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Interplay of hepatic and myeloid signal transducer and activator of transcription 3 in facilitating liver regeneration via tempering innate immunity†
Article first published online: 13 NOV 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 51, Issue 4, pages 1354–1362, April 2010
How to Cite
Wang, H., Park, O., Lafdil, F., Shen, K., Horiguchi, N., Yin, S., Fu, X.-Y., Kunos, G. and Gao, B. (2010), Interplay of hepatic and myeloid signal transducer and activator of transcription 3 in facilitating liver regeneration via tempering innate immunity. Hepatology, 51: 1354–1362. doi: 10.1002/hep.23430
Potential conflict of interest: Nothing to report.
- Issue published online: 26 MAR 2010
- Article first published online: 13 NOV 2009
- Accepted manuscript online: 13 NOV 2009 12:00AM EST
- Manuscript Accepted: 8 NOV 2009
- Manuscript Received: 9 SEP 2009
- intramural program of NIAAA
Liver regeneration triggered by two-thirds partial hepatectomy is accompanied by elevated hepatic levels of endotoxin, which contributes to the regenerative process, but liver inflammation and apoptosis remain paradoxically limited. Here, we show that signal transducer and activator of transcription 3 (STAT3), an important anti-inflammatory signal, is activated in myeloid cells after partial hepatectomy and its conditional deletion results in an enhanced inflammatory response. Surprisingly, this is accompanied by an improved rather than impaired regenerative response with increased hepatic STAT3 activation, which may contribute to the enhanced liver regeneration. Indeed, conditional deletion of STAT3 in both hepatocytes and myeloid cells results in elevated activation of STAT1 and apoptosis of hepatocytes, and a dramatic reduction in survival after partial hepatectomy, whereas additional global deletion of STAT1 protects against these effects. Conclusion: An interplay of myeloid and hepatic STAT3 signaling is essential to prevent liver failure during liver regeneration through tempering a strong innate inflammatory response mediated by STAT1 signaling. (HEPATOLOGY 2010.)
The liver has great ability to regenerate after injury or tissue loss, which is tightly controlled by multiple signaling pathways induced by a wide variety of cytokines, growth factors, and hormones.1–4 Liver regeneration triggered by two-thirds partial hepatectomy (PHx), a widely used experimental model, proceeds initially by proliferation of hepatocytes and then by proliferation of nonparenchymal cells, including biliary epithelial, sinusoidal endothelial, and hepatic stellate cells.1–4 Emerging evidence suggests that a variety of factors contribute to the initiation and progression of liver regeneration. These include hepatocyte growth factors, platelet-derived serotonin, stem cell factor, complements, and the innate inflammatory response.1–4 Among these, the role of the innate inflammatory response has been extensively investigated.1–4 It is generally accepted that PHx leads to elevation of serum levels of bacterial endotoxin (lipopolysaccharide [LPS]),5 which stimulates Kupffer cells to produce tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). The latter then targets the IL-6 receptor complex (gp80/gp130) in hepatocytes, triggering the activation of signal transducer and activator of transcription 3 (STAT3), which promotes hepatocyte survival and proliferation.1–4 However, a recent study suggests that MyD88 rather than LPS acting via Toll-like receptor 4 and CD14 contributes to IL-6/STAT3 activation after PHx, and the role of MyD88 in liver regeneration has been controversial.6, 7 IL-6 knockout (KO) mice display acute liver failure and impaired liver regeneration after PHx,8 although recent studies suggest that IL-6 may play a more important role in hepatoprotection during liver regeneration.9, 10 IL-6 activation of STAT3 also induces expression of suppressor of cytokine signaling 3 (SOCS3), which in turn terminates STAT3 signaling and negatively regulates liver regeneration.11 Although mice with global knockout of IL-6 develop acute liver failure following PHx,8, 9 conditional deletion of the IL-6 downstream signaling molecule gp130 or STAT3 in hepatocytes did not cause acute liver failure, resulting in either no effect or only impaired liver regeneration after PHx.10, 12 The more severe liver damage following IL-6 knockout may be due to STAT3-independent signaling of IL-6, to extrahepatic actions of IL-6, or both.
After PHx, portal and systemic plasma concentrations of LPS are significantly elevated with peak levels reaching 140 pg/mL.5 Despite such high circulating levels of LPS, hepatocyte apoptosis and hepatic and systemic inflammation remain minimal.1–3 For example, PHx reportedly induced only slight or no elevation of hepatocyte apoptosis,13 and even made hepatocytes resistant to Fas-induced and LPS-induced apoptosis.13, 14 PHx is associated with elevated serum levels of proinflammatory cytokines, but except for IL-6, these changes are minimal (Supporting Table 1),15 and there are no obvious inflammatory foci in the liver after PHx.1–3 At present, the mechanisms that temper liver inflammation and apoptosis post-PHx remain obscure. STAT3, a key signal for cell survival,16 is activated by PHx in the liver. However, deletion of STAT3 in hepatocytes only moderately impaired PHx-induced liver regeneration without inducing hepatocyte apoptosis.12 Here, we demonstrate for the first time that STAT3, an important anti-inflammatory signal,17 is also markedly activated in immune cells by PHx. Conditional deletion of STAT3 in myeloid lineage cells resulted in an enhanced inflammatory response and increased liver regeneration. Combined conditional ablation of STAT3 in both hepatocytes and myeloid cells, but not in either cell type alone, resulted in a dramatic reduction in survival with elevated activation of STAT1 and hepatocyte apoptosis after PHx. These findings suggest that an interplay of STAT3 in myeloid cells and hepatocytes plays a critical role in ensuring normal liver regeneration via tempering systemic and hepatic innate inflammatory responses.
Materials and Methods
Eight- to 10-week-old male mice were used in this study. Hepatocyte-specific STAT3KO (STAT3Hep−/−) and Myeloid cell-specific STAT3KO (STAT3Mye−/−) mice were described previously.18 Littermate wild-type mice (STAT3flox/flox) were used as controls. STAT3Mye−/− mice have been proved to be a valuable tool in analyzing the physiologic role of STAT3 in monocytes/macrophages and neutrophils.17 Male STAT3Mye−/− mice were bred with female STAT3Hep−/− mice to generate four lines of mice: wild-type littermates (STAT3flox/flox), STAT3Mye−/−, STAT3Hep−/−, and STAT3Mye−/−Hep−/− mice in which the STAT3 gene was deleted in both myeloid cells and hepatocytes.
STAT3Hep−/−STAT1−/− and STAT3Mye−/−STAT1−/− mice were developed via several steps of crossing STAT3Hep−/− mice with STAT1−/− mice, and STAT3Mye−/− mice with STAT1−/− mice, respectively. Male STAT3Mye−/−STAT1−/− mice were bred with female STAT3Hep−/−STAT1−/− mice to generate STAT3Mye−/−Hep−/−STAT1−/− triple KO mice, in which the STAT3 gene was deleted in myeloid cells and hepatocytes whereas the STAT1 was deleted globally. All knockout strains mentioned above were developmentally normal and have normal life spans. All animal studies were approved by the Institutional Animal Care and Use Committees of the NIAAA, NIH.
Partial Hepatectomy Model.
For two-thirds partial hepatectomy (PHx) surgery, mice were anesthetized with sodium pentobarbital, followed by laparotomy, ligation of the median and left lateral lobes of the liver at their stem and excision under aseptic conditions, as described previously.19 For sham operation, mice were anesthetized and then subjected to laparotomy, followed by brief manipulation of the intestines, but not the liver, with cotton swabs before wound closure. The animals were killed by decapitation at the indicated times following surgery.
Data are expressed as mean ± SD. To compare values obtained from two groups, the Student t test was performed. To compare values obtained from three or more groups, one-factor analysis of variance (ANOVA) was used, followed by Tukey's post hoc test. Statistical significance was taken at the P < 0.05 level.
All other methods are described in the Supporting Document.
Activation of STAT3 in Myeloid Cells After PHx.
Figure 1 A,B show that phospho-STAT3 was markedly elevated by PHx in the liver and spleen tissues (Fig. 1A) as well as in liver leukocytes (Fig. 1B). Flow cytometric analyses show that phospho-STAT3 was elevated in both Gr1high neutrophils and F4/80+ macrophages in the liver post-PHx (Fig. 1C and Supporting Fig. 1). In addition, flow cytometric analyses reveal that the percentage of Gr1high neutrophils was significantly increased in the liver post-PHx while the percentage of F4/80+ macrophages was slightly increased (Fig. 1D). The total number of leukocytes, neutrophils, and macrophages was markedly elevated in the liver post-PHx compared to the sham group (Fig. 1E). Smaller increases of pSTAT3 were also detected in the liver but not in the spleen after sham operation (Fig. 1A), which is in agreement with earlier findings.8
Deletion of STAT3 in Myeloid Cells and Hepatocytes Results in Enhanced and Reduced Liver Regeneration, Respectively, Whereas Deletion of STAT3 in Both Cell Types Results in Liver Failure After PHx.
To explore whether STAT3 activation in neutrophils/macrophages plays a role in controlling liver inflammation after PHx, we generated myeloid cell-specific STAT3 knockout mice (STAT3Mye−/−), in which the STAT3 gene had been deleted in myeloid lineage cells, including neutrophils, monocytes and macrophages.17 To further understand the interaction of myeloid and hepatic STAT3 in controlling liver inflammation and regeneration, we also generated hepatocyte-specific STAT3 knockout (STAT3Hep−/−) and hepatocyte/myeloid cell-specific double knockout (STAT3Mye−/−Hep−/−) mice. After PHx, STAT3Mye−/− and STAT3Hep−/− mice showed no obvious adverse phenotype and no mortality, and their liver/body weight ratios were similar to that in wild-type mice (Supporting Fig. 2 a). In contrast, 75% of STAT3Mye−/−Hep−/− mice died between 24 and 40 hours post-PHx (Fig. 2A), with the remaining 25% surviving for at least 1 month after PHx. Liver histology showed that the number of inflammatory foci was greater in STAT3Mye−/− and STAT3Mye−/−Hep−/− mice compared to wild-type and STAT3Hep−/− mice (Fig. 2B,C). Compared to wild-type mice, hepatocyte proliferation as determined by BrdU incorporation and mitosis was significantly reduced in STAT3Hep−/− mice but was elevated in STAT3Mye−/− mice 40 hours post-PHx. The surviving STAT3Mye−/−Hep−/− mice also had lower BrdU incorporation and mitosis in hepatocytes 40 hours post-PHx compared with wild-type mice (Fig. 2B,D and Supporting Fig. 2b) and had reduced serum albumin compared with other groups (Supporting Fig. 2c). TUNEL analyses revealed that the number of apoptotic hepatocytes was much greater in STAT3Mye−/−Hep−/− mice than in the other groups (Fig. 2B,E).
Deletion of STAT3 in Myeloid Cells Enhances Inflammatory Response After PHx.
Flow cytometric analyses show that in wild-type mice, the number of infiltrating Gr1high cells, which represent neutrophils,20 was elevated significantly 3 and 6 hours post-sham operations and maintained at slightly higher levels at 24 hours, with such elevations being more pronounced and prolonged following PHx (Supporting Fig. 3 and Fig. 3A). The number of F4/80+ macrophages was slightly elevated post-sham and PHx. Similar elevation of Gr1high and F4/80+ cells was also observed in STAT3Hep−/− mice. In addition, the total number of infiltrating Gr1high and F4/80+ cells was much higher in the livers of STAT3Mye−/− and STAT3Mye−/−Hep−/− mice as compared to wild-type and STAT3Hep−/− mice, both before surgery, as well as post-sham and PHx. This suggests that PHx-induced activation of STAT3 in myeloid cells inhibits their infiltration into the liver.
Figure 3B summarizes the serum levels of proinflammatory cytokines such as TNF-α, IL-6, and IFN-γ. In general, after sham operation, serum levels of IL-6 but not other cytokines were elevated in wild-type mice, whereas both STAT3Mye−/− and STAT3Mye−/−Hep−/− mice had higher serum levels of IL-6 as well as TNF-α and IFN-γ.
After PHx, serum levels of IL-6 were markedly elevated in wild-type and STAT3Hep−/− mice, such elevation was prolonged in STAT3Mye−/− and STAT3Mye−/−Hep−/− mice. Serum levels TNF-α and IFN-γ were slightly elevated in wild-type and STAT3Hep−/− mice but were dramatically higher in STAT3Mye−/− and STAT3Mye−/−Hep−/− mice. In addition, serum TNF-α levels were higher in STAT3Mye−/−Hep−/− mice than STAT3Mye−/− mice 6 and 9 hours post-PHx
Deletion of STAT3 Results in Enhanced STAT1 in Myeloid Cells and Hepatocytes After PHx.
Next, we investigated the mechanisms underlying liver failure and impaired liver regeneration in STAT3Mye−/−Hep−/− mice by analyzing the activation of the STAT3 pathway, which promotes hepatocyte survival and liver regeneration,12, 16 as well as STAT1 activation, which induces hepatocyte apoptosis and inhibits liver regeneration.21 STAT3 was activated by PHx in wild-type mice, as reflected by elevated levels of pSTAT3 that peaked 3-6 hour after surgery (Fig. 4 A). Compared to wild-type mice, in STAT3Mye−/− mice, the STAT3 pathway was constitutively active, with both the STAT3 protein levels and pSTAT3 being elevated (PHx 0 hour), and increased slightly further following PHx. In contrast, hepatic STAT3 and pSTAT3 were both very low in STAT3Hep−/− and STAT3Mye−/−Hep−/− mice, as expected.
STAT1 activation (pSTAT1) was not detected in the liver of wild-type and STAT3Mye−/− mice after PHx. However, in both STAT3Hep−/− and STAT3Mye−/−Hep−/− mice hepatic levels of pSTAT1 were greatly increased following PHx, with peaks occurring 3-6 hours post-PHx. A delayed increase in the expression of the STAT1 protein was observed 24 to 40 hours post-PHx in STAT3Hep−/− mice, whereas in STAT3Mye−/−Hep−/− mice, STAT1 protein levels were constitutively elevated compared to wild-type and STAT3Hep−/− mice. Weak pSTAT3 activation was also detected in the liver after sham operation in wild-type and STAT3Mye−/− mice but not in STAT3Hep−/− and STAT3Mye−/−Hep−/− mice (Supporting Fig. 4a). Interestingly, in the spleen STAT3 was activated similarly after PHx in all four lines of mice, whereas pSTAT1 activation was not detected in any of them (Supporting Fig. 4b).
Expression of cyclin D was induced in wild-type mice 24 and 40 hours post-PHx. Such induction was higher in STAT3Mye−/− mice but lower in STAT3Hep−/− and STAT3Mye−/−Hep−/− mice (Fig. 4 and Supporting Fig. 5), which is consistent with the grade of liver regeneration in these mice, as illustrated in Fig. 2. In addition, SOCS3 but not SOCS1 was induced after PHx in wild-type mice, consistent with earlier findings.11 Similar induction of SOCS3 was also observed in STAT3Mye−/− mice. Interestingly, SOCS1 but not SOCS3 was significantly induced after PHx in both STAT3Hep−/− and STAT3Mye−/−Hep−/− mice.
pSTAT3 and pSTAT1 activation were also examined in liver leukocytes after sham operation or PHx. pSTAT3 was detected post-PHx in the liver leukocytes from wild-type and STAT3Hep−/− mice but not from STAT3Mye−/− and STAT3Mye−/−Hep−/− mice (Fig. 4B). Constitutive activation of pSTAT1 was detected in the liver leukocytes of STAT3Mye−/− mice before or after sham or PHx, in agreement with previous reports.17 pSTAT1 was detected in the liver leukocytes 3 hours post-PHx in all groups with the highest levels in STAT3Mye−/−Hep−/− mice.
Deletion of STAT1 Restores Liver Regeneration in STAT3Hep−/− Mice, Reduces Inflammatory Responses in STAT3Mye−/− Mice, and Rescues STAT3Mye−/−Hep−/− Mice from Post-PHx Liver Failure.
The above data (Fig. 4) indicate increased activation of pSTAT1 in the inflammatory cells of STAT3Mye−/− mice and in the liver of STAT3Hep−/− mice, respectively, and increased activation in both the inflammatory cells and the liver in STAT3Mye−/−Hep−/− mice. Because STAT1 plays a key role in the induction of inflammation, cell apoptosis and cell cycle arrest,21 it is possible that elevation of STAT1 in hepatocytes contributes to reduced liver regeneration in STAT3Hep−/− mice, elevation of STAT1 in inflammatory cells contributes to enhanced inflammation in STAT3Mye−/− mice, while the simultaneous elevation of pSTAT1 in both inflammatory cells and the liver contributes to liver failure and impaired liver regeneration in STAT3Mye−/−Hep−/− mice. To test these possibilities, we generated STAT3Hep−/−STAT1−/−, STAT3Mye−/− STAT1−/−, and STAT3Mye−/−Hep−/−STAT1−/− mice.
Expression of STAT1 protein in the liver was induced in STAT3Hep−/− mice but not in wild-type mice (Fig. 5A), which is consistent with previous findings.12 Western blot analyses confirmed the absence of STAT1 and STAT3 protein expression in the liver of STAT3Hep−/−STAT1−/− mice (Fig. 5B). All STAT3Hep−/−STAT1−/− mice survived after PHx (Fig. 5C) and had a greater number of Brdu+ hepatoctyes than STAT3Hep−/− mice after PHx (Fig. 5D), suggesting that deletion of STAT1 in STAT3Hep−/− mice restores the ability of the liver to regenerate. Treatment with a low dose of IFN-γ induced stronger pSTAT1 activation in STAT3Hep−/− than in wild-type hepatocytes (Fig. 5E). As expected, no STAT1 or STAT3 proteins were detected in STAT3Hep−/−STAT1−/− hepatocytes. Furthermore, STAT3Hep−/− hepatocytes were more susceptible to IFN-γ inhibition of cell proliferation, an effect that was abolished in STAT3Hep−/−STAT1−/− hepatocytes.
Western blot analyses (Fig. 6 A) confirmed that in STAT3Mye−/−STAT1−/− mice STAT1 protein was undetectable and STAT3 protein was very low in liver leukocytes. All STAT3Mye−/−STAT1−/− mice survived after PHx (data not shown) and had comparable liver regeneration as STAT3Mye−/− mice (Fig. 6B). Infiltration of neutrophils and macrophages was reduced in STAT3Mye−/− STAT1−/− mice compared with STAT3Mye−/− mice (data not shown). Elevation of serum inflammatory cytokines was also diminished in the former relative to the latter group (Fig. 6C).
Western blotting (Fig. 7 A) confirmed the absence of STAT1 protein expression in hepatocytes and liver leukocytes, and the absence of STAT3 protein expression in hepatocytes and its very low level in liver leukocytes in STAT3Mye−/−Hep−/−STAT1−/− triple KO mice. All STAT3Mye−/−Hep−/−STAT1−/− triple KO mice survived after PHx, in contrast to the 25% survival of STAT3Mye−/−Hep−/− mice (Fig. 7B). Furthermore, the STAT3Mye−/−Hep−/−STAT1−/− mice had enhanced liver regeneration, reduced hepatocyte apoptosis, and reduced serum cytokines after PHx compared to STAT3Mye−/−Hep−/− mice (Fig. 7C,D). These findings suggest that deletion of STAT1 rescues liver function and regeneration, and attenuates the innate inflammatory response as compared to STAT3Mye−/−Hep−/− double KO mice.
In this article, we demonstrate for the first time that PHx results in STAT3 activation in immune cells, in addition to its activation in the liver, as reported previously.8 Additionally, our results indicate that activation of STAT3 in myeloid lineage cells and hepatocytes act in concert to effectively temper the systemic and hepatic inflammatory responses, ensuring normal liver regeneration, as summarized in a proposed model in Fig. 8. The rationale for this model is presented below.
STAT3 is activated in both the liver and myeloid cells after PHx (Fig. 1). Elevation of IL-6 is likely responsible for STAT3 activation in the liver because such activation is markedly diminished in IL-6 KO mice.8, 11 At present, the mechanisms underlying PHx-induced STAT3 activation in myeloid cells are not clear. Both IL-6 and IL-10 are known to activate STAT3 in myeloid cells and to be elevated in the liver and serum after PHx.8, 22 Thus, both of these cytokines likely contribute to STAT3 activation in myeloid cells.
Deletion of STAT3 in myeloid cells resulted in increased infiltration of macrophages and neutrophils into the remnant liver following PHx. Production of the proinflammatory cytokines TNF-α and IL-6 by these cells leads to activation of STAT3 in the liver. This may be responsible for the enhanced liver regeneration observed in STAT3Mye−/− mice after PHx (Fig. 2), because all of these factors have been shown to promote liver regeneration.8, 23, 24 Deletion of STAT3 in myeloid cells also resulted in elevated serum levels of IFN-γ, a cytokine known to induce hepatocyte apoptosis and cell cycle arrest via activation of the STAT1 signaling pathway.21 However, despite the high serum levels of IFN-γ, activation of STAT1 was not detected in the liver of STAT3Mye−/− mice after PHx (Fig. 4A). This may be due to suppression of STAT1 signaling by hepatic STAT3 in STAT3Mye−/− mice. Indeed, deletion of hepatic STAT3 resulted in enhanced hepatic pSTAT1 in both STAT3Hep−/−Mye−/− and STAT3Hep−/− mice. In addition, the strong inflammatory response in STAT3Mye−/− mice after PHx may be partly due to enhanced STAT1 activation in leukocytes (Fig. 4B), as deletion of STAT1 markedly reduced cytokine production (Fig. 6).
Disruption of STAT3 in hepatocytes resulted in decreased liver regeneration without mortality after PHx, consistent with previous reports.12 Interestingly, we have previously shown that mortality rate was significantly higher in mice with STAT3 deficiency in hepatocytes and digestive tissues than wild-type controls.25 These findings suggest that STAT3 in digestive tissues may play a hepatoprotective role while STAT3 in hepatocyte stimulates hepatocyte proliferation during liver regeneration. It is believed that the stimulatory effect of STAT3 on liver regeneration is mediated via induction of several immediate early genes.12 Here we demonstrated that deletion of STAT1 restored liver regeneration in STAT3Hep−/− and STAT3Hep−/−Mye−/− mice (Figs. 5 and 7), suggesting that inhibition of STAT1 signaling is one of the mechanisms through which STAT3 activation promotes liver regeneration. However, the mechanism by which STAT3 suppresses STAT1 signaling is not well understood. STAT signaling pathways can be negatively regulated by several mechanisms, including induction of SOCSs, tyrosine phosphatases, PIAS, etc.26 Fig. 4 shows that induction of SOCS3 and SOCS1 correlates with activation of STAT3 and STAT1, respectively, suggesting that STAT3 activation is responsible for SOCS3 induction whereas SOCS1 induction is dependent on STAT1 activation after PHx. It is probable that STAT3 inhibits STAT1 signaling via at least in part induction of SOCS3 expression because SOCS3 has been shown to inhibit STAT1 signaling.27
No mortality and no obvious hepatocyte apoptosis were observed in STAT3Mye−/− mice after PHx despite high levels of inflammatory cytokines such as TNF-α and IFN-γ. This is probably due to prolonged STAT3 activation in the liver that protects against hepatocyte death, STAT3 being a survival signal for hepatocytes.16 Indeed, deletion of hepatic STAT3 both in hepatocytes and myeloid cells caused massive apoptosis after PHx. Interestingly, deletion of the IL-6 signaling molecule gp130 in both hepatocytes and bone marrow cells did not result in liver failure after PHx.10 This suggests that the critical role of myeloid STAT3 activation in liver regeneration is mediated by a mediator other than IL-6. In addition, deletion of hepatic STAT3 also resulted in further increases in serum levels of TNF-α in STAT3Mye−/− mice after PHx (Fig. 3B). This may be due to increased hepatocyte apoptosis in STAT3Mye−/−Hep−/− mice that can stimulate macrophages/Kupffer cells to produce inflammatory cytokines.28 Such high levels of TNF-α may also contribute to the massive apoptosis and liver failure in STAT3Mye−/−Hep−/− mice after PHx because abnormally high levels of TNF-α were shown to contribute to liver failure after PHx in Timp3−/− mice.29 Although STAT3 is a survival signal for hepatocytes, selective deletion of STAT3 in hepatocytes did not induce apoptosis and mortality. This may be due to maintained STAT3 activation in myeloid cells that limits inflammatory responses such as TNF-α and IFN-γ production. Deletion of STAT3 in both myeloid cells and hepatocytes in STAT3Hep−/−Mye−/− mice resulted in high levels of serum TNF-α and IFN-γ and hepatic STAT1 activation, which resulted in massive apoptosis of hepatocytes and high mortality. It has been recently proposed that STAT3 inhibitors may be used in the treatment of hepatocellular carcinoma (HCC).30 The present findings advocate caution with such an approach, because global inhibition of STAT3 may result in a strong innate inflammatory response and liver failure, especially in the remnant liver of patients with HCC following liver resection. Indeed, liver failure after resection was often seen in patients with HCC with elevated inflammatory responses due to sepsis.31 Additionally, elevated STAT1 expression and activation in the liver were found in patients with chronic liver disease,32 which may impair liver regeneration. Thus, a strategy to increase STAT3/STAT1 ratio in both hepatocytes and leukocytes may have a beneficial effect in preventing liver failure in patients with HCC who have elevated inflammatory responses after liver resection.
Additional Supporting Information may be found in the online version of this article.
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