Cholangiocarcinoma (CCA) is a fatal primary malignancy that is formed in the bile ducts. Cancer-associated myofibroblasts play a crucial role in CCA proliferation and invasion. Furthermore, there is a growing interest in the role of the exosome in the interaction between the cancer-associated myofibroblasts and cholangiocarcinoma which lead to CCA growth. However how cholangiocarcinoma-derived exosome affect the cancer-associated myofibroblasts in the tumor microenvironment remain unknown. In this study, we examined whether exosome produced by cholangiocarcinoma could involve in the prompt of CCA cells growth by regulation of myofibroblast. We found that cholangiocarcinoma-derived exosome could prompt elevated α-smooth muscle actin and stromal cell-derived factor one expression that induces myofibroblast proliferation. We then demonstrated that cholangiocarcinoma-derived exosome upregulated periostin expression that plays an important role in cancer metastasis. In 3D organotypic rat CCA coculture model, TCA and S1P considerably increase the growth of CCA cell. Conclusion: cholangiocarcinoma-derived exosome trigger cancer-associated myofibroblasts proliferation in the tumor microenvironment that leads to prompt CCA growth.

<p>The tumor vasculature is poor and heterogeneous which may result in inadequate oxygenation and changed energy status. In addition the balance between cell proliferation and the rate of cell death is disturbed, which results in tumor growth. </p><p>The aims of this study were 1) to gain more insight into the relation between tumor vascularity, hypoxia, and proliferation in solid tumors, and 2) to study the changes and dynamics of tumor oxygenation in relation to the vascular architecture within individual tumors. For this purpose a double hypoxic marker method was developed, which was subsequently used to 3) determine the turnover rate of hypoxic cells in three different tumor models and 4) to study the effect of cytotoxic drugs on tumor hypoxia and cell death.</p><p>Solid tumor models grown in mice were used. The tumor microenvironment was investigated with exogenous cell markers for hypoxia (pimonidazole and CCI-103F), cell proliferation (BrdUrd) and blood perfusion (Hoechst 33342). The vasculature and the exogenous cell markers were visualized with immunohistochemical techniques. The tumor sections were scanned and quantified with an image analysis systemconsisting of a fluorescence microscope, CCD camera and image analysis software.</p><p>The spatial organization of hypoxia, proliferation, and tumor vasculature was analyzed in several xenograft lines. The study revealed two main hypoxic patterns that seemed to be the consequence of complex relations between vasculature, oxygen delivery, proliferation, and cell loss. The novel double hypoxic cell marker method, with sequential injection of two hypoxic markers, was developed to study dynamic changes of the tumor oxygenation. Based on varying injection intervals between the markers the hypoxic cell half-life was determined in three tumor lines, and ranged from 17 to 49 hours. Intra-tumoral changes in oxygenation status upon oxygen modifying treatments were measured with the double hypoxic marker method. Both decreased levels of tumor hypoxia after carbogen breathing (95%O2 and 5% CO2) and increased levels of tumor hypoxia, as a result of reduced tumor perfusion after hydralazine treatment was detected. Finally the double hypoxic marker assay was used to analyze the effects of the hypoxic cytotoxin tirapazamine in relation to the hypoxic cell population, which caused a reversible decrease of the hypoxic fraction.</p><p>The results presented in this thesis now form the basis for further studies to identify subpopulations of cells that represent specific targets for therapy, and to investigate the effects of different treatment modalities.</p>

The tumor vasculature is poor and heterogeneous which may result in inadequate oxygenation and changed energy status. In addition the balance between cell proliferation and the rate of cell death is disturbed, which results in tumor growth. The aims of this study were 1) to gain more insight into the relation between tumor vascularity, hypoxia, and proliferation in solid tumors, and 2) to study the changes and dynamics of tumor oxygenation in relation to the vascular architecture within individual tumors. For this purpose a double hypoxic marker method was developed, which was subsequently used to 3) determine the turnover rate of hypoxic cells in three different tumor models and 4) to study the effect of cytotoxic drugs on tumor hypoxia and cell death. Solid tumor models grown in mice were used. The tumor microenvironment was investigated with exogenous cell markers for hypoxia (pimonidazole and CCI-103F), cell proliferation (BrdUrd) and blood perfusion (Hoechst 33342). The vasculature and the exogenous cell markers were visualized with immunohistochemical techniques. The tumor sections were scanned and quantified with an image analysis systemconsisting of a fluorescence microscope, CCD camera and image analysis software. The spatial organization of hypoxia, proliferation, and tumor vasculature was analyzed in several xenograft lines. The study revealed two main hypoxic patterns that seemed to be the consequence of complex relations between vasculature, oxygen delivery, proliferation, and cell loss. The novel double hypoxic cell marker method, with sequential injection of two hypoxic markers, was developed to study dynamic changes of the tumor oxygenation. Based on varying injection intervals between the markers the hypoxic cell half-life was determined in three tumor lines, and ranged from 17 to 49 hours. Intra-tumoral changes in oxygenation status upon oxygen modifying treatments were measured with the double hypoxic marker method. Both decreased levels of tumor hypoxia after carbogen breathing (95%O2 and 5% CO2) and increased levels of tumor hypoxia, as a result of reduced tumor perfusion after hydralazine treatment was detected. Finally the double hypoxic marker assay was used to analyze the effects of the hypoxic cytotoxin tirapazamine in relation to the hypoxic cell population, which caused a reversible decrease of the hypoxic fraction. The results presented in this thesis now form the basis for further studies to identify subpopulations of cells that represent specific targets for therapy, and to investigate the effects of different treatment modalities.

Pancreatic cancer is one of the most lethal cancers and despite all research efforts the last 50 years, there are still no effective therapy for this terrible disease. Until quite recently most research in the field of pancreatic duct adenocarcinoma (PDAC) was focused on the tumor cells and mechanisms essential for their proliferation and survival. However, the tumor does not only consist of tumor cells, rather a combination of tumor cells and numerous stroma cell types, i.e. the tumor microenvironment. The tumor cells have developed the ability to activate the surrounding cells to produce factors important for the progression of the tumor. Cancer associated fibroblasts (CAFs) are the major stroma component and as much as 70% of the total PDAC tumor mass consists of these cells. In this thesis I have investigated the mechanisms involved in the cross-talk between tumor cells and CAFs and distinguished the local and systemic effects of this communication. Tumor derived IL-1α was identified as an important factor creating the inflammatory profile seen in CAFs. In PDAC patients, IL-1α was detected in 90% of the tumors and high expression was associated with poor clinical outcome. Moreover, the PDAC tumors had elevated expression levels of many inflammatory factors that were induced in CAFs by the tumor derived IL-1α in vitro. Consequently, this high expression of inflammatory factors in CAFs will attract immune cells including tumor associated macrophages (TAMs), dendritic cells (DCs), and CD8+ T cells. This indicates an immune suppressive role of CAFs, protecting the tumor cells by acting as decoy targets for immune cells homing into the tumor. The inflammatory factors produced in the PDAC microenvironment did not only affect the infiltrating immune cells, but had also systemic effects that included decreased levels of blood DCs in PDAC patients. Furthermore, these myeloid and plasmacytoid DCs were partly activated and had a semi mature phenotype and impaired immunostimulatory function. Low levels of blood DCs were direct associated with poor patient prognosis and the same was seen for low expression of ICOSL by the DCs. The findings presented in this thesis indicate an essential role for the cross-talk between tumor cells and stroma in the production of tumor  promoting factors. Treatment of PDAC patients with drugs that target the IL-1α signaling pathway could prevent the communication between these cells, thus reduce the amount of inflammatory factors both locally and systemically. Altogether, our findings support the idea that neutralization of the IL-1α signaling molecule could be a promising therapy for pancreatic cancer. The findings presented in this thesis indicate an essential role for the cross-talk between tumor cells and stroma in the production of tumor promoting factors. Treatment of PDAC patients with drugs that target the IL-1α signaling pathway could prevent the communication between these cells, thus reduce the amount of inflammatory factors both locally and systemically. Altogether, our findings support the idea that neutralization of the IL-1α signaling molecule could be a promising therapy for pancreatic cancer. / Mindre än 5% av patienterna som drabbas av cancer i bukspottkörteln förväntas överleva i mer än fem år. De typiska symtomen kommer sent och sjukdomen framskrider snabbt. Några av de riskfaktorer som identifierats är tobaksrökning, fetma och typ 2 diabetes. Forskningen har hittills siktat in sig på tumörcellerna och de mekanismer de använder för att överleva och föröka sig. Men en tumör innehåller också normala kroppsceller och vid bukspottkörtelcancer kan så mycket som 70 procent bestå av i sig ofarliga bindvävsceller. Miljön i tumören skapas av samspelet mellan dessa celltyper. De cancerceller som är bäst på att utnyttja omgivningen för sin tillväxt fortlever och för sina egenskaper vidare. En sådan egenskap är att kunna manipulera bindvävsceller till att producera signalsubstanser och tillväxtfaktorer som gynnar tumören. Mekanismerna bakom denna kommunikation har studerats och ett viktigt fynd var att tumörcellerna producerar signalämnet interleukin 1-alpha (IL-1a). Detta protein upptäcktes i 90 procent av de undersökta tumörerna, och var kopplat till dålig prognos hos patienterna. Signalen via IL-1a sätter igång tillverkningen av substanser som behövs för nybildning och tillväxt av blodkärl, i sin tur en förutsättning för att tumören ska leva vidare och växa. Proteinet stimulerar också celldelning i tumören, bidrar till att lura kroppens immunförsvar och underlättar spridning av dottertumörer till andra delar av kroppen. När vi slår ut signaleringen kan tumörcellerna inte längre påverka bindvävscellerna lika effektivt, och således minskar förekomsten av flera faktorer som gynnar tumörtillväxten. IL-1a kan därför vara en lovande kandidat att utforska vidare för framtida som ett läkemedel mot bukspottkörtelcancer.

abstract: Following diagnosis of a glioblastoma (GBM) brain tumor, surgical resection, chemotherapy and radiation together yield a median patient survival of only 15 months. Importantly, standard treatments fail to address the dynamic regulation of the brain tumor microenvironment that actively supports tumor progression and treatment resistance. Moreover, specialized niches within the tumor microenvironment maintain a population of highly malignant glioblastoma stem-like cells (GSCs). GSCs are resistant to traditional chemotherapy and radiation therapy and are likely responsible for near universal rates of tumor recurrence and associated morbidity. Thus, disrupting microenvironmental support for GSCs could be critical to more effective GBM therapies. Three-dimensional (3D) culture models of the tumor microenvironment are powerful tools for identifying key biochemical and biophysical inputs that may support or inhibit malignant behaviors. Here, we developed synthetic poly(N-isopropylacrylamide-co-Jeffamine M-1000® acrylamide) or PNJ copolymers as a model 3D system for culturing GBM cell lines and low-passage patient-derived GSCs in vitro. These temperature responsive scaffolds reversibly transition from soluble to insoluble in aqueous solution by heating from room temperature to body temperature, thereby enabling easy encapsulation and release of cells in a 3D scaffold. We also designed this system with the capacity for presenting the cell-adhesion peptide sequence RGD for adherent culture conditions. Using this system, we identified conditions that promoted GBM proliferation, invasion, GSC phenotypes, and radiation resistance. In particular, using two separate patient-derived GSC models, we observed that PNJ scaffolds regulated self-renewal, provided protection from radiation induced cell death, and may promote stem cell plasticity in response to radiation. Furthermore, PNJ scaffolds produced de novo activation of the transcription factor HIF2α, which is critical to GSC tumorigenicity and stem plasticity. All together, these studies establish the robust utility of PNJ biomaterials as in vitro models for studying microenvironmental regulation of GSC behaviors and treatment resistance. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2017

No description available.

Introdução: Indivíduos sobreviventes à sepse apresentam maior mortalidade à longo prazo e maior risco de apresentar infecções oportunistas. Existem evidências clínicas e experimentais de desregulação imune no estado pós-sepse. Essas alterações apresentam semelhança com aquelas encontradas no microambiente tumoral, estando relacionadas à imunossupressão. O presente trabalho avaliou o papel de macrófagos associados ao tumor (TAM) em modelo de progressão tumoral em camundongos sobreviventes à sepse. Materiais e Métodos: Camundongos C57/BL6 foram submetidos a ligadura e punção cecal (CLP) e tratados com ertapenem (20 mg/kg, i.p., 6 horas após CLP e 12/12 h por 3 dias). Os animais sobreviventes de sepse eram inoculados com células de melanoma B16-F10 (30 mil, s.c., 15 dias após a CLP). Animais naïve foram usados como controle. Foram avaliadas a progressão tumoral, sobrevida e formação de metástases espontâneas à distância. No D+14, animais foram sacrificados para mensuração do acúmulo de TAM por citometria de fluxo (CD45+F4/80+CD206+) e de citocinas no soro e no tumor por ELISA (IFN-?, IL-10, TNF-?, TGF-?, CCL2, CXCL12). Macrófagos derivados de medula óssea de animais pós-CLP ou naïve foram coinoculados com células B16 para avaliação de progressão tumoral e sobrevida. TAM de animais naïve ou pós-CLP foram isolados através de gradiente de Percoll seguido de adesão seletiva e o RNA foi isolado para análise diferencial de expressão gênica por microarray. Para avaliação da participação da via CXCL12/CXCR4 foi realizada sua inibição com o AMD3100, antagonista de CXCR4 (5 mg/kg, i.p., D+10 e D+14). Foi avaliada a progressão tumoral, sobrevida, acúmulo de TAM e proliferação extramedular de TAM no D+14. Resultados: Animais sobreviventes de sepse apresentaram aumento de progressão tumoral (após 15, 30 e 60 dias da CLP), aumento da carga de metástases (após 15 dias da CLP) e redução de sobrevida. Foi detectado o aumento de TAM nos animais pós-CLP, associado a maior marcação de Ki67, em comparação com animais naïve no D+14. Verificamos aumento das concentrações séricas de TGF-?, CXCL12, CCL2 e TNF-?. Camundongos naïve que coinoculados com macrófagos derivados de medula óssea de animais pós-CLP apresentaram aumento de progressão tumoral e redução de sobrevida em comparação com o grupo controle. TAM de animais pós-CLP apresentaram menor expressão de genes relacionados ao MHC-II e genes relacionados à ativação leucocitária. A inibição de CXCL12/CXCR4 preveniu a progressão tumoral induzida por sepse, com menor acúmulo de TAM e menor presença de TAM Ki67+. Conclusões: O estado pós-sepse promove a progressão tumoral de melanoma B16 em camundongos, o qual foi associado a aumento de 12 TAM. A via CXCL12/CXCR4 participa do processo de acúmulo de TAM nesse modelo experimental. / Background: Survivors from sepsis present higher long-term mortality and increased risk of opportunistic infections. There is clinical and experimental evidence for an immunosuppressive immune dysregulation in post-sepsis. These alterations are similar to those found in tumor microenvironment. The present work assessed the role of tumorassociated macrophage (TAM) in a model of tumor progression in sepsis-surviving mice. Materials and Methods: C57/BL6 mice were submitted to cecal ligation and puncture (CLP) and treated with ertapenem (20 mg/kg, ip. - 6 h after CLP and then each 12 h for 3 days). Sepsis surviving mice were inoculated with B16-F10 melanoma cells (30,000, sc., 15 days after CLP). Naïve mice were used as controls. Tumor progression, survival and distant spontaneous metastasis were evaluated. Mice were killed at D+14 for TAM measurement through flow cytometry (CD45+F4/80+CD206+) and for cytokines (IFN-?, IL-10, TNF-?, TGF-?, CCL2, CXCL12) quantification by ELISA. Bone marrow-derived macrophage (BMDM) were isolated and co-inoculated together with B16 melanoma cells for tumor progression and survival evaluation. TAM from naïve or post-sepsis mice were isolated through Percoll gradient (70/30) followed by selective adhesion. The RNA was isolated for gene expression analysis using microarray assay. To evaluate the role of CXCL12/CXCR4, we used the specific antagonist AMD3100 (5 mg/kg, ip., at D+10 and D+14) and assessed tumor progression, survival and TAM accumulation at D+14. Results: Sepsis-surviving mice showed increased tumor progression (15, 30 or 60 days after CLP), higher metastatic burden (15 days after CLP), and less overall survival. TAM were increased in post-sepsis mice at D+14. We found increased serum levels of TGF-?, CXCL12, CCL2 e TNF-?. Naïve mice inoculated with BMDM from post-sepsis and B16 cells showed higher tumoral progression and less survival, when compared to the control group. TAM from post-sepsis showed decreased expression of MHC-II related genes and genes related to leukocyte activation. The inhibition of CXCL12/CXCR4 prevented the post-sepsis-induced tumor progression, with less TAM accumulation and reduced expression of Ki67 in TAM. Conclusions: The post-sepsis state promotes the progression of B16 melanoma in mice, which was associated with an increase in TAM accumulation. CXCL12/CXCR4 mediates TAM accumulation in this experimental model.

O melanoma é a forma mais letal entre os cânceres de pele. Essa neoplasia freqüentemente apresenta-se resistente a abordagens terapêuticas. A angiogênese associada ao tumor representa um crítico passo da tumorigênese, resultado da ação de diferentes citocinas e fatores de crescimento como VEGF produzidos no microambiente tumoral. As galectinas extracelulares participam de múltiplos processos biológicos incluindo angiogênese tumoral e metástases, sua interação com as células presentes no microambiente tumoral pode ocorrer via receptores toll-like sugerindo seu envolvimento nos processos pro-inflamatórios e na secreção de citocinas. Recentemente mostramos que a ausência de gal-3 no estroma e parênquima tumoral diminui a angiogênese por interferir na resposta de macrófagos via VEGF e/ou TGFbeta1. Entretanto, o envolvimento de galectinas extracelulares na angiogênese e na modulação do sistema imune no microambiente tumoral ainda não está esclarecido. Assim, este estudo visa buscar respostas ao envolvimento das galectinas no crescimento tumoral e angiogênese contribuindo ao combate do melanoma maligno. Nossos resultados mostram a participação das galectinas 1 e 3 no crescimento tumoral e seu envolvimento com macrófagos via receptores toll-like, além de coordenarem a modulação do perfil de polarização de macrófagos derivados da medula óssea de camundongos wild-type. Dessa forma, podemos inferir que essas galectinas agem como coordenadoras de mudança de perfil dos macrófagos, uma vez que inibidas extracelularmente promovem uma diminuição do crescimento tumoral em camundongos wild-type, inoculados com células de melanoma murino e uma manutenção do perfil de macrófagos M1 in vitro. Assim, concluimos que as galectinas 1 e 3 extracelulares são importantes para o crescimento tumoral de melanomas murinos pois promovem o crescimento tumoral e são coordenadoras da mudança do perfil de macrófagos / Melanoma is the most aggressive form of skin cancer. This tumor often presents itself resistant to therapeutic approaches. The tumor-associated angiogenesis is a critical step in tumorigenesis and the result of the action of several cytokines and growth factors such as VEGF produced in the tumor microenvironment. The extracellular galectins participate in multiple biological processes including tumor angiogenesis and metastasis, their interaction with cells present in the tumor microenvironment may occur via toll-like receptors suggesting their involvement in pro-inflammatory processes and the secretion of cytokines. We have recently shown that the absence of Gal-3 the stroma and tumor parenchyma decreases angiogenesis by interfering with the macrophage response by VEGF and / or TGFbeta1. However, the involvement of extracellular galectins on angiogenesis modulation of the immune system in the tumor microenvironment is not yet clear. This study aims is to find answers to the involvement of galectins on tumor growth and angiogenesis contributing to the study of the malignant melanoma. Our results demonstrate the involvement of galectin 1 and 3 on tumor growth and its involvement in macrophage by toll-like receptors pathway, and coordinating the modulation of the polarization profile in wild-type mice bone marrow derived macrophages. Therefore, we show these galectins act as coordinators of macrophages profile change, since inhibited extracellularly promote a reduction in tumor growth in wild-type mice inoculated with murine melanoma cells and macrophages M1 maintenance of profile in vitro. Thus, we conclude that galectins 1 and 3 extracellular are important for tumor growth of murine melanomas because they promote tumor growth and are coordinators of change macrophages profile

Une expression élevée de la protéine de la matrice extracellulaire ténascine-C (TNC) favorise la progression du cancer et est corrélée à une réduction de la survie des patients. Dans cette thèse, j’ai étudié comment la TNC affecte l'angiogenèse tumorale. J’ai montré que la TNC altère les protrusions angiogéniques, la tubulogenèse, la migration et la prolifération des cellules endothéliales. J’ai lié ces effets à la perturbation du cytosquelette d'actine et la réduction de la signalisation YAP par la TNC. Chez les cellules tumorales et les fibroblastes associés au cancer, la TNC favorise la sécrétion de facteurs angio-modulateurs qui stimulent la survie et la tubulogenèse des cellules endothéliales de façon paracrine. Cet effet implique la régulation de l’expression de SDF1 (CXCL12) et de deux membres de la famille des lipocalines. Ainsi, la TNC favorise l’angiogenèse en activant chez les cellules tumorales un sécrétome pro-angiogénique, et inhibe la tubulogenèse en altérant la survie des cellules endothéliales. Ces effets opposés pourraient expliquer pourquoi nous avons observé dans un modèle de tumeur spontanée chez la souris que la TNC favorise le switch angiogénique résultant en la formation d’une forte vascularisation tumorale, mais qui reste peu fonctionnelle associée à la formation de plus de métastases. Ce travail fournit pour la première fois la possibilité de contrer l’action de la TNC dans l'angiogenèse tumorale. / A high expression of the extracellular matrix molecule tenascin-C (TNC) enhances multiple steps in cancer progression and correlates with worsened survival prognosis. In this thesis I studied how TNC affects tumor angiogenesis. I showed that TNC impairs endothelial sprouting, tubulogenesis, migration and proliferation. I linked this effect to disruption of the actin cytoskeleton and reduced YAP signaling activity by TNC. In tumor cells and cancer associated fibroblasts, TNC regulated secretion of angio-modulatory factors that promoted endothelial cell survival and tubulogenesis in a paracrine manner involving regulation of SDF1 (CXCL12) and two lipocalin family members. Altogether, TNC promotes endothelial tubulogenesis through a pro-angiogenic secretome from tumor cells, and inhibits by direct contact tubulogenesis by impairing endothelial cell survival. These opposing effects could explain why we observed that TNC promotes the tumor angiogenic switch resulting in more but poorly functional blood vessels associated with more metastasis in a spontaneous tumor mouse model. This knowledge provides for the first time opportunities to counteract TNC activities in tumor angiogenesis.

Le micro-environnement tumoral joue un rôle dans la croissance, l'invasion tumorale et la résistance aux traitements. Il est essentiel de comprendre les mécanismes qui régulent la communication entre les cellules tumorales et ce micro-environnement pour développer des thérapies efficaces. Dans ce contexte, les protéases extracellulaires de la famille des Adamalysines sont des acteurs importants dans la progression tumorale en agissant sur le remodelage de la matrice extracellulaire (MEC) et la biodisponibilité des médiateurs de communication cellulaire tels que les cytokines, les chimiokines et les facteurs de croissance. Mes travaux ont mis en évidence une nouvelle interaction entre ADAM12, un marqueur mésenchymateux induit au cours de la transition épithélio-mésenchymateuse (EMT) dépendante du TGF-β et ZO-1, une protéine d’échafaudage exprimée dans des jonctions serrées de cellules épithéliales. Ces deux protéines sont redistribuées, dans des structures de type invadopodes pour promouvoir la dégradation de la MEC. Nous avons par ailleurs réalisé un criblage in silico qui nous a permis d’identifier un cluster d’adamalysines dont les gènes sont co-exprimés chez des patients atteints d’un carcinome hépatocellulaire. Parmi ces adamalysines, nous avons mis en évidence la protéine ADAMTS12, qui joue un rôle clé dans le développement de la fibrose hépatique en lien avec une réponse inflammatoire aigüe ou chronique. / Tumor microenvironment plays a major role in tumor growth, invasion and resistance to treatments. Understanding the mechanisms that regulate communication between tumor cells and their microenvironment is essential to develop effective therapies. In this context, Adamalysin extracellular proteases play major role in tumor progression, by modulating the extracellular matrix (ECM) remodeling and the bioavailability of cell communication mediators such as cytokines, chemokines and growth factors. My work revealed a new interaction between ADAM12, a mesenchymal marker induced during the epithelial-mesenchymal transition (EMT) dependent on TGF-β and ZO-1, a scaffolding protein expressed in tight junctions of epithelial cells. Both proteins are redistributed in invadopodia-like structures to promote ECM degradation. In a second study, we carried out an in silico screening that allowed us to identify a cluster of Adamalysin genes co-expressed in patients with hepatocellular carcinoma. Among these Adamalysins we have studied the protein ADAMTS12 in more details, and shown that this protein plays a key role in the development of liver fibrosis involving an acute or chronic inflammatory response.