1. Cold stress-induced ferroptosis in liver sinusoidal endothelial cells determines liver transplant injury and outcomes.
- Author
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Kojima, Hidenobu, Hirao, Hirofumi, Kadono, Kentaro, Ito, Takahiro, Yao, Siyuan, Torgerson, Taylor, Kitajima, Hiroaki, Ogawa, Takahiro, Kaldas, Fady, Farmer, Douglas, Kupiec-Weglinski, Jerzy, and Dery, Kenneth
- Subjects
Apoptosis pathways ,Immunology ,Transplantation ,Mice ,Humans ,Animals ,Liver Transplantation ,Endothelial Cells ,Ferroptosis ,NF-E2-Related Factor 2 ,Cold-Shock Response ,Liver ,Calcium-Binding Proteins ,Mitochondrial Membrane Transport Proteins ,Cyclohexylamines ,Phenylenediamines - Abstract
Although cold preservation remains the gold standard in organ transplantation, cold stress-induced cellular injury is a significant problem in clinical orthotopic liver transplantation (OLT). Because a recent study showed that cold stress activates ferroptosis, a form of regulated cell death, we investigated whether and how ferroptosis determines OLT outcomes in mice and humans. Treatment with ferroptosis inhibitor (ferrostatin-1) during cold preservation reduced lipid peroxidation (malondialdehyde; MDA), primarily in liver sinusoidal endothelial cells (LSECs), and alleviated ischemia/reperfusion injury in mouse OLT. Similarly, ferrostatin-1 reduced cell death in cold-stressed LSEC cultures. LSECs deficient in nuclear factor erythroid 2-related factor 2 (NRF2), a critical regulator of ferroptosis, were susceptible to cold stress-induced cell death, concomitant with enhanced endoplasmic reticulum (ER) stress and expression of mitochondrial Ca2+ uptake regulator (MICU1). Indeed, supplementing MICU1 inhibitor reduced ER stress, MDA expression, and cell death in NRF2-deficient but not WT LSECs, suggesting NRF2 is a critical regulator of MICU1-mediated ferroptosis. Consistent with murine data, enhanced liver NRF2 expression reduced MDA levels, hepatocellular damage, and incidence of early allograft dysfunction in human OLT recipients. This translational study provides a clinically applicable strategy in which inhibition of ferroptosis during liver cold preservation mitigates OLT injury by protecting LSECs from peritransplant stress via an NRF2-regulatory mechanism.
- Published
- 2024