.

METHODS

HBV pre-S2/S genes and pre-C/C genes were amplified by PCR and were cloned to adenoviral shuttle plasmid pAdTrack-CMV, respectively. Then the resultant pAd Track-CMV-HBs or pAdTrack-CMV-HBe was cotransfected into BJ5183 bacteria with the plasmid pAdeasy-1. The adenoviral plasmid carrying HBV S and C gene (pAd-HBs and pAd-HBe) was generated with homologous recombination in bacteria and the adenoviruses were produced in 293 cells. Both 293 and Vero cells were infected with adenoviruses and the expression of HBsAg and HBeAg was detected by RT-PCR and ELISA in vitro.

RESULTS

The titer of Ad-HBs and Ad-HBe adenoviruses was up to 5×10¹² pfu/L after proliferation in 293 cells. HBsAg and HBeAg were expressed efficiently in 293 and Vero cells after infection.

CONCLUSION

The recombinant adenoviruses expressing HBsAg or HBeAg were constructed successfully and can be used further in gene therapy of HBV.

Effect of expression of interferon-g gene in inhibition of growth of colon cancer cell

AIM: To investigate the effect of expression of interferon-γ(IFN-γ) in tumor cell and its inhibitory effect on the growth of tumor cell.

METHODS: pcDNA3-IFN-γ vector containing IFN- γ gene was constructed and transfected into LOVO, SW620, HCT116BG and Hela cell lines by lipofectamine, respectively. The expression of IFN-γ, CEA and HLA-DR in transfected cells were tested. Both the number of apoptosis of and the proportion of cell cycles of tumor cells were measured to investigate the anti-tumor effect of IFN-γ gene therapy.

RESULTS: LOVO and HCT116BG transfected cell lines had high expression of CEA, the average level of CEA was significantly increased from 26.02±6.76 to 38.85±7.07 mg/L (P < 0.05). However, there was no detectable increase in the supernatants of Hela, SW620 cell lines that naturally expressed little of CEA. Flow cytometry analysis showed that HLA-DR expression rate (11.67±7.20) was significantly higher than that prior gene transfection (3.91±3.61) (P < 0.01), and the IFN-γ gene transfer effectively induced the apoptosis of tumor cells, the proportion of DNA synthesis phase was deceased gradually after IFN-γ gene transfer, which indicated that the synthesis of DNA and growth of tumor cells were repressed.

CONCLUSION: IFN-γ gene therapy enhanced the expression of antigens on cell surface and thus induced powerful antitumor immunity. Repressing of synthesis of DNA, inducing the apoptosis of tumor cells and inhibiting the proliferation of tumor cells might be anti-tumor mechanisms of IFN-γ.

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Construction, package and identification of replication-deficient recombinant adenovirus expression vector of HCV C

AIM: To construct a replication-deficient recombinant adenovirus expression vector of HCV C.

METHODS: The HCV core gene was cloned at the downstream of CMV promoter of the adenoviral shuttle plasmid pAd. CMV-link. 1, and the resultant recombinant plasmid pAd. HCV-C was cotransfected into 293 cell together with plasmid pJM17 containing adenoviral genome, then the adenovirus expression vector was obtained, and identified by infecting test, electronic microscope observation and PCR co-amplification. The plasmid pAd. HCV-C was identified by endonuclease, PCR and sequencing. The expressive activity of adenovirus vector was identified by immunofluorescence and Western blot.

RESULTS: HCV core gene in the inserted DNA of pAd. HCV-C was confirmed by endonuclease, PCR and sequencing. Results of infecting test, electronic microscopic observation and PCR co-amplification showed that the adenovirus vector had been constructed successfully. Expression of HCV core antigen was proved in the HepG2 cells by immunofluorescence and Western blot.

CONCLUSION: The replication-deficient recombinant adenovirus vector can express HCV core antigen in HepG2 cells. This study established a foundation for further study on HCV vaccines and gene therapy for hepatitis C.

Angiogenesis effect on rat liver after administration of expression vector encoding vascular endothelial growth factor D

AIM

To verify the expressing efficiency and angiogenesis effect after administration of expression vector encoding for vascular endothelial growth factor D in normal and ischemic rat liver.

METHODS

Ten female S-D rats were administrated with liver tissue dot injection of naked PCHO/hVEGF-D, 50 microg/dot, three dots for each. The same amount of physiological saline was used as control in the neighboring lobe. Fourteen S-D rats, using inflow occlusion of left lateral lobe, were divided into two groups, seven rats in each group. One was ischemic plasmid group, which received naked plasmid PCHO/hVEGF-D injection of 150 microg. The other received the equal amount of natural saline injection and designed as control. The expressions of hVEGF-D in mRNA and protein levels were identified by in situ hybridization and immunohistochemistry, respectively. Endothelial cells were labeled by the factor VIII immunohistochemistrically. The average number of peri-sinusoidal capillaries of each group was calculated and compared statistically 8 days after injection.

RESULTS

A large amount of hVEGF-D in mRNA level was found in both normal and ischemic plasmid groups and but none in their corresponding control groups. The protein of hVEGF was also highly expressed in both normal and ischemic plasmid groups than in the controls. The mean number of capillaries under microscopy (X200) of the plasmid group and control was 10.2+/-2.78 vs 7.1+/-2.02 (P<0.05), and those of ischemic plasmid group and ischemic control were 7.43+/-1.72 vs 4.71+/-1.11 with statistical difference (P<0.05).

CONCLUSION

The naked PCHO/hVEGF-D dot injection to normal, ischemic rat liver can produce comparatively high expression of hVEGF in both protein and mRNA levels, and prominently increase the number of new capillaries around hepatic sinuses. Therefore, it could be another ideal choice for the treatment of ischemic liver diseases.

Construction and identification of recombinant adenovirus vaccines of gastric cancer MG7-Ag mimotope

AIM: To develop a cancer vaccine based on MG7-Ag of gastric cancer using recombinant adenovirus as vector.

METHODS: PCR was performed to get fusion gene of the MG7-Ag mimotope and HbcAg. The fusion gene was then subcloned into the pAdTrack-CMV shuttle vector. The resultant plasmid(pAdTrack-CMV-MG7) was cotransduced into E. coli. BJ5183 cells with pAdEasy-1 plasmid to undergo homologous recombination. The linearized recombinant plasmid(pAd-MG7) was transfected into 293 cells. The recombinant adenovirus was detected by examining the expression of the green fluorescence protein tag in the 293 cells.

RESULTS: By sequencing, it was confirmed that the PCR product was a fusion gene of MG7-Ag mimotope gene and HBcAg. Restriction endonuclease analysis confirmed the successful cloning of the fusion gene into the pAdTrack-CMV. The recombinants(pAd-MG7) were selected for kanamycin resistance, and recombination was confirmed by restriction endonuclease analysis. Presence of the recombinant adenoviruses was confirmed by GFP expression.

CONCLUSION: The Recombinant adenovirus vaccine of the MG7-Ag mimotope was constructed successfully, which is helpful to the further investigation of its potentiality in the immunotherapy of gastric cancer.

Effects of pentoxifylline on the hepatic content of TGF-β1 and collagen in Schistosomiasis japonica mice with liver fibrosis

AIM: To study the effects of pentoxifylline (PTX) on the content of hepatic TGF-β1, type I and type III collagen in schistosomiasis japonica mice with liver fibrosis and its mechanism of anti-fibrosis.

METHODS: Forty mice with schistosomiasis were divided into four groups: one group as control without any treatment, other three were treated with Praziquantel 500 mg/(kg·d)for 2 d, high dose PTX 360 mg/(kg·d) for 8 wk, and low dose PTX 180 mg/(kg·d) for 8 wk respectively. Immunohistochemical technique and multimedia color pathographic analysis system were applied to observe the content change of hepatic TGF-β1, type I and type III collagen in schistosomiasis japonica mice with liver fibrosis before and after PTX treatment.

RESULTS: Effects of PTX on the content change of hepatic TGF-β1, type I and type III collagen in schistosomiasis japonica mice with liver fibrosis were related to the dosage of PTX, high dose PTX treated group could significantly reduce the content of TGF-β1 (0.709 ± 0.111), type I (0.644 ± 0.108) and type III (0.654 ± 0.152) collagen compared with those of control group (0.883 ± 0.140, 0.771 ± 0.156, 0.822 ± 0.129) with statistical significance (P < 0.05). Low dose PTX could also reduce the hepatic content of TGF-β1 (0.752 ± 0.152), type I (0.733 ± 0.117) and type III (0.788 ± 0.147) collagen, but without statistical significance (P > 0.05). Both high dose and low dose PTX groups have significant differences on the content of TGF-β1, type I and type III collagen (P < 0.05, P < 0.05, P < 0.01, respectively).

CONCLUSION: High dose of PTX treatment could reduce the content of hepatic TGF-β1, type I and type III collagen significantly in schistosomiasis japonica mice with liver fibrosis, and thus plays its role of antifibrosis.

Estrogen reduces CCL4- induced liver fibrosis in rats

AIM: Chronic liver diseases, such as fibrosis or cirrhosis, are more common in men than in women. This gender difference may be related to the effects of sex hormones on the liver. The aim of the present work was to investigate the effects of estrogen on CCL₄-induced fibrosis of the liver in rats.

METHODS: Liver fibrosis was induced in male, female and ovariectomized rats by CCL₄ administration. All the groups were treated with estradiol (1 mg/kg) twice weekly. And tamoxifen was given to male fibrosis model. At the end of 8 wk, all the rats were killed to study serum indicators and the livers.

RESULTS: Estradiol treatment reduced aspartate aminotransferase (AST), alanine aminotransferase (ALT), hyaluronic acid (HA) and type IV collagen (CIV) in sera, suppressed hepatic collagen content, decreased the areas of hepatic stellate cells (HSC) positive for α-smooth muscle actin (α-SMA), and lowered the synthesis of hepatic type I collagen significantly in both sexes and ovariectomy fibrotic rats induced by CCL₄ administration. Whereas, tamoxifen had the opposite effect. The fibrotic response of the female liver to CCL₄ treatment was significantly weaker than that of male liver.

CONCLUSION: Estradiol reduces CCL₄-induced hepatic fibrosis in rats. The antifibrogenic role of estrogen in the liver may be one reason for the sex associated differences in the progression from hepatic fibrosis to cirrhosis.

Effects of the tyrosine protein kinase inhibitor genistein on the proliferation, activation of cultured rat hepatic stellate cells

AIM: Hepatic stellate cell (HSC) plays a pivotal role in liver fibrosis and is considered as the therapeutic target for the treatment of hepatic fibrosis. Tyrosine protein kinase plays an important role in the proliferation, activation of HSC. The purpose of the study is to investigate the effects of the tyrosine protein kinase inhibitor genistein on the proliferation and activation of cultured rat HSC.

METHODS: Rat HSC were isolated from Wistar rats by in situ perfusion of collagenase and pronase and single-step density Nycodenz gradient. Culture-activated HSC were serum-starved and incubated with 10^-9 to 10^-5 mol/L concentration of genistein for 24, 48 or 72 h. In PDGF-induced HSC proliferation, HSC were stimulated with 10 μg·L^-1 PDGF-BB for 15 min, and then treated with genistein for the same time. Cell proliferation was measured by MTT assay and based on flow cytometric analysis of cell cycle. The α-smooth muscle actin (α-SMA) expression in HSC was studied with confocal laser microscopy and flow cytometry. c-fos, c-jun and cyclin D1 expression in HSC was also detected by flow cytometry.

RESULTS: Genistein inhibited basal and PDGF-induced proliferation of HSC at the concentration of 10^-8 to 10^-5 mol/L, and treatment with 10^-7 mol/L concentration of genistein for 48 h inhibited the HSC proliferation significantly (the inhibition rate was 70.3%, P < 0.05). Immunofluorescence detected by confocal laser microscopy and flow cytometry showed that treatment with 10^-7 mol/L genistein for 48 h suppressed the expression of α-SMA significantly in HSC (the specific fluorescence intensity were 60.2 ± 21.5 vs 35.3 ± 11.6 and 12.8 ± 10.4 vs 9.54 ± 6.39, respectively, both P < 0.05). The intensity of c-fos, c-jun and cyclin D1 expression of HSCs treated with 10^-7 mol/L genistein for 48 h was also significantly decreased compared with the controls.

CONCLUSION: Genistein influences proliferation of HSC, suppresses the expression of α-SMA in HSC and t inhibits the intensity of c-fos, c-jun and cyclin D1 expression of HSCs. Genistein has therapeutic potential against liver fibrosis.

Regulating effect of Chinese herbal medicine on the peritoneal lymphatic stomata in enhancing ascites absorption of experimental hepatofibrotic mice

AIM

To observe the regulatory effect of Chinese herbal medicine on peritoneal lymphatic stomata and its significance in treating ascites in liver fibrosis model mice.

METHODS

Two Chinese herbal composite prescriptions were used separately to treat the carbon tetrachloride-induced mouse model of liver fibrosis. The histo-pathologic changes of the liver sections (HE and VG stainings) were observed. The peritoneal lymphatic stomata was detected by scanning electron microscopy and computer image processing. The changes of urinary volume and sodium ion concentration were measured.

RESULTS

In the model group, lots of fibrous tissue formed in liver and extended into the hepatic lobules to separate them incompletely. In the treated and prevention groups, the histo-pathologic changes of liver was rather milder, only showed much less fibrous tissue proliferation in the hepatic lobules. The peritoneal lymphatic stomata enlarged with increased density in the experimental groups (diameter: PA, 3.07 +/- 0.69 microm; PB, 2.82 +/- 0.37 microm; TA, 3.25 +/- 0.82 microm and TB, 2.82 +/- 0.56 microm; density: PA, 7.11 +/- 1.90 stomata.1000 microm(-2); PB, 8.76 +/- 1.45 stomata.1000 microm(-2); TA, 6.55 +/- 1.44 stomata.1000 microm(-2)and TB, 8.76+/-1.79 stomata.1000 microm(-2)), as compared with the model group (diameter: 2.00+/-0.52 microm density: 4.45+/-1.05 stomata.1000 microm(-2)). After treatment, the urinary volume and sodium ion excretion increased in the experimental groups (PA, 231.28+/-41.09 mmol.L(-1); PB, 171.69 +/- 27.48 mmol.L(-1) and TA, 231.44 +/- 34.12 mmol.L(-1)), which were significantly different with those in the model group (129.33 +/- 36.75 mmol.L(-1)).

CONCLUSION

Chinese herbal medicine has marked effects in alleviating liver fibrosis, regulating peritoneal lymphatic stomata, improving the drainage of ascites from peritoneal cavity and causing increase of urinary volume and sodium ion excretion to reduce the water and sodium retention, and thus have favorable therapeutic effect in treating ascites.

Pharmacokinetics of radioimmunotherapeutic agent of direct labeling mAb 188Re-HAb18

AIM: To label anti-hepatoma monoclonal antibody (mAb) fragment HAb18 F(ab’)₂ was labeled with ¹⁸⁸Re for the pharmacokinetic model of ¹⁸⁸Re-HAb18 F(ab’)₂ and to evaluate its pharmacokinetic parameters in hepatoma-bearing nude mice.

METHODS: HAb18 F(ab’)₂ was directly labeled with ¹⁸⁸Re using 2-mercaptoethanol (2-ME) as reducing agents. Labeling efficiency and immunoreactivity of ¹⁸⁸Re-HAb18 F(ab’)₂ were evaluated by Whatman 3MM paper chromatography and live cell assay, respectively. Biodistribution analysis was also conducted in nude mice bearing human hepatoma in which animals were sacrificed at different time points (1, 4, 18, 24 and 24 h) after ¹⁸⁸Re-HAb18 F (ab’)₂ was injected through tail-vein into hepatoma-bearing nude mice. The blood and radioactivity of organs and mass were measured. The concentrations of ¹⁸⁸Re-HAb18 F(ab’)₂ were evaluated with apharmacokinetic 3P97 software.

RESULTS: The optimum labeling efficiency and immunoreactive fraction were 91.7% and 0.78% respectively. The parameters of ¹⁸⁸Re-HAb18 F(ab’)₂ were: T_1/2, 2.29 h; Vd,1.49 × 10^-9 L·Bq^-1; AUC, 20. 49 × 10⁹ Bq·h·L^-1;CL, 0.45 × 10^-3 L·h^-1. ¹⁸⁸Re-HAb18 F(ab’)₂ could locate specially in hepatoma with high selective reactivity of HAb18 F(ab’)₂. ¹⁸⁸Re-HAb18 F(ab’)₂ was mainly eliminated by kidney. The maximal tumor to blood ratio was at 48 h, and maximal tumor to liver ratio was at 18 h.

CONCLUTION: The pharmacokinetics of ¹⁸⁸Re-HAb18 F (ab’)₂ fital-compartment model.¹⁸⁸Re-HAb18 F(ab’)₂ can be uptaken selectively at the hepatoma site.

Expression of lipopolysaccharide binding protein and its receptor CD14 in experimental alcoholic liver disease

AIM: To evaluate the relationship between the expression of lipopolysaccharides (LPS) binding protein (LBP) and CD14 mRNA and the severity of liver injury in alcohol-fed rats.

METHODS: Twenty Wistar rats were divided into two groups: ethanol-fed group (group E) and control group (group C). Group E was fed with ethanol (5-12 g·kg¯¹·d¯¹) and group C received dextrose instead of ethanol. Rats of the two groups were sacrificed at 4 wk and 8 wk. Levels of endotoxin and alanine transaminase (ALT) in blood were measured, and liver pathology was observed under light and electronic microscopy. Expressions of LBP and CD14 mRNA in liver tissues were determined by RT-PCR analysis.

RESULTS: Plasma endotoxin levels were increased more significantly in group E (129 ± 21) ng·L¯¹ and (187 ± 35) ng·L¯¹ at 4 and 8 wk than in control rats (48 ± 9) ng·L¯¹ and (53 ± 11) ng·L¯¹, respectively (P < 0.05). Mean values of plasma ALT levels were (1867 ± 250) nkat·L¯¹ and (2450 ± 367) nkat·L¯¹ in Group E. The values were increased more dramatically in ethanol-fed rats than in Group C after 4 and 8 wk. In liver section from ethanol-fed rats, there were marked pathological changes (steatosis, cell infiltration and necrosis). In ethanol-fed rats, ethanol administration led to a significant increase in LBP and CD14 mRNA levels compared with the control group (P < 0.05).

CONCLUSION: Ethanol administration led to a significant increase in endotoxin levels in serum and LBP and CD14 mRNA expressions in liver tissues. The increase of LBP and CD14 mRNA expression might wake the liver more sensitive to endotoxin and liver injury.

Clinical application of serial operations with preserving spleen

AIM: To evaluate the clinical application of serial operations with preservation of spleen.

METHODS: Serial operations with preserving spleen were performed on 211 cases in our hospital from 1980 to 2000. The patient’s age ranged from 13 to 56 years, averaging 38 years. Diseases included splenic injury in 171 cases, portal hypertension in 9 cases, splenic cyst in 10 cases, and the lesion of pancreatic body and tail in 21 cases.

RESULTS: All the cases were cured, and 129 patients were followe dup from 3 mo to 3 years with the leukocyte phagocytosis test, detection of immunoglubin, CT, ^99mTc scanning and ultrasonography. The results were satisfactory.

CONCLUSION: The operations with preserving spleen were safe, feasible, and worth of clinical application.