<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD 2.3 20070202//EN" "journalpublishing.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">EXCLI J</journal-id>
      <journal-title>EXCLI Journal</journal-title>
      <issn pub-type="epub">1611-2156</issn>
      <publisher>
        <publisher-name>Leibniz Research Centre for Working Environment and Human Factors</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">2020-1103</article-id>
      <article-id pub-id-type="doi">10.17179/excli2020-1103</article-id>
      <article-id pub-id-type="pii">Doc387</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Role of Kupffer cells in liver injury induced by CpG oligodeoxynucleotide and flucloxacillin in mice</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Gao</surname>
            <given-names>Yuying</given-names>
          </name>
          <xref ref-type="aff" rid="A1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Song</surname>
            <given-names>Binbin</given-names>
          </name>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Aoki</surname>
            <given-names>Shigeki</given-names>
          </name>
          <xref ref-type="aff" rid="A1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ito</surname>
            <given-names>Kousei</given-names>
          </name>
          <xref ref-type="corresp" rid="COR1">&#x0002a;</xref>
          <xref ref-type="aff" rid="A1">1</xref>
        </contrib>
      </contrib-group>
      <aff id="A1">
        <label>1</label>Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, Japan</aff>
      <aff id="A2">
        <label>2</label>Key Laboratory of Ethnomedicine (Minzu University of China), Ministry of Education, School of Pharmacy, Minzu University of China, Beijing, China</aff>
      <author-notes>
        <corresp id="COR1">*To whom correspondence should be addressed: Kousei Ito, Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8675, Japan; Tel: 81-43-226-2886, Fax: 81-43-226-2886, E-mail: <email>itokousei@chiba-u.jp</email></corresp>
      </author-notes>
      <pub-date pub-type="epub">
        <day>13</day>
        <month>03</month>
        <year>2020</year>
      </pub-date>
      <pub-date pub-type="collection">
        <year>2020</year>
      </pub-date>
      <volume>19</volume>
      <fpage>387</fpage>
      <lpage>399</lpage>
      <history>
        <date date-type="received">
          <day>03</day>
          <month>02</month>
          <year>2020</year>
        </date>
        <date date-type="accepted">
          <day>12</day>
          <month>03</month>
          <year>2020</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>Copyright &#xA9; 2020 Gao et al.</copyright-statement>
        <copyright-year>2020</copyright-year>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
          <p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (http://creativecommons.org/licenses/by/4.0/) You are free to copy, distribute and transmit the work, provided the original author and source are credited.</p>
        </license>
      </permissions>
      <self-uri xlink:href="https://www.excli.de/vol19/Ito_13032020_proof.pdf">This article is available from https://www.excli.de/vol19/Ito_13032020_proof.pdf</self-uri>
      <abstract><p>CpG oligodeoxynucleotide (CpG-ODN) is a Toll-like receptor 9 (TLR9) agonist that can induce innate immune responses. In a previous study, flucloxacillin (FLUX; 100 mg&#x2F;kg, gavage)-induced liver injury in mice was enhanced by co-administration of CpG-ODN (40 &#x3BC;g&#x2F;mouse, intraperitoneally). In this study, the mechanism of CpG-ODN sensitization to FLUX-induced liver injury was further investigated in mice inhibited of Kupffer cells (KCs) function by gadolinium chloride (GdCl<sub>3</sub>; 10 mg&#x2F;kg, intravenously). GdCl<sub>3</sub>-treated mice administrated with CpG-ODN and FLUX showed lower liver injury than wild-type (WT) mice treated with CpG-ODN and FLUX. Upregulation of Fas and FasL by CpG-ODN was also inhibited in GdCl<sub>3</sub>-treated mice and mitochondrial swelling in response to FLUX failed to occur regardless of pre-treatment with CpG-ODN. When FasL-mutant <italic>gld&#x2F;gld</italic> mice were treated with CpG-ODN, mitochondrial swelling in response to FLUX was also inhibited. These results suggest that KCs play an essential role in liver injury induced by CpG-ODN and FLUX. CpG-ODN may activate KCs, resulting in induction of Fas&#x2F;FasL-mediated apoptosis of hepatocytes. The Fas&#x2F;FasL pathway may also be an upstream regulator of CpG-ODN- and FLUX-induced changes in mitochondrial permeability transition. These results enhance our understanding of the mechanism of the adjuvant effect of CpG-ODN in this mouse model of liver injury.</p></abstract>
      <kwd-group>
        <kwd>Kupffer cells</kwd>
        <kwd>Toll-like receptor 9</kwd>
        <kwd>Fas&#x2F;Fas ligand</kwd>
        <kwd>pro-inflammatory cytokines</kwd>
        <kwd>mitochondrial permeability transition</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec>
      <title>Abbreviations</title><p>DILI: Drug-induced liver injury</p><p>KCs: Kupffer cells</p><p>TNF-&#x3B1;: Tumor necrosis factor-&#x3B1;</p><p>IL-6: Interleukin-6</p><p>IL-1&#x3B2;: Interleukin-1&#x3B2;</p><p>IFN-&#x3B3;: Interferon-&#x3B3;</p><p>IL-12: Interleukin-12</p><p>LPS: Lipopolysaccharide</p><p>MPT: Mitochondrial permeability transition</p><p>MPTPs: Mitochondrial permeability transition pores</p><p>ROS: Reactive oxygen species</p><p>FLUX: Flucloxacillin</p><p>ALT: Alanine aminotransferase</p><p>AST: Aspartate transaminase</p><p>T-Bil: Total bilirubin</p><p>CpG-ODN: CpG oligodeoxynucleotide</p><p>FasL: Fas ligand</p><p>NKT: Natural killer T</p><p>TLR9: Toll-like receptor 9</p><p>i.p.: Intraperitoneal injection</p><p>i.v.: Intravenous injection</p><p>H&#x26;E: Hematoxylin and eosin</p><p>BSA: Bovine serum albumin</p></sec>
    <sec sec-type="intro">
      <title>Introduction</title><p>Drug-induced liver injury (DILI) has become a significant hindrance to drug development (Watkins, 2011[<xref ref-type="bibr" rid="R42">42</xref>]). It is classified as intrinsic or idiosyncratic according to the clinical symptoms. In general, intrinsic DILI is dose-dependent and predictable, whereas idiosyncratic DILI is dose-independent, associated with immune responses, and challenging to detect in preclinical experiments and even during the clinical phase of drug development. Many experiments have been conducted <italic>in vitro </italic>and<italic> in vivo</italic> to clarify the mechanism of DILI. A potential mechanism may point to dysfunction of the immune system covering the up-regulation of innate immune responses induced by excessive inflammation (Jaeschke, 2006[<xref ref-type="bibr" rid="R18">18</xref>]), and adaptive immune responses (Gunawan and Kaplowitz, 2004[<xref ref-type="bibr" rid="R12">12</xref>]).</p><p>The recruitment of innate immune cells plays a crucial role in the initiation of adaptive immune responses. During infections in the liver, innate immune cells such as resident macrophages and dendritic cells firstly detect the presence of pathogens (bacteria, virus, damaged cells), and then release cytokines and chemokines to evoke a subsequent immune response (Liaskou et al., 2012[<xref ref-type="bibr" rid="R25">25</xref>]). Kupffer cells (KCs) are specialized macrophages in the liver, which account for approximately 20 &#x25; of the non-parenchymal cells (Duarte et al., 2015[<xref ref-type="bibr" rid="R9">9</xref>]; Racanelli and Rehermann, 2006[<xref ref-type="bibr" rid="R31">31</xref>]), as well as 80-90 &#x25; of the body&#x27;s macrophages (Gregory and Wing, 1998[<xref ref-type="bibr" rid="R10">10</xref>]). After recognized with damage-associated molecular patterns or pathogens-associated molecular patterns, KCs are activated, and the pro-inflammatory cytokines, tumor necrosis factor-&#x3B1; (TNF&#x3B1;), interleukin-6 (IL-6), interleukin-1&#x3B2; (IL-1&#x3B2;), interferon-&#x3B3; (IFN-&#x3B3;), interleukin-12 (IL-12) are secreted, which will take part in the activation of immune response (Bilzer et al., 2006[<xref ref-type="bibr" rid="R5">5</xref>]; Schumann et al., 2000[<xref ref-type="bibr" rid="R34">34</xref>]). KCs are also confirmed the crucial role in some liver injury in mice. In the lipopolysaccharide (LPS)-induced liver injury which comes from Propionibacterium acnes, KCs are necessary for the LPS sensitization and the primary cells secreting interleukin-18, which induces the liver injury. Also, KCs contribute to concanavalin A-induced acute liver injury by inducing tissue factors, leading to the development of liver injury with endothelial damage (Tsutsui and Nishiguchi, 2014[<xref ref-type="bibr" rid="R39">39</xref>]). In a previous report, the mechanism of gut-derived bacterial products contributing to liver injury during chronic hepatitis B virus infection was clarified. In mice, the liver injury was dependent on interactions between NKT cells and KCs (Hou et al., 2017[<xref ref-type="bibr" rid="R16">16</xref>]). These studies suggest that KCs always take part in DILI.</p><p>The mechanism, mitochondrial dysfunction, is also concerned with bringing out the liver injury (Labbe et al., 2008[<xref ref-type="bibr" rid="R23">23</xref>]). Mitochondrial permeability transition (MPT) is a significant mechanism of drug-induced mitochondrial dysfunction (Jaeschke et al., 2012[<xref ref-type="bibr" rid="R19">19</xref>]). Generally, MPT is initiated by the opening of mitochondrial permeability transition pores (MPTPs) in the mitochondrial inner membrane (Baines and Gutierrez-Aguilar, 2018[<xref ref-type="bibr" rid="R2">2</xref>]; Biasutto et al., 2016[<xref ref-type="bibr" rid="R4">4</xref>]). Various factors enhance MPTPs opening, including oxidative stress and the presence of high levels of Ca<sup>2&#x2B;</sup> in the mitochondria (Mukherjee et al., 2019[<xref ref-type="bibr" rid="R28">28</xref>]). Although it is widely accepted that MPT can lead to mitochondrial swelling and cell death through apoptosis or necrosis (D&#x27;Arcy, 2019[<xref ref-type="bibr" rid="R6">6</xref>]; Karch et al., 2013[<xref ref-type="bibr" rid="R20">20</xref>]), the underlying mechanism of induction of MPT remains unclear. Drugs are thought to promote MPT by both direct and indirect mechanisms (Begriche et al., 2011[<xref ref-type="bibr" rid="R3">3</xref>]). Direct pathways include interference with MPTPs components and activation of endogenous MPTPs inducers. Indirect mechanisms include drug-induced oxidative stress, which results in the reactive oxygen species (ROS)-induced activation of MPTPs inducers (Jaeschke et al., 2012[<xref ref-type="bibr" rid="R19">19</xref>]).</p><p>Flucloxacillin (FLUX) is used for the treatment of Gram-positive infections. The incidence of FLUX-induced liver injury is estimated at 8.5 in every 100,000 new users in the United Kingdom (Russmann et al., 2005[<xref ref-type="bibr" rid="R33">33</xref>]). Several attempts to reproduce FLUX-induced liver injury in animals have been reported. CD4 T cell-depleted C57BL&#x2F;6J mice treated with retinoic acid and FLUX show a mild and transient increase in serum alanine aminotransferase (ALT) and a dilated gallbladder, with no significant histological changes in the liver (Nattrass et al., 2015[<xref ref-type="bibr" rid="R29">29</xref>]). In our previous study, the CpG oligodeoxynucleotide (CpG-ODN)1826 was co-administrated with FLUX inducing hepatocyte apoptosis in mice. CpG-ODN is a Toll-like receptor 9 (TLR9) agonist, resulting in the initiation of innate immune responses that support the development of adaptive immunity (Hemmi et al., 2001[<xref ref-type="bibr" rid="R14">14</xref>]; Takeshita et al., 2001[<xref ref-type="bibr" rid="R38">38</xref>]). Based on this characteristic, CpG-ODN has been used as a vaccine adjuvant in many clinical trials as well as in experimental models (Al-Mariri et al., 2001[<xref ref-type="bibr" rid="R1">1</xref>]; Klinman, 2006[<xref ref-type="bibr" rid="R22">22</xref>]; Verthelyi et al., 2002[<xref ref-type="bibr" rid="R40">40</xref>]). In this mice model, CpG-ODN sensitized mice to FLUX-induced liver injury by activating natural killer T (NKT) cells to mediate Fas&#x2F;Fas ligand (FasL)-dependent apoptosis against hepatocytes, while also sensitizing the hepatocytes to FLUX-induced mitochondrial dysfunction (Song et al., 2019[<xref ref-type="bibr" rid="R36">36</xref>]). However, the detailed underlying mechanism has not been identified.</p><p>Hence, in the present study, we investigated the involvement of KCs in the liver injury in mice treated with CpG-ODN and FLUX, and report the detailed mechanism through which CpG-ODN enhances susceptibility to MPT. These findings may promote our understanding of the KCs-involvement and MPT induction in DILI.</p></sec>
    <sec sec-type="materials|methods">
      <title>Materials and Methods</title><sec><title>Animals</title><p>Female, 8-12-week-old C57BL&#x2F;6J mice (Charles River Laboratories, Kanagawa, Japan), as well as FasL-mutant <italic>gld&#x2F;gld</italic> mice in the C57BL&#x2F;6J background and their counterpart C57BL&#x2F;6J mice (Japan SLC, Shizuoka, Japan), were housed in an environment maintained at 25 &#xB0;C with 3-70 &#x25; relative humidity and a 12 h light&#x2F;dark cycle. Animals were treated humanely under the guidelines issued by the National Institutes of Health. All procedures were approved by the Animal Care Committee of Chiba University.</p></sec><sec><title>Drug treatment</title><p>For co-treatment of mice with FLUX (Toronto Research Chemicals Inc., Toronto, Canada) and CpG-ODN 1826 (TCCATGACGTTCCTGACGTT) (Fasmac Co., Kanagawa, Japan), mice were fed FLUX (100 mg&#x2F;kg) by oral gavage 5 h after intraperitoneal (i.p.) administration of CpG-ODN (40 &#x3BC;g&#x2F;mouse). For inhibiting KCs&#x27; function, mice were pre-treated with gadolinium chloride (GdCl<sub>3</sub>; Wako, Osaka, Japan) &#x5B;10 mg&#x2F;kg, intravenously (i.v.)&#x5D; 72 h before CpG-ODN administration (Kinoshita et al., 2010[<xref ref-type="bibr" rid="R21">21</xref>]; Lee et al., 2004[<xref ref-type="bibr" rid="R24">24</xref>]).</p></sec><sec><title>Measurement of plasma ALT</title><p>ALT, a biomarker of liver injury, was measured 24 h after FLUX administration as described previously (Song et al., 2018[<xref ref-type="bibr" rid="R37">37</xref>]).</p></sec><sec><title>Histology, immunohistochemistry, andterminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay</title><p>After mice were sacrificed, liver sections were stained with hematoxylin and eosin (H&#x26;E) as previously described (Song et al., 2018[<xref ref-type="bibr" rid="R37">37</xref>]). A TUNEL staining kit (DeadEnd Fluorometric TUNEL System, Promega, Madison, WI, USA) was used to visualize apoptotic cells in liver sections.</p></sec><sec><title>RNA isolation and quantitative real-time PCR</title><p>Total RNA was isolated and quantified as reported previously (Hirao et al., 2018[<xref ref-type="bibr" rid="R15">15</xref>]). GAPDH was used as the internal standard.</p><p>The following primers were used: TNF-&#x3B1;, forward 5&#x2032;-TGGGACAGTGACCTGGACTGT-3&#x2032; and reverse 5&#x2032;-TTCGGAAAGCCCATTTGAGT-3&#x2032;; IL-6, forward 5&#x2032;-TCGGAGGCTTAATTACACATGTTC-3&#x2032; and reverse 5&#x2032;-TGCCATTGCACAACTCTTTTCT-3&#x2032;; Fas, forward 5&#x2032;-TATCAAGGAGGCCCATTTTGC-3&#x2032; and reverse 5&#x2032;-TGTTTCCACTTCTAAACCATGCT-3&#x2032;; FasL, forward 5&#x2032;-TCCGTGAGTTCACCAACCAAA-3&#x2032; and reverse 5&#x2032;-GGGGGTTCCCTGTTAAATGGG-3&#x2032;; and GAPDH, forward 5&#x2032;-ATGTGTCCGTCGTGGATCTG-3&#x2032; and reverse 5&#x2032;-TGAAGTCGCAGGAGACAACC-3&#x2032;.</p></sec><sec><title>Isolation of liver mitochondria and measurement of MPT</title><p>Liver mitochondria were isolated and mitochondrial swelling (as an indicator of MPT) was determined according to a previously described method (Segawa et al., 2018[<xref ref-type="bibr" rid="R35">35</xref>]). Briefly, livers were isolated and placed in ice-cold isolation medium (250 mM sucrose, 10 mM HEPES-KOH (pH 7.2)) containing 0.5 mM EGTA, after which they were cut into small cubes with scissors, placed into 10 mL of medium, and homogenized 5 times in a Potter homogenizer. Homogenates were centrifuged at 770 &#xD7; g for 5 min at 4 &#xB0;C. The resulting supernatant was decanted and further centrifuged at 9,800 &#xD7; g for 10 min at 4 &#xB0;C. The supernatant was discarded, and the pellets were suspended in 10 mL of ice-cold isolation medium containing 0.3 mM EGTA. This suspension was centrifuged at 4,500 &#xD7; g for 10 min at 4 &#xB0;C, the supernatant was discarded, and the pellets were resuspended in 5 mL of ice-cold isolation medium containing 0.3 mM EGTA. Then, the suspension was centrifuged using a centrifugal force ranging from 2,000 &#xD7; g for 2 min to 4,500 &#xD7; g for 8 min and maintained at 4 &#xB0;C. The final mitochondrial pellet was suspended in 150 &#x3BC;L of the ice-cold isolation medium. The protein concentration of the mitochondrial fraction was determined by the method of Lowry et al. (1951[<xref ref-type="bibr" rid="R26">26</xref>]) using a Multiskan JX system (MTX Lab Systems, Vienna, VA, USA).</p><p>Mitochondria (0.5 mg protein&#x2F;mL) were preincubated in reaction medium (125 mM sucrose, 65 mM KCl, 5 mM succinate, and 10 mM HEPES-KOH (pH 7.4)) at 30 &#xB0;C in the presence of 12.5 or 25 &#x3BC;M CaCl<sub>2</sub>. The reaction was initiated by the addition of various concentrations of FLUX (final 200-1,000 &#x3BC;M). Mitochondrial swelling as an indicator of MPT was determined by the decrease in absorbance at 540 nm at 30 &#xB0;C on a UV-2550 spectrophotometer (Shimadzu, Kyoto, Japan).</p></sec><sec><title>Statistical analysis</title><p>Data are presented as the mean &#xB1; standard error of the mean (SEM). Statistical comparisons were performed by two-way analysis of variants (ANOVA) (GraphPad Software, San Diego, USA). P-values &#x3C; 0.05 were considered statistically significant.</p></sec></sec>
    <sec sec-type="results">
      <title>Results</title><sec><title>Involvement of KCs in hepatotoxicity induced by CpG-ODN and FLUX</title><p>To investigate the involvement of KCs in CpG-ODN and FLUX-induced liver injury, mice were first injected with GdCl<sub>3</sub> (10 mg&#x2F;kg, i.v.) to inhibit KCs function. Three days after injection, mice &#x5B;wild-type (WT) or GdCl<sub>3</sub>-treated&#x5D; were treated with CpG-ODN (40 &#x3BC;g&#x2F;mouse, i.p.) followed by administration of FLUX (100 mg&#x2F;kg, gavage) 5 h later. As an indicator of liver damage, the plasma ALT level was evaluated 24 h after FLUX administration, as reported previously (Song et al., 2019[<xref ref-type="bibr" rid="R36">36</xref>]). Consistent with the previous study, increased ALT levels were found in mice co-treated with CpG-ODN and FLUX. By contrast, inhibition of KCs prevented the increase in plasma ALT levels observed in control mice co-treated with CpG-ODN and FLUX (Figure 1a<xref ref-type="fig" rid="F1">(Fig. 1)</xref>).</p><p>Furthermore, liver sections were subjected to histological and TUNEL staining to characterize the liver injury. With H&#x26;E staining, apoptotic cells (arrows) were observed in the livers of WT mice co-treated with CpG-ODN and FLUX, whereas in GdCl<sub>3</sub>-treated mice, the number of apoptotic cells in the liver was greatly reduced (Figure 1b<xref ref-type="fig" rid="F1">(Fig. 1)</xref>). TUNEL staining to label apoptotic cells was consistent with the histological findings (Figure 1c and d<xref ref-type="fig" rid="F1">(Fig. 1)</xref>), and these observations were consistent with the liver injury evidenced by the increased plasma ALT levels. These results demonstrate that KCs are indispensable for CpG-ODN sensitization to FLUX-induced liver injury in mice.</p></sec><sec><title>KCs-inhibition, CpG-ODN-induced immune responses</title><p>It has been reported that KCs respond to CpG-ODN and promote NKT cell activation in hepatitis B surface antigen transgenic mice (Hou et al., 2017[<xref ref-type="bibr" rid="R16">16</xref>]). To further verify the involvement of KCs in CpG-ODN-mediated immune responses, which sensitize mice to FLUX-induced liver injury, mice (WT and GdCl<sub>3</sub>-treated) were administrated with CpG-ODN (40 &#x3BC;g&#x2F;mouse, i.p.). The relative mRNA expression of pro-inflammatory cytokines, TNF-&#x3B1; and IL-6, was measured 5 h after CpG-ODN administration. As shown in Figure 2a and 2b<xref ref-type="fig" rid="F2">(Fig. 2)</xref>, the mRNA expression of both TNF-&#x3B1; and IL-6 was increased by CpG-ODN treatment. When mice were pre-treated with GdCl<sub>3</sub>, although a partial increase in the expression of TNF-&#x3B1; and IL-6 by CpG-ODN was observed, this increase was significantly less than that of mice without KCs inhibition (Figure 2a and 2b<xref ref-type="fig" rid="F2">(Fig. 2)</xref>), simultaneously indicating KCs are prime source cells of TNF-&#x3B1; and IL-6.</p><p>The expression of Fas and FasL was also measured. Similar to the expression of TNF-&#x3B1; and IL-6, CpG-ODN treatment increased the mRNA expression of Fas and FasL compared with the control group (Figure 2c and 2d<xref ref-type="fig" rid="F2">(Fig. 2)</xref>), but the induction of Fas and FasL was inhibited in GdCl<sub>3</sub>-treated mice administrated with CpG-ODN (Figure 2c and 2d<xref ref-type="fig" rid="F2">(Fig. 2)</xref>). These results suggest that KCs inhibition suppresses the induction of Fas&#x2F;FasL-mediated apoptosis in response to CpG-ODN.</p><p>Collectively, these results suggest that CpG-ODN acts on KCs to initiate an innate immune response characterized by increased expression of TNF-&#x3B1; and IL-6, and increased induction of Fas&#x2F;FasL-mediated apoptosis.</p></sec><sec><title>CpG-ODN sensitization to FLUX-induced mitochondrial swelling was suppressed in GdCl<sub>3</sub>-treated mice</title><p>We have shown that KCs play an essential role in CpG-ODN-induced innate immune responses (Figure 2a-2d<xref ref-type="fig" rid="F2">(Fig. 2)</xref>). In our previous study, we found that CpG-ODN sensitized mice to FLUX-induced mitochondrial swelling in an MPT-dependent manner (Song et al., 2019[<xref ref-type="bibr" rid="R36">36</xref>]). Therefore, in this study, we hypothesized that KCs might be involved in the FLUX-induced MPT and investigated the effect of KCs inhibition on MPT induction.</p><p>Mice (WT or GdCl<sub>3</sub>-treated) were fasted overnight. Liver mitochondria were isolated 5 h after the administration of CpG-ODN or vehicle, and then exposed to 0, 200, 500, or 1,000 &#x3BC;M FLUX to investigate mitochondrial swelling. Consistent with our previous study, in WT mice, exposure to FLUX induced MPT in a concentration-dependent manner (Figure 3a<xref ref-type="fig" rid="F3">(Fig. 3)</xref>). As shown in Figure 3b<xref ref-type="fig" rid="F3">(Fig. 3)</xref>, exposure to 200 &#x3BC;M FLUX could induce stronger MPT in the isolated mitochondria of WT mice treated with CpG-ODN than in those from the control group. By contrast, KCs inhibition reduced the mitochondrial swelling to almost the same level as in the control mice, regardless of CpG-ODN pre-treatment (Figure 3b<xref ref-type="fig" rid="F3">(Fig. 3)</xref>). These results suggest that CpG-ODN sensitization to FLUX-induced MPT was also dependent on KCs.</p></sec><sec><title>Fas&#x2F;FasL-mediated apoptosis was required for CpG-ODN-sensitization to FLUX-induced MPT</title><p>Above, we show that KCs mediate the production of pro-inflammatory cytokines in response to CpG-ODN (Figure 2a and 2b<xref ref-type="fig" rid="F2">(Fig. 2)</xref>) and are also involved in the upregulation of Fas and FasL in the liver (Figure 2c and 2d<xref ref-type="fig" rid="F2">(Fig. 2)</xref>). Meanwhile, by KCs inhibition, CpG-ODN sensitization to FLUX-induced mitochondrial swelling was diminished (Figure 3b<xref ref-type="fig" rid="F3">(Fig. 3)</xref>). However, the mechanism underlying this result was unclear. Here, we hypothesized that the MPT in this mouse model was mediated by KCs through the induction of Fas&#x2F;FasL-mediated apoptosis. This hypothesis was tested using <italic>gld&#x2F;gld</italic> (FasL-mutated) and WT mice.</p><p>First, <italic>gld&#x2F;gld</italic> and WT mice were treated with CpG-ODN, and the relative mRNA expression of TNF-&#x3B1;, IL-6, and Fas in the liver was measured 5 h later. As shown in Figure 4<xref ref-type="fig" rid="F4">(Fig. 4)</xref>, the expression of TNF-&#x3B1; (Figure 4a<xref ref-type="fig" rid="F4">(Fig. 4)</xref>) and IL-6 (Figure 4b<xref ref-type="fig" rid="F4">(Fig. 4)</xref>) increased in <italic>gld&#x2F;gld</italic> mice after ad-ministration of CpG-ODN, consistent with the response to CpG-ODN in WT mice. Although FasL is mutated in <italic>gld&#x2F;gld</italic> mice, the expression of Fas on hepatocytes was also slightly upregulated, although this was not statistically significant (Figure 4c<xref ref-type="fig" rid="F4">(Fig. 4)</xref>).</p><p>Next, liver mitochondria were exposed to 200 &#x3BC;M FLUX in the same time course as in the previous swelling assay. As a positive control, isolated mitochondria from WT mice pre-treated with CpG-ODN showed a stronger MPT response compared with those from vehicle control mice (Figure 5a and 5b<xref ref-type="fig" rid="F5">(Fig. 5)</xref>). However, in <italic>gld&#x2F;gld</italic> mice, mitochondrial swelling in the CpG-ODN pre-treatment group was equal to that in the vehicle control group (Figure 5a and 5b<xref ref-type="fig" rid="F5">(Fig. 5)</xref>). These results confirm that the induction of MTP in CpG-ODN-treated mice is dependent on the Fas&#x2F;FasL pathway.</p></sec></sec>
    <sec sec-type="discussion">
      <title>Discussion</title><p>The mechanism of FLUX-induced liver injury is complex and diverse. Apart from genetic factors, increasing age and females suggest an increased risk of injury (Russmann et al., 2005[<xref ref-type="bibr" rid="R33">33</xref>]; Wing et al., 2017[<xref ref-type="bibr" rid="R44">44</xref>]). In our previous study, CpG-ODN, a TLR9 agonist, was used to sensitize female mice to FLUX-induced liver injury (Song et al., 2019[<xref ref-type="bibr" rid="R36">36</xref>]). In this mouse model, the acute liver injury detected 24 h after FLUX administration was characterized by innate immune responses and MPT, which is significantly associated with mitochondrial dysfunction. However, the detailed mechanisms involved in this response had not been elucidated. Therefore, in this study, we further investigated the mechanisms of CpG-ODN sensitization to FLUX-induced liver injury.</p><p>Many cells have been reported to express TLR9, including endothelial cells, hepatic dendritic cells, KCs (Wu et al., 2010[<xref ref-type="bibr" rid="R45">45</xref>]), and hepatic stellate cells (Watanabe et al., 2007[<xref ref-type="bibr" rid="R41">41</xref>]). Among them, KCs play a significant role in clearing bacteria and foreign proteins from the circulation. It has been reported that KCs promote liver disease and DILI by activating the innate immune system. Inhibition of KCs suppresses hepatic steatosis, indicating that activation of KCs plays a crucial role in non-alcoholic fatty liver disease pathogenesis and progression (Huang et al., 2010[<xref ref-type="bibr" rid="R17">17</xref>]). Another report showed that liver injury during alcoholic liver disease was dependent on activation of KCs by endotoxin, which is released by bacteria living in the intestine at the time of alcohol consumption (Wheeler, 2003[<xref ref-type="bibr" rid="R43">43</xref>]). Notably, FLUX is used to treat bacterial infections. Synthetic CpG-ODN, which mimics microbial genomes, has also been used to mimic bacterial infection. Given the role of the gut-liver axis in KCs activation, in our study we investigated the involvement of KCs in liver injury. We found that inhibition of KCs effectively attenuated liver injury induced by co-treatment of CpG-ODN and FLUX (Figure 1<xref ref-type="fig" rid="F1">(Fig. 1)</xref>).</p><p>Activated KCs release cytokines. These cytokines play an essential role in modulating immune responses. Among these, TNF-&#x3B1; and IL-6 (Gregory et al., 1998[<xref ref-type="bibr" rid="R11">11</xref>]; Helk et al., 2013[<xref ref-type="bibr" rid="R13">13</xref>]; Luster et al., 1994[<xref ref-type="bibr" rid="R27">27</xref>]) are largely reported contributing to the liver injury. For instance, TNF-&#x3B1; released by activated KCs contributed to liver destruction in mice with amebic liver abscess (Helk et al., 2013[<xref ref-type="bibr" rid="R13">13</xref>]). IL-6 was produced by KCs early during Listeria infection (Gregory et al., 1998[<xref ref-type="bibr" rid="R11">11</xref>]). Furthermore, in a mouse osteoblastic cell line, a combination of TNF-&#x3B1;, IL-1&#x3B2;, and IFN-&#x3B3; increased the expression of Fas mRNA and protein, and led to Fas&#x2F;FasL-mediated apoptosis (Ozeki et al., 2002[<xref ref-type="bibr" rid="R30">30</xref>]). In our study, we found that co-treatment of mice with CpG-ODN and FLUX increased the expression of TNF-&#x3B1;, IL-6, Fas, and FasL, and this response was significantly, although not completely, prevented by inhibition of KCs (Figure 2a-d<xref ref-type="fig" rid="F2">(Fig. 2)</xref>). The incomplete suppression of this response is likely due to residual KCs or other TLR9-expressing cells in the liver responding to CpG-ODN (Yang and Seki, 2012[<xref ref-type="bibr" rid="R46">46</xref>]).</p><p>MPT plays a central role in apoptosis and necrosis (Desagher and Martinou, 2000[<xref ref-type="bibr" rid="R7">7</xref>]). Previously, we found that CpG-ODN sensitized liver mitochondria to MPT induced by FLUX (200 &#x3BC;M) (Song et al., 2019[<xref ref-type="bibr" rid="R36">36</xref>]). In this study, we found that the increased sensitivity of CpG-ODN-treated mice to MPT was abrogated by KCs inhibition (Figure 3b<xref ref-type="fig" rid="F3">(Fig. 3)</xref>). Apoptosis can be initiated via two signaling pathways: the intrinsic pathway, which originates from mitochondria, and the extrinsic pathway, which originates from death signaling (Dinh et al., 2015[<xref ref-type="bibr" rid="R8">8</xref>]; Roy and Nicholson, 2000[<xref ref-type="bibr" rid="R32">32</xref>]). These two pathways cross-talk in the execution of cell death (Roy and Nicholson, 2000[<xref ref-type="bibr" rid="R32">32</xref>]). Induction of apoptotic signaling pathways leads to activation of caspase-8, which cleaves Bid or other Bcl2 family proteins that promote mitochondrial permeabilization. To clarify whether activation of the Fas&#x2F;FasL-mediated apoptotic pathway was involved in the increased MPT in CpG-ODN-sensitized FLUX-induced liver injury, FasL-mutant <italic>gld&#x2F;gld</italic> mice were used. There was a similar degree of induction of TNF-&#x3B1; and IL-6 in <italic>gld&#x2F;gld</italic> mice compared with WT mice manifesting the activation of KCs step ahead the activation of Fas&#x2F;FasL-mediated pathway (Figure 4a-b<xref ref-type="fig" rid="F4">(Fig. 4)</xref>). However, in FasL-mutant mice pre-treated with CpG-ODN, mitochondrial swelling was equivalent to that seen in vehicle control mice exposed to FLUX (200 &#x3BC;M), while MPT increased in WT mice pre-treated with CpG-ODN. These findings suggest that the effect of CpG-ODN on FLUX-induced MPT was dependent on induction of Fas&#x2F;FasL-mediated apoptosis.</p><p>Taken together, these results indicate that CpG-ODN enhanced FLUX-induced liver injury by activating KCs, resulting in production of pro-inflammatory cytokines (TNF-&#x3B1; and IL-6) and initiation of Fas&#x2F;FasL-mediated apoptosis, but was insufficient to induce liver injury without FLUX administration. When FLUX was administered to mice pre-treated with CpG-ODN, Fas&#x2F;FasL-mediated apoptosis contributed to FLUX-induced MPT, ultimately inducing liver injury. However, we do not yet know whether activation of the Fas&#x2F;FasL pathway is dependent on the release of pro-inflammatory cytokines. In the future, we propose to investigate the association between cytokines release and Fas&#x2F;FasL pathway induction by blockade of cytokines with semapimod, a pharmacological inhibitor of cytokine production, as well as to investigate the specific relationship between TNF-&#x3B1; or IL-6 and the Fas&#x2F;FasL pathway using blocking antibodies.</p><p>In this study, we report the detailed mechanism through which CpG-ODN sensitizes mice to FLUX-induced liver injury. These findings may enhance our understanding of the complex pathogenesis of drug-induced acute liver injury in the clinic.</p></sec>
    <sec>
      <title>Notes</title><p>Yuying Gao and Binbin Song contributed equally as first authors.</p></sec>
    <sec>
      <title>Conflicts of interest</title><p>The authors have no conflicts of interest to report.</p></sec>
    <sec>
      <title>Acknowledgements</title><p>This work was supported by a Japan Society for the Promotion of Science KAKENHI grant (number 19H03386).</p></sec>
  </body>
  <back>
    <ref-list>
      <ref id="R1">
        <label>1</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Al-Mariri</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Tibor</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Mertens</surname>
              <given-names>P</given-names>
            </name>
            <name>
              <surname>De Bolle</surname>
              <given-names>X</given-names>
            </name>
            <name>
              <surname>Michel</surname>
              <given-names>P</given-names>
            </name>
            <name>
              <surname>Godefroid</surname>
              <given-names>J</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Protection of BALB&#x2F;c mice against Brucella abortus 544 challenge by vaccination with bacterioferritin or P39 recombinant proteins with CpG oligodeoxynucleotides as adjuvant</article-title>
          <source>Infect Immun</source>
          <year>2001</year>
          <volume>69</volume>
          <fpage>4816</fpage>
          <lpage>4822</lpage>
        </citation>
      </ref>
      <ref id="R2">
        <label>2</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Baines</surname>
              <given-names>CP</given-names>
            </name>
            <name>
              <surname>Gutierrez-Aguilar</surname>
              <given-names>M</given-names>
            </name>
          </person-group>
          <article-title>The still uncertain identity of the channel-forming unit(s) of the mitochondrial permeability transition pore</article-title>
          <source>Cell Calcium</source>
          <year>2018</year>
          <volume>73</volume>
          <fpage>121</fpage>
          <lpage>130</lpage>
        </citation>
      </ref>
      <ref id="R3">
        <label>3</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Begriche</surname>
              <given-names>K</given-names>
            </name>
            <name>
              <surname>Massart</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Robin</surname>
              <given-names>MA</given-names>
            </name>
            <name>
              <surname>Borgne-Sanchez</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Fromenty</surname>
              <given-names>B</given-names>
            </name>
          </person-group>
          <article-title>Drug-induced toxicity on mitochondria and lipid metabolism: Mechanistic diversity and deleterious consequences for the liver</article-title>
          <source>J Hepatol</source>
          <year>2011</year>
          <volume>54</volume>
          <fpage>773</fpage>
          <lpage>794</lpage>
        </citation>
      </ref>
      <ref id="R4">
        <label>4</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Biasutto</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>Azzolini</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Szabo</surname>
              <given-names>I</given-names>
            </name>
            <name>
              <surname>Zoratti</surname>
              <given-names>M</given-names>
            </name>
          </person-group>
          <article-title>The mitochondrial permeability transition pore in AD 2016: An update</article-title>
          <source>Biochim Biophys Acta</source>
          <year>2016</year>
          <volume>1863</volume>
          <fpage>2515</fpage>
          <lpage>2530</lpage>
        </citation>
      </ref>
      <ref id="R5">
        <label>5</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Bilzer</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Roggel</surname>
              <given-names>F</given-names>
            </name>
            <name>
              <surname>Gerbes</surname>
              <given-names>AL</given-names>
            </name>
          </person-group>
          <article-title>Role of Kupffer cells in host defense and liver disease</article-title>
          <source>Liver Int</source>
          <year>2006</year>
          <volume>26</volume>
          <fpage>1175</fpage>
          <lpage>1186</lpage>
        </citation>
      </ref>
      <ref id="R6">
        <label>6</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>D&#x27;Arcy</surname>
              <given-names>MS</given-names>
            </name>
          </person-group>
          <article-title>Cell death: a review of the major forms of apoptosis, necrosis and autophagy</article-title>
          <source>Cell Biol Int</source>
          <year>2019</year>
          <volume>43</volume>
          <fpage>582</fpage>
          <lpage>592</lpage>
        </citation>
      </ref>
      <ref id="R7">
        <label>7</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Desagher</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Martinou</surname>
              <given-names>JC</given-names>
            </name>
          </person-group>
          <article-title>Mitochondria as the central control point of apoptosis</article-title>
          <source>Trends Cell Biol</source>
          <year>2000</year>
          <volume>10</volume>
          <fpage>369</fpage>
          <lpage>377</lpage>
        </citation>
      </ref>
      <ref id="R8">
        <label>8</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Dinh</surname>
              <given-names>CT</given-names>
            </name>
            <name>
              <surname>Goncalves</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Bas</surname>
              <given-names>E</given-names>
            </name>
            <name>
              <surname>Van de Water</surname>
              <given-names>TR</given-names>
            </name>
            <name>
              <surname>Zine</surname>
              <given-names>A</given-names>
            </name>
          </person-group>
          <article-title>Molecular regulation of auditory hair cell death and approaches to protect sensory receptor cells and&#x2F;or stimulate repair following acoustic trauma</article-title>
          <source>Front Cell Neurosci</source>
          <year>2015</year>
          <volume>9</volume>
          <fpage>96</fpage>
        </citation>
      </ref>
      <ref id="R9">
        <label>9</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Duarte</surname>
              <given-names>N</given-names>
            </name>
            <name>
              <surname>Coelho</surname>
              <given-names>IC</given-names>
            </name>
            <name>
              <surname>Patarrao</surname>
              <given-names>RS</given-names>
            </name>
            <name>
              <surname>Almeida</surname>
              <given-names>JI</given-names>
            </name>
            <name>
              <surname>Penha-Goncalves</surname>
              <given-names>C</given-names>
            </name>
            <name>
              <surname>Macedo</surname>
              <given-names>MP</given-names>
            </name>
          </person-group>
          <article-title>How Inflammation Impinges on NAFLD: A role for Kupffer Cells</article-title>
          <source>Biomed Res Int</source>
          <year>2015</year>
          <volume>2015</volume>
          <fpage>984578</fpage>
        </citation>
      </ref>
      <ref id="R10">
        <label>10</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Gregory</surname>
              <given-names>SH</given-names>
            </name>
            <name>
              <surname>Wing</surname>
              <given-names>EJ</given-names>
            </name>
          </person-group>
          <article-title>Neutrophil-Kupffer-cell interaction in host defenses to systemic infections</article-title>
          <source>Immunol Today</source>
          <year>1998</year>
          <volume>19</volume>
          <fpage>507</fpage>
          <lpage>510</lpage>
        </citation>
      </ref>
      <ref id="R11">
        <label>11</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Gregory</surname>
              <given-names>SH</given-names>
            </name>
            <name>
              <surname>Wing</surname>
              <given-names>EJ</given-names>
            </name>
            <name>
              <surname>Danowski</surname>
              <given-names>KL</given-names>
            </name>
            <name>
              <surname>van Rooijen</surname>
              <given-names>N</given-names>
            </name>
            <name>
              <surname>Dyer</surname>
              <given-names>KF</given-names>
            </name>
            <name>
              <surname>Tweardy</surname>
              <given-names>DJ</given-names>
            </name>
          </person-group>
          <article-title>IL-6 produced by Kupffer cells induces STAT protein activation in hepatocytes early during the course of systemic listerial infections</article-title>
          <source>J Immunol</source>
          <year>1998</year>
          <volume>160</volume>
          <fpage>6056</fpage>
          <lpage>6061</lpage>
        </citation>
      </ref>
      <ref id="R12">
        <label>12</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Gunawan</surname>
              <given-names>B</given-names>
            </name>
            <name>
              <surname>Kaplowitz</surname>
              <given-names>N</given-names>
            </name>
          </person-group>
          <article-title>Clinical perspectives on xenobiotic-induced hepatotoxicity</article-title>
          <source>Drug Metab Rev</source>
          <year>2004</year>
          <volume>36</volume>
          <fpage>301</fpage>
          <lpage>312</lpage>
        </citation>
      </ref>
      <ref id="R13">
        <label>13</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Helk</surname>
              <given-names>E</given-names>
            </name>
            <name>
              <surname>Bernin</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Ernst</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Ittrich</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Jacobs</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Heeren</surname>
              <given-names>J</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>TNF alpha-mediated liver destruction by Kupffer cells and Ly6C(hi) monocytes during Entamoeba histolytica infection</article-title>
          <source>Plos Pathog</source>
          <year>2013</year>
          <volume>9</volume>
          <issue>1</issue>
          <fpage>e1003096</fpage>
        </citation>
      </ref>
      <ref id="R14">
        <label>14</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Hemmi</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Takeuchi</surname>
              <given-names>O</given-names>
            </name>
            <name>
              <surname>Kawai</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Kaisho</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Sato</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Sanjo</surname>
              <given-names>H</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>A Toll-like receptor recognizes bacterial DNA</article-title>
          <source>Nature</source>
          <year>2000</year>
          <volume>408</volume>
          <issue>6813</issue>
          <fpage>740</fpage>
          <lpage>745</lpage>
        </citation>
      </ref>
      <ref id="R15">
        <label>15</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Hirao</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Yamaguchi</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Kikuya</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Chibana</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Ito</surname>
              <given-names>K</given-names>
            </name>
            <name>
              <surname>Aoki</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
          <article-title>Altered intracellular signaling by imatinib increases the anti-cancer effects of tyrosine kinase inhibitors in chronic myelogenous leukemia cells</article-title>
          <source>Cancer Sci</source>
          <year>2018</year>
          <volume>109</volume>
          <fpage>121</fpage>
          <lpage>131</lpage>
        </citation>
      </ref>
      <ref id="R16">
        <label>16</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Hou</surname>
              <given-names>X</given-names>
            </name>
            <name>
              <surname>Hao</surname>
              <given-names>XL</given-names>
            </name>
            <name>
              <surname>Zheng</surname>
              <given-names>MJ</given-names>
            </name>
            <name>
              <surname>Xu</surname>
              <given-names>CF</given-names>
            </name>
            <name>
              <surname>Wang</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Zhou</surname>
              <given-names>RB</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>CD205-TLR9-IL-12 axis contributes to CpG-induced oversensitive liver injury in HBsAg transgenic mice by promoting the interaction of NKT cells with Kupffer cells</article-title>
          <source>Cell Mol Immunol</source>
          <year>2017</year>
          <volume>14</volume>
          <fpage>675</fpage>
          <lpage>684</lpage>
        </citation>
      </ref>
      <ref id="R17">
        <label>17</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Huang</surname>
              <given-names>W</given-names>
            </name>
            <name>
              <surname>Metlakunta</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Dedousis</surname>
              <given-names>N</given-names>
            </name>
            <name>
              <surname>Zhang</surname>
              <given-names>PL</given-names>
            </name>
            <name>
              <surname>Sipula</surname>
              <given-names>I</given-names>
            </name>
            <name>
              <surname>Dube</surname>
              <given-names>JJ</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Depletion of liver Kupffer cells prevents the development of diet-induced hepatic steatosis and insulin resistance</article-title>
          <source>Diabetes</source>
          <year>2010</year>
          <volume>59</volume>
          <fpage>347</fpage>
          <lpage>357</lpage>
        </citation>
      </ref>
      <ref id="R18">
        <label>18</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Jaeschke</surname>
              <given-names>H</given-names>
            </name>
          </person-group>
          <article-title>Mechanisms of liver injury. II. Mechanisms of neutrophil-induced liver cell injury during hepatic ischemia-reperfusion and other acute inflammatory conditions</article-title>
          <source>Am J Physiol Gastrointest Liver Physiol</source>
          <year>2006</year>
          <volume>290</volume>
          <fpage>G1083</fpage>
          <lpage>G1088</lpage>
        </citation>
      </ref>
      <ref id="R19">
        <label>19</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Jaeschke</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>McGill</surname>
              <given-names>MR</given-names>
            </name>
            <name>
              <surname>Ramachandran</surname>
              <given-names>A</given-names>
            </name>
          </person-group>
          <article-title>Oxidant stress, mitochondria, and cell death mechanisms in drug-induced liver injury: Lessons learned from acetaminophen hepatotoxicity</article-title>
          <source>Drug Metab Rev</source>
          <year>2012</year>
          <volume>44</volume>
          <fpage>88</fpage>
          <lpage>106</lpage>
        </citation>
      </ref>
      <ref id="R20">
        <label>20</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Karch</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Kwong</surname>
              <given-names>JQ</given-names>
            </name>
            <name>
              <surname>Burr</surname>
              <given-names>AR</given-names>
            </name>
            <name>
              <surname>Sargent</surname>
              <given-names>MA</given-names>
            </name>
            <name>
              <surname>Elrod</surname>
              <given-names>JW</given-names>
            </name>
            <name>
              <surname>Peixoto</surname>
              <given-names>PM</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Bax and Bak function as the outer membrane component of the mitochondrial permeability pore in regulating necrotic cell death in mice</article-title>
          <source>Elife</source>
          <year>2013</year>
          <volume>2</volume>
          <fpage>e00772</fpage>
        </citation>
      </ref>
      <ref id="R21">
        <label>21</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Kinoshita</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Uchida</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Sato</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Nakashima</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Nakashima</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Shono</surname>
              <given-names>S</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Characterization of two F4&#x2F;80-positive Kupffer cell subsets by their function and phenotype in mice</article-title>
          <source>J Hepatol</source>
          <year>2010</year>
          <volume>53</volume>
          <fpage>903</fpage>
          <lpage>910</lpage>
        </citation>
      </ref>
      <ref id="R22">
        <label>22</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Klinman</surname>
              <given-names>DM</given-names>
            </name>
          </person-group>
          <article-title>Adjuvant activity of CpG oligodeoxynucleotides</article-title>
          <source>Int Rev Immunol</source>
          <year>2006</year>
          <volume>25</volume>
          <fpage>135</fpage>
          <lpage>154</lpage>
        </citation>
      </ref>
      <ref id="R23">
        <label>23</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Labbe</surname>
              <given-names>G</given-names>
            </name>
            <name>
              <surname>Pessayre</surname>
              <given-names>D</given-names>
            </name>
            <name>
              <surname>Fromenty</surname>
              <given-names>B</given-names>
            </name>
          </person-group>
          <article-title>Drug-induced liver injury through mitochondrial dysfunction: mechanisms and detection during preclinical safety studies</article-title>
          <source>Fund Clin Pharmacol</source>
          <year>2008</year>
          <volume>22</volume>
          <fpage>335</fpage>
          <lpage>353</lpage>
        </citation>
      </ref>
      <ref id="R24">
        <label>24</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Lee</surname>
              <given-names>CM</given-names>
            </name>
            <name>
              <surname>Yeoh</surname>
              <given-names>GC</given-names>
            </name>
            <name>
              <surname>Olynyk</surname>
              <given-names>JK</given-names>
            </name>
          </person-group>
          <article-title>Differential effects of gadolinium chloride on Kupffer cells in vivo and in vitro</article-title>
          <source>Int J Biochem Cell B</source>
          <year>2004</year>
          <volume>36</volume>
          <fpage>481</fpage>
          <lpage>488</lpage>
        </citation>
      </ref>
      <ref id="R25">
        <label>25</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Liaskou</surname>
              <given-names>E</given-names>
            </name>
            <name>
              <surname>Wilson</surname>
              <given-names>DV</given-names>
            </name>
            <name>
              <surname>Oo</surname>
              <given-names>YH</given-names>
            </name>
          </person-group>
          <article-title>Innate immune cells in liver inflammation</article-title>
          <source>Mediat Inflamm</source>
          <year>2012</year>
          <volume>2012</volume>
          <fpage>949157</fpage>
        </citation>
      </ref>
      <ref id="R26">
        <label>26</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Lowry</surname>
              <given-names>OH</given-names>
            </name>
            <name>
              <surname>Rosebrough</surname>
              <given-names>NJ</given-names>
            </name>
            <name>
              <surname>Farr</surname>
              <given-names>AL</given-names>
            </name>
            <name>
              <surname>Randall</surname>
              <given-names>RJ</given-names>
            </name>
          </person-group>
          <article-title>Protein measurement with the Folin phenol reagent</article-title>
          <source>J Biol Chem</source>
          <year>1951</year>
          <volume>193</volume>
          <fpage>265</fpage>
          <lpage>275</lpage>
        </citation>
      </ref>
      <ref id="R27">
        <label>27</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Luster</surname>
              <given-names>MI</given-names>
            </name>
            <name>
              <surname>Germolec</surname>
              <given-names>DR</given-names>
            </name>
            <name>
              <surname>Yoshida</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Kayama</surname>
              <given-names>F</given-names>
            </name>
            <name>
              <surname>Thompson</surname>
              <given-names>M</given-names>
            </name>
          </person-group>
          <article-title>Endotoxin-induced cytokine gene-expression and excretion in the liver</article-title>
          <source>Hepatology</source>
          <year>1994</year>
          <volume>19</volume>
          <fpage>480</fpage>
          <lpage>488</lpage>
        </citation>
      </ref>
      <ref id="R28">
        <label>28</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Mukherjee</surname>
              <given-names>R</given-names>
            </name>
            <name>
              <surname>Mareninova</surname>
              <given-names>OA</given-names>
            </name>
            <name>
              <surname>Odinokova</surname>
            </name>
          </person-group>
          <article-title>Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP. Gut. 2016;65:1333-46</article-title>
          <source>Erratum in: Gut</source>
          <year>2019</year>
          <volume>68</volume>
          <fpage>1136</fpage>
        </citation>
      </ref>
      <ref id="R29">
        <label>29</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Nattrass</surname>
              <given-names>R</given-names>
            </name>
            <name>
              <surname>Faulkner</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>Vocanson</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Antoine</surname>
              <given-names>DJ</given-names>
            </name>
            <name>
              <surname>Kipar</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Kenna</surname>
              <given-names>G</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Activation of flucloxacillin-specific CD8&#x2B;T-cells with the potential to promote hepatocyte cytotoxicity in a mouse model</article-title>
          <source>Toxicol Sci</source>
          <year>2015</year>
          <volume>146</volume>
          <fpage>146</fpage>
          <lpage>156</lpage>
        </citation>
      </ref>
      <ref id="R30">
        <label>30</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Ozeki</surname>
              <given-names>N</given-names>
            </name>
            <name>
              <surname>Mogi</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Nakamura</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Togari</surname>
              <given-names>A</given-names>
            </name>
          </person-group>
          <article-title>Differential expression of the Fas-Fas ligand system on cytokine-induced apoptotic cell death in mouse osteoblastic cells</article-title>
          <source>Arch Oral Biol</source>
          <year>2002</year>
          <volume>47</volume>
          <fpage>511</fpage>
          <lpage>517</lpage>
        </citation>
      </ref>
      <ref id="R31">
        <label>31</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Racanelli</surname>
              <given-names>V</given-names>
            </name>
            <name>
              <surname>Rehermann</surname>
              <given-names>B</given-names>
            </name>
          </person-group>
          <article-title>The liver as an immunological organ</article-title>
          <source>Hepatology</source>
          <year>2006</year>
          <volume>43</volume>
          <fpage>S54</fpage>
          <lpage>S62</lpage>
        </citation>
      </ref>
      <ref id="R32">
        <label>32</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Roy</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Nicholson</surname>
              <given-names>DW</given-names>
            </name>
          </person-group>
          <article-title>Cross-talk in cell death signaling</article-title>
          <source>J Exp Med</source>
          <year>2000</year>
          <volume>192</volume>
          <fpage>F21</fpage>
          <lpage>F25</lpage>
        </citation>
      </ref>
      <ref id="R33">
        <label>33</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Russmann</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Kaye</surname>
              <given-names>JA</given-names>
            </name>
            <name>
              <surname>Jick</surname>
              <given-names>SS</given-names>
            </name>
            <name>
              <surname>Jick</surname>
              <given-names>H</given-names>
            </name>
          </person-group>
          <article-title>Risk of cholestatic liver disease associated with flucloxacillin and flucloxacillin prescribing habits in the UK: Cohort study using data from the UK General Practice Research Database</article-title>
          <source>Brit J Clin Pharmacol</source>
          <year>2005</year>
          <volume>60</volume>
          <fpage>76</fpage>
          <lpage>82</lpage>
        </citation>
      </ref>
      <ref id="R34">
        <label>34</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Schumann</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Wolf</surname>
              <given-names>D</given-names>
            </name>
            <name>
              <surname>Pahl</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Brune</surname>
              <given-names>K</given-names>
            </name>
            <name>
              <surname>Papadopoulos</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>van Rooijen</surname>
              <given-names>N</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Importance of Kupffer cells for T-cell-dependent liver injury in mice</article-title>
          <source>Am J Pathol</source>
          <year>2000</year>
          <volume>157</volume>
          <fpage>1671</fpage>
          <lpage>1683</lpage>
        </citation>
      </ref>
      <ref id="R35">
        <label>35</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Segawa</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Sekine</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Sato</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Ito</surname>
              <given-names>K</given-names>
            </name>
          </person-group>
          <article-title>Increased susceptibility to troglitazone-induced mitochondrial permeability transition in type 2 diabetes mellitus model rat</article-title>
          <source>J Toxicol Sci</source>
          <year>2018</year>
          <volume>43</volume>
          <fpage>339</fpage>
          <lpage>351</lpage>
        </citation>
      </ref>
      <ref id="R36">
        <label>36</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Song</surname>
              <given-names>BB</given-names>
            </name>
            <name>
              <surname>Aoki</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Liu</surname>
              <given-names>C</given-names>
            </name>
            <name>
              <surname>Ito</surname>
              <given-names>K</given-names>
            </name>
          </person-group>
          <article-title>A toll-like receptor 9 agonist sensitizes mice to mitochondrial dysfunction-induced hepatic apoptosis via the Fas&#x2F;FasL pathway</article-title>
          <source>Arch Toxicol</source>
          <year>2019</year>
          <volume>93</volume>
          <fpage>1573</fpage>
          <lpage>1584</lpage>
        </citation>
      </ref>
      <ref id="R37">
        <label>37</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Song</surname>
              <given-names>BB</given-names>
            </name>
            <name>
              <surname>Aoki</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Liu</surname>
              <given-names>C</given-names>
            </name>
            <name>
              <surname>Susukida</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Ito</surname>
              <given-names>K</given-names>
            </name>
          </person-group>
          <article-title>An animal model of abacavir-induced HLA-mediated liver injury</article-title>
          <source>Toxicol Sci</source>
          <year>2018</year>
          <volume>162</volume>
          <fpage>713</fpage>
          <lpage>723</lpage>
        </citation>
      </ref>
      <ref id="R38">
        <label>38</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Takeshita</surname>
              <given-names>F</given-names>
            </name>
            <name>
              <surname>Leifer</surname>
              <given-names>CA</given-names>
            </name>
            <name>
              <surname>Gursel</surname>
              <given-names>I</given-names>
            </name>
            <name>
              <surname>Ishii</surname>
              <given-names>KJ</given-names>
            </name>
            <name>
              <surname>Takeshita</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Gursel</surname>
              <given-names>M</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Cutting edge: Role of toll-like receptor 9 in CpG DNA-induced activation of human cells</article-title>
          <source>J Immunol</source>
          <year>2001</year>
          <volume>167</volume>
          <fpage>3555</fpage>
          <lpage>3558</lpage>
        </citation>
      </ref>
      <ref id="R39">
        <label>39</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Tsutsui</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Nishiguchi</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
          <article-title>Importance of Kupffer cells in the development of acute liver injuries in mice</article-title>
          <source>Int J Mol Sci</source>
          <year>2014</year>
          <volume>15</volume>
          <fpage>7711</fpage>
          <lpage>7730</lpage>
        </citation>
      </ref>
      <ref id="R40">
        <label>40</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Verthelyi</surname>
              <given-names>D</given-names>
            </name>
            <name>
              <surname>Kenney</surname>
              <given-names>RT</given-names>
            </name>
            <name>
              <surname>Seder</surname>
              <given-names>RA</given-names>
            </name>
            <name>
              <surname>Gam</surname>
              <given-names>AA</given-names>
            </name>
            <name>
              <surname>Friedag</surname>
              <given-names>B</given-names>
            </name>
            <name>
              <surname>Klinman</surname>
              <given-names>DM</given-names>
            </name>
          </person-group>
          <article-title>CpG oligodeoxynucleotides as vaccine adjuvants in primates</article-title>
          <source>J Immunol</source>
          <year>2002</year>
          <volume>168</volume>
          <fpage>1659</fpage>
          <lpage>1663</lpage>
        </citation>
      </ref>
      <ref id="R41">
        <label>41</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Watanabe</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Hashmi</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Gomes</surname>
              <given-names>DA</given-names>
            </name>
            <name>
              <surname>Town</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Badou</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Flavell</surname>
              <given-names>RA</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Apoptotic hepatocyte DNA inhibits hepatic stellate cell chemotaxis via toll-like receptor 9</article-title>
          <source>Hepatology</source>
          <year>2007</year>
          <volume>46</volume>
          <fpage>1509</fpage>
          <lpage>1518</lpage>
        </citation>
      </ref>
      <ref id="R42">
        <label>42</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Watkins</surname>
              <given-names>PB</given-names>
            </name>
          </person-group>
          <article-title>Drug safety sciences and the bottleneck in drug development</article-title>
          <source>Clin Pharmacol Therap</source>
          <year>2011</year>
          <volume>89</volume>
          <fpage>788</fpage>
          <lpage>790</lpage>
        </citation>
      </ref>
      <ref id="R43">
        <label>43</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Wheeler</surname>
              <given-names>MD</given-names>
            </name>
          </person-group>
          <article-title>Endotoxin and Kupffer cell activation in alcoholic liver disease</article-title>
          <source>Alcohol Res Health</source>
          <year>2003</year>
          <volume>27</volume>
          <fpage>300</fpage>
          <lpage>306</lpage>
        </citation>
      </ref>
      <ref id="R44">
        <label>44</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Wing</surname>
              <given-names>K</given-names>
            </name>
            <name>
              <surname>Bhaskaran</surname>
              <given-names>K</given-names>
            </name>
            <name>
              <surname>Pealing</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>Root</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Smeeth</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>van Staa</surname>
              <given-names>TP</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Quantification of the risk of liver injury associated with flucloxacillin: a UK population-based cohort study</article-title>
          <source>J Antimicrob Chemoth</source>
          <year>2017</year>
          <volume>72</volume>
          <fpage>2636</fpage>
          <lpage>2646</lpage>
        </citation>
      </ref>
      <ref id="R45">
        <label>45</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Wu</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Meng</surname>
              <given-names>ZJ</given-names>
            </name>
            <name>
              <surname>Jiang</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Zhang</surname>
              <given-names>EJ</given-names>
            </name>
            <name>
              <surname>Trippler</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Broering</surname>
              <given-names>R</given-names>
            </name>
            <etal />
          </person-group>
          <article-title>Toll-like receptor-induced innate immune responses in non-parenchymal liver cells are cell type-specific</article-title>
          <source>Immunology</source>
          <year>2010</year>
          <volume>129</volume>
          <fpage>363</fpage>
          <lpage>374</lpage>
        </citation>
      </ref>
      <ref id="R46">
        <label>46</label>
        <citation citation-type="journal">
          <person-group>
            <name>
              <surname>Yang</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>Seki</surname>
              <given-names>E</given-names>
            </name>
          </person-group>
          <article-title>Toll-like receptors in liver fibrosis: cellular crosstalk and mechanisms</article-title>
          <source>Front Physiol</source>
          <year>2012</year>
          <volume>3</volume>
          <fpage>138</fpage>
        </citation>
      </ref>
    </ref-list>
  </back>
  <floats-wrap>
    <fig id="F1" position="float">
      <label>Figure 1</label>
      <caption><title>Liver injury induced by co-treatment of CpG-ODN and FLUX is suppressed by KCs inhibition.</title><p>Mice (WT or GdCl<sub>3</sub>-treated) (Charles River Laboratories) were treated with FLUX (100 mg&#x2F;kg, gavage) and CpG-ODN (40 &#x3BC;g&#x2F;mouse, i.p.). a. Plasma ALT levels were measured 24 h after FLUX administration (n &#x3D; 4). Data represent the mean &#xB1; SEM. <italic>ns</italic>, not significant. &#x2A;<italic>p</italic> &#x3C; 0.05 and &#x2A;&#x2A;<italic>p </italic>&#x3C; 0.01; two-way ANOVA. Liver sections from the mice were subjected to H&#x26;E staining (b) and TUNEL staining (c). In H&#x26;E staining images, arrows indicate apoptotic cells. In TUNEL staining images, green and blue represent TUNEL-positive cells and cell nuclei, respectively. Both images show representative results from three mice per group. Numbers of TUNEL-positive cells (d) were counted in 9 fields and calculated by per mm<sup>2</sup> (n &#x3D; 3). Data represent the mean &#xB1; SEM. &#x2A;<italic>p</italic> &#x3C; 0.05.</p></caption>
      <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="EXCLI-19-387-g-001" />
    </fig>
    <fig id="F2" position="float">
      <label>Figure 2</label>
      <caption><title>KCs produce pro-inflammatory cytokines and activate Fas&#x2F;FasL-mediated apoptosis.</title><p>CpG-ODN (40 &#x3BC;g&#x2F;mouse, i.p.) was administered to WT or GdCl<sub>3</sub>-treated mice (Charles River Laboratories). Five hours later, the liver homogenate was analyzed for the relative mRNA expression of TNF-&#x3B1; (a), IL-6 (b), Fas (c), and FasL (d). n &#x3D; 3. Data represent the mean &#xB1; SEM. <italic>ns</italic>, not significant. &#x2A;<italic>p</italic> &#x3C; 0.05, &#x2A;&#x2A;<italic>p </italic>&#x3C; 0.01, and &#x2A;&#x2A;&#x2A;<italic>p </italic>&#x3C; 0.001; two-way ANOVA</p></caption>
      <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="EXCLI-19-387-g-002" />
    </fig>
    <fig id="F3" position="float">
      <label>Figure 3</label>
      <caption><title>KCs are involved in CpG-ODN sensitization to FLUX-induced mitochondrial swelling.</title><p>a. Mitochondrial swelling curve. Liver mitochondria from WT mice were exposed to 200, 500, and 1000 &#x3BC;M FLUX with 12.5 &#x3BC;M Ca<sup>2&#x2B;</sup>. Mitochondrial swelling was determined by the decrease in absorbance at 540 nm. Data represent the mean &#xB1; SEM (n &#x3D; 3). b. Liver mitochondria were isolated from WT and GdCl<sub>3</sub>-treated mice (Charles River Laboratories) 5 h after treatment of mice with CpG-ODN (40 &#x3BC;g&#x2F;mouse, i.p.) or vehicle. Mitochondrial swelling was determined by the decrease in absorbance at 540 nm. The absorbance 1,200 s after exposure to 200 &#x3BC;M FLUX with 12.5 &#x3BC;M Ca<sup>2&#x2B; </sup>is shown. Data represent the mean &#xB1; SEM (n &#x3D; 3). <italic>ns</italic>, not significant. &#x2A;<italic>p </italic>&#x3C; 0.05; two-way ANOVA</p></caption>
      <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="EXCLI-19-387-g-003" />
    </fig>
    <fig id="F4" position="float">
      <label>Figure 4</label>
      <caption><title>The expression of pro-inflammatory cytokines and Fas is increased by CpG-ODN in both WT and <italic>gld&#x2F;gld</italic> mice.</title><p>WT and <italic>gld&#x2F;gld</italic> mice (Japan SLC) were treated with or without CpG-ODN (40 &#x3BC;g&#x2F;mouse, i.p.). Five hours later, the liver homogenate was analyzed for the relative mRNA expression of TNF-&#x3B1; (a), IL-6 (b), and Fas (c). n &#x3D; 3. Data represent the mean &#xB1; SEM. <italic>ns</italic> not significant. &#x2A;<italic>p</italic> &#x3C; 0.05, &#x2A;&#x2A;<italic>p </italic>&#x3C; 0.01, and &#x2A;&#x2A;&#x2A;<italic>p </italic>&#x3C; 0.001; two-way ANOVA</p></caption>
      <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="EXCLI-19-387-g-004" />
    </fig>
    <fig id="F5" position="float">
      <label>Figure 5</label>
      <caption><title>Fas&#x2F;FasL-mediated apoptosis is critical for CpG-ODN sensitization to FLUX-induced mitochondrial swelling.</title><p>Mitochondria from WT and <italic>gld&#x2F;gld</italic> mice (Japan SLC, Inc.) were isolated 5 hours after CpG-ODN treatment (40 &#x3BC;g&#x2F;mouse, i.p.), and then exposed to 200 &#x3BC;M FLUX with 25 &#x3BC;M Ca<sup>2&#x2B;</sup>. Mitochondrial swelling was determined by the decrease in absorbance at 540 nm. a. Mitochondrial swelling curve. Data represent the mean &#xB1; SEM (n &#x3D; 3). b. Mitochondrial swelling at 384 s. Data represent the mean &#xB1; SEM (n &#x3D; 3).<italic> ns</italic>, not significant. &#x2A;<italic>p</italic> &#x3C; 0.05; two-way ANOVA</p></caption>
      <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="EXCLI-19-387-g-005" />
    </fig>
  </floats-wrap>
</article>