Liver Histology of Treatment-Naïve Children with Chronic Hepatitis B Virus Infection in Shanghai China

Functional cure of a young child with chronic hepatitis B cirrhosis treated by pegylated interferon α combination therapy: A case report

RATIONALE

Current research on antiviral treatment in children is relatively limited, especially in children under 1 year old.

PATIENT CONCERNS

Liu XX, an 8-month-old infant (case number: 3001120473), presented to the hospital in August 2016 with a chief complaint of being "hepatitis B surface antigen positive for 8 months and experiencing abnormal liver function for 5 months."

DIAGNOSES

The patient was diagnosed as chronic hepatitis B cirrhosis (G3S3-4) with active compensatory phase.

INTERVENTIONS

The treatment regimen commenced with lamivudine (LAM) for the initial 8 weeks, followed by the addition of interferon α (IFNα) after 1 year of age. At 2 years old, LAM was substituted with entecavir, and at 3 years old, IFNα was replaced with pegylated interferon α (PEG IFNα).

OUTCOMES

After 8 weeks of LAM monotherapy, Liu XX experienced hepatitis B e antigen loss. Subsequently, after 36 weeks of IFNα add-on therapy, hepatitis B virus DNA became undetectable, and after 48 weeks of switching to PEG IFNα treatment, hepatitis B surface antigen loss was observed. Remarkably, following 50 weeks of drug discontinuation, the child remained functionally cured.

LESSONS

Chronic hepatitis B virus-infected infants and young children can achieve durable functional cure with PEG IFNα-based individualized therapy. This case provides a valuable reference for the diagnosis and treatment of such patients.

Correlation Between Clinical Indicators and Liver Pathology in Children with Chronic Hepatitis B

Background: Chronic hepatitis B (CHB) in children presents a significant global health challenge, with liver inflammation and fibrosis being critical concerns for disease progression and long-term outcomes. Methods: This retrospective study analyzed 1629 pediatric CHB patients from the Fifth Medical Center of Chinese PLA General Hospital, spanning from January 2000 to December 2021. Liver biopsies were performed to assess the severity of liver inflammation and fibrosis, which were graded using the Scheuer scoring system. Key clinical indicators, including age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), were evaluated for their predictive value in determining disease severity using restricted cubic spline regression models. Results: Significant nonlinear associations were found between the clinical indicators and liver pathology. Older age was strongly associated with increased risks of moderate to severe inflammation (OR 2.21, 95% CI: 1.34-3.63, p = 0.002) and significant fibrosis (OR 2.22, 95% CI: 1.31-3.77, p = 0.003). Elevated ALT levels (≥80 U/L) were correlated with a higher likelihood of moderate to severe inflammation (OR 1.82, 95% CI: 1.05-3.15, p = 0.033), while higher GGT levels (≥50 U/L) were significantly associated with advanced fibrosis (OR 2.62, 95% CI: 1.72-3.99, p < 0.001). Conclusions: Regular monitoring of clinical indicators such as ALT, AST, and GGT levels plays a critical role in identifying pediatric CHB patients at higher risk of moderate to severe inflammation and significant fibrosis. Our findings highlight the value of integrating age and key biochemical markers into non-invasive diagnostic algorithms for the early detection and management of liver pathology in children.

Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association, Group of Infectious Diseases, Chinese Pediatric Society, Chinese Medical Association, National Clinical Research Center for Infectious Diseases (Beijing). Expert Consensus on the Prevention and Treatment of Chronic Hepatitis B in Children

The aim of this consensus is to standardize the prevention, diagnosis, and treatment of chronic hepatitis B in children and to achieve the goal of “eliminating viral hepatitis as a major public health threat by 2030” issued by the World Health Organization. Formulated by organized experts of the Chinese Society of Infectious Diseases and Chinese Society of Hepatology, Chinese Medical Association; Group of Infectious Diseases, Chinese Pediatric Society, Chinese Medical Association; and the National Clinical Research Center for Infectious Diseases (Beijing), the consensus provides the latest evidence and recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B in children.

Upregulation of microRNA-125b-5p alleviates acute liver failure by regulating the Keap1/Nrf2/HO-1 pathway

BACKGROUND

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are the two most common subtypes of liver failure. They are both life-threatening clinical problems with high short-term mortality. Although liver transplantation is an effective therapeutic, its application is limited due to the shortage of donor organs. Given that both ACLF and ALF are driven by excessive inflammation in the initial stage, molecules targeting inflammation may benefit the two conditions. MicroRNAs (miRNAs) are a group of small endogenous noncoding interfering RNA molecules. Regulation of miRNAs related to inflammation may serve as promising interventions for the treatment of liver failure.

AIMS

To explore the role and mechanism of miR-125b-5p in the development of liver failure.

METHODS

Six human liver tissues were categorized into HBV-non-ACLF and HBV-ACLF groups. Differentially expressed miRNAs (DE-miRNAs) were screened and identified through high-throughput sequencing analysis. Among these DE-miRNAs, miR-125b-5p was selected for further study of its role and mechanism in lipopolysaccharide (LPS)/D-galactosamine (D-GalN) -challenged Huh7 cells and mice in vitro and in vivo.

RESULTS

A total of 75 DE-miRNAs were obtained. Of these DE-miRNAs, miR-125b-5p was the focus of further investigation based on our previous findings and preliminary results. We preliminarily observed that the levels of miR-125b-5p were lower in the HBV-ACLF group than in the HBV-non-ACLF group. Meanwhile, LPS/D-GalN-challenged mice and Huh7 cells both showed decreased miR-125b-5p levels when compared to their untreated control group, suggesting that miR-125b-5p may have a protective role against liver injury, regardless of ACLF or ALF. Subsequent results revealed that miR-125b-5p not only inhibited Huh7 cell apoptosis in vitro but also relieved mouse ALF in vivo with evidence of improved liver histology, decreased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and reduced tumor necrosis factor-α (TNF-α) and IL-1β levels. Based on the results of a biological prediction website, microRNA.org, Kelch-like ECH-associated protein 1 (Keap1) was predicted to be one of the target genes of miR-125b-5p, which was verified by a dual-luciferase reporter gene assay. Western blot results in vitro and in vivo showed that miR-125b-5p could decrease the expression of Keap1 and cleaved caspase-3 while upregulating the expression of nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and heme oxygenase-1(HO-1).

CONCLUSION

Upregulation of miR-125b-5p can alleviate acute liver failure by regulating the Keap1/Nrf2/HO-1 pathway, and regulation of miR-125b-5p may serve as an alternative intervention for liver failure.