INSERM U1082, Poitiers, France.
FHU SUPORT, Tours-Poitiers-Limoges, France.
Front Immunol. 2021 Sep 21;12:744927. doi: 10.3389/fimmu.2021.744927. eCollection 2021.
Ischemia and reperfusion injury is an early inflammatory process during liver transplantation that impacts on graft function and clinical outcomes. Interleukin (IL)-33 is a danger-associated molecular pattern involved in kidney ischemia/reperfusion injury and several liver diseases. The aims were to assess whether IL-33 was released as an alarmin responsible for ischemia/reperfusion injury in a mouse model of warm hepatic ischemia, and whether this hypothesis could also apply in the setting of human liver transplantation. First, a model of warm hepatic ischemia/reperfusion was used in wild-type and IL-33-deficient mice. Severity of ischemia/reperfusion injury was assessed with ALT and histological analysis. Then, serum IL-33 was measured in a pilot cohort of 40 liver transplant patients. Hemodynamic postreperfusion syndrome, graft dysfunction (assessed by model for early allograft scoring >6), renal failure, and tissue lesions on time-zero biopsies were assessed. In the mouse model, IL-33 was constitutively expressed in the nucleus of endothelial cells, immediately released in response to hepatic pedicle clamping without neosynthesis, and participated in the recruitment of neutrophils and tissue injury on site. The kinetics of IL-33 in liver transplant patients strikingly matched the ones in the animal model, as attested by serum levels reaching a peak immediately after reperfusion, which correlated to clinical outcomes including postreperfusion syndrome, posttransplant renal failure, graft dysfunction, and histological lesions of ischemia/reperfusion injury. IL-33 was an independent factor of graft dysfunction with a cutoff of IL-33 at 73 pg/ml after reperfusion (73% sensitivity, area under the curve of 0.76). Taken together, these findings establish the immediate implication of IL-33 acting as an alarmin in liver I/R injury and provide evidence of its close association with cardinal features of early liver injury-associated disorders in LT patients.
缺血再灌注损伤是肝移植过程中的早期炎症过程,影响移植物功能和临床结果。白细胞介素 (IL)-33 是一种参与肾缺血/再灌注损伤和几种肝病的危险相关分子模式。目的是评估 IL-33 是否作为一种预警信号在小鼠热肝缺血模型中释放,导致缺血/再灌注损伤,以及这一假设是否也适用于肝移植患者。首先,在野生型和 IL-33 缺陷型小鼠中使用了热肝缺血/再灌注模型。通过 ALT 和组织学分析评估缺血/再灌注损伤的严重程度。然后,在 40 例肝移植患者的试点队列中测量血清 IL-33。评估再灌注后的血液动力学后灌注综合征、移植物功能障碍(通过早期移植物评分模型 >6 评估)、肾功能衰竭和时间零活检中的组织损伤。在小鼠模型中,IL-33 在内皮细胞核中持续表达,在肝蒂夹闭时立即释放,无需新合成,参与中性粒细胞的募集和局部组织损伤。肝移植患者的 IL-33 动力学与动物模型非常吻合,血清水平在再灌注后立即达到峰值,与再灌注后综合征、移植后肾功能衰竭、移植物功能障碍和缺血/再灌注损伤的组织病变等临床结果相关。IL-33 是移植物功能障碍的独立因素,再灌注后 IL-33 的截断值为 73pg/ml(73%的敏感性,曲线下面积为 0.76)。综上所述,这些发现确立了 IL-33 作为肝 I/R 损伤预警信号的直接作用,并提供了其与 LT 患者早期肝损伤相关疾病的主要特征密切相关的证据。