A multidisciplinary approach to the treatment of NAFLD patients, based on a careful evaluation of related risk factors and monitoring for cardiovascular and liver complications, is warranted. In particular, health care providers who manage patients with NAFLD (especially those with more advanced stages of NAFLD) not only should focus on liver disease but also should recognize the increased CVD risk Selleck INCB018424 and undertake early,
aggressive risk factor modifications. Giovanni Targher M.D.*, Christopher P. Day Ph.D, M.D., * Section of Endocrinology, Department of Medicine, University of Verona, Verona, Italy, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom. “
“We read with great interest the article by Jeliazkova et al. The authors found that activation of Notch2 is able to reprogram both embryonic hepatoblasts and adult hepatocytes toward biliary cell differentiation. Also, the oncogenic potential of Notch2 is suggested by the development of premalignant lesions in Notch2-overexpressing livers. The latter results further substantiate LDE225 research buy our and others findings on the role of the Notch pathway
in cholangiocarcinogenesis.[2, 3] Although our study was acknowledged by the authors, the interpretation of some of our findings was not entirely correct. Jeliazkova et al. speculated that Notch2 might be more important Histamine H2 receptor than Notch1 in hepatocarcinogenesis, since Notch1 would require the coexpression with AKT to be oncogenic. We instead showed (our supporting Fig. 1) that overexpression of Notch1 alone is sufficient for intrahepatic cholangiocarcinoma (ICC) development (Fig. 1A-C), which is tremendously accelerated by AKT coexpression. Concerning
the origin of ICC from adult hepatocytes in AKT/Notch1 mice, both Jeliazkova et al. and Cardinale et al. questioned the specificity of the tracing model we used. We would like to emphasize here that we put much effort into establishing that using the capsid from adenoassociated virus 8 together with a transthyretin promoter afforded hepatocyte-specific marker gene activation in the mouse liver. Furthermore, we performed morphological studies, further explained in the present letter, that clearly demonstrate the hepatocellular origin of ICC in AKT/Notch1 mice. If we assume that ICC derive from progenitor cells in our experimental system, it would mean that the injected plasmids bypass the liver acinus against the sinusoidal blood flow to reach the utmost periportal area, then transfect progenitor cells without being incorporated by hepatocytes along the way. This hypothesis is highly unlikely since it contradicts the physiologic principle of hydrodynamic gene delivery, known to target nearly exclusively hepatocytes located in acinar zone 3 (i.e., close to the hepatic venule).