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Unique molecular characteristics of NAFLD-associated liver cancer accentuate ß-catenin/TNFRSF19-mediated immune evasion

Wong, Alissa Michelle; Ding, Xiaofan; Wong, Aikha Melissa; Xu, Mingjing; Zhang, Luyao; Leung, Howard Ho-Wai; Chan, Anthony Wing-Hung; Song, Qi Xiu; Kwong, Joseph; Chan, Loucia Kit-Ying; Man, Matthew; He, Mian; Chen, Jinna; Zhang, Zhe; You, Wenxing; Lau, Coleen; Yu, Allen; Wei, Yingying; Yuan, Yunfei; Lai, Paul Bo-San; Zhao, Jingmin; Man, Kwan; Yu, Jun; Kahn, Michael; Wong, Nathalie

Unique molecular characteristics of NAFLD-associated liver cancer accentuate ß-catenin/TNFRSF19-mediated immune evasion Thumbnail


Alissa Michelle Wong

Xiaofan Ding

Aikha Melissa Wong

Mingjing Xu

Luyao Zhang

Howard Ho-Wai Leung

Anthony Wing-Hung Chan

Qi Xiu Song

Loucia Kit-Ying Chan

Matthew Man

Mian He

Jinna Chen

Zhe Zhang

Wenxing You

Coleen Lau

Allen Yu

Yingying Wei

Yunfei Yuan

Paul Bo-San Lai

Jingmin Zhao

Kwan Man

Jun Yu

Michael Kahn

Nathalie Wong


Background & Aims
Metabolic syndrome can lead to the clinical manifestation of non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) as part of the natural history of NAFLD. Despite a strong causative link, NAFLD-HCC is often underrepresented in systematic genome explorations.
Here, tumor-normal pairs from 100 subjects diagnosed with NAFLD-HCC were subject to next generation sequencings. Bioinformatic analyses were performed to identify key genomic, epigenomic and transcriptomic events associated with the pathogenesis of NAFLD to NAFLD-HCC. Establishment of primary patient-derived NAFLD-HCC culture was used as a representative human model for downstream in vitro investigations of underlying CTNNB1 S45P driver mutation. Syngeneic immunocompetent mouse model was used to further test the involvement of CTNNB1mut and TNFRSF19 in reshaping the tumor microenvironment.
Mutational process operative in NAFLD-liver inferred susceptibility to tumor formation through defective DNA repair pathways. Dense promoter mutations and dysregulated transcription factors accentuated activated transcriptional regulation in NAFLD-HCC, in particular the enrichment of MAZ-MYC activities. Somatic events common in HCCs arising from NAFLD and viral hepatitis B infection underscore similar driver pathways, although an incidence shift highlights CTNNB1mut dominance in NAFLD-HCC (33%). Immune exclusion correlated evidently with CTNNB1mut. ChIP-seq integrated with transcriptome and immune profiling showed for the first time a transcriptional axis of CTNNB1mut/TNFRSF19/repressed senescence-associated secretory phenotype-like (SASP-like) cytokines (including IL6 and CXCL8). This phenomenon could be reverted by Wnt-modulator ICG001.
The unique mutational processes in NAFLD-liver and NAFLD-HCC alludes to a “field effect”. Whereby, distinct aberrations and shift in driver events reveal a gain-of-function role of CTNNB1 mutations in immune exclusion via TNFRSF19 inhibition of SASP-like features.
The increasing prevalence of metabolic syndrome in adult populations poised NAFLD-induced HCC to be the major type of liver cancer of the 21st century. We showed a strong “field effect” in NAFLD-liver from mutational signatures detected and a mechanistic path of activated ß-catenin in reshaping the tumor-immune microenvironment.


Wong, A. M., Ding, X., Wong, A. M., Xu, M., Zhang, L., Leung, H. H., …Wong, N. (2022). Unique molecular characteristics of NAFLD-associated liver cancer accentuate ß-catenin/TNFRSF19-mediated immune evasion. Journal of Hepatology, 77(2), 410-423.

Journal Article Type Article
Acceptance Date Mar 1, 2022
Online Publication Date Mar 26, 2022
Publication Date 2022-08
Journal Journal of Hepatology
Print ISSN 0168-8278
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 77
Issue 2
Pages 410-423
Publisher URL