Liver cirrhosis is a life-threatening consequence of liver fibrosis. The aim of this study was to investigate the antifibrotic potential of clinically available vitamin D analogs compared to that of calcitriol in vitro and in vivo. Murine hepatic stellate cells, Kupffer cells, and human LX-2 cells were treated with vitamin D analogs, and the profibrotic behavior of these cells was studied. In vivo liver fibrosis was induced using CCl4 until measurable fibrosis was established. Animals were then treated with calcitriol and paricalcitol. Vitamin D and its analogs showed antifibrotic effects in vitro. Treatment with active vitamin D (calcitriol, CAL) and its analogs reduced the protein expression of α-smooth muscle actin (α-SMA) in mHSC. In human LX-2 cells alfacalcidol reduced transforming growth factor-β (TGF-β) induced platelet-derived growth factor receptor-β protein expression and contractility while paricalcitol (PCT), in its equipotent dose to CAL, reduced TGF-β induced α-SMA protein expression, and ACTA2 and TGF-β mRNA expression. No effects of a treatment with vitamin D and its analogs were observed in Kupffer cells. In vivo, PCT-treated mice had significantly lower calcium levels than CAL-treated mice. CAL and PCT reduced the hepatic infiltration of CD11b-positive cells and alanine transaminase levels, while PCT but not CAL significantly inhibited fibrosis progression, with a favorable side effect profile in the CCl4 model. We conclude that hypocalcemic vitamin D analogs should be considered in future studies investigating vitamin D for the treatment of liver fibrosis.
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This work was supported by grants from the Friedrich-Baur-Stiftung and the Förderprogramm für Forschung und Lehre (FöFoLe) of the Ludwig-Maximilians University Munich. We thank Sebastian Reiter for his support in the illustration of the figures.
Conflict of interest
Michael Trauner and Gerald Denk would like to make the following disclosures: Michael Trauner received a research grant from Intercept, Albireo, Falk, MSD, Takeda, and Gilead; in addition, he holds a patent for the medical use of Nor-UDCA. Gerald Denk received advisory board and lecture fees and travel support from AbbVie, Falk, Gilead, GMP Orphan, Intercept and Novartis. The other authors declare that they have no conflict of interest.
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Reiter, F.P., Ye, L., Bösch, F. et al. Antifibrotic effects of hypocalcemic vitamin D analogs in murine and human hepatic stellate cells and in the CCl4 mouse model. Lab Invest 99, 1906–1917 (2019). https://doi.org/10.1038/s41374-019-0310-1