Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax.

BACKGROUND: Hepatic hydrothorax (HH) is an uncommon and difficult-to-manage complication of cirrhosis with limited treatment options. AIM: To define the clinical outcomes of patients presenting with HH managed with current standards-of-care and to identify factors associated with mortality. METHODS: Cirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 were retrospectively identified. HH was defined as pleural effusion in the absence of cardiopulmonary disease. The primary outcomes were overall and transplant-free survival at 12-mo after the index admission. Cox proportional hazards analysis was used to determine factors associated with the primary outcomes. RESULTS: Overall, 84 patients were included (mean age, 58 years) with a mean model for end-stage liver disease score of 29. Management with diuretics alone achieved long-term resolution of HH in only 12% patients. At least one thoracocentesis was performed in 73.8% patients, transjugular intrahepatic portosystemic shunt insertion in 11.9% patients and 33% patients received liver transplantation within 12-mo of index admission. Overall patient survival and transplant-free survival at 12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidney injury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increased risk of mortality. CONCLUSION: Cirrhotic patients with HH are a challenging population with a poor 12-mo survival despite current treatments. Current smoking and episodes of AKI are potential modifiable factors affecting survival. HH is often refractory of diuretic therapy and transplant assessment should be considered in all cases.

Temperature-dependent metabolic adaptation of Triticum aestivum seedlings to anoxia.

Wheat (Triticum aestivum) is considered anoxia intolerant but it shows variance in anoxia responses between genotypes and environmental treatments. We firstly examined 4 day old seedlings of five wheat genotypes in response to anoxia at 15 °C and 28 °C by assessing growth rate, tissue damage and changes in metabolite abundances. Significant genotypic variations in anoxia tolerance were observed, especially at 28 °C. Wheat seedlings grown at 15 °C appeared to be more anoxia tolerant and showed less genotypic variation than those at 28 °C. To minimize seedling size variations and define the temperature effects, we grew two contrasting genotypes at 15 °C for 3.5 d and adapted to 4 different temperatures for 0.5 d before exposing them to anoxia at each adapted temperature. Genotypic variation in abundance of anoxia induced metabolites occurred at 24 °C and 28 °C but not at 15 °C and 20 °C. Tissue- and temperature-dependent metabolic adaptations to anoxia were revealed. In roots, the ability to maintain sugar/sugar-phosphate and TCA cycle metabolite levels and the accumulation of amino acids when temperature was below 24 °C correlated with anoxia tolerance. Temperatures between 20 °C-24 °C are critical for metabolic adaptation and suggest that further assessment of waterlogging/flooding tolerance of wheat seedlings should consider the temperature-dependence of tolerance in evaluations.

What happens to plant mitochondria under low oxygen? An omics review of the responses to low oxygen and reoxygenation.

Floods can rapidly submerge plants, limiting oxygen to the extent that oxidative phosphorylation no longer generates adequate ATP supplies. Low-oxygen tolerant plants, such as rice, are able to adequately respond to low oxygen by successfully remodelling primary and mitochondrial metabolism to partially counteract the energy crisis that ensues. In this review, we discuss how plants respond to low-oxygen stress at the transcriptomic, proteomic, metabolomic and enzyme activity levels, particularly focusing on mitochondria and interacting pathways. The role of reactive oxygen species and nitrite as an alternative electron acceptor as well as their links to respiratory chain components is discussed. By making intra-kingdom as well as cross-kingdom comparisons, conserved mechanisms of anoxia tolerance are highlighted as well as tolerance mechanisms that are specific to anoxia-tolerant rice during germination and in coleoptiles. We discuss reoxygenation as an often overlooked, yet essential stage of this environmental stress and consider the possibility that changes occurring during low oxygen may also provide benefits upon re-aeration. Finally, we consider what it takes to be low-oxygen tolerant and argue that alternative mechanisms of ATP production, glucose signalling, starch/sucrose signalling as well as reverse metabolism of fermentation end products promote the survival of rice after this debilitating stress.

The rice mitochondria proteome and its response during development and to the environment.

Rice (Oryza sativa L.) is both a major crop species and the key model grass for molecular and physiological research. Mitochondria are important in rice, as in all crops, as the main source of ATP for cell maintenance and growth. However, the practical significance of understanding the function of mitochondria in rice is increased by the widespread farming practice of using hybrids to boost rice production. This relies on cytoplasmic male sterile (CMS) lines with abortive pollen caused by dysfunctional mitochondria. We provide an overview of what is known about the mitochondrial proteome of rice seedlings. To date, more than 320 proteins have been identified in purified rice mitochondria using mass spectrometry. The insights from this work include a broad understanding of the major subunits of mitochondrial respiratory complexes and TCA cycle enzymes, carbon and nitrogen metabolism enzymes as well as details of the supporting machinery for biogenesis and the subset of stress-responsive mitochondrial proteins. Many proteins with unknown functions have also been found in rice mitochondria. Proteomic analysis has also revealed the features of rice mitochondrial protein presequences required for mitochondrial targeting, as well as cleavage site features for processing of precursors after import. Changes in the abundance of rice mitochondrial proteins in response to different stresses, especially anoxia and light, are summarized. Future research on quantitative analysis of the rice mitochondrial proteomes at the spatial and developmental level, its response to environmental stresses and recent advances in understanding of the basis of rice CMS systems are highlighted.

Differential induction of mitochondrial machinery by light intensity correlates with changes in respiratory metabolism and photorespiration in rice leaves.

The light responsiveness of mitochondrial function was investigated through changes in mitochondrial composition and metabolism in rice (Oryza sativa) shoots. The mitochondrial proteome and metabolite abundances under low light, (LL, 100 µmol m(-2) s(-1) ), and high light (HL, 700 µmol m(-2) s(-1) ) were measured along with information on shoot photosynthetic, respiratory and photorespiratory activity. Specific steps in mitochondrial tricarboxylic acid (TCA) cycle metabolism were decreased under HL, correlating with lower respiration rate under HL. The abundance of mitochondrial enzymes in branch chain metabolism was reduced under HL/LL, and correlated with a decrease in the abundance of a range of amino acids in the HL/LL. Mitochondrial nucleoside diphosphate kinase was increased under LL/HL treatments. Significant accumulation of glycine decarboxylase P, T subunits and serine hydroxymethyltransferase occurred in response to light. The abundance of the glycine decarboxylase (GDC) H subunit proteins was not changed by HL/LL treatments, and the abundance of GDC L subunit protein was halved under HL, indicating a change in the stoichiometry of GDC subunits, while photorespiration was fourfold higher in LL- than in HL-treated plants. Insights into these light-dependent phenomena and their importance for understanding the initiation of photorespiration in rice and adaptation of mitochondria to function in photosynthetic cells are discussed.

Pursuing the identification of O(2) deprivation survival mechanisms in plants related to selective mRNA translation, hormone-independent cellular elongation and preparation for the arrival of oxygen.

Anoxia can occur in crop fields when flooding forms a physical barrier that reduces oxygen availability. Rice, but not wheat, can germinate and elongate its coleoptile under anoxia, providing an excellent model for understanding mechanisms of anoxia tolerance. We have shown differential molecular responses of rice and wheat coleoptiles to anoxia and discovered novel metabolic adaptations in amino acid metabolism for tissue tolerance. In this addendum, we elaborate on our discussion to speculate on the functions of differentially regulated proteins and their possible roles in selective transcription and translation, alternative elongation strategies and preparedness for exposure to air. In addition, it is thought that rapid growth is a stress avoidance strategy; if adequate coleoptile growth occurs then plants can outgrow floodwaters to resume or begin aerobic respiration. An innate response mechanism to the arrival of air, and the oxidative stress inherent to this, would therefore be necessary in survival beyond the alleviation of anoxia. Thus, we emphasize the importance of recognizing anoxia as a multi-stage stress where responses otherwise considered counter-intuitive may have evolved as preparative defenses for when exposure to air occurs.

Differential molecular responses of rice and wheat coleoptiles to anoxia reveal novel metabolic adaptations in amino acid metabolism for tissue tolerance.

Rice (Oryza sativa) and wheat (Triticum aestivum) are the most important starch crops in world agriculture. While both germinate with an anatomically similar coleoptile, this tissue defines the early anoxia tolerance of rice and the anoxia intolerance of wheat seedlings. We combined protein and metabolite profiling analysis to compare the differences in response to anoxia between the rice and wheat coleoptiles. Rice coleoptiles responded to anoxia dramatically, not only at the level of protein synthesis but also at the level of altered metabolite pools, while the wheat response to anoxia was slight in comparison. We found significant increases in the abundance of proteins in rice coleoptiles related to protein translation and antioxidant defense and an accumulation of a set of enzymes involved in serine, glycine, and alanine biosynthesis from glyceraldehyde-3-phosphate or pyruvate, which correlates with an observed accumulation of these amino acids in anoxic rice. We show a positive effect on wheat root anoxia tolerance by exogenous addition of these amino acids, indicating that their synthesis could be linked to rice anoxia tolerance. The potential role of amino acid biosynthesis contributing to anoxia tolerance in cells is discussed.