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Hepatic Surf4 Deficiency Impairs Serum Amyloid A1 Secretion and Attenuates Liver Fibrosis in Mice
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Bingxiang Wang1, 2, *, , Huili Li1, 2, , Govind Gill3, Xiangyan Zhang4, Geru Tao1, 2, Boyan Liu1, 2, Lei Zhai1, 2, Wei Chen1, 2, Hao Wang1, 2, Hong-mei Gu3, Shucun Qin1, 2, *, Da-wei Zhang3, *
Research. Vol 7 Article ID 0435
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Research. Vol 7 Article ID 0435
Research Article
Hepatic Surf4 Deficiency Impairs Serum Amyloid A1 Secretion and Attenuates Liver Fibrosis in Mice
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Bingxiang Wang1, 2, *, , Huili Li1, 2, , Govind Gill3, Xiangyan Zhang4, Geru Tao1, 2, Boyan Liu1, 2, Lei Zhai1, 2, Wei Chen1, 2, Hao Wang1, 2, Hong-mei Gu3, Shucun Qin1, 2, *, Da-wei Zhang3, *
Affiliations
  • 1 School of Clinic and Basic Medical Sciences, The Second Affiliated Hospital of Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
  • 2 Institute of Atherosclerosis in Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
  • 3Department of Pediatrics and Group on the Molecular and Cell Biology of Lipids, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
  • 4Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Published: 2024-08-05 doi: 10.34133/research.0435
Outline
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Liver fibrosis is a severe global health problem. However, no effective antifibrotic drugs have been approved. Surf4 is primarily located in the endoplasmic reticulum (ER) and mediates the transport of secreted proteins from the ER to the Golgi apparatus. Knockout of hepatic Surf4 (Surf4LKO) in mice impairs very-low-density lipoprotein secretion without causing overt liver damage. Here, we found that collagen levels are significantly reduced in the liver of Surf4LKO mice compared with control Surf4flox mice, as demonstrated by proteomics, Western blot, and quantitative reverse transcription polymerase chain reaction. Therefore, this study aims to investigate whether and how hepatic Surf4 affects liver fibrosis. We observed that CCl4-induced liver fibrosis is significantly lower in Surf4LKO mice than in Surf4flox mice. Mechanistically, hepatic Surf4 deficiency reduces serum amyloid A1 (SAA1) secretion and hepatic stellate cell (HSC) activation. Surf4 coimmunoprecipitates and colocalizes with SAA1. Lack of hepatic Surf4 significantly reduces SAA1 secretion from hepatocytes, and SAA1 activates cultured human HSCs (LX-2 cells). Conditioned medium (CM) from Surf4-deficient primary hepatocytes activates LX-2 cells to a much lesser extent than CM from Surf4flox primary hepatocytes, and this reduced effect is restored by the addition of recombinant SAA1 to CM from Surf4-deficient hepatocytes. Knockdown of SAA1 in primary hepatocytes or TLR2 in LX-2 cells significantly reduces LX-2 activation induced by CM from Surf4flox hepatocytes but not from Surf4LKO hepatocytes. Furthermore, knockdown of SAA1 significantly ameliorates liver fibrosis in Surf4flox mice but does not further reduce liver fibrosis in Surf4LKO mice. We also observe substantial expression of Surf4 and SAA1 in human fibrotic livers. Therefore, hepatic Surf4 facilitates SAA1 secretion, activates HSCs, and aggravates liver fibrosis, suggesting that hepatic Surf4 and SAA1 may serve as treatment targets for liver fibrosis.

Bingxiang Wang, Huili Li, Govind Gill, Xiangyan Zhang, Geru Tao, Boyan Liu, Lei Zhai, Wei Chen, Hao Wang, Hong-mei Gu, Shucun Qin, Da-wei Zhang. Hepatic Surf4 Deficiency Impairs Serum Amyloid A1 Secretion and Attenuates Liver Fibrosis in Mice[J]. Research, 2024 , 7 (8) : 0435 . DOI: 10.34133/research.0435
Various stimuli, including metabolic dysfunction-associated steatotic liver disease (MASLD), toxic chemicals, etc., cause chronic liver damage and activate hepatic stellate cells (HSCs), leading to liver fibrosis characterized by excessive hepatic extracellular matrix (ECM) deposition. Millions of patients with liver fibrosis develop hepatic dysfunction and hepatocellular carcinoma (HCC) every year [14]. However, no effective antifibrotic drugs, especially for patients with severe cirrhosis, have been approved. Therefore, identification of new therapeutic targets is urgent.
The etiology of liver fibrosis depends on hepatic injuries; however, myofibroblasts (MFBs), primarily producing fibrillar collagen throughout the course of liver fibrosis, primarily originate from activated HSCs [3,5]. The TGF-β1/SMAD pathway has a major role in activating HSC; however, HSC activation also involves non-SMAD pathways, such as NF-κB, p38, JNK, and PI3K/Akt pathways [3,68]. These can activate and transdifferentiate HSCs into MFBs, leading to excessive ECM formation and liver fibrosis.
Serum amyloid A1 (SAA1), an acute-phase response (APR) protein, has a marked role in response to inflammatory stimuli. Emerging evidence implicates its profibrotic role [915]. The SAA family includes SAA1, 2, 3, and 4 in mice and SAA1, 2, and 4 in humans. SAAs are poorly water soluble and mainly bind to high-density lipoprotein (HDL) in the blood. SAA4 is constitutively expressed at a low level, while SAA1 and SAA2 are APR proteins. SAA1 and 2 are prologue genes with 93% identical amino acid composition. However, studies indicate that SAA1 is the predominant isoform, accounting for approximately 74% of total SAA in healthy individuals, and has greater pathogenic properties [16,17]. SAA1 is highly conserved among mammals, with 76% of the amino acid residues identical in human and mouse SAA1. SAA1 is present at low levels in healthy individuals but increases dramatically during APR and decreases rapidly after the APR event is resolved. Chronic inflammation also substantially increases hepatic expression and plasma levels of SAA1 [11,1315,18]. SAA1 can increase hepatic steatosis, activate HSCs, and increase ECM deposition in the liver via the Toll-like receptor (TLR) pathways, and its levels are increased in the liver and blood of patients with MASLD [11,1921]. SAA1 is expressed in a variety of cells, but hepatocytes contribute the majority of circulating SAA1 under basal and stimulated conditions. How SAA1 is transported from the endoplasmic reticulum (ER) and secreted from cells, however, is still unknown.
Surf4 is a cargo receptor in the ER membrane that facilitates protein secretion [22]. It mediates chylomicron and very low-density lipoprotein (VLDL) secretion from enterocytes and hepatocytes, respectively. However, liver-specific Surf4 knockout (Surf4LKO) mice do not exhibit substantial hepatic lipid accumulation or liver damage despite impaired VLDL secretion [23,24]. To further understand the physiological role of hepatic Surf4, we performed proteomics analysis and observed markedly lower collagen levels in the liver of Surf4LKO mice than that of Surf4flox mice. Additionally, CCl4 significantly increased plasma SAA1 in Surf4flox mice but not in Surf4LKO mice. Hepatic Surf4 deficiency significantly decreased SAA1 secretion from isolated primary hepatocytes, lowered circulating SAA1 levels, and attenuated liver fibrosis in mice receiving CCl4. Conditioned medium (CM) from primary hepatocytes of Surf4LKO mice activated cultured human HSCs, LX-2 cells, to a much lesser extent than CM from primary hepatocytes of Surf4flox mice. This reduced effect on LX-2 activation was restored when recombinant SAA1 was added to the CM of Surf4-deficient primary hepatocytes. Furthermore, knockdown of SAA1 significantly reduced liver fibrosis in Surf4flox mice but did not further reduce liver fibrosis in Surf4LKO mice. Therefore, Surf4 mediates hepatic SAA1 secretion, which activates HSCs and exacerbates liver fibrosis.
Proteomics analysis of the liver of Surf4flox and Surf4LKO mice revealed 5,681 quantifiable proteins (330 up-regulated and 153 down-regulated) between the 2 genotypes (Fig. 1A and B and Table S1). Bioinformatic enrichment analysis revealed multiple altered pathways involved in lipid metabolism, for example, synthesis and degradation of ketone bodies, fat digestion and absorption, cholesterol metabolism, fatty acid degradation, retinol metabolism, and peroxisome proliferator-activated receptor signaling pathway. Various other pathways, such as complement and coagulation cascades, protein metabolism, inflammatory mediator regulation of TRP channels, and TGF-β signaling pathway, were also enriched in proteins with altered expression (Fig. 1C). These findings indicate that hepatic Surf4 deficiency alters diverse biological processes in mouse liver.
Cellular component (CC) enrichment analysis of 330 up-regulated proteins revealed protein enrichment on lipoprotein particles and protein-lipid particles, as well as ER lumen and ER chaperone complex and ER-Golgi intermediate compartment in the liver of Surf4LKO mice (Fig. 1D), consistent with previous reports that Surf4 mediates lipoprotein secretion [2227]. Interestingly, the pathway enriched with the highest number of proteins with altered expression was the collagen-containing ECM. Many other pathways, such as blood coagulation, endopeptidase inhibitor activity, and peptidase regulator activity, were also revealed with biological process (BP) and molecular function (MF) analysis (Fig. S1A and B). The top 5 up-regulated proteins included apolipoprotein A-I (APOA-I, Log2Fold change [FC] LKO/Flox = 3.67, P = 0.0362), major urinary protein 2 (MUP2, LKO/Flox = 3.47, P = 0.0068), WASH complex subunit 3 (WASHC3, Log2FC LKO/Flox = 3.387, P = 0.0144), SAA1 (Log2FC LKO/Flox = 3.359, P = 0.0299), and MUP14 (Log2FC LKO/Flox = 3.079, P = 0.0018) (Table S1). APOA-I is the main structural apolipoprotein of HDL. Lack of Surf4 may directly or indirectly affect APOA-I secretion, leading to extremely low plasma HDL levels in Surf4LKO mice [24]. MUPs are secretory proteins expressed in mice but not in humans. Their physiological functions remain elusive. Mice deficient in MUPs are indistinguishable from wild-type littermates [28]. WASHC3, an intracellular protein primarily located in the endosome membrane, regulates endosomal F-actin polymerization, endosomal sorting, and exocytosis [29]. SAA1 is a secretory protein and is involved in diverse roles, such as APR, tissue amyloid deposits, and lipid metabolism [28]. Surf4 mediates protein ER-Golgi export; therefore, the change in these proteins may be caused directly or indirectly by Surf4 deficiency. The distinct functions of these proteins further indicate the complex changes in the liver caused by lacking hepatic Surf4.
We then analyzed the 153 down-regulated proteins with the Gene Ontology (GO) enrichment and also observed changes in multiple pathways. Fatty acid metabolic process and biosynthetic process were enriched in BP analysis (Fig. S1C), consistent with our previous report that hepatic Surf4 deficiency lowers the expression of de novo lipogenesis genes [24,25]. Interestingly, collagen and ECM pathways were also significantly enriched in the CC, BP, and MF analyses (Fig. 1E and Fig. S1C and D). The top 8 most significantly down-regulated proteins were ECM components, including COL3A1, COL2A1, COL1A1, COL11A1, COL5A2, COL1A2, COL11A2, and Fibrillin 1 (FBN1) (Fig. 1B and Table S1). Data in Fig. 1F and G confirmed a significant reduction in mRNA and protein levels of COL1A in the liver of Surf4LKO mice, indicating that Surf4 deficiency reduces hepatic collagen expression.
Excessive accumulation of ECM leads to liver fibrosis. Therefore, we investigated whether the substantial reduction in ECM in Surf4LKO mice affects liver fibrosis. Mice fed a high fat for 50 weeks developed hepatic steatosis with little fibrosis. A methionine- and choline-deficient (MCD) diet (high in sucrose [40%] and fat [10%] but deficient in methionine and choline) can induce notable liver fibrosis after approximately 20 weeks of feeding. However, the MCD diet results in marked weight loss, which is uncommon in patients with metabolic syndromes. On the other hand, CCl4 can induce liver fibrosis quickly. This is the most commonly used mouse model of liver fibrosis and resembles many aspects of human liver fibrosis caused by chronic disease [3032]. Therefore, we administered mice with CCl4 for 6 weeks. Plasma TG, total cholesterol (TC), HDL-cholesterol and non-HDL-cholesterol levels were significantly lower in both male and female Surf4LKO mice than those in Surf4flox mice (Fig. S2A to H), consistent with our previous reports [24,25,33]. On the other hand, Surf4 knockout had no significant effect on blood glucose levels or body weight in male or female mice (Fig. S3A to D). Liver weight was increased in male and female Surf4LKO mice. However, the liver/body weight ratio, lipid droplets, and TG levels showed a mild but statistically significant increase only in male Surf4LKO mice (Fig. S3E to H and Fig. 2A and C). Female Surf4LKO mice also exhibited an increasing trend in these parameters, but the difference did not reach statistical significance (Fig. 2B and D). However, hepatic TC levels and plasma alanine transaminase (ALT) and aspartate aminotransferase (AST) activity were comparable between the 2 groups in both male and female mice (Fig. 2E to J). Therefore, hepatic Surf4 silencing results in mild hepatic TG accumulation, especially in male mice, but does not significantly exacerbate liver damage in mice receiving CCl4.
Masson's trichrome and Sirius red staining of liver sections showed reduced fibrosis in male and female Surf4LKO mice compared with their control (Fig. 3A and B and Fig. S4A and 4B). Detailed analysis of Sirius red-staining sections using polarized light microscopy consistently revealed a significant reduction in collagen content in Surf4LKO mice (Fig. 3C and Fig. S4C). Furthermore, immunostaining of liver sections with F4/80, a macrophage marker, showed that Surf4 deficiency significantly reduced macrophage populations (Fig. 3D and Fig. S4D). Lack of Surf4 also significantly reduced the expression of liver fibrosis markers (Col1a, Acta2/α-Sma) and inflammation markers (Il-1β and Tnf-α) at mRNA and protein levels in male and female Surf4LKO mice (Fig. 3E and F and Fig. S4E and F). We noticed a statistically significant but mild decrease in the protein levels of COL1A, α-SMA, TNF-α, and IL-1β in the liver of Surf4LKO mice (Fig. 3F and Fig. S4F). Notably, HSCs constitute only about 5% to 10% of hepatocytes but are responsible for phenotypic changes in the liver. Whole liver homogenate was used for Western blotting in Fig. 3, which may be attributed to the mild effect observed. Nevertheless, knockout of hepatic Surf4 reduces collagen content and inflammation in the liver of mice receiving CCl4, thereby attenuating liver fibrosis.
HSC activation is the primary driver of ECM production and liver fibrosis and has been implicated as the exclusive source of the MFB pool in CCl4-induced liver fibrosis [34]. Therefore, to understand how knockout of hepatic Surf4 affected CCl4-induced liver fibrosis, we evaluated expression of lecithin:retinol acyltransferase (LRAT), an HSC cell marker, and α-SMA, a marker for HSC activation. As shown in Fig. 3G, both LRAT and α-SMA staining and their co-staining in liver sections were significantly lower in Surf4LKO mice than in Surf4flox mice, indicating fewer total and activated HSCs. Consistently, α-SMA positive staining and its mRNA levels (Fig. 3H and I) and the protein levels of α-SMA, COL1A, and TNF-α (Fig. S4G) were significantly reduced in primary HSCs isolated from Surf4LKO mice, indicating that hepatic Surf4 deficiency suppresses HSC activation in CCl4-treated mice.
TGF-β is critical for HSC activation. However, unlike HSCs, primary hepatocytes of Surf4flox and Surf4LKO mice displayed virtually undetectable expression of TGF-β (Fig. S5A and B), consistent with previous reports [3538]. To understand how knockout of Surf4 in hepatocytes affected HSC activation and liver fibrosis, we performed proteomics on plasma samples and identified 932 proteins (57 up-regulated and 190 down-regulated) in Surf4LKO mice compared with Surf4flox mice (Fig. 4A, Fig. S5C, and Table S2). Plasma proteins with significantly altered expression were involved in diverse processes, such as carbohydrate transport and metabolism, signaling transduction mechanisms and posttranslational modifications, protein turnover, and chaperons (Fig. S5D). Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that multiple pathways were enriched with proteins with the most significant changes in expression, such as the TLR and NF-kappa B pathway, and Salmonella infection (Fig. 4B). Consistently, GO analysis of up-regulated proteins revealed the involvement of diverse pathways, such as the small-molecule catabolic process and reactive oxygen species metabolic process in BP, carbohydrate binding and antioxidant activity in MF, and collagen-containing ECM and myelin sheath in CC (Fig. S6A to C). In addition, GO analysis of down-regulated proteins showed that several BPs and CCs involved in lipid metabolism (e.g., lipid localization, protein-lipid complex remodeling, and various plasma lipoprotein particles) were enriched in Surf4LKO mice (Fig. S6D to F), consistent with the role of Surf4 in mediating lipoprotein secretion [24,25,33]. However, down-regulated proteins also participated in many other cellular functions and processes, such as negative regulation of hydrolase activity in BP, glycosaminoglycan binding in MF, and collagen-containing ECM in CC. Therefore, lacking hepatic Surf4 causes changes in plasma proteins involved in diverse functions.
Many significantly down-regulated proteins identified in proteomics of plasma samples were apolipoproteins and Ig chains (Table S2). We noticed that plasma SAA1 levels were also remarkably reduced in Surf4LKO mice (Log2FC LKO/Flox = −3.16, P = 0.009, Table S2 and Fig. 4A), but significantly increased in the liver of Surf4LKO mice (Log2FC LKO/Flox = 3.358, P = 0.0299, Table S1). SAA1 produced from hepatocytes has been reported to activate HSCs locally and promote hepatic ECM deposition in mice administered a single dose of 20% CCl4 [11]. Therefore, we investigated the possibility that Surf4-deficient hepatocytes impaired SAA1 secretion and consequently reduced HSC activation and liver fibrosis. Immunohistochemistry showed accumulation of SAA1 in the liver and primary hepatocytes of Surf4LKO mice (Fig. 4C and D and Fig. S7A). We also observed overlap of SAA1 with an ER-tracker (orange puncta, Fig. S7B), indicating ER accumulation of SAA1 in Surf4-deficient hepatocytes. We then measured plasma SAA1 levels and observed a significant reduction in Surf4LKO mice (Fig. 4E). Circulating SAA1 is also secreted from extrahepatic tissues, e.g., adipose tissue, the intestine, etc. [14], which may contribute to plasma SAA1 in Surf4LKO mice.
We further isolated primary hepatocytes and measured SAA1 secretion. SAA1 was significantly elevated in cell lysate but decreased in culture medium of primary hepatocytes isolated from Surf4LKO mice (Fig. 4F and G). We then evaluated changes in SAA1 in mice receiving CCl4 for 6 weeks. Surf4 deficiency significantly reduced plasma SAA1 levels and caused accumulation of SAA1 in the liver of Surf4LKO mice (Fig. 4H and I). Consistently, Surf4-deficient primary hepatocytes exhibited a significant increase in SAA1 levels in whole cell lysate and a significant decrease in secreted SAA1 in culture medium (Fig. 4J and K). Furthermore, CCl4 significantly increased plasma SAA1 levels in Surf4flox mice (mean: 3.03 in CCl4 treatment [Fig. 4H] and 1.93 in no CCl4 treatment [Fig. 4E], P < 0.0001), but not in Surf4LKO mice (mean: 1.56 in CCl4 treatment [Fig. 4H] and 1.51 in no CCl4 treatment [Fig. 4E], P = 0.8139). Therefore, Surf4 deficiency impairs SAA1 secretion from hepatocytes.
Liver fibrogenesis is a complex process, in which HSC activation plays an essential role. Therefore, we assessed a potential direct effect of Surf4 deficiency in hepatocytes on HSC activation. We collected CM from primary hepatocytes of Surf4flox and Surf4LKO mice to treat cultured human HSCs, LX-2 cells. α-SMA staining and its protein levels were significantly lower in LX-2 cells incubated with CM of Surf4LKO hepatocytes compared with CM of Surf4flox hepatocytes, and the reduced effect on α-SMA was restored by supplementing CM of Surf4LKO hepatocytes with recombinant SAA1 (Fig. 5A and B). We then isolated primary hepatocytes from CCl4-treated Surf4flox and Surf4LKO mice and transfected them with either negative control (NC) or SAA1 siRNA. SAA1 expression in primary hepatocytes and culture medium was effectively reduced by its siRNA (Fig. S8A). CM was then collected to treat LX-2 cells. Compared with NC siRNA-transfected hepatocytes, knockdown of SAA1 in Surf4flox hepatocytes markedly reduced α-SMA staining in LX-2 cells that received CM of Surf4flox hepatocytes (Fig. 5C, column 1 vs. 3, mean difference: 37.52, p < 0.0001), but the reduction in α-SMA staining was much less in LX-2 cells treated with CM of SAA1-knockdown Surf4LKO hepatocytes (column 2 vs. 4, mean difference: 14.1, P = 0.0085). Immunoblotting of whole cell lysate with α-SMA showed a similar phenotype (Fig. 5D), with knockdown of SAA1 in Surf4flox hepatocytes causing a more significant reduction in α-SMA levels in LX-2 cells (column 1 vs. 3, mean difference: 0.82, P = 0.0062) than knockdown of SAA1 in Surf4LKO hepatocytes (column 2 vs. 4, mean difference: 0.08, P = 0.8223).
We also silenced Surf4 in the cultured human hepatoblastoma-derived cell line, HepG2 [39]. Knockdown of Surf4 reduced secretory SAA1 in medium and increased SAA1 in whole cell lysate (Fig. S8B and C). CM from Surf4 knockdown HepG2 cells significantly reduced expression and staining of α-SMA in LX-2 cells, which was restored by exogenous addition of recombinant SAA1 (Fig. S8D and E). We then investigated the interaction between SAA1 and Surf4. The interaction between cargo receptors and their substrates is usually weak and transient [40]. Therefore, we co-expressed SAA1 and Surf4 in HepG2 cells and then treated cells with sodium azide and D-glucose to inhibit disassociation between cargo receptors and their substrates, followed by crosslinking with a membrane-permeable reversible crosslinker, as previously described [41]. Surf4 was immunoprecipitated from Surf4-expressing cell lysate (Fig. S8F, lanes 6 and 8). SAA1 was co-immunoprecipitated with Surf4 from lysate of cells co-transfected with Surf4 and SAA1 (lane 8). We also conducted confocal microscopy of HepG2 cells transiently co-transfected with Surf4 and SAA1 and treated with sodium azide and D-glucose (Fig. S8G). Both Surf4 (green fluorescence) and SAA1 (red fluorescence) were detected in transfected cells and showed partial colocalization in the overlapped image (yellow), indicating an association between Surf4 and SAA1. Taken together, these findings indicate that Surf4 mediates SAA1 secretion, which contributes, at least in part, to the effect of Surf4 deficiency on HSC activation.
It has been reported that TLR2 mediates SAA1-induced activation of HSCs (11). Proteomics analysis of plasma samples revealed enrichment in the TLR signaling pathway (Fig. 4B). Therefore, we knocked down TLR2 expression in LX-2 cells using siRNA. TLR2 siRNA significantly reduced TLR2 mRNA level compared with control siRNA (Fig. S8H). Cells were then incubated with CM collected from Surf4flox and Surf4LKO hepatocytes. Compared with LX-2 cells transfected with control siRNA, LX-2 cells transfected with TLR2 siRNA displayed a marked decrease in α-SMA levels when treated with CM of Surf4flox hepatocytes (Fig. 5E, column 3 vs. 1, mean difference: 0.51, P = 0.0002), but showed a much less reduction in α-SMA when treated with CM of Surf4LKO hepatocytes (Fig. 5E, column 4 vs. 2, mean difference: 0.1, P = 0.081). A consistent phenotype was observed in immunofluorescence, and knockdown of TLR2 caused a greater reduction in α-SMA staining in LX-2 cells incubated with CM from Surf4flox hepatocytes (Fig. 5F and G, column 3 vs. 1, mean difference=41.07, P < 0.0001) than that in cells incubated with CM from Surf4LKO hepatocytes (Fig. 5F and G, column 4 vs. 2, mean difference: 14.14, P = 0.0459). In HSCs, TLRs-MyD88 activates downstream signaling molecules, such as P38 and JNK, promoting liver fibrosis. As shown in Fig. 5H, phosphorylated P38 (p-P38) and phosphorylated JNK (p-JNK) were significantly down-regulated in the liver of male and female Surf4LKO mice receiving CCl4 compared with Surf4flox mice administered CCl4, whereas the levels of total P38 and JNK were comparable in the 2 groups. Therefore, TLR2 may mediate the effect of SAA1 on HSC activation.
We then investigated whether SAA1 affected liver fibrosis in mice. AAV-shRNA was used to knock down SAA1 in Surf4flox and Surf4LKO mice. AAV-shRNA SAA1 effectively reduced SAA1 levels in liver homogenate and plasma in Surf4flox and Surf4LKO mice compared to mice injected with AAV-shRNA NC (Fig. 6A). As shown in Fig. 6B and C, knockdown of SAA1 significantly decreased liver fibrosis in Surf4flox mice but not in Surf4LKO mice compared with corresponding controls receiving AAV-shRNA NC, as evidenced by Masson's and Picrosirius red staining (column 1 vs. 2 and column 3 vs. 4). Masson's and Sirius red staining was also significantly lower in Surf4LKO mice receiving AAV-shRNA NC than Surf4flox mice receiving AAV-shRNA NC (column 3 vs. 1). However, Surf4flox mice and Surf4LKO mice showed comparable staining when SAA1 was knocked down (column 2 vs. 4). In addition, immunostaining of liver sections with α-SMA showed that SAA1 knockdown markedly reduced α-SMA levels in Surf4flox mice but not Surf4LKO mice compared with respective control mice receiving AAV-shRNA NC (Fig. 6D). Knockdown of SAA1 also significantly lowered α-SMA and TNF-α protein levels in Surf4flox mice (Fig. 6E). Collectively, these findings indicate that knockdown of SAA1 markedly attenuates liver fibrosis in Surf4flox mice but not in Surf4LKO mice.
We also collected liver samples from patients with HCC. The para-HCC region displayed high fibrosis, evidenced by Masson's and Picrosirius red staining (Fig. S9A and B). IHC analyses showed substantial expression of Surf4 and SAA1 in the liver samples (Fig. S9C and D). Altogether, these data suggest that Surf4 mediates SAA1 secretion, which may activate HSCs in a paracrine manner via TLR2, thus exacerbating liver fibrosis (Fig. S9E).
We previously reported that knockout of hepatic Surf4 causes a similar phenotype in male and female mice, dramatically reducing VLDL secretion and plasma TG and cholesterol levels [2325,33]. On the other hand, knockout of intestinal Surf4 leads to more dramatic death in male mice than in female mice, although intestinal chylomicron secretion is markedly reduced in male and female mice [23]. Here, we observed that hepatic Surf4 deficiency has a similar effect on plasma lipids and liver fibrosis in male and female mice administered CCl4, implying no notable impact of sex differences. We previously reported that loss of hepatic Surf4 does not lead to detectable liver damage or hepatic TG accumulation in mice [24,25,33], even though the underlying mechanism remains unclear. Conversely, Surf4LKO mice display a mild increase in hepatic TG levels after CCl4 treatment. CCl4 can increase fatty acid and TG synthesis in hepatocytes [42], which, in combination with impaired VLDL secretion, may lead to increased hepatic TG levels in Surf4LKO mice. However, hepatic Surf4 deficiency does not worsen liver damage in mice receiving CCl4, as supported by no detectable changes in plasma ALT and AST levels.
The activation and transdifferentiation of HSCs into MFBs are essential for the occurrence and progression of liver fibrosis, and TGF-β plays a central role in HSC activation. Nonparenchymal and inflammatory cells, such as Kupffer cells, bone marrow-derived macrophages, and activated HSCs, rather than hepatocytes, are the main origin of TGF-β in liver fibrosis development [3538]. We also consistently observed extremely low expression of TGF-β in hepatocytes. Therefore, lack of hepatic Surf4 may not directly affect TGF-β production in the liver. However, TGF-β is activated by multiple factors, such as inflammation and changes in ECM components and stiffness. Surf4LKO mice exhibit decreased inflammatory factors and ECM deposition, which might reduce TGF-β production and activation and thus contribute to attenuation of liver fibrosis.
SAA1 has been reported to promote renal interstitial and cardiac fibrosis and activate HSCs [1115]. Our current findings showed that Surf4 plays an essential role in hepatic SAA1 secretion. Surf4 deficiency markedly reduces SAA1 secretion from hepatocytes isolated from mice treated with or without CCl4. Lipid-free SAA in the extracellular milieu can bind to different receptors on the cell surface locally, exerting various physiological and pathophysiological functions [18,4346]. In acute liver damage caused by CCl4 or cryoinjury, hepatocytes produce SAA1, which activates HSCs locally and increases ECM deposition at injury sites [11]. SAA1 deficiency also dramatically reduces cardiac fibrosis in mice [15]. We found that lack of Surf4 markedly reduces HSC activation in CCl4-treated mice. In addition, CM of Surf4-deficient primary hepatocytes has a markedly reduced ability to activate LX2 cells compared with CM of primary hepatocytes from Surf4flox mice, and this reduction in LX2 activation is restored by supplementing CM of Surf4-deficient primary hepatocytes with recombinant SAA1, indicating the critical role of SAA1 in HSC activation. Furthermore, SAA1 knockdown, like hepatic Surf4 deficiency, substantially reduces liver fibrosis in Surf4flox mice, but has no detectable effect on liver fibrosis in Surf4LKO mice, suggesting the contribution of SAA1 to Surf4 deficiency-induced alleviation of liver fibrosis in mice. Notably, Surf4 mediates secretion of various cargos [22,47]. Proteomics analysis of liver samples revealed that more than 300 protein levels are increased in Surf4LKO mice compared with Surf4flox mice. Thus, these changes may also directly or indirectly affect CCl4-induced liver fibrosis in mice.
How does SAA1 secreted from hepatocytes activate HSCs? Emerging studies show that TLR2 is a functional receptor for SAA1 [11,4850]. SAA1 binds TLR2, activates the NF-κB pathway, and increases p-P38 and p-JNK levels in diverse cells, e.g., dermal fibroblasts, macrophages, HeLa cells, and dendritic cells [5154]. Recently, Getachew et al. reported that SAA1 secreted from hepatocytes binds to TLR2 on HSCs in a paracrine manner, activating and recruiting HSCs to the injury site. Deficiency of SAA1 or TLR2 markedly reduces SAA1-induced HSC activation and ECM deposition at injury sites [11]. Additionally, TLR2 expression is increased in activated HSCs [55,56]. Lack of TLR2 in mice inhibits HSC activation, reduces p-JNK and p-p38, and attenuates liver fibrosis induced by CCl4 [57], and SAA1 deficiency substantially reduces p-P38 and p-JNK in the myocardium [15]. Here, we found that knockdown of TLR2 in LX2 cells markedly reduces HSC activation induced by CM of Surf4flox primary hepatocytes, but only mildly reduces HSC activation induced by CM of Surf4LKO primary hepatocytes. We also observed that levels of p-P38, p-JNK, IL-1β, and TNF-α in the liver were lower in Surf4LKO mice than in Surf4flox mice. Therefore, our findings implicate that TLR2 on HSCs may mediate SAA1-induced HSC activation. However, additional studies are required to further confirm this possibility. Nevertheless, our findings indicate that hepatic Surf4 mediates SAA1 secretion from hepatocytes, which activates HSCs in a paracrine manner, likely via TLR2. This subsequently increases expression of fibrogenic and inflammatory proteins (e.g., α-SMA and IL-1β), exacerbating liver fibrosis (Fig. S9E).
Targeting the TGF-β pathway can attenuate liver fibrosis in several preclinical animal models [58]; however, the development and translation of TGF-β-based therapies to treat human patients face significant challenges due to the cell-type-dependent pleiotropic roles of TGF-β. Therefore, identification of novel therapeutic targets is in urgent need. Cell–cell communication plays a crucial role in liver fibrogenesis [59], with HSCs acting as a vital signaling hub. Inflammation accompanies and plays a critical role in all stages of liver fibrosis. Inflammation increases SAA1 expression [18], and we observed that CCl4 substantially elevates plasma SAA1 levels in Surf4flox mice, but not in Surf4LKO mice. Specific targeting of hepatocytes has been successfully achieved using GalNAc-conjugated siRNA or antisense oligonucleotides [60,61]. In different mouse models, silencing of hepatic Surf4 dramatically reduces plasma lipid levels and the development of atherosclerosis without causing overt liver damage [2427]. Collectively, these findings implicate the therapeutic potential of liver Surf4 and SAA1. However, one limitation of the study is that only chemical-induced liver fibrosis was investigated. In addition, Surf4 facilitates ER export of a variety of proteins. We also noticed mild TG accumulation in the liver of Surf4LKO mice, which may be caused by impaired VLDL secretion due to Surf4 deficiency. However, we cannot exclude the possibility that accumulated SAA1 in Surf4-deficient hepatocytes is involved in the development of the mild fatty liver. Furthermore, our findings indicate that SAA1 secreted by hepatocytes activates HSCs and promotes liver fibrosis in mice. SAA1 expression is low in mice and humans under normal conditions. Do elevated SAA1 levels induce or promote liver fibrosis in young and/or aged mice with no or only mild insult, such as high-fat or high-fructose feeding? Therefore, caution should be exercised, and more studies on the physiological and pathophysiological roles of Surf4 and SAA1 are warranted.
Surf4LKO mice were generated as described. Briefly, the Surf4flox mice, in which exon 2 of the Surf4 gene was flanked with LoxP sites, were bred with albumin (Alb)-Cre mice (The Jackson Laboratory, 003574) to inactivate Surf4 specifically in the liver [24,33]. Mice were maintained in the animal facility at Shandong First Medical University (Taian, China) with free access to a regular diet (Keao Xieli, Beijing, China) and H2O in a climate-controlled facility. CCl4 (0.6 μl/g body weight) was injected to each mouse (10 to 14 weeks old, 2 to 5 mice per cage) intraperitoneally once every 2 days for 4 or 6 weeks to induce liver fibrosis. Mice in all experiments were fasted for 10 h unless otherwise indicated [25].
Primary hepatocytes were prepared as previously described [24]. Primary HSCs were isolated from the liver [62]. Liver was perfused with Hanks' buffer with pronase (0.4 mg/ml) and collagenase IV (0.5 mg/ml). After centrifugation at 60 × g, supernatant was harvested and applied to a density gradient centrifugation. HSCs were collected and cultured in Dulbecco's Modified Eagle Medium (DMEM) with 10% fetal bovine serum (FBS) for 2 h. After removal of unattached cells, HSCs were cultured in fresh medium for subsequent experiments. HepG2 (National Collection of Authenticated Cell Cultures) and LX-2 (Procell) cells were cultured in DMEM containing 10% FBS and LX-2 special medium (Procell), respectively. siRNA was introduced into cells (primary hepatocytes, LX-2, and HepG2) using Lipofectamine 3000 (Invitrogen). Equal amounts of plasmids containing HA-tagged SAA1 and Myc-DDK-tagged Surf4 were introduced into HepG2 cells using Lipofectamine 3000 as previously described [63].
Fresh livers were fixed in 4% paraformaldehyde. H&E, Oil Red O, Masson's, and Sirius red staining were performed by Servicebio Technology Co., Ltd. (Wuhan, China). All slices were imaged on an Olympus microscope (BX53). Stained areas were quantified with ImageJ (v1.53e).
Fasting blood was collected into EDTA-coated tubes. Plasma was isolated and subjected to analysis of TG, TC, HDL-C, non-HDL-C, ALT, and AST (Nanjing Jiancheng Bioengineering Institute, China) [24]. Plasma IL-1β and TNF-α levels were measured using mouse-specific ELISA assay kits (mlbio, Shanghai, China). The Folch method was used to extract liver lipids for TG and TC measurement with commercial kits (Applygen, China), which was then normalized to the amount of total proteins in the respective sample [24,33].
TRIzol (Invitrogen, 15596018) was used to extract total RNA, which was used for the synthesis of complementary DNA (cDNA) with HiFi Script gDNA Removal RT MaterMix (CWBIO, China, CW2020M). qRT-PCR was performed using TransStart Green qPCR SuperMix (Transgene Biotech, China, AQ101-03). 2−ΔΔCt was used to calculate gene expression, which was normalized to Gapdh expression for a relative level (Primers in Table S2).
RIPA buffer (Solarbio) with protease inhibitors (cOmplete Ultra Tablets, Roche) and PMSF was used to lyse tissue and cells. Cell lysate was collected. Cell culture medium was precipitated with trichloroacetic acid (TCA) [64]. An equal amount of total proteins was used for Western blot with antibodies indicated (Table S2) [24,25]. The same amount of lysate from HepG2 cells transfected with different plasmids was applied to anti-Myc antibody-conjugated beads (Sigma) to pull down Myc-tagged Surf4, which was then detected by immunoblotting [65].
Immunofluorescence was performed as in Gu et al. [66]. After fixation, permeabilization, and blocking in 5% bovine serum albumin, cells were incubated with a primary antibody and then a secondary antibody. Nuclei and ER were revealed with DAPI and an ER tracker. Cells were imaged on a Live Cell Imaging System (BioTek, Lionheart FX) or a Leica SP5 laser scanning confocal microscope.
Fresh liver tissues were shipped to Shanghai Applied Protein Technology for TMT-graded proteomics analysis. Samples were subjected to protein extraction using 4% SDS, trypsin digestion, TMT labeling, and liquid chromatography–mass spectrometry. Differentially expressed proteins were screened according to the expression ratio change of more than 1.2 times (up-regulated greater than 1.2 times or down-regulated less than 0.83 times) and P value < 0.05 [23].
Plasma was collected from fasted mice and shipped to Shenzhen BGI Co. Ltd. for proteomics analysis. Samples were subjected to protein extraction with free SDS lysate, quality control, trypsinolysis, high pH RP separation, Data Dependent Acquisition database construction, and Data Independent Acquisition quantitative detection by liquid chromatography–mass spectrometry [23]. Using the MSstats software package, the error correction and normalization of each sample were completed. The differences between different proteins were then assessed according to the set of comparison groups and the linear mixed-effects model. Fold change >2 and P value <0.05 were used as screening criteria for significantly different proteins. The differential proteins were analyzed using Euclidean distance and the hierarchical cluster method.
Proteins were applied to GO functional annotations and function enrichment analysis using Blast2Go (https://www.blast2go.com/) and Fisher's exact test method [23]. The significance level of the protein enrichment pathway was analyzed based on the KEGG database and calculated using Fisher's exact test.
Recombinant adeno-associated virus (AAV) 8 were generated by transfecting 293T HEK cells with AAV8 vectors containing shRNA SAA1 (F: GAAGGAAGCUAACUGGAAATT; R: UUUCCAGUUAGCUUCCUUCTT; Loop: CTCGA) under the control of the mouse U6 promoter. Cell lysate was subjected to freeze/thaw and treated with 50 U/ml Benzonase for 30 min at 37°C and clarified by centrifugation. AAV8 were purified using iodixanol gradient ultracentrifugation, followed by dialysis against Dulbecco's phosphate-buffered saline using centrifugal filters [67]. AAV particles were titered as viral genomes per ml (vg/ml) using qRT-PCR. Each mouse was injected with 1 × 1011 vg intravenously.
Statistical analysis was conducted using Prism 9 (Version10.2.3). The significance between 2 groups was assessed using Student's t test (unpaired, 2-tailed). One-way or 2-way ANOVA (post-hoc test, Bonferroni or Tukey) was used to evaluate the significance among multiple groups. Data were presented as mean ± SD of at least 3 biological replicates per group. P < 0.05 was set as statistically significant.
  • Joint Research Fund for Overseas Chinese Scholars and Scholars in Hong Kong and Macao (NSFC 81929002)
  • Institute of Nutrition, Metabolism and Diabetes (PS 178091)
  • Academic promotion program of Shandong First Medical University(2019QL010)
  • Natural Science Foundation of Shandong Province (ZR2021MH015)
  • Natural Sciences and Engineering Research Council of Canada (RGPIN-2016-06479)
  • Taishan Scholar Foundation of Shandong Province (ts201511057)
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Year 2024 volume 7 Issue 8
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doi: 10.34133/research.0435
  • Receive Date:2024-06-03
  • Online Date:2025-07-24
  • Published:2024-08-05
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  • Received:2024-06-03
  • Accepted:2024-07-02
Funding
Joint Research Fund for Overseas Chinese Scholars and Scholars in Hong Kong and Macao (NSFC 81929002)
Institute of Nutrition, Metabolism and Diabetes (PS 178091)
Academic promotion program of Shandong First Medical University(2019QL010)
Natural Science Foundation of Shandong Province (ZR2021MH015)
Natural Sciences and Engineering Research Council of Canada (RGPIN-2016-06479)
Taishan Scholar Foundation of Shandong Province (ts201511057)
Affiliations
    1 School of Clinic and Basic Medical Sciences, The Second Affiliated Hospital of Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
    2 Institute of Atherosclerosis in Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
    3Department of Pediatrics and Group on the Molecular and Cell Biology of Lipids, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
    4Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China.

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* Address correspondence to: (B.W.); (S.Q.); (D.Z.)
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表12种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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