Three-dimensional image analysis of hepatic restructuring in liver cirrhosis

OBJECTIVE: To investigate the three-dimensional structure, including the angioarchitecture, of the cirrhotic liver and clarify morphogenesis of the cirrhotic nodule. STUDY DESIGN: The three-dimensional liver structure of nontumor areas in two partially hepatectomized cases of hepatitis C virus-positive liver cirrhosis with hepatocellular carcinoma was examined by computerized reconstruction from serial tissue sections. RESULTS: Our image analysis revealed the following: (1) The parenchyma consisted of two kinds of cirrhotic nodules. The first was the nodule centrifugally formed around the portal veins, and their flows drained into the hepatic veins inside and around the nodule. The second was the nodule derived from the first. The latter was divided into the former by bridging fibrosis-induced intranodular septation. (2) The stroma consisted of the newly formed fibrovascular tissue--i.e., the septum and intranodular inflow and outflow vascular systems and the preexisting one. CONCLUSION: Our computerized reconstruction suggested, from an angioarchitectural point of view, that the first and second kind of cirrhotic nodule might be named the stable and the unstable nodule, respectively, and that the first kind of cirrhotic nodule could be derived from the regenerative nodule appearing in the course of chronic hepatitis.     

猫儿山小鲵肝的组织结构

通过常规石蜡切片技术对2例猫儿山小鲵（Hynobius maoershanens）肝进行组织学观察。结果显示,猫儿山小鲵肝分为两叶,右叶稍大于左叶。肝组织结构主要由被膜、中央静脉、门管区和肝细胞组成。门管区的小叶间静脉和小叶间胆管清晰可见,但小叶间动脉不易观察。肝内结缔组织少,肝小叶之间界限不清。肝细胞索围绕中央静脉呈放射状排列,但放射状不明显。肝实质中含有大量清晰可见的棕黑色色素团,可能与此物种对低氧环境的适应有关。     

Localization of liver myofibroblasts and hepatic stellate cells in normal and diseased rat livers: distinct roles of (myo-)fibroblast subpopulations in hepatic tissue repair

Previous in vitro studies indicated that hepatic stellate cells (HSC) and rat liver myofibroblasts (rMF) have to be regarded as different cell populations of the myofibroblastic lineage with fibrogenic potential. Employing the discrimination features defined by these studies the localization of HSC and rMF was analyzed in diseased livers. Normal and acutely as well as chronically carbon tetrachloride-injured livers were analyzed by immunohistochemistry and by in situ hybridization. In normal livers HSC [desmin/glial fibrillary acid protein (GFAP)-positive cells] were distributed in the hepatic parenchyma, while rMF (desmin/smooth muscle alpha actin-positive, GFAP-negative cells colocalized with fibulin-2) were located in the portal field, the walls of central veins, and only occasionally in the parenchyma. Acute liver injury was characterized almost exclusively by an increase in the number of HSC, while the amount of rMF was nearly unchanged. In early stages of fibrosis, HSC and rMF were detected within the developing scars. In advanced stages of fibrosis, HSC were mainly present at the scar–parenchymal interface, while rMF accounted for the majority of the cells located within the scar. At every stage of fibrogenesis, rMF, in contrast to HSC, were only occasionally detected in the hepatic parenchyma. HSC and rMF are present in normal and diseased livers in distinct compartments and respond differentially to tissue injury. Acute liver injury is followed by an almost exclusive increase in the number of HSC, while in chronically injured livers not only HSC but also rMF are involved in scar formation. Accepted: 16 September 1999     

Chemokine and chemokine receptor interactions provide a mechanism for selective T cell recruitment to specific liver compartments within hepatitis C-infected liver

The role played by chemokines in regulating the selective recruitment of lymphocytes to different tissue compartments in disease is poorly characterized. In hepatitis C infection, inflammation confined to portal areas is associated with a less aggressive course, whereas T cell infiltration of the liver parenchyma is associated with progressive liver injury and cirrhosis. We propose a mechanism to explain how lymphocytes are recruited to hepatic lobules during bursts of necroinflammatory activity in chronic hepatitis C infection. We report here that lymphocytes infiltrating hepatitis C-infected liver express high levels of the chemokine receptors CCR5 and CXCR3. However, whereas the CCR5 ligands macrophage inflammatory protein-1alpha and -1beta were largely confined to vessels within portal tracts, the CXCR3 ligands IFN-inducible protein-10 and monokine-induced by IFN-gamma were selectively up-regulated on sinusoidal endothelium. In vitro, human hepatic sinusoidal endothelial cells secreted IFN-inducible protein-10 and monokine-induced by IFN-gamma in response to stimulation with IFN-gamma in combination with either IL-1 or TNF-alpha. This suggests that intrahepatic Th1 cytokines drive the increased expression of IFN-inducible protein-10 and monokine-induced by IFN-gamma and thereby promote the continuing recruitment of CXCR3-expressing T cells into the hepatic lobule in chronic hepatitis C infection.     

实时超声弹性成像对慢性乙肝并肝纤维化程度的诊断价值分析

目的:探讨实时超声弹性成像(real-time tissue elastograph,RTE)对慢性乙肝并肝纤维化的临床诊断价值。方法:选择慢性乙肝并肝纤维化患者100例,对患者进行RTE检查及肝病理穿刺检查,将RTE评分结果与病理结果进行对比分析。结果:随着肝脏纤维化S分期的不断增加,RTE评分结果亦逐渐升高,RTE评分结果与肝纤维化病理分期呈显著正相关(r=0.665,P0.01)。实时超声弹性成像诊断乙肝并肝纤维化的的敏感度为92,31%、特异度为86.36%、准确率为91%、阳性预测值为96.00%、阴性预测值为76.00%。结论:RTE作为一项无创检查技术,对慢性乙肝并肝纤维化具有较高的临床诊断价值。     

肝纤维化基因治疗的进展

肝硬化是慢性肝病晚期的组织学改变 ,以纤维组织大量增生和肝小叶结构无序化为特征 ,因此又称肝纤维化。近年来随着分子生物学的发展 ,肝纤维化的分子机制逐渐得以阐明 ,从而使肝纤维化的基因治疗成为可能。肝纤维化的基因治疗主要起到阻止纤维化发展、刺激肝细胞分裂和肝组织结构重建三方面的作用。目前 ,常用的方法一般是通过缺陷病毒 (如腺病毒 )转入特定的细胞因子和酶 (如肝细胞生长因子、转化生长因子β1受体、基质金属蛋白酶等 )的基因 ,通过靶细胞表达这些因子作用于受损的肝脏 ,达到延缓和治愈肝纤维化的目的     

封闭群草原兔尾鼠肝脏和胰腺的组织学观察

首次对封闭群草原兔尾鼠的肝脏、胰腺进行了组织学观察,结果表明：1．草原兔尾鼠的肝脏纤维组织极少,肝小叶间界限不明显;部分中央静脉周围可见少量毛细胆管;门管区较少,分布不均匀,其静脉形状不规则、腔大,胆管及动脉则较小。2．胰腺分叶清晰,腺泡细胞较大,胞浆多呈嗜酸染色;小叶中部腺泡着色较深,外侧腺泡着色较浅;胰岛大小不等,细胞排列呈不规则索状,光镜下未见特殊改变。     

A QUANTITATIVE STEREOLOGICAL DESCRIPTION OF THE ULTRASTRUCTURE OF NORMAL RAT LIVER PARENCHYMAL CELLS

The principles of stereology have been applied to a morphometric analysis of parenchymal cells from the peripheral, midzonal, and central regions of normal rat liver lobules. The fractional volumes of cytoplasm occupied by mitochondria, peroxisomes, lysosomes, lipid, and glycogen have been determined. The surface densities of smooth- and rough-surfaced endoplasmic reticulum and of mitochondrial envelope and cristae have also been measured. The average number and dimensions of mitochondria and peroxisomes have been evaluated. By the use of an independent measurement of the average cytoplasmic volume, these data have been expressed as the actual volumes, areas, and numbers per cell in the different parts of the hepatic lobule. Similarly, the volumes of the envelope, cristae, and matrix compartments and the area of cristae membranes have been calculated for the average-sized mitochondrion in each lobular zone. Structural homogeneity is found in over 80% of normal rat liver parenchymal cells, with most of the significant differences being confined to those cells immediately surrounding the central veins.     

Micronuclei formation in liver fibrosis samples from patients infected by hepatitis C virus

Genetic research on fibrosis outset and its progression in chronic hepatitis (CH) by hepatitis C virus (HCV) are limited. The lack of cytogenetic data led us to investigate the presence of micronuclei (MNi), as a sign of genomic damage. Hepatocytes of hepatic parenchyma from 62 cases diagnosed with CH associated with HCV and displaying different degrees of fibrosis (F1-F4) were analyzed. These data were compared to 15 cases without fibrosis (F0). Twelve healthy liver parenchyma samples were included as control. All samples were obtained from paraffin-embedded archival material. Micronucleated hepatocytes (MN-Heps) were analyzed through Feulgen/Fast-green staining. Results showed that the rates of MN-Heps in the F4 group were statistically significant (p < 0.05) and higher than those in the control group. Like results were also obtained on comparing F4 with F0, F1, F2 and F3 cases. Conversely, differences were not significant (p > 0.05) on comparing F0, F1, F2, F3, one against the other, as well as individual versus control. Although chromosomal losses in CH were detected, it was shown that liver parenchyma with fibrosis in the initial stages (F1-F3) cannot be considered cytogenetically abnormal.     

肝细胞脂肪变性程度对慢性病毒性肝炎弥散度成像的影响

目的：探讨肝细胞脂肪变性对肝脏弥散度成像技术（Realtime Tissue Elastography,RTE）无创评估病毒性肝炎肝纤维化及炎 症程度的影响。方法：91 例确诊慢性乙型或丙型病毒性肝炎患者均于肝脏活检穿刺前行肝脏弥散度成像检查,分析不同肝细胞脂 肪变性程度与肝纤维化程度及肝脏炎症程度之间的弥散度成像LF指数差异。结果：中度脂肪变性组LF 指数最高（P=0.0254）;轻 度纤维化（S1-S2）时,不同的脂肪变性程度组间LF 值的差异无统计学意义（P=0.1105）;中- 重度纤维化时,不同的脂肪变性程度 组间LF值的差异无统计学意义（P=0.0994）。轻度炎症时,不同的脂肪变性程度组间LF值的差异具有统计学意义,中度脂肪变性 组的LF值最高（P=0.0010）;中- 重度炎症时,不同的脂肪变性程度组间LF值的差异具有统计学意义（P<0.05）。结论：应用肝脏弥 散度成像的LF指数判断肝脏纤维化程度不受肝细胞脂肪变性的影响,但对于肝脏炎症程度的判断受肝细胞脂肪变性的影响,尤 其应重视中度肝细胞脂肪变性对于测值的影响。     

人肝星状细胞激活和抑制及其相关分子机制的研究进展

肝纤维化是肝脏对一系列慢性刺激的损伤修复反应,以细胞外基质的过度沉积为主要特征。许多研究证明人肝星状细胞(hepatic stellate cells,HSCs)的活化与增殖是肝纤维化形成的中心环节。因此,肝星状细胞激活机制及抑制活化途径的研究和发现成为防治肝纤维化的关键。目前,国际上肝纤维化药物研发的思路之一是从肝纤维化发生的机制,即肝星状细胞激活机制中寻找分子靶点。近年来,对各种使肝星状细胞活化的信号通路及相关抑制机制的研究取得了一些进展,但由于肝星状细胞活化是多条信号通路相互协调的结果,其复杂性、未知性造成了阻断方式的特异性、多样性,使该研究还仅限于实验室阶段,要想应用于临床还需要大量实验证明。该文就最新发现的肝星状细胞激活和抑制及相关分子机制作一综述。     

超声导入疗法治疗慢性乙型肝炎肝纤维化临床研究

目的：探讨超声导入疗法对乙型肝炎肝纤维化患者进行治疗的临床效果。方法：选择符合诊断标准的慢性乙型肝炎肝纤维化患者52例,随机分为试验组和对照组,各26例。对照组患者给予基本保肝治疗,试验组在对照组的基础上加用黄芪注射液进行超声导入,3个月为1个疗程。观察两组患者治疗前后症状、体征、血清肝纤维化指标、肝功能变化及影像学指标。结果：两组患者症状、体征均有不同程度的改善,差异无统计学意义（P〉0．05）;试验组血清肝纤维化指标明显改善,与对照组比较,差异有统计学意义（P〈0．05）;肝功能及影像学指标的改善更明显（P〈0．01）。结论：超声导入疗法对慢性乙型肝炎肝纤维化具有改善肝功能,减少肝细胞外基质的增生与沉积的效用,能够减轻或延缓肝纤维化的进展。     

CD137-mediated pathogenesis from chronic hepatitis to hepatocellular carcinoma in hepatitis B virus-transgenic mice

Chronic hepatitis B virus (HBV) infection is characterized by sustained liver inflammation with an influx of lymphocytes, which contributes to the development of cirrhosis and hepatocellular carcinoma. The mechanisms underlying this immune-mediated hepatic pathogenesis remain ill defined. We report in this article that repetitive infusion of anti-CD137 agonist mAb in HBV-transgenic mice closely mimics this process by sequentially inducing hepatitis, fibrosis, cirrhosis, and, ultimately, liver cancer. CD137 mAb initially triggers hepatic inflammatory infiltration due to activation of nonspecific CD8(+) T cells with memory phenotype. CD8(+) T cell-derived IFN-γ plays a central role in the progression of chronic liver diseases by actively recruiting hepatic macrophages to produce fibrosis-promoting cytokines and chemokines, including TNF-α, IL-6, and MCP-1. Importantly, the natural ligand of CD137 was upregulated significantly in circulating CD14(+) monocytes in patients with chronic hepatitis B infection and closely correlated with development of liver cirrhosis. Thus, sustained CD137 stimulation may be a contributing factor for liver immunopathology in chronic HBV infection. Our studies reveal a common molecular pathway that is used to defend against viral infection but also causes chronic hepatic diseases.     

Molecular determination of liver fibrosis by synchrotron infrared microspectroscopy

Liver fibrosis is an adaptive response to various injuries and may eventually progress to cirrhosis. Although there are several non-invasive methods available to monitor the progression of liver fibrogenesis, they cannot reliably detect fibrosis in its early stages, when the process can be stopped or reversed by removing or eliminating the underlying etiological agent that cause the hepatic injury. In this study, early fibrosis alterations were characterized biochemically, morphologically, and spectroscopically in a rat bile duct ligation (BDL) model. Progressive elevations in serum alanine transaminase (ALT), aspartate transaminase (AST), and bilirubin levels in the BDL rats were found indicating the dynamic deterioration of hepatocellular function. Immunofluorescence microscopy using monoclonal anti-collagen III antibody further revealed abnormal intertwined networks of collagen fibres surrounding the portal areas and extending into the lobules towards the central veins in all BDL samples starting from week one. Synchrotron infrared microspectroscopy of liver sections was exploited to generate false color spectral maps based upon a unique and strong collagen absorption at 1340 cm(- 1), revealing a collagen distribution that correlated very well with corresponding images provided by immunofluorescence imaging. We therefore suggest that infrared microspectroscopy may provide an additional and sensitive means for the early detection of liver fibrosis.     

Experimental study of the morphogenesis of nutmeg fibrosis of the liver]

Partial structure of the inferior vena cava over the diaphragm carried out experimentally in dogs let to blood stasis in the liver. Biopsy material obtained at different experimental periods demonstrated that fibrosis began to develop from the central and collective veins as a result of proliferation of the fibroblasts of the vein adventitita and "emigration" of the fucsinophilic fibers into the adjacent parenchyma. In parallel there occurred a neoformation of the connective tissue in the areas of hemorrhages and necroses associated with proliferation of the Kupffer's cells. Nutmeg fibrosis proved to have a cellular genesis and as associated with increased tropocollagen activity of fibroblasts.     

The vagal contribution to the rat liver innervation: a demonstration with the cobalt impregnation method

The contribution of the vagus nerves to the innervation of the liver has been studied with the cobaltous chloride impregnation method. With this method we have demonstrated that the fiber plexus in the rat hepatic parenchyma, that we had previously described and stained for acetylcholinesterase, is of a nervous nature and of vagal origin. Our results show that branches from the vagus spread abundantly with the connective tissue at the capsule. From this peripheral location, the fibres expand deeply through the parenchyma in close contact with the hepatocytes towards the central veins. Other branches run with the interlobular connective tissue, distributing to the portal veins, hepatic arteries and biliary ducts. They also have lateral branches which penetrate into the parenchyma.     

Molecular determination of liver fibrosis by synchrotron infrared microspectroscopy

Liver fibrosis is an adaptive response to various injuries and may eventually progress to cirrhosis. Although there are several non-invasive methods available to monitor the progression of liver fibrogenesis, they cannot reliably detect fibrosis in its early stages, when the process can be stopped or reversed by removing or eliminating the underlying etiological agent that cause the hepatic injury. In this study, early fibrosis alterations were characterized biochemically, morphologically, and spectroscopically in a rat bile duct ligation (BDL) model. Progressive elevations in serum alanine transaminase (ALT), aspartate transaminase (AST), and bilirubin levels in the BDL rats were found indicating the dynamic deterioration of hepatocellular function. Immunofluorescence microscopy using monoclonal anti-collagen III antibody further revealed abnormal intertwined networks of collagen fibres surrounding the portal areas and extending into the lobules towards the central veins in all BDL samples starting from week one. Synchrotron infrared microspectroscopy of liver sections was exploited to generate false color spectral maps based upon a unique and strong collagen absorption at 1340 cm^− 1, revealing a collagen distribution that correlated very well with corresponding images provided by immunofluorescence imaging. We therefore suggest that infrared microspectroscopy may provide an additional and sensitive means for the early detection of liver fibrosis.     

TGF-β1和FBRS可指示肝纤维化发展程度

为了探讨转化生长因子(TGF-β1)、外周血纤维化蛋白(FBRS)表达水平变化与肝纤维化发生发展的相关性,本研究选取自2015年5月至2017年6月间在我院诊治的慢性病毒性肝炎患者120例,设为肝炎组。采用免疫组化法检测肝组织TGF-β1的表达水平,酶联免疫分析检测血清中TGF-β1的含量,RT-PCR检测外周血单个核细胞FBRS mRNA的表达水平,分析TGF-β1、FBRS与肝纤维化程度的相关性。研究结果表明:随肝纤维化程度的不同,肝组织TGF-β1、血清TGF-β1表达水平、FBRS mRNA表达水平与肝脏胶原含量同步性升高(p<0.05)。进一步的相关分析表明:肝组织TGF-β1水平、FBRS mRNA与肝纤4项检查,即血清Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原片段(Ⅳ-C)、层粘连蛋白(LN)和透明质酸(HA)水平之间均呈正相关。本研究结果初步得出结论,慢性病毒性肝炎肝组织TGF-β1、血清TGF-β1表达水平、外周血FBRS的表达水平与肝组织纤维化程度呈正相关。     

Resolving fibrosis in the diseased liver: translating the scientific promise to the clinic

Liver fibrosis and its end-stage disease cirrhosis are a major cause of mortality and morbidity throughout the world. Fibrosis is a response to chronic liver injury or infection that if unabated leads to the replacement of normal functional liver tissue with scar tissue. Basic research over the past decade has generated a vastly improved knowledge of the cell and molecular biology of liver fibrosis that provides a framework on which to design and develop therapeutics. The field has also witnessed a genuine paradigm shift from the original dogma that liver fibrosis is only ever a progressive process, to the new understanding that liver fibrosis even in an advanced stage can be reversible. There is therefore renewed optimism that liver fibrosis may be cured providing that we develop therapies that halt the fibrogenic process and encourage the natural regenerative properties of the liver. The key to the design of effective therapeutics will be to exploit the ongoing discoveries pertaining to the biology and function of fibrogenic hepatic myofibroblasts and their interplay with other liver cells and with the hepatic extracellular matrix. This review provides a critique of those discoveries in basic research that provide the most promise for translation to the clinic. In addition, we review the latest developments in the search for minimal invasive diagnostic tests for fibrosis that will be essential for determining the efficacy of anti-fibrotic drugs.