Chronic liver diseases are among the leading causes of mortality and morbidity in the U.S., with 5.5 million people suffering from these diseases. Currently, liver transplantation is the only definitive treatment for end-stage liver diseases; however, the shortage of donor livers makes this therapy extremely limited. Augmenting innate liver regeneration in advanced liver diseases is an attractive therapeutic alternative. To develop such a therapy, it is crucial to understand the molecular mechanisms of liver regeneration, particularly in the diseased liver. Upon liver injury, hepatocytes proliferate to yield more hepatocytes to restore lost liver mass and maintain liver function. However, when hepatocyte proliferation is compromised, a phenomenon observed in advanced liver diseases, or when massive hepatocyte necrosis occurs, liver progenitor cells (LPCs) are activated and these LPCs expand and are able to differentiate into hepatocytes. A correlation between disease severity and LPC numbers in patients with chronic liver diseases suggests the occurrence of LPC activation in the diseased livers but its poor differentiation into hepatocytes. In addition, LPCs secrete pro-inflammatory, pro-fibrogenic cytokines that can perpetuate inflammation and contribute to subsequent fibrosis. Thus, augmenting innate LPC-driven liver regeneration is expected to have beneficial effects in liver patients by generating more functional hepatocytes and by concomitantly reducing inflammation and fibrosis. Despite this significance, the molecular basis of LPC- driven liver regeneration remains poorly understood. Our long-term goal is to completely delineate the molecular mechanisms underlying LPC-driven liver regeneration. In pursuit of this goal, during the previous grant cycle, we elucidated the crucial role of bone morphogenetic protein (BMP) signaling in LPC-driven liver regeneration; in this renewal grant application, we propose to determine how the nuclear receptor farnesoid X receptor (FXR) regulates LPC-driven liver regeneration. We have established both zebrafish and mouse liver injury models for LPC-driven liver regeneration. Using the zebrafish model, we performed chemical screening and discovered that treatment with a synthetic FXR agonist, GW4064, impaired LPC-driven regeneration. Given the beneficial effects of FXR agonists on hepatic steatosis, fibrosis, and hepatocyte-driven liver regeneration and the multiple clinical trials of the agonists, their negative effect on LPC-driven liver regeneration is unexpected and surprising, justifying an extensive mechanistic investigation. Based on our preliminary findings, we hypothesize that FXR activation impairs LPC-driven liver regeneration by repressing the PI3K-AKT-mTOR pathway. We will test this hypothesis by elucidating the effects of FXR activation and suppression on LPC-driven liver regeneration (Aim 1) and by determining the role of the PTEN-PI3K-AKT-mTOR axis in the regeneration process (Aim 2). Successful accomplishment of the proposed work will not only significantly advance the mechanistic understanding of liver regeneration in diseased livers, but also support a more cautionary administration of FXR agonists for treating patients with advanced liver diseases.
Liver transplantation is the only effective treatment for patients with end-stage liver diseases; however, the shortage of donor livers makes this therapy very limited. Comprehensive and detailed understanding of innate liver regeneration in diseased livers will provide significant insights into developing therapeutic strategies to promote liver regeneration in the patients. Our studies will delineate the molecular mechanisms underlying liver progenitor cell-driven liver regeneration and support a more cautionary administration of FXR agonists for treating patients with advanced liver diseases owing to their detrimental impact on the regeneration.
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