Andrographis paniculata Leaf Extract Prevents Thioacetamide-Induced Liver Cirrhosis in Rats

This study investigated the hepatoprotective effects of ethanolic Andrographis paniculata leaf extract (ELAP) on thioacetamide-induced hepatotoxicity in rats. An acute toxicity study proved that ELAP is not toxic in rats. To examine the effects of ELAP in vivo, male Sprague Dawley rats were given intraperitoneal injections of vehicle 10% Tween-20, 5 mL/kg (normal control) or 200 mg/kg TAA thioacetamide (to induce liver cirrhosis) three times per week. Three additional groups were treated with thioacetamide plus daily oral silymarin (50 mg/kg) or ELAP (250 or 500 mg/kg). Liver injury was assessed using biochemical tests, macroscopic and microscopic tissue analysis, histopathology, and immunohistochemistry. In addition, HepG2 and WRL-68 cells were treated in vitro with ELAP fractions to test cytotoxicity. Rats treated with ELAP exhibited significantly lower liver/body weight ratios and smoother, more normal liver surfaces compared with the cirrhosis group. Histopathology using Hematoxylin and Eosin along with Masson’s Trichrome stain showed minimal disruption of hepatic cellular structure, minor fibrotic septa, a low degree of lymphocyte infiltration, and minimal collagen deposition after ELAP treatment. Immunohistochemistry indicated that ELAP induced down regulation of proliferating cell nuclear antigen. Also, hepatic antioxidant enzymes and oxidative stress parameters in ELAP-treated rats were comparable to silymarin-treated rats. ELAP administration reduced levels of altered serum liver biomarkers. ELAP fractions were non-cytotoxic to WRL-68 cells, but possessed anti-proliferative activity on HepG2 cells, which was confirmed by a significant elevation of lactate dehydrogenase, reactive oxygen species, cell membrane permeability, cytochrome c, and caspase-8,-9, and, -3/7 activity in HepG2 cells. A reduction of mitochondrial membrane potential was also detected in ELAP-treated HepG2 cells. The hepatoprotective effect of 500 mg/kg of ELAP is proposed to result from the reduction of thioacetamide-induced toxicity, normalizing reactive oxygen species levels, inhibiting cellular proliferation, and inducing apoptosis in HepG2 cells.     

Therapy of Experimental NASH and Fibrosis with Galectin Inhibitors

Non-alcoholic steatohepatitis (NASH) and resultant liver fibrosis is a major health problem without effective therapy. Some data suggest that galectin-3 null mice are resistant to the development of NASH with fibrosis. We examined the ability of two complex carbohydrate drugs that bind galectin-3, GM-CT-01 and GR-MD-02, to treat NASH with fibrosis in a murine model. GR-MD-02 treatment resulted in marked improvement in liver histology with significant reduction in NASH activity and collagen deposition. Treatments seemed also to improve both glomerulopathy and interstitial fibrosis observed in kidneys. The improvement in liver histology was evident when animals were treated early in disease or after establishment of liver fibrosis. In all measures, GM-CT-01 had an intermediate effect between vehicle and GR-MD-02. Galectin-3 protein expression was increased in NASH with highest expression in macrophages surrounding lipid laden hepatocytes, and reduced following treatment with GR-MD-02, while the number of macrophages was unchanged. Treatment with GR-MD-02 also reduced the expression of pathological indicators including iNOS, an important TH1 inflammatory mediator, CD36, a scavenger receptor for lipoproteins on macrophages, and α-smooth muscle actin, a marker for activated stellate cells which are the primary collagen producing cells in liver fibrosis. We conclude that treatment with these galectin-3 targeting drugs improved histopathological findings of NASH and markedly reduced fibrosis in a murine model of NASH. While the mechanisms require further investigation, the treatment effect is associated with a reduction of galectin-3 expressed by activated macrophages which was associated with regression of NASH, including hepatocellular fat accumulation, hepatocyte ballooning, intra-portal and intra-lobular inflammatory infiltrate, and deposition of collagen. Similar effects were found with GM-CT-01, but with approximately four-fold lower potency than GR-MD-02. The results, in combination with previous experiments in toxin-induced fibrosis, suggest that these galectin-targeting drugs may have potential in human NASH with fibrosis.     

超声造影对肝硬化和肝纤维化的应用价值

目的：评估超声造影对于肝硬化和肝纤维化的I临床应用价值。方法：选取2011年5月至2013年5月在我院接受诊治的慢性病毒性肝炎患者32例,其中肝纤维化24例,肝硬化12例,均经过超声造影下的肝功能检测和肝穿刺病理证实。另选取10例到我院经检查身体健康的志愿者作为对照组,无任何肝脏病史。采用实时灰阶造影,经肘静脉注射造影SonoVue,记录测定造影剂进入肝静脉到达时间（HVAT）、肝动脉到达时间（HAAT）及肝动静脉渡越时间（HAVTT）。结果：肝纤维化组超声造影剂到达肝静脉的时间较对照组明显延长,肝硬化组较对照组和肝纤维化组的超声造影剂到达肝静脉的时间要明显缩短,差异符合统计学意义（P〈0．05）;造影剂到达肝动脉的时间组间比较无统计学差异;肝硬化组肝动静脉渡越时间（HAVTT）较对照组时间明显缩短,组间比较具有统计学差异（P〈0．05）;HAVTT随着肝纤维化程度的升高而缩短,中、重度肝纤维化患者的时间缩短较明显,差异具有统计学意义（P〈0．05）。结论：超声造影在肝硬化和肝纤维化诊断上具有一定的临床诊断价值,尤其是对于诊断肝纤维化程度具有重要的参考价值,可以更好地指导临床治疗,但是对于轻度的肝纤维化的诊断的准确性上有些缺陷。     

肝纤维化发生发展及逆转过程中肝巨噬细胞亚群分类

肝纤维化是由持续性损伤修复反应引起的,导致肝组织内细胞外基质异常沉积,进一步引发肝脏结构和肝功能异常改变的一种病理过程.已有大量研究表明,肝纤维化在去除损伤因素后是可以逆转的.肝星状细胞作为主要的效应细胞,合成和分泌各种胶原和细胞外基质,一直被认为是肝纤维化发生发展的中心环节.最近的研究发现,巨噬细胞作为主要的调节细胞,能同时调节肝星状细胞的功能和基质胶原的降解,促进肝纤维化的形成.而在肝纤维化逆转过程中,促使活化的肝星状细胞凋亡和纤维胶原的降解,促进肝纤维化的逆转.目前已有研究表明,巨噬细胞亚群在肝纤维化发生发展及逆转中具有双向调控作用,但是对于动物模型体内还没有系统的研究巨噬细胞亚群的分类.本文对巨噬细胞亚群的分类研究做一个全面的综述,对肝脏巨噬细胞在肝纤维化中分子机制的进一步研究具有一定的参考价值和借鉴意义.     

Differential Sympathetic Vasomotor Activation Induced by Liver Cirrhosis in Rats

We tested the hypothesis that there is a topographical sympathetic activation in rats submitted to experimental cirrhosis. Baseline renal (rSNA) and splanchnic (sSNA) sympathetic nerve activities were evaluated in anesthetized rats. In addition, we evaluated main arterial pressure (MAP), heart rate (HR), and baroreceptor reflex sensitivity (BRS). Cirrhotic Wistar rats were obtained by bile duct ligation (BDL). MAP and HR were measured in conscious rats, and cardiac BRS was assessed by changes in blood pressure induced by increasing doses of phenylephrine or sodium nitroprusside. The BRS and baseline for the control of sSNA and rSNA were also evaluated in urethane-anesthetized rats. Cirrhotic rats had increased baseline sSNA (BDL, 102 vs control, 58 spikes/s; p<0.05), but no baseline changes in the rSNA compared to controls. These data were accompanied by increased splanchnic BRS (p<0.05) and decreased cardiac (p<0.05) and renal BRS (p<0.05). Furthermore, BDL rats had reduced basal MAP (BDL, 93 vs control, 101 mmHg; p<0.05) accompanied by increased HR (BDL, 378 vs control, 356; p<0.05). Our data have shown topographical sympathetic activation in rats submitted to experimental cirrhosis. The BDL group had increased baseline sSNA, independent of dysfunction in the BRS and no changes in baseline rSNA. However, an impairment of rSNA and HR control by arterial baroreceptor was noted. We suggest that arterial baroreceptor impairment of rSNA and HR is an early marker of cardiovascular dysfunction related to liver cirrhosis and probably a major mechanism leading to sympathoexcitation in decompensated phase.     

The Pathology of Liver Cirrhosis in Patients with Cystic Fibrosis of the Pancreas

The peculiarities of the type of liver cirrhosis that occurs in patients with cystic fibrosis of the pancreas depend on a number of factors. Two such factors, which have received little attention in the past, became apparent during a study of the livers of patients dying of this disease at the Henry Ford Hospital, Detroit. Firstly, the onset of the disease in fetal life may disturb the development of the bile duct system whose normal development is essential for normal structural relationships to be maintained in the liver. Focal lesions of intrahepatic biliary atresia will then complicate the histologic picture of “multi-lobular biliary cirrhosis”. Secondly, scars formed in an infantile liver will considerably distort the subsequent growth of the liver, resulting in bizarre nodularity. Despite massive deformation large portions of the liver will still be composed of primary parenchyma that will enable normal liver functions as revealed by laboratory tests.     

应用骨髓干细胞治疗肝硬化研究进展

随着干细胞研究的深入和技术的发展,再生医学的干细胞疗法治疗肝脏疾病已成为研究热点。骨髓来源造血干细胞和间充质干细胞等在肝脏疾病治疗方面有巨大潜力。骨髓干细胞参与肝纤维化与肝硬化修复主要包括迁移、归巢与转化等过程,并需要多种细胞因子和趋化因子的协同作用促进肝细胞再生与减轻肝纤维化。本文拟对骨髓干细胞治疗肝硬化的最新研究进展进行综述。     

壮肝逐瘀煎对肝纤维化大鼠肝脏Fas/FasL表达的影响

目的:研究壮肝逐瘀煎对肝纤维化(HF)大鼠肝脏肝星状细胞(HSC)的凋亡因子Fas/FasL表达的影响,探讨该方抗HF的作用机制。方法:58只SD大鼠随机取14只作为正常对照组,正常饲养。剩余大鼠采用CCl4复合因素法进行HF造模,实验第4周末随机处死造模大鼠4只,证实HF形成。其余随机分为病理模型组、壮肝逐瘀煎组、秋水仙碱组及大黄蛰虫丸组,每组10只。病理模型组给予生理盐水灌胃处理,其他3组分别予对应药物灌胃处理。治疗第6周末,处死所有大鼠,获取肝组织,HE染色光镜观察肝组织结构变化,免疫组化染色分析Fas、FasL分布。结果:与病理模型组大鼠比较,壮肝逐瘀煎治疗组肝小叶结构趋于正常,纤维间隔明显变薄,肝组织Fas、FasL的表达显著表达显著减少(P0.01)。结论:壮肝逐瘀煎能够明显改善HF大鼠肝脏的病理变化,具有明显的抗HF作用,其作用机制可能与壮肝逐瘀煎能调控HSC中凋亡因子Fas/FasL的表达有关。     

The Value of MRI in the Diagnosis of Primary Biliary Cirrhosis and Assessment of Liver Fibrosis

Objectives

To evaluate MRI findings in patients with primary biliary cirrhosis (PBC) and to determine the value of MRI in the diagnosis of PBC and assessment of liver fibrosis.

Materials and Methods

This study reviewed the prevalence of MRI abnormalities seen in 45 PBC patients in the past four years, including 33 patients who underwent liver biopsy. Correlation between the MRI findings and the pathological stage was determined.

Results

There were 33 patients who underwent liver biopsy. Twenty-five patients (75.8%) had non-homogeneous changes in the liver signal intensity, 25 (75.8%) had a periportal halo sign, and 29 (87.9%) had lymphadenopathy. The short axis of the enlarged lymph nodes was a mean of 1.2±0.3 cm. A strong positive correlation was observed between histological stage and the inhomogeneity of liver signal intensity (P<0.001). There were significant differences among the four histological stages based on the periportal halo sign (P=0.034), and the grading of the periportal halo sign was found to be significantly correlated with the histological stage (P<0.001). Grading of the periportal halo sign was significantly different at stage II versus III, and stage III versus IV; no significant difference was found between stages I and II. There were also no significant differences among the four histological states in the occurrence and size of enlarged lymph nodes (P=0.674 and P=0.394).

Conclusion

MRI is valuable in the diagnosis of PBC, and the periportal halo sign and liver signal intensity help to evaluate the degree of liver fibrosis.     

Serum Cell Death Biomarkers for Prediction of Liver Fibrosis and Poor Prognosis in Primary Biliary Cirrhosis

The development of simple, noninvasive markers of liver fibrosis is urgently needed for primary biliary cirrhosis (PBC). This study examined the ability of several serum biomarkers of cell death to estimate fibrosis and prognosis in PBC. A cohort of 130 patients with biopsy-proven PBC and 90 healthy subjects were enrolled. We assessed the utility of the M30 ELISA, which detects caspase-cleaved cytokeratin-18 (CK-18) fragments and is representative of apoptotic cell death, as well as the M65 and newly developed M65 Epideath (M65ED) ELISAs, which detect total CK-18 as indicators of overall cell death, in predicting clinically relevant fibrosis stage. All 3 cell death biomarkers were significantly higher in patients with PBC than in healthy controls and were significantly correlated with fibrosis stage. The areas under the receiver operating characteristic curve for the M65 and M65ED assays for differentiation among significant fibrosis, severe fibrosis, and cirrhosis were 0.66 and 0.76, 0.66 and 0.73, and 0.74 and 0.82, respectively. In multivariate analysis, high M65ED (hazard ratio 6.13; 95% confidence interval 1.18–31.69; P = 0.031) and severe fibrosis (hazard ratio 7.45; 95% confidence interval 1.82–30.51; P = 0.005) were independently associated with liver-related death, transplantation, or decompensation. High serum M65ED was also significantly associated with poor outcome in PBC (log-rank test; P = 0.001). Noninvasive cell death biomarkers appear to be clinically useful in predicting fibrosis in PBC. Moreover, the M65ED assay may represent a new surrogate marker of adverse disease outcome.     

siRNA对肝纤维化的抑制作用

目的:研究肝星状细胞(HSC)中smad2特异性小干扰RNA(siRNA)对Ⅰ型胶原表达的抑制作用,探讨抗肝纤维化的基因治疗新方法。方法:设计合成靶向Smad2基因的siRNA,将筛选成功的siRNA瞬时转染入体外培养的肝星状细胞(HSC),并给予转化生长因子β(TGF-β)刺激,应用RT-PCR和Western blot技术检测对照组与实验组Ⅰ型胶原mRNA水平和蛋白水平表达差异,研究siRNA对Ⅰ型胶原表达的抑制作用。结果:siRNA能明显降低肝星状细胞中Smad2的RNA和蛋白的表达水平,证实筛选的siRNA有效,能特异性抑制Smad2的基因表达;TGF-β刺激肝星状细胞后,与对照组比较,siRNA转染组细胞外基质(ECM)成分Ⅰ型胶原的表达水平明显降低(P<0.05)。结论:siRNA能够抑制TGFβ对肝星状细胞的激活,阻断TGFβ-Smads传导通路,使Ⅰ型胶原分泌下调,有效抑制TGFβ诱导的肝纤维化。     

siRNA对肝纤维化的抑制作用

目的：研究肝星状细胞（use）中smad2特异性小干扰RNA（siRNA）对I型胶原表达的抑制作用,探讨抗肝纤维化的基因治疗新方法。方法：设计合成靶向Smad2基因的siRNA,将筛选成功的siRNA瞬时转染入体外培养的肝星状细胞（HSC）,并给予转化生长因子p（TGF．B）刺激,应用RT—PCR和Westernblot技术检测对照组与实验组I型胶原mRNA水平和蛋白水平表达差异,研究siRNA对I型胶原表达的抑制作用。结果：siRNA能明显降低肝星状细胞中Smad2的RNA和蛋白的表达水平,证实筛选的siRNA有效,能特异性抑制Smad2的基因表达;TGF-β刺激肝星状细胞后,与对照组比较,siRNA转染组细胞外基质（ECM）成分I型胶原的表达水平明显降低（P〈0．05）。结论：siRNA能够抑制TGFβ对肝星状细胞的激活,阻断TGFB—Smads传导通路,使I型胶原分泌下调,有效抑制TGFB诱导的肝纤维化。     

幽门螺旋杆菌诱发肝硬化大鼠高氨血症的实验研究

目的：探讨幽门螺旋杆菌与肝硬化大鼠高氨血症的相关性。方法：选取32 只SD大鼠,将其随机分为正常组(n=8)、Hp 感染组 (n=8)、肝硬化组(n=8)、肝硬化合并Hp 感染组(n=8)。肝硬化组及肝硬化合并Hp 感染组给予50%四氯化碳橄榄油腹腔注射;正常 组与Hp 感染组给予同量的橄榄油腹腔注射。从建立模型的第9 周开始,Hp 感染组与肝硬化合并Hp 感染组每周感染2 次Hp,共 8 次。记录各组大鼠的一般状态,检测大鼠血氨水平及胃粘膜Hp数量。结果：与正常组比较,肝硬化组及肝硬化合并Hp感染组体 重较低(P＜0.05);与肝硬化组比较,肝硬化合并Hp 感染组体重较低(P＜0.05)。与正常组比较,其余各组胃粘膜Hp 数量较高(P＜ 0.05),与肝硬化组与Hp 感染组比较,肝硬化合并Hp 感染组胃粘膜Hp 数量高(P＜0.05)。与正常组比较,肝硬化组及肝硬化合并 Hp 感染组血氨水平高(P＜0.05),与肝硬化组比较,肝硬化合并Hp 感染组血氨水平高(P＜0.05)。结论：幽门螺旋杆菌能诱发肝硬 化大鼠高氨血症     

Impaired Expression of Type I and Type II Interferon Receptors in HCV-Associated Chronic Liver Disease and Liver Cirrhosis

Purpose

Chronic Hepatitis C Virus (HCV)-infected patients with liver cirrhosis (LC) respond poorly to interferon-alpha (IFN-α) and ribavirin (RBV) combination therapy, but the reason for this is unclear. We previously reported that HCV-infection induces endoplasmic reticulum (ER) stress and autophagy response that selectively down regulates the type I IFN-α receptor-1 (IFNAR1) and RBV transporters (CNT1 and ENT1), leading to IFN-α/RBV resistance. The goal of this study is to verify whether an increase in ER stress and autophagy response is also associated with the reduced expression of IFNAR1 and RBV transporters in chronic HCV-infected patients.

Methods

Primary human hepatocytes (PHH) were infected with cell culture grown HCV particles (JFH-ΔV3-Rluc). HCV replication was confirmed by the detection of viral RNA by RT-qPCR and HCV-core protein by Western blotting. The ER stress and autophagy response and expression of IFN receptors and RBV transporters in HCV infected PHH and liver tissues derived from patients were measured by Western blotting.

Result

HCV infection of PHH showed impaired expression of IFNAR1, IFNγR1 (Type II IFN receptor) and RBV transporters but not IL10Rβ (Type III IFN-λ receptor). ER stress markers (BiP, IRE1α and peIF2α) and autophagy response (LC3II, Beclin 1 and ATG5) were induced in HCV infected chronic liver disease (CLD) and LC patients. Liver biopsies (CLD) show a 50% reduced expression of IFNAR1 and RBV transporters. Furthermore, the expression of IFNAR1 and RBV transporters was impaired in almost all LC patients.

Conclusion

HCV infection induces ER stress and autophagy response in infected PHH and chronically infected liver tissues. The expression of IFNAR1, IFNγR1 and RBV transporters were significantly impaired in CLD and cirrhotic livers. Our study provides a potential explanation for the reduced response rate of IFN-α and RBV combination therapy in HCV infected patients with liver cirrhosis.     

腹腔注射四氯化碳辅以饮食改良制备犬慢性肝纤维化模型

探讨一种经典的、与人类慢性肝纤维化——肝硬化进程相似的大动物模型建立方法.采用15只成年健康中华田园犬:对照组5只,使用生理盐水腹腔注射及正常饲料干预;实验组10只,采用小剂量四氯化碳(CCl4)腹腔注射及高脂饮食干预.间断采血检测肝功能、血清学肝纤维化指标,B超引导下定期肝穿活检作HE染色和Masson染色.56周后所有实验动物成功诱导至不同程度的肝纤维化.丙氨酸氨基转移酶、门冬氨酸转氨酶、球蛋白、总胆红素、γ-谷氨酰基转肽酶以及透明质酸与对照组相比,差异均有统计学意义(P<0.05).联合应用小剂量CCl4和单纯高脂饮食可成功诱导犬慢性肝纤维化-肝硬化模型,该方法动物存活率和成模率均较高,可为后续的相关研究提供更好的平台.     

非酒精性脂肪性肝病大鼠肝脏PPAR-γ的表达

目的：研究PPAR-γ在非酒精性脂肪性肝病（NAFLD）大鼠肝脏组织中的表达,探讨非酒精脂肪性肝病可能的发病机制。方法：雄性SD大鼠30只,随机分为A（正常组）15只普通饮食,B（高脂组）15只高脂饮食。8周后,自两组各随机抽取2只大鼠处死,光镜观察证实脂肪肝造模成功,继续喂养4周后处死所有大鼠,取血清做免疫生化检查,取肝组织标本,分别以光镜观察做出NAS评分,免疫组化和PCR法检测肝组织PPAR-γ蛋白的表达。结果：1.高脂饮食可以成功的复制NAFLD的大鼠模型;2.血清GLU、TC、TG、HDL-C、LDL-C在高脂组表达量较正常组明显升高,差异具有统计学意义（P〈0.05）;3.免疫组化显示：高脂组PPAR-γ表达量较正常组升高;结论：1.高脂饮食可成功复制NAFLD模型;2.PPAR-γ在NAFLD大鼠肝脏成脂性改变中具有重要作用。