Hepatology : official journal of the American Association for the Study of Liver Diseases
-
This study assesses the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis with specific analysis of the contrast enhancement pattern. Cholangiocarcinoma may show increased contrast uptake in the arterial phase, and, if washout in the delayed venous phase were to be detected, the noninvasive diagnostic criteria proposed in the American Association for the Study of Liver Diseases guidelines would be refuted. We reviewed the MR findings of 25 patients with cirrhosis with 31 histologically confirmed ICC nodules. ⋯ The most characteristic MR contrast pattern in ICC in cirrhosis is a progressive contrast uptake throughout the different phases, whereas contrast washout at delayed phases is not observed. Because stable enhancement pattern without washout also can be registered in small HCC nodules, the evaluation of delayed phase is mandatory for a proper nodule characterization. If washout is not registered, a biopsy should be mandatory for diagnosis.
-
Ferritin plays a central role in iron metabolism by acting both as iron storage and a detoxifying protein. We generated a ferritin H allele with loxP sites and studied the conditional ferritin H deletion in adult mice. Ten days after Mx-Cre induced deletion, ferritin H messenger RNA (mRNA) was below 5% in the liver, spleen, and bone marrow of deleted mice compared to control littermates. Mice lost their cellular iron stores indicating the requirement of ferritin H in iron deposition. Serum iron and transferrin saturation were slightly increased and correlated with a two-fold increased liver hepcidin 1 mRNA and a reduced duodenal DcytB mRNA level. Under a normal iron regimen, deleted mice survived for 2 years without visible disadvantage. Mice fed on a high iron diet prior to ferritin H deletion suffered from severe liver damage. Similarly, ferritin H deleted mouse embryonic fibroblasts showed rapid cell death after exposure to iron salt in the medium. This was reversed by wild-type ferritin H but not by a ferritin H mutant lacking ferroxidase activity. Cell death was preceded by an increase in cytoplasmic free iron, reactive oxygen species, and mitochondrial depolarization. ⋯ Our results provide evidence that the iron storage function of ferritin plays a major role in preventing iron-mediated cell and tissue damage.
-
A decrease of hepatocellular phosphatidylcholine (PC) is associated with hepatic injury, e.g., in nonalcoholic steatohepatitis (NASH). Therefore, we evaluated the hepatoprotective effect of a PC-precursor lipid specifically targeted to the liver. We synthesized the bile acid-phospholipid conjugate ursodeoxycholyl lysophosphatidylethanolamide (UDCA-LPE), which was designed to target PC to hepatocytes by way of bile-acid transport systems. We synthesized a fluorescently labeled analogue UDCA-6-[(7-nitro-2-1,3-benzoxadiazol-4-yl)amino]hexanoyl PE (UDCA-NBDPE) for uptake and metabolism studies. Unexpectedly, the majority of UDCA-NBDPE was still intact and not hydrolyzed efficiently in HepG2 cells. For targeting in vivo, NBD fluorescence from UDCA-NBDPE-injected mice was recovered in the liver the most, whereas injection of NBDPE alone resulted in an even distribution in liver, kidneys, and intestine. Cytoprotection by UDCA-LPE was tested in starvation and tumor necrosis factor alpha (TNF-alpha) apoptosis models using HepG2 cells. Only the intact UDCA-LPE was able to persistently stimulate growth after 36 to 120-hour starvation, and significantly inhibited TNF-alpha-induced apoptosis. In both models, LPC, LPE, UDCA, or UDCA added with LPE exhibited weak to no cytoprotection. UDCA-LPE stabilized mitochondrial membranes by lowering mitochondrial membrane potential. Western blot analyses of phosphorylated Akt and glycogen synthase kinase-3 (GSK-3)alpha/beta revealed that UDCA-LPE activated phosphatidyl inositol 3-kinase (PI3K)/Akt signaling pathways. The PI3K inhibitor LY294002 or Akt small interfering (si)RNA consistently inhibited the proproliferative effects of UDCA-LPE during starvation. The TNF-alpha death-receptor extrinsic pathway involves caspase 8 activation, which is inhibited by cellular FLICE-inhibitory protein (cFLIP); thus, cFLIP siRNA was employed in our studies. cFLIP siRNA was able to reverse the cytoprotective effects of UDCA-LPE during TNF-alpha-induced apoptosis, and UDCA-LPE concomitantly upregulated protein expression of cFLIP(L). ⋯ UDCA-LPE, which targeted the liver in vivo, elicited potent biological activities in vitro by stimulating hepatocyte growth and by inhibiting TNF-alpha-induced apoptosis. Thus, UDCA-LPE may be suitable for evaluation of treatment efficacy in NASH.
-
To determine the current quality of reporting of randomized clinical trials (RCTs) in the field of gastroenterology and hepatology, we evaluated the methodological reporting of RCTs in six major gastroenterology and hepatology journals. The methodological quality, including generation of the allocation sequence, allocation concealment, double-blinding, and sample size calculation; number of patients; disease area; and funding source was also retrieved from each trial, and the relevant trials were identified by searching MEDLINE in 2006 using a highly sensitive search strategy. The status of reporting the methodological quality of RCTs was descriptively reported. One hundred five trials were included in the final analysis; of these, 81% (85/105) reported adequate generation of the allocation sequence, 61% (64/105) reported adequate allocation concealment, 51% (54/105) were double-blind, and 75% (79/105) reported adequate sample size calculation. The reported methodological quality greatly improved when compared with historical cohorts. ⋯ This study shows that there was substantial improvement in the reported methodological quality in the major gastroenterology and hepatology journals, but this quality can be further improved.
-
Dithiolethiones, a novel class of adenosine monophosphate-activated protein kinase (AMPK) activators, prevent insulin resistance through AMPK-dependent p70 ribosomal S6 kinase-1 (S6K1) inhibition. There is no known effect of S6K1 for liver X receptor-alpha (LXRalpha)-mediated lipogenic gene expression and steatosis, a cause of chronic liver disease. This study investigated the role of S6K1 in LXRalpha activation and the effects of oltipraz (prototype) and other dithiolethiones on LXRalpha-dependent lipogenesis in hepatocytes and high-fat diet animal model. Oltipraz prevented the ability of LXRalpha agonist (T0901317) to activate sterol regulatory element binding protein-1c (SREBP-1c), inhibiting its own mRNA and protein induction. Impaired SREBP-1c activity by oltipraz caused inhibition of LXRalpha-induced transcription of the fatty acid synthase, LXRalpha, acetyl-CoA carboxylase, stearoyl-CoA desaturase-1, and adenosine triphosphate-binding cassette transporter A1 genes. S6K1 activation antagonized the inhibitory effect of oltipraz on SREBP-1c activation, whereas dominant negative (DN) mutant S6K1 and rapamycin inhibited the T0901317-induced SREBP-1c expression. Oltipraz impaired LXRalpha DNA binding activity and LXR agonist-induced CYP7A1-LXRE-luciferase (CYP7A1) transactivation. Moreover, in vitro S6K1 directly phosphorylated LXRalpha at serine residues for gene transactivation, which was antagonized by its DN mutant. S6K1 inhibition antagonized CYP7A1 induction promoted by AMPK inhibition, whereas AMPK activation abrogated S6K1-dependent CYP7A1 induction, supporting the opposing role of S6K1 and AMPK in LXR activity. Finally, oltipraz was found to inhibit hepatic triglyceride accumulation and lipogenic gene induction in mice fed a high-fat diet. Other dithiolethiones also inhibited SREBP-1c induction by T0901317. ⋯ Our findings showing the role of AMPK-S6K1 pathway in LXR activity and S6K1-dependent inhibition of LXRalpha-induced lipogenic gene transactivation by a novel class of dithiolethiones led to the identification of S6K1 as a particularly attractive target for intervention in hepatic steatosis.