title: Insulin resistance, ceramide accumulation and endoplasmic reticulum stress in experimental chronic alcohol-induced steatohepatitis.
abstract: OBJECTIVE
  Chronic alcohol abuse causes steatohepatitis with insulin resistance, which impairs hepatocellular growth, survival and metabolism. However, growing evidence supports the concept that progressive alcohol-related liver injury may be mediated by concurrent mal-signaling through other networks that promote insulin resistance, e.g. pro-inflammatory, pro-ceramide and endoplasmic reticulum (ER) stress cascades.
  
  
  METHODS
  Using the Long Evans rat model of chronic ethanol feeding, we characterized the histopathologic and ultrastructural features of steatohepatitis in relation to biochemical and molecular indices of tissue injury, inflammation, insulin resistance, dysregulated lipid metabolism and ER stress.
  
  
  RESULTS
  Chronic steatohepatitis with early chicken-wire fibrosis was associated with enlargement of mitochondria and disruption of ER structure by electron microscopy, elevated indices of lipid storage, lipid peroxidation and DNA damage, increased activation of pro-inflammatory cytokines, impaired signaling through the insulin receptor (InR), InR substrate-1, Akt, ribosomal protein S6 kinase and proline-rich Akt substrate 40 kDa, glycogen synthase kinase 3β activation and constitutive up-regulation of ceramide and ER stress-related genes. Liquid chromatography coupled with tandem mass spectrometry demonstrated altered ceramide profiles with higher levels of C14 and C18, and reduced C16 species in ethanol-exposed livers.
  
  
  CONCLUSIONS
  The histopathologic and ultrastructural abnormalities in chronic alcohol-related steatohepatitis are associated with persistent hepatic insulin resistance and pro-inflammatory cytokine activation, dysregulated lipid metabolism with altered ceramide profiles and both ER and oxidative stress. Corresponding increases in lipid peroxidation, DNA damage and protein carbonylation may have contributed to the chronicity and progression of disease. The findings herein suggest that multi-pronged therapeutic strategies may be needed for effective treatment of chronic alcoholic liver disease in humans.
authors.affiliation: Liver Research Center, Divisions of Gastroenterology and Neuropathology, Departments of Medicine, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Claverick Street, Providence, RI 02903, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ramirez
authors.forename: Lisa
authors.initials: L
authors.lastname: Longato
authors.forename: Miroslav
authors.initials: M
authors.lastname: Dostalek
authors.forename: Ming
authors.initials: M
authors.lastname: Tong
authors.forename: Jack R
authors.initials: JR
authors.lastname: Wands
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: de la Monte
mesh_terms: D000818:Animals; D002518:Ceramides / Q000096:biosynthesis*; D002908:Chronic Disease; D004195:Disease Models, Animal; D059865:Endoplasmic Reticulum Stress / Q000187:drug effects / Q000502:physiology*; D000431:Ethanol / Q000633:toxicity*; D005235:Fatty Liver, Alcoholic / Q000378:metabolism* / Q000473:pathology; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D051381:Rats; D020318:Rats, Long-Evans
chemical_list: D002518:Ceramides; D000431:Ethanol