title: Steatosis and liver cell apoptosis in chronic hepatitis C: a mechanism for increased liver injury.
abstract: Steatosis is increasingly recognized as a cofactor influencing the progression of fibrosis in chronic hepatitis C; however, the mechanisms by which it contributes to liver injury remain uncertain. We studied 125 patients with chronic hepatitis C to assess the effect of steatosis on liver cell apoptosis and the expression of Bcl-2, Bcl-x(L), Bax, and tumor necrosis factor alpha (TNF-alpha) and the relationship between liver cell apoptosis and disease severity. A significant increase in liver cell apoptosis was seen in liver sections with increasing grade of steatosis (r = 0.42; P <.0001). Hepatic steatosis and previous heavy alcohol consumption were the only two variables independently associated with the apoptotic index. Increasing steatosis was associated with decreased Bcl-2 mRNA levels and an increase in the proapoptotic Bax/Bcl-2 ratio (r = -0.32, P =.007; and r = 0.27, P =.02, respectively). In the absence of steatosis, increased liver cell apoptosis was not associated with stellate cell activation or fibrosis (r = 0.26, P =.11; r = 0.06, P =.71, respectively). In contrast, in the presence of steatosis, increasing apoptosis was associated with activation of stellate cells and increased stage of fibrosis (r = 0.35, P =.047; r = 0.33, P =.03, respectively), supporting the premise that the steatotic liver is more vulnerable to liver injury. In patients with hepatitis C virus genotype 3, there was a significant correlation between TNF-alpha mRNA levels and active caspase-3 (r = 0.54, P =.007). In conclusion, these observations suggest a mechanism whereby steatosis contributes to the progression of liver injury in chronic hepatitis C. Further investigation will be required to determine the molecular pathways responsible for the proapoptotic effect of steatosis and whether this increase in apoptosis contributes directly to fibrogenesis.
authors.affiliation: School of Medicine, Southern Division, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Meagan J
authors.initials: MJ
authors.lastname: Walsh
authors.forename: Daina M
authors.initials: DM
authors.lastname: Vanags
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Clouston
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Richardson
authors.forename: David M
authors.initials: DM
authors.lastname: Purdie
authors.forename: Julie R
authors.initials: JR
authors.lastname: Jonsson
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Powell
mesh_terms: D000328:Adult; D017209:Apoptosis; D001706:Biopsy; D053148:Caspase 3; D020169:Caspases / Q000378:metabolism; D005234:Fatty Liver / Q000473:pathology* / Q000503:physiopathology / Q000821:virology*; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D020287:In Situ Nick-End Labeling; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D008297:Male; D011518:Proto-Oncogene Proteins / Q000235:genetics; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000235:genetics; D012333:RNA, Messenger / Q000032:analysis; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics; D051028:bcl-2-Associated X Protein; D051020:bcl-X Protein
chemical_list: C494826:BAX protein, human; C494811:BCL2L1 protein, human; D011518:Proto-Oncogene Proteins; D019253:Proto-Oncogene Proteins c-bcl-2; D012333:RNA, Messenger; D014409:Tumor Necrosis Factor-alpha; D051028:bcl-2-Associated X Protein; D051020:bcl-X Protein; C505407:CASP3 protein, human; D053148:Caspase 3; D020169:Caspases