Estrogen Receptor 1 Signaling in Hepatic Stellate Cells Designates Resistance to Liver Fibrosis

Abstract The prevalence and severity of liver fibrosis appear higher in men than in premenopausal women, while postmenopausal women exhibit the worsened disease. However, the pathophysiological mechanism underlying such clinical observations remains incompletely understood. Here, we show that sex hormone depletion in adult female mice exaggerates the model of liver fibrosis, while estradiol replacement in castrated male mice is sufficient to mitigate the disease severity. Transcriptomic analyses and immunohistochemistry then demonstrate that both human and mouse hepatic stellate cells (HSCs), the primary cell type responsible for extracellular fibrous depositions, predominantly express the estrogen receptor 1 (ESR1). Of importance, genetic deletion of ESR1 in mouse HSCs markedly promotes liver fibrosis. Moreover, chromatin immunoprecipitation followed by sequencing (ChIP-seq) and in vitro manipulations reveal that ESR1 can directly target the expression of fibrosis-related genes in HSCs. Together, this study has elucidated a critical aspect of ESR1 signaling in the sexual dimorphism of liver fibrosis.