Felkin, L. | bioRxiv Science

bioRxiv2019

Redefining Interleukin 11 as a regeneration-limiting hepatotoxin

Acetaminophen (APAP) overdose is a leading cause of untreatable liver failure. In the mouse model of APAP-induced liver injury (AILI), the administration of recombinant human interleukin 11 (rhIL11) is protective. Here we show that the beneficial effect of rhIL11 in the mouse is due to its unexpected and paradoxical inhibition of endogenous mouse IL11 activity. Contrary to the accepted paradigm IL11 is a potent hepatotoxin across species, which is secreted from damaged hepatocytes to drive an autocrine loop of NOX4 and JNK-dependent apoptosis. Mice with hepatocyte-specific Il11 expression spontaneously develop liver failure whereas those with Il11ra1 deletion are remarkably protected from AILI. Neutralizing anti-IL11R antibodies administered to moribund mice 10 hours following a lethal APAP overdose results in 90% survival that is associated with very large liver regeneration. Our data overturn a misconception, identify a new disease mechanism and suggest IL11 as a therapeutic target for liver regeneration.

physiology↗

bioRxiv2018

Quantitative approaches to variant classification increase the yield and precision of genetic testing in Mendelian diseases: The case of hypertrophic cardiomyopathy

BackgroundInternational guidelines for variant interpretation in Mendelian disease set stringent criteria to report a variant as (likely) pathogenic, prioritising control of false positive rate over test sensitivity and diagnostic yield. Genetic testing is also more likely informative in individuals with well-characterised variants from extensively studied European-ancestry populations. Inherited cardiomyopathies are relatively common Mendelian diseases that allow empirical calibration and assessment of this framework.\n\nResultsWe compared rare variants in large hypertrophic cardiomyopathy (HCM) cohorts to reference populations to identify variant classes with high prior likelihoods of pathogenicity, as defined by etiological fraction (EF). Analysis of variant distribution identified regions in which variants are significantly enriched in cases and variant location was a better discriminator of pathogenicity than generic computational functional prediction algorithms. Non-truncating variant classes with an EF[≥]0.95, and therefore clinically actionable, were identified in 5 established HCM genes. Applying this approach leads to an estimated 14-20% increase in cases with actionable HCM variants.\n\nConclusionsWhen found in a patient confirmed to have disease, novel variants in some genes and regions are empirically shown to have a sufficiently high probability of pathogenicity to support a \"likely pathogenic\" classification, even without additional segregation or functional data. This could increase the yield of high confidence actionable variants, consistent with the framework and recommendations of current guidelines. The techniques outlined offer a consistent, unbiased and equitable approach to variant interpretation for Mendelian disease genetic testing. We propose adaptations to ACMG/AMP guidelines to incorporate such evidence in a quantitative and transparent manner.

genetics↗