Available online at www.sciencedirect.com Current Opinion in ScienceDirect Toxicology Polychlorinated biphenyls and nonalcoholic fatty liver disease Banrida Wahlang1,2,3,9, Josiah E. Hardesty1,9, Jian Jin3, K. Cameron Falkner1 and Matthew C. Cave1,2,3,4,5,6,7,8 Abstract Introduction Polychlorinated biphenyls (PCBs) have been associated with Polychlorinated biphenyls (PCBs) have been associated abnormal liver enzymes and suspected nonalcoholic fatty liver with liver injury since 1937, when three cases of fatal disease (NAFLD) in cohort studies. NAFLD affects greater jaundice were reported in workers exposed to PCBs and than 25% of the global population and may result in liver- chlorinated naphthalenes [1]. In 1981, dose-dependent related mortality. Both dioxin-like and nondioxin-like PCBs liver enzyme elevation and hepatomegaly was reported have been associated with NAFLD, but their effects and in PCB-exposed electrical workers [2]. In the United mechanisms differ. Dioxin-like PCBs altered the gut–liver axis States, PCBs were manufactured by Monsanto under and microbiome and caused hepatic steatosis by disrupting trade names including AroclorÒ for industrial applica- hepatic lipid metabolism. In contrast, nondioxin-like PCBs tions including dielectric and hydraulic fluids. reduced the liver’s protective responses to promote diet- Monsanto’s material safety data sheet (MSDS induced NAFLD. Mechanisms included the disruption of #M00018515) reported that “The consistent finding in phosphoprotein signaling resulting in altered nuclear receptor animal studies is that PCBs produce liver injury function. following prolonged and repeated exposure by any route, if the exposure is of sufficient degree and duration. Addresses 1 Department of Medicine, Division of Gastroenterology, Hepatology Liver injury is produced first, and by exposures that are and Nutrition, University of Louisville School of Medicine, Louisville, KY less than those reported to cause cancer in rodents. 40202, USA Therefore, exposure by all routes should be kept suffi- 2 University of Louisville Superfund Research Center, University of ciently low to prevent liver injury.” Despite their his- Louisville, Louisville, KY 40202, USA 3 Department of Pharmacology and Toxicology, University of Louisville torical role in occupational hepatotoxicity, PCBs were School of Medicine, Louisville, KY 40202, USA only recently associated with an environmental liver 4 Department of Biochemistry and Molecular Genetics, University of disease consistent with nonalcoholic fatty liver disease Louisville School of Medicine, Louisville, KY 40202, USA (NAFLD) [3,4]. Indeed, PCBs were among the most 5 Hepatobiology & Toxicology COBRE Center, University of Louisville potent chemicals associated with hepatic steatosis in School of Medicine, Louisville, KY 40202, USA 6 University of Louisville Alcohol Research Center, University of archived rodent toxicologic pathology studies [5]. Louisville, Louisville, KY, 40202, USA 7 The Robley Rex Veterans Affairs Medical Center, Louisville, KY Structurally, PCBs are a thermodynamically stable 40206, USA chlorine-substituted biphenyl ring. Approximately 130 of 8 The Jewish Hospital Liver Transplant Program, Louisville, KY 40202, 209 theoretical PCB congeners were commercially pro- USA duced before PCBs were banned. PCBs are persistent Corresponding author: Cave, Matthew C ([email protected]) organic pollutants which continue to contaminate the 9 Indicates joint first authorship. environment, the food supply, breast milk, and even the air in homes and schools. PCBs ranked #5 on the Agency for Toxic Substances and Disease Registry’s 2017 Sub- Current Opinion in Toxicology 2019, 14:21–28 stance Priority List. All analyzed adult participants in the This review comes from a themed issue on Mechanistic Toxicology National Health and Nutrition Examination Survey Edited by Martin Van Den Berg and Stephen Safe (NHANES) 2003e2004 had detectable PCB levels in Available online 4 July 2019 blood [6]. PCB congeners have been classified as either For a complete overview see the Issue and the Editorial dioxin-like (DL) or nondioxin-like (NDL) based on their https://doi.org/10.1016/j.cotox.2019.06.001 ability to activate the aryl hydrocarbon receptor (AhR) [7].BothPCBtypeswereassociatedwithsuspected 2468-2020/© 2019 Published by Elsevier B.V. NAFLD in a cohort study [3]. PCBs concentrate in adi- pose and liver. The more highly chlorinated congeners are Keywords more resistant to environmental degradation and hepatic PCBs, Aroclor, Toxicant associated steatohepatitis, Metabolism metabolism resulting in their bioaccumulation. PCBs disrupting chemicals, Signaling disrupting chemicals. undergo enterohepatic circulation, so it is not surprising www.sciencedirect.com Current Opinion in Toxicology 2019, 14:21–28 22 Mechanistic Toxicology Abbreviations IL6R interleukin 6 receptor IR insulin resistance ACHS Anniston Community Health Survey LXRa/b liver X receptor a/b AhR aryl hyodrocarbon receptor MCD methionine-choline deficient AKT protein kinase B MDCs metabolism disrupting chemicals ALT alanine aminotransferase mTOR mammalian target of rapamycin AMPK AMP-activated protein kinase MSDS material safety data sheet AOP adverse outcome pathway LEPR leptin receptor ApoB-100 apolipoprotein B-100 NAFLD nonalcoholic fatty liver disease CAR constitutive androstane receptor NASH nonalcoholic steatohepatitis CK2 casein kinase 2 NDL non-dioxin-like CK18 cytokeratin 18 NHANESNational Health and Examination Survey CREB-1 cyclic AMP responsive element binding protein 1 NRF2 nuclear factor erythroid 2-related factor Cyp7a1 cytochrome P450 family 7 subfamily A member 1 PAI-1 plasminogen activator inhibitor-1 DL dioxin-like PCBs polychlorinated biphenyls EDCs endocrine disrupting chemicals PEPCK phosphoenolpyruvate carboxykinase EGF epidermal grow factor PKA protein kinase A EGFR epidermal growth factor receptor PNPLA3 patatin-like phospholipase domain-containing protein 3 EPA Environmental Protection Agency PPARa/d/g peroxisome proliferator-activated receptor a/d/g ERK extracellular-regulated protein kinase PXR pregnane X receptor ESR1 estrogen receptor 1 or a RXR retinoid X receptor FXR farnesoid x receptor SDCs signaling disrupting chemicals FGF-15 fibroblast growth factor-15 STAT3 signal transducer and activator of transcription 3 FGF-21 fibroblast growth factor-21 TAFLD toxicant associated fatty liver disease GLP-1 glucagon-like peptide-1 TASH toxicant associated steatohepatitis GCG glucagon 1,4-Bis-[2-(3,5-dichloropyridyloxy)]benzene 3,30,5,50-Tetrachloro- GCGR glucagon receptor 1,4-bis(pyridyloxy) GSH glutathione benzene, TCPOBOP HFD high fat diet TGF-b transforming growth factor b HNF4a hepatocyte nuclear factor 4-alpha TRa thyroid hormone receptor a INSR insulin receptor IL6 interleukin 6 that they may affect bile acids, the microbiome, and fecal as increased dietary sugar or fat [15]. NDL PCBs metabolites [8e12]. including PCB 153 and the Aroclor 1260 PCB mixture worsened diet-induced NAFLD but did not cause Global NAFLD prevalence exceeds 25%, and NAFLD NAFLD in mice fed with a normal diet [5,17,18,23e27]. may result in liver-related morality or transplantation In contrast, DL PCB 126 not only caused NAFLD in [13]. NAFLD represents a pathologic spectrum ranging rodents fed with normal diet but also worsened diet- from steatosis to steatohepatitis (NASH) with or induced NAFLD [5,8,9,11,18e20,28e30]. Signaling without fibrosis, cirrhosis, and hepatocellular carcinoma disrupting chemicals alter intracellular signaling regu- [14]. A two ‘hit’ hypothesis has been proposed to explain lating normal hepatic metabolism, cell survival, inflam- why only some subjects with NAFLD develop progres- mation, and fibrosis. PCBs inhibited epidermal growth sive liver disease. Classically described second ‘hits’ factor receptor (EGFR) signal transduction to alter include insulin resistance (IR), oxidative stress, proin- downstream protein kinase and transcription factor flammatory cytokines, organelle dysfunction, as well as phosphorylation and function in NAFLD models alterations in organokines and the intestinal micro- [16,17,21e23]. biome. NAFLD is often considered the hepatic mani- festation of metabolic syndrome. Thus, it is hardly The terms toxicant-associated fatty liver disease surprising that PCBs, which are endocrine, metabolism, (TAFLD) and toxicant-associated steatohepatitis and signaling disrupting chemicals have been associated (TASH) were coined to describe the fatty liver disease with NAFLD [15e17]. Recently, PCBs were shown to associated with industrial chemical exposures [14]. alter organokines previously implicated in NAFLD Here, TAFLD will be used interchangeably with pathogenesis including fibroblast growth factor-21 NAFLD. The U.S. Environmental Protection Agency (FGF-21), FGF-15, glucagon peptide 1, leptin, and (EPA)’s hepatic steatosis adverse outcome pathway adiponectin [4,8,10,17e22]. Metabolism disrupting (AOP) proposed disruption of crosstalking xenobiotic chemicals are defined as chemicals that promote obesity, receptors to be the molecular initiating event for envi- diabetes, fatty liver, and/or alterations in lipid and ronmental chemicals in TAFLD [31]. Indeed, nuclear glucose metabolism but may require a second ‘hit’ such receptor dysregulation is a hallmark of NAFLD, and Current Opinion in Toxicology 2019, 14:21–28 www.sciencedirect.com Polychlorinated biphenyls and nonalcoholic fatty liver disease Wahlang et al. 23 several nuclear receptor agonists are currently in phase alanine