# Mechanisms of Liver Regeneration After Acetaminophen-Induced Acute Liver Failure

> **NIH NIH R01** · UNIVERSITY OF KANSAS MEDICAL CENTER · 2021 · $344,250

## Abstract

Project Summary
Overdose of acetaminophen (APAP), the popular analgesic and antipyretic agent, is the most common cause
of acute liver failure (ALF) in the Western world. Treatment options for APAP-induced ALF are extremely
limited. Most ALF patients are treated with N-acetyl cystein, a precursor of glutathione, which works only if
delivered within hours after APAP overdose. The only other therapy is liver transplantation, which is
complicated by scarcity of donor organs, life long immunosuppressant use and exorbitant cost. There is a
critical need to develop novel therapies for APAP-induced ALF. Recent studies using animal models and
patient samples have demonstrated that timely stimulation of innate liver regeneration is associated with better
outcomes including transplant free survival in APAP-induced ALF. These studies indicate that without proper
liver regeneration, APAP-induced acute liver injury can develop into ALF and result in death. These studies
underscore the therapeutic potential of liver regeneration following APAP-induced ALF. However, the
mechanisms of liver regeneration after APAP overdose are not completely known. In the previous cycle of this
grant, we investigated the role of canonical Wnt--catenin signaling in liver regeneration after APAP overdose.
Interestingly, our preliminary studies have uncovered a novel and paradoxical role for Hippo Kinase pathway
and its downstream regulator yes associated protein (Yap) in pathogenesis of APAP-induced ALF. Our studies,
performed using hepatocyte specific Yap knockout (Yap-KO) mice, indicate that Yap activation after APAP
overdose is associated with delayed regeneration after APAP overdose. Deletion of Yap resulted in enhanced
liver regeneration leading to faster recovery after APAP overdose. Mechanistically, deletion of Yap in
hepatocytes resulted in faster activation of -catenin, which stimulated the faster liver regeneration after APAP
administration. Furthermore, we observed a faster and augmented pro-regenerative inflammatory response
driven by higher expression of serum amyloid A and CXCL1, both -catenin targets in hepatocytes, in the Yap-
KO mice. Finally, our preliminary studies indicate that Yap and its target gene connective tissue growth factor
(CTGF) could be used as prognostic markers in APAP-induced ALF. These studies will explore an
unconventional and novel role of Yap in drug induced acute liver failure and subsequent liver regeneration.
Successful completion of these studies will have substantial impact on clinical management of APAP overdose
because they will identify Yap as a new target for regenerative therapies for APAP-induced ALF patients.

## Key facts

- **NIH application ID:** 10077553
- **Project number:** 5R01DK098414-07
- **Recipient organization:** UNIVERSITY OF KANSAS MEDICAL CENTER
- **Principal Investigator:** Udayan Apte
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $344,250
- **Award type:** 5
- **Project period:** 2013-04-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10077553

## Citation

> US National Institutes of Health, RePORTER application 10077553, Mechanisms of Liver Regeneration After Acetaminophen-Induced Acute Liver Failure (5R01DK098414-07). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10077553. Licensed CC0.

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