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Trevisiol L, Bersani M, Lobbia G, Scirpo R, D’Agostino A. Sequencing in Orthognathic Bimaxillary Surgery: Which Jaw Should Be Operated First? A Scoping Review. J Clin Med 2023; 12:6826. [PMID: 37959291 PMCID: PMC10649175 DOI: 10.3390/jcm12216826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Bimaxillary orthognathic surgery is widely used for the correction of dentoskeletal deformities. Surgery sequencing (maxilla or mandible first) remains debated, and guidelines and consensus are lacking. This scoping review summarizes the state of the art and compares the advantages and disadvantages of both approaches. The review was conducted following PRISMA-ScR guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were searched using the PICO protocol and key words in orthognathic surgical sequencing. Four reviewers screened the records independently, and disagreement was resolved by consensus. A total of 23 records met the inclusion criteria. The advantages and disadvantages of the two approaches were compared and assessed for accuracy of reporting. Within the limitations of the present study, available evidence for the intrinsic advantages and the accuracy of the mandible-first sequence supports the choice of this approach in most cases. Nevertheless, each clinical case needs to be evaluated individually, as no dogmatic recommendations can be given for sequencing in bimaxillary orthognathic surgery.
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Affiliation(s)
- Lorenzo Trevisiol
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, 37134 Verona, Italy; (M.B.); (G.L.); (R.S.); (A.D.)
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Toia F, Zabbia G, Scirpo R, Pirrello R, Nalbone L, Cordova A. Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries. HANDCHIR MIKROCHIR P 2019; 51:484-491. [PMID: 31698490 DOI: 10.1055/a-1017-3013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND "Orthoplastics" is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. MATERIAL AND METHODS Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. RESULTS In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. CONCLUSION The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction.
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Affiliation(s)
- Francesca Toia
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo
| | - Giovanni Zabbia
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo
| | - Roberto Scirpo
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo
| | - Roberto Pirrello
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo
| | - Lorenzo Nalbone
- Section of Orthopaedic Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo
| | - Adriana Cordova
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo
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Strazzabosco M, Fiorotto R, Cadamuro M, Spirli C, Mariotti V, Kaffe E, Scirpo R, Fabris L. Pathophysiologic implications of innate immunity and autoinflammation in the biliary epithelium. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1374-1379. [PMID: 28754453 DOI: 10.1016/j.bbadis.2017.07.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/12/2022]
Abstract
The most studied physiological function of biliary epithelial cells (cholangiocytes) is to regulate bile flow and composition, in particular the hydration and alkalinity of the primary bile secreted by hepatocytes. After almost three decades of studies it is now become clear that cholangiocytes are also involved in epithelial innate immunity, in inflammation, and in the reparative processes in response to liver damage. An increasing number of evidence highlights the ability of cholangiocyte to undergo changes in phenotype and function in response to liver damage. By participating actively to the immune and inflammatory responses, cholangiocytes represent a first defense line against liver injury from different causes. Indeed, cholangiocytes express a number of receptors able to recognize pathogen- or damage-associated molecular patterns (PAMPs/DAMPs), such as Toll-like receptors (TLR), which modulate their pro-inflammatory behavior. Cholangiocytes can be both the targets and the initiators of the inflammatory process. Derangements of the signals controlling these mechanisms are at the basis of the pathogenesis of different cholangiopathies, both hereditary and acquired, such as cystic fibrosis-related liver disease and sclerosing cholangitis. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
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Affiliation(s)
- Mario Strazzabosco
- Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA; International Center for Digestive Health, Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan, Italy.
| | - Romina Fiorotto
- Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA; International Center for Digestive Health, Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan, Italy
| | - Massimiliano Cadamuro
- International Center for Digestive Health, Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan, Italy
| | - Carlo Spirli
- Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA; International Center for Digestive Health, Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan, Italy
| | - Valeria Mariotti
- Department of Molecular Medicine, University of Padova School of Medicine, Padova, Italy
| | - Eleanna Kaffe
- Department of Molecular Medicine, University of Padova School of Medicine, Padova, Italy
| | - Roberto Scirpo
- Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA
| | - Luca Fabris
- Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA; International Center for Digestive Health, Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan, Italy; Department of Molecular Medicine, University of Padova School of Medicine, Padova, Italy
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Fiorotto R, Villani A, Kourtidis A, Scirpo R, Amenduni M, Geibel PJ, Cadamuro M, Spirli C, Anastasiadis PZ, Strazzabosco M. The cystic fibrosis transmembrane conductance regulator controls biliary epithelial inflammation and permeability by regulating Src tyrosine kinase activity. Hepatology 2016; 64:2118-2134. [PMID: 27629435 PMCID: PMC5115965 DOI: 10.1002/hep.28817] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/22/2016] [Accepted: 08/06/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED In the liver, the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) regulates bile secretion and other functions at the apical membrane of biliary epithelial cells (i.e., cholangiocytes). CF-related liver disease is a major cause of death in patients with CF. CFTR dysfunction affects innate immune pathways, generating a para-inflammatory status in the liver and other epithelia. This study investigates the mechanisms linking CFTR to toll-like receptor 4 activity. We found that CFTR is associated with a multiprotein complex at the apical membrane of normal mouse cholangiocytes, with proteins that negatively control Rous sarcoma oncogene cellular homolog (Src) activity. In CFTR-defective cholangiocytes, Src tyrosine kinase self-activates and phosphorylates toll-like receptor 4, resulting in activation of nuclear factor kappa-light-chain-enhancer of activated B cells and increased proinflammatory cytokine production in response to endotoxins. This Src/nuclear factor kappa-light-chain-enhancer of activated B cells-dependent inflammatory process attracts inflammatory cells but also generates changes in the apical junctional complex and loss of epithelial barrier function. Inhibition of Src decreased the inflammatory response of CF cholangiocytes to lipopolysaccharide, rescued the junctional defect in vitro, and significantly attenuated endotoxin-induced biliary damage and inflammation in vivo (Cftr knockout mice). CONCLUSION These findings reveal a novel function of CFTR as a regulator of toll-like receptor 4 responses and cell polarity in biliary epithelial cells; this mechanism is pathogenetic, as shown by the protective effects of Src inhibition in vivo, and may be a novel therapeutic target in CF-related liver disease and other inflammatory cholangiopathies. (Hepatology 2016;64:2118-2134).
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Affiliation(s)
- Romina Fiorotto
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut, USA,International Center for Digestive Health, University of Milan-Bicocca, Milan Italy
| | - Ambra Villani
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut, USA
| | - Antonis Kourtidis
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, USA
| | - Roberto Scirpo
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut, USA
| | - Mariangela Amenduni
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut, USA
| | - Peter J. Geibel
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Massimilano Cadamuro
- International Center for Digestive Health, University of Milan-Bicocca, Milan Italy,Section of Digestive Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Carlo Spirli
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut, USA,International Center for Digestive Health, University of Milan-Bicocca, Milan Italy
| | - Panos Z. Anastasiadis
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, USA
| | - Mario Strazzabosco
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut, USA,International Center for Digestive Health, University of Milan-Bicocca, Milan Italy,Section of Digestive Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Locatelli L, Cadamuro M, Spirli C, Fiorotto R, Lecchi S, Morell CM, Popov Y, Scirpo R, De Matteis M, Amenduni M, Pietrobattista A, Torre G, Schuppan D, Fabris L, Strazzabosco M. Macrophage recruitment by fibrocystin-defective biliary epithelial cells promotes portal fibrosis in congenital hepatic fibrosis. Hepatology 2016; 63:965-82. [PMID: 26645994 PMCID: PMC4764460 DOI: 10.1002/hep.28382] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/02/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED Congenital hepatic fibrosis (CHF) is a disease of the biliary epithelium characterized by bile duct changes resembling ductal plate malformations and by progressive peribiliary fibrosis, in the absence of overt necroinflammation. Progressive liver fibrosis leads to portal hypertension and liver failure; however, the mechanisms leading to fibrosis in CHF remain elusive. CHF is caused by mutations in PKHD1, a gene encoding for fibrocystin, a ciliary protein expressed in cholangiocytes. Using a fibrocystin-defective (Pkhd1(del4/del4)) mouse, which is orthologous of CHF, we show that Pkhd1(del4/del4) cholangiocytes are characterized by a β-catenin-dependent secretion of a range of chemokines, including chemokine (C-X-C motif) ligands 1, 10, and 12, which stimulate bone marrow-derived macrophage recruitment. We also show that Pkhd1(del4/del4) cholangiocytes, in turn, respond to proinflammatory cytokines released by macrophages by up-regulating αvβ6 integrin, an activator of latent local transforming growth factor-β1. While the macrophage infiltrate is initially dominated by the M1 phenotype, the profibrogenic M2 phenotype increases with disease progression, along with the number of portal myofibroblasts. Consistent with these findings, clodronate-induced macrophage depletion results in a significant reduction of portal fibrosis and portal hypertension as well as of liver cysts. CONCLUSION Fibrosis can be initiated by an epithelial cell dysfunction, leading to low-grade inflammation, macrophage recruitment, and collagen deposition; these findings establish a new paradigm for biliary fibrosis and represent a model to understand the relationship between cell dysfunction, parainflammation, liver fibrosis, and macrophage polarization over time.
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Affiliation(s)
- Luigi Locatelli
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, 20126, Milan, Italy
| | - Massimiliano Cadamuro
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, 20126, Milan, Italy,Department of Molecular Medicine, University of Padua School of Medicine, 35121, Padua, Italy
| | - Carlo Spirli
- Section of Digestive Diseases, Yale University, New Haven, CT 06520, USA
| | - Romina Fiorotto
- Section of Digestive Diseases, Yale University, New Haven, CT 06520, USA
| | - Silvia Lecchi
- Center for Liver Research (CeLiveR), Papa Giovanni XXIII Hospital, 24121, Bergamo, Italy
| | - Carola Maria Morell
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, 20126, Milan, Italy
| | - Yury Popov
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Roberto Scirpo
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, 20126, Milan, Italy
| | - Maria De Matteis
- Department of Molecular Medicine, University of Padua School of Medicine, 35121, Padua, Italy
| | | | | | - Giuliano Torre
- Liver Unit, Bambino Gesu Pediatric Hospital, IRCSS, 00146, Rome, Italy
| | - Detlef Schuppan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA,Institute of Translational Immunology, Johannes Gutenberg University, 55122, Mainz, Germany
| | - Luca Fabris
- Department of Molecular Medicine, University of Padua School of Medicine, 35121, Padua, Italy,Section of Digestive Diseases, Yale University, New Haven, CT 06520, USA,Correspondence. Luca Fabris M.D., Ph.D., Department of Molecular Medicine, University of Padova School of Medicine, Viale G. Colombo, 3; 35131 Padova, Italy, Phone: +39 049 827 6127; Fax: +39 049 807 3310, ;
| | - Mario Strazzabosco
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, 20126, Milan, Italy,Section of Digestive Diseases, Yale University, New Haven, CT 06520, USA
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Scirpo R, Fiorotto R, Villani A, Amenduni M, Spirli C, Strazzabosco M. Stimulation of nuclear receptor peroxisome proliferator-activated receptor-γ limits NF-κB-dependent inflammation in mouse cystic fibrosis biliary epithelium. Hepatology 2015; 62. [PMID: 26199136 PMCID: PMC4618241 DOI: 10.1002/hep.28000] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Cystic fibrosis-associated liver disease is a chronic cholangiopathy that negatively affects the quality of life of cystic fibrosis patients. In addition to reducing biliary chloride and bicarbonate secretion, up-regulation of toll-like receptor 4/nuclear factor kappa light-chain-enhancer of activated B cells (NF-κB)-dependent immune mechanisms plays a major role in the pathogenesis of cystic fibrosis-associated liver disease and may represent a therapeutic target. Nuclear receptors are transcription factors that regulate several intracellular functions. Some nuclear receptors, including peroxisome proliferator-activated receptor-γ (PPAR-γ), may counterregulate inflammation in a tissue-specific manner. In this study, we explored the anti-inflammatory effect of PPAR-γ stimulation in vivo in cystic fibrosis transmembrane conductance regulator (Cftr) knockout mice exposed to dextran sodium sulfate and in vitro in primary cholangiocytes isolated from wild-type and from Cftr-knockout mice exposed to lipopolysaccharide. We found that in CFTR-defective biliary epithelium expression of PPAR-γ is increased but that this does not result in increased receptor activity because the availability of bioactive ligands is reduced. Exogenous administration of synthetic agonists of PPAR-γ (pioglitazone and rosiglitazone) up-regulates PPAR-γ-dependent genes, while inhibiting the activation of NF-κB and the secretion of proinflammatory cytokines (lipopolysaccharide-induced CXC chemokine, monocyte chemotactic protein-1, macrophage inflammatory protein-2, granulocyte colony-stimulating factor, keratinocyte chemoattractant) in response to lipopolysaccharide. PPAR-γ agonists modulate NF-κB-dependent inflammation by up-regulating nuclear factor of kappa light polypeptide gene enhancer in B cells inhibitor alpha, a negative regulator of NF-κB. Stimulation of PPAR-γ in vivo (rosiglitazone) significantly attenuates biliary damage and inflammation in Cftr-knockout mice exposed to a dextran sodium sulfate-induced portal endotoxemia. CONCLUSION These studies unravel a novel function of PPAR-γ in controlling biliary epithelium inflammation and suggest that impaired activation of PPAR-γ contributes to the chronic inflammatory state of CFTR-defective cholangiocytes.
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Affiliation(s)
- Roberto Scirpo
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut,Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
| | - Romina Fiorotto
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut
| | - Ambra Villani
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut
| | - Mariangela Amenduni
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut
| | - Carlo Spirli
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut
| | - Mario Strazzabosco
- Section of Digestive Diseases, Liver Center, Yale University, New Haven, Connecticut,Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
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Fiorotto R, Raizner A, Morell CM, Torsello B, Scirpo R, Fabris L, Spirli C, Strazzabosco M. Notch signaling regulates tubular morphogenesis during repair from biliary damage in mice. J Hepatol 2013; 59:124-30. [PMID: 23500150 PMCID: PMC3777645 DOI: 10.1016/j.jhep.2013.02.025] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 02/24/2013] [Accepted: 02/28/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Repair from biliary damages requires the biliary specification of hepatic progenitor cells and the remodeling of ductular reactive structures into branching biliary tubules. We hypothesized that the morphogenetic role of Notch signaling is maintained during the repair process and have addressed this hypothesis using pharmacologic and genetic models of defective Notch signaling. METHODS Treatment with DDC (3,5-diethoxycarbonyl-1,4-dihydrocollidine) or ANIT (alpha-naphthyl-isothiocyanate) was used to induce biliary damage in wild type mice and in mice with a liver specific defect in the Notch-2 receptor (Notch-2-cKO) or in RPB-Jk. Hepatic progenitor cells, ductular reaction, and mature ductules were quantified using K19 and SOX-9. RESULTS In DDC treated wild type mice, pharmacologic Notch inhibition with dibenzazepine decreased the number of both ductular reaction and hepatic progenitor cells. Notch-2-cKO mice treated with DDC or ANIT accumulated hepatic progenitor cells that failed to progress into mature ducts. In RBP-Jk-cKO mice, mature ducts and hepatic progenitor cells were both significantly reduced with respect to similarly treated wild type mice. The mouse progenitor cell line BMOL cultured on matrigel, formed a tubular network allowing the study of tubule formation in vitro; γ-secretase inhibitor treatment and siRNAs silencing of Notch-1, Notch-2 or Jagged-1 significantly reduced both the length and number of tubular branches. CONCLUSIONS These data demonstrate that Notch signaling plays an essential role in biliary repair. Lack of Notch-2 prevents biliary tubule formation, both in vivo and in vitro. Lack of RBP-Jk inhibits the generation of biliary-committed precursors and tubule formation.
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Affiliation(s)
- Romina Fiorotto
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Aileen Raizner
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Carola M. Morell
- Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy
| | - Barbara Torsello
- Department of Health Sciences, University of Milano-Bicocca, Milan, Italy
| | - Roberto Scirpo
- Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy
| | - Luca Fabris
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Carlo Spirli
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mario Strazzabosco
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA,Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy,Corresponding author. Address: Dept. of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street LMP1080, New Haven, CT 06520, USA. Tel.: +1 203 785 7281; fax: +1 203 785 7273. (M. Strazzabosco)
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Fiorotto R, Scirpo R, Trauner M, Fabris L, Hoque R, Spirli C, Strazzabosco M. Loss of CFTR affects biliary epithelium innate immunity and causes TLR4-NF-κB-mediated inflammatory response in mice. Gastroenterology 2011; 141:1498-508, 1508.e1-5. [PMID: 21712022 PMCID: PMC3186841 DOI: 10.1053/j.gastro.2011.06.052] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/18/2011] [Accepted: 06/10/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Loss of function of the cystic fibrosis transmembrane conductance regulator (CFTR) in the biliary epithelium reduces bile flow and alkalinization in patients with cystic fibrosis (CF). Liver damage is believed to result from ductal cholestasis, but only 30% of patients with CF develop liver defects, indicating that another factor is involved. We studied the effects of CFTR deficiency on Toll-like receptor 4 (TLR4)-mediated responses of the biliary epithelium to endotoxins. METHODS Dextran sodium sulfate (DSS) was used to induce colitis in C57BL/6J-Cftrtm1Unc (Cftr-KO) mice and their wild-type littermates. Ductular reaction and portal inflammation were quantified by keratin-19 and CD45 immunolabeling. Cholangiocytes isolated from wild-type and Cftr-KO mice were challenged with lipopolysaccharide (LPS); cytokine secretion was quantified. Activation of nuclear factor κB (NF-κB), phosphorylation of TLR4, and activity of Src were determined. HEK-293 that expressed the secreted alkaline phosphatase reporter and human TLR4 were transfected with CFTR complementary DNAs. RESULTS DSS-induced colitis caused biliary damage and portal inflammation only in Cftr-KO mice. Biliary damage and inflammation were not attenuated by restoring biliary secretion with 24-nor-ursodeoxycholic acid but were significantly reduced by oral neomycin and polymyxin B, indicating a pathogenetic role of gut-derived bacterial products. Cftr-KO cholangiocytes incubated with LPS secreted significantly higher levels of cytokines regulated by TLR4 and NF-κB. LPS-mediated activation of NF-κB was blocked by the TLR4 inhibitor TAK-242. TLR4 phosphorylation by Src was significantly increased in Cftr-KO cholangiocytes. Expression of wild-type CFTR in the HEK293 cells stimulated with LPS reduced activation of NF-κB. CONCLUSIONS CFTR deficiency alters the innate immunity of the biliary epithelium and reduces its tolerance to endotoxin, resulting in an Src-dependent inflammatory response mediated by TLR4 and NF-κB. These findings might be used to develop therapies for CF-associated cholangiopathy.
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Affiliation(s)
- Romina Fiorotto
- Dept. of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven CT, USA, Center for liver Research (CeliveR), and Division of Gastroenterology, Ospedali Riuniti Bergamo, Italy
| | - Roberto Scirpo
- Dept. of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven CT, USA, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy
| | - Michael Trauner
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Luca Fabris
- Center for liver Research (CeliveR), and Division of Gastroenterology, Ospedali Riuniti Bergamo, Italy, Department of Medical and Surgical Sciences “P.G.Cevese,” Università di Padova, Padova, Italy
| | - Rafaz Hoque
- Dept. of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven CT, USA
| | - Carlo Spirli
- Dept. of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven CT, USA, Center for liver Research (CeliveR), and Division of Gastroenterology, Ospedali Riuniti Bergamo, Italy
| | - Mario Strazzabosco
- Dept. of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven CT, USA, Center for liver Research (CeliveR), and Division of Gastroenterology, Ospedali Riuniti Bergamo, Italy, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy
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