Key result
Cilostazol prevented ectopic erythrophagocytosis and mitigated hepatic iron overload-mediated ferroptosis, ameliorating hepatic steatosis and inflammation in NASH models.
Why the study?
Hepatic iron overload marks NAFLD with poor prognosis, and the emerging role of hepatic erythrophagocytosis as its cause prompted evaluation of cilostazol.
Does cilostazol prevent ectopic erythrophagocytosis and mitigate ferroptosis in NASH models?
Does cilostazol prevent ectopic erythrophagocytosis and mitigate ferroptosis in NASH models?
Cilostazol may offer a therapeutic approach for NASH by preventing ectopic erythrophagocytosis and subsequent hepatic iron overload-mediated ferroptosis.
Hypothesis-generating for cilostazol in NASH; prospective trials needed before clinical adoption.
Hepatic iron overload (HIO) is a hallmark of nonalcoholic fatty liver disease (NAFLD) with a poor prognosis. Recently, the role of hepatic erythrophagocytosis in NAFLD is emerging as a cause of HIO. We undertook various assays using human NAFLD patient pathology samples and an in vivo nonalcoholic steatohepatitis (NASH) mouse model named STAMTM. To make the in vitro conditions comparable to those of the in vivo NASH model, red blood cells (RBCs) and platelets were suspended and subjected to metabolic and inflammatory stresses. An insert-coculture system, in which activated THP-1 cells and RBCs are separated from HepG2 cells by a porous membrane, was also employed. Through various analyses in this study, the effect of cilostazol was examined. The NAFLD activity score, including steatosis, ballooning degeneration, inflammation, and fibrosis, was increased in STAMTM mice. Importantly, hemolysis occurred in the serum of STAMTM mice. Although cilostazol did not improve lipid or glucose profiles, it ameliorated hepatic steatosis and inflammation in STAMTM mice. Platelets (PLTs) played an important role in increasing erythrophagocytosis in the NASH liver. Upregulated erythrophagocytosis drives cells into ferroptosis, resulting in liver cell death. Cilostazol inhibited the augmentation of PLT and RBC accumulation. Cilostazol prevented the PLT-induced increase in ectopic erythrophagocytosis in in vivo and in vitro NASH models. Cilostazol attenuated ferroptosis of hepatocytes and phagocytosis of RBCs by THP-1 cells. Augmentation of hepatic erythrophagocytosis by activated platelets in NASH exacerbates HIO. Cilostazol prevents ectopic erythrophagocytosis, mitigating HIO-mediated ferroptosis in NASH models.
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Park et al. (2023) studied Nonalcoholic fatty liver disease (NAFLD) / Nonalcoholic steatohepatitis (NASH). Cilostazol was evaluated. Cilostazol prevented ectopic erythrophagocytosis and mitigated hepatic iron overload-mediated ferroptosis, ameliorating hepatic steatosis and inflammation in NASH models.
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