Background and Aims: The disease progression of nonalcoholic fatty liver disease (NAFLD) from simple steatosis (NAFL) to nonalcoholic steatohepatitis (NASH) is driven by multiple factors. Berberine (BBR) is an ancient Chinese medicine and has various beneficial effects on metabolic diseases, including NAFLD/NASH. However, the underlying mechanisms remain incompletely understood due to the limitation of the NASH animal models used. Methods: A high-fat and high-fructose diet-induced mouse model of NAFLD, the best available preclinical NASH mouse model, was used. RNAseq, histological, and metabolic pathway analyses were used to identify the potential signaling pathways modulated by BBR. LC–MS was used to measure bile acid levels in the serum and liver. The real-time RT-PCR and Western blot analysis were used to validate the RNAseq data. Results: BBR not only significantly reduced hepatic lipid accumulation by modulating fatty acid synthesis and metabolism but also restored the bile acid homeostasis by targeting multiple pathways. In addition, BBR markedly inhibited inflammation by reducing immune cell infiltration and inhibition of neutrophil activation and inflammatory gene expression. Furthermore, BBR was able to inhibit hepatic fibrosis by modulating the expression of multiple genes involved in hepatic stellate cell activation and cholangiocyte proliferation. Consistent with our previous findings, BBR’s beneficial effects are linked with the downregulation of microRNA34a and long noncoding RNA H19, which are two important players in promoting NASH progression and liver fibrosis. Conclusion: BBR is a promising therapeutic agent for NASH by targeting multiple pathways. These results provide a strong foundation for a future clinical investigation.

Acetaminophen (APAP) overdose is one of the most frequent causes of acute liver failure (ALF). N-acetylcysteine (NAC) is currently being used as part of the standard care in the clinic but its usage has been limited in severe cases, in which liver transplantation becomes the only treatment option. Therefore, there still is a need for a specific and effective therapy for APAP induced ALF. In the current study, we have demonstrated that treatment with 25-Hydroxycholesterol 3-Sulfate (25HC3S) not only significantly reduced mortality but also decreased the plasma levels of liver injury markers, including LDH, AST, and ALT, in APAP overdosed mouse models. 25HC3S also decreased the expression of those genes involved in cell apoptosis, stabilized mitochondrial polarization, and significantly decreased the levels of oxidants, malondialdehyde (MDA), and reactive oxygen species (ROS). Whole genome bisulfite sequencing analysis showed that 25HC3S increased demethylation of ^5mCpG in key promoter regions and thereby increased the expression of those genes involved in MAPK-ERK and PI3K-Akt signaling pathways. We concluded that 25HC3S may alleviate APAP induced liver injury via up-regulating the master signaling pathways and maintaining mitochondrial membrane polarization. The results suggest that 25HC3S treatment facilitates the recovery and significantly decreases the mortality of APAP induced acute liver injury and has a synergistic effect with NAC in propylene glycol (PG) for the injury.

The unfolded protein response (UPR) is a highly orchestrated survival response initiated in cells under endoplasmic reticulum (ER) stress. Steroidogenic acute regulatory-related lipid transfer domain 5 (StarD5) is an ER stress-responsive, cholesterol-binding protein under the regulation of IRE1. Based upon in vitro findings, StarD5 delivers a protective response by translocating ER cholesterol to the plasma membrane (PM) and accompanying protective changes in PM fluidity. The study aimed to determine if StarD5′s ability to provide in vitro hepatocyte protective responses is translatable to in vivo conditions. ER stress in mouse livers was induced by intraperitoneal injection of tunicamycin (Tm). Adenovirus was used to restore the expression of StarD5 in the livers of StarD5^−/− mice. Immunoblotting, histological analysis, and lipid measurements were performed. Induction of ER stress led to increased expression of StarD5 and steatosis in the livers of wild-type (WT) mice, while in StarD5^−/− mice, steatosis and apoptosis were more acute compared to WT mice, as evidenced by increased lipid accumulation and cleavage of PARP, respectively. Selectively restoring StarD5 expression to ER-stressed StarD5^−/− mice blunted the effects of tunicamycin. StarD5 appears to play a critical role in the ER stress survival response through its ability to regulate intracellular cholesterol homeostasis.

Figure S2. StarD5 protein is increased in most human colorectal tumors compared to adjacent normal tissue.

Figure S10. PM cholesterol levels in Dual hi CRCSC.

An aberration in cellular, especially plasma membrane (PM), cholesterol level is arguably the most critical targetable hallmark of colorectal cancer and colorectal cancer stem cell (CRCSC) phenotypes. We recently identified Star-related lipid transfer protein 5 (StarD5) as an intracellular cholesterol transport protein that regulates PM cholesterol levels. In this study, we show that StarD5 protein levels are significantly elevated in most human colorectal cancer tissues compared with adjacent normal mucosa, with a preferential increase in the epithelial compartment. Additionally, allograft growth in StarD5 knockout mice was largely unaffected. StarD5 levels were particularly elevated in CRCSCs compared with non-CRCSCs in several colon cancer cell lines and primary human colorectal cancer samples. Genetic knockdown of StarD5 (shRNA; KD) inhibited the CRCSC phenotype in vitro—growth and self-renewal (1°→3° spheroid formation), CRCSC maker levels, and sensitivity to 5-fluorouracil. Also, StarD5-depleted HT-29 cells showed a robust (40-fold) reduction in tumor formation (CRCSC characteristics) in vivo and CRCSC phenotype ex vivo, including CRCSC marker expression and spheroid formation (1°→3°). StarD5 inhibition also caused a significant increase in apoptosis induction. Mechanistically, PM cholesterol levels were significantly higher in CRCSCs than in non-CRCSCs, and StarD5 depletion decreased accessible PM cholesterol, particularly in specialized lipid raft domains. Finally, cholesterol depletion in the PM is critical for StarD5 KD’s inhibition of the CRCSC phenotype as supplementation with low-density lipoprotein caused a significant reversal of the StarD5 KD effects on PM/raft cholesterol levels and the CRCSC phenotype. Implications:Given StarD5’s critical role in regulation of CRCSCs, translational research targeting StarD5 will lead to improved outcomes in patients with colorectal cancer.