Elevated TGF-β1/IL-31 Pathway Is Associated with the Disease Severity of Hepatitis B Virus-Related Liver Cirrhosis

The proinflammatory cytokines transforming growth factor beta 1 (TGF-β1) and interleukin (IL)-31 have been implicated in tissue injury. However, whether TGF-β1/IL-31 are stimulated and elevated in response to liver injury that leads to fibrogenesis in hepatitis B virus-related liver cirrhosis (HBV-LC) remains unclear. To investigate the association between TGF-β1/IL-31 and stages of chronic HBV infection, serum TGF-β1, IL-9, IL-10,IL-17, IL-22, IL-23, IL-31, IL-33, and IL-35 were determined among patients with chronic hepatitis B (CHB; n=19), HBV-LC (n=20), and a normal control population (NC; n=18). Disease severity in patients with HBV-LC was assessed using model for end-stage liver disease (MELD) scores. Serum TGF-β1 and IL-31 levels were strongly positively linked in all subjects, and both correlated positively with IL-22, IL-33, and IL-17. TGF-β1 and IL-31 levels in the blood were both significantly higher in CHB and HBV-LC patients than in NC subjects. Elevated serum TGF-β1 and IL-31 levels were positively associated with albumin, alpha-fetoprotein, creatinine, white blood cell count, and platelet levels. Serum TGF-β1 and IL-31 were markedly higher in HBV-LC patients who did not have esophageal varices, and IL-31 had the highest sensitivity and specificity (90.9% and 66.7%, respectively) for indicating the absence of this complication. In summary, TGF-β1 and IL-31 were linked to progression from CHB to LC, and correlated well with the severity of HBV-LC. These findings suggest possible roles of the TGF-β1/IL-31 pathway in the pathogenesis of liver fibrosis during chronic HBV infection.

Synthesis and properties of a Cu(II) complexing pyrazole ligandoside in DNA

The development of metal base pairs is of immense importance for the construction of DNA nanostructures. Here we report the synthesis of a biaryl pyrazole-phenol nucleoside that forms in DNA a stable self-pair upon complexation of a Cu(II) ion. A sequence with five consecutive pyrazole nucleotides allows the complexation of five Cu(II) ions in a row.

Ratios of regulatory T cells/T-helper 17 cells and transforming growth factor-β1/interleukin-17 to be associated with the development of hepatitis B virus-associated liver cirrhosis

BACKGROUND AND AIM

The aim of this study is to evaluate the association of the regulatory T cells (Treg)/T-helper (Th) 17 cells and transforming growth factor-β1 (TGF-β1)/interleukin-17 (IL-17) ratios with the survival and disease progression in patients with hepatitis B virus (HBV)-associated liver cirrhosis (LC).

METHODS

The frequencies of Treg and Th17 cells were analyzed in 28 patients with HBV-LC, 70 patients with chronic hepatitis B (CHB) and 20 normal controls (NC) by flow cytometry. The levels of cytokines related to Treg/Th17 differentiation, including IL-10, TGF-β1, IL-17, and IL-23, were measured by ELISA.

RESULTS

Compared with NC, Treg cells were significantly increased in CHB patients and slightly increased in HBV-LC patients, whereas Th17 cells were markedly increased both in patients with CHB and HBV-LC. HBV-LC patients, especially the nonsurvival ones, manifested a profound decrease in the Treg/Th17 ratio, which was negatively correlated with Child-Pugh and model of end-stage liver disease scores. Serum IL-10, TGF-β1, IL-17, and IL-23 levels were all significantly higher in HBV-LC patients than in NC. In addition, the TGF-β1/IL-17 ratio was also markedly increased in patients with HBV-LC, especially in nonsurvival and decompensated liver cirrhosis patients, and positively correlated with total bilirubin, Child-Pugh, and model of end-stage liver disease scores.

CONCLUSIONS

The decreased Treg/Th17 ratio and increased TGF-β1/IL-17 ratio may be associated with the survival and disease progression in HBV-LC patients, and both of the two ratios can be used independently to predict the prognosis and disease progression of HBV-LC patients.

Optimal conditions for "heat-conduct effect" in liver tissue during radiofrequency ablation

AIM

This study was conducted to optimize the "heat-conduct effect" to increase the efficacy of radiofrequency ablation (RFA) in the treatment of liver tumors.

METHODS

To simulate the "heat-conduct effect" caused by RFA, isolated pig livers were heated by an inserted metal tube through which water with different incoming temperatures was passed. The tissue temperature was measured within 5- and 10-mm radiuses. Further, changes in color and morphology of the tissue were recorded.

RESULTS

Using an incoming temperature of 70 °C, the effective ablation radius of 5 mm was achieved within 10 min. To expand the effective radius to 10 mm, the tube temperature needed to be maintained at above 80 °C for 40 min; alternatively, the tube temperature above 90 °C and heating time of 25 min were also sufficient.

CONCLUSION

To achieve the complete ablation in isolated liver within the 10 mm radius by "heat-conduct effect", the temperature of the heating center should be maintained above 80 - 90 °C with the exposure time of 25-40 min.

Nuclear factor κB (NF-κB) suppresses food intake and energy expenditure in mice by directly activating the Pomc promoter

AIMS/HYPOTHESIS

While chronic low-grade inflammation is associated with obesity, acute inflammation reduces food intake and leads to negative energy balance. Although both types of inflammation activate nuclear factor κB (NF-κB) signalling, it remains unclear how NF-κB activation results in opposite physiological responses in the two types of inflammation. The goal of this study was to address this question, and to understand the link between inflammation and leptin signalling.

METHODS

We studied the ability of NF-κB to modulate Pomc transcription, and how it impinges on signal transducer and activator of transcription 3 (STAT3)-mediated leptin signalling by using a combination of animal models, biochemical assays and molecular biology.

RESULTS

We report that suppression of food intake and physical movement with acute inflammation is not dependent on STAT3 activation in pro-opiomelanocortin (POMC) neurons. Under these conditions, activated NF-κB independently leads to increased Pomc transcription. Electrophoretic mobility shift assay and chromatin immunoprecipitation (ChIP) experiments reveal that NF-κB v-rel reticuloendotheliosis viral oncogene homologue A (avian) (RELA [also known as p65]) binds to the Pomc promoter region between -138 and -88 bp, which also harbours the trans-acting transcription factor 1 (SP1) binding site. We found significant changes in the methylation pattern at this region and reduced Pomc activation under chronic inflammation induced by a high-fat diet. Furthermore, RELA is unable to bind and activate transcription when the Pomc promoter is methylated. Finally, RELA binds to STAT3 and inhibits STAT3-mediated promoter activity, suggesting that RELA, possibly together with forkhead box-containing protein 1 (FOXO1), may prevent STAT3-mediated leptin activation of the Pomc promoter.

CONCLUSIONS/INTERPRETATION

Our study provides a mechanism for the involvement of RELA in the divergent regulation of energy homeostasis in acute and chronic inflammation.

Characteristics of diagnosis and therapy of adolescent malignant ovarian tumors

BACKGROUND

To improve the early diagnosis rate of adolescent malignant ovarian tumors, avoid misdiagnosis, select proper therapy, avoid excessive therapy, and render therapy more tolerable.

MATERIALS AND METHODS

A comprehensive review of adolescent malignant ovarian tumors, such as types, difficulties of early diagnosis, therapeutic principles, prognosis, fertility preserving through the authors' clinical experience, with reference to Chinese and international literatures.

RESULTS AND CONCLUSION

The majority of adolescent malignant tumors are malignant germ cell, the malignancy is high and it is difficult to diagnose in the early stage, likely to be ignored. Their diagnosis is therefore fundamental, while selecting the most appropriate therapeutic approach that also considers fertility-sparing without compromising prognosis and avoiding over-treatment.

Potential metabolite markers of schizophrenia

Schizophrenia is a severe mental disorder that affects 0.5-1% of the population worldwide. Current diagnostic methods are based on psychiatric interviews, which are subjective in nature. The lack of disease biomarkers to support objective laboratory tests has been a long-standing bottleneck in the clinical diagnosis and evaluation of schizophrenia. Here we report a global metabolic profiling study involving 112 schizophrenic patients and 110 healthy subjects, who were divided into a training set and a test set, designed to identify metabolite markers. A panel of serum markers consisting of glycerate, eicosenoic acid, β-hydroxybutyrate, pyruvate and cystine was identified as an effective diagnostic tool, achieving an area under the receiver operating characteristic curve (AUC) of 0.945 in the training samples (62 patients and 62 controls) and 0.895 in the test samples (50 patients and 48 controls). Furthermore, a composite panel by the addition of urine β-hydroxybutyrate to the serum panel achieved a more satisfactory accuracy, which reached an AUC of 1 in both the training set and the test set. Multiple fatty acids and ketone bodies were found significantly (P<0.01) elevated in both the serum and urine of patients, suggesting an upregulated fatty acid catabolism, presumably resulting from an insufficiency of glucose supply in the brains of schizophrenia patients.

SU-E-J-108: Quantitative Analysis of Longitudinal Cognitive Impairment Due to Radiation Therapy Based on Automatic Segmentation of Hippocampus and Subcortical Structure

PURPOSE

In this study, we developed a quantitative analysis tool based on patient's longitudinal MR images to 1) measure the radiation dose received by each subcortical structure, 2) follow the change of volume and shape of each structure longitudinally. This tool provides a systematic approach to study the radiation therapy (and subsequent chemotherapy) associated with cognitive impairments.

METHODS

MRI scans of one patient taken before and after radiation therapy are demonstrated in this study. 3D Conformal radiation therapy was performed on RapidArc™. An open source MRI analysis tool, FMRIB's Integrated Registration and Segmentation Tool (FIRST), was used for segmentation. The images are registered to a standard template with expert-defined labeling for all sub-cortical structures, and the labeling of each structure is mapped back to the individual MRI space for segmentation. After the segmentation, the radiation dose map was coregistered to the MRI space to calculate the dose received by each structure.

RESULTS

For the structure that is contained within the radiation zone, we can calculate the total dose based on the volumetric distribution of radiation dose. For the structure that is outside the radiation field, we can calculate the distance from the radiation zone. We have demonstrated in this work that the analysis can be done for all segmented sub-cortical structures. The change of volume before and after radiation treatment can be analyzed, and the results can be correlated with the change of cognitive performance over time.

CONCLUSIONS

We presented an automated tool for efficient, quantitative and user-independent measurements of radiation dose in subcortical structures. The obtained results can be correlated with the cognitive test score and the clinical outcome to evaluate radiation and the subsequent chemotherapy induced changes in brain structures and functions.

Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy

BACKGROUND

Optimal duration of anti-viral therapy in chronic hepatitis B virus (HBV) infection remains unclear.

AIM

To investigate factors that could predict relapse after stopping anti-viral agents.

METHODS

Chronic hepatitis B patients who were treated with anti-viral agents (lamivudine, adefovir, entecavir) and have stopped the treatment were recruited. Anti-viral agents were stopped according to the recommendations of the Asian Pacific Association for the Study of the Liver. Virological relapse was defined as an increase in serum HBV DNA to >1000 copies/mL after discontinuation of treatment.

RESULTS

Eighty-four (69 treatment naïve and 15 lamivudine resistant) patients were eligible for this study. Thirty-seven patients developed virological relapse at 4.3 ± 2.9 (range 1-11) months after discontinuation of therapy. The 1-year cumulative probability of virological relapse was 42% and 47% in HBeAg (hepatitis B e antigen)-positive (n = 41) and HBeAg (hepatitis B e antigen)-negative (n = 43) patients, respectively. On multivariate analysis by Cox proportional hazard model, pre-existing lamivudine resistance, delayed suppression of HBV DNA to undetectable level during anti-viral therapy and to a higher HBsAg (hepatitis B surface antigen) level at the end of treatment were associated with virological relapse. Twelve of the 15 (80%) lamivudine resistant patients developed virological relapse. Among the 11 treatment naïve patients who had HBsAg ≤ 2 log IU/mL at the end of treatment, 1 (9%) of them had virological relapse.

CONCLUSIONS

Treatment cessation among lamivudine resistant patients is associated with high risk of virological relapse. Serum HBsAg level at the end of treatment and rate of HBV DNA suppression can provide supplementary information to guide the timing of stopping anti-viral drugs.

Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy

BACKGROUND

Optimal duration of anti-viral therapy in chronic hepatitis B virus (HBV) infection remains unclear.

AIM

To investigate factors that could predict relapse after stopping anti-viral agents.

METHODS

Chronic hepatitis B patients who were treated with anti-viral agents (lamivudine, adefovir, entecavir) and have stopped the treatment were recruited. Anti-viral agents were stopped according to the recommendations of the Asian Pacific Association for the Study of the Liver. Virological relapse was defined as an increase in serum HBV DNA to >1000 copies/mL after discontinuation of treatment.

RESULTS

Eighty-four (69 treatment naïve and 15 lamivudine resistant) patients were eligible for this study. Thirty-seven patients developed virological relapse at 4.3 ± 2.9 (range 1-11) months after discontinuation of therapy. The 1-year cumulative probability of virological relapse was 42% and 47% in HBeAg (hepatitis B e antigen)-positive (n = 41) and HBeAg (hepatitis B e antigen)-negative (n = 43) patients, respectively. On multivariate analysis by Cox proportional hazard model, pre-existing lamivudine resistance, delayed suppression of HBV DNA to undetectable level during anti-viral therapy and to a higher HBsAg (hepatitis B surface antigen) level at the end of treatment were associated with virological relapse. Twelve of the 15 (80%) lamivudine resistant patients developed virological relapse. Among the 11 treatment naïve patients who had HBsAg ≤ 2 log IU/mL at the end of treatment, 1 (9%) of them had virological relapse.

CONCLUSIONS

Treatment cessation among lamivudine resistant patients is associated with high risk of virological relapse. Serum HBsAg level at the end of treatment and rate of HBV DNA suppression can provide supplementary information to guide the timing of stopping anti-viral drugs.