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Rajeeth, K.* ; Roessing, M.* ; Lehners, M.* ; Dietz, L.* ; Schmitt, A.* ; Hailfinger, S.* ; Peter, A. ; Quintanilla-Martinez, L.* ; Gonzalez-Menendez, I.* ; Mederacke, I.* ; Ott, G.* ; Sandner, P.* ; Schwab, M.* ; Feil, R.* ; Feil, S.*

Pharmacological activation of NO-cGMP signalling attenuates metabolic dysfunction-associated steatohepatitis.

Br. J. Pharmacol., DOI: 10.1111/bph.70523 (2026)
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Background and Purpose: Metabolic dysfunction-associated steatohepatitis (MASH) is linked to activation of hepatic stellate cells (HSCs) to α-smooth muscle actin–positive myofibroblasts that produce collagen and proinflammatory cytokines. Quiescent HSCs express the NO-cGMP signalling axis. Modulating this pathway could alter HSC activation and fibrosis during MASH progression. Experimental Approach: Using transgenic cGMP sensor mice, we monitored NO-induced cGMP in living HSCs. The relevance of this pathway was analyzed using HSC-specific mouse models, ApoE-deficient mice on high-fat diet as a MASH model, human liver sections, and published scRNA-seq datasets. For pharmacological activation of NO-cGMP signalling, BAY-543, an activator of NO-sensitive guanylyl cyclase (NO-GC) was used. Key Results: HSCs in primary culture and liver tissue generated NO-induced cGMP and expressed NO-GC and cGMP-dependent protein kinase type I (cGKI). Compared to controls, HSC-specific cGKI knockout livers showed enhanced myofibroblast marker expression, indicating increased HSC activation and MASH susceptibility. MASH mice developed steatosis, fibrosis, and inflammation, and showed a high number of HSCs expressing NO-GC and cGKI. cGKI expression was also increased in human fibrotic livers as compared to healthy tissue. In MASH livers, oxidative stress could lead to reduced sensitivity of NO-GC to NO. Treatment of MASH mice with BAY-543, which targets oxidized/NO-insensitive NO-GC, significantly attenuated HSC activation, inflammation, collagen deposition, macro-steatosis, fibrosis, and serum liver enzymes. Conclusion and Implications: The NO-cGMP-cGKI axis serves as both a functional pathway marker and regulator of HSCs. Pharmacological elevation of cGMP with an NO-GC activator represents a promising therapeutic strategy for MASH.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Cgmp Signalling ; Fret Imaging ; Gucy ; Hepatic Stellate Cells ; Liver Fibrosis ; Mash ; No-gc Activator ; Prkg1; Dependent Protein-kinase; Soluble Guanylate-cyclase; Hepatic Stellate Cells; Nitric-oxide; Concise Guide; Portal-hypertension; Mice; Mechanisms; Cirrhosis; Adhesion
ISSN (print) / ISBN 0007-1188
e-ISSN 1476-5381
Publisher Wiley
Publishing Place 111 River St, Hoboken 07030-5774, Nj Usa
Reviewing status Peer reviewed
Grants Reinhard Frank Stiftung
Robert Bosch Stiftung
Dr. K.H. Eberle Stiftung
Horizon 2020 Framework Programme
EU Framework Program for Research and Innovation "Horizon 2020"-ERA-CVD JTC2017-044
Deutsche Forschungsgemeinschaft