Gan, Lay Theng
Description
Non-alcoholic fatty liver disease (NAFLD) affects ~30% of the
world population with similar or higher prevalence in Australia.
The pathology of NAFLD ranges from benign simple steatosis (SS)
to non-alcoholic steatohepatitis (NASH), with fibrosis that can
progress to cirrhosis. Understanding the pathogenesis of NASH
remains a challenge. In both humans and mice, obesity, diabetes
and metabolic syndrome are associated with NAFLD, but free
cholesterol (FC)...[Show more] accumulates in livers showing NASH but not in
those with SS. Such cholesterol-loaded livers are sensitised to
cytokine-mediated mitochondrial injury. However, at the time this
research was conducted, there was no direct evidence that linked
FC lipotoxicity to hepatocyte cell death or inflammatory
recruitment.
In this thesis, primary murine hepatocytes were loaded with FC by
exposing them to human low-density lipoprotein (LDL), and these
cells were used to characterise the mechanisms of hepatocellular
injury and cell death (apoptosis and necrosis). In particular we
tested the hypothesis that c-Jun N-terminal kinase (JNK)
activation and mitochondrial injury are essential steps in FC
hepatocellular lipotoxicity. We also examined how FC-injured
hepatocytes could promote activation of Kupffer cells (KC), which
is a key feature of liver inflammation in NASH.
The background to NAFLD and NASH as an important public health
problem, and as a liver disease is introduced in Chapter 1.
Concepts about NASH pathogenesis are discussed in light of
available knowledge up to the start of this PhD in 2011. The
common research materials and methods are discussed in Chapter
2.
In Chapter 3, the novel in vitro model of FC-loaded primary
murine hepatocytes is described. Briefly, primary murine
hepatocytes (C57B6/J wild type [WT]) were incubated with LDL
(0–40 µM), and shown to be loaded with FC. The subcellular
sites of primary hepatocyte FC were determined by co-localising
filipin fluorescence with organelle markers. The results were
compared with the intracellular distribution of FC seen in
atherogenic diet-fed foz/foz mouse livers, an in vivo model of
NASH. In mice with NASH, FC co-localised to plasma membrane (PM),
mitochondria and endoplasmic reticulum (ER) compartments. This
pattern was replicated in hepatocytes incubated with LDL to
dose-dependently increase hepatocyte FC. Further, FC loading
reduced PM fluidity and caused cell surface blebbing, with
release of extracellular vesicles (EVs), as evident on scanning
and transmission electron microscopy (EM).
In Chapter 4, the role of JNK1 in FC-mediated hepatocellular
injury was explored using primary hepatocytes from WT, Jnk1-/-and
Jnk2-/- mice. These cells were incubated with LDL (0–40 μM),
and molecular pathways of FC-mediated cell death determined by
western blot and immunofluorescence. Separate experiments were
performed with chemical specific JNK1 inhibitors (CC-401, CC-930
and CC-003) in WT hepatocytes. Supernatant was collected from
FC-loaded WT, Jnk1-/- and Jnk2-/- hepatocyte experiments and
assayed for high mobility group box 1 (HMGB1) and EVs.
Supernatant or EVs from WT FC-injured primary hepatocytes were
added to primary KC cultures from WT and Tlr4-/- mice.
Ultrastructural changes were assessed by electron microscopy
(EM), while TNF and IL-1β release into the supernatant was
quantified by enzyme-linked immunosorbent assay (ELISA).
FC loading caused dose-dependent LDH leakage, apoptosis, necrosis
and HMGB1 release. At 40 μM LDL, hepatocellular cell death was
associated with JNK1 activation, c-Jun phosphorylation,
mitochondrial membrane pore transition, cellular oxidative stress
(increased GSSG with reciprocal decrease in GSH concentration)
and ATP depletion. Administration of JNK inhibitors (CC-401,
CC-930 and CC-003) ameliorated hepatocellular apoptosis and
necrosis, while Jnk1-/- hepatocytes were refractory to FC-induced
injury. Cyclosporine A (inhibits mitochondrial membrane
permeability transition [MPT] pore opening) and caspase-3
inhibitors abrogated FC-mediated hepatocellular cell death.
Importantly, there was no increase of ER stress proteins in vitro
or in vivo, while inhibitors of ER stress-mediated cell death,
4-phenylbutyric acid failed to protect FC-loaded hepatocytes.
In Chapter 5, the supernatant and EVs isolated from pervious
experiments were studied, in particular their ability to active
KCs and proinflammatory pathways. Addition of HMGB1-enriched
culture medium from FC-loaded hepatocytes activated KCs, as
assessed by increased nuclear NF-κB (p65) fluorescence, release
of IL-1β and TNF-α, and ultrastructural changes. These effects
were mitigated by administration of HMGB1-neutralising antibody,
and were absent in Myd88-/- knockout hepatocytes. As mentioned
above, deposition of FC within the PM of hepatocytes also
released EVs and these were shown here to contain HMGB1. The
results allowed us to conclude that FC loading of hepatocytes
stimulates HMGB1 secretion and release of PM-derived EVs. In
turn, HMGB1 activates KCs through a TLR4-MyD88 dependent
process.
In Chapter 6 we sought to characterise EVs from both human and
experimental NASH, with a particular focus on their
cell-of-origin and protein composition. To achieve this, EVs were
isolated from healthy human controls, NAFLD patients with simple
SS, NASH but with no or mild-moderate fibrosis (F0-F2), and NAFLD
with advanced fibrosis (F3-F4), as well as atherogenic diet-fed
foz/foz mice with NASH and wildtype (WT) mice with SS.
Composition of EVs harvested from the circulation was studied
using a combination of western blotting and flow cytometry. EVs
were found to circulate in both experimental and human NAFLD,
with significantly higher levels in patients with clinical NASH
and advanced fibrosis compared with healthy controls or those
with SS. Furthermore, these EVs were highly enriched with HMGB1
and TLR4, in addition to CD4-, CD8-, CD36- and CD147-positive
markers. A significant proportion of circulating EVs were
hepatocellular in origin, as shown by their “tags” of
asialoglycoprotein receptor 1 (ASGRP1) and solute carrier family
10 member 1 (SCL10A1). Chapter 7 summarises the key experimental
findings from Chapters 3 to 6 in a broader context, and proposes
several important directions for future research.
Collectively, the research findings presented here demonstrate
that FC deposition in mitochondria and PM causes hepatocyte cell
death, confirm the role of JNK1 activation as an important
pathway for hepatocyte lipotoxic injury and reveal a link between
HMGB1 and EVs with lipotoxicity and engagement of KC activation
in a TLR4-dependent manner. It is proposed that this is a likely
causal link in the transition from steatosis to NASH.
Additionally, in both human and experimental NASH, distinct EV
populations circulate, and this provides a potential for
development of novel non-invasive diagnostic tests, as well as
molecular targets.
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