Predictive Ability of Preoperative PT-INR and Postoperative MCP1 for Post-hepatectomy Liver Failure
IN VIVO
Authors: Arisaka, Sayaka; Matsuyama, Ryusei; Goto, Koki; Suwa, Yusuke; Mori, Ryutaro; Morioka, Daisuke; Taguri, Masataka; Endo, Itaru
Abstract
Background: We sought a diagnostic tool using perioperative variables that might predict post-hepatectomy liver failure (PHLF). Patients and Methods: In 68 patients undergoing major hepatectomy, data on inflammatory markers and coagulation factors were prospectively collected and were compared between patients with International Study Group of Liver Surgery definition grade B/C PHLF (LF group) and those without LF (non-LF group). Results: Preoperatively, the LF group (n=9; 13.2%) had a lower platelet count and a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTSJ3) activity and a higher prothrombin time-International Normalized Ratio (PT-INR) than the non-LF group. On postoperative day 1, the LF group had significantly higher serum interleukin 6 (IL6), C-C motif chemokine ligand 2 (CCL2), and IL10 levels than the non-LF group. The logistic regression model that included preoperative PT-INR and CCL2 on postoperative day 1 predicted grade B/C PHLF with 100% sensitivity and 89.8% specificity. Conclusion: Our findings suggest that the combination of preoperative PT-INR and CCL2 on postoperative day 1 can predict PHLF earlier and precisely after major hepatectomy.
A TRAIL-TL1A Paracrine Network Involving Adipocytes, Macrophages, and Lymphocytes Induces Adipose Tissue Dysfunction Downstream of E2F1 in Human Obesity
DIABETES
Authors: Maixner, Nitzan; Pecht, Tal; Haim, Yulia; Chalifa-Caspi, Vered; Goldstein, Nir; Tarnovscki, Tania; Liberty, Idit F.; Kirshtein, Boris; Golan, Rachel; Berner, Omer; Monsonego, Alon; Bashan, Nava; Blueher, Matthias; Rudich, Assaf
Abstract
Elevated expression of E2F1 in adipocyte fraction of human visceral adipose tissue (hVAT) associates with a poor cardiometabolic profile. We hypothesized that beyond directly activating autophagy and MAP3K5 (ASK)-MAP kinase signaling, E2F1 governs a distinct transcriptome that contributes to adipose tissue and metabolic dysfunction in obesity. We performed RNA sequencing of hVAT samples from age-, sex-, and BMI-matched patients, all obese, whose visceral E2F1 protein expression was either high (E2F1(high)) or low (E2F1(low)). Tumor necrosis factor superfamily (TNFSF) members, includingTRAIL(TNFSF10),TL1A(TNFSF15), and their receptors, were enriched in E2F1(high). WhileTRAILwas equally expressed in adipocytes and stromal vascular fraction (SVF),TL1Awas mainly expressed in SVF, and TRAIL-inducedTL1Awas attributed to CD4(+)and CD8(+)subclasses of hVAT T cells. In human adipocytes, TL1A enhanced basal and impaired insulin-inhibitable lipolysis and altered adipokine secretion, and in human macrophages it induced foam cell biogenesis and M1 polarization. Two independent human cohorts confirmed associations between TL1A and TRAIL expression in hVAT and higher leptin and IL6 serum concentrations, diabetes status, and hVAT-macrophage lipid content. Jointly, we propose an intra-adipose tissue E2F1-associated TNFSF paracrine loop engaging lymphocytes, macrophages, and adipocytes, ultimately contributing to adipose tissue dysfunction in obesity.