Global burden of Liver Disease: 2023 Update

Ganoderma lucidum spore oil attenuates acute liver injury by modulating lipid metabolism and gut microbiota

The incidence of acute liver injury is increasing and poses a significant threat to human health. Ganoderma lucidum spore oil (GLSO), a lipid substance extracted from Ganoderma lucidum spore powder using supercritical CO2 technology, has been investigated for its potential to prevent acute liver injury. However, the specific mechanism underlying the protective effects of GLSO remains incompletely understood. In this study, we investigated the preventive effect of GLSO on acute liver injury in rats, focusing on the gut microbiome and serum metabolomics. GLSO effectively alleviated liver dysfunction and reduced inflammation, leading to the prevention of acute liver injury in rats. Serum metabolomics analysis revealed that GLSO primarily modulated lipid metabolic pathways related to glycerophospholipid metabolism and sphingolipid metabolism. Specifically, GLSO decreased the levels of metabolites such as lysophosphatidylcholine (LPC), glycerophosphatidylcholine (GPC), and sphinganine 1-phosphate (SA1P), while increasing the levels of phosphatidylglycerol (PG) and digalactosylceramide (DGC). Gut microbiomics data indicated that GLSO effectively regulated the composition of the gut microbiota in rats with acute liver injury. Specifically, it increased the abundance of Firmicutes and decreased the abundance of Proteobacteria. Mantel test correlation analysis revealed a close relationship between gut microbial Burkholderiales and lipid metabolites in GLSO-mediated prevention of acute liver injury. GLSO exerts its preventive effects on acute liver injury by remodeling the gut microbiota and regulating lipid metabolism. These findings provide novel insights and potential directions for the development of new drugs targeting acute liver injury.

Immune cell phenotypes as causal factors in liver disease progression revealed by Mendelian randomization

Immune cells are central mediators of the immune response and play critical roles in the pathogenesis and progression of liver diseases. Understanding the specific contributions of immune cells to liver disease progression is essential for developing targeted therapeutic strategies. In this study, we employed a two-sample Mendelian randomization (MR) approach to explore potential causal relationships between peripheral immune cell phenotypes and liver diseases, using genetic instrumental variables from large-scale genome-wide association studies (GWAS). Applying the inverse variance weighted (IVW) methods, we identified that monocyte count(odds ratio (OR) 0.81; 95% confidence interval (CI) 0.74-0.90; P  =  5.95 × 10- 5, PFDR = 3.57 × 10- 4), CD3- lymphocyte/lymphocyte (OR 0.59, 95% CI 0.45-0.79; P  =  3.29 × 10- 4, PFDR = 5.92 × 10- 3) and SSC-A (Side Scatter Area) on Natural Killer (NK) cells (OR 0.89, 95% CI 0.82-0.95; P  =  1.37 × 10- 3, PFDR = 0.0396) acted as protective factors against alcoholic liver disease. Similarly, the trait HLA DR++ monocyte/monocyte was associated with a lower risk of autoimmune hepatitis (OR 0.56, 95% CI 0.41-0.79; P  =  7.42 × 10- 4, PFDR = 0.0475). Conversely, an elevated blood monocytic Myeloid-Derived Suppressor Cells (MDSCs) count was associated with a higher risk of chronic hepatitis (OR 1.23, 95% CI 1.11-1.37; P  =  1.13 × 10- 4, PFDR = 1.58 × 10- 3). Similarly, higher levels of HLA DR on CD14- CD16+ monocyte (OR 0.84, 95% CI 0.78-0.91; P  =  2.07 × 10- 5, PFDR = 1.32 × 10- 3) conferred lower risk for cirrhosis of liver. In hepatic failure, CD39+ resting CD4 regulatory T cell count (OR 0.85, 95% CI 0.79-0.92; P  =  1.70 × 10- 5, PFDR = 5.25 × 10- 3) played a protective role and CD28+ CD45RA- CD8dim T cell/CD8dim T cell (OR 1.14, 95% CI 1.06-1.22; P  =  2.63 × 10- 4, PFDR = 0.0406) exhibited a risk function. Our findings highlight key immune pathways in liver disease progression and underscore potential immunomodulatory targets for future therapeutic interventions. Further research is warranted to clarify the mechanistic underpinnings of these associations.

A robust diagnostic model for high-risk MASH: integrating clinical parameters and circulating biomarkers through a multi-omics approach

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a critical health concern, with metabolic dysfunction-associated steatohepatitis (MASH) representing a severe subtype that poses significant risks. This study aims to develop a robust diagnostic model for high-risk MASH utilizing a multi-omics approach.

METHODS

We initiated proteomic analysis to select differential proteins, followed by liver transcriptional profiling to localize these proteins. An intersection of differential proteins and liver-expressed genes facilitated the identification of candidate biomarkers. Subsequently, scRNA-seq data helped ascertain the subcellular localization of these biomarkers in kupffer cells. We then established two MASLD models to investigate the co-localization of F4/80 and the target proteins in Kupffer cells using immunofluorescence dual-labeling. Correlation analyses were performed using blood samples from a discovery cohort of 144 individuals with liver pathology to validate the relationships between candidate biomarkers and MASLD phenotypes. Using LASSO regression, we established the ABD-LTyG predictive model for high-risk MASH (NAS ≥ 4 + F ≥ 2) and validated its efficacy in an independent cohort of 171 individuals. Finally, we compared this model against three classic non-invasive liver fibrosis diagnostic methods.

RESULTS

A proteo-transcriptomic comparison identified 58 consistent biomarkers in plasma and liver, with 25 closely associated with MASLD phenotype. Utilizing single-cell data and the HPA database, we delineated the localization of these biomarkers in liver cells, identifying TREM2, IL18BP, and LGALS3BP predominantly in the Kupffer cell subpopulation. Validation in animal models confirmed elevated expression and cellular localization of TREM2, IL18BP, and LGALS3BP in MASLD. To enhance diagnostic capability, we integrated clinical characteristics using LASSO regression to develop the ABD-LTyG model, comprising AST, BMI, total bilirubin (TB), vitamin D, TyG, and the biomarkers LGALS3BP and TREM2. This model demonstrated an AUC of 0.832 (95% CI 0.753-0.911) in the discovery cohort and 0.807 (95% CI 0.742-0.872) in the validation cohort for diagnosing high-risk MASH, outperforming traditional assessments such as FIB-4, NFS, and APRI.

CONCLUSION

The integration of circulating biomarkers and clinical parameters into the ABD-LTyG model offers a promising approach for diagnosing high-risk MASH. This study underscores the importance of multi-omics strategies in enhancing diagnostic accuracy and guiding clinical decision-making.

Total Sanghuangporus vaninii extract inhibits hepatocyte ferroptosis and intestinal microbiota disturbance to attenuate liver fibrosis in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Sanghuangporus, the dried fruiting body of Sanghuangporus vaninii (Ljub) L.W.Zhou et Y.C.Dai. As the main species of Sanghuang, it has been well-known and used commonly as a traditional medicinal and edible macrofungi for thousands of years in many countries, including China, Korea and Japan. Although it has good hepatoprotective activity, its potential efficacy and mechanism on liver fibrosis remain elusive.

AIM OF THE STUDY

Total Sanghuangporus vaninii extract (TSH) was prepared by ethanol extraction to investigate its chemical components and to conduct an initial assessment of its efficacy and underlying mechanism in a murine model of liver fibrosis.

MATERIALS AND METHODS

The chemical components of TSH were initially analyzed by UHPLC-Q-Orbitrap HRMS. To elucidate the effects of TSH, an in vivo model of fibrosis was established in mice using carbon tetrachloride (CCl4), followed by assessments of serum liver function and histopathological analysis. Besides, indicators related to liver fibrosis, hepatic stellate cells (HSCs) activation, inflammation response and ferroptosis related indicators were detected by western blotting, immunohistochemistry and real-time quantitative PCR (RT-qPCR) analysis. Additionally, the 16S rDNA sequencing and untargeted metabolomics analysis of intestinal microbiota were employed to investigating the role of TSH in gut microbiome. In vitro, the human hepatocyte line L02 was stimulated with erastin and treated with or without TSH to elucidate its underlying mechanism.

RESULTS

The administration of TSH significantly improved serum indicators of liver injury in CCl4-induced fibrosis mice, reduced HSCs activation and collagen deposition, while inhibiting the expressions of transforming growth factor-β1(TGF-β1)/Smad signaling pathway. Notably, TSH treatment attenuated hepatocyte ferroptosis and lipid peroxidation both in vivo and in vitro, as evidenced by a marked decrease in liver iron and malondialdehyde (MDA) contents. In particular, TSH was demonstrated to activate the nuclear factor erythroid 2-related factor 2 (Nrf2)-glutathione peroxidase 4 (GPX4) signaling pathway, thereby protecting hepatocytes from ferroptosis with a particular enhancement of Nrf2 nuclear transcription. Furthermore, TSH influenced gut microbiota composition and ameliorated intestinal metabolic disorders. The increased abundance of Parasutterella and Olsenellas due to TSH treatment was significantly positively correlated with elevated phosphatidylcholines involved in linoleic acid metabolism, and negatively correlated with the reduction of fatty acyls. And the enrichment of intestinal linoleic acid metabolism presented a negative correlation in liver fibrosis biomarkers.

CONCLUSIONS

Our findings indicate that the TSH treatment exerts a significantly protective effect on CCl4-induced mice by ameliorating hepatic injury and ferroptosis damage, inhibiting HSCs activation and collagen deposition, and remodeling gut microbiota homeostasis and metabolic imbalance. Notably, TSH attenuated hepatocyte ferroptosis in liver fibrosis and exhibited upregulation of the Nrf2-GPX4 signaling pathway. Furthermore, TSH could enrich the abundance of Parasutterella and Olsenellas, which may contribute to intestinal linoleic acid metabolism, thereby contributing to the reduction of liver fibrosis damage. Our study provides more effective and unreported evidence of TSH in anti-fibrosis activity.

Ginseng and its functional components in non-alcoholic fatty liver disease: therapeutic effects and multi-target pharmacological mechanisms

Background

Non-alcoholic fatty liver disease (NAFLD) is a common type of chronic liver disease and its incidence is increasing. Its disease progression is closely related to non-alcoholic steatohepatitis and liver fibrosis. Effective treatment is currently lacking. The traditional Chinese medicine ginseng (Panax ginseng) shows unique advantages in NAFLD intervention, but its complex compositional system and molecular mechanism network still need to be systematically analyzed.

Objective

This paper systematically integrates evidence from nearly 20 years of research to elucidate the multi-target pharmacological mechanism of ginseng for the treatment of NAFLD.

Methods

Relevant information was sourced from Pubmed, Web of science, Embase and CNKI databases. Using BioRender and visio to draw biomedical illustrations.

Results

The active ingredients of ginseng contain 2 classes of saponins (tetracyclic triterpene saponins, pentacyclic triterpene saponins and other modified types) and non-saponins. Different cultivation methods, processing techniques and extraction sites have expanded the variety of ginseng constituents and demonstrated different pharmacological activities. Studies have shown that ginseng and its functional components have the ability to regulate lipid metabolism disorders, inflammation, oxidative stress, endoplasmic reticulum stress, insulin resistance, disruption of intestinal flora structure, cell death and senescence. Demonstrates the potential of ginseng for the treatment of NAFLD.

Conclusion

This study reveals for the first time the integrative mechanism of ginseng in the treatment of NAFLD through the tertiary mode of action of "multi-component multi-target multi-pathway". The multilevel modulatory ability of ginseng provides a new direction for the development of comprehensive therapeutic strategies for NAFLD.

Hepatocellular carcinoma: pathogenesis, molecular mechanisms, and treatment advances

Hepatocellular Carcinoma (HCC), a highly prevalent malignancy, poses a significant global health challenge. Its pathogenesis is intricate and multifactorial, involving a complex interplay of environmental and genetic factors. Viral hepatitis, excessive alcohol consumption, and cirrhosis are known to significantly elevate the risk of developing HCC. The underlying biological processes driving HCC are equally complex, encompassing aberrant activation of molecular signaling pathways, dysregulation of hepatocellular differentiation and angiogenesis, and immune dysfunction. This review delves into the multifaceted nature of HCC, exploring its etiology and the intricate molecular signaling pathways involved in its development. We examine the role of immune dysregulation in HCC progression and discuss the potential of emerging therapeutic strategies, including immune-targeted therapy and tumor-associated macrophage interventions. Additionally, we explore the potential of traditional Chinese medicine (TCM) monomers in inhibiting tumor growth. By elucidating the complex interplay of factors contributing to HCC, this review aims to provide a comprehensive understanding of the disease and highlight promising avenues for future research and therapeutic development.

Limitations in real-world telemonitoring applicability in gastroenterology and hepatology: a systematic review

Objective

Telemonitoring has the potential to improve healthcare delivery. While the field continues to develop, ensuring interventions are accessible across disease populations is essential for successful clinical translation. This systematic review of telemonitoring aims to understand the generalisability of study findings in the distinctly different patient cohorts of inflammatory bowel disease (IBD) and decompensated cirrhosis, focusing on differences in sociodemographic characteristics.

Design/method

Relevant studies were identified by searching Ovid MEDLINE, EMBASE and Cochrane databases from 2013 to January 2024. A narrative review was conducted.

Results

27 studies with 3806 patients were included. IBD-based studies predominated (n=23, 85%) with four (15%) studies in patients with decompensated cirrhosis. All studies were undertaken in high-income economies. While age and gender were documented in most studies, only 11% documented ethnicity, 33% documented socioeconomic status and 33% documented education status. Substance misuse with alcohol, smoking or other illicit drugs was documented in 7%. Multiple languages were available in 15% of studies. There was significant heterogeneity in endpoints used across studies investigating interventions in both patient cohorts.

Conclusions

This systematic review demonstrates the lack of reporting in critical demographic domains with significant heterogeneity in study design and endpoints across both disease processes. This potentially limits the use of telemonitoring outside of a trial setting. To improve real-world implementation and reduce the impact of health inequalities, it is critical that a consensus is reached for minimum reporting standards for telemedicine interventions.

PROSPERO registration number

CRD42024497369.

Research Progress of Electrochemical Biosensors for Diseases Detection in China: A Review

Disease diagnosis is not only related to individual health but is also a crucial part of public health prevention. Electrochemical biosensors combine the high sensitivity of electrochemical methods with the inherent high selectivity of biological components, offering advantages such as excellent sensitivity, fast response time, and low cost. The generated electrical signals have a linear relationship with the target analyte, allowing for identification and concentration detection. This has become a very attractive technology. This review offers a summary of recent advancements in electrochemical biosensor research for disease diagnosis in China. It systematically categorizes and summarizes biosensors developed in China for detecting cancer, infectious diseases, inflammation, and neurodegenerative disorders. Additionally, the review delves into the fundamental working principles, classifications, materials, preparation techniques, and other critical aspects of electrochemical biosensors. Finally, it addresses the key challenges impeding the advancement of electrochemical biosensors in China and examines promising future directions for their development.

Temporal and geospatial patterns of hepatitis C virus prevalence: a longitudinal examination using national health insurance service data in the Republic of Korea (2005-2022)

BACKGROUND

Viral hepatitis, recognized as a significant global public health threat by the World Health Organization (WHO), has spurred efforts to establish elimination goals by 2030. In Republic of Korea (Korea), the prevalence of Hepatitis C virus (HCV) infection exhibits significant regional disparities, necessitating tailored infection control measures at the regional level. This study aimed to analyze the HCV prevalence trend by area (region/town) in Korea, from 2005 to 2022, and identify the areas requiring priority management.

METHODS

A comprehensive analysis of HCV prevalence trends across different geographical regions and towns from 2005 to 2022 was conducted. Using data from the National Health Insurance Service, individuals diagnosed with acute or chronic HCV during this period were included in the analysis. HCV prevalence was adjusted by area, year, sex, and age. Additionally, trends in annual percent changes (APC) and average APC (AAPC) in HCV prevalence were examined using Joinpoint regression analysis.

RESULTS

Age, sex, and region adjusted HCV prevalence per 100,000 people declined from 151 in 2005 to 98 in 2022. During the 18 years, the highest HCV prevalence was recorded in the southern regions of Korea (Busan, Jeonnam, and Gyeongnam) and in the towns of Namhae-gun of Gyeongnam, Boeun-gun of Chungbuk, and Sunchang-gun of Jeonbuk. The age-, sex-, and region-adjusted annual HCV prevalence decreased significantly at an APC of -2.5% (95% confidence interval [CI]: -3.5, -1.4) and AAPC of -2.7% (95%CI: -4.3, -1.0). By town, the prevalence decreased the most in Boeun-gun of Chungbuk (AAPC: -23.7%; 95%CI: -30.2, -16.5) and increased the most in Gunwi-gun of Gyeongbuk (AAPC: 3.0%; 95%CI: 1.1, 4.9).

CONCLUSIONS

Over 18 years, a notable decline in HCV prevalence was observed in Korea, although this trend exhibited regional disparities. To effectively achieve the WHO hepatitis elimination goals by 2030, targeted interventions should prioritize areas with persistent or emerging prevalence.

Enlightened prognosis: Hepatitis prediction with an explainable machine learning approach

Hepatitis is a widespread inflammatory condition of the liver, presenting a formidable global health challenge. Accurate and timely detection of hepatitis is crucial for effective patient management, yet existing methods exhibit limitations that underscore the need for innovative approaches. Early-stage detection of hepatitis is now possible with the recent adoption of machine learning and deep learning approaches. With this in mind, the study investigates the use of traditional machine learning models, specifically classifiers such as logistic regression, support vector machines (SVM), decision trees, random forest, multilayer perceptron (MLP), and other models, to predict hepatitis infections. After extensive data preprocessing including outlier detection, dataset balancing, and feature engineering, we evaluated the performance of these models. We explored three modeling approaches: machine learning with default hyperparameters, hyperparameter-tuned models using GridSearchCV, and ensemble modeling techniques. The SVM model demonstrated outstanding performance, achieving 99.25% accuracy and a perfect AUC score of 1.00 with consistency in other metrics with 99.27% precision, and 99.24% for both recall and F1-measure. The MLP and Random Forest proved to be in pace with the superior performance of SVM exhibiting an accuracy of 99.00%. To ensure robustness, we employed a 5-fold cross-validation technique. For deeper insight into model interpretability and validation, we employed an explainability analysis of our best-performed models to identify the most effective feature for hepatitis detection. Our proposed model, particularly SVM, exhibits better prediction performance regarding different performance metrics compared to existing literature.

Thyroid function and hepatic fibrosis/cirrhosis: a two-sample Mendelian randomization study

Background

Evidence on the relationship between thyroid function and hepatic fibrosis/cirrhosis are still unclear, with inconsistent conclusions. This Mendelian randomization (MR) study aimed to investigate the potential causal association between thyroid function and hepatic fibrosis/cirrhosis in order to provide new insights for improving prevention and control strategies for this disease.

Methods

Genome-wide association study (GWAS) data on exposures, which included hyperthyroidism, hypothyroidism, and thyroid-stimulating hormone (TSH), were extracted from the MRC Integrative Epidemiology Unit (MRC-IEU) (https://gwas.mrcieu.ac.uk/), and GWAS data for outcomes, including hepatic fibrosis/cirrhosis and chitinase-3-like protein 1 (CHI3L1), were obtained from the FinnGen consortium (https://www.finngen.fi/fi). Inverse variance weighted (IVW), weighted median, and MR-Egger methods were utilized to examine the causal association between thyroid function and the risk of hepatic fibrosis/cirrhosis. Cochran's Q test was used to assess the heterogeneity of instrumental variables (IVs), while MR-PRESSO and leave-one-out analyses were conducted for sensitivity analysis.

Results

IVW estimates suggested that hypothyroidism had a potential causal association with higher odds of hepatic fibrosis/cirrhosis (OR = 1.247, 95% CI: 1.087-1.431). Leave-one-out results indicated that this potential causal relationship was relatively robust. In addition, we assessed the causal association between hypothyroidism and hepatic fibrosis/cirrhosis before and after removal of outliers with heterogeneity. After removing the outliers, the association was still significant (OR = 1.266, 95% CI: 1.082-1.482, P = 0.0046).

Conclusion

Patients with hypothyroidism may have a higher risk of hepatic fibrosis/cirrhosis, and this finding may provide some references for the early screening and prevention of the disease. However, further studies are needed to explore the specific mechanisms by which hypothyroidism influences hepatic fibrosis/cirrhosis.

Developing a novel predictive model for identifying risk factors associated with being lost to follow-up among high-risk patients for recurrence following radical resection of hepatocellular carcinoma: the first report

BACKGROUND

Follow-up is essential especially for patients who are at a high risk of recurrence after radical resection of hepatocellular carcinoma (HCC). The aim of this study was to develop a predictive model aimed at identifying the risk factors associated with being lost to follow-up (LTFU) in high-risk patients for recurrence following radical resection of HCC.

METHODS

The retrospective study was conducted at our institution between October 2018 to May 2023. The patients who underwent radical liver resection for HCC and had high-risk factors for recurrence were categorized into an LTFU group and a control group. Multivariate logistic regression analysis was utilized to determine risk factors and construct a nomogram predictive model.

RESULTS

A total of 352 patients were included and subsequently classified into two distinct groups: the LTFU group (n = 123, 34.94%) and the control group (n = 229, 65.06%). Logistic regression analysis was then conducted to explore the potential associations between various factors and the occurrence of LTFU. The findings identified several independent risk factors for LTFU, including smoking (odds ratio, OR = 1.823, 95% confidence interval, CI 1.086-3.060, p = 0.023); residing more than 200 km away from the hospital (OR = 1.857, 95% CI 1.105-3.121, p = 0.019); having an unstable profession (OR = 1.918, 95% CI 1.112-3.311, p = 0.019); and lacking medical insurance (OR = 5.921, 95% CI 1.747-20.071, p = 0.004); the presence of liver cirrhosis (OR = 2.161, 95% CI 1.153-4.048, p = 0.016); an operation time less than 240 min (OR = 2.138, 95% CI 1.240-3.688, p = 0.006); and the absence of postoperative adjuvant therapy (OR = 2.641, 95% CI 1.504-4.637, p = 0.001). Based on these seven significant factors, a main effects model was established, designated as the Wei-LTFU model, which achieved an area under the curve value of 0.744 (95% CI 0.691-0.798) in predicting the likelihood of LTFU.

CONCLUSION

A main effects model, namely the Wei-LTFU model, incorporating the seven significant factors was formulated to predict the likelihood of LTFU occurrence, ultimately aiming to assist healthcare workers in developing effective strategies to improve follow-up outcomes for patients.

Geniposidic Acid Targeting FXR "S332 and H447" Mediated Conformational Change to Upregulate CYPs and miR-19a-3p to Ameliorate Drug-Induced Liver Injury

Drug-induced liver injury (DILI), caused by chemical drugs and traditional Chinese medicine, often leads to severe outcomes like liver failure due to a lack of early detection markers. Farnesoid X receptor (FXR), a key regulator of bile acid (BA) and cholesterol metabolism, is a potential therapeutic target. This study investigates the pathogenesis, markers, and treatment strategies for DILI, focusing on the hepatoprotective effects of geniposidic acid (GPA) from Gardenia jasminoides J. Ellis. Using cellular and animal models of acute and chronic DILI induced by acetaminophen and triptolide, we explored GPA's mechanisms in BA and cholesterol metabolism. Lipidomic and BA analyses revealed that GPA alleviates DILI by enhancing bile acid synthesis and transport via FXR activation. Experiments using AAV-shFXR, Fxr- / - mice and molecular assays demonstrated that GPA targets Ser332 and His447 on FXR ligand-binding domain, promoting FXR nuclear translocation and initiating cytochrome P450 proteins (CYPs) transcriptional activation for BA metabolism. Additionally, miRNA sequencing and RNA-pulldown assays showed that GPA-activated FXR upregulates miR-19a-3p, binding to LXR 3'UTR to inhibit cholesterol production. These findings reveal the GPA-FXR "structure-target" relationship, highlighting a dual mechanism in which GPA promotes CYPs-mediated bile acid metabolism and miR-19a-3p-mediated cholesterol synthesis inhibition, providing a basis for FXR-targeted DILI therapies.

Hepatic HKDC1 deletion alleviates western diet-induced MASH in mice

The global prevalence of Metabolic Dysfunction-Associated Steatohepatitis (MASH) has been rising sharply, closely mirroring the increasing rates of obesity and metabolic syndrome. MASH exhibits a strong sexual dimorphism where females are affected with more severe forms after menopause. Hexokinase domain-containing protein 1 (HKDC1) has recently been recognized for its role in liver diseases, where its expression is minimal under normal conditions but significantly increases in response to metabolic stressors like obesity and liver injury. This selective upregulation suggests HKDC1's potential specialization in hepatic glucose and lipid dysregulation, linking it closely to the progression of MASH. This study aims to clarify the role of HKDC1 in Western diet-induced MASH in female mice by examining its impact on hepatic glucose and lipid metabolism, offering insights into its potential as a therapeutic target and addressing the need for sex-specific research in liver disease. This study reveals that HKDC1 expression is elevated in obese women with MASH and correlates with liver pathology. In a mouse model, liver-specific HKDC1 knockout (HKDC1LKO) protected against Western diet-induced obesity, glucose intolerance, and MASH features, including steatosis, inflammation, and fibrosis. Transcriptomic analysis showed that HKDC1 deletion reduced pro-inflammatory and pro-fibrotic gene expression, while gut microbiome analysis indicated a shift toward MASH-protective bacteria. These findings suggest that HKDC1 may exacerbate MASH progression through its role in metabolic and inflammatory pathways, making it a potential therapeutic target.

Neem leaf extract alleviates LPS/D-GalN induced acute hepatitis in mice through its anti-inflammatory effects and activation of autophagy

Acute hepatitis, characterized by rapid onset and high mortality, can result from infections, toxins, and other factors. However, current treatment options have significant side effects, necessitating further research into alternative therapies. This study investigated the extraction method of neem extract and found that its ethanolic extract effectively reduced mortality and decreased ALT and AST levels in mice serum, improving liver pathology. HPLC analysis identified azadirachtin and nimbolide in the extract. It also downregulated NF-κB, NLRP3, and p62 levels, while upregulating Lc3B and Atg5 levels. Experiments in Atg5 knockout mice showed that the absence of Atg5 weakened the extract's efficacy in reducing liver damage and inflammation and affected the extent of NLRP3 protein downregulation. However, it did not affect the extract's ability to reduce NF-κB. Overall, the ethanolic extract of neem leaves primarily modulates the inflammatory response through the NF-κB signaling pathway. The extract's efficacy in reducing NLRP3 is associated with autophagy. These discoveries offer a new theoretical basis for the role of neem in treating acute hepatitis.

Endothelial RUNX3 controls LSEC dysfunction and angiocrine LRG1 signaling to prevent liver fibrosis

BACKGROUND AND AIMS

Liver fibrosis represents a global health burden, given the paucity of approved antifibrotic therapies. Liver sinusoidal endothelial cells (LSECs) play a major gatekeeping role in hepatic homeostasis and liver disease pathophysiology. In early tumorigenesis, runt-related transcription factor 3 (RUNX3) functions as a sentinel; however, its function in liver fibrosis in LSECs remains unclear. This study aimed to investigate the role of RUNX3 as an important regulator of the gatekeeping functions of LSECs and explore novel angiocrine regulators of liver fibrosis.

APPROACH AND RESULTS

Mice with endothelial Runx3 deficiency develop gradual and spontaneous liver fibrosis secondary to LSEC dysfunction, thereby more prone to liver injury. Mechanistic studies in human immortalized LSECs and mouse primary LSECs revealed that IL-6/JAK/STAT3 pathway activation was associated with LSEC dysfunction in the absence of RUNX3. Single-cell RNA sequencing and quantitative RT-PCR revealed that leucine-rich alpha-2-glycoprotein 1 ( LRG1 ) was highly expressed in RUNX3-deficient and dysfunctional LSECs. In in vitro and coculture experiments, RUNX3-depleted LSECs secreted LRG1, which activated HSCs throughTGFBR1-SMAD2/3 signaling in a paracrine manner. Furthermore, circulating LRG1 levels were elevated in mouse models of liver fibrosis and in patients with fatty liver and cirrhosis.

CONCLUSIONS

RUNX3 deficiency in the endothelium induces LSEC dysfunction, LRG1 secretion, and liver fibrosis progression. Therefore, endothelial RUNX3 is a crucial gatekeeping factor in LSECs, and profibrotic angiocrine LRG1 may be a novel target for combating liver fibrosis.

Cardiometabolic risk factors and clinical course of liver cirrhosis

BACKGROUND

The global prevalence of Metabolic Dysfunction-Associated Liver Disease is dramatically increasing with the diffusion of cardiometabolic risk factors (CMRFs). The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of CMRFs (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia).

PATIENTS

667 patients with liver cirrhosis (50 with CMRFs and without non-metabolic aetiological factors, 167 with non-metabolic aetiological factors and without CMRFs, and 450 with both non-metabolic aetiological factors and at least one CMRF) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included.

RESULTS

No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the metabolic or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients in the non-metabolic group, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent CMRFs, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality.

CONCLUSION

Compared to patients without CMRFs, those with CMRFs had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.

Therapeutic Role of Probiotics Against Environmental-Induced Hepatotoxicity: Mechanisms, Clinical Perspectives, Limitations, and Future

Hepatotoxicity is one of the biggest health challenges, particularly in the context of liver diseases, often aggravated by gut microbiota dysbiosis. The gut-liver axis has been regarded as a key idea in liver health. It indicates that changes in gut flora caused by various hepatotoxicants, including alcoholism, acetaminophen, carbon tetrachloride, and thioacetamide, can affect the balance of the gut's microflora, which may lead to increased dysbiosis and intestinal permeability. As a result, bacterial endotoxins would eventually enter the bloodstream and liver, causing hepatotoxicity and inducing inflammatory reactions. Many treatments, including liver transplantation and modern drugs, can be used to address these issues. However, because of the many side effects of these approaches, scientists and medical experts are still hoping for a therapeutic approach with fewer side effects and more positive results. Thus, probiotics have become well-known as an adjunctive strategy for managing, preventing, or reducing hepatotoxicity in treating liver injury. By altering the gut microbiota, probiotics offer a secure, non-invasive, and economical way to improve liver health in the treatment of hepatotoxicity. Through various mechanisms such as regulation of gut microbiota, reduction of pathogenic overgrowth, suppression of inflammatory mediators, modification of hepatic lipid metabolism, improvement in the performance of the epithelial barrier of the gut, antioxidative effects, and modulation of mucosal immunity, probiotics play their role in the treatment and prevention of hepatotoxicity. This review highlights the mechanistic effects of probiotics in environmental toxicants-induced hepatotoxicity and current findings on this therapeutic approach's experimental and clinical trials.

Epidemiology and Risk Determinants of Drug-Induced Liver Injury: Current Knowledge and Future Research Needs

AIMS

Drug-induced liver injury (DILI) is a major global health concern resulting from adverse reactions to medications, supplements or herbal medicines. The relevance of DILI has grown with an aging population, the rising prevalence of chronic diseases and the increased use of biologics, including checkpoint inhibitors. This article aims to summarise current knowledge on DILI epidemiology and risk factors.

METHODS

This review critically appraises available evidence on DILI frequency, outcomes and risk determinants, focusing on drug properties and non-genetic host factors that may influence susceptibility.

RESULTS

DILI incidence varies across populations, with hospitalised patients experiencing notably higher rates than outpatients or the general population. Increased medication use, particularly among older adults and women, may partly explain age- and sex-based disparities in DILI incidence and reporting. Physiological changes associated with aging likely increase susceptibility to DILI in older adults, though further exposure-based studies are needed for definitive conclusions. Current evidence does not strongly support that women are inherently more susceptible to DILI than men; rather, susceptibility appears to depend on specific drugs. However, once DILI occurs, older age and female sex are associated with greater severity and poorer outcomes. Other less-studied host-related risk factors are also discussed based on available evidence.

CONCLUSIONS

This article summarises existing data on DILI frequency, outcomes, drug properties affecting hepatotoxicity and non-genetic host risk factors while identifying critical knowledge gaps. Addressing these gaps through future research could enhance understanding and support preventive measures.

Automated ultrasonography of hepatocellular carcinoma using discrete wavelet transform based deep-learning neural network

This study introduces HCC-Net, a novel wavelet-based approach for the accurate diagnosis of hepatocellular carcinoma (HCC) from abdominal ultrasound (US) images using artificial neural networks. The HCC-Net integrates the discrete wavelet transform (DWT) to decompose US images into four sub-band images, a lesion detector for hierarchical lesion localization, and a pattern-augmented classifier for generating pattern-enhanced lesion images and subsequent classification. The lesion detection uses a hierarchical coarse-to-fine approach to minimize missed lesions. CoarseNet performs initial lesion localization, while FineNet identifies any lesions that were missed. In the classification phase, the wavelet components of detected lesions are synthesized to create pattern-augmented images that enhance feature distinction, resulting in highly accurate classifications. These augmented images are classified into 'Normal,' 'Benign,' or 'Malignant' categories according to their morphologic features on sonography. The experimental results demonstrate the significant effectiveness of the proposed coarse-to-fine detection framework and pattern-augmented classifier in lesion detection and classification. We achieved an accuracy of 96.2 %, a sensitivity of 97.6 %, and a specificity of 98.1 % on the Samsung Medical Center dataset, indicating HCC-Net's potential as a reliable tool for liver cancer screening.

Ginkgolide C attenuated Western diet-induced non-alcoholic fatty liver disease via increasing AMPK activation

BACKGROUND

Non-alcoholic steatohepatitis (NASH) is a metabolic dysregulation-related disorder that is generally characterized by lipid metabolism dysfunction and an excessive inflammatory response. Currently, there are no authorized pharmacological interventions specifically designed to manage NASH. It has been reported that Ginkgolide C exhibits anti-inflammatory effects and modulates lipid metabolism. However, the impact and function of Ginkgolide C in diet-induced NASH are unclear.

METHODS

In this study, mice were induced by a Western Diet (WD) with different doses of Ginkgolide C with or without Compound C (adenosine 5 '-monophosphate (AMP)-activated protein kinase (AMPK) inhibitor). The effects of Ginkgolide C were evaluated by assessing liver damage, steatosis, fibrosis, and AMPK expression.

RESULTS

The results showed that Ginkgolide C significantly alleviated liver damage, steatosis, and fibrosis in the WD-induced mice. In addition, Ginkgolide C markedly improved insulin resistance and attenuated hepatic inflammation. Importantly, Ginkgolide C exerted protective effects by activating the AMPK signaling pathway, which was reversed by AMPK inhibition.

CONCLUSION

Ginkgolide C alleviated NASH induced by WD in mice, potentially via activating the AMPK signaling pathway.

Palliative care & management of symptoms in advanced liver disease: an expert review

INTRODUCTION

Chronic liver disease (CLD) is a leading cause of death worldwide. End-stage liver disease (ESLD) causes a rapid and progressive decline in health and quality of life (QOL) and creates significant suffering and burdens for patients, families, and health systems alike. These patients have significant physical, psychological, and complex social needs that benefit from the support of an interdisciplinary palliative care (PC) team.

AREAS COVERED

This review of the English literature analyzes general palliative care principles for the CLD and ESLD populations including factors affecting QOL and review of symptom management per AASLD and AGA Guidelines. We have also reviewed the impacts of palliative support on QOL, caregiver burden, and healthcare-related outcomes.

EXPERT OPINION

ESLD causes significant suffering and burdens for patients, families, and healthcare systems. PC is an essential component of ESLD care; it improves QOL, reduces caregiver burdens, and shows benefits of reduced healthcare costs and aggressive care at end of life. Provider and community misunderstanding or inexperience of PC is often a barrier to PC involvement. There is a clear lack of standardization in medical training and lack of clear guidelines on when to involve PC in the ESLD population that must be addressed.

Nonparametric Estimation of a Biometric Function Using Ranked Set Sampling With Ties Information

The mean residual life (MRL) function plays an important role in the summary and analysis of survival data. The main advantage of this function is that it summarizes the information in units of time instead of a probability scale, which requires careful interpretation. Ranked set sampling (RSS) is a sampling technique designed for situations, where obtaining precise measurements of sample units is expensive or difficult, but ranking them without referring to their accurate values is cost-effective or easy. However, the practical application of RSS is hindered because each sample unit is required to assign a unique rank. To alleviate this difficulty, Frey developed a novel variation of RSS, called RSS-t, that records and utilizes the tie structure in the ranking process. In this paper, we propose several different nonparametric estimators for the MRL function based on RSS-t. Then, we compare the proposed estimators with their counterparts in simple random sampling (SRS) and RSS, where tie information is not utilized. We also implemented our proposed estimators on a real data set related to patient waiting times for liver transplantation, to show their applicability and efficiency in practice. Our results show that using ties information leads to an improved statistical inference for the MRL function, and therefore a smaller sample size is needed to reach a predetermined precision.

Metabolic dysfunction and alcohol-related liver disease (MetALD): Position statement by an expert panel on alcohol-related liver disease

In this position statement, we explore the intricate relationship between alcohol intake and metabolic dysfunction in the context of the 2023 nomenclature update for steatotic liver disease (SLD). Recent and lifetime alcohol use should be accurately assessed in all patients with SLD to facilitate classification of alcohol use in grams of alcohol per week. Alcohol biomarkers (i.e., phosphatidylethanol), use of validated questionnaires (i.e. AUDIT-C [alcohol use disorders identification test consumption]), and collateral information from friends and relatives could help facilitate differentiation between alcohol-related liver disease (ALD) per se and liver disease with both metabolic and alcohol-related components (MetALD). Heavy alcohol use can contribute to cardiometabolic risk factors such as high blood pressure, hypertriglyceridaemia, and hyperglycaemia. As a result, caution should be exercised in the application of only one metabolic dysfunction criterion to diagnose MASLD, as suggested in the 2023 nomenclature document, particularly in individuals exceeding weekly alcohol use thresholds of 140 g for women and 210 g for men. This is particularly important in those individuals with isolated high blood pressure, hypertriglyceridaemia, or hyperglycaemia, where the disease process may be driven by alcohol itself. Additionally, metabolic dysfunction and alcohol use should be reassessed over time, especially after periods of change in risk factor exposure. This approach could ensure a more accurate prognosis and effective management of SLD, addressing both metabolic and alcohol-related factors.

Liver Diseases and Brain Disorders: Genetic Mechanisms and Biomarker Pathways in a Prospective Cohort Study From the UK Biobank

Population-based evidence directly linking liver diseases to brain disorders is limited, and its genetic and biochemical associations remain unclear. Our aim is to examine the links between liver diseases and brain disorders. This prospective cohort study utilized data from 492 059 participants in the UK Biobank. We identified 508 cases of alcoholic liver disease (ALD), 583 cases of non-alcoholic fatty liver disease (NAFLD), and 557 cases of viral hepatitis (VH) based on International Classification of Diseases (ICD) codes. Initially, we employed multiple linear and logistic regression to assess associations between liver diseases, polygenic risk score (PRS), inflammatory and metabolic biomarkers, and brain function. Cox proportional hazard models were then applied to determine the impact of liver diseases on the incidence of brain disorders. Ultimately, structural equation models were used to explore potential genetic and biomarker pathways. During a median follow-up of 14.46 years, participants with ALD, NAFLD, and VH demonstrated poorer cognition, mental health, and motor function compared to the healthy group, with p < 0.05 for false discovery rate (FDR-Q < 0.05). They exhibited increased risks for dementia (hazard ratios [HRs]: 2.28-4.10; FDR-Q < 0.001), major depressive disorder (HRs: 2.25-3.23; FDR-Q < 0.001), and generalized anxiety disorder (HRs: 1.70-2.66; FDR-Q < 0.01). Additionally, C-reactive protein, neutrophil-to-lymphocyte ratio, platelets, and low-density lipoprotein lipid components mediated the associations between PRS, liver diseases, and brain disorders. Our findings demonstrated that liver diseases were risk factors for brain disorders, with genetic and biochemical associations contributing to these risks.

FibroScan-AST Score vs Liver Stiffness for the Prediction of Liver Events After HCV Cure

Background

Liver stiffness (LS) predicts liver complication occurrence in patients with hepatitis C virus (HCV) infection after sustained virological response (SVR). The FibroScan-AST (FAST) score, which includes aspartate aminotransferase (AST) and controlled attenuation parameter (CAP; measured by FibroScan), may improve the prediction ability of isolated LS. Our aim was to compare the predictive capacity of LS vs FAST in this setting.

Methods

Multicenter cohort study including individuals with HIV/HCV coinfection or HCV monoinfection from Spain if they had (1) LS ≥9.5 kPa pretreatment, (2) SVR with a direct-acting antiviral (DAA)-based regimen, and (3) LS and CAP measurement at SVR. Fatty liver disease (FLD) was defined as CAP ≥248 dB/m. The primary outcome was the occurrence of a liver complication (decompensation or hepatocellular carcinoma [HCC]) after SVR.

Results

Three hundred patients were included; 213 (71%) had HIV. At SVR, 131 (44%) had FLD. The FAST score was <0.35 in 182 (61%), 0.35-0.67 in 79 (27%), and >0.67 in 34 (12%) patients. After a median (Q1-Q3) follow-up of 73 (53-83) months, 36 (12%) liver complications (15 [5%] HCC) occurred. LS was independently associated with an increased risk of developing liver complications (sub-hazard ratio [sHR], 1.06; 95% CI, 1.04-1.08; P < .001). In a separate model, FAST ≥0.35 was also independently associated with greater risk of liver complications (sHR, 8.12; 95% CI, 3.11-21.17; P < .001). The area under the receiver operating characteristics curve of the model based on LS was 0.83 (95% CI, 0.76-0.91), and that of the model based on FAST was 0.80 (95% CI, 0.72-0.88; P = .158).

Conclusions

The FAST score predicts the development of liver events after SVR but does not improve the predictive capacity of LS alone at this time point.

Unravelling the Role of PANoptosis in Liver Diseases: Mechanisms and Therapeutic Implications

PANoptosis is a multimodal form of cell death that involves inflammatory, apoptotic, and necroptotic pathways, playing a key role in the development of liver diseases. This article first outlines the definition and characteristics of PANoptosis, and then explores its mechanisms of action in different types of liver diseases, including acute liver injury, liver failure, metabolic dysfunction-associated fatty liver disease, and hepatocellular carcinoma. Furthermore, this article analyses the molecular regulatory network of PANoptosis and potential therapeutic targets. Finally, this article summarises the current research on PANoptosis in liver diseases and future research directions, and it reviews the role of the emerging cell death mechanism of PANoptosis in liver diseases.

Design and rationale for a global novel non-invasive screening observational study using genetics and non-invasive methodologies to identify at-risk MASLD participants: The ALIGN study

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease that is heterogenous in nature with various drivers and modifiers such as metabolic dysfunction and genetic factors. MASLD and the progressive subtype, metabolic dysfunction-associated steatohepatitis (MASH) represent the most rapidly increasing cause of liver-related mortality. There are limited treatment options for patients living with MASLD and MASH, various treatments with an array of different targets are under investigation and one therapeutic has been approved since the initiation of this study. Clinical trials investigating treatments for MASLD and MASH are associated with a high screen failure rate, driven largely by the regulatory required histological inclusion criteria for clinical trial eligibility. Other available clinically utilized biomarkers, typically referred to as non-invasive tests (NITs), can assess both the presence of steatosis and the severity of liver fibrosis in patients with MASLD and MASH in the clinic but are not yet approved over histological changes as endpoints for pivotal trials. However, the use of NITs have been demonstrated to increase the likelihood of meeting clinical trial entry criteria. All-Liver Interventional Global Network (ALIGN) is the first described multi-centre global observational screening study aimed at identifying individuals with a high likelihood of MASLD/MASH interested in participating in therapeutic clinical trials using non-invasive methodologies and genetic testing. This study represents a valuable prototype for industry and academic groups looking to evaluate large populations for MASH eligibility and interest in clinical trial participation.

Dihydromyricetin regulates the miR-155-5p/SIRT1/VDAC1 pathway to promote liver regeneration and improve alcohol-induced liver injury

BACKGROUND

Alcohol-related liver disease (ALD) has become an increasingly serious global health issue. In recent years, growing evidence has highlighted the restoration of liver regenerative capacity as an effective therapeutic strategy for improving ALD. Previous studies have demonstrated the protective effect of dihydromyricetin (DMY) in alcohol-induced liver injury, but its pharmacological role in ALD-related liver regeneration impairment remains poorly understood.

OBJECTIVE

This study aims to explore the therapeutic potential and molecular mechanisms of DMY in the context of liver regeneration impairment in ALD.

METHODS

The classic Lieber-DeCarli alcohol liquid diet was used to establish an ALD model in vivo. DMY (75 and 150 mg/kg/day) and silybin (200 mg/kg) were administered for 7 weeks to assess the hepatoprotective effects of DMY. First, biochemical markers and liver histopathology were used to evaluate liver inflammation and steatosis in ALD mice. Second, we explored the potential molecular mechanisms by which DMY improves ALD through serum untargeted metabolomics, hepatic transcriptomics, and single-cell sequencing data. Furthermore, in vivo and in vitro experiments, combined with Western blotting, dual-luciferase reporter assays, and immunofluorescence, were conducted to elucidate the protective mechanisms underlying DMY's effects on ALD.

RESULTS

In vivo studies showed that DMY significantly ameliorated ALT/AST abnormalities, liver inflammation, and steatosis in ALD mice. Multi-omics and bioinformatics analyses revealed that DMY may exert its anti-ALD effects by regulating the miR-155-5p/SIRT1/VDAC1 pathway, thereby mitigating cellular senescence. Notably, knockdown of miR-155 provided partial protection against ethanol-induced liver damage. Additionally, clinical ALD samples and in vivo and in vitro experiments further confirmed that excessive alcohol exposure induces the production of miR-155-5p in liver Kupffer cells. miR-155-5p targets and inhibits SIRT1, promoting the expression of mitochondrial VDAC1, leading to mitochondrial DNA leakage, thereby accelerating hepatocyte senescence and inflammation. However, DMY improved the disruption of the miR-155-5p/SIRT1/VDAC1 pathway and hepatocyte senescence, thereby restoring liver regenerative function and exerting anti-ALD effects.

CONCLUSION

In this study, we provide the first evidence that DMY improves liver inflammation and cellular senescence by regulating the miR-155-5p/SIRT1/VDAC1 positive feedback loop, promoting liver regeneration to improve ALD. In summary, our work provides important research evidence and theoretical support for DMY as a promising candidate drug for the prevention and treatment of ALD.

Hepatic microRNA-320 restrains ferroptosis to mitigate acute-on-chronic alcohol-induced liver injury

Alcohol-associated Liver Disease (ALD) is one of the major chronic liver diseases worldwide and has high mortality and high incidence rate. microRNA-320 (miR-320), a highly conserved and widely expressed miRNA, has been reported to be involved in lipid metabolism; however, whether miR-320 affects the progression of ALD remains unclear. In this study, we demonstrated that hepatic miR-320 was significantly downregulated in chronic-plus-binge alcohol-fed mice. Interestingly, such downregulation might accelerate ALD progression as evidenced that hepatocyte-specific miR-320 deficient mice displayed higher susceptibility to acute-on-chronic alcohol feeding-induced steatosis and inflammation. Moreover, restoration of hepatic miR-320 ameliorated acute-on-chronic alcohol-induced hepatocyte damage and steatosis. Mechanistically, miR-320 inhibited alcohol-induced ferroptosis by targeting Transferrin Receptor 1 (TFRC) to suppress iron accumulation. Moreover, silencing of Tfrc in hepatocytes attenuated ethanol-induced iron accumulation, thus inhibiting ferroptosis and ultimately mitigating ALD. Taken together, these findings suggest that miR-320 plays an important role in limiting ALD progression via inhibiting ferroptosis, providing a therapeutic target for the treatment of ALD.

Hepatoprotective potential of Ceiba chodatii Hassl. Against carbon tetrachloride-induced chronic liver damage supported with phytochemical investigation

Hepatic fibrosis is a major health concern that can develop into other life-threatening pathologies, with no fully effective treatments are available to date. Ceiba is a genus of multipurpose trees with diverse therapeutic applications, including liver ailments. Prior research has also unveiled the protecting role of Ceiba plants in chemical liver injuries via a number of in vitro and in vivo tests. Due to the crucial need for alternative therapies to prevent liver damage and stop its progress, the present work evaluates the protective effects of the total extract of Ceiba chodatii Hassl. flowers and its derived fractions (I-IV) against CCl4-induced chronic liver damage for the first time. The obtained results indicated the ability of C. chodatii flowers, particularly their chloroform- and ethyl acetate-soluble fractions (II and III), to alleviate liver damage in CCl4-intoxicated rats via normalizing high liver injury hallmarks (e.g., ALT, AST, albumin, and total bilirubin), preventing the build-up of malondialdehyde, enhancing the antioxidant capacity of hepatocytes, mitigating aberrant histopathological changes, and reducing extracellular matrix accumulation. Further mechanistic studies showed the aptitude of C. chodatii flowers to attenuate inflammatory, fibrotic, and apoptotic responses via counteracting the production of inflammatory cytokines (e.g., IL-6 and TNF-α), reducing the levels of cleaved caspase-3, and inhibiting JAK2/STAT3 and TGF-β/Smad signaling pathways. Interestingly, the liver-protecting actions of fractions II and III were also comparable to those of silymarin (50 mg/kg). Moreover, phytochemical investigation of C. chodatii flowers led to the isolation and identification of a group of flavonoid glycosides (1-10), with good antioxidant and liver supporting properties, suggesting their potential contribution to the anti-fibrotic properties of C. chodatii. These data highlight the multi-target hepatoprotective effects of C. chodatii and its potential as an alternative source to develop natural therapeutic agents against liver fibrosis.

Preclinical insights into the potential of itaconate and its derivatives for liver disease therapy

Annually, approximately 3.5 % of the world's population dies of cirrhosis or liver cancer, and the burden of liver disease is steadily expanding owing to multiple factors such as alcohol consumption, irrational diets, viral transmission, and exposure to drugs and toxins. However, the lack of effective therapies and the adverse effects of some medications remain a threat to the management of liver disease. Recently, immunometabolism, as an emerging discipline, appears to be the focus of unprecedented research. As a natural metabolite that regulates cellular functions, itaconate is a crucial bridge connecting metabolism and immune response. Remodeling immune function through metabolic modulation may be a promising alternative for disease intervention strategies. In this review, we first briefly describe the historical origin of itaconate and the development of its derivatives. This was followed by a review of the molecular mechanisms by which itaconate regulated immune-metabolic responses. Furthermore, we analyzed the effects of itaconate regulation on immune cells of the hepatic system. Finally, we summarized the experimental evidence for itaconate and its derivatives in the therapeutic application of liver diseases. Itaconate is potentially an invaluable component of emerging therapeutic strategies for liver disease.

Long-term use of colchicine is associated with incident cirrhosis: a real-world cohort study

INTRODUCTION

Chronic effect of colchicine on the liver was not studied enough. We aimed to examine the association between long term colchicine use and incident cirrhosis among new colchicine initiators.

STUDY

Using database of Maccabi Healthcare Services (MHS), we included all patients aged ≥18 years old who initiated colchicine between 1 January 2000 and 31 December 2018 and followed them until the earliest of the following: incident cirrhosis, leaving MHS, death or 31 December 2020. Incident cirrhosis was diagnosed according to ICD-9 code. We defined incident decompensated cirrhosis as the first presentation of cirrhosis, once ascites, encephalopathy and/or variceal bleeding were diagnosed within a period of 90 days before until 90 days after incident cirrhosis. Exposure to colchicine was evaluated in two manners: proportion of months covered (PMC) and mean daily dose (MDD).

RESULTS

A total of 21,773 eligible patients were included. We identified 129 incident cases of cirrhosis. Seventy-six (59%) had decompensated cirrhosis, as a first clinical presentation of cirrhosis. Familial Mediterranean Fever (FMF), BMI > 40, FIBROSIS-4 (FIB-4) score and colchicine PMC were all significantly associated with incident cirrhosis. Patients in '60-80%' PMC group had the highest risk for developing cirrhosis (hazard ratio (HR) 3.68, 95% confidence interval (CI) 2.23-6.07). The risk was higher for patients on colchicine >60 months (HR 6.69, 95% CI 3.56-12.56).

CONCLUSIONS

long term colchicine use is associated with incident cirrhosis, mainly with decompensation at the time of diagnosis. Long term colchicine treatment should be limited to diseases with no other alternative, such as FMF.

The protective effects and mechanism of myricetin in liver diseases (Review)

Liver diseases have become one of the significant threats to global health. However, there is a lack of effective targeted therapeutic drugs in this field and the existing drugs used for liver disease treatment usually have side‑effects. Traditional Chinese medicine (TCM) has the distinctive advantages of multi‑target and low side‑effects. As a flavonoid with various pharmacological activities such as anti‑tumour, anti‑oxidant, anti‑inflammatory and anti‑bacterial, the TCM myricetin has been widely used in liver disease research. The present work focuses on the role and molecular mechanism of myricetin in liver diseases such as acute liver injury, fatty liver, liver fibrosis and hepatocellular carcinoma. It is a promising reference for further research and application of myricetin in the treatment of liver diseases.

Unlocking the power of probiotics, postbiotics: targeting apoptosis for the treatment and prevention of digestive diseases

Digestive diseases are becoming an increasingly serious health burden, creating an urgent need to develop more effective treatment strategies. Probiotics and postbiotics have been extensively studied for their potential to prevent and treat digestive diseases. Growing evidence suggests that programmed cell death, especially apoptosis, is a critical mechanism influencing the molecular and biological aspects of digestive diseases, contributing to disease progression. Understanding the mechanisms and signaling pathways by which probiotics and postbiotics regulate apoptosis could reveal new therapeutic targets for treating digestive diseases. This review focuses on the beneficial effects of probiotics and postbiotics in regulating apoptosis across a range of liver diseases, including non-alcoholic fatty liver disease, liver injury, cirrhosis, and liver cancer. It also explores their effects on gastrointestinal diseases, such as colorectal cancer, colitis, gastrointestinal injury, and infectious diarrhea. Furthermore, some probiotics help balance the gut microbiota, enhance intestinal barrier function, and regulate the immune system, all of which are closely associated with apoptosis. Moreover, emerging technologies, such as encapsulation methods, have been developed to stabilize probiotics, primarily based on experimental findings from rodent and human studies.

Assessing the effect of modifiable risk factors on hepatocellular carcinoma: evidence from a bidirectional Mendelian randomization analysis

BACKGROUND

The pathogenesis of hepatocellular carcinoma (HCC) involves a variety of environmental risk factors, some of which have yet to be fully clarified. Using the Mendelian randomization (MR) approach, this study comprehensively investigates the causal effect of genetically predicted modifiable risk factors on HCC.

METHODS

Genetic variants related to the 50 risk factors that had been identified in previous research were derived from genome-wide association studies. Summary statistics for the discovery cohort and validation cohort of HCC were sourced from the FinnGen consortium and the UK Biobank, respectively. Bidirectional MR analysis and sensitivity analysis were performed to establish causative risk factors for HCC.

RESULTS

Through the inverse variance weighted method, the results of the discovery cohort indicated that waist circumference, nonalcoholic fatty liver disease (NAFLD), alanine aminotransferase (ALT) levels, and aspartate aminotransferase (AST) levels were significantly linked to HCC occurrence risk. Furthermore, body fat percentage, glycated hemoglobin (HbA1c), obesity class 1-3, waist-to-hip ratio, iron, ferritin, transferrin saturation, and urate had suggestive associations with HCC. The validation cohort further confirmed that NAFLD and ALT levels were strongly related to HCC. Reverse MR indicated that genetic susceptibility to HCC was connected to NAFLD and transferrin saturation. Sensitivity analyses showed that most of the findings were robust.

CONCLUSION

This MR study delivers evidence of the complex causal relationship between modifiable risk factors and HCC. These findings offer new insights into potential prevention and treatment strategies for HCC.

Global trends in artificial intelligence applications in liver disease over seventeen years

BACKGROUND

In recent years, the utilization of artificial intelligence (AI) technology has gained prominence in the field of liver disease.

AIM

To analyzes AI research in the field of liver disease, summarizes the current research status and identifies hot spots.

METHODS

We searched the Web of Science Core Collection database for all articles and reviews on hepatopathy and AI. The time spans from January 2007 to August 2023. We included 4051 studies for further collection of information, including authors, countries, institutions, publication years, keywords and references. VOS viewer, CiteSpace, R 4.3.1 and Scimago Graphica were used to visualize the results.

RESULTS

A total of 4051 articles were analyzed. China was the leading contributor, with 1568 publications, while the United States had the most international collaborations. The most productive institutions and journals were the Chinese Academy of Sciences and Frontiers in Oncology. Keywords co-occurrence analysis can be roughly summarized into four clusters: Risk prediction, diagnosis, treatment and prognosis of liver diseases. "Machine learning", "deep learning", "convolutional neural network", "CT", and "microvascular infiltration" have been popular research topics in recent years.

CONCLUSION

AI is widely applied in the risk assessment, diagnosis, treatment, and prognosis of liver diseases, with a shift from invasive to noninvasive treatment approaches.

Hepatic cirrhosis and decompensation: Key indicators for predicting mortality risk

Liver cirrhosis represents the final stage of liver diseases. The transition from the compensated to the decompensated form is a critical phase, as it is associated with a negative impact on patient prognosis. Therefore, having a tool to identify patients at higher risk of complications and mortality is an ideal goal. Currently, the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score. However, these scores have limitations, as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective. Among these, alterations in body composition, particularly sarcopenia, increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.

Training and Performance of an Electrocardiogram-Enabled Machine Learning Model for Detection of Advanced Chronic Liver Disease

INTRODUCTION

Building on prior results, we hypothesized that an electrocardiogram (ECG)-enabled machine learning (ML) model could be used to detect advanced chronic liver disease (CLD).

METHODS

A cohort with CLD and 12-lead ECGs was matched with controls from electronic health records. A ML model was trained as a binary classifier.

RESULTS

There are 12,930 patients with CLD and 64,577 controls in the cohort. The model's discriminative ability to classify CLD showed an area under the receiver-operating characteristic curve 0.858 (95% confidence interval: 0.850-0.866), and at the chosen threshold, CLD ECGs had 12 times higher odds of being classified as CLD (diagnostic odds ratio 12.33, 95% confidence interval: 11.16-13.63).

DISCUSSION

An ECG-enabled ML model affords great promise in identifying advanced CLD in low resource areas.

Synthesis and Biological Evaluation of Peripheral 5HT2B Antagonists for Liver Fibrosis

Liver fibrosis is characterized by an excessive accumulation of extracellular matrix components, leading to the distortion of liver architecture and function. Recent studies have shown that antagonizing 5-hydroxytryptamine receptor 2B (5HT2B) stimulates the apoptosis of activated hepatic stellate cells and inhibits their proliferation while concurrently regressing hepatocyte proliferation. In this study, we present compound 19c, which demonstrates promising efficacy both in vitro and in vivo. 19c showed robust in vitro activity with an IC50 value of 1.09 nM and limited blood-brain barrier penetration. Furthermore, 19c did not significantly inhibit hERG and cytochrome P450 enzymes. 19c markedly reduced fibrotic deposition, with a decrease in fibrosis stage and area in the CCl4-induced liver fibrosis mouse model. Additionally, treatment with 19c led to downregulation of key fibrosis-related genes, including α-SMA, Timp1, Col1a1, and Col3a1. Taken together, these results suggest that 19c has the potential to be a novel antifibrotic agent.

Triptolide combined with salvianolic acid B alleviates CCL4-induced liver fibrosis by suppressing the Th17/IL-17A axis

Liver fibrosis represents a significant public health challenge, with immune dysregulation being a key pathological mechanism involved in its progression. The combined use of triptolide and salvianolic acid B has been demonstrated effective in ameliorating CCL4-induced liver fibrosis, but the underlying mechanism remains to be elucidated. In this study, we integrated network pharmacology and experimental validation to uncover the therapeutic mechanisms of the combined use of triptolide and salvianolic acid B. First, animal experiments demonstrated that the combination notably alleviated CCL4-induced liver injury and fibrosis. Second, network pharmacology was employed to predict the potential mechanisms, and the results highlighted Th17 cell differentiation and the IL-17 signaling pathway as the key pathways mediating the anti-fibrotic effects of the combination. Next, with the help of flow cytometry analysis, we confirmed that the combination effectively inhibited the differentiation of Th17 cells, both in vivo and in vitro, and decreased the expression of pro-inflammatory/fibrotic cytokines. Finally, to preliminary ascertain the role of IL-17 signaling in HSC activation and if the combination could affect it, we used recombinant human IL-17A protein to trigger LX-2 cells, the results suggested that IL-17A signaling did engage in HSC activation, and the combination could significantly suppress IL-17A-induced LX-2 activation partly by inhibiting the expression of IL-17RA. Taken together, those results implied that the combined use of triptolide and salvianolic acid B could attenuate CCL4-induce liver fibrosis, and this effect was related to the suppression of inflammation and hepatic stellate cell activation via Th17/IL-17A axis.

Diagnosis and Management of Early Stages of ALD

Early forms of alcohol-associated liver disease (ALD) include different stages in the progression of compensated liver disease ranging from steatosis to steatohepatitis and fibrosis. ALD has been classically diagnosed at advanced stages more frequently than other liver diseases. This fact probably contributed to the scarcity of studies on early forms of ALD. Recent studies have investigated the prevalence of early ALD in the general population and have described the natural history of alcohol-induced steatosis and fibrosis, which have been linked to worse prognosis compared with early stages of other chronic liver diseases. In addition, studies on screening and early diagnosis of ALD in at-risk populations have shown that these strategies allow early detection and intervention. Of note, up to 28% of the United States population has concurrent alcohol use and metabolic syndrome, and estimated prevalence of advanced fibrosis among heavy drinkers with metabolic syndrome has increased from 3% in the 1990s to more than 10% in the 2010s. Therefore, new challenges and treatment opportunities will emerge for patients with ALD. In this review, we provide an overview of the state of the art in early ALD, focusing on natural history, diagnosis, and management, and provide insights into future perspectives.

Preparation and Evaluation of Hepatoma-Targeting Glycyrrhetinic Acid Composite Micelles Loaded with Curcumin

Background: Liver cancer, especially hepatocellular carcinoma, a prevalent malignant tumor of the digestive system, poses significant therapeutic challenges. While traditional chemotherapy can inhibit tumor progression, its clinical application is limited by insufficient efficacy. Hydrophobic therapeutic agents further encounter challenges including low tumor specificity, poor bioavailability, and severe systemic toxicity. This study aimed to develop a liver-targeted, glutathione (GSH)-responsive micellar system to synergistically enhance drug delivery and antitumor efficacy. Methods: A GSH-responsive disulfide bond was chemically synthesized to conjugate glycyrrhetinic acid (GA) with curcumin (Cur) at a molar ratio of 1:1, forming a prodrug Cur-GA (CGA). This prodrug was co-assembled with glycyrrhizic acid (GL) at a 300% w/w loading ratio into micelles. The system was characterized for physicochemical properties, in vitro drug release in PBS (7.4) without GSH and in PBS (5.0) with 0, 5, or 10 mM GSH, cellular uptake in HepG2 cells, and in vivo efficacy in H22 hepatoma-bearing BALB/c mice. Results: The optimized micelles exhibited a hydrodynamic diameter of 157.67 ± 2.14 nm (PDI: 0.20 ± 0.02) and spherical morphology under TEM. The concentration of CUR in micelles can reach 1.04 mg/mL. In vitro release profiles confirmed GSH-dependent drug release, with 67.5% vs. <40% cumulative Cur release observed at 24 h with/without 10 mM GSH. Flow cytometry and high-content imaging revealed 1.8-fold higher cellular uptake of CGA-GL micelles compared to free drug (p < 0.001). In vivo, CGA-GL micelles achieving 3.6-fold higher tumor accumulation than non-targeted controls (p < 0.001), leading to 58.7% tumor volume reduction (p < 0.001). Conclusions: The GA/GL-based micellar system synergistically enhanced efficacy through active targeting and stimuli-responsive release, providing a promising approach to overcome current limitations in hydrophobic drug delivery for hepatocellular carcinoma therapy.

LPS-Induced Liver Inflammation Is Inhibited by Psilocybin and Eugenol in Mice

Background/Objectives: Liver inflammatory diseases are a major global health burden and are often exacerbated by inflammation driven by lipopolysaccharides (LPS) through toll-like receptor 4 signaling. This study evaluates the anti-inflammatory effects of psilocybin and eugenol in an LPS-induced liver inflammation model in C57BL/6J mice. Methods: Mice were treated with psilocybin (0.88 mg/kg) and/or eugenol (17.59 mg/kg) either before (pre-treatment) or after (post-treatment) LPS injection. Results: Psilocybin and eugenol, individually and in combination, significantly reduced the LPS-induced mRNA levels of pro-inflammatory cytokines, with post-treatment administration exhibiting stronger effects than pre-treatment. Psilocybin alone displayed the most pronounced anti-inflammatory response, especially for IL-1β, IL-6, and MCP-1, while its combination with eugenol in 1:50 ratio demonstrated similar results, with strongly reduced COX-2 and TNF-α. Histological analysis revealed improved nuclear circularity and reduced inflammatory infiltration in the treatment groups. Eugenol alone showed potential adverse effects, including increased MCP-1 and GM-CSF, but this was mitigated by the co-administration of psilocybin. Conclusions: These findings highlight psilocybin and its combination with eugenol as promising therapies for hepatic inflammation, suggesting their application in treating acute and chronic liver diseases. Future research should explore their long-term effects, the mechanisms underlying their anti-inflammatory actions, and their therapeutic efficacy in humans.

Interplay Between Polyphenols and Autophagy: Insights From an Aging Perspective

The relationship between polyphenols and autophagy, particularly in the context of aging, presents a promising avenue for therapeutic interventions in age-related diseases. A decline in autophagy is associated with aging-related affections, and an increasing number of studies suggest that this enhancement is linked to cellular resilience and longevity. This review delves into the multifaceted roles of autophagy in cellular homeostasis and the potential of polyphenols to modulate autophagic pathways. We revised the most updated literature regarding the modulatory effects of polyphenols on autophagy in cardiovascular, liver, and kidney diseases, highlighting their therapeutic potential. We highlight the role of polyphenols as modulators of autophagy to combat age-related diseases, thus contributing to improving the quality of life in aging populations. A better understanding of the interplay of autophagy between autophagy and polyphenols will help pave the way for future research and clinical applications in the field of longevity medicine.