PROJECT SUMMARY
Acute liver failure (ALF) is characterized by coagulopathy, hepatic encephalopathy, jaundice and multi-organ
failure. Fifty percent of all ALF cases in the United States and UK are due to acetaminophen (APAP) overdose.
Supraphysiological doses of APAP overwhelm safe detoxification pathways in the liver leading to excessive
bioactivation of APAP by Cyp2e1 into the highly reactive metabolite, N-acetyl-p-benzoquinone imine (NAPQI).
This initiates a cascade of intracellular events driving hepatocyte death. An extensive body of work has
elucidated the molecular mechanisms of hepatocyte necrosis during APAP overdose, but detailed mechanisms
involved in the development of ALF have been largely unexplored. The innate immune response after liver
injury plays a critical role in liver recovery in the human relevant mouse model of APAP overdose. However,
immune cell dysfunction has been implicated in the development of ALF. Though crosstalk between stressed
hepatocytes and immune cells actively supports liver recovery, persistent and prolonged hepatocyte stress
may alter this communication network, resulting in immune cell reprogramming towards detrimental
phenotypes which facilitate ALF. Excessive cell stress can elicit temporary or permanent cell cycle arrest, a cell
fate decision called senescence. Some cells acquire a senescent associated secretory phenotype (SASP)
which can elicit pleotropic effects on nearby cells and the tissue microenvironment. Our preliminary data
demonstrate that Klf6 and p21 induce hepatocyte senescence after a severe APAP overdose and that these
hepatocytes have an active SASP, enriched in the cytokine Cxcl14 which persists in circulation. These key
findings lead us to hypothesize that upon severe APAP-induced liver injury, prolonged hepatocyte senescence
results in a sustained secretome exposure enriched in Cxcl14 causing immune cell reprogramming impeding
tissue repair and injury resolution. This hypothesis will be tested by pursuit of two specific aims. Experiments in
Aim 1 are designed to evaluate how Klf6 induces p21 and Cxcl14 and the influence of in vivo silencing of Klf6
on APAP-induced senescence and liver recovery after injury. Aim 2 will use single-cell RNA sequencing in
combination with wet-lab approaches to define how the critical SASP component Cxcl14 alters the global
communication network between senescent hepatocytes and immune cells after a severe APAP overdose.
Collectively, these data will define the molecular mechanisms responsible for sustained induction of hepatocyte
senescence, its relationship to the induction of a senescent associated secretory phenotype, and the signaling
interactions between senescent hepatocytes and the innate immune response. This proposed work will provide
valuable insights into why ALF develops after severe APAP overdose and will assist in addressing this unmet
clinical need.