Diploid Hepatocytes Resist Acetaminophen Induced Acute Liver Injury and Drive Compensatory Liver Regeneration
Authors: Delgado Evan R. , Leek Madeleine , Kamel Kerollos , Wilkinson Patrick , Alencastro Frances , Roy Nairita , Duncan Andrew 
Published: April 2020

BackgroundAcetaminophen (APAP) is a commonly used analgesic that can be safely used at doses under 4 g/day. When taken in excess, APAP causes acute liver injury, which leads to acute liver failure and death. APAP overdose leads to 56,000 emergency room visits and 26,000 hospitalizations annually and is the leading cause of acute liver failure in the United States. The only available pharmacological treatment, N‐acetyl cysteine, is effective within hours of overdose. The only other treatment option is orthotopic liver transplantation, and this is limited by the availability of donor organs. Considering the paucity of therapeutic options, there is an urgent need to understand mechanisms of liver regeneration and repair.Most mammalian somatic cells are diploid and contain pairs of each chromosome, but there are also polyploid cells, such as hepatocytes that contain additional sets of chromosomes. Polyploid hepatocytes are among the best described, and in adult humans and mice comprise more than 25% and 90%, respectively, of the hepatocyte population. The cellular and molecular mechanisms that regulate polyploidy have been well‐characterized; however, it is poorly understood if diploid and polyploid hepatocytes play specialized roles in liver injury and repair.MethodsOur lab recently found that diploid hepatocytes are inherently more proliferative than polyploid hepatocytes. Additionally, we can specifically study diploid hepatocytes using mice lacking E2f7 and E2f8 in the liver (referred to as “LKO” mice), which are functionally normal, but livers are depleted of polyploid hepatocytes. Considering that liver regeneration affects the outcome of APAP‐medicated injury, we asked if LKO mice enriched with highly proliferative diploid hepatocytes would respond differently than control livers. We fasted LKO and control mice for 16 hours, injected intraperitoneally 300 mg/kg (the LD50 dose) APAP and harvested livers after 0.5, 3, 6, 12, 24, and 48 hours. We used these tissues to investigate differences in liver injury, necrosis, and proliferation.ResultsLiver injury enzymes, alanine aminotransferase and aspartate aminotransferase, were higher in control mice compared to LKO mice beginning at 3 hours. Necrotic liver tissue was abundant in control mice and was markedly reduced in LKO mice. We also measured more apoptotic, TUNEL positive hepatocytes in control mice. We next assessed the proliferation response after APAP‐induced liver injury by staining for PCNA which was induced by 6 hours in LKO mice compared to 24 hours in control mice. Finally, we treated wild‐type 19‐day old hepatocytes with 5 mM APAP for 12, 24, and 36 hours in vitro and found that diploid hepatocytes proliferate more readily compared to polyploids as marked by BrdU incorporation.ConclusionBased on these data, diploid hepatocytes appear to be the main contributors of early‐stage compensatory regeneration following APAP‐mediated liver injury. These data suggest that, compared to polyploid hepatocytes, diploids initiate and drive liver healing/regeneration after acute injury.Support or Funding InformationThis work supported by the NIH to AWD (R01DK103645).