Effect of remifentanil on toll-like receptor 4, NF-κB and IL-6 in rabbit myocardial ischemia/reperfusion model

Objective： To investigate whether remifentanil induced cardioprotecting effect is associated with expression of toll-like receptor 4 （TLR4）, nuclear factor rB （NF-r.B） and serum interleukin -6 （IL-6）. Methods： Fifty rabbits were randomly divided into 5 groups （n=10） according to the treatment： sham operation group （group A）, ischemla-reperfusion group （group B）, low-dose remifentanil group （group C）, mediate-dose remifentanil group （group D）, and high-dose remlfentanil group （group E） Myocardial TLR4 mRNA levels, NF-r.B protein expression and serum levels of IL-6 were observed in 120 min after reperfusion. Results： The myocardial expressions of TLR4 mRNA, NF-rd3 protein and IL-6 level in sera of groups B, C, D and E were elevated compared with group A. However, remifentanil significantly reduced the levels of TLR4 mRNA, NF- r.B protein expression and serum IL-6 in groups C, D and E compared with group B. There were remarkable differences between the groups （P〈O.O1）. Conclusion： Intravenous remifentanil has protective effect against rabbit myocardial ischemia/reperfusion injury. This effect may be associated with TLR4, NF-r.B expressions on myocytes and serum level of IL-6 in a dose-dependent manner

Accurate preterm labor diagnosis using a CD55-TLR4 combination biomarker model

We previously demonstrated immune activation in the maternal peripheral circulation associated with preterm labor (PTL). There was an elevation in WBC mRNA of anti-inflammatory complement decay-accelerating factor (CD55) and the innate-immune response activating toll-like receptor 4 (TLR4). These findings suggested that collectively, these two molecules might serve as useful biomolecules to aid in the diagnosis of PTL. In this study, we used a combined marker approach to determine whether a dual marker model utilizing both CD55 and TLR4 mRNA levels to classify PTL would increase diagnostic accuracy compared to either molecule alone. Two methods were evaluated;a linear discriminant (LD) method and a distribution free (DF) method, in order to find the optimal linear combination of TLR4 and CD55 data to diagnose PTL accurately. Our results indicated that a combined CD55-TLR4 dual marker model could provide statistically significant improve- ments compared to CD55 or TLR4 single marker models for PTL classification performance.

Chaihu Longgu Muli Decoction relieving temporal lobe epilepsy in rats by inhibiting TLR4 signaling pathway through miR-146a-3p and miR-146a-5p

Objective To explore the effect and mechanism of Chaihu Longgu Muli Decoction(柴胡龙骨牡蛎汤,CHLGMLD)in rats with temporal lobe epilepsy(TLE).Methods A total of 80 Sprague-Dawley(SD)male rats were randomized into control(CON),model(MOD),carbamazepine(CBZ,0.1 g/kg),CHLGMLD low dose(CHLGMLD-L,12.5 g/kg),and high dose(CHLGMLD-H,25 g/kg)groups,with 16 rats in each group.TLE rat models were established in the four groups with the use of lithium-pilocarpine except for the CON group.After the successful establishment of TLE models,all drugs were administered through gavage,and distilled water was given to rats in the CON and MOD groups for four weeks.The frequency and duration of seizures before and after treatment were recorded for the evaluation of the alleviation degree.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to detect the expression levels of miR-146a-3p and miR-146a-5p.The expression levels of toll-like receptor 4(TLR4),interleukin-1 receptor-associated kinase 1(IRAK1),tumor necrosis factor(TNF)receptor-associated factor 6(TRAF6),TAK1-binding protein(TAB),nuclear factor-kappa B(NF-κB),and interleukin-1 beta(IL-1β)in hippocampus were tested by immunofluorescence assay.Correlation analysis between the above factors and expressions of miR-146a-3p and miR-146a-5p were performed separately.Results CHLGMLD decreased the frequency(P<0.05)and duration(P<0.01)of seizures in rats.CHLGMLD down-regulated the expression levels of miR-146a-5p and miR-146a-3p(P<0.05),and inhibited the expression levels of TLR4,IRAK1,TRAF6,TAB,NF-κB,and IL-1β(P<0.01).The correlation analysis revealed that the expression levels of TLR4,IRAK1,TRAF6,TAB,NF-κB,and IL-1β were positively correlated with the expression levels of miR-146a-3p and miR-146a-5p detected by qRT-PCR,respectively(P<0.01).Conclusion CHLGMLD can inhibite the TLR4 signaling pathway by lowering the expression levels of miR-146a-3p and miR-146a-5p to alleviate hippocampal dentate gyrus inflammation in TLE rats,thus relieving seizures.

蠲痹历节清方对改良痛风性关节模型大鼠滑膜的TLR4,NF-κB,PPARγ的影响

目的：观察蠲痹历节清方对改良痛风性关节炎大鼠滑膜组织中Toll样受体4（Toll-like receptors 4,TLR4）,核转录因子kappa B（nuclear factor-kappa B,NF-κB）,过氧化物酶体增殖物激活受体γ（peroxisome proliferator-activated receptorγ,PPARγ）的影响,探讨蠲痹历节清方治疗急性痛风性关节炎局部组织炎症的可能作用机制。方法：将42只SD雄性大鼠,按随机数字表法选取6只为正常组,30只为造模组,造模组采用改良痛风性关节炎造模后随机分为模型组,蠲痹历节清方高、中、低剂量组（4 400,2 200,1 100 mg·kg^-1）,依托考昔组（11 mg·kg^-1）,吡格列酮组（20 mg·kg^-1）,每组6只。正常组及模型组的大鼠以生理盐水灌胃20 mL·kg^-1。每组每只大鼠每日灌胃给药2次,连续2 d后处死大鼠,取受试右踝关节,分离出滑膜组织,分为两部分,一部分用于病理形态学观察,一部分用逆转录聚合酶链式反应（RT-PCR）检测TLR4,NF-κB p65,PPARγmRNA的表达水平,蛋白质免疫印迹法（Western blot）检测TLR4,NF-κB p65,PPARγ蛋白表达水平。结果：与正常组比较,模型组中TLR4和NF-κB mRNA和蛋白表达显著升高（P〈0.01）,PPARγmRNA和蛋白表达升高（P〈0.05）;与模型组比较,吡格列酮组及蠲痹历节清方高、中、低剂量组TLR4和NF-κB mRNA和蛋白的表达显著降低（P〈0.01）,PPARγmRNA和蛋白的表达显著升高（P〈0.05）。结论：蠲痹历节清方可能通过上调PPARγ表达,抑制TLR4,NF-κB表达从而抑制急性痛风性关节炎局部组织炎症。

温肾方对乙肝肝硬化合并肝性脑病患者疗效及HMGB1,TLR4含量的影响

目的:观察温肾方治疗乙肝肝硬化合并肝性脑病肾阳虚证患者的临床疗效及其对高迁移率族蛋白B1(high mobility group protein B1,HMGB1),Toll样受体4(Toll-like receptor 4,TLR4)含量的影响。方法:纳入成都中医药大学附属医院2013年8月至2015年1月收治的66例乙肝肝硬化合并肝性脑病患者。采用前瞻性、平行对照方法设计,将纳入的66例患者按1∶1分为治疗组和对照组,每组各33例。对照组给予常规内科综合治疗、结肠透析和安慰剂灌肠。治疗组给予常规内科综合治疗、结肠透析和温肾方灌肠。疗程均为10日。治疗前后分别检测患者肝功能水平、数字连接试验(number connect test,NCT)时间、数字符号试验(digit-symbol test,DST)评分及血氨水平,外周血HMGB1,TLR4含量。治疗结束后,分别计算两组患者清醒时间及总有效率。结果:两组患者基线具有可比性。治疗结束后,治疗组总有效率优于对照组(P <0. 05)。治疗组在血氨下降幅度,肝功能恢复程度,NCT时间下降幅度,SDT评分增加程度以及患者清醒时间缩短幅度等方面均优于对照组(P <0. 05)。治疗结束后,治疗组外周血HMGB1,TLR4含量低于对照组(P <0. 05)。结论:温肾方可显著提高乙肝肝硬化合并肝性脑病肾阳虚证患者的临床疗效,其作用机制可能与抑制HMGB1,TLR4含量,进而抑制炎症因子释放,降低血氨水平有关。

基于TLR4/NF-κB/NLRP3信号通路探讨脉络舒通丸保护小鼠脑缺血再灌注损伤的作用机制

目的:探讨脉络舒通丸对小鼠脑缺血再灌注损伤的保护作用及机制。方法:60只雄性ICR小鼠按体质量随机分为假手术对照组、模型对照组、尼莫地平0.024g/kg组和脉络舒通丸1.8、3.6、7.2 g/kg组,每组10只。各组灌胃给予相应药物或水预处理7 d,采用线栓法制备小鼠大脑中动脉阻塞(MCAO)模型。再灌注24 h后评估各组小鼠神经功能评分、脑含水量及脑梗死体积占比;HE染色观察缺血核心区脑组织病理学改变;ELISA法检测脑组织匀浆中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6含量;免疫印迹法分析小鼠缺血脑组织与半暗带组织中TLR4、p-NF-κB p65、NLRP3、ASC、cleaved Caspase-1、cleaved IL-1β蛋白表达。结果:与假手术对照组相比,模型对照组小鼠神经功能评分、脑含水量、脑梗死体积占比明显升高(P<0.05或P<0.01),HE染色显示脑组织产生损伤性病理改变,脑组织TNF-α、IL-1β及IL-6的含量均显著升高(P<0.01),缺血脑组织与半暗带组织中TLR4、p-NF-κB p65、NLRP3、ASC、cleaved Caspase-1、cleaved IL-1β蛋白表达均显著上调(P<0.01);与模型对照组相比,脉络舒通丸3.6、7.2 g/kg组神经功能评分、脑含水量、脑梗死体积占比明显减少(P<0.05或P<0.01);脉络舒通丸各组小鼠脑组织病理学均有显著改善,脑组织TNF-α、IL-1β及IL-6的含量明显降低(P<0.05或P<0.01);脉络舒通丸7.2 g/kg组小鼠缺血脑组织与半暗带组织中TLR4、p-NF-κB p65、NLRP3、ASC、cleaved Caspase-1、cleaved IL-1β蛋白表达显著下调(P<0.01)。结论:脉络舒通丸可通过调控TLR4/NF-κB/NLRP3信号通路,抑制神经炎症反应,从而达到对小鼠脑缺血再灌注损伤的保护作用。

Catalpol ameliorates LPS-induced endometritis by inhibiting inflammation and TLR4/NF-κB signaling

Catalpol is the main active ingredient of an extract from Radix rehmanniae,which in a previous study showed a protective effect against various types of tissue injury.However,a protective effect of catalpol on uterine inflammation has not been reported.In this study,to investigate the protective mechanism of catalpol on lipopolysaccharide(LPS)-induced bovine endometrial epithelial cells(bEECs)and mouse endometritis,in vitro and in vivo inflammation models were established.The Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway and its downstream inflammatory factors were detected by enzyme-linked immunosorbent assay(ELISA),quantitative real-time polymerase chain reaction(qRT-PCR),western blot(WB),and immunofluorescence techniques.The results from ELISA and qRT-PCR showed that catalpol dose-dependently reduced the expression of pro-inflammatory cytokines such as tumor necrosis factorα(TNF-α),interleukin(IL)-1β,and IL-6,and chemokines such as C-X-C motif chemokine ligand 8(CXCL8)and CXCL5,both in bEECs and in uterine tissue.From the experimental results of WB,qRT-PCR,and immunofluorescence,the expression of TLR4 and the phosphorylation of NF-κB p65 were markedly inhibited by catalpol compared with the LPS group.The inflammatory damage to the mouse uterus caused by LPS was greatly reduced and was accompanied by a decline in myeloperoxidase(MPO)activity.The results of this study suggest that catalpol can exert an anti-inflammatory impact on LPS-induced bEECs and mouse endometritis by inhibiting inflammation and activation of the TLR4/NF-κB signaling pathway.

Modulating effects of Astragalus polysaccharide on immune disorders via gut microbiota and the TLR4/NF-κB pathway in rats with syndrome of dampness stagnancy due to spleen deficiency

The syndrome of dampness stagnancy due to spleen deficiency(DSSD)is relatively common globally.Although the pathogenesis of DSSD remains unclear,evidence has suggested that the gut microbiota might play a significant role.Radix Astragali,used as both medicine and food,exerts the effects of tonifying spleen and qi.Astragalus polysaccharide(APS)comprises a macromolecule substance extracted from the dried root of Radix Astragali,which has many pharmacological functions.However,whether APS mitigates the immune disorders underlying the DSSD syndrome via regulating gut microbiota and the relevant mechanism remains unknown.Here,we used DSSD rats induced by high-fat and low-protein(HFLP)diet plus exhaustive swimming,and found that APS of moderate molecular weight increased the body weight gain and immune organ indexes,decreased the levels of interleukin-1β(IL-1β),IL-6,and endotoxin,and suppressed the Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)pathway.Moreover,a total of 27 critical genera were significantly enriched according to the linear discriminant analysis effect size(LEfSe).APS increased the diversity of the gut microbiota and changed its composition,such as reducing the relative abundance of Pseudoflavonifractor and Paraprevotella,and increasing that of Parasutterella,Parabacteroides,Clostridium XIVb,Oscillibacter,Butyricicoccus,and Dorea.APS also elevated the contents of short-chain fatty acids(SCFAs).Furthermore,the correlation analysis indicated that 12 critical bacteria were related to the body weight gain and immune organ indexes.In general,our study demonstrated that APS ameliorated the immune disorders in DSSD rats via modulating their gut microbiota,especially for some bacteria involving immune and inflammatory response and SCFA production,as well as the TLR4/NF-κB pathway.This study provides an insight into the function of APS as a unique potential prebiotic through exerting systemic activities in treating DSSD.

Effect of Huangqin Qingre Chubi Capsule on Bone Metabolism and Serum TLR4NF-kB in Rats with Rheumatoid Arthritis

Objective:To elucidate the effects of Huangqin Qingre Chubi capsule(HQC)on bone metabolism and serum TLR4 and NF-kB in rats with rheumatoid arthritis(RA),and to provide experimental bases for the treatment of RA with HQC.Methods:A total of 40 SD rats were randomly divided into the normal group,model group,western medicine treatment group,and HQC group,with 10 rats in each group,and the RA model was induced by complete adjuvant in all groups except the normal group.After successful modeling,they were treated for 4 weeks to compare the degree of joint swelling;meanwhile,micro-CT was used to evaluate bone microstructural parameters,and changes in serum TLR4 and NF-kB expression levels were detected by ELISA.Results:There was no statistical significance in comparing the degree of joint swelling among the model group,western medicine treatment group and HQC group(P>0.05);Micro-CT results showed that bone microstructural parameters deteriorated in the osteoporosis model group compared with the normal group.Both western medicine and traditional Chinese medicine HQC could improve the bone microjunction of RA rats,and the HQC group was better than the western medicine treatment in improving the number of bone trabeculae(2.58±0.19)·mm^(-1);the serum results showed that RA was accompanied by the up-regulation of the expression of TLR4 and NF-kB.Both western drugs and HQC down-regulated the high expression of serum TLR4 and NF-kB in osteoporotic rats,and the down-regulation of serum TLR4(9.90±0.55)ng·ml^(-1)and NF-kB(350.29±3.14)ng·L^(-1)by HQC was more obvious.Conclusion:Chinese herbal medicine HQC can significantly improve the bone microstructure of RA rats,and its effect is better than that of western medicine in some aspects.The mechanism of action of HQC is related to the inhibition of the activation of the TLR4/NF-kB pathway,and this study provides an experimental basis for the further development and utilization of HQC.

Therapeutic Effect of Crocin on Diabetic Retinopathy in Rats Based on TLR4/My D88/NF-κB Pathway

Objective:To study the therapeutic effect of crocin on diabetic retinopathy(DR)in rats based on toll-like receptor 4(TLR4)/myeloid differentiation factor 88(My D88)/nuclear factor-κB(NF-κB)pathway.Methods:Thirty SPF SD rats were used in the experiment,which were randomly divided into DR group,control group and crocin group,with 10 rats in each group.The DR rat model was established by feeding the rats in both the DR group and crocin group with a high glucose and high fat diet,along with intraperitoneal injection(IP)of streptozotocin.Crocin IP was administered to the rats in the crocin group,whereas the rats in the DR group and control group received an equivalent dosage of saline IP for 12 weeks.A comparison was made among the three groups regarding retinal thickness,vascular permeability,expression of TLR4/My D88/NF-κB pathway protein,levels of inflammatory factors,and levels of Bcl-2,Bax,and Bcl-2/Bax.Results:The DR group and crocins group exhibited a lower retinal thickness compared to the control group,while the crocins group displayed a higher thickness than the DR group.The DR group and crocins group had higher retinal vascular permeability than the control group,and the crocins group had lower retinal vascular permeability than the DR group(P<0.05).TLR4,My D88,and P-NF-κB relative expressions were higher in the DR and crocin groups than in the control group,whereas TLR4,My D88,and P-NF-κB relative expressions were lower in the crocin group than in the DR group(P<0.05).The DR group and crocin group exhibited elevated levels of inflammatory cytokines compared to the control group,while the crocin group displayed decreased levels in comparison to the DR group(P<0.05).The DR group and crocin group exhibited lower levels of Bcl-2 and Bcl-2/Bax compared to the control group,whereas the control group displayed higher levels of Bax.The crocin group exhibited elevated levels of Bcl-2 and Bcl-2/Bax compared to the DR group,whereas the DR group displayed diminished levels of Bax(P<0.05).Conclusion:Crocin has the potential to enhance the retinal thickness and vascular permeability of DR rats,and the inhibition of the TLR4/My D88/NF-κB pathway by crocin could play a crucial role in impeding the advancement of DR.

Toll样受体和核转录因子-κB在子痫前期患者胎盘组织中的表达

目的:探讨子痫前期患者胎盘组织中Toll样受体4(TLR4)以及核转录因子(NF-κB)表达及意义。方法:选取50例子痫前期患者(轻度子痫前期20例,重度子痫前期30例)作为研究对象,以30例正常晚孕妇女作为正常对照,采用免疫组化及逆转录-聚合酶链反应(RT-PCR)法测定胎盘组织中TLR4及NF-κB的定位及表达。结果:轻、重度子痫前期患者胎盘组织中TLR4及NF-κB蛋白和mRNA的表达水平均明显高于正常晚孕妇女(P<0.05)。且随着病情加重,两者表达均增强;子痫前期胎盘组织中TLR4和NF-κB的表达呈正相关(P<0.05)。结论:TLR4介导的炎症因子释放可能是导致子痫前期发生的重要原因之一。

Toll样受体4介导的MyD88信号通路在脑缺血损伤中的作用

脑缺血损伤发生机制十分复杂,目前有多种相关学说,大量研究表明炎症反应是脑缺血损伤主要机制之一,然而炎性瀑布反应触发后更加剧了脑损伤的发展,其中炎性受体发挥了重要作用。研究表明Toll样受体4(TLR4)在脑缺血的发生、发展和继发性脑损伤中起重要作用,髓样分化因子88(MyD88)是TLR4信号转导通路中关键的衔接蛋白,能够启动下游炎性因子的转导。对TLR4介导的MyD88信号通路在脑缺血损伤中的作用进展做一综述。

Potential therapeutic molecular targets for blood-brain barrier disruption after subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage remains serious hemorrhagic stroke with high morbidities and mortalities.Aneurysm rupture causes arterial bleeding-induced mechanical brain tissue injuries and elevated intracranial pressure,followed by global cerebral ischemia.Post-subarachnoid hemorrhage ischemia,tissue injuries as well as extravasated blood components and the breakdown products activate microglia,astrocytes and Toll-like receptor 4,and disrupt blood-brain barrier associated with the induction of many inflammatory and other cascades.Once blood-brain barrier is disrupted,brain tissues are directly exposed to harmful blood contents and immune cells,which aggravate brain injuries furthermore.Blood-brain barrier disruption after subarachnoid hemorrhage may be developed by a variety of mechanisms including endothelial cell apoptosis and disruption of tight junction proteins.Many molecules and pathways have been reported to disrupt the blood-brain barrier after subarachnoid hemorrhage,but the exact mechanisms remain unclear.Multiple independent and/or interconnected signaling pathways may be involved in blood-brain barrier disruption after subarachnoid hemorrhage.This review provides recent understandings of the mechanisms and the potential therapeutic targets of blood-brain barrier disruption after subarachnoid hemorrhage.

HMGB1 is a critical molecule in the pathogenesis of Gram-negative sepsis

Gram-negative sepsis is a severe clinical syndrome associated with significant morbidity and mortality.Lipopolysaccharide(LPS),expressed on Gram-negative bacteria,is a potent pro-inflammatory toxin that induces inflammation and coagulation via two separate receptor systems.One is Toll-like receptor 4(TLR4),expressed on cell surfaces and in endosomes,and the other is the cytosolic receptor caspase-11(caspases-4 and-5 in hu-mans).Extracellular LPS binds to high mobility group box 1(HMGB1)protein,a cytokine-like molecule.The HMGB1-LPS complex is transported via receptor for advanced glycated end products(RAGE)-endocytosis to the endolysosomal system to reach the cytosolic LPS receptor caspase-11 to induce HMGB1 release,inflammation,and coagulation that may cause multi-organ failure.The insight that LPS needs HMGB1 assistance to generate severe inflammation has led to successful therapeutic results in preclinical Gram-negative sepsis studies target-ing HMGB1.However,to date,no clinical studies have been performed based on this strategy.HMGB1 is also actively released by peripheral sensory nerves and this mechanism is fundamental for the initiation and prop-agation of inflammation during tissue injury.Homeostasis is achieved when other neurons actively restrict the inflammatory response via monitoring by the central nervous system and the vagus nerve through the cholinergic anti-inflammatory pathway.The neuronal control in Gram-negative sepsis needs further studies since a deeper understanding of the interplay between HMGB1 and acetylcholine may have beneficial therapeutic implications.Herein,we review the synergistic overlapping mechanisms of LPS and HMGB1 and discuss future treatment opportunities in Gram-negative sepsis.

Opposite effects of miR-155 in the initial and later stages of lipopolysaccharide(LPS)-induced inflammatory response

Although microRNA-155(miR-155)is considered a pro-inflammatory mediator,cumulative evidence indicates that it also has anti-inflammatory effects in macrophages and dendritic cells.In this study,we identified the dramatic expression changes of more than half of potential miR-155-targeted genes upon lipopolysaccharide(LPS)stimulation;223 genes were down-regulated and 85 genes were up-regulated,including suppressor of cytokine signaling 1(SOCS1)and transforming growth factor-β-activated kinase 1-binding protein 2(TAB2),two well-known genes involved in miR-155-mediated regulation of the Toll-like receptor 4(TLR4)signaling pathway.We also found that miR-155 acted as an anti-inflammatory mediator in the initial stage of LPS-induced inflammatory response mainly through repressing TAB2 protein translation,and as a proinflammatory mediator by down-regulating SOCS1 in the later stage.Meanwhile,overexpression of TAB23'untranslated region(UTR)in macrophages promoted the development of endotoxin tolerance by competing for binding with miR-155,which resulted in an elevated expression level of SOCS1 protein.These findings provide new insights for understanding the regulatory mechanisms in fine-tuning of LPS-induced innate immune response.

New insights in the pathogenesis of alcohol-related liver disease:The metabolic,immunologic,and neurologic pathways

Alcohol-related liver disease(ALD)became an important health issue worldwide.Following chronic alcohol consumption,the development of ALD might be caused by metabolic and immunologic factors,such as reactive oxygen species(ROS)and pro-inflammatory cytokines.For example,hepatic cytochrome P4502E1 enzyme increases ROS production and stimulates de novo lipogenesis after alcohol exposure.In addition,damage-and pathogen-associated molecular patterns stimulate their specific receptors in nonparenchymal cells,including Kupffer cells,hepatic stellate cells(HSCs),and lymphocytes,which result in hepatocyte death and infiltration of pro-inflammatory cells(e.g.,neutrophils and macrophages)in the liver.Moreover,our studies have suggested the novel involvement of neurologic signaling pathways(e.g.,endocannabinoid and glutamate)through the metabolic synapse between hepatocytes and HSCs in the development of alcohol-related hepatic steatosis.Additionally,agouti-related protein and beta2-adrenergic receptors aggravate hepatic steatosis.Furthermore,organ-crosstalk has emerged as a critical issue in ALD.Chronic alcohol consumption induces dysbiosis and barrier disruption in the gut,leading to endotoxin leakage into the portal circulation,or lipolysis-mediated transport of triglycerides from the adipose tissue to the liver.In summary,this review addresses multiple pathogeneses of ALD,provides novel neurologic signaling pathways,and emphasizes the importance of organ-crosstalk in the development of ALD.