INTRODUCTION
Sepsis describes a dysregulated immune response to an infection that leads to multiple organ dysfunction. A clearer understanding of its pathophysiology is crucial for the optimization of sepsis management [
1]. The metabolic and immune functions of the liver place this organ at the center of the body’s response to the systemic infection underlying sepsis, during which it participates in the bacterial clearance, production of acute-phase proteins and cytokines, and adaptation of metabolism to inflammation. It is acknowledged that sepsis-induced hepatic dysfunction aggravates the septic prognosis and is an independent predictor of mortality in the intensive care unit [
2]. However, work remains to be done on mechanistic aspects of sepsis-induced liver injury to enable identification of molecular targets for diagnosis and treatment.
The current study reveals that propofol can inhibit hepatic oxidative stress, lipid peroxidation, and inflammation, which ultimately helps protect the liver from sepsis [
3]. Liver LD (lipid droplet) overload is associated with increased sepsis severity and liver injury. The synthesis of hepatic LDs can be reduced by inhibiting DGAT1, which can lead to a decrease in inflammation, lipid peroxidation, and improvement in liver function [
4]. During sepsis, there is a starvation response which is worsened by the rapid decline of hepatic peroxisome proliferator activated receptor alpha(PPARa) and PGC-1a levels, leading to poor mitochondria function, excess free fatty acids, lipotoxicity, and glycerol. Mice treated with the PPARa agonist pemafibrate are protected against bacterial sepsis as it improves hepatic PPARa function and reduces lipotoxicity and tissue damage [
5]. Aberrations in fatty acid metabolism, including lipolysis, beta-oxidation, and lipogenesis, contribute to the pathogenesis of sepsis. Clinically, this phenomenon is addressed as steatosis in the liver after the onset of sepsis [
6]. These findings confirm that dysregulated lipid metabolism is a critical factor in the hepatic pathology of sepsis and lipid metabolism in liver damage associated with sepsis.
RNA binding proteins (RBPs) regulate gene expression by binding RNA during transcription, splicing, modification, transportation, translation, and degradation. Abnormal RBP expression or altered function has suggested therapeutic targets for a number of disorders [
7]. Recent studies have indicated that abnormal RBP expression has been implicated in the immune response to sepsis, and targeting has been shown to reduce inflammation and organ injury [
8,
9]. RBP dysfunction might be expected to impact splicing of downstream genes with implications for the septic liver [
10,
11]. Therefore, a systematic genome-wide analysis of abnormal RBP expression may illuminate splicing modifications specific to septic liver injury.
The GEO database was searched with the keywords “sepsis or severe sepsis or septic shock,” “RNA binding protein or RBP,” and “liver,” and GSE167127 data was selected to analyze RBP expression and alternative splicing. Relevant publications had 12 mice divided into sham operation (Sham), cecal ligation and puncture (CLP), and cecal ligation and puncture treatment with dichloroacetic acid (CLPDCA) groups. Transcriptomic analysis revealed that differentially expressed genes (DEGs) in CLP mice were reversed by dichloroacetic acid (DCA) therapy but by an unknown mechanism. DCA is used to treat lactic acidosis, inborn errors of mitochondrial metabolism, and diabetes [
12]. It has been shown to improve sepsis survival in animal models [
13] but effects on RBP and sepsis-induced liver injury remain unknown. The current study explored the impact of DCA treatment in reversing RBP and alternative splicing changes and attenuation of septic liver damage. Underlying mechanisms require further investigation.
DISCUSSION
Transcriptomic sequencing (RNA-seq) has been used to reveal molecular phenotypic changes underlying physiological conditions and disease progression [
18]. Variations in gene expression are acknowledged to affect physiological parameters. The current study analyzed RNA-seq data from liver tissue in an animal model of sepsis and found altered gene expression and varying alternative splicing associated with sepsis progression. DCA treatment was found to reverse the aberrant gene expression and ameliorate liver injury [
19]. DCA activates pyruvate dehydrogenase, affecting oxidative metabolism [
20,
21] and attenuated lactic acidosis during orthotopic liver transplantation (OLT) [
22] producing a hepato-protective effect [
23]. DCA also protected Nnt−/− mice from developing high-fat diet (HFD)-induced non-alcoholic fatty liver disease (NAFLD) which may be due to the reactivation of pyruvate dehydrogenase, restoring the capacity of the pyruvate-supported liver mitochondria to manage peroxide [
24]. Thus, the protective effect of DCA against sepsis-induced liver injury may rely on metabolic reprogramming.
The GO functional analysis showed up-regulation of genes involved in immune/inflammatory response, apoptosis, and cell migration, whereas down-regulated genes tended to be associated with redox reactions and lipid metabolism. The current study’s findings agree with previous reports in indicating that variable gene expression accompanies disease progression. Lipid metabolism has been associated with the development of sepsis [
25] and consequent liver damage [
26]. However, mechanistic connections between liver injury and sepsis progression remain to be elucidated.
RBPs are involved in liver inflammation and lipid homeostasis, and the expression of immune-associated RBPs is a biomarker for predicting the targeted therapeutic response of liver cancer and patient survival [
27]. The current study found that CLP-induced abnormal expression of RBPs, such as S100a11, ads2, Fndc3b, Fn1, Ddx28, Car2, Cisd1, and Ptms, and DCA treatment reversed these effects. Sepsis-related RBPs were found to regulate alternative splicing of downstream genes involved in lipid metabolism. Previous studies have reported that the liver RBP, HuR, regulates lipid homeostasis in response to a high-fat diet [
28], and HuR promoted miRNA-mediated up-regulation of NFI-A protein expression in Myeloid-derived suppressor cells (MDSCs) and enhanced resistance to uncontrolled infection in septic mice [
29]. HuR deficiency leads to inflammation and fibrosis of the liver [
30]. The cold-inducible RBP, CIRP, induces inflammatory responses in hemorrhagic shock and sepsis [
31] and activation of splenic T cells dependent on the TLR4 [
32]. Thus, targeting of RBPs, such as with anti-peptides of CIRP, reduced sepsis-induced inflammation and organ damage in septic mice [
8]. Thus, RBPs are attractive candidates for therapeutic targeting with essential functions in liver immunity, metabolic diseases, and sepsis.
RBPs regulate the development of a number of liver diseases through variable splicing, which is otherwise a source of protein diversity [
33,
34]. Degradation of the RBP, SRSF3, led to abnormal splicing in the liver, promoting disease progression [
35]. The dysregulation of AS associated with sepsis means that RBPs may be potential targets for the treatment of septic liver injury. Abnormal splicing of acidic sphingomyelinase 1 (SMPD1) mRNA is known to result in altered enzyme activity and an impact on the development of sepsis [
10]. Abnormal alternative splicing of the myosin phosphatase gene resulted in reduced enzyme activity, oxidative stress, and altered NO vasodilator reserve in the early and late stages of the mouse model of LPS-induced sepsis, affecting disease progression [
36]. The current findings demonstrate that DCA reversed abnormal alternative splicing events in the liver tissue in sepsis with ASEGs enriched in lipid metabolism and oxidation-reduction–related genes. Disordered lipid metabolism is known to affect alternative splicing of mRNA [
37-
39]. In summary, altered RBP function may lead to AS abnormalities associated with liver injury in sepsis, and RBPs may be a therapeutic target.
The S100a11 calcium–binding member of the S100 family is up-regulated during sepsis [
40] and promotes liver steatosis via the RAGE-mediated AKT-mTOR signaling pathway [
41] and foxo1-mediated autophagy and lipogenesis [
42]. Based on the available evidence, it appears that S100a11 has the potential to significantly affect the activity of SREBF1, which is a vital transcription factor involved in liver lipid metabolism. It has been observed that SREBF1 can enhance lipid synthesis while reducing lipid degradation, leading to the accumulation of lipids in the liver and improper regulation of autophagy. These findings indicate that S100a11 may have a crucial role to play in the regulation of liver lipid metabolism through its impact on SREBF1 [
43,
44]. Indeed, KDM1A-mediated attenuation of SREBF1 activity underlies suppression of
de novo lipogenesis by oxidative stress [
45]. Moreover, Down-regulation of PPARG and SREBF1 in response to PER2 silencing highlights the importance of circadian clock signaling for lipogenesis regulation [
46].
CerS2 maintains normal cell division through the MAD2‐MKLP2‐CPC axis [
47] but down-regulation of CerS2 resulted in LC (long-chain) ceramide accumulation and growth arrest, unaccompanied by apoptosis [
48]. Ceramide synthase is known to be enhanced in LPS-mediated septic shock in Cers2-deficient mice [
49], and inhibition of ceramide synthesis prevented diabetes, steatosis, and cardiovascular disease in rodents [
50]. The current study found SREBF1/CERS2 to be predicted targets of S100a11. In conclusion, lipid metabolism appears to be involved in sepsis-induced liver injury. RBP dysfunction disturbs alternative splicing of lipid metabolism genes, such as SREBF1/CerS2, indicating RBPs as possible therapeutic targets for sepsis-induced liver injury. Further investigations are required to elucidate the mechanisms involved.
We have identified several areas that require improvement in our study. To investigate sepsis liver tissue, we systematically analyzed RNA-seq data from document number one and established a sepsis animal model. We validated the gene expression of S100a11, srebf1, and cers2 using RT-qPCR, but it would be more beneficial to perform additional tests such as immuno-histochemistry and Western blot to detect protein expression levels in the animal model. It is also necessary to continuously and dynamically observe the changes in S100a11, srebf1, cers2, and liver injury markers in the animal model and conduct correlation analysis. Additionally, RNA-binding protein immuno-precipitation experiments would be helpful to elucidate further the intrinsic connections between S100a11, srebf1, cers2, and the pathogenesis of sepsis liver injury.
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