Alcohol and HIV-Derived Hepatocyte Apoptotic Bodies Induce Hepatic Stellate Cell Activation

Simple Summary Did you know that alcohol abuse among people living with HIV (PLWH) is twice as frequent as in the general population? This undoubtedly makes alcohol abuse in the context of HIV a severe public health issue, which is often attributed to several comorbidities including liver disease. In fact, 50% of mortality from HIV-related liver disease in the United States is attributed to alcohol. Previously, we showed that an alcohol metabolite, acetaldehyde, drives HIV accumulation in hepatocytes, which generates oxidative stress leading to hepatocyte death. When large vesicles (apoptotic bodies) from dead hepatocytes are internalized by hepatic stellate cells (HSC), it causes their profibrotic activation. In fact, our data revealed that upon internalization of HIV-containing hepatocyte apoptotic bodies, HSC generate reactive oxygen species (ROS), which induce fibrosis by activating JNK-ERK1/2 and JAK-STAT3 pathways. Therefore, a potential therapeutic regimen for reducing liver fibrosis among PLWH should include ROS-scavenging antioxidants. Recently, we found that both HIV and acetaldehyde, an alcohol metabolite, induce hepatocyte apoptosis, resulting in the release of large extracellular vesicles called apoptotic bodies (ABs). The engulfment of these hepatocyte ABs by hepatic stellate cells (HSC) leads to their profibrotic activation. This study aims to establish the mechanisms of HSC activation after engulfment of ABs from acetaldehyde and HIV-exposed hepatocytes (AB(AGS+HIV)). In vitro experiments were performed on Huh7.5-CYP (RLW) cells to generate hepatocyte ABs and LX2 cells were used as HSC. To generate ABs, RLW cells were pretreated for 24 h with acetaldehyde, then exposed overnight to HIV1(ADA) and to acetaldehyde for 96 h. Thereafter, ABs were isolated from cell suspension by a differential centrifugation method and incubated with LX2 cells (3:1 ratio) for profibrotic genes and protein analyses. We found that HSC internalized ABs via the tyrosine kinase receptor, Axl. While the HIV gag RNA/HIV proteins accumulated in ABs elicited no productive infection in LX2 and immune cells, they triggered ROS and IL6 generation, which, in turn, activated profibrotic genes via the JNK-ERK1/2 and JAK-STAT3 pathways. Similarly, ongoing profibrotic activation was observed in immunodeficient NSG mice fed ethanol and injected with HIV-derived RLW ABs. We conclude that HSC activation by hepatocyte AB(AGS+HIV) engulfment is mediated by ROS-dependent JNK-ERK1/2 and IL6 triggering of JAK-STAT3 pathways. This can partially explain the mechanisms of liver fibrosis development frequently observed among alcohol abusing PLWH.