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IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 DOI: 10.1016/S2589-5559(24)00264-7
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引用次数: 0
Editorial Board page 编辑委员会页面
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 DOI: 10.1016/S2589-5559(24)00261-1
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引用次数: 0
Clinical and molecular characterization of steatotic liver disease in the setting of immune-mediated inflammatory diseases 免疫介导的炎症性疾病背景下脂肪肝的临床和分子特征描述
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.jhepr.2024.101167
Enrique García-Nieto , Juan Carlos Rodriguez-Duque , Coral Rivas-Rivas , Paula Iruzubieta , María José Garcia , Laura Rasines , Ana Alvarez-Cancelo , Agustín García-Blanco , José Ignacio Fortea , Angela Puente , Beatriz Castro , Maria Luisa Cagigal , Javier Rueda-Gotor , Ricardo Blanco , Montserrat Rivero , Susana Armesto , Marcos Antonio González-López , Anna Esteve Codina , Marta Gut , Jose Pedro Vaque , María Teresa Arias-Loste

Background & Aims

Growing evidence suggests an increased prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in the context of immune-mediated inflammatory diseases (IMIDs). We aimed to clinically and mechanistically characterize steatotic liver disease (SLD) in a prospective cohort of patients with IMID compared to controls.

Methods

Cross-sectional, case-control study including a subset of patients with IMID. Controls from the general population were age-, sex-, type 2 diabetes-, and BMI-matched at a 1:2 ratio. SLD was established using controlled attenuation parameter. Liver biopsies were obtained when significant liver fibrosis was suspected. Total RNA was extracted from freshly frozen cases and analyzed by RNA-seq. Differential gene expression was performed with ‘limma-voom’. Gene set-enrichment analysis was performed using the fgsea R package with a preranked “limma t-statistic” gene list.

Results

A total of 1,456 patients with IMID and 2,945 controls were included. Advanced SLD (liver stiffness measurement ≥9.7 kPa) (13.46% vs. 3.79%; p <0.001) and advanced MASLD (12.8% vs. 2.8%; p <0.001) prevalence were significantly higher among patients with IMID than controls. In multivariate analysis, concomitant IMID was an independent, and the strongest, predictor of advanced SLD (adjusted odds ratio 3.318; 95% CI 2.225-4.947; p <0.001). Transcriptomic data was obtained in 109 patients and showed 87 significant genes differentially expressed between IMID-MASLD and control-MASLD. IMID-MASLD cases displayed an enriched expression of genes implicated in pro-tumoral activities or the control of the cell cycle concomitant with a negative expression of genes related to metabolism.

Conclusions

The prevalence of advanced SLD and MASLD is disproportionately elevated in IMID cohorts. Our findings suggest that IMIDs may catalyze a distinct MASLD pathway, divergent from classical metabolic routes, highlighting the need for tailored clinical management strategies.

Impact and implications

The prevalence of steatotic liver disease with advanced fibrosis is increased in patients with immune-mediated inflammatory diseases, independent of classic metabolic risk factors or high-risk alcohol consumption. Transcriptomic analysis revealed a unique gene expression signature associated with cellular activities that are compatible with a liver condition leading to an accelerated and aggressive form of steatotic liver disease. Our findings underscore the importance of heightened screening for advanced liver disease risk across various medical disciplines overseeing patients with immune-mediated inflammatory diseases.
背景& 目的越来越多的证据表明,在免疫介导的炎症性疾病(IMID)的背景下,代谢功能障碍相关性脂肪性肝病(MASLD)的发病率越来越高。我们的目的是从临床和机理上对前瞻性队列中的 IMID 患者与对照组进行脂肪肝(SLD)比较。来自普通人群的对照组在年龄、性别、2 型糖尿病和体重指数方面均按 1:2 的比例进行了匹配。使用受控衰减参数确定 SLD。如果怀疑有明显的肝纤维化,则进行肝活检。从新鲜冷冻病例中提取总 RNA,并进行 RNA-seq 分析。使用 "limma-voom "进行差异基因表达分析。使用fgsea R软件包和预先排序的 "limma t-statistic "基因列表进行了基因集富集分析。IMID患者的晚期SLD(肝脏硬度测量值≥9.7 kPa)(13.46% vs. 3.79%; p <0.001)和晚期MASLD(12.8% vs. 2.8%; p <0.001)患病率明显高于对照组。在多变量分析中,并发 IMID 是晚期 SLD 的独立且最强的预测因素(调整后的几率比 3.318; 95% CI 2.225-4.947; p <0.001)。研究人员获得了109例患者的转录组数据,结果显示IMID-MASLD与对照组-MASLD之间有87个显著的基因表达差异。IMID-MASLD病例中与促肿瘤活动或细胞周期控制有关的基因表达丰富,而与新陈代谢有关的基因表达为负。我们的研究结果表明,免疫介导的炎症性疾病可能会催化一种不同于传统代谢途径的独特的MASLD途径,这就凸显了制定有针对性的临床管理策略的必要性。影响和意义免疫介导的炎症性疾病患者中伴有晚期纤维化的脂肪性肝病发病率增加,与传统的代谢风险因素或高风险饮酒无关。转录组分析揭示了一种独特的基因表达特征,这种特征与导致脂肪肝的加速和侵袭性形式的肝病的细胞活动有关。我们的研究结果表明,对免疫介导的炎症性疾病患者的不同医学领域加强晚期肝病风险筛查非常重要。
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引用次数: 0
Copyright and information 版权和信息
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/S2589-5559(24)00243-X
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引用次数: 0
MASLD-related HCC: Multicenter study comparing patients with and without cirrhosis MASLD 相关 HCC:比较有肝硬化和无肝硬化患者的多中心研究
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.jhepr.2024.101160
Carole Vitellius , Elvire Desjonqueres , Marie Lequoy , Giuliana Amaddeo , Isabelle Fouchard , Gisele N’Kontchou , Clemence M. Canivet , Marianne Ziol , Hélène Regnault , Adrien Lannes , Frederic Oberti , Jerome Boursier , Nathalie Ganne-Carrie

Background & Aims

Despite its growing incidence, hepatocellular carcinoma (HCC) related to metabolic dysfunction-associated steatotic liver disease (MASLD) in non-cirrhotic livers remains poorly characterized. We compared the characteristics, management, survival, and trends of MASLD-related HCC in patients with or without underlying cirrhosis in a large multicenter cohort.

Methods

A total of 354 cases of MASLD-related HCC presented at the liver tumor meetings of four French university hospitals between 2007 and 2018 were included in the study. Data were extracted from the meetings’ databases and from the French Birth and Death Registry.

Results

Of HCC cases, 35% occurred in the absence of cirrhosis. HCC was diagnosed through screening in 60% of patients with cirrhosis, and incidentally in 72% of patients without it. Patients without cirrhosis were older, had a greater tumor burden, but also better liver function than patients with cirrhosis. Patients without cirrhosis showed better overall survival than those with cirrhosis (p = 0.043). However, cirrhosis was not independently associated with overall survival, the independent predictors were age, liver function, tumor burden and BCLC classification. Patients without cirrhosis underwent surgery more frequently than patients with cirrhosis (41% vs. 11%, p <0.001), even in cases where the largest tumors were ≥5 cm (42% vs. 14%, p = 0.002) or there were four or more lesions (19% vs. 2%, p = 0.024). Among the patients (with/without cirrhosis) who underwent surgery, survival was not significantly different. The cirrhosis/no cirrhosis ratio remained stable over the study period.

Conclusions

In MASLD-related HCC, patients without cirrhosis account for 35% of cases and have poor prognostic factors (higher age and larger tumors) but also better liver function, resulting in more aggressive management of advanced tumors and better survival compared to patients with cirrhosis.

Impact and implications:

The incidence of hepatocellular carcinoma (HCC) related to metabolic dysfunction-associated steatotic liver disease (MASLD) is projected to increase by 47% to 130% by year 2030 with one-third of cases occurring in non-cirrhotic livers, making them inaccessible to screening and therefore more likely to be diagnosed at an advanced stage. Our study shows that survival in patients with MASLD-related HCC depends on age, tumor burden and underlying liver function and the preserved liver function of these non-cirrhotic patients allows them to be managed surgically. A better understanding of the pathophysiological processes driving HCC occurrence in patients with non-cirrhotic MASLD will help guide the screening and early management of these patients.
背景& 目的尽管肝细胞癌(HCC)的发病率越来越高,但在非肝硬化肝脏中与代谢功能障碍相关性脂肪性肝病(MASLD)有关的肝细胞癌(HCC)的特征仍不十分明确。我们在一个大型多中心队列中比较了有或无基础肝硬化患者中与 MASLD 相关的 HCC 的特征、管理、存活率和趋势。研究纳入了 2007 年至 2018 年间在法国四所大学医院肝脏肿瘤会议上报告的 354 例与 MASLD 相关的 HCC。数据来自会议数据库和法国出生与死亡登记处。结果在HCC病例中,35%的病例在没有肝硬化的情况下发生。60%的肝硬化患者是通过筛查确诊的,72%的非肝硬化患者是偶然确诊的。与肝硬化患者相比,无肝硬化患者年龄更大,肿瘤负荷更大,但肝功能更好。无肝硬化患者的总生存率高于有肝硬化的患者(P = 0.043)。然而,肝硬化与总生存率并无独立关联,年龄、肝功能、肿瘤负荷和BCLC分类才是独立的预测因素。未患肝硬化的患者比患肝硬化的患者更常接受手术治疗(41% 对 11%,p <0.001),即使在最大肿瘤≥5 厘米(42% 对 14%,p = 0.002)或有四个或更多病灶(19% 对 2%,p = 0.024)的情况下也是如此。在接受手术的患者(有/无肝硬化)中,存活率没有显著差异。结论 在MASLD相关HCC病例中,无肝硬化患者占35%,他们的预后较差(年龄较大、肿瘤较大),但肝功能较好,因此与肝硬化患者相比,晚期肿瘤的治疗更积极,生存率更高。影响和意义:预计到2030年,与代谢功能障碍相关性脂肪性肝病(MASLD)有关的肝细胞癌(HCC)发病率将增加47%至130%,其中三分之一的病例发生在非肝硬化肝脏,使其无法接受筛查,因此更有可能在晚期阶段被诊断出来。我们的研究表明,MASLD 相关 HCC 患者的存活率取决于年龄、肿瘤负荷和基础肝功能,而这些非肝硬化患者的肝功能得以保留,因此可以对他们进行手术治疗。更好地了解非肝硬化MASLD患者发生HCC的病理生理过程将有助于指导这些患者的筛查和早期治疗。
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引用次数: 0
Editorial Board page 编辑委员会页面
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/S2589-5559(24)00241-6
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引用次数: 0
Persistent varices in cured patients: Understanding the role of hepatic venous pressure gradient 治愈患者中的顽固性静脉曲张:了解肝静脉压力梯度的作用
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.jhepr.2024.101170
Pol Olivas , Alexandre Soler-Perromat , Luis Tellez , José Antonio Carrión , Edilmar Alvarado-Tapias , José Ferrusquía-Acosta , Sabela Lens , Antonio Guerrero , Ángeles Falgà , Pamela Vizcarra , Lara Orts , Valeria Perez-Campuzano , Sarah Shalaby , Sonia Torres , Anna Baiges , Fanny Turon , Juan Carlos García-Pagán , Ángeles García-Criado , Virginia Hernández-Gea

Background & Aims

Etiologic factor removal (ER) drives recompensation and improves portal hypertension in cirrhosis. Esophageal varices (EV) and portosystemic shunts (PSS) have been found in patients despite hepatic venous pressure gradient (HVPG) dropping below 10 mmHg after ER, questioning HVPG accuracy in reflecting true portal pressure in the setting of ER. We aim to evaluate the correlation of HVPG with direct portal pressure (DPP) in patients with persistence of EV after ER despite HVPG <10 mmHg.

Methods

This is a bicentric ‘proof of concept’ study evaluating HVPG and ultrasound-guided percutaneous DPP in patients with HCV or alcohol-related cirrhosis with persistent varices and HVPG <10 mmHg after at least 5 years of ER.

Results

Seven patients with HCV and three with alcohol-related cirrhosis with persistent varices and HVPG <10 mmHg after at least 5 years of ER were included. At evaluation, all patients had a patent portal vein and were compensated. The median platelet count was 129.5 (IQR 95–145) × 109/ml, and the median liver stiffness measurement was 16.15 (IQR 14.4–22.3) kPa. In five patients, EV remained the same size (two large and three small), and five downsized to small after ER. Wedge hepatic vein pressure (median 19 [IQR 16.5–20] mmHg) and portal pressure (median 18 [IQR 15–19.5] mmHg) had an excellent correlation (R = 0.93, p <0.0001). Portal pressure gradient (PPG) confirmed the absence of clinically significant portal hypertension as identified by HVPG across all the patients.

Conclusions

HVPG accurately reflects PPG in the context of HCV and alcohol-related cirrhosis regression. After ER, EV may persist despite HVPG <10 mmHg. The benefit of prophylaxis in patients with EV and HVPG <10 mmHg is unknown. Future studies with clinical endpoints are needed to validate our findings.

Impact and implications:

Despite a favorable evolution after the removal of the etiologic factor, varices persist in some patients, and there is a lack of concise guidelines for the evaluation and management of portal hypertension in this population. Our research underscores the persistence of varices in the absence of clinically significant portal hypertension and significantly demonstrates the accuracy of hepatic venous pressure gradient (HVPG) in reflecting portal vein pressure in this specific patient group. These findings emphasize the crucial role of HVPG in the assessment of portal hypertension after etiologic factor removal and lay the groundwork for further investigation into clinical outcomes and the necessity of non-selective beta-blockers in individuals with persistent varices after the removal of etiologic factor.
背景& 目的去除致病因子(ER)可促进肝硬化门脉高压的恢复和改善。尽管ER后肝静脉压阶差(HVPG)降至10 mmHg以下,但仍有患者发现食管静脉曲张(EV)和门脉分流(PSS),这对ER时HVPG反映真实门脉压力的准确性提出了质疑。方法这是一项双中心 "概念验证 "研究,对至少 5 年ER 后仍有静脉曲张且 HVPG≥10 mmHg 的 HCV 或酒精相关肝硬化患者的 HVPG 和超声引导下经皮 DPP 进行评估。结果纳入了 7 名患有 HCV 的患者和 3 名患有酒精相关肝硬化的患者,这些患者均患有顽固性静脉曲张,且在接受 ER 至少 5 年后 HVPG <10 mmHg。在评估时,所有患者的门静脉均通畅,并得到代偿。血小板计数中位数为 129.5(IQR 95-145)×109/ml,肝硬度测量中位数为 16.15(IQR 14.4-22.3)kPa。五名患者的EV大小保持不变(两大三小),五名患者的EV在急诊室手术后缩小为小EV。楔形肝静脉压(中位数 19 [IQR 16.5-20] mmHg)和门静脉压(中位数 18 [IQR 15-19.5] mmHg)具有极好的相关性(R = 0.93,p <0.0001)。门静脉压力梯度(PPG)证实,所有患者均无 HVPG 发现的临床意义上的门静脉高压。ER 后,尽管 HVPG 为 10 mmHg,但 EV 仍可能持续存在。对于 EV 和 HVPG <10 mmHg 患者,预防性治疗的益处尚不清楚。影响和意义:尽管去除致病因素后病情发展良好,但一些患者的静脉曲张仍持续存在,目前缺乏评估和管理这类人群门静脉高压症的简明指南。我们的研究强调了在没有临床显著门静脉高压的情况下静脉曲张的持续存在,并显著证明了肝静脉压力梯度(HVPG)在反映这一特殊患者群体的门静脉压力方面的准确性。这些发现强调了 HVPG 在病因去除后评估门静脉高压中的关键作用,并为进一步研究临床结果和去除病因后静脉曲张持续存在者使用非选择性β-受体阻滞剂的必要性奠定了基础。
{"title":"Persistent varices in cured patients: Understanding the role of hepatic venous pressure gradient","authors":"Pol Olivas ,&nbsp;Alexandre Soler-Perromat ,&nbsp;Luis Tellez ,&nbsp;José Antonio Carrión ,&nbsp;Edilmar Alvarado-Tapias ,&nbsp;José Ferrusquía-Acosta ,&nbsp;Sabela Lens ,&nbsp;Antonio Guerrero ,&nbsp;Ángeles Falgà ,&nbsp;Pamela Vizcarra ,&nbsp;Lara Orts ,&nbsp;Valeria Perez-Campuzano ,&nbsp;Sarah Shalaby ,&nbsp;Sonia Torres ,&nbsp;Anna Baiges ,&nbsp;Fanny Turon ,&nbsp;Juan Carlos García-Pagán ,&nbsp;Ángeles García-Criado ,&nbsp;Virginia Hernández-Gea","doi":"10.1016/j.jhepr.2024.101170","DOIUrl":"10.1016/j.jhepr.2024.101170","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Etiologic factor removal (ER) drives recompensation and improves portal hypertension in cirrhosis. Esophageal varices (EV) and portosystemic shunts (PSS) have been found in patients despite hepatic venous pressure gradient (HVPG) dropping below 10 mmHg after ER, questioning HVPG accuracy in reflecting true portal pressure in the setting of ER. We aim to evaluate the correlation of HVPG with direct portal pressure (DPP) in patients with persistence of EV after ER despite HVPG &lt;10 mmHg.</div></div><div><h3>Methods</h3><div>This is a bicentric ‘proof of concept’ study evaluating HVPG and ultrasound-guided percutaneous DPP in patients with HCV or alcohol-related cirrhosis with persistent varices and HVPG &lt;10 mmHg after at least 5 years of ER.</div></div><div><h3>Results</h3><div>Seven patients with HCV and three with alcohol-related cirrhosis with persistent varices and HVPG &lt;10 mmHg after at least 5 years of ER were included. At evaluation, all patients had a patent portal vein and were compensated. The median platelet count was 129.5 (IQR 95–145) × 10<sup>9</sup>/ml, and the median liver stiffness measurement was 16.15 (IQR 14.4–22.3) kPa. In five patients, EV remained the same size (two large and three small), and five downsized to small after ER. Wedge hepatic vein pressure (median 19 [IQR 16.5–20] mmHg) and portal pressure (median 18 [IQR 15–19.5] mmHg) had an excellent correlation (R = 0.93, <em>p</em> &lt;0.0001). Portal pressure gradient (PPG) confirmed the absence of clinically significant portal hypertension as identified by HVPG across all the patients.</div></div><div><h3>Conclusions</h3><div>HVPG accurately reflects PPG in the context of HCV and alcohol-related cirrhosis regression. After ER, EV may persist despite HVPG &lt;10 mmHg. The benefit of prophylaxis in patients with EV and HVPG &lt;10 mmHg is unknown. Future studies with clinical endpoints are needed to validate our findings.</div></div><div><h3>Impact and implications:</h3><div>Despite a favorable evolution after the removal of the etiologic factor, varices persist in some patients, and there is a lack of concise guidelines for the evaluation and management of portal hypertension in this population. Our research underscores the persistence of varices in the absence of clinically significant portal hypertension and significantly demonstrates the accuracy of hepatic venous pressure gradient (HVPG) in reflecting portal vein pressure in this specific patient group. These findings emphasize the crucial role of HVPG in the assessment of portal hypertension after etiologic factor removal and lay the groundwork for further investigation into clinical outcomes and the necessity of non-selective beta-blockers in individuals with persistent varices after the removal of etiologic factor.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"6 10","pages":"Article 101170"},"PeriodicalIF":9.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Altered fatty acid metabolism rewires cholangiocarcinoma stemness features 脂肪酸代谢改变重塑了胆管癌干性特征
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.jhepr.2024.101182
Giulia Lori , Mirella Pastore , Nadia Navari , Benedetta Piombanti , Richell Booijink , Elisabetta Rovida , Ignazia Tusa , Monika Lewinska , Jesper B. Andersen , Tiziano Lottini , Annarosa Arcangeli , Maria Letizia Taddei , Erica Pranzini , Caterina Mancini , Cecilia Anceschi , Stefania Madiai , Elena Sacco , Stefano Rota , Adriana Trapani , Gennaro Agrimi , Chiara Raggi

Background & Aims

Among the reprogrammed metabolic pathways described in cancer stem cells, aberrant lipid metabolism has recently drawn increasing attention. Our study explored the contribution of fatty acids (FA) in the regulation of stem-like features in intrahepatic cholangiocarcinoma (iCCA).

Methods

We previously identified a functional stem-like subset in human iCCA by using a three-dimensional sphere (SPH) model in comparison to parental cells grown as monolayers (MON). In this study, quantification of intracellular free FA and lipidomic analysis (triacylglycerol [TAG] composition, de novo synthesis products) was performed by Liquid chromatography–mass spectrometry (LC–MS); quadrupole time-of-flight liquid chromatography/mass spectrometry (Q-TOF LC/MS), respectively, in both SPH and MON cultures.

Results

Stem-like SPH showed a superior content of free FA (citric, palmitic, stearic, and oleic acids) and unsaturated TAG. Molecularly, SPH showed upregulation of key metabolic enzymes involved in de novo FA biosynthesis (AceCS1, ACLY, ACAC, FASN, ACSL1) and the mTOR signalling pathway. In patients with iCCA (n = 68), tissue expression of FASN, a key gene involved in FA synthesis, correlated with 5-year overall survival. Interference with FASN activity in SPH cells through both specific gene silencing (siRNA) or pharmacological inhibition (orlistat) decreased sphere-forming ability and expression of stem-like markers. In a murine xenograft model obtained by injection of iCCA-SPH cells, FASN inhibition by orlistat or injection of FASN-silenced cells significantly reduced tumour growth and expression of stem-like genes.

Conclusion

Altered FA metabolism contributes to the maintenance of a stem-like phenotype in iCCA. FASN inhibition may represent a new approach to interfere with the progression of this deadly disease.

Impact and implications

Recent evidence indicates that metabolic disorders correlate with an increased susceptibility to intrahepatic cholangiocarcinoma (iCCA). Our investigation emphasises the pivotal involvement of lipid metabolism in the tumour stem cell biology of iCCA, facilitated by the upregulation of crucial enzymes and the mTOR signalling pathway. From a clinical perspective, this underscores the dual role of FASN as both a prognostic indicator and a therapeutic target, suggesting that FASN inhibitors could enhance patient outcomes by diminishing stemness and tumour aggressiveness. These findings pave the way for novel therapeutic strategies for iCCA and shed light on its relationship with metabolic disorders such as diabetes, obesity, metabolic syndrome, and metabolic dysfunction-associated steatotic liver disease.
背景& 目的在癌症干细胞中描述的重编程代谢途径中,异常脂质代谢最近引起了越来越多的关注。我们的研究探讨了脂肪酸(FA)在调控肝内胆管癌(iCCA)干样特征中的贡献。方法我们先前通过使用三维球体(SPH)模型与单层生长的亲代细胞(MON)进行比较,确定了人类iCCA中的功能性干样亚群。在本研究中,采用液相色谱-质谱法(LC-MS)和四极杆飞行时间液相色谱/质谱法(Q-TOF LC/MS)分别对SPH和MON培养物进行了细胞内游离FA定量和脂质体分析(三酰甘油[TAG]组成、新合成产物)。结果类茎 SPH 显示出较高的游离脂肪酸(柠檬酸、棕榈酸、硬脂酸和油酸)和不饱和 TAG 含量。从分子角度看,SPH显示出参与新脂肪酸生物合成的关键代谢酶(AceCS1、ACLY、ACAC、FASN、ACSL1)和mTOR信号通路的上调。在 iCCA 患者(68 人)中,参与 FA 合成的关键基因 FASN 的组织表达与 5 年总生存率相关。通过特异性基因沉默(siRNA)或药物抑制(奥利司他)干扰SPH细胞中FASN的活性,可降低球形成能力和干样标志物的表达。在注射iCCA-SPH细胞获得的小鼠异种移植模型中,通过奥利司他抑制FASN或注射FASN沉默的细胞可显著减少肿瘤生长和干样基因的表达。影响和意义最近的证据表明,代谢紊乱与肝内胆管癌(iCCA)的易感性增加有关。我们的研究强调了脂质代谢在 iCCA 肿瘤干细胞生物学中的关键作用,关键酶和 mTOR 信号通路的上调促进了脂质代谢。从临床角度来看,这强调了FASN作为预后指标和治疗靶点的双重作用,表明FASN抑制剂可通过降低干细胞和肿瘤侵袭性来改善患者预后。这些发现为iCCA的新型治疗策略铺平了道路,并阐明了iCCA与糖尿病、肥胖症、代谢综合征和代谢功能障碍相关性脂肪肝等代谢性疾病的关系。
{"title":"Altered fatty acid metabolism rewires cholangiocarcinoma stemness features","authors":"Giulia Lori ,&nbsp;Mirella Pastore ,&nbsp;Nadia Navari ,&nbsp;Benedetta Piombanti ,&nbsp;Richell Booijink ,&nbsp;Elisabetta Rovida ,&nbsp;Ignazia Tusa ,&nbsp;Monika Lewinska ,&nbsp;Jesper B. Andersen ,&nbsp;Tiziano Lottini ,&nbsp;Annarosa Arcangeli ,&nbsp;Maria Letizia Taddei ,&nbsp;Erica Pranzini ,&nbsp;Caterina Mancini ,&nbsp;Cecilia Anceschi ,&nbsp;Stefania Madiai ,&nbsp;Elena Sacco ,&nbsp;Stefano Rota ,&nbsp;Adriana Trapani ,&nbsp;Gennaro Agrimi ,&nbsp;Chiara Raggi","doi":"10.1016/j.jhepr.2024.101182","DOIUrl":"10.1016/j.jhepr.2024.101182","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Among the reprogrammed metabolic pathways described in cancer stem cells, aberrant lipid metabolism has recently drawn increasing attention. Our study explored the contribution of fatty acids (FA) in the regulation of stem-like features in intrahepatic cholangiocarcinoma (iCCA).</div></div><div><h3>Methods</h3><div>We previously identified a functional stem-like subset in human iCCA by using a three-dimensional sphere (SPH) model in comparison to parental cells grown as monolayers (MON). In this study, quantification of intracellular free FA and lipidomic analysis (triacylglycerol [TAG] composition, <em>de novo</em> synthesis products) was performed by Liquid chromatography–mass spectrometry (LC–MS); quadrupole time-of-flight liquid chromatography/mass spectrometry (Q-TOF LC/MS), respectively, in both SPH and MON cultures.</div></div><div><h3>Results</h3><div>Stem-like SPH showed a superior content of free FA (citric, palmitic, stearic, and oleic acids) and unsaturated TAG. Molecularly, SPH showed upregulation of key metabolic enzymes involved in <em>de novo</em> FA biosynthesis (AceCS1, ACLY, ACAC, FASN, ACSL1) and the mTOR signalling pathway. In patients with iCCA (n = 68), tissue expression of <em>FASN</em>, a key gene involved in FA synthesis, correlated with 5-year overall survival. Interference with FASN activity in SPH cells through both specific gene silencing (siRNA) or pharmacological inhibition (orlistat) decreased sphere-forming ability and expression of stem-like markers. In a murine xenograft model obtained by injection of iCCA-SPH cells, FASN inhibition by orlistat or injection of <em>FASN</em>-silenced cells significantly reduced tumour growth and expression of stem-like genes.</div></div><div><h3>Conclusion</h3><div>Altered FA metabolism contributes to the maintenance of a stem-like phenotype in iCCA. FASN inhibition may represent a new approach to interfere with the progression of this deadly disease.</div></div><div><h3>Impact and implications</h3><div>Recent evidence indicates that metabolic disorders correlate with an increased susceptibility to intrahepatic cholangiocarcinoma (iCCA). Our investigation emphasises the pivotal involvement of lipid metabolism in the tumour stem cell biology of iCCA, facilitated by the upregulation of crucial enzymes and the mTOR signalling pathway. From a clinical perspective, this underscores the dual role of FASN as both a prognostic indicator and a therapeutic target, suggesting that FASN inhibitors could enhance patient outcomes by diminishing stemness and tumour aggressiveness. These findings pave the way for novel therapeutic strategies for iCCA and shed light on its relationship with metabolic disorders such as diabetes, obesity, metabolic syndrome, and metabolic dysfunction-associated steatotic liver disease.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"6 10","pages":"Article 101182"},"PeriodicalIF":9.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ALT levels, alcohol use, and metabolic risk factors have prognostic relevance for liver-related outcomes in the general population 谷丙转氨酶(ALT)水平、饮酒和代谢风险因素与普通人群肝脏相关结果的预后有关
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.jhepr.2024.101172
Ville Männistö , Veikko Salomaa , Antti Jula , Annamari Lundqvist , Satu Männistö , Markus Perola , Fredrik Åberg
<div><h3>Background & Aims</h3><div>A new nomenclature and subclassification for steatotic liver disease (SLD) was recently introduced. We validated the prognostic value of SLD subclasses in a Finnish population-based cohort and explored the impact of metabolic risk factors and alcohol consumption on liver-related outcomes and death.</div></div><div><h3>Methods</h3><div>The study included 23,910 individuals (47% men, mean age 50.5 ± 14.0 years, BMI 27.0 ± 4.7 kg/m<sup>2</sup>) from the FINRISK and Health 2000 health examination surveys with healthcare registry linkage for severe liver-related outcomes and deaths. SLD was identified by alanine aminotransferase (ALT) levels >20 U/L in women and >30 U/L in men (primary analysis) or fatty liver index (FLI) ≥60 (sensitivity analysis).</div></div><div><h3>Results</h3><div>The prevalence of ALT-defined SLD was 43% (n = 10,380), with subclass rates of 34.5% for metabolic dysfunction-associated steatotic liver disease (MASLD), 4.2% for coexistent MASLD and alcohol-related liver disease (ALD) (i.e., MetALD), and 1.8% for ALD. During a median 13.3-year follow-up, we observed 129 liver-related events. MetALD and ALD increased the age- and sex-adjusted liver-related outcome risk by fourfold (HR 3.83, 95% CI 2.51–5.84, <em>p</em> <0.001) and eightfold (HR 7.90, 95% CI 5.16–12.30, <em>p</em> <0.001), respectively, compared with patients with MASLD. ALD was also associated with the highest risk for non-liver mortality. Metabolic risk factors were present in 93% and 96% of individuals with ALT-defined SLD and ALD, respectively. Alcohol use amplified the risk of liver-related outcomes in individuals with MASLD. Sensitivity analyses by the FLI were similar.</div></div><div><h3>Conclusion</h3><div>SLD is a significant public health concern. Nearly all ALD cases exhibit metabolic risk factors. Among ALT-defined SLD subclasses, ALD presents the highest risk for both liver-related and non-liver-related outcomes. Alcohol use increases the risk of liver-related outcomes in individuals with MASLD.</div></div><div><h3>Impact and implications</h3><div>This study provides important information for physicians, researchers, and patients, demonstrating that the new classification of steatotic liver disease (SLD) has prognostic relevance at the population level. Evaluating the SLD subclass for a patient helps in understanding the magnitude of the risk for liver- and non-liver-related outcomes. In particular, the risks are highest in those with alcohol-related liver disease (ALD), but also increased in individuals with coexisting metabolic dysfunction-associated steatotic liver disease (MASLD) and ALD (MetALD) when compared with those with MASLD. However, alcohol use increased the risk of liver-related outcomes also in individuals with MASLD, highlighting the importance of evaluating alcohol use in every patient with SLD. Nearly all individuals with ALD have metabolic risk factors, and it is important to treat the
背景& 目的最近推出了一种新的脂肪性肝病(SLD)命名法和亚分类。我们在芬兰人群队列中验证了SLD亚类的预后价值,并探讨了代谢风险因素和饮酒对肝脏相关结果和死亡的影响。研究纳入了23910人(47%为男性,平均年龄为50.5 ± 14.0岁,体重指数为27.0 ± 4.7 kg/m2),他们来自FINRISK和Health 2000健康体检调查,并与严重肝脏相关结果和死亡的医疗登记进行了连接。结果 ALT 定义的 SLD 患病率为 43%(n = 10,380),代谢功能障碍相关性脂肪性肝病 (MASLD) 的亚类患病率为 34.5%,代谢功能障碍相关性脂肪性肝病和酒精相关性肝病 (ALD) 共存的亚类患病率为 4.2%(即:MetALD),而代谢功能障碍相关性脂肪性肝病 (MASLD) 的亚类患病率为 1.2%、MetALD)的发病率为 4.2%,ALD 的发病率为 1.8%。在中位 13.3 年的随访期间,我们观察到 129 例肝脏相关事件。与 MASLD 患者相比,MetALD 和 ALD 患者经年龄和性别调整后的肝脏相关结果风险分别增加了四倍(HR 3.83,95% CI 2.51-5.84,p <0.001)和八倍(HR 7.90,95% CI 5.16-12.30,p <0.001)。ALD还与最高的非肝死亡风险相关。分别有 93% 和 96% 的 ALT 定义的 SLD 和 ALD 患者存在代谢风险因素。酗酒会增加MASLD患者出现肝脏相关结果的风险。通过FLI进行的敏感性分析结果类似。几乎所有 ALD 病例都有代谢风险因素。在 ALT 定义的 SLD 亚类中,ALD 导致肝脏相关和非肝脏相关结果的风险最高。这项研究为医生、研究人员和患者提供了重要信息,表明新的脂肪性肝病(SLD)分类在人群水平上具有预后相关性。评估患者的 SLD 亚类有助于了解肝脏和非肝脏相关结果的风险程度。尤其是酒精相关性肝病(ALD)患者的风险最高,但同时患有代谢功能障碍相关性脂肪性肝病(MASLD)和ALD(MetALD)的患者与代谢功能障碍相关性脂肪性肝病(MASLD)患者相比,风险也会增加。然而,饮酒也会增加MASLD患者出现肝脏相关结果的风险,这突出了对每一位SLD患者进行饮酒评估的重要性。几乎所有 ALD 患者都有代谢风险因素,因此治疗这些因素对改善这些患者的生存非常重要。
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引用次数: 0
Molecular imaging of macrophage composition and dynamics in MASLD MASLD 中巨噬细胞组成和动态的分子成像
IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.jhepr.2024.101220
Bin Q. Yang , Mandy M. Chan , Gyu Seong Heo , Lanlan Lou , Hannah Luehmann , Christopher Park , Alexandria Li , Divangana Lahad , Deborah Sultan , Peter Voller , Kathleen Byrnes , Christina Fu , Yongjian Liu , Joel D. Schilling

Background & Aims

Metabolic-dysfunction associated steatohepatitis (MASH) is associated with obesity and diabetes, and is linked to liver fibrosis and cardiovascular disease. Identification of patients who have MASH is challenging and the development of non-invasive strategies to diagnose and follow this condition is an important unmet need. Recent studies in mouse and humans have identified that significant changes occur in liver macrophage composition during MASH progression; namely, resident Kupffer cells decrease in number while recruited monocyte-derived macrophages increase.

Methods

We developed peptide radiotracers targeted to C–C motif chemokine receptor 2 (CCR2) and CD163 to conduct positron emission tomography (PET) imaging of recruited vs. resident macrophages, respectively. Mice were placed on a MASH-inducing diet and non-invasive PET imaging of the liver was performed with tissue confirmation studies using flow cytometry and immunofluorescence. Statistical analyses were conducted using Student’s t tests, Pearson correlational analysis, and linear regression.

Results

Using a mouse model of MASH, we found that the liver uptake of both CCR2 and CD163 radiotracers detected an increase in recruited cells and a decrease in resident macrophages. These findings correlated well with tissue macrophage content assessed by flow cytometry with an r value of 0.77 (p = 0.002) and 0.78 (p = 0.001) for CCR2 and CD163, respectively. Serial imaging with these radiotracers at several time points during MASH progression and regression revealed good correlation between liver macrophage composition and PET signal intensity.

Conclusion

We demonstrate that novel PET radiotracers targeting CCR2 and CD163 can be used to image macrophage composition in MASH. Non-invasive molecular imaging of inflammation has the potential for diagnosis and monitoring of disease activity in humans with MASH.

Impact and implications:

Macrophage-mediated inflammation contributes to MASH progression and fibrosis; however, liver biopsy is currently the only tool to assess this response. Thus, the development of non-invasive imaging modalities to identify and follow inflammatory activation is an area of need for patient care. In this study, we leverage molecular imaging using PET radiotracers to follow changes in macrophage composition that are related to MASH disease activity. The results in our preclinical model provide important proof of concept evidence that this approach can be used to diagnose MASH and to follow disease activity in response to intervention. Ongoing studies will evaluate the utility of this modality in humans with MASH.
背景& 目的代谢功能障碍相关性脂肪性肝炎(MASH)与肥胖和糖尿病有关,并与肝纤维化和心血管疾病相关。鉴别 MASH 患者具有挑战性,开发诊断和跟踪该病症的非侵入性策略是一项尚未满足的重要需求。最近在小鼠和人类身上进行的研究发现,在 MASH 进展过程中,肝脏巨噬细胞的组成发生了显著变化;即常驻 Kupffer 细胞数量减少,而招募的单核细胞衍生巨噬细胞数量增加。方法我们开发了针对 C-C motif 趋化因子受体 2 (CCR2) 和 CD163 的多肽放射性racers,分别对招募的巨噬细胞和常驻的巨噬细胞进行正电子发射断层扫描(PET)成像。将小鼠置于 MASH 诱导饮食中,对肝脏进行无创 PET 成像,并使用流式细胞术和免疫荧光进行组织确认研究。结果使用 MASH 小鼠模型,我们发现肝脏对 CCR2 和 CD163 放射性核素的摄取检测到招募细胞的增加和常驻巨噬细胞的减少。这些发现与流式细胞术评估的组织巨噬细胞含量密切相关,CCR2和CD163的r值分别为0.77(p = 0.002)和0.78(p = 0.001)。结论我们证明了靶向 CCR2 和 CD163 的新型 PET 放射性同位素可用于 MASH 中巨噬细胞组成的成像。影响和意义:巨噬细胞介导的炎症导致了 MASH 的进展和纤维化;然而,肝活检是目前评估这种反应的唯一工具。因此,开发无创成像模式来识别和跟踪炎症激活是患者护理的一个需求领域。在这项研究中,我们利用 PET 放射性同位素的分子成像技术来跟踪与 MASH 疾病活动相关的巨噬细胞组成的变化。我们在临床前模型中取得的结果提供了重要的概念验证证据,证明这种方法可用于诊断 MASH 并跟踪疾病活动对干预措施的反应。正在进行的研究将评估这种方法在人类MASH患者中的实用性。
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引用次数: 0
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