The authors would like to acknowledge the financial support of the German Research Foundation (SFB/TRR57, Q3 and Q2).&#160;The authors thank Mareike Schulz, Pascal Paschenda, and Klaudia Warzecha for their help in preparing the photographs.

NOTE: All experiments were approved by the official State animal care and use committee (LANUV, Recklinghausen, Germany). The mice are housed under specific-pathogen-free conditions according to the guidelines of the Federation for Laboratory Animal Science Associations (FELASA). All experiments were conducted in accordance with the German federal law regarding the protection of animals and &#39;Guide for the Care and Use of Laboratory Animals&#39; (National Institutes of Health publication 8th Edition, 2011).
1. Presurgical Preparation
NOTE: Carry out all procedures under clean but non-sterile conditions. All instruments and other reusable equipment such as surgical forceps, scissors, and Colibri retractor that are used to perform surgery must be sterilized prior to use according to protocols that are in strict compliance with the institutional guidelines for performing surgeries in animals. &#160;For a detailed list of necessary reagents, materials and equipment, please refer to the list of Specific Materials/Equipment.
<ol>
	<li>During the complete experimentation, keep the animal on a warming plate at a temperature of 37 &#176;C, permanently connected to an anesthesia system, and the cover the operational area overall with fluid-impermeable, self-adhesive drapes. Properly arrange all instrumentations and solutions that are used during the experimentation prior to surgery (Figure 1).</li>
	<li>Anesthetize the mouse with inhalation of 4 vol% isoflurane in 100% oxygen at a flow rate of 4 L/min for the induction of the anesthesia. The depth of anesthetization is sufficient when the following vital criteria are reached: regular spontaneous breathing, no reflex after setting of pain stimuli between toes, and no response to pain.</li>
	<li>Shave the abdominal fur of the mouse with an electric fur shaver and protect the eyes from drying out by usage of eye and nose ointment.</li>
	<li>Place the mouse on a 37 &#176;C heated hot plate, insert the mouse snout in the Fluovac mask of the Fluovac anesthesia system, and fix the legs of the animal with stripes of silk tape.</li>
	<li>Maintain anesthesia of the mouse by inhalation of 1.5-3 vol% isoflurane in 100% oxygen at a flow rate of 1 L/min and induct perioperative analgesia via intraperitoneal injection of buprenorphine solution (0.1 mg/kg BW dissolved in 0.9% NaCl solution).</li>
	<li>Sterilize the shaved abdominal skin with a gauze swab that is moistened with a standard antiseptic, ready to use alcoholic solution for pre-operative treatment of the skin. &#160;Note: In our protocols we use a poly-alcohol skin antisepticum. This is in full accordance with the German federal law regarding the protection of animals and the guidelines of the Federation for Laboratory Animal Science Associations. This antiseptic contains 70% (v/v) 2-propanol, butan-1,3.diol and traces of quinoline yellow, and perfume.</li>
</ol>
2. Surgical Procedures
<ol>
	<li>Open the abdomen with a midline laparotomy of a length of approximately 2 cm by cutting the cutis plus fascia at the same time with an 11.5 cm surgical scissor.</li>
	<li>Dissect the connective tissue on top of the peritoneum by using the scissor as a spreader.</li>
	<li>Cut the peritoneum along the linea alba to open the peritoneal cavity.</li>
	<li>Enlarge the cavity by inserting a holding suture in the sternum, raising the filament of the suture, and fixing it on top of the Fluovac mask.</li>
	<li>Spread the operation area by inserting a Colibri retractor in the peritoneal cavity (Figure 2).</li>
	<li>Lift the liver with a moisturized (0.9% NaCl solution) cotton swab so that the ventral side of it sticks to the diaphragm and the hilum is clearly visible.</li>
	<li>Expose the bile duct by caudal movement of the gut (Figure 3).</li>
	<li>Separate carefully the bile duct from the flanking portal vein and hepatic artery using a micro-serrations forceps (Figure 4A).</li>
	<li>Place the 5-0 suture around the bile duct and secure it with two surgical knots. When tying the knots increase the tractive force continuously to ensure effective obstruction without severing the bile duct (Figure 4B).</li>
	<li>Add a second cranial ligation in the same manner but do not dissect the bile duct in between (Figure 4C). Otherwise there is a considerable risk that bile leaks if one knot is not secure, and the animals experience no cholestasis but develop severe peritonitis.</li>
	<li>Cut the ends of the sutures (Figure 4D), lower the sternum, and remove the retractor.</li>
	<li>Rinse the peritoneal cavity with 0.9% NaCl solution and replace the abdominal organs to the physiological positions.</li>
	<li>Close both abdominal layers (peritoneum and cutis plus facia) with separate running sutures with 6-0 Mersilk.</li>
	<li>Cut the ends of the sutures and sterilize the operation area with a gauze swab moistened with antiseptic solution. 
	NOTE: When performing the surgery for the first time, perform all procedures under a surgical microscope at a magnification of 16X-20X. This allows better recognition of the bile duct and clearly distinguishes it from the portal vein and hepatic artery (Figures 5 and 6). Some laboratories recommend the dissection of the bile duct in between the two ligatures. Leave the bile duct intact because potential leaks in one of the knots will result in severe acute peritonitis, ascites, and systemic endotoxemia when the bile duct is dissected.</li>
</ol>
3. Postoperative Treatment and Follow-up
<ol>
	<li>Allow the mouse to recover in a cage warmed up by an infrared lamp until the mouse is fully awake and active.</li>
	<li>Afterwards, move the mouse to a normal cage and provide ad libitum access to water and food.</li>
	<li>After the surgery, monitor the animals at regular intervals and carry out follow-up postoperative treatment with suitable analgesia (e.g., buprenorphine solution) following the local recommendation of the internal animal care and use committees. 
	NOTE: Perform analgesic therapy for 3 days. Any abnormal behavior may indicate rare complications such as peritonitis, sepsis or internal bleeding and should be handled as human endpoint to terminate the experiment.</li>
	<li>Animals are kept with free access to food and water ad libitum until the end of the experiment. There is no need for blood drawing since ongoing fibrogenesis is indicated by jaundice.</li>
	<li>When animals are sacrificed, blood is collected for measurement of clinical chemistry parameters (AST, ALT, bilirubin etc.) and the liver is retrieved for histochemical and biochemical analysis.</li>
</ol>

<ol>
	<li>Liedtke, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+liver+fibrosis+research:+update+on+animal+models,+legal+issues+and+translational+aspects.">Experimental liver fibrosis research: update on animal models, legal issues and translational aspects.</a> Fibrogenesis Tissue Repair. 6 (1), 19 (2013).</li><li>Aller, M. A., Arias, J. L., Garc&#237;a-Dom&#237;nguez, J., Arias, J. I., Dur&#225;n, M., Arias, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+obstructive+cholestasis:+the+wound-like+inflammatory+liver+response.">Experimental obstructive cholestasis: the wound-like inflammatory liver response.</a> Fibrogenesis Tissue Repair. 1 (1), 6 (2008).</li><li>Tacke, F., Weiskirchen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Update+on+hepatic+stellate+cells:+pathogenic+role+in+liver+fibrosis+and+novel+isolation+techniques.">Update on hepatic stellate cells: pathogenic role in liver fibrosis and novel isolation techniques.</a> Expert Rev Gastroenterol Hepatol. 6 (1), 67-80 (2012).</li><li>Weiler-Normann, C., Herkel, J., Lohse, A. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mouse+models+of+liver+fibrosis.">Mouse models of liver fibrosis.</a> Z. Gastroenterol. 45 (1), 43-50 (2007).</li><li>Cameron, G. R., Oakley, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ligation+of+the+common+bile+duct.">Ligation of the common bile duct.</a> J. Pathol. 35 (5), 769-798 (1932).</li><li>Cameron, G. R., Hasan, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Disturbances+of+structure+and+function+in+the+liver+as+the+result+of+biliary+obstruction.">Disturbances of structure and function in the liver as the result of biliary obstruction.</a> J. Pathol. 75 (2), 333-349 (1958).</li><li>Accatino, L., Contreras, A., Ferna&#324;dez, S., Quintana, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+complete+biliary+obstruction+on+bile+flow+and+bile+acid+excretion:+postcholestatic+choleresis+in+the+rat.">The effect of complete biliary obstruction on bile flow and bile acid excretion: postcholestatic choleresis in the rat.</a> J Lab Clin Med. 93 (5), 706-717 (1979).</li><li>Accatino, L., Contreras, A., Berdichevsky, E., Quintana, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+complete+biliary+obstruction+on+bile+secretion.+Studies+on+the+mechanisms+of+postcholestatic+choleresis+in+the+rat.">The effect of complete biliary obstruction on bile secretion. Studies on the mechanisms of postcholestatic choleresis in the rat.</a> J Lab Clin Med. 97 (4), 525-534 (1981).</li><li>Kountouras, J., Billing, B. H., Scheuer, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prolonged+bile+duct+obstruction:+a+new+experimental+model+for+cirrhosis+in+the+rat.">Prolonged bile duct obstruction: a new experimental model for cirrhosis in the rat.</a> Br J Exp Pathol. 65 (3), 305-311 (1984).</li><li>Tuchweber, B., Desmouli&#232;re, A., Bochaton-Piallat, M. L., Rubbia-Brandt, L., Gabbiani, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proliferation+and+phenotypic+modulation+of+portal+fibroblasts+in+the+early+stages+of+cholestatic+fibrosis+in+the+rat.">Proliferation and phenotypic modulation of portal fibroblasts in the early stages of cholestatic fibrosis in the rat.</a> Lab Invest. 74 (1), 265-278 (1996).</li><li>Desmouli&#232;re, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extracellular+matrix+deposition,+lysyl+oxidase+expression,+and+myofibroblastic+differentiation+during+the+initial+stages+of+cholestatic+fibrosis+in+the+rat.">Extracellular matrix deposition, lysyl oxidase expression, and myofibroblastic differentiation during the initial stages of cholestatic fibrosis in the rat.</a> Lab Invest. 76 (6), 765-778 (1997).</li><li>Arias, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adenoviral+expression+of+a+transforming+growth+factor-&#946;1+antisense+mRNA+is+effective+in+preventing+liver+fibrosis+in+bile-duct+ligated+rats.">Adenoviral expression of a transforming growth factor-&#946;1 antisense mRNA is effective in preventing liver fibrosis in bile-duct ligated rats.</a> BMC Gastroenterol. 3 (29), (2003).</li><li>Borkham-Kamphorst, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dominant-negative+soluble+PDGF-&#946;+receptor+inhibits+hepatic+stellate+cell+activation+and+attenuates+liver+fibrosis.">Dominant-negative soluble PDGF-&#946; receptor inhibits hepatic stellate cell activation and attenuates liver fibrosis.</a> Lab. Invest. 84 (6), 766-777 (2004).</li><li>Borkham-Kamphorst, E., Huss, S., Van de Leur, E., Haas, U., Weiskirchen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adenoviral+CCN3/NOV+gene+transfer+fails+to+mitigate+liver+fibrosis+in+an+experimental+bile+duct+ligation+model+because+of+hepatocyte+apoptosis.">Adenoviral CCN3/NOV gene transfer fails to mitigate liver fibrosis in an experimental bile duct ligation model because of hepatocyte apoptosis.</a> Liver Int. 32 (9), 1342-1353 (2012).</li><li>Borkham-Kamphorst, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+anti-fibrotic+effects+of+CCN1/CYR61+in+primary+portal+myofibroblasts+are+mediated+through+induction+of+reactive+oxygen+species+resulting+in+cellular+senescence,+apoptosis+and+attenuated+TGF-&#946;+signaling.">The anti-fibrotic effects of CCN1/CYR61 in primary portal myofibroblasts are mediated through induction of reactive oxygen species resulting in cellular senescence, apoptosis and attenuated TGF-&#946; signaling.</a> Biochim. Biophys. Acta. 1843 (5), 902-914 (2014).</li><li>Huss, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+and+evaluation+of+an+open+source+Delphi-based+software+for+morphometric+quantification+of+liver+fibrosis.">Development and evaluation of an open source Delphi-based software for morphometric quantification of liver fibrosis.</a> Fibrogenesis Tissue Repair. 3 (1), 10 (2010).</li><li>Borkham-Kamphorst, E., Drews, F., Weiskirchen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Induction+of+lipocalin-2+expression+in+acute+and+chronic+experimental+liver+injury+moderated+by+pro-inflammatory+cytokines+interleukin-1&#946;+through+nuclear+factor-&#954;B+activation.">Induction of lipocalin-2 expression in acute and chronic experimental liver injury moderated by pro-inflammatory cytokines interleukin-1&#946; through nuclear factor-&#954;B activation.</a> Liver Int. 31 (5), 656-665 (2011).</li><li>Karlmark, K. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+fractalkine+receptor+CX3CR1+protects+against+liver+fibrosis+by+controlling+differentiation+and+survival+of+infiltrating+hepatic+monocytes.">The fractalkine receptor CX3CR1 protects against liver fibrosis by controlling differentiation and survival of infiltrating hepatic monocytes.</a> Hepatology. 52 (5), 1769-1782 (2010).</li><li>Tarcin, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Time+course+of+collagen+peak+in+bile+duct-ligated+rats.">Time course of collagen peak in bile duct-ligated rats.</a> BMC Gastroenterol. 11, 45 (2011).</li><li>Takase, S., Leo, M. A., Nouchi, T., Lieber, C. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Desmin+distinguishes+cultured+fat-storing+cells+from+myofibroblasts,+smooth+muscle+cells+and+fibroblasts+in+the+rat.">Desmin distinguishes cultured fat-storing cells from myofibroblasts, smooth muscle cells and fibroblasts in the rat.</a> J. Hepatol. 6 (3), 267-276 (1988).</li><li>Borkham-Kamphorst, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protective+effects+of+lipocalin-2+(LCN2)+in+acute+liver+injury+suggest+a+novel+function+in+liver+homeostasis.">Protective effects of lipocalin-2 (LCN2) in acute liver injury suggest a novel function in liver homeostasis.</a> Biochim. Biophys. Acta. 1832 (5), 660-673 (2013).</li><li>Labbus, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proteomic+profiling+in+Lipocalin+2+deficient+mice+under+normal+and+inflammatory+conditions.">Proteomic profiling in Lipocalin 2 deficient mice under normal and inflammatory conditions.</a> J Proteomics. 78, 188-196 (2013).</li><li>Kirkland, J. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reversible+surgical+model+of+biliary+inflammation+and+obstructive+jaundice+in+mice.">Reversible surgical model of biliary inflammation and obstructive jaundice in mice.</a> J. Surg. Res. 164 (2), 221-227 (2010).</li><li>Heinrich, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Partial+bile+duct+ligation+in+mice:+a+novel+model+of+acute+cholestasis.">Partial bile duct ligation in mice: a novel model of acute cholestasis.</a> Surgery. 149 (3), 445-451 (2011).</li><li>Scholten, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genetic+labeling+does+not+detect+epithelial-to-mesenchymal+transition+of+cholangiocytes+in+liver+fibrosis+in+mice.">Genetic labeling does not detect epithelial-to-mesenchymal transition of cholangiocytes in liver fibrosis in mice.</a> Gastroenterology. 139 (3), 987-998 (2010).</li><li>Aller, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+half+century+(1961-2011)+of+applying+microsurgery+to+experimental+liver+research.">A half century (1961-2011) of applying microsurgery to experimental liver research.</a> World J Hepatol. 4 (7), 199-208 (2012).</li><li>Russell, W. M. S., Burch, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> The Principles of Humane Experimental Technique. , (1959).</li></ol>

The authors have nothing to disclose.

Cholestatic liver injury is one of the major causative factors for the development of liver fibrosis and cirrhosis in patients with chronic liver disease. Based on the fact that these diseases produce imponderable health care costs, it is comprehensible that many researchers are trying to understand the pathogenic mechanisms of ongoing hepatic fibrosis. Therefore, experimental models have been generated that mimic various aspects of the complex mechanisms that lead to hepatic inflammation, fibrosis and cirrhosis1.
Surgical BDL is one of the most widespread experimental models that is used to induce obstructive cholestatic injury in mice and rats4,23,24. In most of the protocols, animals are anesthetized and a midsection laparotomy is performed. Subsequently, the bile duct is uncovered from the abdominal cavity and ligated twice using surgical twine. As a consequence, the mice and rats that received this surgery develop a strong fibrotic reaction that at first originate from the periportal fields25. During the years several different surgical techniques and modifications have been described. Special procedures even allow reconnection or reanastomosis after BDL23. Other techniques are based on partial BDL resulting in significantly less necrosis formation and consequently hepatocyte proliferation24. Partial BDL in combination with subsequent removal of the gallbladder (cholecystectomy) that prevents formation of cholecystitis also represents an excellent experimental model for acute cholestasis. It was proposed to be a model that is closer to the human situation24. And indeed, during the establishment of this model, it was already demonstrated that it reproducibly causes cholestasis with only minimal histological tissue injury and does not proceed to chronic cholestasis25. Therefore, it was suggested that this model is ideal for studying late effects of reversed cholestasis24. Even more sophisticated methods are based on microsurgery and allow a fast and reproducible way to inflict cholestatic liver injury only in selected parts of the liver26.
Although these sophisticated modifications from the original BDL protocol have been proven very helpful in investigating specific research questions, many laboratories worldwide basically aim at employing the BDL model as a highly reproducible and reliable model for cholestatic liver fibrosis. However, many complications can occur that could substantially alter the reproducibility and reliability of the results obtained by this model, if technical inaccuracies are not avoided. For instance, bleeding complications related to injury of the blood vessels accompanying the bile duct (see Figures 3-4) may occur during or rapidly after surgery. Overdosing of anesthesia with subsequent cardiodepression or respiratory failure are also avoidable complications of the procedure. Severe infections, ranging from peritonitis to sepsis, may occur during the whole period of the experiment, if the sutures are not accurately performed and bile leaks into the peritoneal cavity. Accidental injuries to the intestine during surgery could also lead to peritonitis. Therefore, it is obvious that standardized protocols which are in compliance with strict handling guidelines are strongly required. This stipulation was also recently demanded within the countries of the European Union, which implemented new animal welfare rules in 20131. The respective requirements that are associated with this regulation are not new and were already proposed in 1959, when Russell and Burch suggested an ethical framework for conducting scientific experiments with animals that is mainly based on a replacement, refinement and reduction (3R) principle27.
When following the outlined protocol there are only a few complications that may arise from technical inaccuracies. Three specific issues might occur in rather low frequency.
As with all surgical procedures, the overdose of anesthetic is a potential source of danger to the animals especially in combination with hypothermia. If during the surgery cardiovascular complications occur, the supply of anesthetics should be stopped immediately and the operator should try to provide much as possible oxygen to the mouse. This can be done by means of a small plastic syringe that is filled with air and pumped into the mouth of the impaired animal. Alternatively, the use of a small Peleusball for ventilation of the affected animal is often helpful for the revitalization process.
Problems in wound healing
After the BDL surgery, mice may bite their own sore seams or those of other animals. If this occurs, respective mice should be separately caged. Animals with open wounds should be anesthetized, the region around the wound gently sterilized with a standard antiseptic, and the wound should be sewn up again. During the next 3 days, the wound of these animals should be regularly inspected (two to three times a day).
Distensions of the abdomen or formation of ascites are indicative for bacterial infections. These might occur due to non-sterile working during the surgery. All kind of infections should be handled without exception as a humane endpoint and the affected animals should be sacrificed.
We provided an easy to follow protocol that allows the performance of BDL in mice that is simple to implement and evokes only low animal mortality combined with a high reproducibility. All of the surgical protocols can be quickly apprehended by skilled scientists. During the complete experimentation, the animals are kept on a warming plate at 37 &#176;C and permanently connected to an anesthesia system minimizing pain and distress. For surgery, the abdomen is opened with a midline laparotomy and the bile duct double-ligated without dissecting it. The representative results that were discussed here demonstrate that the phenotypic alterations in regard to liver morphology (inflammation, fibrosis, cirrhosis) are highly reproducible and allow to study different aspects of fibrogenesis (e.g., initiation, inflammation, progression, end-stage disease) at defined time-points.
We hope that the summary of our protocol will help to shorten the learning curve that is necessary to successfully establish this fibrosis model in other laboratories and to guarantee reliable and reproducible results at different locations. Thereby we think that the presented protocol supports the 3R principle that was supposed by Russell and Burch in 1959 and represents the basis of new animal welfare rules that are presently implemented in many countries within the European Framework.

Liver fibrosis is defined as the excessive production and accumulation of extracellular matrix (ECM) that originates from a complex network of interactions of matrix-producing hepatic stellate cells and a wide variety of liver-resident and infiltrating cells blood cells1,2. Although hepatic fibrosis can be caused by a multitude of different stimuli the molecular mechanisms underlying fibrosis are generally very similar. Following hepatic damage, a highly orchestrated program of molecular and cellular changes is initiated. In this program a close interaction between inflammatory signals, monocytes/macrophages and hepatic stellate cells occurs that at the end results in stellate cell activation and transdifferentiation to myofibroblasts, ECM deposition and consecutive anatomical and functional alterations of liver tissue integrity3. Activation of hepatic stellate cells is particularly driven by inflammatory signals and interactions with liver residental macrophages (i.e. the Kupffer cells). Pathogen associated molecular patterns are recognized by specialized pattern recognition receptors such as the Toll-like receptors that when activated signal through a complex network of different pathways that trigger the expression and secretion of a multitude of inflammatory cytokines and chemokines that drive the inflammatory process3. The inflammatory response and the formed hepatic insult is only temporary when the disease-producing factor is removed. In contrast, if the injury persists, chronic inflammation evolves within the liver and the expression and accumulation of ECM crowds in the foreground resulting in progressive substitution of normal liver parenchyma by scar tissue formation.
Since hepatic fibrogenesis in humans is a worldwide clinical problem, several experimental rodent models of acute and chronic hepatic failure have been established during the last decades. In the murine system for example, common models are the administration of a variety of different hepatotoxins, the ligation of the common bile duct, induction of immune-mediated liver injury, and the targeted introduction of gene defects or vice versa the overexpression of transgenes that affect critical signaling pathways involved in the pathogenesis of liver fibrosis4.
Ligation of the common bile duct in rodents has been carried out as an experimental procedure in research for many years5-8. A first highly reproducible protocol for prolonged bile duct ligation (BDL) in rodents was already presented now more than three decades ago9. In this protocol both cannulation/obstruction and ligation induced a high yield of cirrhosis in rats with morphological changes that were comparable to those observed in human biliary cirrhosis9. The respective protocol is simple, the surgical procedure is relatively rapidly applicable, and the survival rates of the animals are high with over 95%. In the classical rat cannulation/obstruction protocol, a short incision of 2 cm is made just below the xiphoid process. Thereafter, a cannula is inserted into the proximal portion of the bile duct and fixed in its position with silk sutures. In a next step, the distal portion of the cannula is obstructed with 3 knots, put through the lower end of the midline incision and buried subcutaneously in the right lower quadrant9. At the end, the abdomen is closed and animals are allowed to recover. In the ligation protocol, the rats are subjected to double ligation of the common bile duct either with or without dissection of the bile duct between the ligatures9.
This experimental model is well accepted and used worldwide in hundreds of laboratories to induce liver cholestasis and fibrosis. It induces intrahepatic biliary epithelial cell proliferation, myofibroblastic differentiation of portal fibroblasts around proliferating biliary epithelial cells, resulting in a highly reproducible, massive expression and deposition of ECM10,11. Therefore, the application of this model in rats and mice is being popular among scientists that aim to understand the pathogenesis of hepatic inflammation and fibrosis.
In our laboratory, we have extensively used this protocol in the past in rats in several experimental studies aiming to investigate special molecular and cellular aspects of hepatic fibrogenesis and to test novel antifibrotic concepts and drugs12-15.
Recently, we adapted this methodology to the murine system and found that the bile duct ligation surgery is also an attractive mean to establish time-dependent fibrosis with low variation and mortality in mice16-18. Due to the smaller size of the animals, however, some important modifications with regard to anesthesia, surgical intervention and post-treatment observation are necessary to obtain reliable and reproducible outcome in this model. The complete adaptation is summarized in the following protocol and in the accompanying video documentation.

<table><tbody><tr><td>Isoflurane</td><td>Forene Abbott</td><td>B 506</td><td></td></tr><tr><td>Shaver Favorita II</td><td>Aeskulap</td><td>GT104</td><td></td></tr><tr><td>Cutter head</td><td>Aeskulap</td><td>GT730</td><td></td></tr><tr><td>Bepanthen eye and nose ointment</td><td>Bayer Vital GmbH</td><td>6029009.00.00</td><td></td></tr><tr><td>Warming plate and controller</td><td>Labotect</td><td>HP 062</td><td></td></tr><tr><td>Fluovac anesthesia system</td><td>Harvard Apparatus</td><td>34-1030</td><td></td></tr><tr><td>ISOFLO (Isoflurane Vapor) vaporiser</td><td>Eickemeyer</td><td>4802885</td><td></td></tr><tr><td>Scotch Tape</td><td>commercially available</td><td></td><td></td></tr><tr><td>Tissue paper</td><td>commercially available</td><td></td><td></td></tr><tr><td>Durapore silk tape</td><td>3M</td><td>1538-1</td><td></td></tr><tr><td>Cotton Gauze swabs</td><td>Fuhrmann GmbH</td><td>32014</td><td></td></tr><tr><td>Poly-Alcohol Haut&amp;hellip;farblos Antisepticum</td><td>Antiseptica GmbH</td><td>72PAH200</td><td></td></tr><tr><td>Raucodrape OR adhesive drapes</td><td>Lohmann &amp;amp; Rauscher GmbH</td><td>33013</td><td></td></tr><tr><td>Scissor</td><td>Fine Science Tools Inc.</td><td>14074-11</td><td></td></tr><tr><td>Graefe forceps straight</td><td>Fine Science Tools Inc.</td><td>11050-10</td><td></td></tr><tr><td>6-0 Mersilk suture</td><td>Ethicon</td><td>K889H</td><td>Silk, non-absorbable/Abdominal closure</td></tr><tr><td>Needle holder Mathieu</td><td>Fine Science Tools Inc.</td><td>12010-14</td><td></td></tr><tr><td>Colibri retractor</td><td>Fine Science Tools Inc.</td><td>17000-03</td><td></td></tr><tr><td>Cotton swabs</td><td>Noba Verbandmittel</td><td>974202</td><td></td></tr><tr><td>Cotton swabs</td><td>Heinz Herenz Medizinalbedarf GmbH</td><td>1032238</td><td></td></tr><tr><td>25mL beaker</td><td>Schott Duran</td><td>50-1150</td><td></td></tr><tr><td>Isotonic (0.9%) NaCl solution</td><td>DeltaSelect GmbH</td><td>PZN 00765145</td><td></td></tr><tr><td>Micro-serrations forceps Moria MC31</td><td>Fine Science Tools Inc.</td><td>11370-31</td><td>Bile duct separation</td></tr><tr><td>5-0 Mersilene suture</td><td>Ethicon</td><td>EH6731H</td><td>Polyester, non-absorbable/Bile duct ligation</td></tr><tr><td>5mL syringe</td><td>BD Discardit II</td><td>300296</td><td></td></tr><tr><td>1mL syringe</td><td>BD Plastipak</td><td>300013</td><td></td></tr><tr><td>Sterican needle 26 G x 1</td><td>B. Braun</td><td>4657683</td><td></td></tr><tr><td>Buprenorphine</td><td>Essex Pharma</td><td>997.00.00</td><td>Analgeticum, 0.1 mg/kg</td></tr><tr><td>Infrared lamp</td><td>Petra Electric</td><td>IR 11</td><td></td></tr></tbody></table>

bile duct ligation in mice: induction of inflammatory liver injury and fibrosis by obstructive cholestasis

In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well as to excrete bilirubin and other metabolic products. In the liver, the experimental obstruction of the extrahepatic biliary system initiates a complex cascade of pathological events that leads to cholestasis and inflammation resulting in a strong fibrotic reaction originating from the periportal fields. Therefore, surgical ligation of the common bile duct has become the most commonly used model to induce obstructive cholestatic injury in rodents and to study the molecular and cellular events that underlie these pathophysiological mechanisms induced by inappropriate bile flow. In recent years, different surgical techniques have been described that either allow reconnection or reanastomosis after bile duct ligation (BDL), e.g., partial BDL, or other microsurgical methods for specific research questions. However, the most frequently used model is the complete obstruction of the common bile duct that induces a strong fibrotic response after 21 to 28 days. The mortality rate can be high due to infectious complications or technical inaccuracies. Here we provide a detailed surgical procedure for the BDL model in mice that induce a highly reproducible fibrotic response in accordance to the 3R rule for animal welfare postulated by Russel and Burch in 1959.

In a typical experimentation BDL was performed in 40 male C57BL/6 wild-type mice weighting about 18-20 gram. This experiment was done to investigate hepatic fibrogenesis in the initiation phase (3 and 7 days), during progression (10, 14, and 20 days), and during long-term (30 and 60 days)16. In this model, persinusoidal fibrosis has already developed on day 10 after the surgery, while periportal fibrosis that permanently increased up to the end of the experiment was fully developed after 20 days. In the mentioned experiment, all animals that received a simple sham-operation survived, and only two of the 40 mice (5%) that received BDL developed a poor general condition and were therefore prematurely sacrificed before the planned end point of the experiment. The activity of sham-operated animals was without exception already normal one day after laparotomy, while most of the animals subjected to BDL showed reduced activity during the first three days. Jaundiced skin had been already apparent in all BDL animals one or two days after setting of the BDL16.
The values of both alanine aminotransferase (ALT) and aspartate transaminase (AST) that represent well-established serum markers of hepatic injury rapidly increased and peaked during day 7 and day 20 after BDL (Table 1). Thereafter, ALT and AST decreased steadily until day 30 and remained stable until 60 days after surgery. In line with the cholestatic injury, serum concentrations of total bilirubin were steadily elevated and reached a plateau after 7 days16. Similar time course of ALT and AST serum activities were also reported for rats that underwent BDL. In a recent study it was demonstrating that serum AST and ALT levels increased up to 5 or 10 fold of normal at the first week after the BDL surgery and decreased after two weeks19.
Typically, the livers of sham-operated animals still look smooth at the end of the experiment, while the livers of animals that received BDL show architectural alterations that are mainly characterized by the formation of edema and fibrotic nodules on the surface of corresponding livers and hydrops of the gall bladder that is filled with large quantities of bile (Figure 7). The characteristic morphological alterations of the liver that are induced by the BDL surgery are also demonstrable in standard histological analysis (Figure 8).
In the same set of experiments, development of liver fibrosis was semi-quantitatively assessed based on liver histology evaluated by a blinded pathologist using a scoring system in which periportal fibrosis was staged from 0-4 and perisinusoidal fibrosis from 0-2, giving a maximum value that was equivalent to cirrhosis of 6. As expected, the mean fibrosis score in the group of sham-operated animals was 0.00 ± 0.00. In contrast, in the group of animals that received BDL, the score increased steadily until day 60 to a value of 4.83 ± 0.17. The maximum of 3 for periportal fibrosis was reached at day 20. In all animals analyzed, perisinusoidal fibrosis was absent during the first 10 days of the experiment and was firstly noticeable after two weeks. Thereafter, it increased steadily up to the end of the experiment to values of 1.8 ± 0.17 (Table 1).
Also in several other independent animal experiments that were performed, it was observed that the formation of fibrosis was highly reproducible showing time-dependent increase of intrahepatic collagen expression and deposition as a consequence of ongoing fibrogenesis (Figure 9). Similarly, the process of ongoing fibrogenesis is noticeable in elevated expression of α-smooth muscle actin (α-SMA) that represents a marker of fibroblastic cells, i.e. activated hepatic stellate cells and portal myofibroblasts, and hepatic hydroxyproline, an amino acid abundantly found in collagen matrices18 (Figure 9). In addition, the expression of vimentin that indicates increasing amounts of myofibroblasts or fibroblasts is increased after setting of the BDL surgery20. The concomitance of inflammation in injured livers are further reflected by increased expression of Lipocalin 2 (LCN2) that is strongly induced during acute and chronic liver injury and evolves hepato-protective effects during acute liver injury21,22.
Inflammatory cells that infiltrate the livers of animals that received BDL can be detected by specific staining with an antibody that is specific for CD45 (Figure 10). This cellular surface marker that is also known as PTPRC (protein tyrosine phosphatase, receptor type) is specifically expressed in all differentiated hematopoietic cells except erythrocytes and plasma cells.
<table fo:keep-together.within-page="always" border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td rowspan="2">Time after bile duct ligation (days)</td>
			<td>Total bilirubin</td>
			<td rowspan="2">AST (U/L)</td>
			<td rowspan="2">ALT (U/L)</td>
			<td rowspan="2">Portal fibrosis</td>
			<td rowspan="2">Perisinusoidal fibrosis</td>
			<td rowspan="2">Total score</td>
		</tr>
		<tr>
			<td>(mg/dL)</td>
		</tr>
		<tr>
			<td>0 (n = 3)</td>
			<td>0.17 ± 0.06</td>
			<td>192.67 ± 30.50</td>
			<td>50.33 ± 6.03</td>
			<td>0.0 ± 0.0</td>
			<td>0.0 ± 0.0</td>
			<td>0.0 ± 0.0</td>
		</tr>
		<tr>
			<td>3 (n = 5)</td>
			<td>6.85 ± 2.21</td>
			<td>1159.25 ± 319.27</td>
			<td>566.50 ± 335.25</td>
			<td>0.0 ± 0.0</td>
			<td>0.0 ± 0.0</td>
			<td>0.0 ± 0.0</td>
		</tr>
		<tr>
			<td>7 (n = 5)</td>
			<td>14.38 ± 2.14±</td>
			<td>976.60 ± 477.16</td>
			<td>448.20 ± 259.47</td>
			<td>0.60 ± 0.25</td>
			<td>0.0 ± 0.0</td>
			<td>0.60 ± 0.25</td>
		</tr>
		<tr>
			<td>10 (n = 5)</td>
			<td>15.92 ± 2.60</td>
			<td>1916.60 ± 868.25 </td>
			<td>560.40 ± 80.88</td>
			<td>1.40 ± 0.25</td>
			<td>0.25 ± 0.25</td>
			<td>1.67 ± 0.25</td>
		</tr>
		<tr>
			<td>14 (n = 5)</td>
			<td>17.90 ± 3.84</td>
			<td>1088.60 ± 276.32</td>
			<td>505.00 ± 96.15±</td>
			<td>2.4 ± 0.25</td>
			<td>1.0 ± 0.0</td>
			<td>3.40 ± 0.24</td>
		</tr>
		<tr>
			<td>20 (n = 4)</td>
			<td>18.00 ± 2.12</td>
			<td>1072.67 ± 364.27</td>
			<td>404.00 ± 195.48</td>
			<td>3.0 ± 0.0</td>
			<td>1.0 ± 0.0</td>
			<td>4.0 ± 0.0</td>
		</tr>
		<tr>
			<td>30 (n = 5)</td>
			<td>16.04 ± 4.79</td>
			<td>446.40 ± 169.75</td>
			<td>260.20 ± 126.97</td>
			<td>2.8 ± 0.2</td>
			<td>1.4 ± 0.25</td>
			<td>4.20 ± 0.20</td>
		</tr>
		<tr>
			<td>60 (n = 6)</td>
			<td>16.02 ± 1.19</td>
			<td>484.67 ± 117.79</td>
			<td>257.17 ± 50.97</td>
			<td>3.0 ± 0.0</td>
			<td>1.8 ± 0.17</td>
			<td>4.83 ± 0.17</td>
		</tr>
	</tbody>
</table>
Abbreviations used are: ALT, alanine aminotransferase; AST, aspartate aminotransferase.
Table 1: Fibrosis scoring in a representative experiment. The data of this table was reproduced from a study in which liver fibrosis was induced by bile duct ligation in C57BL/6 mice16. In this study, the mortality rate after the BDL surgery was 5% (2 of 40 animals were prematurely sacrificed because poor animal conditions developed).
<img alt="Surgical setup, sterilization instruments, autoclave, scalpel, medical equipment for operation procedure." src="/files/ftp_upload/52438/52438fig1highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 1"> 
Figure 1: Experimental setup for performing a bile duct ligation. The animal is kept on a warming plate at a temperature of 37 oC and the operational area is covered overall with fluid-impermeable, self-adhesive drapes. During the complete surgery, the animal is permanently connected to an anesthesia system. All instrumentations and solutions (analgesics, anesthetics, antiseptic solution, 0.9% NaCl) are arranged clearly.
<img alt="Surgical procedure setup with retractors exposing tissue in sterile environment for medical study." src="/files/ftp_upload/52438/52438fig2highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 2"> 
Figure 2: Preparation of the surgery area. Prior opening of the peritoneal cavity, the abdominal skin should be shaved with an electric fur shaver and disinfected with an antiseptic gauze swab. The surgery area is then covered with fluid-impermeable, self-adhesive drapes. The abdomen is opened with a midline laparotomy (~ 2 cm in length). The cavity is enlarged by inserting a holding suture in the sternum and the operation area spread by inserting a Colibri retractor allowing unhindered experimentation during the surgery.
<img alt="Bile duct dissection process in surgical experiment, with labeled anatomy, procedure diagram." src="/files/ftp_upload/52438/52438fig3highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 3"> 
Figure 3: Exposure of the bile duct. (A) For conducting the bile duct ligation, the ventral side of the liver is lifted so that it can stick to the diaphragm and the hepatic hilus becomes clearly visible. (B) To better expose the bile duct, the gut is caudally moved with a humidified cotton swab. The bile duct is marked with an arrow.
<img alt="Surgical procedure on animal tissue, step-by-step, suture placement, veterinary surgery technique." src="/files/ftp_upload/52438/52438fig4highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 4"> 
Figure 4: Ligating the bile duct. (A) In a first step, the bile duct is separated carefully from the flanking portal vein and hepatic artery using a micro-serration forceps. (B) Subsequently, a suture is placed around the bile duct and secured with a surgical knot. (C) Thereafter, a second suture is placed in close proximity to the first suture and knotted around the bile duct. (D) The suture is shortened, the cavity rinsed with 0.9% NaCl solution, and all organs replaced to their physiological position.
<img alt="Bile duct ligation surgery: sequential steps (A-E) with anatomical diagram (E') showing liver and bile duct." src="/files/ftp_upload/52438/52438fig5highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 5"> 
Figure 5: Precise representation of knotting. To document the placement of the sutures and the setting of the two knots that prevent bile flow, the same procedure outlined in Figure 4 was documented under a binocular. (A) Confinement of the bile duct with the first suture. (B) Knotting of the first suture. (C) Confinement of the bile duct with the second suture. (D) Knotting of the second suture. (E) Double-ligated bile duct after shortening of excess sutures. (E') This panel depicts a sketch of (E). The positions of the right (rl), left (ll) and median (ml) lobes of the liver as well as the bile duct, stomach, and duodenum are lettered. In the sketch the bile duct is double ligated by two sutures.
<img alt="Liver anatomy diagram; portal vein, hepatic artery, bile duct; educational use in human physiology." fo:content-width="4in" src="/files/ftp_upload/52438/52438fig6highres.jpg" width="400" data-altupdatedat="1747911167000" data-alt="Figure 6"> 
Figure 6: Anatomy of bile duct, portal vein and hepatic artery in mice. For better anatomic location of the common bile duct, portal vein and hepatic artery are depicted as a scheme. Marked are also the positions of the right (rl), left (ll) median (ml) and the caudate (cl) lobes of the liver.
<img alt="Liver tissue comparison, sham vs. 2-week BDL; surgical outcome, hepatic analysis, experimental setup." src="/files/ftp_upload/52438/52438fig7highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 7"> 
Figure 7: Representative appearance of livers 2 weeks after sham operation and BDL. C57BL/6 mice were subjected to sham operation or BDL surgery. After two weeks the visceral cavity was opened. While the livers of sham-operated animals showed no sign of fibrosis, the livers of animals receiving ligation of the biliary duct had an irregular surface structure with formation of edema and fibrotic nodules on the surface of corresponding livers.
<img alt="Histology microscope images; liver tissue comparison; cellular structure analysis, 50µm scale." src="/files/ftp_upload/52438/52438fig8highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 8"> 
Figure 8: Hematoxylin and eosin stain. Liver sections were prepared from C57BL/6 wild type animals that were sham-operated (A) or received BDL for three weeks (B). The sections were stained with hematoxylin and eosin following standard procedures. Please note the typical alterations within the BDL liver that include signs of inflammation (infiltrating cells), parenchymal (hepatocyte) necrosis, and proliferation of bile ducts. The scale bar in each figure panel represents 50 µm. <a href="https://www.jove.com/files/ftp_upload/52438/52438fig8large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Liver fibrosis analysis; histology and Western blot results; Sirius red stain and protein markers α-SMA, Vimentin." src="/files/ftp_upload/52438/52438fig9highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 9"> 
Figure 9: Histological and biochemical readouts for hepatic fibrogenesis. (A) Liver sections were prepared from animals that received sham operation or BDL for 2 weeks and stained with Sirius Red (upper panel, collagen fibers in red) or analyzed for expression of α-smooth muscle actin (α-SMA) (lower panel, α-SMA positive cells in brown) by immunohistochemistry. The scale bar in each figure panel represents 100 µm. (B) Protein extracts from livers were subjected to Western blot and analyzed for expression of collagen type I, α-SMA, and Vimentin that are well established markers of hepatic fibrogenesis. The expression of Lipocalin-2 (LCN2) indicates the inflammatory response that is associated with ongoing fibrogenesis. In this analysis, equal protein loading was demonstrated by probing the blots with an antibody specific for β-actin. <a href="https://www.jove.com/files/ftp_upload/52438/52438fig9large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Histology comparison of liver tissues with H&amp;E stain and immunohistochemistry, showing cellular detail." src="/files/ftp_upload/52438/52438fig10highres.jpg" data-altupdatedat="1747911167000" data-alt="Figure 10"> 
Figure 10: Immunological staining of infiltrating inflammatory cells. Serial liver sections were prepared from a liver of an animal that received bile duct ligation for 3 weeks. The sections were stained with hematoxylin and eosin (A) or with an antibody that is specific for CD45 (B). Please note, the high number of CD45 positive cells surrounding the bile ducts. These massive infiltrates that indicate inflammation are not visible in liver sections derived from sham-operated animals (not shown). The scale bar in each figure panel represents 500 µm. <a href="https://www.jove.com/files/ftp_upload/52438/52438fig10large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis at JoVE.com

Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

Disruption of bile flow results in severe inflammatory cholestatic liver injury with a characteristic time-dependent sequence of morphological alterations. Here we present a protocol for the surgical ligation of the common bile duct in mice that allows to induce a strong fibrotic response after 21 to 28 days.

In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well ...

bile-duct-ligation-mice-induction-inflammatory-liver-injury-fibrosis

Research

JoVE Journal

Medicine

52.0K Views.  RWTH Aachen University. Disruption of bile flow results in severe inflammatory cholestatic liver injury with a characteristic time-dependent sequence of morphological alterations. Here we present a protocol for the surgical ligation of the common bile duct in mice that allows to induce a strong fibrotic response after 21 to 28 days.

Video: Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

Creation of Reversible Cholestatic Rat Model

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and affect the nutritional status and surgical outcomes. Study of the pathophysiological changes occurring in the liver and other organs is of importance. Various studies have been done in cholestatic rat models.
We used a reversible cholestatic rat model in our recent study looking at the role of methylprednisolone in the ischemia reperfusion injury. Various techniques for creation of a reversible cholestatic model have been described. Creation of a reversible cholestatic rat model can be challenging in view of the smaller size and unique hepatopancreatobiliary anatomy in rats. This video article demonstrates the creation of a reversible cholestatic model.
This model can be used in various studies, such as looking at the changes in nutritional, physiological, pathological, histological and immunological changes in the gastrointestinal tract. This model can also be used to see the effects of cholestasis and various therapeutic interventions on major hepatic surgeries.

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Creation of a reversible cholestatic rat model can be challenging in view of the smaller size and unique hepatopancreatobiliary anatomy in rats. This video article demonstrates the creation of a reversible cholestatic model.

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and ...

Determining Bile Duct Density in the Mouse Liver

Mouse is broadly used as a model organism to study biliary diseases. To evaluate the development and function of the biliary system, various techniques are used, including serum chemistry, histological analysis, and immunostaining for specific markers. Although these techniques can provide important information about the biliary system, they often do not present a full picture of bile duct (BD) developmental defects across the whole liver. This is in part due to the robust ability of the mouse liver to drain the bile even in animals with significant impairment in biliary development. Here we present a simple method to calculate the average number of BDs associated with each portal vein (PV) in sections covering all lobes of mutant/transgenic mice. In this method, livers are mounted and sectioned in a stereotypic manner to facilitate comparison among various genotypes and experimental conditions. BDs are identified via light microscopy of cytokeratin-stained cholangiocytes, and then counted and divided by the total number of PVs present in liver section. As an example, we show how this method can clearly distinguish between wild-type mice and a mouse model of Alagille syndrome. The method presented here cannot substitute for techniques that visualize the three-dimensional structure of the biliary tree. However, it offers an easy and direct way to quantitatively assess BD development and the degree of ductular reaction formation in mice.

We present a rather simple and sensitive method for accurate quantification of bile duct density in the mouse liver. This method can aid in determining the effects of genetic and environmental modifiers and the effectiveness of potential therapies in mouse models of biliary diseases.

Mouse is broadly used as a model organism to study biliary diseases. To evaluate the development and function of the biliary system, various techniques ...

Developmental Biology

The Influence of Liver Resection on Intrahepatic Tumor Growth

The high incidence of tumor recurrence after resection of metastatic liver lesions remains an unsolved problem. Small tumor cell deposits, which are not detectable by routine clinical imaging, may be stimulated by hepatic regeneration factors after liver resection. It is not entirely clear, however, which factors are crucial for tumor recurrence.
The presented mouse model may be useful to explore the mechanisms that play a role in the development of recurrent malignant lesions after liver resection. The model combines the easy-to-perform and reproducible techniques of defined amounts of liver tissue removal and tumor induction (by injection) in mice. The animals were treated with either a single laparotomy, a 30% liver resection, or a 70% liver resection. All animals subsequently received a tumor cell injection into the remaining liver tissue. After two weeks of observation, the livers and tumors were evaluated for size and weight and examined by immunohistochemistry.
After a 70% liver resection, the tumor volume and weight were significantly increased compared to a laparotomy alone (p &#60;0.05). In addition, immunohistochemistry (Ki67) showed an increased tumor proliferation rate in the resection group (p &#60;0.05).
These findings demonstrate the influence of hepatic regeneration mechanisms on intrahepatic tumor growth. Combined with methods like histological workup or RNA analysis, the described mouse model could serve as foundation for a close examination of different factors involved in tumor growth and metastatic disease recurrence within the liver. A considerable number of variables like the length of postoperative observation, the cell line used for injection or the timing of injection and liver resection offer multiple angles when exploring a specific question in the context of post-hepatectomy metastases. The limitations of this procedure are the authorization to perform the procedure on animals, access to an appropriate animal testing facility and acquisition of certain equipment.

A high incidence of tumor recurrence after resection of liver metastases remains an unsolved problem. The illustrated mouse model may be useful to investigate the reasons for such recurrences. It combines a liver resection model with intrahepatic tumor cell injection for the first time.

The high incidence of tumor recurrence after resection of metastatic liver lesions remains an unsolved problem. Small tumor cell deposits, which are not ...

A Silver Nanoparticle Method for Ameliorating Biliary Atresia Syndrome in Mice

Biliary atresia (BA) is a severe type of cholangitis with high mortality in children of which the etiology is still not fully understood. Viral infections may be one possible cause. The typical animal model used for studying BA is established by inoculating a neonatal mouse with a rhesus rotavirus. Silver nanoparticles have been shown to exert antibacterial and antiviral effects; their function in the BA mouse model is evaluated in this study. Currently, in BA animal experiments, the methods used to improve the symptoms of BA mice are generally symptomatic treatments given via food or other drugs. The aim of this study is to demonstrate a new method for ameliorating BA syndrome in mice by the intraperitoneal injection of silver nanoparticles and to provide detailed methods for preparing the silver nanoparticle gel formulation. This method is simple and widely applicable and can be used to research the mechanism of BA, as well as in clinical treatments. Based on the BA mouse model, when the mice exhibit jaundice, the prepared silver nanoparticle gel is injected intraperitoneally to the surface of the lower liver. The survival status is observed, and biochemical indicators and liver histopathology are examined. This method allows a more intuitive understanding of both the establishment of the BA model and novel BA treatments.

This article describes in detail a method based on silver nanoparticles for ameliorating biliary atresia syndrome in an experimental biliary atresia mouse model. A solid understanding of the reagent preparation process and the neonatal mouse injection technique will help familiarize researchers with the method used in neonatal mouse model studies.

Biliary atresia (BA) is a severe type of cholangitis with high mortality in children of which the etiology is still not fully understood. Viral infections ...

Immunology and Infection

Ileectomy-induced Bile Overaccumulation in Mouse Intestine

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer that often results in severe short bowel syndrome-like adverse effects including bile acid diarrhea, dehydration, electrolyte disturbances, and nutrient malabsorption. Here we introduce a murine ileal resection model, termed ileectomy, to evaluate tissue communication and the maintenance of systemic homeostasis. After ileal resection, circulating blood is permanently devoid of the ileum-specific endocrine hormone fibroblast growth factor 15 (FGF15), which releases its endocrinal inhibition of bile acid synthesis in the liver. In combination with the increased production and abolished reabsorption of bile acids after removing the ileum, mice that underwent surgery suffer from bile salt overaccumulation in the intestine and associated diarrhea, morbidity, and mortality. Novel usage of the surgery model introduced in this study may provide mechanistic and functional insights into ileal control of systemic metabolic regulation in physiology and disease.

Small intestine-dependent bile acid reabsorption and feedback inhibition of hepatic bile acid synthesis is important for systemic homeostasis and health. In this study, we describe a mouse model for ileal resection to evaluate ileectomy-induced bile malabsorption, overaccumulation, and toxicity in mouse intestine.

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer ...

A Mouse Model of Chronic Liver Fibrosis for the Study of Biliary Atresia

Biliary atresia (BA) is a fatal disease involving obstructive jaundice, and it is the most common indication for liver transplantation in children. Due to the complex etiology and unknown pathogenesis, there are still no effective drug treatments. At present, the classic BA mouse model induced by rhesus rotavirus (RRV) is the most commonly used model for studying the pathogenesis of BA. This model is characterized by growth retardation, jaundice of the skin and mucosa, clay stools, and dark yellow urine. The histopathology shows severe liver inflammation and obstruction of the intrahepatic and extrahepatic bile ducts, which are similar to the symptoms of human BA. However, the livers of end-stage mice in this model lack fibrosis and cannot fully simulate the characteristics of liver fibrosis in clinical BA. The presented study developed a novel BA mouse model of chronic liver fibrosis by injecting 5-10 &#181;g of anti-Ly6G antibody four times, with gaps of 2 days after each injection. The results showed that some of the mice successfully formed chronic BA with typical fibrosis after the time lapse, meaning these mice represent a suitable animal model for the virus-induced liver fibrosis mechanistic study of BA and a platform for developing future BA treatments.

We established a mouse model of chronic liver fibrosis, which provides a suitable animal model for the virus-induced liver fibrosis mechanistic study of biliary atresia (BA) and a platform for future BA treatments.

Biliary atresia (BA) is a fatal disease involving obstructive jaundice, and it is the most common indication for liver transplantation in children. Due to ...

Murine Precision-Cut Liver Slices as an Ex Vivo Model of Liver Biology

Understanding the mechanisms of liver injury, hepatic fibrosis, and cirrhosis that underlie chronic liver diseases (i.e., viral hepatitis, non-alcoholic fatty liver disease, metabolic liver disease, and liver cancer) requires experimental manipulation of animal models and in vitro cell cultures. Both techniques have limitations, such as the requirement of large numbers of animals for in vivo manipulation. However, in vitro cell cultures do not reproduce the structure and function of the multicellular hepatic environment. The use of precision-cut liver slices is a technique in which uniform slices of viable mouse liver are maintained in laboratory tissue culture for experimental manipulation. This technique occupies an experimental niche that exists between animal studies and in vitro cell culture methods. The presented protocol describes a straightforward and reliable method to isolate and culture precision-cut liver slices from mice. As an application of this technique, ex vivo liver slices are treated with bile acids to simulate cholestatic liver injury and ultimately assess the mechanisms of hepatic fibrogenesis.

This protocol provides a simple and reliable method for the production of viable precision-cut liver slices from mice. The ex vivo tissue samples can be maintained under laboratory tissue culture conditions for multiple days, providing a flexible model to examine liver pathobiology.

Understanding the mechanisms of liver injury, hepatic fibrosis, and cirrhosis that underlie chronic liver diseases (i.e., viral hepatitis, non-alcoholic ...

A Mouse Model for Chronic Pancreatitis via Bile Duct TNBS Infusion

Chronic pancreatitis (CP) is a complex disease involving pancreatic inflammation and fibrosis, glandular atrophy, abdominal pain and other symptoms. Several rodent models have been developed to study CP, of which the bile duct 2,4,6 -trinitrobenzene sulfonic acid (TNBS) infusion model replicates the features of neuropathic pain seen in CP. However, bile duct drug infusion in mice is technically challenging. This protocol demonstrates the procedure of bile duct TNBS infusion for generation of a CP mouse model. TNBS was infused into the pancreas through the ampulla of Vater in the duodenum. This protocol optimized drug volume, surgical techniques, and drug handling during the procedure. TNBS-treated mice showed features of CP as reflected by bodyweight and pancreas weight reductions, changes in pain-associated behaviors, and abnormal pancreatic morphology. With these improvements, mortality associated with TNBS injection was minimal. This procedure is not only critical in generating pancreatic disease models but is also useful in local pancreatic drug delivery.

Chronic pancreatitis (CP) is a disease characterized by inflammation and fibrosis of the pancreas, often associated with intractable abdominal pain. This article focuses on refining the technique to generate a mouse model of CP via bile duct infusion with 2,4,6 -trinitrobenzene sulfonic acid (TNBS).

Chronic pancreatitis (CP) is a complex disease involving pancreatic inflammation and fibrosis, glandular atrophy, abdominal pain and other symptoms. ...

The Murine Choline-Deficient, Ethionine-Supplemented (CDE) Diet Model of Chronic Liver Injury

Chronic liver diseases, such as viral hepatitis, alcoholic liver disease, or non-alcoholic fatty liver disease, are characterized by continual inflammation, progressive destruction and regeneration of the hepatic parenchyma, liver progenitor cell proliferation, and fibrosis. The end-stage of every chronic liver disease is cirrhosis, a major risk factor for the development of hepatocellular carcinoma. To study processes regulating disease initiation, establishment, and progression, several animal models are used in laboratories. Here we describe a six-week time course of the choline-deficient and ethionine-supplemented (CDE) mouse model, which involves feeding six-week old male C57BL/6J mice with choline-deficient chow and 0.15% DL-ethionine-supplemented drinking water. Monitoring of animal health and a typical body weight loss curve are explained. The protocol demonstrates the gross examination of a CDE-treated liver and blood collection by cardiac puncture for subsequent serum analyses. Next, the liver perfusion technique and collection of different hepatic lobes for standard evaluations are shown, including liver histology assessments by hematoxylin and eosin or Sirius Red stainings, immunofluorescent detection of hepatic cell populations as well as transcriptome profiling of the liver microenvironment. This mouse model is suitable for studying inflammatory, fibrogenic, and liver progenitor cell dynamics induced through chronic liver disease and can be used to test potential therapeutic agents that may modulate these processes.

The Murine Choline-Deficient, Ethionine-Supplemented CDE Diet Model of Chronic Liver Injury

Here we describe a common method to induce chronic liver injury in mice by feeding of a choline-deficient and ethionine-supplemented (CDE) diet. We demonstrate health monitoring, liver perfusion, isolation, and preservation. A time course of six weeks can inform about liver injury, pathohistology, fibrosis, inflammatory, and liver progenitor cell responses.

Chronic liver diseases, such as viral hepatitis, alcoholic liver disease, or non-alcoholic fatty liver disease, are characterized by continual ...

Biology

Partial Bile Duct Ligation in the Mouse: A Controlled Model of Localized Obstructive Cholestasis

In rodents, complete bile duct ligation (cBDL) of the common bile duct is an established surgical technique for studying obstructive cholestasis and bile duct proliferation. However, long-term experiments can lead to increased morbidity and mortality. In select mouse strains with underlying liver disease, meaningful comparisons can be made even with ligation of a single lobe of the liver, which can reduce animal losses and expenses. Here, we describe partial bile duct ligation (pBDL) in the mouse, in which only the left hepatic bile duct is ligated, causing biliary obstruction in the left lobe but not the remaining lobes. With careful microsurgical technique, pBDL experiments can be cost-effective, since the unligated lobe serves as an internal control to the ligated lobes, when subjected to the same conditions in the same animal. Unlike cBDL, a separate sham-operated control group is not necessary. pBDL is highly useful to directly compare localized versus systemic effects of cholestasis and other retained bile components. pBDL can also be repurposed as a novel method to investigate mechanisms related to medications and cell migration.

Here, we present partial bile duct ligation as a surgical model of liver injury and regeneration in rodents.

In rodents, complete bile duct ligation (cBDL) of the common bile duct is an established surgical technique for studying obstructive cholestasis and bile ...

Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

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