7A,B; Supporting Information Fig. 4), PBC (Fig. 7A,C), AIH, and

PSC (Fig. 7A), suggesting that OPN induction is a conserved response to chronic liver injury. Cirrhosis rarely occurs unless NAFLD progresses to NASH, a condition that is characterized by inflammation and hepatocyte death.31 However, only a minority of individuals with NASH actually develop cirrhosis. Fibrosis stage in NASH has been shown to correlate with the level of hepatic apoptotic activity.1, 32 Index liver biopsy specimens of NASH patients who eventually progress to cirrhosis also harbor more myofibroblasts (MFs) than specimens of patients who do not progress BMS-777607 to cirrhosis.3 These observations link hepatocyte apoptosis with myofibroblast accumulation and fibrosis progression in NASH. There is further evidence that

phagocytosis of apoptotic debris stimulates HSCs to become MFs.33 Recently, we identified a potentially related DAPT mechanism by which hepatocyte apoptosis promotes MF accumulation and liver fibrosis by demonstrating that dying hepatocytes produce Hh ligands.4 Biologically active Hh ligands are detected in apoptotic fragments released by ligand-producing cells.34 Hh ligands, in turn, engage various types of Hh-responsive cells, including HSCs, ductular-type cells, and NKT cells, to trigger fibrogenic responses.7, 35, 36 Consistent with these findings, we observed that Hh activity correlated with MF accumulation and fibrosis stage in NAFLD patients and in rodent models of NAFLD, suggesting that interindividual differences in Hh signaling influenced intensity of fibrogenic responses during NASH.7 The present study provides further support for this concept, because it identifies OPN as a proximal effector of Hh-mediated fibrogenesis, and demonstrate that livers of OPN-deficient mice are significantly protected from NASH-related fibrosis. A recent analysis of the OPN gene revealed binding sites for Gli transcription factors, suggesting that OPN transcription is likely to be regulated by Hh signaling.14 By demonstrating colocalization of Gli and OPN in

liver cells, and proving that expression of OPN mRNA is increased by a Smoothened agonist but decreased by a Smoothened 上海皓元医药股份有限公司 antagonist, our results support and advance this concept. In addition, our data demonstrate that changes in OPN gene expression are paralleled by changes in OPN protein content and biological activity, because OPN aptamers reverse the profibrogenic actions of OPN. The latter findings also verify that OPN is a significant downstream target of Hh signaling (rather than vice versa), because neutralizing OPN had no effect on cellular expression of the Hh target gene Gli2 but significantly diminished fibrogenic gene expression, even in Ptc-deficient cells with supranormal Hh pathway activity.