TY  - GEN
A1  - Lin, Tao
UR  - https://archiv.ub.uni-heidelberg.de/volltextserver/30591/
ID  - heidok30591
N2  - Background & Aims: In patients with acute on chronic liver failure (ACLF) who suffer from massive hepatocyte loss, liver progenitor cells (LPC) take over key hepatocyte functions, which ultimately determines survival. This study investigated how the expression of HNF4?, its regulators and targets in LPC determines clinical outcome of ALF patients. 
Approach & Results: Clinicopathological associations were scrutinized in 19 ACLF patients (9 recovered and 10 receiving liver transplantation). Regulatory mechanisms between follistatin, activin, HNF4? and coagulation factor expression in LPC were investigated in vitro and in metronidazole-treated zebrafish. A prospective clinical study followed up 186 cirrhotic patients for 80 months to observe the relevance of follistatin levels in prevalence and mortality of acute-on-chronic liver failure (ACLF). Recovered ACLF patients robustly express HNF4? in either LPC or remaining hepatocytes. As in hepatocytes, HNF4? controls the expression of coagulation factors by binding to their promoters in LPC. HNF4? expression in LPC requires the FOXH1-SMAD2/3/4 transcription factor complex, which is promoted by the TGF-? superfamily member activin. Activin signaling in LPC is negatively regulated by follistatin, a hepatocyte-derived hormone controlled by insulin and glucagon. In contrast to patients requiring liver transplantation, recovered patients demonstrate a normal activin/follistatin ratio, robust abundance of the activin effectors phosphorylated SMAD2 and HNF4? in LPC, leading to significantly improved coagulation function. A follow-up study indicated that serum follistatin levels could predict the incidence and mortality of ACLF.
CONCLUSIONS: These results highlight a crucial role of the follistatin-controlled activin-HNF4?-coagulation axis in determining the clinical outcome of massive hepatocyte loss-induced ACLF. The effects of insulin and glucagon on follistatin suggests a key role of the systemic metabolic state in ACLF.
TI  - Activin drives liver progenitor cells to take over coagulation function through upregulating HNF4? in acute on chronic liver failure
Y1  - 2021///
CY  - Heidelberg
AV  - public
ER  -