Angiotensin-converting enzyme 2 alleviates liver fibrosis through the renin-angiotensin system

The present letter to the editor is related to the study titled‘Angiotensin-converting enzyme 2 improves liver fibrosis in mice by regulating autophagy of hepatic stellate cells’.Angiotensin-converting enzyme 2 can alleviate liver fibrosis by regulating autophagy of hepatic stellate cells and affecting the renin-angiotensin system.

Therapeutic Targeting of PKM2 Ameliorates NASH Fibrosis Progression in a Macrophage-Specific and Liver-Specific Manner

Nonalcoholic steatohepatitis(NASH)may soon become the leading cause of end-stage liver disease worldwide with limited treatment options.Liver fibrosis,which is driven by chronic inflammation and hepatic stellate cell(HSC)activation,critically determines morbidity and mortality in patients with NASH.Pyruvate kinase M2(PKM2)is involved in immune activation and inflammatory liver diseases;however,its role and therapeutic potential in NASH-related fibrosis remain largely unexplored.Bioinformatics screening and analysis of human and murine NASH livers indicated that PKM2 was upregulated in nonparenchymal cells(NPCs),especially macrophages,in the livers of patients with fibrotic NASH.Macrophage-specific PKM2 knockout(PKM2^(FL/FL)LysM-Cre)significantly ameliorated hepatic inflammation and fibrosis severity in three distinct NASH models induced by a methionine-and choline-deficient(MCD)diet,a high-fat high-cholesterol(HFHC)diet,and a western diet plus weekly carbon tetrachloride injection(WD/CCl_(4)).Single-cell transcriptomic analysis indicated that deletion of PKM2 in macrophages reduced profibrotic Ly6C^(high) macrophage infiltration.Mechanistically,PKM2-dependent glycolysis promoted NLR family pyrin domain containing 3(NLRP3)activation in proinflammatory macrophages,which induced HSC activation and fibrogenesis.A pharmacological PKM2 agonist efficiently attenuated the profibrotic crosstalk between macrophages and HSCs in vitro and in vivo.Translationally,ablation of PKM2 in NPCs by cholesterol-conjugated heteroduplex oligonucleotides,a novel oligonucleotide drug that preferentially accumulates in the liver,dose-dependently reversed NASH-related fibrosis without causing observable hepatotoxicity.The present study highlights the pivotal role of macrophage PKM2 in advancing NASH fibrogenesis.Thus,therapeutic modulation of PKM2 in a macrophage-specific or liver-specific manner may serve as a novel strategy to combat NASH-related fibrosis.

Metabolic dysfunction-associated steatotic liver disease-associated fibrosis and cardiac dysfunction in patients with type 2 diabetes

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),particularly in the presence of liver fibrosis,increases the risk of cardiovascular morbidity and mortality,but the nature of the cardio-hepatic interaction in the context type 2 diabetes mellitus(T2DM)is not fully understood.AIM To evaluate the changes in cardiac morphology and function in patients with T2DM and MASLD-associated liver fibrosis.METHODS T2DM patients with MASLD underwent a medical evaluation that included an assessment of lifestyle,anthropometric measurements,vital signs,an extensive laboratory panel,and a standard echocardiography.Liver fibrosis was evaluated using two scores[Fibrosis-4(FIB4)and Non-alcoholic fatty liver disease-Fibrosis Score(NFS)],and subjects were classified as having advanced fibrosis,no fibrosis,or an indeterminate risk.The correlations between structural and functional cardiac parameters and markers of liver fibrosis were evaluated through bivariate and multiple regression analyses.Statistical significance was set at P<0.05.RESULTS Data from 267 T2DM-MASLD subjects with complete assessment was analyzed.Patients with scores indicating advanced fibrosis exhibited higher interventricular septum and left ventricular(LV)posterior wall thickness,atrial diameters,LV end-systolic volume,LV mass index(LVMi),and epicardial adipose tissue thickness(EATT).Their mean ejection fraction(EF)was significantly lower(49.19%±5.62%vs 50.87%±5.14%vs 52.00%±3.25%;P=0.003),and a smaller proportion had an EF≥50%(49.40%vs 68.90%vs 84.21%;P=0.0017).Their total and mid LV wall motion score indexes were higher(P<0.05).Additionally,they had markers of diastolic dysfunction,with a higher E/e’ratio[9.64±4.10 vs 8.44(2.43-26.33)vs 7.35±2.62;P=0.026],and over 70%had lateral e’values<10 cm/second,though without significant differences between groups.In multiple regression analyses,FIB4 correlated with left atrium diameter(LAD;β=0.044;P<0.05),and NFS with both LAD(β=0.039;P<0.05)and right atrium diameter(β=0.041;P<0.01),Moreover,LVMi correlated positively with age and EATT(β=1.997;P=0.0008),and negatively with serum sex-hormone binding protein(SHBP)concentrations(β=-0.280;P=0.004).SHBP also correlated negatively with LAD(β=-0.036;P<0.05).CONCLUSION T2DM patients with markers of MASLD-related liver fibrosis exhibit lower EF and present indicators of diastolic dysfunction and cardiac hypertrophy.Additionally,LVMi and LAD correlated negatively with serum SHBP concentrations.

Antioxidant axis Nrf2-keap1-ARE in inhibition of alcoholic liver fibrosis by IL-22

AIM To explore the effect of interleukin(IL)-22 on in vitro model of alcoholic liver fibrosis hepatic stellate cells(HSCs), and whether this is related to regulation of Nrf2-keap1-ARE.METHODS HSC-T6 cells were incubated with 25, 50, 100, 200 and 400 μmol/L acetaldehyde. After 24 and 48 h, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay was used to detect proliferation of HSCs to choose the best concentration and action time. We used the optimal concentration of acetaldehyde(200 μmol/L) to stimulate HSCs for 24 h, and treated the cells with a final concentration of 10, 20 or 50 ng/m L IL-22. The cell proliferation rate was detected by MTT assay. The cell cycle was analyzed by flow cytometry. The expression of nuclear factor-related factor(Nrf)2 and α-smooth muscle antigen was detected by western blotting and immunocytochemistry. The levels of malondialdehyde(MDA) and glutathione(GSH) were measured by spectrophotometry. RESULTS In the MTT assay, when HSCs were incubated with acetaldehyde, activity and proliferation were higher than in the control group, and were most obvious after 48 h treatment with 200 μmol/L acetaldehyde. The number of cells in G0/G1 phases was decreased and the number in S phase was increased in comparison with the control group. When treated with different concentrations of IL-22, HSC-T6 cell activity and proliferation rate were markedly decreased in a dosedependent manner, and cell cycle progression was arrested from G1 to S phase. Western blotting and immunocytochemistry demonstrated that expression of Nrf2 total protein was not significantly affected. Expression of Nrf2 nuclear protein was low in thecontrol group, increased slightly in the model group(or acetaldehyde-stimulated group), and increased more obviously in the IL-22 intervention groups. The levels of MDA and GSH in the model group were significantly enhanced in comparison with those in the control group. In cells treated with IL-22, the MDA level was attenuated but the GSH level was further increased. These changes were dose-dependent. CONCLUSION IL-22 inhibits acetaldehyde-induced HSC activation and proliferation, which may be related to nuclear translocation of Nrf2 and increased activity of the antioxidant axis Nrf2-keap1-ARE.

Morin enhances hepatic Nrf2 expression in a liver fibrosis rat model

AIM To investigate whether morin can reduce hepatic fibrosis by activating the NF-E2-related factor 2(Nrf2) signaling pathway.METHODS Twenty male Sprague-Dawley rats were randomly divided into four groups: control group, morin group, carbon tetrachloride(CCl4) group, and morin + CCl4 group. Rats in both the CCl4 and morin + CCl4 groups were injected intraperitoneally with CCl4 at a dose of 2 mL/kg twice a week. Rats in both the morin and morin + CCl4 groups were treated orally with morin at a dose of 50 mg/kg twice a week. Control rats were treated with vehicle only twice a week. At the end-point of the 8 wk of the experimental period, serum AST, ALT, and ALP were measured, and the liver specimenswere obtained for pathological assessment. Real-time PCR and Western blot methods were used to analyze the expression of α-smooth muscle actin(α-SMA), collagen Ⅰ, collagen Ⅲ, Nrf2, heme oxygenase(HO-1), and quinone oxidoreductase 1(NQO1) using frozen liver specimens.RESULTS Morin-treated rats in the morin + CCl4 group had less hyperplasia of fiber tissue, minimal inflammatory cells, and less body weight loss with favorable liver enzyme measurements compared to rats treated with CCl4 only. Additionally, morin-treated rats had significantly lower m RNA and protein expression of α-SMA, collagen Ⅰ, and collagen Ⅲ, but significantly higher m RNA and protein expression of Nrf2, HO-1, and NQO1 compared to rats treated with CCl4 only(P < 0.05).CONCLUSION Morin could play a protective role by inducing the expression of Nrf2 and its downstream antioxidant factors(HO-1 and NQO1) and reducing the expression of α-SMA, collagen Ⅰ, and collagen Ⅲ in CCl4-induced liver fibrosis rats.

Impact of sodium glucose cotransporter-2 inhibitors on liver steatosis/fibrosis/inflammation and redox balance in non-alcoholic fatty liver disease

BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT2-I)are the most recently approved drugs for type 2 diabetes(T2D).Recent clinical trials of these compounds reported beneficial cardiovascular(CV)and renal outcomes.A major cause of vascular dysfunction and CV disease in diabetes is hyperglycemia associated with inflammation and oxidative stress.Pre-clinical studies demonstrated that SGLT2-I reduce glucotoxicity and promote anti-inflammatory effects by lowering oxidative stress.AIM To investigate the effects of SGLT2-I on markers of oxidative stress,inflammation,liver steatosis,and fibrosis in patients of T2D with non-alcoholic fatty liver disease(NAFLD).METHODS We referred fifty-two consecutive outpatients treated with metformin monotherapy and exhibiting poor glycemic control to our centre.We introduced the outpatients to an SGLT2-I(dapagliflozin,empagliflozin,or canagliflozin;n=26)or a different hypoglycemic drug[other glucose-lowering drugs(OTHER),n=26].We evaluated circulating interleukins and serum hydroxynonenal(HNE)-or malondialdehyde(MDA)-protein adducts,fatty liver index(FLI),NAFLD fibrosis score,aspartate aminotransferase(AST)/alanine aminotransferase(ALT)ratio,AST-to-platelet-ratio index(APRI),and fibrosis-4 on the day before(T0)and following treatment for six months(T1).We also performed transient elastography at T0 and T1.RESULTS Add-on therapy resulted in improved glycemic control and reduced fasting blood glucose in both groups.Of note,following treatment for six months,a reduction of FLI and APRI,as well as of the FibroScan result,was reported in patients treated with SGLT2-I,but not in the OTHER group;furthermore,in the SGLT2-I group,we reported lower circulating levels of interleukin(IL)-1β,IL-6,tumor necrosis factor,vascular endothelial growth factor,and monocyte chemoattractant protein-1,and higher levels of IL-4 and IL-10.We did not observe any modification in circulating interleukins in the OTHER group.Finally,serum HNE-and MDA-protein adducts decreased significantly in SGLT2-I rather than OTHER patients and correlated with liver steatosis and fibrosis scores.CONCLUSION The present data indicate that treatment with SGLT2-I in patients with T2D and NAFLD is associated with improvement of liver steatosis and fibrosis markers and circulating pro-inflammatory and redox status,more than optimizing glycemic control.

MicroRNA-194 inactivates hepatic stellate cells and alleviates liver fibrosis by inhibiting AKT2

BACKGROUND Activation of hepatic stellate cells(HSCs)is a pivotal event in the onset and progression of liver fibrosis.Loss of microRNA-194(miR-194)has been reported in activated HSCs,but the actual role of miR-194 in liver fibrosis remains uncertain.AIM To explore the role and potential mechanism of miR-194-mediated regulation of liver fibrosis in vitro and in vivo.METHODS The expression of miR-194 was examined in human fibrotic liver tissues,activated HSCs,and a carbon tetrachloride(CCl4)mouse model by qPCR.The effects of AKT2 regulation by miR-194 on the activation and proliferation of HSCs were assessed in vitro.For in vivo experiments,we reintroduced miR-194 in mice using a miR-194 agomir to investigate the functions of miR-194 in liver fibrosis.RESULTS MiR-194 expression was notably lacking in activated HSCs from both humans and mice.Overexpression of miR-194(OV-miR-194)inhibitedα-smooth muscle actin(α-SMA)and type I collagen(Col I)expression and suppressed cell proliferation in HSCs by causing cell cycle arrest in G0/G1 phase.AKT2 was predicted to be a target of miR-194.Notably,the effects of miR-194 knockdown in HSCs were almost blocked by AKT2 deletion,indicating that miR-194 plays a role in HSCs via regulation of AKT2.Finally,miR-194 agomir treatment dramatically ameliorated liver fibrosis in CCl4-treated mice.CONCLUSION We revealed that miR-194 plays a protective role by inhibiting the activation and proliferation of HSCs via AKT2 suppression.Our results further propose miR-194 as a potential therapeutic target for liver fibrosis.

M2BPGi for assessing liver fibrosis in patients with hepatitis C treated with direct-acting antivirals

BACKGROUND Assessing liver fibrosis is important for predicting the efficacy of direct-acting antivirals(DAAs)and patient prognosis.Non-invasive techniques to assess liver fibrosis are becoming important.Recently,serum Mac-2 binding protein glycosylation isomer(M2BPGi)was identified as a non-invasive marker of liver fibrosis.AIM To investigate the diagnostic accuracy of M2BPGi in assessing liver fibrosis in patients with chronic hepatitis C(CHC)treated with DAAs.METHODS From December 2017 to August 2018,80 treatment-naive adult patients with CHC who were eligible for DAAs therapy were consecutively enrolled in this observational cohort study.For 12 weeks,65 patients were treated with sofosbuvir/daclatasvir,and 15 patients were treated with sofosbuvir/daclatasvir and a weight-based dose of ribavirin at knowledge and technology association for hepatitis C management clinic,Cairo,Egypt.We measured serum M2BPGi levels,PAPAS index,fibrosis-4(FIB-4)score and liver stiffness measurements(LSM)at baseline and 12 weeks after the end of treatment.Serum M2BPGi levels were measured using enzyme-linked immunosorbent assay.RESULTS All patients achieved sustained virologic response(SVR12)(100%).Serum M2BPGi levels,LSM,FIB-4 score and PAPAS index decreased significantly at SVR12(P<0.05).Serum M2BPGi levels correlated positively with LSM at baseline and SVR12(P<0.001).At baseline,compared with the FIB-4 score and PAPAS index,M2BPGi was the best marker to distinguish patients with grade F4 fibrosis(AUC=0.801,P<0.001),patients with grade F2 from grade F0-1 fibrosis(AUC=0.713,P=0.012),patients with grade F3-4 from grade F0-2 fibrosis(AUC=0.730,P<0.001),and patients with grade F2-4 from grade F0-1 fibrosis(AUC=0.763,P<0.001).At SVR12,M2BPGi had the greatest AUCs for differentiating patients with grade F4 fibrosis(AUC=0.844,P<0.001),patients with grade F3 from grade F0-2 fibrosis(AUC=0.893,P=0.002),patients with grade F3-4 from grade F0-2 fibrosis(AUC=0.891,P<0.001),and patients with grade F2-4 from grade F0-1 fibrosis(AUC=0.750,P<0.001).CONCLUSION M2BPGi is a reliable marker for the non-invasive assessment and prediction of liver fibrosis regression in patients with CHC who achieved an SVR with DAAs therapy.

Angiotensin-converting enzyme 2 improves liver fibrosis in mice by regulating autophagy of hepatic stellate cells

BACKGROUND Liver fibrosis is the common pathological process associated with the occurrence and development of various chronic liver diseases.At present,there is still a lack of effective prevention and treatment methods in clinical practice.Hepatic stellate cell(HSC)plays a key role in liver fibrogenesis.In recent years,the study of liver fibrosis targeting HSC autophagy has become a hot spot in this research field.Angiotensin-converting enzyme 2(ACE2)is a key negative regulator of reninangiotensin system,and its specific molecular mechanism on autophagy and liver fibrosis needs to be further explored.AIM To investigate the effect of ACE2 on hepatic fibrosis in mice by regulating HSC autophagy through the Adenosine monophosphate activates protein kinases(AMPK)/mammalian target of rapamycin(mTOR)pathway.METHODS Overexpression of ACE2 in a mouse liver fibrosis model was induced by injection of liver-specific recombinant adeno-associated virus ACE2 vector(rAAV2/8-ACE2).The degree of liver fibrosis was assessed by histopathological staining and the biomarkers in mouse serum were measured by Luminex multifactor analysis.The number of apoptotic HSCs was assessed by terminal deoxynucleoitidyl transferase-mediated dUTP nick-end labeling(TUNEL)and immunofluorescence staining.Transmission electron microscopy was used to identify the changes in the number of HSC autophagosomes.The effect of ACE2 overexpression on Wu Y et al.ACE2 improves liver fibrosis through autophagy WJG https://www.wjgnet.com 4976 September 7,2023 Volume 29 Issue 33 autophagy-related proteins was evaluated by multicolor immunofluorescence staining.The expression of autophagy-related indicators and AMPK pathway-related proteins was measured by western blotting.RESULTS A mouse model of liver fibrosis was successfully established after 8 wk of intraperitoneal injection of carbon tetrachloride(CCl4).rAAV2/8-ACE2 administration reduced collagen deposition and alleviated the degree of liver fibrosis in mice.The serum levels of platelet-derived growth factor,angiopoietin-2,vascular endothelial growth factor and angiotensin II were decreased,while the levels of interleukin(IL)-10 and angiotensin-(1-7)were increased in the rAAV2/8-ACE2 group.In addition,the expression of alpha-smooth muscle actin,fibronectin,and CD31 was down-regulated in the rAAV2/8-ACE2 group.TUNEL and immunofluorescence staining showed that rAAV2/8-ACE2 injection increased HSC apoptosis.Moreover,rAAV2/8-ACE2 injection notably decreased the number of autophagosomes and the expression of autophagy-related proteins(LC3I,LC3II,Beclin-1),and affected the expression of AMPK pathway-related proteins(AMPK,p-AMPK,p-mTOR).CONCLUSION ACE2 overexpression can inhibit HSC activation and promote cell apoptosis by regulating HSC autophagy through the AMPK/mTOR pathway,thereby alleviating liver fibrosis and hepatic sinusoidal remodeling.

Xiaochaihutang attenuates liver fibrosis in rats through activation of Nrf2 pathway

OBJECTIVE Oxidative sress is one of the key factor responsible for occurrence and development of hepatic fibrosis,a common consequence of chronic liver injury of multiple etiology.Nuclear factor erythroid 2-related factor 2(Nrf2)serves as a major regulator of a celular defense system against oxidative stress.Xiaochaihutang(XCHT),a compound of seven botanical extracts used for liver diseases traditionally in East Asia.However,few studies have investigated its anti-hepatic fibrosis effects and pathophysiological mechanism of action.The present study was designed to confirm the anti-hepatic fibrosis effects and explore its potential mechanism of action by investigating the intervention of Nrf2 pathway.METHODS Liver fibrosis was induced by repeated injection of Carbon tetrachloride(CCl4) over a period of 9 weeks.Starting from the 6 th week,the animals in treatment groups were given the appropriate dose of XCHT granules and silybin.Biochemical parameters,histological changes of the liver and alpha-smooth muscle actin(α-SMA) were determined.The expressions of Nrf2,Keap1,Nqo1,HO-1,Gclc and Gclm were assessed by RT-PCR and Western blot.RESULTS CCl4 caused a significant fibrosis damage in the rat liver and the liver functions and fibrosis degree were significantly improved by XCHT(5 g·kg^(-1) and 10 g·kg^(-1)).XCHT(5 g·kg^(-1) and 10 g·kg^(-1)) treatment significantly decreased the number of cells labeled with α-SMA antibodies.Moreover,XCHT(5 g·kg^(-1) and 10 g·kg^(-1))significantly increase Nqo1,HO-1,Gclc and Gclm expressions in the liver.CONCLUSION T hese studies establish XCHT is a potentially useful therapeutic agent for treatment of hepatic fibrosis and it might be via regulation of Nrf2 pathway in rats against oxidative stress,making further efforts to inhibiting the activated HSCs.Activation or up-regulation of Nrf2 pathway may be an alternative treatment strategy for liver fibrosis.

Effect of Artemisia decoction on liver function and pERK/eIF2a signaling pathway in rats with alcoholic liver fibrosis

Objective: To investigate the effects of Artemisia decoction on liver function and phosphorylation of extracellular regulated protein kinase/eukaryotic translation initiation factor 2α (pERK/eIF2a) signaling pathway in rats with alcoholic liver fibrosis. Methods: A total of 40 healthy Sprague-Dole (SD) rats were randomly divided into 4 groups: the normal group, the sham operation group, the model group and the Artemisia decoction group, with 10 rats in each group. Alcoholic liver fibrosis model was established by "alcohol-corn oil-pyrazole" combined with a 12-week high-fat diet. After successful modeling, the normal group was not treated, and the sham operation group was given saline. The model group and the Artemisia decoction group were given the same amount of wormwood soup at the same time. The serum hydroxyproline (HYP), hyaluronidase (HA), laminin (LN), type IV collagen (CIV), type III procollagen (PIIINP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltranspeptidase (γ-TG), total bile acid (TBA), total bilirubin (TB), albumin (ALB), total cholesterol (CHOL), triglyceride (TG), glutathione (GSH), superoxide dismutase (SOD) and malondialdehyde (MDA) levels were measured after 12 weeks of continuous treatment. The degree of liver fibrosis was observed by hematoxylin-eosin staining (HE). The expression of pERK/eIF2a signaling pathway in liver tissue was detected by enzyme-linked immunosorbent assay (ELISA). Results: Compared with the normal group, the levels of serum HYP, HA, LN, CIV, PIIINP, AST, ALT, γ-GT, ALP, TBL and TB in the sham operation group were not significantly changed (P>0.05), while these indexes in the model group were significantly elevated (P<0.01). After treatment with Artemisia decoction, the levels of serum HYP, HA, LN, CIV, PIIINP, AST, ALT, γ-GT, ALP, TBL and TB were significantly lower than those in the model group (P<0.01). The serum albumin, lipid metabolism and oxidative damage indicators showed that there was no significant change in serum ALB, CHOL, TG, GSH, SOD and MDA levels in the sham operation group compared with the normal group (P>0.01). The levels of GSH and SOD in the model group were significantly decreased (P<0.01), and the levels of CHOL, TG and MDA in the model group were significantly increased (P<0.01). Compared with the model group, the serum ALB, GSH and SOD levels were significantly increased (P<0.01), and CHOL, TG and MDA levels were significantly decreased after giving intervention with Artemisia decoction (P<0.01). The results of HE staining showed that compared with the control group, the morphology of the liver sections of the sham operation group was normal, while the liver sections of the model group showed obvious vacuolization changes. The liver sections of the rats treated with Artemisia decoction were significantly improved. The results of ELISA showed that there was no significant change in the levels of pERK and eIF2a in the liver tissue of the sham operation group compared with the normal group (P>0.05). The levels of pERK and eIF2a in the liver tissue of the model group were significantly increased (P<0.01). After treatment with Artemisia decoction, the levels of pERK and eIF2a in rat liver tissues were significantly lower than those in the model group (P<0.01). Conclusion: Artemisia decoction can effectively block the degree of liver fibrosis in rats with alcoholic liver fibrosis, reduce liver fibrosis index and improve hepatobiliary function. This effect may be related to inhibition of the pERK/eIF2a signaling pathway.

Correlation of serum TGF-β1 content with liver fibrosis and Th1/Th2 immune levels in patients with chronic hepatitis b

Objective:To investigate the correlation of serum TGF-β1 content with liver fibrosis and Th1/Th2 immune levels in patients with chronic hepatitis b.Methods: A total of 178 patients who were diagnosed with chronic hepatitis b in our hospital between February 2015 and August 2017 were selected as chronic hepatitis b group, and 100 healthy volunteers who received physical examination in our hospital during the same period were selected as normal control group. The differences in serum levels of TGF-β1, liver fibrosis indexes and Th1/Th2 cytokines were compared between the two groups, and the Pearson test was adopted to evaluate the correlation between serum TGF-β1 content and disease severity in patients with chronic hepatitis b.Results: Serum TGF-β1 level of chronic hepatitis b group was higher than that of normal control group;serum liver fibrosis indexes CⅣ, PC-Ⅲ, HA and LN levels were higher than those of normal control group;serum Th1 cytokines IFN-γ and IL-12 levels were lower than those of normal control group whereas Th2 cytokines IL-4 and IL-13 levels were higher than those of normal control group. Pearson test showed that the serum TGF-β1 level in patients with chronic hepatitis b was positively correlated with the degree of liver fibrosis and Th1/Th2 immune imbalance.Conclusions: Serum TGF-β1 expression is abnormally high in patients with chronic hepatitis b and directly correlated with the degree of liver fibrosis and immune imbalance.

Yinhuang granule alleviates carbon tetrachloride-induced liver fibrosis in mice and its mechanism

BACKGROUND Liver fibrosis is a formidable global medical challenge,with no effective clinical treatment currently available.Yinhuang granule(YHG)is a proprietary Chinese medicine comprising Scutellariae Radix and Lonicerae Japonicae Flos.It is frequently used for upper respiratory tract infections,pharyngitis,as well as acute and chronic tonsillitis.AIM To investigate the potential of YHG in alleviating carbon tetrachloride(CCl4)-induced liver fibrosis in mice.METHODS To induce a hepatic fibrosis model in mice,this study involved intraperitoneal injections of 2 mL/kg of CCl4 twice a week for 4 wk.Meanwhile,liver fibrosis mice in the low dose of YHG(0.4 g/kg)and high dose of YHG(0.8 g/kg)groups were orally administered YHG once a day for 4 wk.Serum alanine/aspartate aminotransferase(ALT/AST)activity and liver hydroxyproline content were detected.Sirius red and Masson's trichrome staining assay were conducted.Realtime polymerase chain reaction,western-blot and enzyme-linked immunosorbent assay were conducted.Liver glutathione content,superoxide dismutase activity level,reactive oxygen species and protein carbonylation amount were detected.RESULTS The administration of YHG ameliorated hepatocellular injury in CCl4-treated mice,as reflected by decreased serum ALT/AST activity and improved liver histological evaluation.YHG also attenuated liver fibrosis,evident through reduced liver hydroxyproline content,improvements in Sirius red and Masson's trichrome staining,and lowered serum hyaluronic acid levels.Furthermore,YHG hindered the activation of hepatic stellate cells(HSCs)and ameliorated oxidative stress injury and inflammation in liver from CCl4-treated mice.YHG prompted the nuclear accumulation of nuclear factor erythroid 2-related factor 2(Nrf2)and upregulated the expression of Nrf2-dependent downstream antioxidant genes.In addition,YHG promoted mitochondrial biogenesis in liver from CCl4-treated mice,as demonstrated by increased liver adenosine triphosphate content,mitochondrial DNA levels,and the expression of peroxisome proliferator-activated receptor gamma coactivator 1 alpha and nuclear respiratory factor 1.CONCLUSION YHG effectively attenuates CCl4-induced liver fibrosis in mice by inhibiting the activation of HSCs,reducing inflammation,alleviating liver oxidative stress damage through Nrf2 activation,and promoting liver mitochondrial biogenesis.

Quantitative Assessment of Liver Fibrosis by Elastography in Patients with Chronic Liver Disease: A Cross-Sectional Study in Lomé (Togo)

Aim: To describe the two-dimensional elastographic profile according to the Shearwave (2D-SWE) technique in patients with chronic liver disease in Lom. Materials and method: Cross-sectional, descriptive study conducted over seven month at the Autel dElie Clinic in Lom, from January to August 2022, on adult patients with chronic liver disease who underwent abdominal ultrasound coupled with two-dimensional elastography. Results: The sample size was 54 patients. The mean age of the patients was 33 12 years, with extremes of 18 and 66 years. Patients aged 30 years or less accounted for 48.1% (n = 26). All patients (n = 54) had at least one transaminase assay with a mean of 69.3 78.3 IU/l (AST) and 59.3 82.8 IU/l (ALT). There was no statistically significant association between the biological parameters and the presence of fibrosis. Viral liver disease was the main cause, accounting for 81.5% (n = 44) of cases, with no significant association with the degree of fibrosis. Ultrasound revealed a dysmorphic liver (57.4%;n = 31) and portal hypertension (18.5%, n = 10). Fibrosis stages F1, F2 and F4 accounted for (48.1%, n = 26), (24.1%, n = 13) and (13%, n = 7) of cases respectively. Liver dysmorphia was significantly associated with the presence of fibrosis (p = 0.012) and portal hypertension was significantly associated with the degree of fibrosis (p = 0.0063). Conclusion: Assessment of liver fibrosis in patients with chronic liver disease using 2D-SWE elastography is essential for patient follow-up.

入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平与CHB肝纤维化严重程度的相关性及对疾病预后的预测价值

目的探讨入院时血清转化生长因子-β1(TGF-β1)、Smad同源蛋白2(Smad2)、Smad同源蛋白3(Smad3)及透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)、Ⅳ型胶原(CⅣ)水平与慢性乙型肝炎(CHB)肝纤维化严重程度的相关性及联合检测对疾病预后的预测价值。方法选取河南省中医院2021年3月至2022年3月收治的78例CHB肝纤维化患者作为研究组,选择同期78名健康体检者作为对照组。比较研究组和对照组及不同肝纤维化分期、不同炎症活动分级CHB肝纤维化患者入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平;分析入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平与肝纤维化分期、炎症活动分级的相关性。CHB肝纤维化患者治疗3个月后,根据患者预后分为预后良好和预后不良亚组,比较预后良好和预后不良患者入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平;分析入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平联合检测对CHB肝纤维化患者预后不良的预测价值。结果研究组入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ高于对照组(P<0.05);不同肝纤维化分期、炎症活动分级CHB肝纤维化患者入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ比较:S1<S2<S3<S4、G1<G2<G3<G4,差异有统计学意义(P<0.05);入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平与肝纤维化分期、炎症活动分级均呈正相关(P<0.05)。预后良好患者入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平均低于预后不良患者(P<0.05);入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平联合预测肝纤维化患者预后不良的曲线下面积(AUC)优于各指标单一检测(P<0.05)。结论CHB肝纤维化患者入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平均呈现高表达,且与肝纤维化分期、炎症活动分级密切相关,其联合检测对CHB肝纤维化患者预后有较高的预测价值,可用于评估CHB肝纤维化患者病情严重程度和预后,为制定针对性治疗措施提供参考。

非酒精性脂肪性肝炎患者血清Nrf2、AOPP水平与血脂、肝纤维化的关系

目的探讨非酒精性脂肪性肝炎(NASH)患者血清核因子E2相关因子2(Nrf2)、晚期氧化蛋白产物(AOPP)水平与血脂、肝纤维化的关系。方法选择重庆医科大学附属璧山医院收治的104例NASH患者作为研究组,另选90例体检健康者作为对照组。检测并比较各组血清Nrf2、AOPP水平,采用Pearson或Spearman相关分析NASH患者血清Nrf2、AOPP水平与血脂、肝纤维化的关系,采用受试者工作特征(ROC)曲线评估血清Nrf2、AOPP水平对NASH的诊断价值。结果研究组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、Nrf2、AOPP水平均高于对照组(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平明显低于对照组(P<0.05)。重度组血清Nrf2、AOPP水平高于中度组、轻度组(P<0.05),中度组血清Nrf2、AOPP水平高于轻度组(P<0.05)。相关分析结果显示,NASH患者血清Nrf2、AOPP水平与TG、TC、LDL-C、肝纤维化程度均呈正相关(P<0.05),与HDL-C呈负相关(P<0.05)。血清Nrf2诊断NASH的曲线下面积(AUC)为0.830(95%CI 0.780~0.880),血清AOPP诊断NASH的AUC为0.866(95%CI 0.816~0.916),二者联合诊断NASH的AUC为0.925(95%CI 0.875~0.975)。结论NASH患者血清Nrf2、AOPP水平均升高,且二者水平与血脂、肝纤维化程度均存在密切关系,有望作为诊断NASH发生的有效指标。

2型糖尿病合并代谢相关脂肪性肝病患者血清同型半胱氨酸与肝纤维化的相关性

目的探讨2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者血清同型半胱氨酸(HCY)水平与肝纤维化之间的关联。方法选取于吉林大学第二医院收治的T2DM同时伴有MAFLD患者214例,采用肝脏超声影像和瞬时弹性技术测定肝脏硬度(LSM)及受控脂肪衰减参数(CAP),再将入选患者分为非肝纤维化组及肝纤维化组,将肝脂肪变性和显著纤维化分别定义为CAP评分≥260 dB/m和LSM评分≥8 kPa。收集全部病人的基本信息,同时测定了空腹血糖、血脂、肝功、同型半胱氨酸等血液指标,组间比较使用两独立样本t检验、Mann-Whitney检验及χ2检验,用Spearman相关分析方法评价变量与肝纤维化之间的相关程度,将单因素线性回归分析中有统计学意义的变量纳入多因素线性回归中。结果相较于非肝纤维化组,肝纤维化组的体重指数、胰岛素抵抗指数、CAP、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、尿酸、HCY更高(P<0.05),多因素线性回归表明:体重指数、胰岛素抵抗指数、天门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、HCY与LSM独立相关(R2:0.312,调整后R2:0.285,均P<0.05)。结论T2DM合并MAFLD的肝纤维化患者血清中HCY水平较高,HCY是发生肝纤维化的独立危险因素。

长链非编码RNA NEAT1、miRNA-182-5p与2型糖尿病合并代谢性脂肪性肝病患者肝纤维化风险的相关性研究

背景随着慢性代谢性疾病的发病率逐年增加,已威胁全民健康,目前非编码RNA与内分泌代谢相关疾病的研究已成为国内外研究热点,其中长链非编码RNA核富集转录体(lncRNA NEAT1)及微小RNA(miRNA)-182-5p在2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)中的研究鲜有报道。目的探讨T2DM合并MAFLD患者lncRNA NEAT1、miRNA-182-5p在肝纤维化发生、发展中的机制及临床意义。方法纳入2021年10月—2022年6月在内蒙古科技大学包头医学院第一附属医院内分泌科就诊的T2DM患者236例为研究对象,同时纳入49名健康志愿者为健康对照组。收集研究对象一般资料与实验室检测结果。测定内脏脂肪面积(VFA)、皮下脂肪面积(SFA)。采集外周血,测定lncRNA NEAT1、miRNA-182-5p。将T2DM患者其分为T2DM合并非MAFLD组(n=82)与T2DM合并MAFLD组(n=154)。进一步根据肝纤维化指数(FIB-4)将T2DM合并MAFLD组分为肝纤维化低危亚组(n=55)、肝纤维化中危亚组(n=69)、肝纤维化高危亚组(n=30)。采用Spearman秩相关分析探究肝纤维化高危亚组lncRNA NEAT1、miRNA-182-5p表达水平的相关性,采用多因素有序Logistic回归分析探究T2DM合并MAFLD患者肝纤维化风险的影响因素。结果健康对照组年龄、颈围(NC)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)低于T2DM合并MAFLD组、T2DM合并非MAFLD组,白蛋白(Alb)高于T2DM合并MAFLD组、T2DM合并非MAFLD组(P<0.05);T2DM合并MAFLD组BMI、腰围(WC)、VFA、SFA、稳态模型评估胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、血尿酸(SUA)、lncRNA NEAT1高于健康对照组、T2DM合并非MAFLD组,血小板计数(PLT)低于健康对照组、T2DM合并非MAFLD组,总胆固醇(TC)低于健康对照组(P<0.05);T2DM合并非MAFLD组HOMA-IR、lncRNA NEAT1高于健康对照组,miRNA-182-5p高于健康对照组、T2DM合并MAFLD组,丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)低于健康对照组、T2DM合并MAFLD组(P<0.05)。肝纤维化低危亚组VFA、SFA、AST、lncRNA NEAT1低于肝纤维化中危亚组、肝纤维化高危亚组,PLT、miRNA-182-5p高于肝纤维化中危亚组、肝纤维化高危亚组,BMI、WC、NC低于肝纤维化高危亚组,TC高于肝纤维化高危亚组(P<0.05);肝纤维化中危亚组PLT、miRNA-182-5p高于肝纤维化高危亚组,AST、lncRNA NEAT1低于肝纤维化高危亚组(P<0.05)。Spearman秩相关分析结果显示,肝纤维化高危亚组患者lncRNA NEAT1与miRNA-182-5p呈负相关(r_(s)=-0.438,P<0.05)。多因素有序Logistic回归分析结果显示,lncRNA NEAT1(OR=1.326,95%CI=1.087~1.616)、VFA(OR=1.019,95%CI=1.006~1.033)、miRNA-182-5p(OR=0.083,95%CI=0.027~0.257)、PLT(OR=0.956,95%CI=0.942~0.970)、AST(OR=1.048,95%CI=1.022~1.075)是T2DM合并MAFLD患者肝纤维化风险的影响因素。结论外周血lncRNA NEAT1、miRNA-182-5p与T2DM合并MAFLD患者并发肝纤维化密切相关,为该病的早期预测及诊治提供依据。

灵芝提取物通过Nrf2/ARE通路对肝硬化小鼠肝功能的保护作用研究

[目的]探讨灵芝提取物(ganoderma lucidum extract,GLE)对肝硬化小鼠的肝保护作用及机制。[方法]将10只雄性C57BL/6小鼠作为对照组,剩余40只小鼠采用四氯化碳橄榄油混悬液诱导肝硬化模型,并随机分为模型组和GLE低(50 mg/kg·d)、中(100 mg/kg·d)、高(200 mg/kg·d)剂量组,对照组及模型组均灌胃等量0.9%氯化钠溶液。计算肝脏指数;以全自动生化分析仪检测小鼠血清中谷氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)活性和总胆固醇(total cholesterol,TC)、总胆红素(total bilirubin,TB)和肌酐(creatinine,Cr)水平;以苏木精-伊红(hematoxylin eosin,HE)染色观察肝组织病理学变化,Masson染色观察肝组织纤维化程度;以脱氧核苷酸末端转移酶介导的dUTP缺口末端标记(terminal-deoxynucleotidyl transferase mediated dUTP nick end labeling,TUNEL)染色观察肝细胞凋亡情况;酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、IL-6、丙二醛(malondialdehyde,MDA)水平和超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)活性;免疫印迹法检测肝组织中总核因子E2相关因子2(nuclear factor E2 related factor 2,Nrf2)和核Nrf2、血红素加氧酶-1(heme oxygenase-1,HO-1)及醌氧化还原酶1[NAD(P)H:quinone oxidoreductase 1,NQO1]、α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、Ⅰ型胶原蛋白(CollagenⅠ)及E-钙黏蛋白(E-cadherin)的表达情况。[结果]与对照组比较,模型组小鼠肝损伤明显,肝脏指数,血清ALT、AST活性,TC、TB及Cr水平,肝纤维化程度,肝细胞凋亡指数,血清TNF-α、IL-1β、IL-6及MDA水平,α-SMA及CollagenⅠ蛋白相对表达量升高(P<0.05),血清SOD和GSH-Px活性、肝组织总Nrf2和核Nrf2、HO-1、NQO1及E-cadherin蛋白表达降低(P<0.05)。与模型组比较,GLE低、中、高剂量组小鼠肝损伤逐步减轻,肝脏指数,血清ALT、AST活性,TC、TB及Cr水平,肝纤维化程度,肝细胞凋亡指数,血清TNF-α、IL-1β、IL-6及MDA水平,α-SMA及CollagenⅠ蛋白表达降低(P<0.05),血清SOD和GSH-Px活性、肝组织总Nrf2和核Nrf2、HO-1、NQO1及E-cadherin蛋白表达升高(P<0.05)。[结论]GLE可减轻肝硬化小鼠组织病理损伤,改善肝功能,这可能与激活Nrf2/ARE通路,抑制氧化应激和炎症反应,进而干预肝纤维化有关。

2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化检出率及预测因素分析

目的探讨2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)及其肝纤维化发生率和影响因素。方法2020年4月~2022年4月我院收治的482例T2DM患者,使用超声检查诊断NAFLD,检测杨氏模量值诊断肝纤维化。应用Lasso回归模型和有序多分类Logistic回归分析法筛查和分析T2DM患者罹患NAFLD严重程度的风险因素,绘制受试者工作特征(ROC)曲线评估风险因素预测NAFLD患者发生肝纤维化的效能。结果在482例T2DM患者中,诊断NAFLD者276例(57.3%),后者包括肝纤维化者58例(12.0%);T2DM/NAFLD/肝纤维化组年龄、周围神经病发生率、体质指数和杨氏模量值分别为(46.0±4.2)岁、82.8%、(28.3±3.2)kg/m^(2)和(10.8±2.2)kPa,均显著大于T2DM/NAFLD组【分别为(45.6±4.9)岁、45.4%、(27.9±3.1)kg/m^(2)和(5.3±1.0)kPa,P<0.05】或T2DM组【分别为(42.5±5.8)岁、44.2%、(25.0±2.7)kg/m^(2)和(4.8±0.6)kPa,P<0.05】;T2DM/NAFLD/肝纤维化组血清甘油三酯、尿酸、HOMA-IR、甘油三酯/血糖/体质指数、血清TNF-α和IL-6水平分别为(2.6±0.8)mmol/L、(355.2±24.6)μmol/L、(2.6±0.4)、(270.8±18.5)、(8.2±2.3)pg/ml和(13.6±2.4)pg/ml,显著大于T2DM/NAFLD组【分别为(2.2±0.4)mmol/L、(334.6±31.0)μmol/L、(2.6±0.4)、(219.1±40.4((1)))、(5.5±1.4)pg/ml和(9.7±2.1)pg/ml,P<0.05】或T2DM【分别为(2.1±0.5)mmol/L、(328.7±36.8)μmol/L、(2.3±0.7)、(207.9±39.1)、(5.3±1.1)pg/ml和(6.7±1.1)pg/ml,P<0.05】;LASSO回归和多因素Logistic回归分析结果显示,TyG-BMI(OR=1.012,P=0.000)、IL-6(OR=2.782,P=0.000)、TNF-α(OR=1.008,P=0.026)、UA(OR=1.530,P=0.000)和糖尿病周围神经病(OR=1.855,P=0.010)为T2DM患者罹患NAFLD严重程度的独立危险因素;ROC曲线分析结果显示,TyG-BMI、IL-6、TNF-α和UA预测患者发生肝纤维化的曲线下面积(AUC)分别为0.897、0.928、0.840和0.762。结论T2DM合并NAFLD患者可能会进展至肝纤维化,了解一些预测因子并进行有效的干预可能能延缓病情发展。