Altered peripheral blood monocyte phenotype and function in chronic liver disease:Implications for hepatic recruitment and systemic inflammation

Background and Aim

CRIg-expressing peritoneal macrophages are associated with disease severity in patients with cirrhosis and ascites

Infections are an important cause of morbidity and mortality in patients with decompensated cirrhosis and ascites. Hypothesizing that innate immune dysfunction contributes to susceptibility to infection, we assessed ascitic fluid macrophage phenotype and function. The expression of complement receptor of the immunoglobulin superfamily (CRIg) and CCR2 defined two phenotypically and functionally distinct peritoneal macrophage subpopulations. The proportion of CRIg(hi) macrophages differed between patients and in the same patient over time, and a high proportion of CRIg(hi) macrophages was associated with reduced disease severity (model for end-stage liver disease) score. As compared with CRIg(lo) macrophages, CRIg(hi) macrophages were highly phagocytic and displayed enhanced antimicrobial effector activity. Transcriptional profiling by RNA sequencing and comparison with human macrophage and murine peritoneal macrophage expression signatures highlighted similarities among CRIg(hi) cells, human macrophages, and mouse F4/80(hi) resident peritoneal macrophages and among CRIg(lo) macrophages, human monocytes, and mouse F4/80lo monocyte-derived peritoneal macrophages. These data suggest that CRIg(hi) and CRIg(lo) macrophages may represent a tissue-resident population and a monocytederived population, respectively. In conclusion, ascites fluid macrophage subset distribution and phagocytic capacity is highly variable among patients with chronic liver disease. Regulating the numbers and/or functions of these macrophage populations could provide therapeutic opportunities in cirrhotic patients

Visual methodologies, sand and psychoanalysis: employing creative participatory techniques to explore the educational experiences of mature students and children in care

Social science research has witnessed an increasing move towards visual methods of data production. However, some visual techniques remain pariah sites because of their association with psychoanalysis; and a reluctance to engage with psychoanalytically informed approaches outside of therapy based settings. This paper introduces the method of ‘sandboxing’, which was developed from the psychoanalytical approach of the ‘world technique’. ‘Sandboxing’ provides an opportunity for participants to create three-dimensional scenes in sand-trays, employing miniature figures and everyday objects. Data is presented from two studies conducted in Wales, UK. The first, exploring mature students’ accounts of higher education, and the second, exploring the educational experiences of children and young people in public care. The paper argues that psychoanalytical work can be adapted to enable a distinctive, valuable and ethical tool of qualitative inquiry; and illustrates how ‘sandboxing’ engendered opportunities to fight familiarity, enabled participatory frameworks, and contributed to informed policy and practice

Deletion of Wntless in myeloid cells exacerbates liver fibrosis and the ductular reaction in chronic liver injury

Background: Macrophages play critical roles in liver regeneration, fibrosis development and resolution. They are among the first responders to liver injury and are implicated in orchestrating the fibrogenic response via multiple mechanisms. Macrophages are also intimately associated with the activated hepatic progenitor cell (HPC) niche or ductular reaction that develops in parallel with fibrosis. Among the many macrophage-derived mediators implicated in liver disease progression, a key role for macrophage-derived Wnt proteins in driving pro-regenerative HPC activation towards a hepatocellular fate has been suggested. Wnt proteins, in general, however, have been associated with both pro-and anti-fibrogenic activities in the liver and other organs. We investigated the role of macrophage-derived Wnt proteins in fibrogenesis and HPC activation in murine models of chronic liver disease by conditionally deleting Wntless expression, which encodes a chaperone essential for Wnt protein secretion, in LysM-Cre-expressing myeloid cells (LysM-Wls mice)

Combining immunodetection with histochemical techniques: the effect of heat-induced antigen retrieval on picro-sirius red staining

Picro-Sirius red is a routine diagnostic stain intended for the histological visualization of collagen fibers (fibrosis) in tissue. Multi-label immunohistochemistry is a powerful tool used by researchers to visualize different cell types and their location within a tissue specimen, and to observe co-localization of antigens. Combining the specificity of immunodetection with the simplicity of Sirius red staining will allow researchers to visualize multi-antigen detection in relation to fibrosis, a common histological feature of injury in many chronic diseases. Pre-treatment of formalin-fixed, paraffin-embedded tissue (FFPE) specimens with antigen retrieval is essential for the work-up of most commercially available antibodies. The most common form of antigen retrieval involves boiling tissue specimens in buffer to break the cross-linkages caused by formalin fixation. However, this method causes tissue modification and collagen fiber shrinkage leading to suboptimal results when counterstaining for Sirius red. Reduced heat and enzymatic digestion are antigen retrieval methods compatible with Sirius red counterstaining. This paper will discuss the difficulties faced when combining these two staining methods, and provide a detailed method for the simultaneous detection of antigen and Sirius red in FFPE tissues

New paradigms in the histopathology of NAFLD

Non-alcoholic fatty liver disease (NAFLD) is a rapidly growing global health problem. It can be separated histologically into two broad groups: steatosis, which usually follows a benign clinical course and non-alcoholic steatohepatitis (NASH) that typically has hepatocyte ballooning, necroinflammatory activity and can progress to fibrosis and cirrhosis. More recently the histological spectrum has expanded with the recognition of a paediatric pattern of NASH that has portal-based inflammation and fibrosis without ballooning. An overlap pattern is also described. There is increasing interest in the portal changes of NASH as these correlate with the progression of fibrosis. Disease-associated hepatocyte senescence appears to trigger an alternative regenerative pathway and the development of a periportal ductular reaction (DR), which in turn may have a role in progressive fibrogenesis. Portal inflammation, particularly in association with the DR, is an area of recent study

Exploiting in silico modelling to enhance translation of liver cell therapies from bench to bedside

Cell therapies are emerging as promising treatments for a range of liver diseases but translational bottlenecks still remain including: securing and assessing the safe and effective delivery of cells to the disease site; ensuring successful cell engraftment and function; and preventing immunogenic responses. Here we highlight three therapies, each utilising a different cell type, at different stages in their clinical translation journey: transplantation of multipotent mesenchymal stromal/signalling cells, hepatocytes and macrophages. To overcome bottlenecks impeding clinical progression, we advocate for wider use of mechanistic in silico modelling approaches. We discuss how in silico approaches, alongside complementary experimental approaches, can enhance our understanding of the mechanisms underlying successful cell delivery and engraftment. Furthermore, such combined theoretical-experimental approaches can be exploited to develop novel therapies, address safety and efficacy challenges, bridge the gap between in vitro and in vivo model systems, and compensate for the inherent differences between animal model systems and humans. We also highlight how in silico model development can result in fewer and more targeted in vivo experiments, thereby reducing preclinical costs and experimental animal numbers and potentially accelerating translation to the clinic. The development of biologically-accurate in silico models that capture the mechanisms underpinning the behaviour of these complex systems must be reinforced by quantitative methods to assess cell survival post-transplant, and we argue that non-invasive in vivo imaging strategies should be routinely integrated into transplant studies