Old age as a risk factor for liver diseases: Modern therapeutic approaches

The role and function of lncRNA in ageing-associated liver diseases

Liver diseases are a significant global health issue, characterized by elevated levels of disorder and death. The substantial impact of ageing on liver diseases and their prognosis is evident. Multiple processes are involved in the ageing process, which ultimately leads to functional deterioration of this organ. The process of liver ageing not only renders the liver more susceptible to diseases but also compromises the integrity of other organs due to the liver's critical function in metabolism regulation. A growing body of research suggests that long non-coding RNAs (lncRNAs) play a significant role in the majority of pathophysiological pathways. They regulate gene expression through a variety of interactions with microRNAs (miRNAs), messenger RNAs (mRNAs), DNA, or proteins. LncRNAs exert a major influence on the progression of age-related liver diseases through the regulation of cell proliferation, necrosis, apoptosis, senescence, and metabolic reprogramming. A concise overview of the current understanding of lncRNAs and their potential impact on the development of age-related liver diseases will be provided in this mini-review.

Identifying liver cirrhosis in patients with chronic hepatitis B: an interpretable machine learning algorithm based on LSM

BACKGROUND

Chronic hepatitis B (CHB) is a common cause of liver cirrhosis (LC), a condition associated with an unfavourable prognosis. Therefore, timely diagnosis of LC in CHB patients is crucial.

OBJECTIVE

This study aimed to enhance the diagnostic accuracy of LC in CHB patients by integrating liver stiffness measurement (LSM) with traditional indicators.

METHODS

The study participants were randomly divided into training and internal validation sets. Employing the least absolute shrinkage and selection operator (LASSO) and random forest-recursive feature elimination (RF-RFE) for feature selection, we developed both traditional logistic regression and five machine learning models (k-nearest neighbors, random forest (RF), artificial neural network, support vector machine and eXtreme Gradient Boosting). Performance evaluation included receiver operating characteristic curves, calibration curves and decision curve analysis. Shapley additive explanations (SHAP) was employed to improve the interpretability of the optimal model.

RESULTS

We retrospectively included 1609 patients with CHB, among whom 470 were diagnosed with cirrhosis. Cirrhosis was diagnosed based on histological confirmation or clinical assessment, supported by characteristic findings on abdominal ultrasound and corroborative evidence such as thrombocytopenia, varices or imaging from CT/MRI. In the internal validation, the RF model achieved an accuracy above 0.80 and an AUC above 0.80, with outstanding calibration ability and clinical net benefit. Additionally, the model exhibited excellent predictive performance in an independent external validation set. The SHAP analysis indicated that LSM contributed the most to the model. The model still showed strong discriminative power when using only LSM or traditional indicators alone.

CONCLUSIONS

Machine learning models, especially the RF model, can effectively identify LC in CHB patients. Integrating LSM with traditional indicators can enhance diagnostic performance.

Cell cycle regulation by the ribotoxic stress response

Cells must sense and respond to numerous stimuli to maintain their function. Stress-activated protein kinases (SAPKs) are part of an integrated network that responds to these stimuli and have critical roles in determining cell behavior. Over the past 5 years, ribosomes and the ribotoxic stress response (RSR) have unexpectedly emerged as critical regulators of the SAPK network and drivers of global cell fate changes. In particular, RSR-SAPK signaling has potent effects on cellular proliferation, with important implications for senescence and cancer. In this review, we discuss cell cycle regulation by the SAPK p38, with a particular focus on how ribotoxic stress affects key cell cycle transitions.

Calorie-restriction treatment mitigates the aging in rat liver model

The aging process promotes progressive impairment of homeostasis and the increase of the risk of disease and death. A major hallmark of the aging process is the systemic chronic inflammation which strongly contributes to the onset of aging-related diseases. In the liver, the aging condition drives the hepatocytes to develop a metabolic dysfunction-associated steatosis. Caloric restriction (CR) is a remarkable strategy to delay biological aging, occurring through several mechanisms. In this study we aimed to explore, employing an in vivo rat model, the impact of CR on aging-mediated liver inflammation markers. The experiments were performed on 14 male Sprague-Dawley rats (24 months old). At 18 months old, rats were allocated into two groups: the normal diet (ND) group was continued ad libitum diet, and the CR regimen group was fed a diet of the same chow restricted to 60% of the intake. All animals were sacrificed at 24 months old. Compared to the ND group, morphological examination of the liver revealed a lower level of fibrosis in the CR group, concomitantly with a reduced expression of key fibrotic markers, such as collagen I, fibronectin, and αSMA. Furthermore, CR improved the liver oxidative balance, as showed by the increased expression of two scavenging enzymes, SOD1/SOD. Moreover, we reported concomitant reduction of NLRP3 inflammasome signalling. Interestingly, CR significantly improved the signalling of key members of the nutrition-sensitizing affected by aging, AMPK/SIRT1/LKB1. Collectively our findings support the evidence on the metabolic benefits of CR about aging-related liver inflammation, by inducing a morphological improvement that mirrors the decrease in the expression of inflammatory molecular markers.

Real-World Trends and Future Projections of the Prevalence of Cirrhosis and Hepatic Encephalopathy Among Commercially and Medicare-Insured Adults in the United States

INTRODUCTION

Describing cirrhosis and hepatic encephalopathy (HE) burden over time can inform clinical management and resource allocation. Using healthcare claims data, this observational study examined recent trends in the prevalence of cirrhosis and HE and associated healthcare resource utilization among commercially and Medicare-insured adults in the United States.

METHODS

Data from the MarketScan Commercial Claims and Encounters Database and 100% Medicare Research Identifiable Files were analyzed (2007-2020). Annual prevalence of cirrhosis, HE, overt HE (OHE) hospitalizations, and rifaximin ± lactulose use, and costs per hospitalization per year were calculated. Average year-over-year changes in prevalence of cirrhosis, and HE were estimated. Trends were extrapolated to 2030 using ordinary least-squares regression.

RESULTS

From 2007 to 2020, the prevalence of cirrhosis increased by an average of 4.6% year-over-year in the Commercial population and 8.1% in the Medicare population; the prevalence of HE increased by 4.3% and 2.5%, respectively. Rates of OHE hospitalizations decreased from 27.5% to 5.5% (Commercial) and from 26.2% to 9.5% (Medicare), and rates of liver transplantation increased. Average payer costs (Commercial) and provider charges (Medicare) per OHE hospitalization increased (from $40,881 to $77,699 and from $45,913 to $74,894, respectively). Use of rifaximin ± lactulose showed an increasing trend during the observation period, whereas lactulose use declined steadily.

DISCUSSION

The healthcare burden of cirrhosis and HE in the United States is increasing. Trends are projected to continue unless action is taken, such as improving medication access and developing policies addressing the contributing factors.

Rosuvastatin restores liver tissue-resident NK cell activation in aged mice by improving mitochondrial function

BACKGROUND AND AIM

Aging has an impact on Natural Killer (NK) cells surveillance against tumors and infections. Our study aims to assess the aging effects on metabolic and mitochondrial markers influencing NK cell activity.

METHODS

C57BL/6 J mice aged 12, 24, 48, and 72 weeks were used. Liver injury serum and histological markers, pro-inflammatory cytokines [IL-1β, IL-2, IL-6] and chemoattractant markers [CCL2, CXCL8] were assessed. Moreover, cholesterol metabolic markers [HMG-CoA synthetase, HMG-CoA reductase, mevalonate kinase], mitochondrial biogenesis [PGC1α] and functional gene markers [TFAM, HSPA9, Seahorse, apoptosis] in liver trNK cells, were assessed by RT-PCR. Senescence [p16, p21], exhaustion [PD-1, TIGIT, LAG3], activation [CD107a, NKp46], and chemokine receptor [CCR2, CXCR1] markers were assessed in trNK cells using flow cytometry. Liver trNK cells of aged mice were treated with Rosuvastatin [10μM] for 12 h.

RESULTS

Data showed a linear increase in liver injury markers, pro-inflammatory and chemotaxis along aging. These results were associated with reductions in liver trNK cell counts and activations with a noticeable decrease in their chemoattractant receptor expressions. TrNK cells of aged mice exhibited elevated markers of senescence and exhaustion with a gradual increase in cholesterol accumulation. Mitochondrial biogenesis and functional gene markers showed a decrease in their expressions in aged mice while ameliorated following rosuvastatin treatment. Results were correlated with a decrease in cholesterol metabolism and restoring their NK cell activity.

CONCLUSION

Our study demonstrates age-related cholesterol accumulation in trNK cells correlated with senescence and functional impairment. Rosuvastatin is suggested to boost, rejuvenate and recover NK cell functionality.

Canine-derived Weissella confusa ZJUIDS-D034 and Enterococcus faecalis ZJUIDS-D016 combat aging by regulating gut microbiota

Old age raises the susceptibility of age-related disease in domestic dogs. Discovering effective anti-aging interventions is key for mitigating age-related disease and conserving "healthspan" in pet dogs. In this study, 2 bacterial strains were isolated from canine feces. After screening and identifying the strains, Weissella confusa ZJUIDS-D034 and Enterococcus faecalis ZJUIDS-D016 were chosen to intervene during d-galactose-induced senescence in mice. We found that administering Weissella confusa ZJUIDS-D034 and Enterococcus faecalis ZJUIDS-D016 improved the aging phenotype of mice, including an increase in antioxidant activity, a decrease in pro-inflammatory cytokines, and the restoration of intestinal and liver tissue damage. In addition, Weissella confusa ZJUIDS-D034 and Enterococcus faecalis ZJUIDS-D016 lead to changes in the structure of intestinal microbiota in aging mice. Specifically, there was a decrease in the abundance of the Cyanobacteria and an increase in the abundance of Akkermansia and Lactobacillus. More importantly, there was a significant increase in acetic acid, a short-chain fatty acid, due to intervention with the 2 strains. This increase might be attributed to higher Akkermansia. We show that the modulation of gut microbiota and metabolism in aging mice may be a promising strategy through which Weissella confusa ZJUIDS-D034 and Enterococcus faecalis ZJUIDS-D016 might exert their anti-aging effects.

Exceeding the Limits with Nutraceuticals: Looking Towards Parkinson's Disease and Frailty

One of the most pressing challenges facing society today is the rising prevalence of physical and cognitive frailty. This geriatric condition makes older adults more vulnerable to disability, illness, and a heightened risk of mortality. In this scenario, Parkinson's disease (PD) and geriatric frailty, which share several common characteristics, are becoming increasingly prevalent worldwide, underscoring the urgent need for innovative strategies. Nutraceuticals are naturally occurring bioactive compounds contained in foods, offering health benefits over and above essential nutrition. By examining the literature from the past decade, this review highlights how nutraceuticals can act as complementary therapies, addressing key processes, such as oxidative stress, inflammation, and neuroprotection. Notably, the antioxidant action of nutraceuticals appears particularly beneficial in regard to PD and geriatric frailty. For instance, antioxidant-rich nutraceuticals may mitigate the oxidative damage linked to levodopa therapy in PD, potentially reducing the side effects and enhancing treatment sustainability. Similarly, the antioxidant effects of nutraceuticals may amplify the benefits of physical activity, enhancing muscle function, cognitive health, and resilience, thereby reducing the risk of frailty. This review proposes a holistic approach integrating nutraceuticals with exercise, pharmacotherapy, and lifestyle adjustments. It promises to transform the management of ARD, prolong life, and improve the quality of life and well-being of older people.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty

Introduction

Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.

Methods

The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients with a diagnosis of cirrhosis (n = 627) were matched in a 1:1 proportion to patients who did not have cirrhosis. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative outcomes, and hospital utilization metrics between the two groups. Following Bonferroni correction, an alpha value of 0.003 defined significance.

Results

Patients with cirrhosis exhibited higher rates of postoperative medical and implant-related complications following primary TSA, including acute renal failure (6.3% vs 1.1%: p < 0.001), urinary tract infection (3.5% vs 0.6%; p < 0.001), transfusions (3.0% vs 0.2%; p < 0.001), acute respiratory distress syndrome (2.9% vs 0.2%: p = 0.002), surgical site infection (2.0% vs 0.2%: p = 0.001), dislocation (2.1% vs 0.0%: p < 0.001), and prosthetic loosening (1.5% vs 0.0%; p = 0.002). These patients also exhibited higher rates of all-cause complications (32% vs 9.2%: p < 0.001) and mortality (1.5% vs 0.0%; p = 0.002) within 180 days of surgery and had an increased cost of admission ($24,633 vs $18,500; p < 0.001) and LOS (2.6 vs 1.5 days; p < 0.001).

Conclusion

Patients with cirrhosis were found to have increased risk of medical and surgical complications, higher costs, and longer LOS following TSA. These findings can assist orthopedic surgeons in developing strategies in the preoperative period to mitigate complications in this at-risk patient group.

Level of evidence

Level III - Retrospective cohort study.

Systematic review and meta-analysis assessing the status of carotid intima-media thickness and lipid profiles in type 2 diabetes mellitus

OBJECTIVES

Carotid intima-media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the status of carotid health and lipid profile in T2DM.

DESIGN

This systematic review and meta-analysis synthesised data published from clinical studies.

DATA SOURCES

Google Scholar, PubMed and Scopus were searched from inception to 18 January 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies conducted in patients with T2DM and those without T2DM were included. Studies conducted in T2DM adults evaluating carotid status and lipid profile were considered.

DATA EXTRACTION AND SYNTHESIS

Two authors independently used standardised methods to comprehensively search, screen and extract data from all relevant studies. The risk of bias was assessed using the Newcastle-Ottawa checklist. Meta-analysis was conducted using Review Manager and metaHun through random effects models. The random effect model was used due to high heterogeneity.

RESULTS

Evidence was analysed from 57 studies with a sample size of 29 502 (8254 T2DM and 21 248 people without T2DM). There was a significantly higher CIMT, with a standardised mean difference (SMD) of 1.01 (95% CI 0.75, 1.26, p<0.00001). Additionally, there was an elevated triglyceride (TG) (SMD=1.12, 95% CI 0.82, 1.41, p<0.00001), total cholesterol (TC), (SMD=0.24, 95% CI 0.02, 0.46, p=0.03) and low-density lipoprotein-cholesterol (LDL-C), (SMD=0.35, 95% CI 0.11, 0.59, p=0.004) in patients with T2DM compared with those without T2DM. Furthermore, a significant decrease in high-density lipoprotein cholesterol (HDL-C) was observed in the T2DM compared with people without T2DM, SMD=-0.79, 95% CI -0.96, -0.62, p<0.00001). Age, body mass index and hypertension were associated with increased CIMT and TG and decreased HDL-C in T2DM. Additionally, age, gender and hypertension were associated with an increased LDL-C in T2DM.

CONCLUSION

Our findings suggest that an increased CIMT is accompanied by increased TG, TC, LDL-C and HDL-C reduction in patients with T2DM.

PROSPERO REGISTRATION NUMBER

CRD42023451731.

Advances in the management of alcohol-associated liver disease

Alcohol-associated liver disease (ALD) is a significant global health challenge, encompassing a spectrum from steatotic liver disease to cirrhosis and alcohol-associated hepatitis, and contributed to 25% of global cirrhosis deaths in 2019. The identification of both modifiable (e.g. heavy drinking, metabolic syndromes) and non-modifiable risk factors (e.g. genetic predispositions) is crucial for effective disease management. Alcohol use assessment and treatment, by using both behavioral therapy and pharmacotherapeutic modalities, nutrition support, and optimization of liver disease modifiers, form the cornerstone of management. Advances in medical therapies, such as fecal microbiota transplantation and novel agents such as IL-22, are being explored for their therapeutic potential. A unifying theme in ALD care is the need for a personalized approach to management, accounting for the spectrum of the disease and individual patient characteristics, to tailor interventions effectively. Finally, it is essential to address the challenges to effective ALD treatment, including socioeconomic, logistical, and stigma-related barriers, to improve patient outcomes. This review discusses the current knowledge on ALD, including epidemiology, pathophysiology, risk factors, and management strategies, highlighting the critical role of integrated care models.

The Impact of Japanese Dietary Patterns on Metabolic Dysfunction-Associated Steatotic Liver Disease and Liver Fibrosis

This study aimed to investigate the effect of Japanese dietary patterns on metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis. After excluding factors affecting the diagnosis of hepatic steatosis, 727 adults were analyzed as part of the Health Promotion Project. The dietary patterns of the participants were classified into rice, vegetable, seafood, and sweet based on their daily food intake. Liver stiffness measurements and controlled attenuation parameters were performed using FibroScan. Energy and nutrient intake were calculated using the Brief-type Self-administered Diet History Questionnaire. Univariate and multivariate analyses were used to identify the risk factors for liver fibrosis within the MASLD population. The vegetable group had significantly lower liver fibrosis indicators in the MASLD population than the rice group. The multivariate analysis identified a body mass index ≥ 25 kg/m2 (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.01-1.83; p = 0.047) and HOMA-IR ≥ 1.6 (OR, 3.18; 95% CI, 1.74-5.78; p < 0.001) as risk factors for liver fibrosis, and vegetable group membership was a significant low-risk factor (OR, 0.38; 95% CI, 0.16-0.88; p = 0.023). The multivariate analysis of nutrients in low-risk foods revealed high intake of α-tocopherol (OR, 0.74; 95% CI, 0.56-0.99; p = 0.039) as a significant low-risk factor for liver fibrosis. This study suggests that a vegetable-based Japanese dietary pattern, through the antioxidant effects of α-tocopherol, may help prevent liver fibrosis in MASLD and the development of MASLD.

Is MASLD lost in translation in mice?

Lack of preclinical model translation is often blamed for failed drug development. Here we discuss mouse models within the context of human steatotic liver disease (SLD). Variables such as aging and non-food hepatic stressors are often ignored but could explain challenges in reproducing the human disease in a laboratory.