Burden of liver diseases in the world

Mixture analysis of associations between environmental and workplace toxins and liver damage and telomere length, stratified by race/ethnicity

This study aimed to identify the worst "bad actors" in mixtures of pollutants contributing to liver damage and shorter telomeres in the U.S. population, using weighted quantile sum (WQS) modeling with stratification by race/ethnicity. We conducted a comprehensive cross-sectional analysis of mixtures of pollutants in National Health and Nutrition Examination Survey datasets: (1) 33,979 adults with blood levels of cadmium (Cd), lead (Pb), and mercury, including subsets with measurements of per-/polyfluoroalkyl substances (PFAS), and polychlorinated biphenyls (PCBs)/polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs); and (2) 7360 adults with measurements of telomeres, Cd, and Pb. Multivariable-adjusted WQS regression examined associations between WQS mixture indices and liver injury (alanine aminotransferase (ALT)-elevation), advanced liver-fibrosis (LF), and telomere length. WQSmetal indices were associated with advanced-LF in all racial/ethnic groups. The top contributor was Cd in the total population and in non-Hispanic Whites (NHW), while Pb was the top contributor in non-Hispanic Blacks (NHB). The WQSmetal-PCB-PCDD/F index was associated with ALT-elevation, with PCB126, Cd and Pb as main contributors; the odds ratio (OR) per decile was 1.50 (95 % CI, 1.26-1.78), while the OR per decile of the WQSmetal-PFAS index was 1.03 (95 % CI, 0.98-1.05), not significant. WQSmetal indices were associated with shorter telomeres. Cd was main contributor associated with advanced-LF in NHW, while Pb was the major bad actor in NHB, suggesting that NHB may be especially susceptible to Pb toxicity. Metals were associated with shorter telomeres. Metal and PCB/PCDD/F mixtures were associated with ALT-elevation. Heavy metals and organic chemicals may contribute to liver-related morbidity and healthcare disparities.

Toward near real-time precise supervision of radiofrequency ablation for liver fibrosis using hyperspectral imaging

BACKGROUND AND AIMS

Chronic liver diseases pose a significant global health concern, ranking as the 11th leading cause of death worldwide. It often progresses to organ fibrosis and severe complications such as portal hypertension and cirrhosis. Liver transplantation is the most effective treatment for such diseases, however, the persistent shortage of donors highlights the need for alternatives. Radiofrequency ablation (RFA) is a promising alternative since it is a minimally invasive procedure. RFA uses heat to destroy abnormal tissues. Its benefits include reduced recovery time compared to surgery, precise targeting of affected areas, and long-lasting symptom relief in many cases. However, RFA has challenges, such as potential risks of nerve damage, infection, or incomplete ablation, requiring repeat treatments. Although significant progress in RFA techniques, effective monitoring remains challenging due to the limited ability to accurately characterize the dynamic thermal diffusion and complex tissue responses.

METHODS

To address this challenge, hyperspectral imaging (HSI) shows promise in monitoring tissue necrosis post-ablation. Our study evaluated HSI's efficacy in monitoring RFA on ex vivo human fibrotic liver tissue samples.

RESULTS

Statistical analysis revealed correlations between spectral patterns and tissue conditions, which helped identify the optimal spectral bands of 543 nm and 579 nm for accurately distinguishing different tissue states. Analyzing the hemoglobin absorption profile indicated significant reductions in absorption of the green light band, showing approximately 40 % reduction in fibrotic tissue and around 20 % reduction in ablated tissue when compared to normal liver tissue. Additionally, a threshold was established for predicting the ablated area of liver samples, ensuring a condition of 90 % specificity.

CONCLUSIONS

Consequently, HSI proved to be a valuable tool for monitoring ablation and a step for improving treatment outcomes for liver fibrosis.

Mesenchymal stromal/stem cell spheroid-derived extracellular vesicles advance the therapeutic efficacy of 3D-printed vascularized artificial liver lobules in liver failure treatment

Acute liver failure (ALF) is a highly lethal condition characterized by massive tissue necrosis, excessive oxidative stress, and serious inflammatory storms, necessitating prompt medical intervention. Although hepatocyte-like cells (HLCs) derived from mesenchymal stromal/stem cells (MSCs) offer a promising alternative cell source for hepatocyte therapy, their low in-vivo integration and differentiation efficiency may compromise the eventual therapeutic efficacy. To this end, MSCs are bioengineered into multicellular spheroids in the present study. The proteomic analyses and experimental results reveal that extracellular vesicles (EVs) derived from these MSC spheroids (SpEV) contain abundant highly expressed bioactive proteins and can be efficiently endocytosed by recipient cells, resulting in enhanced pro-angiogenic and antioxidative effects. In addition, MSC spheroids exhibit superior hepatic cell differentiation compared to an equivalent number of dissociated single MSCs, particularly when being co-cultured with hexagonally patterned endothelial cells in a liver lobule-like arrangement. Following orthotopic implantation in the mouse model, the enhanced paracrine effects of SpEV, combined with an immunoregulatory decellularized extracellular matrix hydrogel carrier and functional artificial liver lobules (ALL), synergically contribute to the effective amelioration of ALF, highlighting the substantial potential for clinical translation.

Combined quercetin with phosphodiesterase inhibitors; sildenafil and pentoxifylline alleviated CCl4-induced chronic hepatic fibrosis: Role of redox-sensitive pathways

Liver fibrosis is a common pathological condition that is caused by complicated molecular and cellular processes. This study evaluated the therapeutic potential of combined quercetin (QU) with either sildenafil (Sild) or pentoxifylline (PTX) in chronic carbon tetrachloride (CCl4)-induced liver fibrosis in Wistar albino rats. Fibrosis was induced by CCl4 injections (1.5 mg/kg, i.p.) three times weekly for 10 weeks. After six weeks, rats received oral QU (50 mg/kg/day), Sild (50 mg/kg/day), or PTX (10 mg/kg twice/day) individually or in combination for the remaining four weeks. Results showed significant alterations in liver biochemical markers, histopathology, oxidative stress, inflammation, apoptosis, and hypoxic responses due to CCl4 exposure. These changes included reduced expression of Nrf-2, HO-1, and cytoglobin, alongside increased levels of NF-κB, cleaved caspase-3, TNF-α, IL-1β, and HIF-1. Notably, QU, Sild, and PTX, individually or in combination, improved these parameters. The combination of QU with Sild or PTX proved more effective than single treatments, modulating anti-oxidant (Nrf2/HO-1/cytoglobin), anti-inflammatory (NF-κB/TNF-α), and hypoxic signaling pathways (HIF-1α). In conclusion, QU combined with phosphodiesterase inhibitors shows promise as a therapy for liver fibrosis, offering enhanced protection through anti-oxidants and anti-inflammatory mechanisms.

Comparative association of MAFLD/MASLD and Subtypes with Cardiovascular Diseases Outcomes

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) acts as an alternative for demarcating metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to investigate the factors that significantly influence the relationship between MAFLD and MASLD in relation to the incidence of major cardiovascular outcomes.

METHODS AND RESULTS

A total of 340,998 participants in the UK Biobank study were included. Multivariable Cox proportional hazards models were used to estimate the effect of MAFLD and MASLD on the outcomes of cardiovascular diseases (CVDs) (coronary artery disease, stroke, heart failure, and CVD-related death) with hazard ratios (HRs) and 95 % confidence intervals (CIs). A total of 126,077 (36.97 %) participants had MAFLD and 97,418 (28.57 %) had MASLD. Over a median follow-up of 13.5 years (interquartile range 12.6-14.2), there were 41,548 new events of CVDs recorded. MAFLD (HR = 1.52; 95 % CI: 1.49-1.55) and MASLD (HR = 1.42; 95 % CI: 1.39-1.45) were associated with high risks of CVDs. Among the subtypes of MAFLD and steatotic liver disease (SLD), MAFLD diabetes subtype (HR = 2.26; 95 % CI: 2.17-2.35) and alcohol-associated liver disease (ALD) (HR = 1.65; 95 % CI: 1.55-1.76) exhibited the highest risk of CVDs. MAFLD overweight without MD subtype were not associated with CVDs. The effect of MAFLD on the CVD outcomes was consistent regardless of the presence of MASLD.

CONCLUSION

The metabolic health status and alcohol consumption function as more critical factors than obesity in assessing CVD outcomes in participants with MAFLD or MASLD.

Effects of Probiotics on Liver Diseases: Current In Vitro and In Vivo Studies

Various types of liver or hepatic diseases cause the death of about 2 million people worldwide every year, of which 1 million die from the complications of cirrhosis and another million from hepatocellular carcinoma and viral hepatitis. Currently, the second most common solid organ transplant is the liver, and the current rate represents less than 10% of global transplant requests. Hence, finding new approaches to treat and prevent liver diseases is essential. In liver diseases, the interaction between the liver, gut, and immune system is crucial, and probiotics positively affect the human microbiota. Probiotics are a non-toxic and biosafe alternative to synthetic chemical compounds. Health promotion by lowering cholesterol levels, stimulating host immunity, the natural gut microbiota, and other functions are some of the activities of probiotics, and their metabolites, including bacteriocins, can exert antimicrobial effects against a broad range of pathogenic bacteria. The present review discusses the available data on the results of preclinical and clinical studies on the effects of probiotic administration on different types of liver diseases.

cPLA2α on the influence of Th17 and its role in the formation of liver fibrosis

This study primarily investigated the mechanism and pathways of the cPLA2α signaling pathway on Th17-mediated HSC activation and liver fibrosis, providing insights for clinical strategies to target HSC activation and delay the rapid progression of liver fibrosis. In vitro and in vivo model were established, and different concentrations of the cPLA2α inhibitor AACOCF3 were administered respectively for intervention. The expression of IL- 17 was detected by ELISA, and the expression of cPLA2α protein and HSC activation protein α-SMA index were detected by Western blot and immunofluorescence. In addition, observe the changes in the degree of liver fibrosis in mice through the pathological staining of mouse livers. In an in vitro system, Th17 could induce HSC activation. And after intervention, the results showed that the inhibitor could inhibit Th17 activation of HSC. Next, in an in vivo model, Th17 could also induce HSC activation. And after intervention, the results showed that the inhibitor could also inhibit HSC activation by Th17. Observation under liver pathological staining showed that the inflammation and staining were significantly reduced in the intervention group, suggesting a therapeutic effect of AACOCF3. Using in vitro and in vivo approaches, these data suggest that Th17 cells can promote the activation and proliferation of HSCs, which further exerts a role in promoting liver fibrosis. These data also suggest that the cPLA2α pathway may be involved in the activation of HSCs by Th17 cells and induce liver fibrosis mechanisms.

Exploring the Hepatoprotective Effects of Naringin: A Systematic Review and Meta-Analysis of Preclinical Evidence

This study aimed to perform a systematic review and meta-analysis on the hepatoprotective effects of naringin based on the pre-clinical evidence.A detailed literature search was performed using online databases such as Google Scholar, PubMed, Scopus, and EMBASE. Based on the predefined inclusion and exclusion criteria, 20 studies were considered for meta-analysis.The outcomes of the meta-analysis revealed that naringin improved liver function by reducing the elevated levels of ALT, AST, GGT, LDH, ALP, and bilirubin. It improved the enzymatic and non-enzymatic antioxidants, such as SOD, catalase, GSH, GST, GR, and GPx (p < 0.05 for all the parameters), while reducing the LPO/MDA levels (p < 0.05). NAR treatment also alleviated the levels of inflammatory mediators (IL-1β, IL-6, and TNF-α, p < 0.001 for all the parameters; NF-κB, p = 0.29) in various animal models of liver injury. In addition, NAR significantly reduced the caspase-3 and Bax/Bcl-2 ratio (p < 0.05) compared to the control group. Furthermore, naringin treatment has normalised the liver and body weights compared to the disease control group.This systematic review and meta-analysis demonstrate that naringin significantly improved the liver function in various animal models of liver injury, via potent antioxidant and anti-inflammatory mechanisms.

Evaluation of Annona muricata for hepatoprotection, hematological assessment and inhibitor of TGFβR1 in liver diseases

BACKGROUND

This study was conducted to assess the hepatoprotective potential of Annona muricata flower (AMF) using albino rats' model.

MATERIALS AND METHODS

Liver function assays such as alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBILI), antioxidants, haematology (HGB), histology, inhibition of transforming growth factor beta receptor I (TGFβR1) and antibacterial assays were investigated.

RESULTS AND DISCUSSION

Induction with acetaminophen gave rise to a significant increase (p < 0.05) in serum of liver enzymes of ALT, AST, ALP and TBILI in the acetaminophen (APAP) only group, which indicates hepatocellular injury, whereas AMF attenuated liver enzymes level. The histological assessment confirmed that AMF possesses blood-enhancing ability. AMF significantly showed inhibition of TGFβR1. AMF was active against all the tested bacteria with high zones of inhibition.

CONCLUSION

This study provides information on the uses of AMF as a natural product for hepatoprotection and other therapeutic purposes.

Nonlinear association between AST/ALT ratio and 28-day all-cause mortality following ICU admission in critically ill cirrhotic patients: a retrospective cohort study

BACKGROUND

The AST/ALT ratio is a biochemical marker associated with poor clinical outcomes in various patients, but its role in severe cirrhosis is unclear. This study investigated the relationship between the AST/ALT ratio and mortality in the intensive care unit (ICU) patients with cirrhosis.

METHODS

This retrospective cohort study analyzed 2,090 liver cirrhosis patients from the MIMIC-IV database, focusing on their first ICU admission between 2008 and 2019. The AST/ALT ratio, measured within 24 h of admission, was the exposure variable, and the main outcome was 28-day mortality. A multivariable logistic regression model evaluated the link between the AST/ALT ratio and mortality. Nonlinear relationships were explored using smooth curve fitting and saturation effect analyses. Stratified analyses and interaction tests were also performed based on demographic and clinical characteristics.

RESULTS

The study involved 2,090 critically ill liver cirrhosis patients, averaging 59.1 years old, with 65% male and a 28-day post-ICU admission mortality rate of 29%. The AST/ALT ratio was linked to mortality risk (adjusted odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0-1.2; p = 0.015), showing a nonlinear pattern with a critical point at 3.6. Below this, each unit increase raised mortality risk by 40% (adjusted OR 1.4, 95% CI 1.2-1.6, p < 0.001), but the effect plateaued beyond this level (adjusted OR 1.0, 95% CI 0.8-1.1, p = 0.600). Subgroup analyses confirmed the consistent association, with interaction P values over 0.05.

CONCLUSIONS

The AST/ALT ratio is an independent predictor of 28-day mortality in critically ill cirrhotic patients, with a nonlinear relationship (risk increases up to a ratio of ~ 3.6, then plateaus). This marker could enhance ICU risk stratification and inform clinical decision-making.

The Impact of Housing Insecurity on Hospitalized Patients With Diagnosis of Cirrhosis: A Comparative Analysis Using Data from the National Inpatient Sample

BACKGROUND

The impact of homelessness on clinical outcomes and health care utilization among hospitalized cirrhosis patients has not been well-characterized.

METHODS

We conducted a cross-sectional study using the National Inpatient Sample (2016 to 2021) to analyze hospitalizations of adults with cirrhosis, comparing outcomes between those with and without homelessness. Demographic, clinical, and hospital-level characteristics were assessed, along with outcomes such as mortality and AMA discharges. Health care utilization metrics, including length of stay (LOS) and cost, were also evaluated, with multivariable regression used to adjust for confounders.

RESULTS

Among 4,579,858 hospitalizations for cirrhosis, 109,640 (2.4%) involved homeless patients, who were younger (mean 53.5 vs. 60.6 y, P<0.001) and predominantly male (80.4% vs. 58.9%, P<0.001). Homeless patients had higher rates of alcohol use (73.5% vs. 30.9%, P<0.001), opioid use disorder (11.8% vs. 3.6%, P<0.001), and psychiatric comorbidities (62% vs. 37.4%, P<0.001). Hispanic and Native American patients were over-represented, while white patients were under-represented. Mortality was lower in homeless patients (aOR=0.49, 95% CI: 0.45-0.54, P<0.001). However, AMA discharges were significantly higher (9.6% vs. 2.7%, P<0.001). Homeless patients had longer hospital stays (mean 7.3 vs. 6.2 d, P<0.001) but lower per-day hospitalization costs ($2278 vs. $2859, P<0.001).

CONCLUSION

Despite lower mortality rates and cost per hospitalization day, high AMA discharge rates and prolonged hospital stays underscore the challenges to safe discharge among patients with cirrhosis experiencing homelessness.

Identification of novel potential biomarkers using bulk RNA and single cells to build a neural network model for diagnosis of liver cancer

BACKGROUND

As a common cancer, liver cancer imposes an unacceptable burden on patients, but its underlying molecular mechanisms are still not fully understood. Therefore, there is an urgent need to potential biomarkers and diagnostic models for liver cancer.

METHODS

In this study, transcriptome and single-cell datasets related to liver cancer were downloaded from the UCSC Xena database and the Mendeley database, and differential analysis and weighted gene co-expression network analysis were used to find differentially expressed genes related to liver cancer. We used multiple machine algorithms to find hub genes related to liver cancer, and constructed new artificial neural network models based on their transcriptome expression patterns to assist in the diagnosis of liver cancer. Subsequently, we conducted survival analysis and immune infiltration analysis to explore the correlation between hub genes and immune cells, and used single-cell data to verify hub genes related to liver cancer.

RESULTS

This study identified MARCO, KCNN2, NTS, TERT and SFRP4 as central genes associated with liver cancer, and constructed a new artificial neural network model for molecular diagnosis of liver cancer. The diagnostic performance of the training cohort and the validation cohort was good, with the areas under the ROC curves of 1.000 and 0.986, respectively. Immune infiltration analysis determined that these central genes were closely associated with different types of immune cells. The results of immunohistochemistry and the results at the single cell level were consistent with those at the transcriptome level, and also showed obvious differences between different cell types in liver cancer and healthy states.

CONCLUSION

This study identified MARCO, KCNN2, NTS, TERT, and SFRP4 from multiple dimensions and highlighted their key roles in the diagnosis and treatment of liver cancer from multiple dimensions, providing promising biomarkers for the diagnosis of liver cancer.

Alcohol-Associated Hepatocarcinogenesis: Wnt/β-Catenin in Action

Chronic alcohol consumption is a leading global health concern, primarily due to its deleterious effects on liver function and its well-established association with hepatocellular carcinoma (HCC). Alcohol-related liver disease (ALD) encompasses a continuum-from reversible hepatic steatosis and steatohepatitis through progressive fibrosis and cirrhosis to overt HCC. Accumulating studies have revealed that the Wnt/β-catenin signaling pathway is an essential regulator in ALD pathogenesis, orchestrating diverse molecular, immunological, and epigenetic processes. Aberrant β-catenin activity disrupts redox homeostasis, promotes chronic inflammation, drives extracellular matrix (ECM) remodeling, and alters hepatocyte fate decisions, thereby creating a microenvironment that is highly conducive to carcinogenesis. Here, we provide a systemic review of the significant function of Wnt/β-catenin signaling in ALD, emphasizing its regulatory impact on liver fat accumulation, its inflammatory role in steatohepatitis, its involvement in fibrogenesis, and its tumor-promoting effects in alcohol-related HCC. In addition, we explore emerging therapeutic strategies-including direct Wnt modulators, combinatory therapeutics, and precision medicine approaches-that offer potential for early identification and tailored therapy of ALD.

Nonlinear associations of serum vitamin D levels with advanced liver disease and mortality: a US Cohort Study

Background

Vitamin D deficiency is prevalent and linked to chronic diseases; its association with advanced liver disease progression requires clarification.

Objectives

To investigate the association between vitamin D levels and risks of liver cirrhosis, hepatocellular carcinoma (HCC), and mortality, and assess risk changes after achieving sufficiency post-supplementation.

Design

This was a retrospective cohort study.

Methods

Utilized TriNetX US data (3,905,594 patients, 2000-2024). Adults with vitamin D deficiency (20.00-30.00 ng/mL) were compared with those with sufficient levels (30.01-80.00 ng/mL). Follow-up was initiated from the first vitamin D test or start of supplementation to minimize immortal time bias. Propensity score matching (1:1) balanced >20 baseline confounders.

Results

After matching, 1,204,760 patients with vitamin D deficiency and 1,204,760 with sufficient vitamin D levels were included. Vitamin D deficiency was associated with an increased risk of liver cirrhosis (hazard ratio (HR), 1.30; 95% confidence interval (CI), 1.25-1.36), HCC (HR, 1.22; 95% CI, 1.08-1.37), and all-cause mortality (HR, 1.14; 95% CI, 1.13-1.16). Achieving sufficient vitamin D levels reduced the risk of all-cause mortality (HR, 0.93; 95% CI, 0.88-0.99) and aligned HCC outcomes (HR, 1.16; 95% CI, 0.68-2.00). However, it did not significantly reduce the risk of liver cirrhosis (HR, 2.05; 95% CI, 1.69-2.50). Dose-response analysis showed a U-shaped relationship for liver cirrhosis and HCC, with the lowest risks at 40-60 ng/mL.

Conclusion

Serum vitamin D levels showed a nonlinear association with liver cirrhosis and HCC risk; deficiency independently increased the risks for cirrhosis, HCC, and mortality. Supplementation achieving sufficiency reduced mortality and normalized HCC risk but not cirrhosis risk, potentially reflecting limitations in reversing established disease. The lowest liver disease risk was associated with vitamin D levels of 40-60 ng/mL in this cohort, although causality and the clinical benefit of targeting this specific range require confirmation.

Quantitative Proteomic Study Reveals Amygdalin Alleviates Liver Fibrosis Through Inhibiting mTOR/PDCD4/JNK Pathway in Hepatic Stellate Cells

Purpose

Hepatic fibrosis is a major cause of morbidity and mortality for which there is currently limited therapy. Amygdalin, a cyanogenic glucoside derived from Semen Persicae, exerts significant anti-fibrotic effects in the liver. However, the molecular mechanism by which amygdalin inhibits the progression of liver fibrosis remains unclear. This study aimed to elucidate the potential mechanism of action of amygdalin against liver fibrosis.

Methods

Quantitative proteomic profiling of the mouse liver tissues from control, carbon tetrachloride (CCl4)-induced fibrosis, and amygdalin-treated groups was performed to explore the key effector proteins of amygdalin. Histology and immunohistochemistry as well as serum biochemical analysis were performed to evaluate amygdalin efficacy in mice. The key gene programmed cell death protein 4 (PDCD4) was overexpressed or knocked down in human hepatic stellate cells (HSCs). The mRNA and protein levels of related molecules were detected by RT-qPCR and Western blotting, respectively.

Results

Amygdalin could effectively ameliorated CCl4-induced liver fibrosis in mice. Bioinformatics analysis revealed that PDCD4 was downregulated in CCl4-induced liver fibrosis, but amygdalin treatment reversed these changes. An in vitro study showed that PDCD4 inhibited the activation of human hepatic stellate cell line LX-2 cells by regulating the JNK/c-Jun pathway and amygdalin inhibited the activation of LX-2 cells in a PDCD4-dependent manner. We further found that amygdalin inhibited the phosphorylation of PDCD4 at Ser67 by inhibiting the mTOR/S6K1 pathway to enhance PDCD4 expression.

Conclusion

Our data demonstrated a potential pharmaceutical mechanism by which amygdalin alleviates liver fibrosis by inhibiting the mTOR/PDCD4/JNK pathway in HSCs, suggesting that PDCD4 is a potential target for the treatment of liver fibrosis.

Trajectories of depressive symptoms and risk of chronic liver disease: evidence from CHARLS

BACKGROUND

It is unclear whether there is a association between the long-term depressive symptoms and chronic liver disease(CLD). The aim of present study was to investigate the relationship between the trajectories of depressive symptoms and CLD in middle-aged and older Chinese adults.

METHODS

The study included data from 7351 Chinese individuals, which from the China Health and Retirement Longitudinal Study (CHARLS). Latent Class Growth Model (LCGM) and Growth Mixture Model (GMM) identified five categories of depressive symptom trajectories from 2011 to 2015. Multiple logistic regression models were used to analyze the relationship between depressive symptom trajectories and CLD in 2015-2020.

RESULTS

We identified five distinct trajectories of depressive symptoms characterized by persistent low CES-D scores throughout follow-up (low-stable; 4621 cases [62.86%]); high starting CES-D scores but then declining (high-decreasing; 824 cases [11.21%]); persistent high CES-D scores during follow-up (high-stable; 508 cases [6.91%]); starting moderate CES-D scores but then increasing (moderate-increasing; 844 cases [11.48%]); and low starting CES-D scores that increased and then remitted through follow-up (remitting; 554 cases [7.54%]). A total of 420 (5.71%) participants developed chronic liver disease during follow-up. The ORs (95% CI) for the risk of developing chronic liver disease in participants on the moderate-increasing trajectory, high-decreasing trajectory, and high-stable trajectory were 1.44 (1.05-1.93), 1.59 (1.17-2.12), and 2.25 (1.62-3.08), respectively, compared with participants on the low-stable trajectory.

CONCLUSION

In Chinese middle-aged and older adults, individuals with moderate-increasing, high-decreasing, and high-stable trajectories of depressive symptoms over time had an increased risk of developing CLD.

Geriatric Nutritional Risk Index as a Predictor of Overall Survival in Cirrhosis: A Retrospective Cohort Study

OBJECTIVE

The geriatric nutritional risk index (GNRI) is widely used for nutritional assessment. Poor nutritional status is associated with complications and poor survival in cirrhotic patients. We aimed to investigate the value of the GNRI in predicting outcomes in cirrhotic patients.

METHODS

This retrospective study included 420 cirrhotic patients from three centers between 2013 and 2017. Patients were divided into the high GNRI group (≥ 92) and low GNRI group (< 92). Overall survival (OS) in the two groups was evaluated via the Kaplan‒Meier method. Cox proportional hazards model was used to estimate the value of the GNRI in predicting outcomes. Restricted cubic spline model was used to intuitively display the dose‒response associations between the GNRI and OS. A nomogram was constructed to predict OS.

RESULTS

During the 2-year follow-up period, 58 (13.81%) patients died, and 262 (62.38%) patients experienced episodes of complications. Compared with patients in the low GNRI group, those in the high GNRI group had lower mortality rates (18.73% vs. 5.23%, P < 0.001). The GNRI was an independent predictor of OS (hazard ratio [HR] = 0.958, 95% confidence interval [CI] 0.929-0.988, P = 0.007). The GNRI was associated with the cumulative incidence of ascites (HR = 0. 954, 95% CI 0.940-0.969, P < 0.001), spontaneous bacterial peritonitis (HR = 0.928, 95% CI 0.891-0.966, P < 0.001), hepatic encephalopathy (HE; HR = 0.944, 95% CI 0.920-0.968, P < 0.001), and hepatorenal syndrome (HRS) (HR = 0.916, 95% CI 0.861-0.974, P = 0.005). Furthermore, 6 independent factors were included to construct the nomogram for OS prediction, including GNRI, age, total bilirubin, serum sodium, history of HE and HRS. The C statistics of our model were 0.83 (95% CI 0.75-0.90) and 0.80 (95% CI 0.73-0.86) at 1 and 2 years, respectively. Patients whose GNRI score decreased within 3 and 6 months had poorer outcomes (P < 0.001).

CONCLUSIONS

The lower GNRI score was associated with the higher cumulative incidence of complications and poorer OS of cirrhotic patients. The GNRI could be a helpful tool for assessing nutritional status and prognosis of these patients.

Explainable Artificial Intelligence for Diagnosis and Staging of Liver Cirrhosis Using Stacked Ensemble and Multi-Task Learning

Background/Objectives: Liver cirrhosis is a critical chronic condition with increasing global mortality and morbidity rates, emphasizing the necessity for early and accurate diagnosis. This study proposes a comprehensive deep-learning framework for the automatic diagnosis and staging of liver cirrhosis using T2-weighted MRI images. Methods: The methodology integrates stacked ensemble learning, multi-task learning (MTL), and transfer learning within an explainable artificial intelligence (XAI) context to improve diagnostic accuracy, reliability, and transparency. A hybrid model combining multiple pre-trained convolutional neural networks (VGG16, MobileNet, and DenseNet121) with XGBoost as a meta-classifier demonstrated robust performance in binary classification between healthy and cirrhotic cases. Results: The model achieved a mean accuracy of 96.92%, precision of 95.12%, recall of 98.93%, and F1-score of 96.98% across 10-fold cross-validation. For staging (mild, moderate, and severe), the MTL framework reached a main task accuracy of 96.71% and an average AUC of 99.81%, with a powerful performance in identifying severe cases. Grad-CAM visualizations reveal class-specific activation regions, enhancing the transparency and trust in the model's decision-making. The proposed system was validated using the CirrMRI600+ dataset with a 10-fold cross-validation strategy, achieving high accuracy (AUC: 99.7%) and consistent results across folds. Conclusions: This research not only advances State-of-the-Art diagnostic methods but also addresses the black-box nature of deep learning in clinical applications. The framework offers potential as a decision-support system for radiologists, contributing to early detection, effective staging, personalized treatment planning, and better-informed treatment planning for liver cirrhosis.

Quality review and content analysis of liver complications mobile apps in Iran: A statistical and machine learning approach

BACKGROUND

Liver disease accounts for 4 % of global mortality. The advent of mobile technology has introduced a novel domain in liver disease management. Identifying effective mobile apps with pertinent information on liver diseases is essential. This study seeks to evaluate liver disease-related mobile applications using the Mobile Application Rating Scale (MARS) quality assessment tool.

METHOD

This research employs a cross-sectional descriptive and analytical methodology focusing on liver disease-related mobile applications. We evaluated all Persian and English mobile applications available on the Google Play, Cafe Bazaar, and Myket Stores dedicated to liver diseases until 2023. After eliminating duplicates, evaluators extracted technical specifications and features of apps. The MARS was employed to assess the quality of the mobile applications. Both statistical and machine learning methods were employed for analysis.

RESULTS

A total of 2,044 mobile applications were identified, with 49 selected for final analysis. The apps focused on liver-related issues included general liver disease (n = 20, 40.82 %), hepatitis (n = 9, 18.37 %), and fatty liver disease (n = 8, 16.33 %). In terms of functionality, the majority of apps (n = 20, 40.82 %) served as calculators, with 15 specifically for calculation. Among these, three integrated educational elements, and two also supported diet and fitness alongside calculator functions. Additionally, 20 apps aimed to provide educational and informative content. The average quality score was 3.17 (SD = 0.20), with scores ranging from 2.33 to 4.45. Generally, the mean score of Engagement, Functionality, Aesthetics and Information were 4.20 (SD = 0.67), 4.00 (SD = 0.67), 4.00 (SD = 0.92), and 4.00 (SD = 0.67), respectively. The highest Subjective quality score was 4.75.

CONCLUSIONS

Liver disease-related mobile applications serve users in educational, diet and lifestyle, calculation, risk assessment, and management domains, focusing mainly on general liver diseases and hepatitis. However, the results revealed that the apps lack sufficient and reliable information.

Peptidoglycan isolated from the fruit of Lycium barbarum alleviates liver fibrosis in mice by regulating the TGF-β/Smad7 signaling and gut microbiota

The hepatoprotective effect of the fruit of Lycium barbarum has been documented in China over millennia. Lycium barbarum polysaccharides (LBPs) were the first macromolecules reported to mitigate liver fibrosis in carbon tetrachloride (CCl4)-treated mice. Herein, a neutral peptidoglycan, named as LBPW, was extracted from the fruit of Lycium barbarum. In this study, we investigated the hepatoprotective mechanisms of LBPW. CCl4-induced liver fibrosis mice were administered LBPW (50, 100, 200 mg ·kg-1 ·d-1, i.p.) or (100, 200, 300 mg· kg-1 ·d-1, i.g.) for 6 weeks. We showed that either i.p. or i.g. administration of LBPW dose-dependently attenuated liver damage and fibrosis in CCl4-treated mice. Pharmacokinetic analysis showed that cyanine 5.5 amine (Cy5.5)-labeled LBPW (Cy5.5-LBPW) could be detected in the liver through i.p. and i.g. administration with i.g.-administered Cy5.5-LBPW mainly accumulating in the intestine. In TGF-β1-stimulated LX-2 cells as well as in the liver of CCl4-treated mice, we demonstrated that LBPW significantly upregulated Smad7, a negative regulator of TGF-β/Smad signaling, to retard the activation of hepatic stellate cells (HSCs) and prevent liver fibrosis. On the other hand, LBPW significantly boosted the abundance of Akkermansia muciniphila (A. muciniphila) and fortified gut barrier function. We demonstrated that A. muciniphila might be responsible for the efficacy of LBPW since decreasing the abundance of this bacterium by antibiotics (Abs) blocked the effectiveness of LBPW. Overall, our results show that LBPW may exert the hepatoprotective effect via rebalancing TGF-β/Smad7 signaling and propagating gut commensal A. muciniphila, suggesting that LBPW could be leading components to be developed as new drug candidates or nutraceuticals against liver fibrosis.

Extracellular vesicles derived from bone marrow mesenchymal stem cells ameliorate liver fibrosis via micro-7045-5p

INTRODUCTION

Liver fibrosis is a crucial pathological factor in the persistence and progression of chronic liver disease. Increasing evidence has demonstrated the significant potential of extracellular vesicles (EVs) secreted by bone marrow mesenchymal stem cells (BMSCs) in the clinical treatment of liver fibrosis. This study aimed to mechanistically investigate the impact of BMSC-derived EVs (BMSC-EVs) containing miR-7045-5p on the autophagy of activated hepatic stellate cells (HSCs) during liver fibrosis.

METHOD

BMSCs were isolated from the bilateral femurs and tibiae of mice. Their identity was confirmed via immunofluorescence staining for the BMSC marker CD44. EVs were harvested from BMSC culture medium at passages 3-5 and then DiR-labeled. Labeled BMSC-EVs were co-cultured with the HSC-T6 cell line to determine their uptake and sub-cellular localization in HSCs. Various methods, such as western blotting, qRT-PCR, and ELISA, were employed to assess the effects of BMSC-EVs on the fibrotic activation (marked by COL1-A1 and α-SMA expression) and autophagy (p62, Atg16L1, Beclin-1, and LC3 expression) of HSC-T6 cells. Additionally, the BMSC-EV-induced changes in autophagy-related signaling pathways (PI3K, AKT, and mTOR pathways) in these cells were evaluated. Finally, the gene-chip detection technology was utilized to predict the involvement of BMSC-EV-derived miRNAs (BMSC-EV-miRs) in the observed effects, with a focus on miR-7045-5p, and our findings were validated in HSCs transfected with a miR-7045-5p mimic.

RESULT

The gene-chip detection results indicated that miR-7045-5p was enriched in BMSC-EVs compared with BMSCs and targeted Akt. In the CCl4-induced mouse model of liver fibrosis, BMSC-EV-miR-7045-5p ameliorated the fibrosis and enhanced liver function by suppressing the PI3K/Akt/mTOR signaling pathway. Additionally, miR-7045-5p inhibited TGF-β1-induced fibrotic activation of HSC-T6 cells.

CONCLUSION

BMSC-EVs promote autophagy in HSC-T6 cells and alleviate liver fibrosis by inhibiting the PI3K/Akt/mTOR signaling pathway at least in part by delivering anti-fibrotic miRNAs, such as miR-7045-5p.

Use of Hepatoscope 2DTE for non-invasive assessment of liver stiffness among Mexican immigrant adults in a community-based setting

PURPOSE

Mexican-origin adults have one of the highest rates of metabolic dysfunction-associated steatotic liver disease (MASLD) and its severe form metabolic dysfunction steatohepatitis (MASH) in the US. Given the costs and invasiveness of liver biopsy, this study assessed the application of Hepatoscope® 2DTE, the latest-generation transient elastography for liver stiffness in Mexican adult immigrants from Southern Arizona and compared it with FibroScan® VCTE™.

METHODS

Participants (n = 199) from a cross-sectional community-based study completed anthropometric measures, demographic information, a blood draw, and liver stiffness measurements (LSM) with FibroScan VCTE and the ultraportable Hepatoscope 2DTE. LSM2DTE and LSMVCTE were compared using Spearman's correlation and Bland-Altman analysis. The number of at-risk for fibrosis participants as assessed using each system was compared according to FIB-4.

RESULTS

A total of 122 participants were considered for this sub-analysis which consisted of 71.3 % women. Mean age was 51.9 ± 12.1 years, BMI was 30.7 ± 5.7 kg/m², 43.4 % of participants had obesity, and 19.7 % were diabetic. Mean FIB-4 was 1.00 ± 0.53, and median LSM were 5.6 [4.7 - 6.7] and 5.3 [4.1 - 5.8] kPa for 2DTE and VCTE, respectively. 2DTE significantly correlated with VCTE (r = 0.53, p < 0.0001) and there was no systematic bias between the two LSM. There was no difference in the number of at-risk for fibrosis participants between the two LSM per FIB-4 categories.

CONCLUSION

Hepatoscope can be used for point-of-care liver stiffness assessment and risk stratification of adults at risk of liver fibrosis in community-based settings.

Lycopene, a natural plant extract, alleviates atrazine-induced ferroptosis in hepatocytes by activating cytochrome P450 oxidoreductase

Atrazine (ATZ) and diaminochlorotriazine (DACT) accumulation poses liver health risks in animals and humans. Lycopene (LYC), a carotenoid found in red plants and fruits, exhibits potent antioxidant effects. This study explores the interaction between LYC and ATZ in mouse hepatocyte ferroptosis and the potential regulatory role of Cytochrome P450 oxidoreductase (CYPOR) in this process. Male mice were exposed to ATZ (50 mg/kg or 200 mg/kg) and/or LYC (5 mg/kg) by gavage for 21 days. In vitro experiments, a mouse hepatocyte cell line (AML12) was exposed to DACT (200 μM) and/or LYC (2 μM) for 12 h with or without small interfering RNA treatment. We found that both ATZ and DACT promoted CYPOR expression and caused liver injury. ATZ/DACT promotes Fe2+ accumulation and lipid peroxidation, ultimately leading to Ferroptosis in mouse hepatocytes. However, LYC alleviated ATZ/DACT-induced Ferroptosis by inhibiting CYPOR. The CYPOR knockdown resulted in the blockage of ATZ/DACT-induced ferroptosis, while the alleviation of ferroptosis by LYC was further enhanced. Thus, CYPOR can regulate ferroptosis in mouse hepatocytes and is a novel target for the treatment of hepatocyte ferroptosis-related diseases. Lycopene can be used as a functional dietary supplement to scavenge ferroptosis and reduce chronic liver disease.

Modeling crash avoidance behaviors in vehicle-pedestrian near-miss scenarios: Curvilinear time-to-collision and Mamba-driven deep reinforcement learning

Interactions between vehicle-pedestrian at intersections often lead to safety-critical situations. This study aims to model the crash avoidance behaviors of vehicles during interactions with pedestrians in near-miss scenarios, contributing to the development of collision avoidance systems and safety-aware traffic simulations. Unmanned aerial vehicles were leveraged to collect high-resolution trajectory data of vehicle-pedestrian at urban intersections. A new surrogate safety measure, curvilinear time-to-collision (CurvTTC), was employed to identify vehicle-pedestrian near-miss scenarios. CurvTTC takes into account the curved trajectories of road users instead of assuming straight-line future trajectories, making it particularly suitable for safety analysis at intersections, where turning vehicles usually follow curved paths. An effective algorithm considering predicted trajectories and collision types was designed to compute CurvTTC. When CurvTTC was applied to capture vehicle-pedestrian conflicts at intersections, it demonstrated superior performance in identifying risks more accurately compared to other surrogate safety measures, emphasizing the importance of considering the curved trajectories of road users. Further, a novel deep deterministic policy gradient based on the Mamba network (Mamba-DDPG) approach was used to model vehicles' crash avoidance behaviors during the vehicle-pedestrian conflicts captured. Results revealed that the Mamba-DDPG approach effectively learned the vehicle behaviors sequentially in both lateral and longitudinal dimensions during near-miss scenarios with pedestrians. The Mamba-DDPG approach achieved superior predictive accuracy by utilizing Mamba's dynamic data reweighting, which prioritizes critical states. This resulted in better performance compared to both the standard DDPG and the Transformer-enhanced DDPG (Transformer-DDPG) methods. The Mamba-DDPG approach was employed to reconstruct evasive trajectories of vehicles when approaching pedestrians and its effectiveness in capturing the underlying policy of crash avoidance behaviors was validated.

Liver-Quant: Feature-based image analysis toolkit for automatic quantification of metabolic dysfunction-associated steatotic liver disease

BACKGROUND

Liver biopsy assessment by pathologists remains the gold standard for diagnosing metabolic dysfunction-associated steatotic liver disease (MASLD). Current automated image analysis tools for patient risk stratification are often proprietary or not applicable to whole slide images (WSIs). Here, we introduce "Liver-Quant," an open-source Python package for quantifying steatosis and fibrosis in liver WSIs.

METHOD

Liver-Quant leverages colour and morphological features to measure Steatosis Proportionate Area (SPA) and Collagen Proportionate Area (CPA). We evaluated the method using an internal dataset of 414 WSIs from adult patients (Leeds Teaching Hospitals NHS Trust, 2016-2022) and an external public dataset (109 WSIs). Semi-quantitative scores were extracted from pathological reports. The Spearman rank coefficient (ρ) assessed correlations between computed SPA/CPA and pathologist scores.

RESULTS

Steatosis quantification showed a substantial correlation (ρ = 0.92), while fibrosis quantification yielded a moderate correlation (ρ = 0.51). We further investigated the impact of three staining dyes (Van Gieson (VG), Picro Sirius Red (PSR), and Masson's Trichrome (MTC)) on fibrosis quantification (n = 18). Stain normalisation yielded excellent agreement in CPA measurements across all three stains. Without normalisation, PSR achieved the strongest correlation with human scores (ρ = 0.9) followed by VG (ρ = 0.8) and MTC (ρ = 0.59). Finally, we explored the impact of apparent magnification on SPA and CPA. High-resolution images (0.25 or 0.50 μm per pixel (MPP)) were necessary for accurate SPA measurement, while lower resolution (10 MPP) sufficed for CPA measurements.

CONCLUSIONS

Liver-Quant offers an open-source solution for rapid and precise MASLD quantification in WSIs applicable to multiple histological stains.

Getting Blood out of a Stone: Vascularization via Spheroids and Organoids in 3D Bioprinting

Current developments in bioequivalent technology have led to the creation of excellent models that mimic the structure and function of human organs. These models are based on the original tissues and organs of the human body, but they lack the complex interaction with the extensive network of vasculature, and this is a major challenge for these models. A functional vasculature is essential for oxygen, nutrient, and waste exchange. It is also responsible for inductive biochemical exchange, and provides a structural pattern for organ growth. In vitro systems, containing no perfusable vessels, suffer from the quick formation of a necrotic core of organoids, and further development does not occur due to increased metabolic demands. Another key limitation of 3D-based techniques is the absence of accurate architectural structures and large-scale tissue sizes. Recently, new 3D bioprinting methods have been developed for organoids and spheroids as living building blocks. These methods aim to address some of the challenges associated with 3D technologies. In this review, we discuss recent strategies for vascularization via organoids and spheroids, which are used as structural units in bioprinting to recreate natural organs and tissues with ever-increasing accuracy in structure and function.

Cirrhosis epidemiology in Denmark 1998-2022, and 2030 forecast

Background & Aims

The incidence of cirrhosis resulting from alcohol-related liver disease (ALD) is decreasing in Denmark, whereas the incidence of obesity is increasing, driving an increase in metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to perform an up-to-date study of the epidemiology of cirrhosis in Denmark, including etiologies, and a forecast through to 2030.

Methods

We identified all patients diagnosed with cirrhosis between 1998 and 2022, categorized into ALD and non-ALD cirrhosis, in nationwide Danish healthcare registries. Cirrhosis prevalence and incidence were computed. We used an age-period-cohort model to visualize impacts of age, calendar year, and birthyear on etiology-specific cirrhosis incidence rates (alcohol or non-alcohol, interpreted as mainly the result of MASLD), with predicted incidence rates for 2023-2030. The Kaplan-Meier function was used for survival probabilities.

Results

We included 30,747 (76%) patients with ALD cirrhosis and 9,548 (24%) with non-ALD cirrhosis. Patients with non-ALD cirrhosis were older and had more comorbidities compared with patients with ALD cirrhosis; median age at diagnosis was 66 vs. 59 years, increasing in both groups overall, from 56 years in 1998 to 66 years in 2022. The ALD cirrhosis proportion was stable at around 80% from 1998 to the end of 2014, and gradually declined to 58% in 2022. Overall cirrhosis prevalence will have peaked in 2024, and non-ALD cirrhosis will outnumber ALD cirrhosis from 2027. Thus, mortality among patients with cirrhosis is declining owing to fewer deaths the first year after cirrhosis diagnosis.

Conclusions

We forecast a change in cirrhosis epidemiology affecting hepatology practice in Denmark: patients will be older, fewer will have ALD, more will have MASLD, and their longer life expectancy and comorbidities will be more burdensome for healthcare systems.

Impact and implications

Alcohol-related liver (ALD) cirrhosis poses a substantial and growing burden on hospitals worldwide. Information about the current and imminent epidemiology of cirrhosis is important for our understanding of the public health, for researchers designing trials of interventions, and for planning of future assignments of healthcare systems. In the current study, we used Danish nationwide healthcare registries to study past, current, and future trends in the epidemiology of cirrhosis. Our results forecast a change in cirrhosis epidemiology and thereby a change in hepatology practice in Denmark. We expect that patients with ALD cirrhosis will be outnumbered by increasingly older patients who present in the outpatient clinic with cirrhosis from MASLD and a higher burden of comorbidities.

Evaluating the role of targeted silymarin loaded hyaluronic acid/protein nanoparticles in activating hepatic progenitor stem cells for liver regeneration after CCl4-induced liver damage

BACKGROUND

Silymarin is a natural flavonoid component isolated from the Silybum Marianum (Milk Thistle) plant with multiple pharmacological activities. We investigated its anti-fibrotic effect on the liver and demonstrated its role in activating hepatic progenitor stem cells during liver regeneration.

METHODS

Hybrid polymeric protein nanoparticles were prepared by loading silymarin with an albumin-hyaluronic acid complex to achieve stem cell targeting and increase silymarin's bioavailability.

RESULTS

TEM, Zeta potential, DLS, UV-visible spectrophotometer, Fluorescence analysis, and FTIR verified the successful formation of nanoparticles and efficient encapsulation. In the present study, The liver fibrotic model was induced by the intraperitoneal injection of carbon tetrachloride, followed by the injection of silymarin NPs into mice twice a week for 4 weeks. We evaluated the expression of hepatic fibrosis markers such as (Collagen I, TGF-β1, SMAD3, and MMP-3) and hepatic progenitor stem cell activation markers such as (HNF1β, FOXl1, CD90, Vimentin, and CD105). The results showed that the targeted silymarin NPs caused significant suppression and downregulation of Collagen I, TGF-β, SMAD-3, and MMP-3 and upregulation of the hepatic progenitor stem cells markers HNF1β, FOXl1, CD90, Vimentin, and CD105. They also didn't induce expression of IL-6, IL-1β, and TNF-α, proving that they cause no signs of inflammation.

CONCLUSION

The novel point is that these results demonstrated that the targeted Silymarin NPs not only could efficiently alleviate CCl4-induced liver fibrosis more than using only free silymarin; by inhibiting the TGF-β/Smad-3 signaling pathway, but also could activate hepatic progenitor stem cells causing liver regeneration.

A deep-red hemicyanine fluorescent probe for imaging butyrylcholinesterase in living cells and in mice with APAP-induced liver injury

As a serine hydrolase synthesized by the liver, butyrylcholinesterase (BChE) is an important biomarker in the clinical diagnosis of liver diseases. To track BChE activity in drug-induced liver injury, we designed a deep-red BChE-activatable fluorescent probe (CYL-BChE) with hemi-cyanine structure by using a cyclopropyl carbonyl group as a specific recognition moiety. Its near-infrared absorption wavelength (665 nm) and emission wavelength (762 nm) provide excellent tissue penetration capabilities, making it suitable for biological imaging. Additionally, CYL-BChE has a large Stokes shift (97 nm) and a low detection limit (0.96 U/L), effectively distinguishing BChE from the interfering substance acetylcholinesterase (AChE). Besides of detection of endogenous BChE in live cells, the resulting probe has been successfully used to detect BChE expression levels in an acetaminophen-induced (APAP-induced) drug liver injury mouse model. Therefore, this probe is expected to be a valuable biological tool in the detection of BChE activity.

The Potential Hepatocyte Differentiation Targets and MSC Proliferation by FH1

The main cause of acute liver failure (ALF) is hepatocellular necrosis, which induces liver repair dysfunction and leads to high mortality. In recent years, studies have increasingly shown that stem cell-derived hepatocyte-like cells (HLCs) can be used for treatment in animal models of ALF. Notably, a hepatocyte differentiation strategy based on the small-molecule compound functional hit 1 (FH1) successfully replaces HGF to promote the maturation of HLCs, but the underlying mechanism is still unclear. In this study, we used network pharmacology analysis to clarify the important role of the HGF/c-Met signalling pathway in FH1-induced hepatocyte (FH1-iHeps) differentiation. After FH1 was added to mesenchymal stem/stromal cells (MSCs), proliferation and cell cycle progression were rescued by treatment with a tyrosine kinase (c-Met) inhibitor. Additionally, c-Met signalling in MSCs was significantly increased by treatment with FH1, as shown by the increased c-Met, p-p38, p-AKT and p-ERK1/2 protein levels. FH1-iHeps efficiently improved the liver function of mice with acute liver injury and prolonged their lifespan. These data provide new insight into the mechanisms regulating the stemness properties of human umbilical cord-derived stem cells (hUC-MSCs) and reveal a previously unrecognised link between FH1 and c-Met in directing hepatocyte differentiation.

Grafting of syringic acid onto fucoidan: Enhanced functional properties and therapeutic potential in histamine-induced liver injury

This study explores the grafting of syringic acid onto fucoidan and assesses the resultant graft's (FS) enhanced functional properties and therapeutic potential in a histamine-induced liver injury model. Utilizing a redox system of ascorbic acid and hydrogen peroxide, the grafting process achieved a grafting rate of 290.45 mg CAE/g, confirmed through UV-Vis spectroscopy, FT-IR spectroscopy, scanning electron microscopy, and thermogravimetric analysis. In vivo investigations using histamine-sensitive mice demonstrated that FS significantly mitigated histamine-induced damage, evidenced by improvements in body weight, organ index, and colon length. FS exhibited superior efficacy in restoring liver function indices (ALT, AST, ALP, GGT), enhancing antioxidant defenses (GSH, SOD), and reducing oxidative stress markers (MDA). Anti-inflammatory effects included reduced levels of pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) and modulation of apoptosis-related proteins (BCl2, BAX). Additionally, FS upregulated key antioxidant genes in the Nrf2/KEAP1 pathway and downregulated inflammatory genes in the NF-κB pathway. Restoration of colonic tight junction proteins (ZO-1, Occludin, Claudin-1) and normalization of gut microbiota composition further underscored the therapeutic potential of FS. The study highlights the significant enhancement in functional properties of fucoidan through SA grafting, presenting FS as a promising candidate for developing functional foods and nutraceuticals aimed at preventing and mitigating liver damage and related disorders.

Study on the pharmacodynamic substances and mechanism of hepatoprotection of Acanthus ilicifolius Linn

BACKGROUND

The coastal wetland mangrove plant Acanthus ilicifolius l. (AI) is used as traditional medicine for liver protection and liver fibrosis treatment, but the pharmacodynamics of the hepatoprotective substance and the mechanisms of liver protection are not clear.

PURPOSE

This work aimed to assess the liver-protective ability of AI and elucidate the pharmacodynamics of the hepatoprotective substance of AI responsible for its liver activity.

STUDY DESIGN AND METHODS

This study first appraised the hepatoprotective activity of the alcohol extract of AI. To identify the hepatoprotective substance in AI, network topology and the contribution index were comprehensively analyzed and screened. The screened medicinal substances, acteoside (ACT) and isoacteoside (IACT), were tested for hepatoprotective activity using mouse liver damage model and l-02 hepatocyte injury model, and metabolomics was employed to explore the mechanism of liver protection.

RESULTS

AI could restore the biochemical indicators of liver damage induced by CCl4 to normal conditions. The phenylethanoid glycoside compounds ACT and IACT, are the hepatoprotective substances of AI. ACT protects the liver tissue by regulating α-linolenic acid metabolism, glycerophospholipid metabolism, and amino acid-related pathway.

CONCLUSION

This research provides basic information of the research and development of liver-protective effects of AI and ACT.

Liver cancer in 2021: Global Burden of Disease study

BACKGROUND & AIMS

The epidemiology of adult primary liver cancer continues to evolve, owing to the increasing prevalence of metabolic disease, rising alcohol consumption, advances in vaccination for HBV, and antiviral therapy for HCV. Disparities in care and the burden of liver cancer between populations persist. We assess trends in the burden of liver cancer and contributions by various etiologies across 204 countries and territories from 2010 to 2021.

METHODS

Utilizing the methodological framework of the Global Burden of Disease Study 2021, we analyzed global and regional temporal trends in incidence and mortality, and the contributions of various etiologies of liver disease.

RESULTS

In 2021, there were an estimated 529,202 incident cases and 483,875 deaths related to liver cancer. From 2010 to 2021, global liver cancer incident cases and deaths increased by 26% and 25%, respectively. Age-standardized incidence rates (ASIRs) and death rates (ASDRs) for liver cancer declined globally, but rose in the Americas and Southeast Asia. HBV remained the dominant cause of global incident liver cancer cases and deaths. MASLD (metabolic dysfunction-associated steatotic liver disease) was the only etiology of liver cancer with rising ASIRs and ASDRs. By contrast, ASIRs and ASDRs remained stable for alcohol-related liver cancer, and declined for HBV- and HCV-related liver cancer.

CONCLUSIONS

While age-adjusted incidence and deaths from liver cancer have started to decline, the absolute number of incident cases and deaths continues to increase. Population growth and aging contribute to the observed disconnect in the temporal trends of absolute cases and rates. Disparities remain, and the incidence and mortality associated with MASLD-related liver cancer continue to rise.

IMPACT AND IMPLICATIONS

Liver cancer remains a major cause of death globally, but its causes and burden in various regions are changing. This study highlights that new diagnoses and deaths related to liver cancer continue to rise. Age-adjusted death rates of liver cancer related to viral hepatitis are declining but remain high. By contrast, age-adjusted death rates of liver cancer related to MASLD (metabolic dysfunction-associated steatotic liver disease) are rising. Sustained efforts and resources are needed to eliminate viral hepatitis, reverse current trends in heavy alcohol use, and tackle the metabolic risk factors of MASLD.

The trend in incidence of non-alcoholic fatty liver disease and its impact on cirrhosis and liver cancer: An analysis from Global Burden of Disease 2021

OBJECTIVES

We aimed to recognize the burden of NAFLD and support public health policy development for its prevention and management.

STUDY DESIGN

A cross-sectional analysis of GBD 2021 results was conducted.

METHODS

We collected incidence data on NAFLD from 1990 to 2021 using Global Burden of Disease Study in 2021. Estimated annual percentage changes (EAPCs) in NAFLD age standardized incidence rate (ASR) were calculated to quantify the temporal trends in NAFLD ASR. Bayesian age-period-cohort models were constructed to project NAFLD incidence rates and cases up to 2050. Additionally, we assessed the percentage of cirrhosis and liver cancer attributable to NAFLD.

RESULTS

Globally, the newly-occurred cases of NAFLD increased by 94.49 % from 24, 856, 159 in 1990 to 48, 353, 272 in 2021. The case number will further increase to 78,602,984 in 2050, and ASR will increase from 5.93 per 1000 in 2021 to 7.26 per 1000 in 2050. The most pronounced increases were observed in young people and men. In 2021, NAFLD accounted for 82.7 % of cirrhosis and other chronic liver diseases and 8.0 % of liver cancer cases.

CONCLUSIONS

From 1990 to 2021, the incidence of NAFLD has been continuously increasing and is expected to continue rising until 2050. The increases in young people and men highlight their priority in future schedules. The rising proportions of cirrhosis and liver cancer caused by NAFLD further underscore the serious health risks.

Disulfiram in liver diseases: a double-edged sword

Disulfiram, a synthetic drug, has historically played a significant role in the treatment of alcoholic liver disease as the first medication approved by the U.S. Food and Drug Administration for alcohol use disorders. Beyond its efficacy in inhibiting alcohol addiction and treating alcoholic liver disease, disulfiram has also demonstrated potential in managing various liver conditions, including certain metabolic liver injuries and liver cancer. As an established, cost-effective drug with well-documented synthesis methods, disulfiram holds promise for broader application in liver disease treatment. However, its clinical use is hindered by the risk of inducing pharmacologic liver injury. This potential for liver toxicity necessitates careful patient selection, monitoring, and consultation with healthcare providers, which can limit its practicality in treating patients with existing liver conditions. This review aims to analyze the multifaceted role of disulfiram in liver diseases comprehensively. By exploring its therapeutic efficacy, potential benefits, and inherent limitations, we seek to provide a balanced perspective that maximizes disulfiram's therapeutic potential while ensuring the safety and well-being of patients. This thorough examination will also highlight areas for future research, paving the way for optimized treatment protocols that incorporate disulfiram in the context of liver disease management.

Single-cell RNA sequencing and functional analysis reveal the role of altered glycosylation levels of hepatic macrophages in liver cirrhosis

BACKGROUND

Liver cirrhosis represents a critical stage of chronic liver disease, characterized by progressive liver damage, cellular dysfunction, and disrupted cell-to-cell interactions. Glycosylation, an essential post-translational modification, significantly influences cellular behavior and disease progression. Its role in cirrhosis at the single-cell level remains unclear, despite its importance.

METHODS

This study, based on single-cell glycosylation and transcriptome data, compared the expression of differentially expressed genes in liver tissues from cirrhotic and healthy control samples, identifying changes in glycosylation-related genes and their functional pathway enrichment characteristics. Additionally, it analyzed the composition of immune cells and intercellular interaction features, with a focus on the interaction between macrophages and other immune cells and their potential role in immune regulation.

RESULTS

The analysis revealed significant changes in immune cell composition and glycosylation patterns in cirrhotic livers. Specifically, the number of macrophages increased substantially, while overall glycosylation levels decreased. Enhanced interactions between macrophages and other cell types were observed, highlighting the central role of macrophages in reshaping the immune microenvironment during cirrhosis progression. Gene expression analysis showed a marked upregulation of FUCA1, a gene encoding a glycosylation-related hydrolase. This change was strongly associated with the observed reduction in glycosylation levels. Functional enrichment analysis further revealed that glycosylation-related genes were primarily involved in immune pathways, including antigen processing and presentation, cytokine signaling, and immune activation.

CONCLUSIONS

Single-cell glycosylation analysis provides crucial insights into immune cell interactions in cirrhosis. Targeting glycosylation pathways in macrophages may offer new treatment strategies for cirrhosis.

Cell therapy for liver disorders: past, present and future

The liver fulfils a plethora of vital functions and, due to their importance, liver dysfunction has life-threatening consequences. Liver disorders currently account for more than two million deaths annually worldwide and can be classified broadly into three groups, considering their onset and aetiology, as acute liver diseases, inherited metabolic disorders and chronic liver diseases. In the most advanced and severe forms leading to liver failure, liver transplantation is the only treatment available, which has many associated drawbacks, including a shortage of organ donors. Cell therapy via fully mature cell transplantation is an advantageous alternative that may be able to restore a damaged organ's functionality or serve as a bridge until regeneration can occur. Pioneering work has shown that transplanting adult hepatocytes can support liver recovery. However, primary hepatocytes cannot be grown extensively in vitro as they rapidly lose their metabolic activity. Therefore, different cell sources are currently being tested as alternatives to primary cells. Human pluripotent stem cell-derived cells, chemically induced liver progenitors, or 'liver' organoids, hold great promise for developing new cell therapies for acute and chronic liver diseases. This Review focuses on the advantages and drawbacks of distinct cell sources and the relative strategies to address different therapeutic needs in distinct liver diseases.

Integrative bioinformatics analysis and experimental validation of key biomarkers driving the progression of cirrhotic portal hypertension

Background

Portal hypertension is a driving factor of cirrhosis complications, but the specific molecular mechanism of portal hypertension in cirrhosis remains unclear. The aim of this study was to identify hub genes for predicting persistent progression of portal hypertension in patients with liver cirrhosis.

Methods

Related microarray datasets were obtained from the Gene Expression Omnibus database. Weighted gene co-expression network analysis and differential expression genes analysis were used to identify the correlation sets of genes. In addition, protein-protein interaction networks and machine learning algorithms were conducted to screen center of candidate genes. To validate the diagnostic effect of hub genes, receiver operating characteristic curves were utilized in another dataset that is publicly accessible. Furthermore, the CIBERSORT algorithm was employed to investigate the immune infiltration levels of 22 immune cells and their connection to hub gene markers. Immunohistochemistry and reverse transcription quantitative polymerase chain reaction (RT-qPCR) were conducted to validate novel hub genes in clinical specimens.

Results

We obtained 671 differentially expressed genes and 11 module genes related to cirrhotic portal hypertension. Two candidate genes namely oncoprotein-induced transcript 3 protein (OIT3) and lysyl oxidase like protein 1 (LOXL1) were identified as biomarkers. RT-qPCR and immunohistochemistry (IHC) verified the expression of LOXL1 and OIT3 at mRNA and protein levels in liver tissue.

Conclusions

OIT3 and LOXL1 were identified as potential novel targets for the diagnosis and treatment of cirrhotic portal hypertension (CPH).

Extracellular Matrix Microstructures Modulate Hepatic Methionine Cycle and Methylations

The field of mechanobiology has grown in the past decade, but limited studies investigate how the extracellular matrix affects the cell metabolome. The methionine cycle involves the catabolism and regeneration of methionine through the donation and recovery of a single methyl group; this methyl group can methylate DNA, RNA, and proteins to alter gene expression and protein-protein interactions. Through studying cells cultured on fibrous (mimicking healthy extracellular matrice (ECM)) and flat (mimicking severely fibrotic ECM) substrates, we observed an increase in methionine cycle enzyme expression in cells on the flat substrate. We also present how the methionine cycle is modulated by the ECM through transmembrane protein integrin β1. By inhibiting integrin activation through the ligand-mimicking peptide RGD, we observed that the methionine cycle was protected from alteration. The results presented provide insight into possible therapeutic targets for fibrotic diseases and knowledge of mechanisms by which the ECM alters cell processes.

Circularized Supramolecular Spherical Nucleic Acids Alleviates Liver Fibrosis through Blocking Upstream Activation and Reversing Activation State of Hepatic Stellate Cells

Inhibition of hepatic stellate cell (HSC) activation and reversal of its activation state represent two distinct yet complementary strategies in antifibrotic therapy. While synergy of those two strategies is anticipated to improve the therapeutic outcomes, synergism through nanomedicine remains elusive. Herein, we report a circular spherical nucleic acid (cSNA) with a supramolecular core comprising collagenase I and ML-290 and a surface attached with circular PDGF-BB aptamer instead of the stereotypical linear counterpart. Unlike conventional inert SNA, this cSNA core dissociates in response to elevated ROS levels in the fibrotic liver so that collagenase I is released to disrupt the collagen barrier to promote the penetration of ensuing nanoparticles. Of significant importance is that the PDGF-BB aptamer after circularization exhibits enhanced nuclease resistance and improved molecular recognition, thereby demonstrating superior capability in blocking HSC activation mediated by PDGF-BB/PDGFR-β signaling. Meanwhile, relaxin family peptide receptor 1 (RXFP1) agonist ML-290 initially transforms pro-fibrogenic macrophages into pro-resolution macrophages by activating RXFP1 signaling, facilitating the secretion of pro-resolution factors for the reversal of the activated state of HSCs. This work thus presents a proof-of-concept demonstration of a supramolecular SNA that undergoes structural and functional refinements, enabling concurrent upstream etiological blockade and downstream pathological restoration in liver fibrosis.

The associations between dairy intake and chronic liver disease mortality and liver cancer incidence: a prospective cohort study

BACKGROUND

The incidence and prevalence of chronic liver diseases (CLD) and liver cancer are increasing worldwide.

OBJECTIVES

This study aimed to evaluate the associations between the intake levels of high-fat and low-fat dairy products and CLD mortality and liver cancer incidence.

METHODS

This study included eligible participants from the NIH-American Association of Retired Persons Diet and Health Study cohort established between 1995 and 1996. Epidemiological data, including dietary factors, were collected using a self-administered validated questionnaire. Portion size and frequency of intake of dairy products were recorded. Cox proportional hazard models were used to examine the associations.

RESULTS

A total of 485,931 eligible participants, 59.8% male, with an average age of 61.5 y (SD = 5.4 y) at baseline were included in this analysis after excluding those with pre-existing cancer diagnoses or extreme caloric intakes. During a median follow-up of 15.5 y, 993 deaths from CLD and 940 incident liver cancer cases occurred. CLD mortality was positively associated with intake of high-fat dairy [hazard ratio (HR)21+ compared with 0-<3.5 serv/wk = 1.51, 95% confidence interval (CI): 1.24, 1.84, Ptrend = 0.009] and high-fat milk (HR14+ compared with 0 serv/wk = 2.03, 95% CI: 1.31, 3.14, Ptrend <0.001), and was inversely associated with low-fat dairy (HR21+ compared with 0-<3.5 serv/wk =0.62, 95% CI: 0.46, 0.84, Ptrend = 0.002), low-fat milk (HR14+ compared with 0 serv/wk =0.54, 95% CI: 0.41, 0.70, Ptrend = 0.028) and yogurt (HR4+ compared with 0 serv/wk = 0.60, 95% CI: 0.37, 0.97, Ptrend = 0.057). Total dairy intake (HR21-<28 compared with 0-<7 serv/wk = 1.26, 95% CI: 0.99, 1.59, Ptrend = 0.040) and high-fat dairy (HR14-<21 compared with 0-<3.5 serv/wk = 1.35, 95% CI: 1.07, 1.70, Ptrend = 0.14) showed marginally positive association with liver cancer risk. Milk intake was positively associated with risk of hepatocellular carcinoma (HCC).

CONCLUSIONS

High-fat dairy intake is positively associated with CLD mortality, and low-fat dairy show an inverse association. Total dairy intake is marginally positively associated with liver cancer, and milk intake is positively associated with HCC.

The role of rehabilitation across the continuum of liver disease from cirrhosis to transplantation and beyond: A narrative review

OBJECTIVE

The authors' objective with this narrative review is to explore the impact of rehabilitative interventions at each stage of liver disease. TYPE: Narrative review.

LITERATURE SURVEY

Literature search conducted in Medline, Embase, and Google Scholar databases.

METHODOLOGY

Articles were included if they were identified in one of the three database, written in English, peer-reviewed, and involved human participants without any restrictions on the publication date. Reference lists of these publications were also scrutinized for other articles that might be relevant. Elibigle articles were reviewed to determine whether they met inclusion crtieria.

SYNTHESIS

Authors synthesized findings in the eligible articles to create a narrative summary.

CONCLUSIONS

Chronic liver disease is a major cause of morbidity and mortality across the globe. Cirrhosis causes alterations in metabolic and circulatory functions that negatively affect nutritional status and exercise capacity. Frailty is identified in nearly half of patients with advanced liver disease and bears a poor prognosis. Exercise and nutritional interventions improve key components of physical frailty and quality of life in chronic liver disease and after liver transplantation. Early mobility is generally recommended following liver transplantation and deemed to be safe and feasible. Inpatient rehabilitation may be considered in patients who require ongoing daily medical management by a physician, demonstrate a significant functional decline from their baseline, tolerate intensive rehabilitation, and have functional goals that can be addressed by at least two skilled therapies. Rehabilitation is safe and improves outcomes at every stage of liver disease from cirrhosis to following transplantation. This literature review explores the impact of rehabilitative interventions at each stage of liver disease from cirrhosis to transplantation and beyond.

Modulation of glucose metabolism and insulin resistance following hepatitis C virus clearance via direct-acting antivirals

The positive sense RNA virus, hepatitis C virus (HCV), is affiliated with the Flaviviridae family. Approximately 1% of people around the globe experience the impact of the HCV, which can coax them into potentially fatal conditions, including cirrhosis and carcinoma. The second-highest hepatitis C infection burden lies in Pakistan. The case of a HCV-infected patient who additionally has obesity or concurrent medical conditions like diabetes, HBV infection, or HIV infection is susceptible to becoming direr. Direct-acting antiviral medications replaced interferons as a staple of the treatment plan since they have fewer, milder side effects and a higher SVR rate in patients. The present study sought to assess the modifications to glucose homeostasis in non-diabetic chronic HCV-infected patients getting DAA treatment and the factors that independently pertain to insulin resistance. The study enrolled 250 patients, with 190 individuals having HCV-positive PCR results. The analysis included CBC, LFTs, glycaemic and insulin measurements, and the insulin resistance index calculation. Key cardiometabolic risk factors crucial for defining MASLD were assessed, including BMI measurement, evaluation of type 2 diabetes, and lipid profile analysis. The same tests were repeated following DAA therapy, and HOMA-IR was computed to compare pre-and post-treatment results. Among the 250 recruited patients, 190 were detected as HCV positive by the PCR assay, 57% (110 patients) were women, 43% (80 patients) were men, and patients were 47 years old on average. The patients showed high BMI (average 26.28 kg/m2) and signs of severe insulin resistance (HOMA-IR > 2.5). Multivariable logistic regression analysis pointed out that elevated baseline levels of triglycerides, ALT, ALP, cholesterol, and total bilirubin were independently associated with high insulin resistance. A notable improvement in HOMA-IR from 13.63 ± 2.63 to 3.16 ± 1.52 (p < 0.005) was spotted after administering interferon-free antiviral therapy for 3 months. The presence of high BMI, hyperlipidemia, and elevated levels of ALP, ALT, and AST in non-diabetic HCV-infected patients were independently associated with IR. In patients who previously had a higher IR index, there was a decrease in the HOMA-IR index after infection clearance by direct-acting antivirals.

Artificial intelligence in imaging for liver disease diagnosis

Liver diseases, including hepatitis, non-alcoholic fatty liver disease (NAFLD), cirrhosis, and hepatocellular carcinoma (HCC), remain a major global health concern, with early and accurate diagnosis being essential for effective management. Imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) play a crucial role in non-invasive diagnosis, but their sensitivity and diagnostic accuracy can be limited. Recent advancements in artificial intelligence (AI) have improved imaging-based liver disease assessment by enhancing pattern recognition, automating fibrosis and steatosis quantification, and aiding in HCC detection. AI-driven imaging techniques have shown promise in fibrosis staging through US, CT, MRI, and elastography, reducing the reliance on invasive liver biopsy. For liver steatosis, AI-assisted imaging methods have improved sensitivity and grading consistency, while in HCC detection and characterization, AI models have enhanced lesion identification, classification, and risk stratification across imaging modalities. The growing integration of AI into liver imaging is reshaping diagnostic workflows and has the potential to improve accuracy, efficiency, and clinical decision-making. This review provides an overview of AI applications in liver imaging, focusing on their clinical utility and implications for the future of liver disease diagnosis.

Artemsieverlides A-M, diverse sesquiterpenoid dimers with antihepatic fibrosis activity isolated from Artemisia sieversiana based on molecular networking

Artemsieverlides A-M (1-13), undescribed sesquiterpenoid dimers, were isolated from Artemisia sieversiana (Asteraceae) under the guidance of antihepatic fibrosis activity and molecular networking. Their structures were elucidated by spectral data (HRESIMS, UV, IR, 1D and 2D NMR), and ECD calculations. Of them, compounds 3, 7 and 12 were unambiguously confirmed by the single-crystal X-ray diffraction. Structurally, the sesquiterpenoid dimers are classified into three types, involving one guaiane-eudesmane, one guaiane-1,10-seco-guaiane, and 11 guaiane dimers. Artemsieverlides C-F are the first examples of guaiane dimers fused via C-1/C-2' and C-3/C-3' single bonds, which suggest chemical diversity of sesquiterpenoid dimers in A. sieversiana. Antihepatic fibrosis assay suggested that most of the compounds displayed inhibitory activity on HSC-LX2. The most active artemsieverlide K (11) gave an IC50 value of 58.6 μM, which was 2 times more active than the positive drug silybin (IC50, 133.7 μM).

Polymer-Encapsulated Catalase for Targeted Redox Regulation in Acute Liver Injury

The liver plays a critical role in maintaining homeostasis, and its dysfunction can lead to severe conditions like acute liver injury (ALI), which is primarily caused by viral infections, toxins, and oxidative stress. Reactive oxygen species (ROS), especially hydrogen peroxide (H₂O₂), significantly drive hepatocyte injury, initiating oxidative stress and inflammation. Current antioxidants, such as N-acetylcysteine (NAC) and superoxide dismutase (SOD), show limited clinical efficacy due to poor targeting, instability, and toxicity. Catalase (CAT), an essential enzyme for H₂O₂ decomposition, represents a promising therapeutic for ALI; however, its clinical application faces challenges in stability, rapid degradation, and insufficient targeting. Here, a novel nanocapsule-based CAT delivery system (n(CAT)) is presented, formed through in situ radical polymerization using 2-methacryloyloxyethyl phosphorylcholine (MPC) and N-(3-aminopropyl)-methacrylamide hydrochloride (APM). This strategy significantly enhances CAT's stability, retains enzyme activity, and improves selective liver accumulation, particularly at inflammation sites. The results demonstrate that n(CAT) effectively reduces oxidative stress, minimizes inflammation, and facilitates liver repair in ALI and ischemia-reperfusion injury (IRI) models. These findings highlight the potential of n(CAT) as a promising platform for advanced antioxidant therapies targeting liver diseases, including hepatitis.

Hepatoprotective Effect of Kaempferol-A Review

Liver diseases, including chronic inflammation and related metabolic dysfunction-associated steatotic liver disease (MASLD), fibrosis and cirrhosis remain a growing global health burden. Currently, available pharmacotherapy for liver dysfunction has limited efficacy. Kaempferol, a naturally occurring flavonoid, has demonstrated significant hepatoprotective effects in preclinical models. This substance activates the SIRT1/AMPK signalling pathway, improves mitochondrial function, inhibits proinflammatory cytokine production via TLR4/NF-κB suppression and attenuates hepatic stellate cell activation by modulating the TGF-β/Smad pathway. In addition, kaempferol regulates the composition of the gut microbiota, thus improving bile acid metabolism and alleviating steatosis and fibrosis. This review presents an integrated analysis of recent in vitro and in vivo studies on the mode of action and utility of kaempferol in liver disease and hepatoprotection.

Fabrication of sodium alginate/polyvinyl alcohol@ ZnNPs with SPI scaffold for evaluation of immune-stimulating and liver-protective effects in methotrexate-treated rats

Fabrication of new 3D scaffold based on sodium alginate (SA), polyvinyl alcohol (PVA), sesame protein isolate (SPI) and Zinc nanoparticles (ZnNPs) has been prepared. SPI was extracted and evaluated via its amino acid composition, solubility, and antioxidant activity. The scaffolds were formulated with different ratios of SA/PVA/Zn/SPI and investigated via different instruments FTIR, XRD and SEM/EDX. Additionally, the effect of the scaffold on the hepato-protection and immune-stimulating in methotrexate (MTX) treated rats has been studied. The results showed that SPI rich in Arginine (21.33 %), Histidine (15 %), Aspartic acid (12.7 %) and Glutamic acid (9.69 %). SPI exhibited higher solubility and antioxidant activity at pH 7 (47.55 and 87.23 %) when measured by DPPH and ABTS methods respectively. SPI and Zn have the ability to mitigate the effects of MTX on body weight loss. SA/PVA/ZnNPs and SA/PVA/ZnNPs/SPI scaffolds have potential liver protection by down-regulating liver functions (34.83 ± 1.17 U/L and 27.83 ± 1.08 U/L, respectively for ALT and 53.00 ± 1.15 U/L and 48.29 ± 1.29 U/L, respectively for AST) and oxidative and inflammatory markers (MDA, IL-6, IL-1β, and TNF-α) and up-regulating liver antioxidant enzymes (GPx and SOD). Furthermore, the immune-enhancing effects of SA/PVA/ZnNPs and SA/PVA/ZnNPs/SPI scaffolds were demonstrated by the reduction in INF-γ (33.17 ± 0.94 pg/mL and 27.73 ± 0.68 pg/mL, respectively) and CD8 (381.5 ± 2.56 pg/mL and 337.8 ± 1.87 pg/mL, respectively) levels and the elevation in CD4/CD8 ratio (1.79 ± 0.02 and 3.00 ± 0.01, respectively) comparable to the MTX group (41.25 ± 0.85 pg/mL, 531.7 ± 2.56 pg/mL and 0.99 ± 0.005, respectively). Thus, the scaffold may have a role in liver protection and immune enhancement.

Precision Strike Strategy for Liver Diseases Trilogy with Xiao-Chai-Hu Decoction: A Meta-Analysis with Machine Learning

BACKGROUND AND PURPOSE

The progression from hepatitis to liver fibrosis (LF) and ultimately to hepatic carcinoma (HCC) represents the advanced stages of various liver diseases. Currently, no universal treatment effectively addresses all three conditions. The Traditional Chinese Medicine formula Xiao-Chai-Hu decoction (XCHD) has shown promise in treating hepatitis, inhibiting LF, and serving as an adjunct therapy for HCC. This study evaluates the efficacy and optimal treatment durations of XCHD in managing these liver diseases using meta-analysis and machine learning techniques.

METHODS

Registered in the PROSPERO database (CRD42024534445), this meta-analysis systematically searched seven databases, including 54 studies with a total of 5,710 patients. Statistical analysis was performed using Stata 17.0. Five machine learning models-Random Forest (RF), XGBoost, Lasso, Multilayer Perceptron (MLP), and a stacking model combining these algorithms-were employed to analyze the data and predict the time-effect relationships. The optimal durations of XCHD treatment for the liver disease trilogy were subsequently projected.

RESULTS

XCHD significantly improved the primary outcome indicators for hepatitis, liver fibrosis, and HCC. Additionally, XCHD demonstrated a beneficial effect on liver dysfunction caused by these diseases. Machine learning predicted the optimal treatment durations of XCHD as 12 weeks for hepatitis, 20.31 weeks for liver fibrosis, and 12 weeks for HCC.

CONCLUSION

XCHD is effective in treating the liver disease trilogy, with optimal treatment durations of 12 weeks for hepatitis and HCC, and 20.31 weeks for liver fibrosis. These findings support the potential of XCHD in developing precise clinical strategies for managing liver diseases. This study innovatively integrates meta-analysis with machine learning to determine the optimal treatment durations, providing a novel approach for evidence-based precision medicine in Traditional Chinese Medicine.