George K. Michalopoulos | |
---|---|
Occupation(s) | Pathologist and academic |
Academic background | |
Education | MD PhD., Oncology |
Alma mater | University of Athens University of Wisconsin |
Academic work | |
Institutions | University of Pittsburgh |
George K. Michalopoulos is a Greek-American pathologist and academic. He served as Maud L. Menten Professor of Experimental Pathology and Chair of the Department of Pathology at the University of Pittsburgh and UPMC from 1991 to 2023. [1]
Michalopoulos is most known for his research in the molecular processes associated with liver regeneration,with a specific focus on the significance of hepatocyte growth factor (HGF) and its receptor (MET),as well as the role of the extracellular matrix. [2] He is the recipient of the American Society for Investigative Pathology Rous Whipple Award in 2009, [3] the 2010 American Liver Foundation Distinguished Scientist Award, [4] and was named as Distinguished Professor by the University of Pittsburgh in 2012. [5]
Michalopoulos is a Fellow of the American Association for the Advancement of Science and the American Association for the Study of Liver Diseases,and an elected member of the Association of American Physicians [6] and the Greek National Academy. [7]
Michalopoulos earned an M.D. at the University of Athens in 1969 and a Ph.D. in Oncology at the University of Wisconsin-Madison School of Medicine and Public Health,where he also completed his residency in anatomic pathology in 1977. [1]
Michalopoulos began his academic career as an Assistant Professor of Pathology at Duke University Medical Center in 1977,and was later appointed to Associate Professor in 1983 and Professor in 1987. He served as Professor and Chairman of the Department of Pathology at the University of Pittsburgh and UPMC from 1991 to 2023,and he remained as Professor of Pathology after he stepped down as Chair of Pathology. [5] He also served as Interim Dean of the School of Medicine from 1995 to 1998.
In 2008,Michalopoulos was appointed Chair of the Board of Scientific Counselors for the National Institute on Alcohol Abuse and Alcoholism at the NIH, [8] and then served as the President of the American Association for Investigative Pathology from 2016 to 2017. [9]
Michalopoulos has contributed to the field of pathology through his work on liver function,regeneration,and carcinogenesis. He has utilized various experimental models,such as hepatocyte cultures,hepatic organoids,established cell lines,studies on liver regeneration after partial hepatectomy,examinations of regeneration through progenitor cell pathways,investigations into liver enlargement induced by chemical mitogens (known as augmentative hepatomegaly),and analyses of liver carcinogenesis using rodent models,along with genomic analysis of human liver cancer. [2]
Michalopoulos has researched Hepatocyte Growth Factor (HGF) and its receptor HGFR,also known as MET,and their significance for liver regeneration. He used hepatocyte cultures as bioassays and discovered and identified HGF as a circulating mitogen in peripheral blood. [10] He also found that HGF functions as the ligand for the c-MET receptor,with HGF stimulating phosphorylation and kinase activity of the p190c-met protein,documenting the functional interaction between the two. [11] In addition,he observed an early rise in plasma HGF after partial hepatectomy,derived from release of HGF from hepatic extracellular matrix mediated by urokinase activation and coinciding with liver regeneration signals. These studies documented the fundamental role of plasma hepatocyte growth factor and norepinephrine in fostering liver regeneration. [12]
Michalopoulos,together with Liu and Zarnegar,also identified and characterized the mouse hepatocyte growth factor (HGF) gene,revealing its homology with other kringle-containing proteins and indicating its likely evolution through gene duplication and exon shuffling,with significant conservation among various vertebrate species. [13]
Michalopoulos studied early signaling pathways triggering liver regeneration. In 1999,he identified EGFR and MET as the sole two mitogenic receptor tyrosine kinases linked to hepatocyte proliferative signals,showing their early activation during the regenerative process and the vital role they play in these regenerative events. [14] Additionally,he highlighted the significance of the alpha-1 adrenergic receptor in amplifying regenerative signals, [15] the near-instant activation of urokinase,which initiates a sequence of matrix remodeling,along with the release and activation of HGF in both liver and peripheral blood. [16] Furthermore,his research revealed the early activation of Notch and Wnt/beta catenin signaling shortly after hepatectomy. [17] The importance of EGFR and MET for control of liver regeneration was demonstrated when combined inhibition of the two receptors resulted in complete arrest of liver regeneration,followed by death of mice. [18]
Michalopoulos investigated mechanisms of termination of liver regeneration. He and his colleagues researched the liver's original liver-to-body weight ratio following the regeneration process,coining the term "hepatostat". [19] He showed that mechanisms governing the termination of liver regeneration,involving integrin-linked kinase (ILK) and pericellular proteins like Glypican 3 (GPC3),are highly complex,and the disruption of these pathways influences the regenerative outcome and final liver weight. The elimination of ILK leads to excessive regeneration,while over-expression of GPC3 results in defective regeneration, [20] as both GPC3 and ILK regulate growth suppressor signaling pathways,which are often disrupted in liver cancer. [21] Additionally,he found that GPC3 exerts its influence by binding to and inhibiting CD81,the entry point for Hepatitis C virus,and interacts with Sonic Hedgehog,a signaling protein that triggers non-parenchymal cell growth. [22] He also determined that the interaction between HCV,GPC3,and CD81 activates the Hippo pathway via Ezrin phosphorylation and diminishes nuclear Yap. [23]
Michalopoulos' contributions in studies of liver regeneration were acknowledged in a bibliometric analysis. [24]
Michalopoulos researched transdifferentiation of hepatocytes and biliary cells in liver repair. In a collaborative study,he demonstrated that the cells with "hepatocyte progenitor" phenotypes which mature into hepatocytes when the proliferation of hepatocytes is impeded during the process of regeneration,originate from the biliary compartment. [25] Subsequently,he showed that the reverse pathway is also present in both humans and rodents,as when the biliary compartment sustains damage,the adjacent periportal hepatocytes trans-differentiate into biliary cells, [26] which is a process influenced by the signaling of the MET and EGFR receptors. [27] In 2018,his research work determined that both of these transdifferentiation processes are active in the human liver during chronic liver disease and acute liver failure. [28]
Michalopoulos and Luo explored genomic alterations and associated signaling pathways in human hepatocellular carcinoma. In a joint study,he investigated genetic changes and associated pathways in liver cancer,analyzing gene copy number variations in 98 cases of hepatocellular carcinoma (HCC). They identified Leucocyte Specific Protein 1 (LSP1) as the most commonly affected gene,impacting the RAF-MEK-ERK signaling pathway and liver regeneration termination,and also highlighted the significance of PTPRD in deactivating STAT3 and Rsu-1 as a Ras signaling suppressor gene with deletions in some HCC cases. [29]
Michalopoulos and colleagues looked into the functional significance of leukocyte-specific protein-1 (LSP1) in liver cancer,showing that loss of LSP1 expression enhances proliferation and migration in hepatoma cells. [30] He also investigated the role of LSP1 in liver regeneration and sensitivity to sorafenib,highlighting that loss of LSP1 function increases sensitivity to sorafenib treatment and promotes hepatocellular proliferation. [31] Furthermore,he examined the role of glypican-3 (GPC3) in hepatocellular carcinomas (HCCs),revealing its association with CD81 and its role in the activation of the Hippo pathway,with implications for HCV infection and hepatic neoplasia promotion. His studies demonstrated that more than 70% of HCC do not express the CD81 protein,thus allowing Yap to increase in HCC. GPC3 itself is regulated by Yap,thus explaining the high rise of GPC3 in HCC in the absence of CD81. [23]
Michalopoulos investigated the role of the Epidermal Growth Factor Receptor (EGFR) in regulation of Metabolism Associated Steatotic Liver Disease (MASLD). Hepatic steatosis,due to alcohol or nutritional imbalance,is associated with deposition of lipids in hepatocytes,and the proportions of affected hepatocytes vary,but uncontrolled increase leads to liver inflammation and potentially to HCC. In a collaborative study with Bhushan,he demonstrated that chemical inhibitors of EGFR already used in human pharmacology eliminate the lipid accumulation in hepatocytes. [32]
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis. HCC is the third leading cause of cancer-related deaths worldwide.
Autoimmune hepatitis,formerly known as lupoid hepatitis,plasma cell hepatitis,or autoimmune chronic active hepatitis,is a chronic,autoimmune disease of the liver that occurs when the body's immune system attacks liver cells,causing the liver to be inflamed. Common initial symptoms may include fatigue,nausea,muscle aches,or weight loss or signs of acute liver inflammation including fever,jaundice,and right upper quadrant abdominal pain. Individuals with autoimmune hepatitis often have no initial symptoms and the disease may be detected by abnormal liver function tests and increased protein levels during routine bloodwork or the observation of an abnormal-looking liver during abdominal surgery.
Primary biliary cholangitis (PBC),previously known as primary biliary cirrhosis,is an autoimmune disease of the liver. It results from a slow,progressive destruction of the small bile ducts of the liver,causing bile and other toxins to build up in the liver,a condition called cholestasis. Further slow damage to the liver tissue can lead to scarring,fibrosis,and eventually cirrhosis.
Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts,which normally allow bile to drain from the gallbladder. Affected individuals may have no symptoms or may experience signs and symptoms of liver disease,such as yellow discoloration of the skin and eyes,itching,and abdominal pain.
Cholestasis is a condition where the flow of bile from the liver to the duodenum is impaired. The two basic distinctions are:
Hepatocyte growth factor receptor is a protein that in humans is encoded by the MET gene. The protein possesses tyrosine kinase activity. The primary single chain precursor protein is post-translationally cleaved to produce the alpha and beta subunits,which are disulfide linked to form the mature receptor.
Hepatocyte growth factor (HGF) or scatter factor (SF) is a paracrine cellular growth,motility and morphogenic factor. It is secreted by mesenchymal cells and targets and acts primarily upon epithelial cells and endothelial cells,but also acts on haemopoietic progenitor cells and T cells. It has been shown to have a major role in embryonic organ development,specifically in myogenesis,in adult organ regeneration,and in wound healing.
Des-gamma carboxyprothrombin (DCP),also known as protein induced by vitamin K absence/antagonist-II (PIVKA-II),is an abnormal form of the coagulation protein,prothrombin. Normally,the prothrombin precursor undergoes post-translational carboxylation by gamma-glutamyl carboxylase in the liver prior to secretion into plasma. DCP/PIVKA-II may be detected in people with deficiency of vitamin K and in those taking warfarin or other medication that inhibits the action of vitamin K.
Glypicans constitute one of the two major families of heparan sulfate proteoglycans,with the other major family being syndecans. Six glypicans have been identified in mammals,and are referred to as GPC1 through GPC6. In Drosophila two glypicans have been identified,and these are referred to as dally and dally-like. One glypican has been identified in C. elegans. Glypicans seem to play a vital role in developmental morphogenesis,and have been suggested as regulators for the Wnt and Hedgehog cell signaling pathways. They have additionally been suggested as regulators for fibroblast growth factor and bone morphogenic protein signaling.
Liver cancer,also known as hepatic cancer,primary hepatic cancer,or primary hepatic malignancy,is cancer that starts in the liver. Liver cancer can be primary in which the cancer starts in the liver,or it can be liver metastasis,or secondary,in which the cancer spreads from elsewhere in the body to the liver. Liver metastasis is the more common of the two liver cancers. Instances of liver cancer are increasing globally.
The canals of Hering,or intrahepatic bile ductules,are part of the outflow system of exocrine bile product from the liver. Liver stem cells are hypothesized to inhabit the canals.
Glypican-3 is a protein that,in humans,is encoded by the GPC3 gene. The GPC3 gene is located on human X chromosome (Xq26) where the most common gene encodes a 70-kDa core protein with 580 amino acids. Three variants have been detected that encode alternatively spliced forms termed Isoforms 1 (NP_001158089),Isoform 3 (NP_001158090) and Isoform 4 (NP_001158091).
The liver is a major metabolic organ only found in vertebrate animals,which performs many essential biological functions such as detoxification of the organism,and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans,it is located in the right upper quadrant of the abdomen,below the diaphragm and mostly shielded by the lower right rib cage. Its other metabolic roles include carbohydrate metabolism,the production of hormones,conversion and storage of nutrients such as glucose and glycogen,and the decomposition of red blood cells.
miR-122 is a miRNA that is conserved among vertebrate species. miR-122 is not present in invertebrates,and no close paralogs of miR-122 have been detected. miR-122 is highly expressed in the liver,where it has been implicated as a regulator of fatty-acid metabolism in mouse studies. Reduced miR-122 levels are associated with hepatocellular carcinoma. miR-122 also plays an important positive role in the regulation of hepatitis C virus replication.
Lenvatinib,sold under the brand name Lenvima among others,is an anti-cancer medication for the treatment of certain kinds of thyroid cancer and for other cancers as well. It was developed by Eisai Co. and acts as a multiple kinase inhibitor against the VEGFR1,VEGFR2 and VEGFR3 kinases.
c-Met inhibitors are a class of small molecules that inhibit the enzymatic activity of the c-Met tyrosine kinase,the receptor of hepatocyte growth factor/scatter factor (HGF/SF). These inhibitors may have therapeutic application in the treatment of various types of cancers.
Randy Jirtle is an American biologist noted for his research in epigenetics,the branch of biology that deals with inherited information that does not reside in the nucleotide sequence of DNA. Jirtle retired from Duke University,Durham,NC in 2012. He is Professor of Epigenetics in the Department of Biological Sciences at North Carolina State University,Raleigh,NC,and Senior Visiting Scientist at the McArdle Laboratory of Cancer Research,University of Wisconsin,Madison,WI. Jirtle is noted for his research on genomic imprinting,and for his use of the Agouti mouse model to investigate the effect of environmental agents on the mammalian epigenome and disease susceptibility.
A liver support system or diachysis is a type of therapeutic device to assist in performing the functions of the liver. Such systems focus either on removing the accumulating toxins,or providing additional replacement of the metabolic functions of the liver through the inclusion of hepatocytes to the device. This system is in trial to help people with acute liver failure (ALF) or acute-on-chronic liver failure.
Liver regeneration is the process by which the liver is able to replace damaged or lost liver tissue. The liver is the only visceral organ with the capacity to regenerate. The liver can regenerate after partial hepatectomy or injury due to hepatotoxic agents such as certain medications,toxins,or chemicals. Only 51% of the original liver mass is required for the organ to regenerate back to full size. The phenomenon of liver regeneration is seen in all vertebrates,from humans to fish. The liver manages to restore any lost mass and adjust its size to that of the organism,while at the same time providing full support for body homeostasis during the entire regenerative process. The process of regeneration in mammals is mainly compensatory growth or hyperplasia because while the lost mass of the liver is replaced,it does not regain its original shape. During compensatory hyperplasia,the remaining liver tissue becomes larger so that the organ can continue to function. In lower species such as fish,the liver can regain both its original size and mass.
Nimer Assy is an Israeli hepatologist and academic focusing on internal medicine and liver transplantation. He is a professor at the Bar-Ilan University Azrieli Medical School and the Department Head of the Clinical Research Unit within Internal Medicine Ward A of the Galilee Medical Center.