Assessment of factors associated with pre-diabetes in HCV infection including direct and dynamic measurements of insulin action.

Although hepatitis C (HCV) is associated with diabetes, few studies have examined pre-diabetes in this population. We aimed to evaluate factors associated with pre-diabetes in HCV-infected patients, including direct measurement of insulin action. Ninety-seven non-cirrhotic, non-diabetic and HCV-infected patients underwent clinical evaluation and oral glucose tolerance testing (OGTT). Insulin sensitivity was measured directly by steady-state plasma glucose (SSPG) concentration during insulin suppression test. Early phase and total insulin secretion were determined using OGTT. Rates of pre-diabetes were as follows: 21% impaired fasting glucose (IFG), 7% impaired glucose tolerance (IGT) and 9% combined IFG/IGT. Twelve percent of Caucasians, 50% of African Americans and 70% of Latinos had pre-diabetes (P = 0.002). Patient characteristics among the glucose metabolism categories were similar except those with combined IFG/IGT had a higher body mass index (BMI) vs normal glucose tolerance (NGT) (30 vs 26 kg/m(2), P = 0.007) and lower LDL vs NGT and IGT (74, 104 and 112 mg/dL, respectively, P ≤ 0.01). On multivariable analysis, non-Caucasian race (OR 23.1, P = 0.003), BMI (OR 3.4, P = 0.02) and greater liver inflammation (OR 7.9, P = 0.03) predicted IFG, whereas non-Caucasian race (OR 14.8, P = 0.01) and SSPG (OR 1.1 per 10 units, P = 0.01) predicted IGT. Early and total insulin secretion adjusted for the degree of insulin resistance was decreased in pre-diabetes compared with NGT (P = 0.01 and P = 0.02, respectively). Pre-diabetes is highly prevalent among HCV-infected patients, and in some instances, coincides with host responses to the virus. In most cases, however, factors that are associated with pre-diabetes in HCV-infected patients are similar to those observed in the non-HCV population.

Activation of the Met receptor by cell attachment induces and sustains hepatocellular carcinomas in transgenic mice.

Overexpression is the most common abnormality of receptor tyrosine kinases (RTKs) in human tumors. It is presumed that overexpression leads to constitutive activation of RTKs, but the mechanism of that activation has been uncertain. Here we show that overexpression of the Met RTK allows activation of the receptor by cell attachment and that this form of activation can be tumorigenic. Transgenic mice that overexpressed Met in hepatocytes developed hepatocellular carcinoma (HCC), one of the human tumors in which Met has been implicated previously. The tumorigenic Met was activated by cell attachment rather than by ligand. Inactivation of the transgene led to regression of even highly advanced tumors, apparently mediated by apoptosis and cessation of cellular proliferation. These results reveal a previously unappreciated mechanism by which the tumorigenic action of RTKs can be mediated, provide evidence that Met may play a role in both the genesis and maintenance of HCC, and suggest that Met may be a beneficial therapeutic target in tumors that overexpress the receptor.

Cell-specific expression of hepatocyte growth factor in liver. Upregulation in sinusoidal endothelial cells after carbon tetrachloride.

The cellular origin of hepatocyte growth factor (HGF), a polypeptide implicated in liver regeneration, was examined in normal liver and in hepatic regeneration induced by carbon tetrachloride. In normal liver, HGF and its mRNA were abundant in lipocytes, with smaller amounts present also in sinusoidal endothelial and Kupffer cells. In regenerating liver, HGF gene expression increased exclusively in endothelial cells. HGF mRNA levels rose sixfold in these cells, peaking at 6 h after toxin administration and returning to near normal by 24 h. The rise in HGF mRNA was accompanied by a 5.4-fold increase in HGF secretion. CCl4 did not alter HGF expression by either Kupffer cells or lipocytes; nor did it induce HGF expression by hepatocytes. Nonparenchymal liver cells contained two HGF transcripts: one predicting a full-length molecule of 728 amino acids; and the other encoding a functional five-amino acid deletion variant of HGF. The variant was less abundant than the full-length transcript, but increased in parallel with native HGF mRNA in response to CCl4. The response of nonparenchymal cells to HGF was examined by plating endothelial cells and lipocytes in the presence of recombinant human HGF. Under the conditions examined, the growth factor exerted neither mitogenic nor scatter factor activity on these cells.

Extracellular matrix gene expression increases preferentially in rat lipocytes and sinusoidal endothelial cells during hepatic fibrosis in vivo.

Whether parenchymal or nonparenchymal liver cells play a predominant role in the pathophysiology of hepatic fibrosis has not been firmly established in vivo. We have addressed this question by quantitating the relative abundance of specific mRNAs for collagen types I, III, and IV, and laminin in purified populations of hepatocytes, sinusoidal endothelial cells, and lipocytes from normal and fibrotic rat liver. In normal liver, type I collagen gene expression was minimal in all cell types; mRNA for types III and IV collagen were apparent in endothelial cells and lipocytes, but not in hepatocytes. Laminin mRNA was present in all cell types. Induction of fibrogenesis by either bile duct ligation or carbon tetrachloride administration was associated with a substantial increase in mRNA for types I and III collagen in nonparenchymal cells. Lipocytes from fibrotic animals exhibited a greater than 30-fold increase in type I collagen mRNA relative to normal lipocytes, and greater than 40-fold relative to hepatocytes. Type III collagen mRNA reached 5 times that in normal lipocytes and greater than 120 times that in hepatocytes. Endothelial cells exhibited an isolated increase in type I collagen mRNA, reaching five times that in normal liver. Type IV collagen and laminin gene expression were not significantly increased in nonparenchymal cells during fibrogenesis; in fact, mRNA for type IV collagen and laminin decreased by up to 50% in endothelial cells. Despite the pronounced changes that occurred in matrix gene expression in nonparenchymal cells during fibrogenesis, no change was noted in hepatocytes. We conclude that nonparenchymal liver cells, particularly lipocytes, are important effectors of hepatic fibrosis in vivo.

Support of cultured hepatocytes by a laminin-rich gel. Evidence for a functionally significant subendothelial matrix in normal rat liver.

The subendothelial space of normal rat liver contains the constituent proteins of a basal lamina, as judged by immunohistochemical study of tissue sections. However, it is unknown whether these proteins constitute a complex with effects on hepatocellular function. We have examined this question, using normal rat hepatocytes cultured on substrata of matrix proteins as a model of the interaction between cells and basal lamina in vivo. In cultures on a type I collagen substratum, albumin secretion decreased progressively after 2 d. By contrast, when cells were cultured on a laminin-rich gel matrix, albumin secretion was stable for at least 3 wk; other functions and ultrastructural morphology were similarly maintained. None of the individual matrix proteins effectively substituted for the gel matrix, suggesting that full support of hepatocellular function requires a complex of matrix proteins. We speculate that a cause of hepatocellular dysfunction in acute inflammation is disruption of this matrix and alteration of its interaction with the hepatocyte plasma membrane.

Collagen measured in primary cultures of normal rat hepatocytes derives from lipocytes within the monolayer.

The cellular origin of hepatic collagen is under active investigation. Several recent studies using cells in primary culture suggest that hepatocytes are the source of much of the collagen in normal rat liver. In view of other data indicating that lipocytes produce substantial amounts of this protein, we have reexamined collagen biosynthesis in hepatocyte cultures that have been carefully characterized with respect to the presence of lipocytes. We find that routinely prepared hepatocyte isolates contain, by number, approximately 10% lipocytes. Lipocytes in early culture are difficult to visualize by phase-contrast microscopy but after 4 d proliferate and eventually replace the parenchymal cells. The size of the lipocyte subpopulation in these cultures correlates positively with collagen production. Similarly, removal of lipocytes by further processing of the initial hepatocyte isolate significantly reduces collagen production. Moreover, the only cells within hepatocyte cultures that display type I collagen by immunohistochemistry are lipocytes. We conclude that lipocytes are the principal source of collagen in primary hepatocyte cultures. The findings indicate also that these cells are the previously described "fibroblast" that appear in relatively long-term hepatocyte cultures.

Glutathione regulation in rat hepatic stellate cells. Comparative studies in primary culture and in liver injury in vivo.

Lipid peroxidation accompanies many types of liver injury and is believed to promote liver fibrosis. Cellular antioxidants are likely to play an important role in modulating this process; however, little is known about antioxidants in hepatic stellate cells, the major collagen-producing cells of liver. In this study, we measured glutathione homeostasis in stellate cells isolated from rat liver. Glutathione, measured by HPLC in stellate cell homogenates, increased significantly when the cells were plated in primary culture. The rise in glutathione coincided with pretranslational up-regulation of the synthetic enzyme gamma-glutamylcysteine synthetase (GCS). Additional experiments were performed to determine whether stellate cell glutathione and GCS are similarly altered during liver injury in vivo. Two types of hepatic insults, namely, bile duct ligation (8 days) and carbon tetrachloride treatment (4 weeks), failed to provoke an increase in either stellate cell glutathione or GCS. This disparate behavior of stellate cells in culture and in vivo is unusual; the data suggest that stellate cells might respond variably to oxidants depending on their glutathione status.

Exploring alcohol's effects on liver function.

A large proportion of heavy drinkers develop serious alcoholic liver disease. Susceptibility to alcoholic hepatitis and cirrhosis appears to be influenced by heredity, gender, diet, and co-occurring liver illness. Most alcoholic liver damage is attributed to alcohol metabolism. Liver injury may be caused by direct toxicity of metabolic by-products of alcohol as well as by inflammation induced by these by-products. Exposure of liver cells to bacterial toxins may contribute to liver disease. Escalating liver injury can lead to fibrosis and, ultimately, to cirrhosis. Increased understanding of the mechanisms of liver injury has led to innovative treatments for alcoholic liver disease, including the use of corticosteroids, antioxidants, antibiotics, and certain polyunsaturated fats.

Rat hepatocytes and Kupffer cells interact to produce interleukin-8 (CINC) in the setting of ethanol.

Interleukin-8 is a neutrophil chemoattractant that has been implicated in the pathogenesis of alcoholic hepatitis. The mechanism of ethanol-induced interleukin-8 production in liver is uncertain, although hepatocytes and Kupffer cells have both been proposed as sources of the chemokine. In this study we investigated whether short-term ethanol exposure stimulates production of rat interleukin-8 [cytokine-induced neutrophil chemoattractant (CINC)] by normal rat hepatocytes and Kupffer cells in primary culture. Initial experiments verified that hepatocytes and Kupffer cells produce CINC in response to cytokines or lipopolysaccharide. Ethanol, by contrast, failed to stimulate CINC secretion by either cell type even at concentrations as high as 100 mM. Although ethanol had no direct effect on liver cell CINC production, conditioned medium from ethanol-treated hepatocytes induced a threefold rise in CINC production by Kupffer cells. The increase was abrogated when hepatocytes were treated with ethanol and the metabolic inhibitor 4-methylpyrazole. The results suggest that the mechanism of ethanol-induced CINC production is indirect, involving ethanol oxidation and communication between hepatocytes and Kupffer cells.

Interactions between hepatic stellate cells and the immune system.

Stellate cells and immune cells are both active participants in the pathogenesis of liver disease. Interactions between these two populations are important determinants of disease outcome. Kupffer cells, neutrophils, and lymphocytes all have the potential to influence stellate cells. They produce a host of humoral mediators, including oxidants, nitric oxide, cytokines, eicosanoids, and proteinases, which can affect stellate cell proliferation, gene expression, and contractility. One important feature of stellate cell-immune cell interactions is that they are bidirectional. Not only do stellate cells receive signals from leukocytes, but they also elaborate signals that target leukocytes. Specifically, stellate cells can promote leukocyte chemotaxis and adherence, and they may also influence leukocyte activation by producing regulatory cytokines. Studies in culture provide an important background for understanding the effects of specific mediators on stellate cells and immune cells. Experiments in vivo offer an important adjunct, but often lead to confounding effects that limit interpretation. Both types of studies are required to develop a better understanding of the complex interplay between stellate cells and leukocytes.

Leukocytes as modulators of stellate cell activation.

Activation of stellate cells is central to the process of hepatic fibrogenesis. Stellate cell activation can be influenced by many factors, including cytokines, oxidants, and alterations in the perisinusoidal extracellular matrix. These factors can be produced by resident liver cells (hepatocytes, Kupffer cells, or stellate cells themselves); however, infiltrating leukocytes may also play an important role. Because liver fibrosis often follows a prolonged period of hepatic inflammation, investigators have begun to study leukocytes as modulators of stellate cell activation. The following data summarize recent investigations in this area that focus on neutrophils as well as mononuclear cells.

Cytokines: overview.

Cytokines are involved in a number of physiologic and pathophysiologic processes in the liver. These small molecules impact hepatic growth and repair, regulate inflammation, and influence fibrogenesis. Cytokines acting within the liver derive from both resident and recruited cells; the pattern of cytokines produced in a given clinical situation depends upon the inciting stimulus and the background cellular milieu. Experimental animals display inherited differences in cytokine responses to environmental insults. If these differences are operative in human beings, they may account in part for variations in susceptibility among individuals or groups to certain types of liver disease.

Hepatic fibrosis caused by alcohol.

The past decade of research has brought us closer to an understanding of the mechanisms whereby alcohol promotes fibrosis in liver. The perivenular and perisinusoidal fibrosis that characterizes alcoholic cirrhosis suggests that it is a unique entity, distinct from other types of fibrotic liver disease. On a cellular level, though, the target population and the regulatory events that control fibrogenesis may be typical of all types of fibrotic liver disease. The putative pathways to alcoholic fibrosis are exemplified in Figure 1. Fibrosis can be either the direct result of a stimulus from ethanol or one of its metabolites to a target cell population, presumably the lipocytes, or it can begin indirectly in response to hepatic inflammation. The indirect pathway to hepatic fibrosis is likely to be initiated by cytokines, elaborated by inflammatory cells. In addition, invasion of the liver by inflammatory cells may disrupt the normal hepatic extracellular matrix, which may in itself act as a stimulus for fibrogenesis by altering critical cell-matrix interactions. If alteration of the normal hepatic matrix is sufficient to promote fibrogenesis, it may act as a fixed stimulus that perpetuates fibrogenesis in the absence of ongoing inflammation. This may explain the progression of alcoholic fibrosis in some patients in the apparent absence of alcoholic hepatitis. It has been gratifying to observe a consensus emerge among experimental observations regarding the process of alcoholic fibrosis. In particular, the discovery of transitional cells in fibrotic liver tissue, and their relationship to lipocytes, correlates well with studies documenting activation of lipocytes in culture to a fibrogenic phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile duct ligation in rats induces biliary expression of cytokine-induced neutrophil chemoattractant.

BACKGROUND & AIMS: Bile duct obstruction causes neutrophilic inflammation of the liver and leads to hepatic fibrosis. In obstructive liver disease, the localization of neutrophils in portal tracts suggests that cells within this region produce neutrophil chemoattractants. In this study, we investigated whether bile duct obstruction in rats induces portal expression of cytokine-induced neutrophil chemoattractant (CINC). METHODS: Rats underwent bile duct ligation for 3 hours to 8 days. CINC regulation was examined in vivo at various intervals by immunohistochemistry, ribonuclease protection, and in situ hybridization. CINC production was also investigated in cell culture, in response to putative stimuli from obstructed liver. RESULTS: Bile duct ligation caused neutrophilic infiltration of the liver within 3 hours. CINC was also rapidly induced, with specific expression identified in biliary cells. Rat intrahepatic biliary cells produced CINC constitutively in culture; when exposed to cholestatic bile, they showed a 12-fold increase in CINC secretion. The effect of bile was not attributable to toxicity or to dissolved cytokines or endotoxin. Mechanical strain, designed to mimic the stretching of biliary cells during obstruction, did not induce CINC. CONCLUSIONS: Biliary cells contribute to hepatic inflammation during cholestasis by producing neutrophil chemoattractants. A major stimulus to biliary chemoattractant production in vivo may be bile itself.

Partial cloning of the M subunit of laminin from adult rat lipocytes: expression of the M subunit by cells isolated from normal and injured liver.

Laminin is a heterotrimeric glycoprotein found in the perisinusoidal space of adult rat liver. The principal cellular source of laminin in liver is the lipocyte, with its three subunits measuring 324, 200 and 200 kD. The large subunit of lipocyte-derived laminin is distinct from the A subunit of murine laminin (440 kD); its size suggests that it represents a peptide, called M, recently cloned from human placenta. Using oligonucleotide primers derived from the human M-subunit cDNA, we amplified a 445-bp sequence encoding a fragment of M-laminin from adult rat lipocytes. The rat cDNA is 90% homologous to the human M-subunit cDNA and recognizes an mRNA in lipocytes measuring about 10 kb. M-subunit transcripts were identified only in lipocytes from normal adult liver; they could not be identified in hepatocytes, endothelial cells or Kupffer cells. Lipocytes were screened for M-subunit protein with a polyclonal M antiserum. Cells stained specifically for the M-subunit after 36 hr in primary culture; the protein was also identified in freshly isolated cells by means of immunoblotting. To determine whether lipocytes alter their expression of the laminin M subunit during liver injury, we monitored M-subunit mRNA in these cells at various intervals after carbon tetrachloride administration. M-subunit transcripts increased twofold within 12 hr of toxin exposure, returning to below baseline by 48 hr. The results indicate that lipocytes produce the M subunit of laminin in place of A. Production of this subunit by lipocytes may facilitate cell growth and reorganization during liver regeneration.

Selection and characterization of RNAs that relieve transcriptional interference in Escherichia coli.

Oligonucleotide-directed triple helix formation offers a method for duplex DNA recognition, and has been proposed as an approach to the rational design of gene-specific repressors. Indeed, certain RNA and DNA oligonucleotides have previously been shown to bind duplex DNA and repress in vitro transcription by occluding the binding of transcription factors or RNA polymerase at target genes. While similar oligonucleotides have reportedly caused repression of target genes in cultured cells, physical evidence of triple helix formation in vivo is generally lacking. In the present study we wished to determine whether RNA transcripts could repress the activity of an Escherichia coli promoter in vivo by binding to the duplex promoter DNA. An in vivo genetic selection previously developed to identify DNA binding proteins was modified for this purpose. Using expression libraries encoding RNAs predisposed to forming triple helices with a DNA target site, we have selected RNA transcripts that confer survival to E.coli by disrupting transcriptional interference. Surprisingly, genetic and biochemical evidence shows that these RNAs do not form triple helices at the target promoter in vivo , despite the fact that they contain sequences capable of forming triple helices at the duplex DNA target in vitro . Rather, the selected RNAs appear to disrupt transcriptional interference via an antisense mechanism.

Radial artery cannulation guided by Doppler ultrasound.

A technique to enhance difficult percutaneous radial artery cannulations using Doppler ultrasound is described. A series of 12 patients (nine hypotensive and three normotensive patients with poorly palpable or absent radial pulses) was assembled and the radial arteries were cannulated using standard intravenous catheters and a hand-held Doppler ultrasound device. Localization and cannulation of the arteries was facilitated by noting the characteristic sounds using the Doppler. Eleven of the 12 patients had successful cannulation of the radial artery. In one case the artery was localized but the catheter could not be advanced. No complications were encountered. It was concluded that the use of a common Doppler ultrasound on selected patients with poor peripheral pulses may facilitate percutaneous radial artery cannulations and minimize the number of catheter punctures before successful placement.

Cell-matrix interactions in liver.

Studies of cell-matrix interaction in liver have demonstrated the biological impact of extracellular matrix on the structure and function of liver cells, both parenchymal and mesenchymal. Much of the work involves cell culture models, in which either hepatocytes or non-parenchymal liver cells are plated on various extracellular matrix proteins and the expression of tissue-specific function is assessed. The data suggest that a basement membrane-like matrix exists within the perisinusoidal space and is critical to the maintenance of normal liver function. There are reservations concerning the accuracy of cell-culture models with respect to the intact liver, in that the precise composition and structure of this matrix still is uncertain. Nonetheless, work to date has added a new dimension to the role of the extracellular matrix of the normal liver and a new appreciation of the potential impact of pathologically altered matrix ('fibrosis') in liver disease.

Malondialdehyde stimulates collagen production by hepatic lipocytes only upon activation in primary culture.

Lipid aldehydes have been proposed as mediators of hepatic fibrosis in alcoholics. In this study we examined whether hepatic lipocytes, the principal matrix-producing cells in liver, exhibit enhanced collagen synthesis in response to the lipid aldehyde malondialdehyde. Lipocytes isolated from normal rat liver and plated in primary culture for 3 days were not affected by malondialdehyde in concentrations ranging from 2 to 200 microM. Cells cultured for 7 days displayed a modest increase in collagen synthesis (137% of control levels) in response to malondialdehyde, but only at a concentration of 200 microM. The malondialdehyde-induced increase in collagen synthesis was paralleled by a rise in type I procollagen mRNA. Subcultured rat fibroblasts at confluent density responded better to malondialdehyde than did 7-day lipocytes. The results indicate that lipocytes respond to the fibrogenic effects of malondialdehyde only after activation in primary culture. This delayed response suggests that lipid aldehydes may enhance, but do not initiate, alcoholic liver fibrosis in vivo.

Acetaldehyde-induced stimulation of collagen synthesis and gene expression is dependent on conditions of cell culture: studies with rat lipocytes and fibroblasts.

Acetaldehyde has been proposed as a mediator of fibrogenesis in alcoholic liver disease, based in part on its ability to stimulate collagen synthesis by hepatic lipocytes in late primary or passaged culture. In this study, we examined the effect of acetaldehyde on rat lipocytes and fibroblasts at various stages of culture, in an effort to determine whether culture-related events influence responsiveness to this compound. Lipocytes from normal rat liver were studied in primary culture at 3 and 7 days after plating; fibroblasts were studied in subculture, at subconfluent and confluent densities. Both cell types were incubated with 100 microM acetaldehyde for 24 hr followed by measurement of collagen synthesis and type I collagen gene expression. Acetaldehyde had no effect on lipocytes at either 3 or 7 days in primary culture. The inability of acetaldehyde to stimulate collagen synthesis in primary culture was not attributable to toxicity, because cell morphology and total protein synthesis were identical in both treated and untreated cultures. Fibroblasts exhibited a variable response to acetaldehyde that was dependent on cell density: subconfluent cells contained similar amounts of type I collagen mRNA in both the presence and absence of acetaldehyde, whereas confluent cells exhibited a 2- to 3-fold increase in collagen mRNA levels upon acetaldehyde exposure. To determine whether quiescent lipocytes would respond to acetaldehyde in a culture system that mimics the hepatic environment in vivo, lipocytes were plated in coculture with hepatocytes on a basement membrane gel and incubated with 20 mM ethanol for 72 hr. Direct communication between these two cell types did not provoke lipocyte activation, even in the setting of ethanol oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)