Somatic mutations and clonal dynamics in healthy and cirrhotic human liver

The commonest causes of chronic liver disease are excess alcohol intake, viral hepatitis or non-alcoholic fatty liver disease, with the clinical spectrum ranging in severity from hepatic inflammation through cirrhosis to liver failure or hepatocellular carcinoma. The hepatocellular carcinoma genome exhibits diverse mutational signatures, resulting in recurrent mutations across >20-30 cancer genes(1–7). Stem cells from normal livers have low mutation burden and limited diversity of signatures(8), suggesting that the complexity of hepatocellular carcinoma arises during progression to chronic liver disease and subsequent malignant transformation. We sequenced whole genomes of 482 microdissections of 100-500 hepatocytes from 5 normal and 9 cirrhotic livers. Compared to normal liver, cirrhotic liver had higher mutation burden. Although rare in normal hepatocytes, structural variants, including chromothripsis, were prominent in cirrhosis. Driver mutations, both point mutations and structural variants, affected 1-5% clones. Clonal expansions millimetres in diameter occurred in cirrhosis, sequestered by bands of fibrosis engirdling regenerative nodules. Some mutational signatures were universal and equally active in both non-malignant hepatocytes and HCC; some were substantially more active in HCC than chronic liver disease; and others, arising from exogenous exposures, were present in a subset of patients. Up to 10-fold within-patient variation in activity of exogenous signatures existed between adjacent cirrhotic nodules, arising from clone-specific and microenvironmental forces. Synchronous hepatocellular carcinomas exhibited the same mutational signatures as background cirrhotic liver, but with higher burden. Somatic mutations chronicle the exposures, toxicity, regeneration and clonal structure of liver tissue as it progresses from health to disease.