Aya A. Abbas, Alan F. Hofmann, Reham Hassan, Ute Hofmann, Selahaddin Sezgin, Peter L.M. Jansen, Patricio Godoy, Nachiket Vartak, Frank Lammert, Steven Dooley, Jan G. Hengstler, Dirk Drasdo, Kai Markus Schneider, Christian Trautwein, Yasser A. Ahmed, Michael Spiteller, Raymond Reif, Lars Kuepfer, Verena Keitel, Georgia Guenther, Ahmed Ghallab, A Zaza, Department of Forensic Medicine and Veterinary Toxicology [Qena], Faculty of Veterinary Medicine [Qena], South Valley University [Qena]-South Valley University [Qena], Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology [Stuttgart], Technische Universität Dortmund [Dortmund] (TU), Leibniz Research Centre for Working Environment and Human Factors [Dortmund] (IFADO), Rheinisch-Westfälische Technische Hochschule Aachen (RWTH), South Valley University [Qena], Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf], Computational Systems Biology [Leverkusen], Bayer Technology Services [Leverkusen], Universität Mannheim [Mannheim], Saarland University [Saarbrücken], Modelling and Analysis for Medical and Biological Applications (MAMBA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire Jacques-Louis Lions (LJLL (UMR_7598)), Université Paris Diderot - Paris 7 (UPD7)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), University of California [San Diego] (UC San Diego), University of California, Maastricht University [Maastricht], RS: FSE MaCSBio, Maastricht Centre for Systems Biology, RS: FHML MaCSBio, RS: FPN MaCSBio, Heinrich-Heine-Universität Düsseldorf [Düsseldorf], Rheinisch-Westfälische Technische Hochschule Aachen University (RWTH), Universität Mannheim, Universitätsklinikum RWTH Aachen - University Hospital Aachen [Aachen, Germany] (UKA), and University of California (UC)
International audience; Bile duct ligation (BDL) is an experimental procedure that mimics obstructive cholestatic disease. One of the early consequences of BDL in rodents is the appearance of so-called bile infarcts that correspond to Charcot-Gombault necrosis in human cholestasis. The mechanisms causing bile infarcts and their pathophysiological relevance are unclear. Therefore, intravital two photon-based imaging of BDL mice was performed with fluorescent bile salts (BS) and non-BS organic anion analogues. Key findings were followed up by matrix-assisted laser desorption ionization imaging, clinical chemistry, immunostaining, and gene expression analyses. In the acute phase, 1-3 days after BDL, BS concentrations in bile increased and single-cell bile microinfarcts occurred in dispersed hepatocytes throughout the liver caused by the rupture of the apical hepatocyte membrane. This rupture occurred after loss of mitochondrial membrane potential, followed by entry of bile, cell death, and a "domino effect" of further death events of neighboring hepatocytes. Bile infarcts provided a trans-epithelial shunt between bile canaliculi and sinusoids by which bile constituents leaked into blood. In the chronic phase, ≥21 days after BDL, uptake of BS tracers at the sinusoidal hepatocyte membrane was reduced. This contributes to elevated concentrations of BS in blood and decreased concentrations in the biliary tract. Conclusion: Bile microinfarcts occur in the acute phase after BDL in a limited number of dispersed hepatocytes followed by larger infarcts involving neighboring hepatocytes, and they allow leakage of bile from the BS-overloaded biliary tract into blood, thereby protecting the liver from BS toxicity; in the chronic phase after BDL, reduced sinusoidal BS uptake is a dominant protective factor, and the kidney contributes to the elimination of BS until cholemic nephropathy sets in. (Hepatology 2019;69:666-683). SEE EDITORIAL ON PAGE 473 R ecently, the concept of an ascending patho-physiology of cholestatic liver disease has been proposed, whereby lesions start in large or small bile ducts followed by the involvement of upstream structures, such as the bile canalicular network and liver parenchyma. (1) Our knowledge of the responses of the biliary tree to cholestasis stems mainly from studies in rodents after bile duct ligation