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Schäfer A, Kovacs MS, Eder A, Nigg A, Feuchtenberger M. Longitudinal assessment of liver stiffness using ARFI technique does not support increased risk of fibrosis in rheumatoid arthritis patients on methotrexate. J Ultrasound 2025; 28:323-329. [PMID: 38227146 PMCID: PMC12145398 DOI: 10.1007/s40477-023-00843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/30/2023] [Indexed: 01/17/2024] Open
Abstract
AIMS To assess the liver stiffness in patients with rheumatoid arthritis treated with methotrexate monotherapy using non-invasive, ultrasound-based elastography (acoustic radiation force impulse (ARFI) imaging) in a longitudinal approach. METHODS In total, 23 MTX-naive patients were longitudinally assessed using acoustic radiation force impulse (ARFI) imaging. Baseline assessments were carried out between July 2018 and April 2019, and the follow-up evaluations took place after an average of 2.6 years. The main outcome variable was the mean shear wave velocity as measured by the ARFI method. It was calculated from 10 valid ARFI measurements for each patient. Inferential statistical analyses (within-group comparisons) were performed using t-tests for dependent samples or suitable nonparametric procedures. RESULTS The main finding was that observed ARFI shear wave velocities did not increase during the observation period. In fact, this parameter decreased over time from 1.07 m/s (SD = 0.23) at baseline without MTX exposure to 0.97 m/s (SD = 0.16) at follow-up after a mean of 2.6 years (P = 0.013). Moreover, the magnitude of the change in shear wave velocity could not be predicted by indicators of inflammation or disease activity, BMI, age, sex or NSAR intake (corresponding regression analysis: corrected R2 = 0.344; P = 0.296). CONCLUSIONS No increased risk of liver fibrosis was found in RA patients treated with MTX monotherapy during observation period.
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Affiliation(s)
- Arne Schäfer
- Diabetes Zentrum Mergentheim, Bad Mergentheim, Germany
- Medizinische Klinik und Poliklinik II, University Hospital Würzburg, Würzburg, Germany
| | | | - Anna Eder
- MVZ MED|BAYERN OST, Krankenhausstraße 1, 84489, Burghausen, Germany
| | - Axel Nigg
- MVZ MED|BAYERN OST, Krankenhausstraße 1, 84489, Burghausen, Germany
| | - Martin Feuchtenberger
- Medizinische Klinik und Poliklinik II, University Hospital Würzburg, Würzburg, Germany.
- MVZ MED|BAYERN OST, Krankenhausstraße 1, 84489, Burghausen, Germany.
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Agoglia L, Chindamo MC, Villela-Nogueira C. Psoriasis, metabolic syndrome and methotrexate: Is this association suitable for a new subcategory in steatotic liver disease? World J Hepatol 2025; 17:102978. [PMID: 40308817 PMCID: PMC12038415 DOI: 10.4254/wjh.v17.i4.102978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 03/08/2025] [Accepted: 03/27/2025] [Indexed: 04/25/2025] Open
Abstract
Psoriasis is a prevalent inflammatory disease that shares chronic inflammation pathways with the pathophysiology of metabolic syndrome (MetS), type-2 diabetes mellitus and atherosclerosis. A high prevalence of steatosis and advanced liver fibrosis has been described in psoriasis. The influence of MetS and its compounds, patatin-like phospholipase domain containing 3 and transmembrane 6 superfamily member 2 gene polymorphisms and the cumulative dose of methotrexate (MTX) in the progression of steatotic disease are still under debate. A suitable new classification for psoriasis-related liver disease, under the umbrella of steatotic liver disease (SLD), might be evaluated due to the potential impact of MTX on liver steatosis. Considering the interplay between the MetS, steatosis and MTX, a new definition for this complex disease might be discussed since it is not entirely addressed under the umbrella of SLD and metabolic-dysfunction associated SLD. Hence, shortly, a discussion could be raised on the feasible term "Met-Drug SLD", metabolic and drug-induced SLD, which comprises both metabolic dysfunction and drug-related SLD. This review aims to report the best evidence to accurately classify liver disease in psoriasis, considering the new definition of SLD, allowing appropriate management once it is carefully defined.
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Affiliation(s)
- Luciana Agoglia
- Department of Internal Medicine, School of Medicine, Section of Gastroenterology, Hospital Universitário Antônio Pedro, Federal University Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
| | - Maria Chiara Chindamo
- Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Cristiane Villela-Nogueira
- Department of Internal Medicine, School of Medicine and Hepatology Division, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.
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3
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Saidi AN, Theel WB, Burggraaf B, van der Lelij AJ, Grobbee DE, van Zeben JD, van der Zwan-van Beek E, Rauh SP, Cabezas MC. Metabolic dysfunction-associated steatotic liver disease and cardiovascular risk factors in rheumatoid arthritis. Clin Rheumatol 2025; 44:1485-1492. [PMID: 39962010 PMCID: PMC11993437 DOI: 10.1007/s10067-025-07364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 01/30/2025] [Accepted: 02/01/2025] [Indexed: 04/13/2025]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic autoimmune disease linked with metabolic dysfunction-associated steatotic liver disease (MASLD), which may increase cardiovascular (CV) risk. This study explores the association between liver fibrosis, assessed by the Fibrosis-4 (FIB-4) index, and CV risk factors in RA patients. METHODS Cross-sectional data from the Franciscus Rheumatoid Arthritis and Cardiovascular Intervention Study (FRANCIS), a randomized, cardiovascular single center, intervention study involving RA patients without cardiovascular disease (CVD) or type 2 diabetes (T2DM), were analyzed. Liver fibrosis was assessed using FIB-4, with a cut-off point of ≥ 1.3 to define high fibrosis risk, and its relationship with CV risk factors, medication use, and subclinical atherosclerosis, measured by carotid intima-media thickness (cIMT), was evaluated. RESULTS Among 326 patients (68.4% female, age 53 ± 11 years, BMI 26.5 ± 4.5 kg/m2), those with high FIB-4 (n = 49) had higher cIMT (p = 0.002), apolipoprotein B48 (p = 0.04), systolic blood pressure (p = 0.007), alkaline phosphatase (p = 0.002), and anti-CCP levels (p = 0.02). High FIB-4 was associated with lower leukocyte count and complement component 3. Statin use was linked to higher FIB-4 (OR = 4.49, p = 0.014), while hydroxychloroquine use was associated with lower FIB-4 (OR = 0.11, p = 0.004). Disease activity scores did not differ between low and high FIB-4 groups. CONCLUSIONS Elevated FIB-4 in RA patients is associated with increased cIMT, higher blood pressure, and elevated atherogenic remnants. Incorporating FIB-4 measurements into routine clinical care for RA populations could effectively identify individuals at the highest CV risk, enabling the implementation of more intensive CV risk management strategies. Key Points • RA patients with liver fibrosis have higher cIMT, indicating greater risk of atherosclerosis. • RA patients with liver fibrosis show accumulation of circulating atherogenic chylomicron remnants, contributing to atherogenesis. • HCQ may provide a protective effect against liver fibrosis in RA patients.
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Affiliation(s)
- A N Saidi
- Department of Internal Medicine, Centre of Endocrinology, Diabetes and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - W B Theel
- Department of Internal Medicine, Centre of Endocrinology, Diabetes and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Obesity Center CGG, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - B Burggraaf
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A J van der Lelij
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - J D van Zeben
- Department of Rheumatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - E van der Zwan-van Beek
- Department of Clinical Chemistry, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - S P Rauh
- Department of Science, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - M Castro Cabezas
- Department of Internal Medicine, Centre of Endocrinology, Diabetes and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Clinical, Zeist, the Netherlands
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Dos Santos Pereira M, Stolnicki DK, Azulay-Abulafia L, de Mello Perez R, Filho CART, Avelleira JCR. Evaluation of liver fibrosis by transient elastography in Brazilian patients with psoriasis using methotrexate. J Eur Acad Dermatol Venereol 2025. [PMID: 40116576 DOI: 10.1111/jdv.20654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 03/11/2025] [Indexed: 03/23/2025]
Affiliation(s)
- Mariana Dos Santos Pereira
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniela Kampel Stolnicki
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - João Carlos Regazzi Avelleira
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Lagoa Federal Hospital, Rio de Janeiro, Brazil
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Agoglia L, Peixoto H, Cardoso AC, Barbosa L, Victer CSXL, Carneiro S, Salles GF, Villela-Nogueira CA, Chindamo MC. Psoriasis and cardiovascular risk: associated and protective factors. An Bras Dermatol 2025:S0365-0596(25)00021-2. [PMID: 40082144 DOI: 10.1016/j.abd.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND Psoriasis (Pso) is an inflammatory skin disease associated with Metabolic Syndrome (MetS), Steatotic Liver Disease (SLD) and cardiovascular risk. However, the effect of anti-inflammatory therapy on cardiovascular risk is uncertain. OBJECTIVES To determine the relationship between anti-inflammatory therapy and subclinical atherosclerosis in individuals with Pso, using the gold standard carotid-femoral Pulse Wave Velocity (cf-PWV) measurement. Additionally, to evaluate the association between cf-PWV, steatosis and Advanced Fibrosis (AF) using Transient Elastography (TE) by Fibroscan®. METHODS Cross-sectional study including Pso patients submitted to cf-PWV and TE. Steatosis was defined as a controlled attenuation parameter ≥ 275 dB/m, AF as liver stiffness measurement ≥ 10 kPa, and increased Aortic Stiffness (AoS) as cf-PWV ≥ 10 m/s. Significant cumulative methotrexate dose was ≥ 1500 mg (MTX1500). Logistic regression analysis evaluated the independent variables associated with increased AoS. RESULTS Eighty patients were included (mean age 56.2 ± 11.5-years, 57.5% female, BMI 28.6 ± 5.3 kg/m2). Prevalences of MetS, diabetes mellitus, dyslipidemia, systemic arterial hypertension, steatosis and AF were 57.5%, 40.0%, 67.5%, 70.0%, 50.0% and 16.3%, respectively. MTX1500 was present in 45%, immunobiological treatment in 33.8%, and cf-PWV ≥ 10 m/s in 21.2%. On logistic regression analysis, age was independently related to cf-PWV ≥ 10 m/s (OR = 1.21; 95% CI 1.06‒1.38; p = 0.003) and MTX1500 was a protective cardiovascular factor (OR = 0.18; 95% CI 0.038‒0.87; p = 0.033). No association was observed between steatosis, AF or immunobiological therapy and cf-PWV ≥10 m/s. STUDY LIMITATIONS Sample size. CONCLUSION In patients with Pso, increased AoS was associated with age, but not with steatosis or AF. A protective cardiovascular effect of MTX was found in a Pso population with a high prevalence of MetS and its components.
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Affiliation(s)
- Luciana Agoglia
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil; Section of Gastroenterology, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | - Helena Peixoto
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Ana Carolina Cardoso
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Lívia Barbosa
- Dermatology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, RJ, Brazil
| | - Cecília S X L Victer
- Dermatology Unit, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sueli Carneiro
- Dermatology Unit, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Gil F Salles
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Cristiane A Villela-Nogueira
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Maria Chiara Chindamo
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
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Yang R, Yang L, Zhang N, Wan Y, Chen S, Xiao Y, Liang X, Yang S, Zhong Y, Huang D, Chen W, Zhao B. Targeted delivery of polymeric NO-donor micelles to hepatic stellate cells for restoration of liver function and inhibition of hepatic fibrosis. J Control Release 2025; 379:466-477. [PMID: 39824287 DOI: 10.1016/j.jconrel.2025.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 12/16/2024] [Accepted: 01/14/2025] [Indexed: 01/20/2025]
Abstract
Liver fibrosis is a prevalent liver disease associated with significant morbidity, and the activation of hepatic stellate cells (HSCs) serves as the primary causative factor driving the progression of liver fibrosis. However, capillarization of liver sinusoidal endothelial cells (LSECs) induced by hepatic fibrosis can reduce nitric oxide (NO) production and bioavailability, which consequently loses the ability to retain HSCs dormant, leading to amplified HSCs activation. Herein, an elaborate micelle (VN-M@BN) loaded with benazepril (BN) was constructed by self-assembly of polymeric NO donor, aiming for the controlled release of NO in liver fibrosis lesions thereby impeding the progression of liver fibrosis. VN-M@BN with the vitamin A (VA) ligand modification was designed to target HSCs for efficient liver fibrosis inhibition. Controlled NO release significantly downregulated α-smooth muscle actin (α-SMA) and induced apoptosis of activated HSCs, thus enhancing the inhibition effects of BN towards HSCs. Furthermore, the in suit antifibrotic treatment results confirmed that VN-M@BN possessed good circulatory stability and targetability to liver fibrotic tissues, thereby effectively ameliorating the collagen deposition and fibrosis process in damaged liver tissues. The NO-based targeted nanodrug system enabled precise delivery of therapeutic drugs to activated HSCs, thereby synergizing the efficacy in treating liver fibrosis with minimal adverse effects.
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Affiliation(s)
- Rui Yang
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Lifen Yang
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Ni Zhang
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Yuqing Wan
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Shineng Chen
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Yiqing Xiao
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Xiaoping Liang
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Shangjie Yang
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Yinan Zhong
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Dechun Huang
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China; Engineering Research Center for Smart Pharmaceutical Manufacturing Technologies, Ministry of Education, School of Engineering, China Pharmaceutical University, Nanjing 211198, China.
| | - Wei Chen
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China; Engineering Research Center for Smart Pharmaceutical Manufacturing Technologies, Ministry of Education, School of Engineering, China Pharmaceutical University, Nanjing 211198, China.
| | - Bingbing Zhao
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing 211198, China.
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Gopalakrishna H, Hercun J, Shah NN, Roschewski M, Rotman Y. Acute Transient Aminotransferase Elevation is Common With Intrathecal Methotrexate, but Liver Injury is Infrequent. Liver Int 2025; 45:e70022. [PMID: 39927416 PMCID: PMC11808631 DOI: 10.1111/liv.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 01/14/2025] [Accepted: 01/26/2025] [Indexed: 02/11/2025]
Abstract
BACKGROUND AND AIMS Hepatotoxicity is a known risk of oral and intravenous methotrexate (MTX), but whether intrathecal (IT) administration causes hepatotoxicity remains unknown. We aimed to explore whether IT-MTX causes acute hepatoxicity. METHODS Retrospective single-centre analysis of all patients treated with IT-MTX from 2000 to 2020. We compared liver enzymes (LE) at baseline (within 7 days before IT-MTX) to post-MTX (within 7 days after IT-MTX). LE elevation was defined as ≥ 50% increase in LE from baseline and greater than upper limit of normal. Drug-induced liver injury (DILI) was defined based on established criteria. RESULTS A total of 270 patients (184 adults and 86 paediatric) received IT-MTX and had available LE data. Aminotransferase elevation was seen post-MTX in 107 (40%) patients, of whom 96 (36%) had ALT and 68 (25%) had AST elevation. DILI occurred in 16 (6%) patients. Aminotransferases peaked a median of 4 (3-5) days post-MTX, returning near baseline by day 7. Paediatric patients had higher incidence of aminotransferase elevations and DILI than adults (ALT 51% vs. 28%; AST 41% vs. 18%; DILI 11% vs. 3%; p < 0.01 for all). No significant predictors of LE elevation or DILI were identified, and no patient developed liver failure. The severity of ALT elevation after the first IT-MTX dose did not predict severity of a subsequent dose. CONCLUSION Acute transient aminotransferase elevation is common after IT-MTX, especially in paediatric patients. Only a fraction of patients developed DILI, which was self-limited with no sensitisation or liver failure.
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Affiliation(s)
- Harish Gopalakrishna
- Liver & Energy Metabolism Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Julian Hercun
- Liver & Energy Metabolism Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMarylandUSA
- Liver UnitCentre Hospitalier de l'Universite de MontrealMontrealQuebecCanada
| | - Nirali N. Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Yaron Rotman
- Liver & Energy Metabolism Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMarylandUSA
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8
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Krasselt M. Methotrexate - Safe Backbone for the Treatment of Rheumatoid Arthritis. Curr Rheumatol Rev 2025; 21:169-181. [PMID: 38982927 DOI: 10.2174/0115733971317122240626053727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/06/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
Methotrexate (MTX) is the primarily used disease-modifying antirheumatic drug (DMARD) for the treatment of Rheumatoid Arthritis (RA). MTX is a safe agent, even when used for years - provided that treatment is regularly monitored and prescribers follow some simple rules, such as prescribing tablets of a single strength only. Proper patient education contributes greatly to safe treatment. The knowledge of important pharmacologic facts, possible interactions, and clinical warning signs also helps to prevent or recognize intoxications early. Therefore, this review addresses key aspects regarding the safety of MTX. In this respect, it includes adverse events, possible interactions with frequently used drugs and details on the rare but life-threatening intoxication, e.g., due to erroneous daily intake.
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Affiliation(s)
- Marco Krasselt
- Department of Endocrinology, Nephrology and Rheumatology, Medical Clinic III, Leipzig University Medical Centre, Liebigstr. 20, Leipzig, 04103, Germany
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Aydin I, Erisgin Z, Cinar E, Barak MZ, Tekelioglu Y, Usta M, Mutlu HS, Turkoglu I. Should combined MTX and CoQ10 use be reconsidered in terms of steatosis? A biochemical, flow cytometry, histopathological experimental study. Drug Chem Toxicol 2024:1-14. [PMID: 39734089 DOI: 10.1080/01480545.2024.2442660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 11/26/2024] [Accepted: 12/10/2024] [Indexed: 12/31/2024]
Abstract
In the present study, the effects of coenzyme Q10 (CoQ10), which is widely used in daily life, on the methotrexate (MTX)-induced hepatotoxicity, which is widely used today in malignancies and autoimmune diseases, were examined. Twenty-four female Wistar albino rats were divided into four groups. The group 1 (n = 6) was given 1 mL corn oil by oral gavage (p.o.) during seven days. Group 2 was given 20 mg/kg intraperitoneal (i.p.) MTX only on the first day of the experiment. Group 3 was given 20 mg/kg (i.p.) MTX on the first day of the experiment and 100 mg/kg CoQ10 dissolved in 1 mL corn oil were given by oral gavage during seven days, and group 4 was given 100 mg/kg CoQ10 dissolved in 1 mL corn oil by oral gavage during seven days. At the end of experiment, all animals were euthanized under anesthesia. In the liver tissue, histopathologic analysis on the hematoxylin and eosin (H&E), Masson trichrome, and periodic acid Schiff (PAS) stained sections, apoptotic analysis (% Annexin V positivity) by flow cytometry, and biochemical analysis for oxidative stress markers (GSH, CAT, and TBARS) was performed. According to histopathological analysis, apoptosis, concession, fibrosis, and inflammatory cell infiltration increased in the MTX group and those results significantly decreased in the MTX + CoQ10 groups. As an interesting result, fatty degeneration and TBARS elevation were observed in the MTX + CoQ10 group. As a result, although CoQ10 has protective effects on MTX-induced hepatotoxicity, fatty degeneration due to the combined usage of MTX and CoQ10 should be investigated with further studies.
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Affiliation(s)
- Ismail Aydin
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkiye
| | - Zuleyha Erisgin
- Department of Histology and Embryology, Faculty of Medicine, Giresun University, Giresun, Turkiye
| | - Esma Cinar
- Department of Pathology, Faculty of Medicine, Giresun University, Giresun, Turkiye
| | - M Zuhal Barak
- Department of Business, Adana Science and Technic University, Adana, Turkiye
| | - Yavuz Tekelioglu
- Department of Histology and Embryology, Faculty of Medicine, Black Sea Technical University, Trabzon, Turkiye
| | - Murat Usta
- Department of Medical Biochemistry, Faculty of Medicine, Giresun University, Giresun, Turkiye
| | - Hasan Serdar Mutlu
- Department of Histology and Embryology, Faculty of Medicine, Giresun University, Giresun, Turkiye
| | - Ismail Turkoglu
- Department of Histology and Embryology, Faculty of Medicine, Giresun University, Giresun, Turkiye
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10
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Xiao Y, Gao J, Wang Y, Hao D, Yan W, Wen D, Zeng S, Yang S, Shi Y, Li W. Systemic treatment type is not associated with abnormal post-treatment noninvasive liver stiffness measurement in psoriasis. Front Immunol 2024; 15:1487959. [PMID: 39726606 PMCID: PMC11670192 DOI: 10.3389/fimmu.2024.1487959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 11/25/2024] [Indexed: 12/28/2024] Open
Abstract
Background Psoriasis is commonly associated with metabolic dysfunction-associated steatotic liver disease, raising concerns about the hepatic effects of systemic treatments on psoriasis and its comorbid conditions. This study evaluates liver stiffness measurement (LSM) alterations and identifies predictors of abnormal LSM in psoriatic patients following systemic treatments, including biologics and methotrexate. Methods This prospective cohort study is based on the PSOWCH database (Psoriasis Cohort of West China Hospital). We initially included psoriatic patients who had undergone sound touch elastography (STE), then recruited patients who had STE before systemic treatment and reassessed them after at least six months. Three treatment subgroups were formed (interleukin inhibitors, tumor necrosis factor inhibitors, and methotrexate), classifying post-treatment STE outcomes using threshold values of 6.5 kPa and 10.3 kPa. Results Among the 52 recruited patients, overall STE values significantly increased during follow-up. Univariate regression analysis showed that age, gender, psoriasis severity, psoriatic arthritis status, and current treatment type were not significantly correlated with abnormal STE outcomes at cutoff values of 6.5 kPa and 10.3 kPa. In the multivariate model, body mass index (BMI) was identified as a risk factor for post-treatment STE ≥ 6.5 kPa (odds ratio [OR], 1.26; 95% CI, 1.04 to 1.60, P=0.031). Conclusions This exploratory study reveals that systemic treatment type is not associated with abnormal post-treatment LSM. However, a significant association exists between BMI and abnormal LSM outcomes. These findings highlight the critical importance of BMI management in therapeutic interventions for psoriasis.
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Affiliation(s)
- Yue Xiao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Jingya Gao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyi Wang
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Hao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Yan
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyi Zeng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Shiqi Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yingyu Shi
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
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11
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Li W, Chi Y, Xiao X, Li J, Sun M, Sun S, Xu W, Zhang L, Li X, Cheng F, Qi X, Rao J. Plasma FSTL-1 as a noninvasive diagnostic biomarker for patients with advanced liver fibrosis. Hepatology 2024:01515467-990000000-01090. [PMID: 39703007 DOI: 10.1097/hep.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 10/28/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND AND AIMS Reliable novel noninvasive biomarkers for the diagnosis of advanced liver fibrosis are urgently needed in clinical practice. We aimed to investigate the accuracy of plasma Follistatin-like protein 1 (FSTL-1) in the diagnosis of advanced liver fibrosis in chronic liver diseases. APPROACH AND RESULTS We collected cross-sectional clinical data for a derivation cohort (n = 86) and a validation cohort (n = 431), totaling 517 subjects with liver biopsy. Advanced liver fibrosis was defined by the METAVIR pathological score (F ≥3). Dual cutoff values for diagnosis were explored. In the derivation cohort, plasma FSTL-1 levels were significantly elevated in patients with advanced liver fibrosis, with an AUROC of 0.85 (95% CI, 0.75-0.96). In the validation cohort, plasma FSTL-1 maintained good diagnostic performance, with an AUROC of 0.88 (95% CI, 0.83-0.92). Plasma FSTL-1 levels were significantly associated with individual histological features of the METAVIR scoring system, including interface hepatitis, lobular necrosis, and hepatocellular ballooning (p < 0.0001). A cutoff value ≤ 0.43 ng/mL was the optimal rule-out threshold, with a sensitivity of 84.62% (95% CI, 76.46%-90.30%) and a specificity of 79.51% (95% CI, 74.81%-83.53%), while ≥0.50 ng/mL was the best rule-in threshold, with a specificity of 86.41% (95% CI, 81.06%-90.43%) and a sensitivity of 70.67% (95% CI, 64.41%-76.23%). CONCLUSIONS Plasma FSTL-1 has high diagnostic accuracy and could potentially reduce the need for liver biopsy in identifying patients with advanced liver fibrosis.
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Affiliation(s)
- Wenzhu Li
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Yongquan Chi
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Xuan Xiao
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Junda Li
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Mingmin Sun
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Shanke Sun
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Wei Xu
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Long Zhang
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Xiaoguo Li
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing, China
- Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
| | - Feng Cheng
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
| | - Xiaolong Qi
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing, China
- Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
| | - Jianhua Rao
- Hepatobiliary Center, The First Affiliated Hospital with Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, Nanjing, China
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12
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Jesuthasan A, Baheerathan A, Auger S, Dorsey R, Coker R, Selvapatt N, Viegas S. Methotrexate for the neurologist. Pract Neurol 2024; 24:369-375. [PMID: 38821881 DOI: 10.1136/pn-2024-004156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
The use of methotrexate in clinical practice has expanded significantly in recent years, as an effective chemotherapeutic agent as well as disease-modifying treatment for conditions such as rheumatoid arthritis, psoriasis and Crohn's disease. It is also used as a steroid-sparing agent for a range of inflammatory diseases of the central and peripheral nervous systems. Clinical neurologists must, therefore, know how to start and uptitrate methotrexate, its monitoring requirements and its potential toxicities. This review aims first to explore the evidence base for using methotrexate in various neurological diseases and second to discuss important practicalities around its use, ensuring its safe application and appropriate monitoring.
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Affiliation(s)
| | | | - Stephen Auger
- Department of Neurology, Charing Cross Hospital, London, UK
| | - Rachel Dorsey
- Department of Neurology, Charing Cross Hospital, London, UK
| | - Robina Coker
- Department of Respiratory Medicine, Hammersmith Hospital, London, UK
| | | | - Stuart Viegas
- Department of Neurology, Charing Cross Hospital, London, UK
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13
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Sequier L, Caron B, Loeuille D, Honap S, Jairath V, Netter P, Danese S, Sibilia J, Peyrin-Biroulet L. Systematic review: Methotrexate-A poorly understood and underused medication in inflammatory bowel disease. Aliment Pharmacol Ther 2024; 60:686-700. [PMID: 39076140 DOI: 10.1111/apt.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/14/2024] [Accepted: 07/21/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Methotrexate, an immunosuppressant used for the treatment of inflammatory bowel disease (IBD) for over 30 years, remains underused compared to thiopurines. AIMS To review the efficacy, safety, optimal dosing and delivery regimens of methotrexate in adults with IBD. METHODS We conducted a systematic review of studies involving patients with IBD treated with methotrexate from inception to August 2023. All studies were included from the MEDLINE database via PubMed. RESULTS For Crohn's disease, we included eight randomised controlled trials (RCTs) and 17 observational studies. Parenteral methotrexate effectively increased remission rates in steroid-dependent patients at 25 mg/week for 16 weeks and at 15 mg/week for maintenance. Methotrexate can be used in combination with anti-tumour necrosis factor (TNF) agents to reduce immunogenicity. Data comparing thiopurines and methotrexate remain scarce. For ulcerative colitis (UC), we included five RCTs and 10 observational studies were included; there was no evidence to support the use of methotrexate in (UC). We extracted safety data from 17 studies; mild-to-moderate adverse effects were common. The incidence of liver fibrosis or cirrhosis was low. CONCLUSION Methotrexate is effective at inducing and maintaining remission in steroid-refractory Crohn's disease and can reduce anti-TNF-induced immunogenicity when used in combination therapy. Data regarding tolerance and safety are reassuring. These findings challenge preconceived ideas on methotrexate and suggest that it is a valid first-line conventional option for the treatment of mild-to-moderate Crohn's disease.
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Affiliation(s)
- Léa Sequier
- Department of Gastroenterology and Hepatology, Nîmes University Hospital, Carémeau Hospital, Nîmes, France
- Department of Gastroenterology and Hepatology A, Saint-Éloi Hospital, Montpellier, France
| | - Bénédicte Caron
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, Nancy, France
- INFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA) UMR 7365 CNRS, University of Lorraine, Nancy, France
| | - Sailish Honap
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Patrick Netter
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA) UMR 7365 CNRS, University of Lorraine, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Immunology, Transplantation and Infectious Disease, Università Vita-Salute San Raffaele, Milan, Italy
| | - Jean Sibilia
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, Nancy, France
- INFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy, France
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14
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Petersen CL, David M, Stilgren L, Ennis ZN. Atypical fractures of the lower extremities in two patients with rheumatoid arthritis: clinical presentations of presumed methotrexate osteopathy. BMJ Case Rep 2024; 17:e256567. [PMID: 39216879 DOI: 10.1136/bcr-2023-256567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
We present two patients who developed multiple lower limb stress fractures. Potential causes, such as osteoporosis, malignancies and disturbances in calcium metabolism were investigated. This led the physicians to consider whether methotrexate (MTX) exposure posed a risk of atypical fractures.The association between MTX and lower limb fractures has been described in at least 80 cases in the literature. Stress fractures associated with MTX treatment are atypical of osteoporosis and located in the lower extremities, most often the tibia. The limited data suggest that discontinuation of MTX may improve symptoms and chances of fracture healing, while antiresorptive or osteoanabolic therapies have not proven clinically efficient. It seems evident, however, that the benefits of MTX treatment in rheumatological disease clearly outweigh the risk of MTX osteopathy and related fractures.
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Affiliation(s)
| | - Marc David
- Odense University Hospital, Svendborg, Syddanmark, Denmark
| | - Lis Stilgren
- Odense University Hospital, Svendborg, Syddanmark, Denmark
| | - Zandra Nymand Ennis
- Department of Clinical Pharmacology, Odense University Hospital, Odense C, Denmark
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15
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Lebwohl M, Merola JF, Strober B, Armstrong A, Yoshizaki A, Gisondi P, Szilagyi B, Peterson L, de Cuyper D, Cross N, Davies O, Gottlieb AB. Bimekizumab safety in moderate to severe plaque psoriasis: Rates of hepatic events and changes in liver parameters over 2 years in randomized phase 3/3b trials. J Am Acad Dermatol 2024; 91:281-289. [PMID: 38588819 DOI: 10.1016/j.jaad.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Patients with psoriasis are at increased risk of liver function abnormalities. OBJECTIVE Explore rates of hepatic treatment-emergent adverse events (TEAEs) and changes in liver parameters in bimekizumab-treated patients with psoriasis. METHODS Data are reported from 5 phase 3/3b trials over 2 years. Hepatic TEAEs, laboratory elevations in alanine aminotransferase (ALT) or aspartate aminotransferase (AST), and changes in clinical markers of liver fibrosis (Fibrosis-4 [FIB-4] Index and AST to Platelet Ratio Index [APRI]) are reported. TEAEs are presented using exposure-adjusted incidence rates (EAIRs) per 100 patient-years (PY). RESULTS 2186 patients received ≥1 bimekizumab dose. Over 2 years, the EAIR of hepatic TEAEs was 3.5/100 PY and did not increase from first to second year. 2-year EAIRs of ALT/AST elevations >3x and >5x the upper limit of normal were 2.3 and 0.6/100 PY; rates were similar to placebo, adalimumab, secukinumab, and ustekinumab during controlled study periods. FIB-4 and APRI scores did not increase through 2 years, regardless of fibrosis risk at baseline. LIMITATIONS Obesity, diabetes, dyslipidemia, chronic alcohol consumption, and medication changes are confounding factors for hepatic dysfunction. CONCLUSION Rates of hepatic adverse events (AEs) with bimekizumab were consistent through 2 years; incidences of transaminase elevations were similar to comparators during phase 3/3b controlled study periods.
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Affiliation(s)
- Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Joseph F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut; Central Connecticut Dermatology Research, Cromwell, Connecticut
| | - April Armstrong
- University of California Los Angeles (UCLA), Los Angeles, California
| | - Ayumi Yoshizaki
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Campbell F, Laws P. Managing risk of liver fibrosis in patients with psoriasis being considered for methotrexate. Br J Dermatol 2024; 191:163. [PMID: 38504462 DOI: 10.1093/bjd/ljae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Fiona Campbell
- University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Philip Laws
- University of Leeds, Chapel Allerton Hospital, Leeds, UK
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17
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Babakinejad P, Lapsley R, Forster L, McPherson S, Pearce MS, Reynolds NJ, Slack E, Weatherhead SC, Hampton PJ. Cumulative methotrexate dose is not associated with liver fibrosis in patients with a history of moderate-to-severe psoriasis. Br J Dermatol 2024; 191:275-283. [PMID: 38366967 DOI: 10.1093/bjd/ljae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND There are established risk factors for liver fibrosis (LF), but data on the impact of methotrexate on LF in patients with psoriasis are lacking. OBJECTIVES This cross-sectional study aimed to determine the prevalence of LF in patients with psoriasis and to evaluate the relationship between LF, cumulative methotrexate dose and other LF risk factors. METHODS Adults with a history of moderate-to-severe chronic plaque psoriasis were recruited between June 2020 and March 2021. Patients underwent transient elastography to evaluate LF. Three values for liver stiffness measurement (LSM) were assessed, indicating mild or worse LF (≥ 7 kPa), moderate or worse LF (≥ 7.9 kPa) and advanced LF (≥ 9.5kPa). Cumulative methotrexate dose and other potential risk factors for LF were assessed. RESULTS Overall, 240 patients were recruited and 204 participants with valid LSM values were included in the analysis [median age 48 years [interquartile range (IQR) 37-57]; 51% female sex; 56% body mass index (BMI) ≥ 30 (kg m-2) and a median Alcohol Use Disorders Identification Test (AUDIT) score of 4 (IQR 1-7, 23% score ≥ 8)]. In total, 91% had received methotrexate [median duration 36 months (IQR 14-78)]. Prevalence of LF was 36%, 25% and 17% using LSM ≥ 7 kPa, ≥ 7.9 kPa and ≥ 9.5 kPa, respectively. There was no association between cumulative methotrexate dose [median 2.16 (IQR 0.93-5.2)] and continuous LSM values [unstandardized coefficient 0.16, 95% confidence interval (CI) -0.49 to 0.82, P = 0.626] or using the categorical LSM cutoff values: ≥ 7 kPa [unadjusted odds ratio 1.06 (95% CI 0.97-1.15), P = 0.192], ≥ 7.9 kPa [unadjusted odds ratio 1.03 (95% CI 0.94-1.12), P = 0.577] and ≥ 9.5 kPa (unadjusted odds ratio 1.01, 95% CI 0.91-1.12; P = 0.843). The following risk factors were associated with higher LSM values: BMI (P ≤ 0.001), waist circumference (P ≤ 0.001), metabolic syndrome (P ≤ 0.001), AUDIT score (P = 0.020) and FIB-4 score (P = 0.03). BMI ≥ 28, diabetes and metabolic syndrome were shown to be better predictors of LF compared with FIB-4 score. CONCLUSIONS This study confirms a high prevalence of significant LF in patients with psoriasis. Cumulative methotrexate dose was not associated with LF. Patients with BMI ≥ 28, metabolic syndrome and diabetes are at higher risk for LF. These risk factors may help to identify when a more detailed liver health assessment is needed.
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Affiliation(s)
| | | | - Lara Forster
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart McPherson
- Liver unit, Freeman Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
| | - Mark S Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nick J Reynolds
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
| | - Emma Slack
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Philip J Hampton
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
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18
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Agoglia L, Cardoso AC, Barbosa L, Victer CSXL, Carneiro S, de França PHC, Chindamo MC, Villela-Nogueira CA. Psoriasis and steatotic liver disease: Are PNPLA3 and TM6SF2 polymorphisms suitable for the hepato-dermal axis hypothesis? Ann Hepatol 2024; 29:101477. [PMID: 38360269 DOI: 10.1016/j.aohep.2024.101477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION AND OBJECTIVES A high prevalence of steatotic liver disease has been described in psoriasis. However, the influence of genetic polymorphisms has yet to be investigated in this scenario. This study aims to determine the frequency of steatosis, advanced liver fibrosis and PNPLA3/TM6SF2 genotypes in individuals with psoriasis and to evaluate the impact of genetic polymorphisms, metabolic parameters and cumulative methotrexate dose on steatosis and fibrosis. MATERIALS AND METHODS Cross-sectional study that prospectively included psoriasis outpatients, submitted to clinical and laboratory analysis, transient elastography (FibroScan®, Fr) and PNPLA3/TM6SF2 genotyping. Steatosis was defined by CAP ≥275 dB/m and advanced liver fibrosis as transient elastography ≥10 kPa. Logistic regression analysis evaluated the independent variables related to steatosis and fibrosis; p-value< 0.05 was considered significant. RESULTS One hundred and ninety-nine patients were enrolled (age 54.6 ± 12.6 years, 57.3% female). Metabolic syndrome (MetS), steatosis and advanced liver fibrosis prevalence were 55.8%, 54.8% and 9%, respectively. PNPLA3 and TM6SF2 genotypes frequencies were CC 42.3%/CG 49.5%/GG 8.2% and CC 88.7%/ CT 11.3%/ TT 0%. MetS (OR3.01 95%CI 1.51-5.98; p = 0.002) and body mass index (OR1.17 95%CI 1.08-1.26; p < 0.01) were independently associated with steatosis. Diabetes Mellitus (T2DM) (OR10.76 95%CI 2.42-47.87; p = 0.002) and harboring at least one PNPLA3 G allele (OR5.66 95%CI 1.08-29.52; p = 0.039) were associated with advanced fibrosis, but not TM6SF2 polymorphism or cumulative MTX dose. CONCLUSIONS MetS and T2DM confer higher odds for steatosis and advanced fibrosis in individuals with psoriasis. PNPLA3 G allele, but not TM6SF2 polymorphism, impacts a 5-fold odds of advanced liver fibrosis.
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Affiliation(s)
- Luciana Agoglia
- School of Medicine and Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil; Section of Gastroenterology, Hospital Universitário Antônio Pedro, Federal University Fluminense, Niterói, Brazil.
| | - Ana Carolina Cardoso
- School of Medicine and Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
| | - Lívia Barbosa
- Dermatology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | | | - Sueli Carneiro
- School of Medicine and Dermatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
| | | | - Maria Chiara Chindamo
- School of Medicine and Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
| | - Cristiane Alves Villela-Nogueira
- School of Medicine and Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
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19
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Hizli P, Oğuz ID, Kulakli S, Kiliç FA, Duyan A. Unveiling the impact of psoriasis on liver health: does methotrexate play a villainous role? Arch Dermatol Res 2024; 316:437. [PMID: 38940980 DOI: 10.1007/s00403-024-03193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
Psoriasis might bring about an increased risk of liver diseases like nonalcoholic fatty liver disease and fibrosis. The impact of methotrexate on liver function is still a cause for concern, because of the studies suggesting an increased risk of liver damage and others finding no association. The focus of this study was the liver functions in psoriatic patients investigating the impact of long-term use of methotrexate on liver in psoriasis. A retrospective investigation including 140 patients with psoriasis receiving methotrexate treatment for at least 6 months and a control group consisted of 105 healthy ones was conducted. Liver function tests (AST, ALT, PLT) were assessed, and the association of baseline PASI with FIB-4 and APRI values was investigated. Additionally, FIB-4 and APRI values at baseline, 3rd, and 6th months of methotrexate treatment for psoriasis were compared. Compared with the controls, psoriatic patients exhibited significantly higher FIB-4 scores (p = 0.004). A moderate and significant correlation was observed between baseline PASI score and baseline FIB-4 score in psoriatic patients (p < 0.001, rho = 0.626). Long-term methotrexate use had no effect on APRI or FIB-4 (p = 0.104 and p = 0.475, respectively). Psoriatic patients face an elevated risk of liver fibrosis. Long-term methotrexate use does not adversely affect liver function in psoriatic patients. Noninvasive tools like APRI and FIB-4 scores can be employed to evaluate the risk of liver disease in these patients.
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Affiliation(s)
- Pelin Hizli
- Department of Dermatology, Faculty of Medicine, Balikesir University, Balikesir, Turkey.
| | - Işıl Deniz Oğuz
- Department of Dermatology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Sevgi Kulakli
- Department of Dermatology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Fatma Arzu Kiliç
- Department of Dermatology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Ayser Duyan
- Department of Dermatology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
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20
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Ge Q, Liu Z. Familial clustering of MASLD: Rethinking strategies for population screening. J Hepatol 2024; 80:e289-e290. [PMID: 38309441 DOI: 10.1016/j.jhep.2024.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Qiaoyue Ge
- Department of Maternal and Child Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, Chengdu, China; Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, Chengdu, China
| | - Zhenmi Liu
- Department of Maternal and Child Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, Chengdu, China; Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, Chengdu, China.
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21
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Wang L, Zhou J, Wang J, Wang X, Dong H, Zhao L, Wu J, Peng J. Hepatic Stellate Cell-Targeting Micelle Nanomedicine for Early Diagnosis and Treatment of Liver Fibrosis. Adv Healthc Mater 2024; 13:e2303710. [PMID: 38293743 DOI: 10.1002/adhm.202303710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/23/2024] [Indexed: 02/01/2024]
Abstract
Diagnosing and treating liver fibrosis is a challenging yet crucial endeavor due to its complex pathogenesis and risk of deteriorating into cirrhosis, liver failure, and even hepatic cancer. Herein, a silica cross-linked micelles (SCLMs) based nano-system is developed for both diagnosing and treating liver fibrosis. The SCLMs are first modified with peptide CTCE9908 (CT-SCLMs) and can actively target CXCR4, which is overexpressed in activated hepatic stellate cells (HSCs). To enable diagnosis, an ONOO--responded near-infrared fluorescent probe NOF2 is loaded into the CT-SCLMs. This nano-system can target the aHSCs and diagnose the liver fibrosis particularly in CCl4-induced liver damage, by monitoring the reactive nitrogen species. Furthermore, a step is taken toward treatment by co-encapsulating two anti-fibrosis drugs, silibinin and sorafenib, within the CT-SCLMs. This combined approach results in a significant alleviation of liver injury. Symptoms associated with liver fibrosis, such as deposition of collagen, expression of hydroxyproline, and raised serological indicators show notable improvement. In summary, the CXCR4-targeted nano-system can serve as a promising theragnostic system of early warning and diagnosis for liver fibrosis, offering hope against progression of this serious liver condition.
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Affiliation(s)
- Lei Wang
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China
| | - Jieying Zhou
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, 33199, USA
| | - Jian Wang
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China
| | - Xiaotang Wang
- Department of Chemistry and Biochemistry, Florida International University, Miami, FL, 33199, USA
| | - Haijuan Dong
- The Public Laboratory Platform, China Pharmaceutical University, Nanjing, 211198, China
| | - Lingzhi Zhao
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China
| | - Junchen Wu
- Institute of Innovative Drug Discovery and Development, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China
| | - Juanjuan Peng
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China
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22
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Mo H, Li R, Yang N, Han J, Xiao X, Zhang Y, Xiao Z, Jiao L, Xu Q, Tu K. USP40 promotes hepatocellular carcinoma progression through a YAP/USP40 positive feedback loop. Cancer Lett 2024; 589:216832. [PMID: 38537774 DOI: 10.1016/j.canlet.2024.216832] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Yes-associated protein (YAP) is an essential driver of hepatocellular carcinoma (HCC) progression and the ubiquitin-proteasome system controls its abundance. However, the role of ubiquitin-specific protease 40 (USP40) in YAP stability remains unclear. Here, USP40 was first identified as a novel regulator of YAP abundance and its target genes in HCC cells. USP40 interacted with YAP to remove the lysine 48 (K48)-linked polyubiquitination of YAP at K252 and K315 sites, thereby maintaining YAP stability. USP40 facilitated the proliferation, colony formation, migration and spheroid formation of HCC cells in vitro and promoted HCC growth in vivo in a YAP-dependent manner. In turn, YAP transcriptionally activated USP40 expression in HCC cells. RNA sequencing analysis showed that about 37% of USP40-regulated genes overlapped with YAP-regulated genes. Interestingly, stiffness-induced USP40 upregulation was abolished by YAP knockdown, and USP40 knockdown attenuated stiffness-induced YAP accumulation in HCC cells. Clinical data demonstrated that USP40 was positively associated with YAP expression in HCC tissues and its high expression indicated a poor prognosis. In conclusion, the USP40/YAP positive feedback loop contributes to HCC progression, suggesting that USP40 may be a promising drug target for anti-HCC.
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Affiliation(s)
- Huanye Mo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Runtian Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Nan Yang
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jiaqi Han
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Xuelian Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yilei Zhang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Zhengtao Xiao
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Lianying Jiao
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Qiuran Xu
- Zhejiang Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014, China.
| | - Kangsheng Tu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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23
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Maresca R, Mignini I, Varca S, Calvez V, Termite F, Esposto G, Laterza L, Scaldaferri F, Ainora ME, Gasbarrini A, Zocco MA. Inflammatory Bowel Diseases and Non-Alcoholic Fatty Liver Disease: Piecing a Complex Puzzle Together. Int J Mol Sci 2024; 25:3278. [PMID: 38542249 PMCID: PMC10970310 DOI: 10.3390/ijms25063278] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 01/03/2025] Open
Abstract
Inflammatory bowel diseases (IBD), comprising Crohn's disease and ulcerative colitis, are systemic and multifaceted disorders which affect other organs in addition to the gastrointestinal tract in up to 50% of cases. Extraintestinal manifestations may present before or after IBD diagnosis and negatively impact the intestinal disease course and patients' quality of life, often requiring additional diagnostic evaluations or specific treatments. Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Current evidence shows an increased prevalence of NAFLD (and its more advanced stages, such as liver fibrosis and steatohepatitis) in IBD patients compared to the general population. Many different IBD-specific etiopathogenetic mechanisms have been hypothesized, including chronic inflammation, malabsorption, previous surgical interventions, changes in fecal microbiota, and drugs. However, the pathophysiological link between these two diseases is still poorly understood. In this review, we aim to provide a comprehensive overview of the potential mechanisms which have been investigated so far and highlight open issues still to be addressed for future studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Maria Assunta Zocco
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Rome, 00168 Rome, Italy; (R.M.); (I.M.); (S.V.); (V.C.); (F.T.); (G.E.); (L.L.); (F.S.); (M.E.A.); (A.G.)
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24
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Slouma M, Lahmar W, Mohamed G, Dhrif O, Dhahri R, Bellali H, Gharsallah I, Ebdelli N. Associated factors with liver fibrosis in rheumatoid arthritis patients treated with methotrexate. Clin Rheumatol 2024; 43:929-938. [PMID: 38159207 DOI: 10.1007/s10067-023-06847-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION There are conflicting findings on the link between liver fibrosis and cumulative methotrexate dosages. We aimed to determine the frequency of liver fibrosis in rheumatoid arthritis patients treated with methotrexate and to identify its associated factors. METHODS We conducted a cross-sectional study over 9 months (April-December 2021), including rheumatoid arthritis patients treated with methotrexate. Demographic and clinical data were collected. Liver stiffness was assessed by FibroScan. Fibrosis and significant liver fibrosis were defined as liver stiffness higher than 6 and 7.2 kPa, respectively. Liver tests, albuminemia, lipid profile, and blood glycemia were measured. Metabolic syndrome was also evaluated. Statistical analyses were performed using SPSS. RESULTS We included 21 men and 47 women. The mean age was 51.60 ± 1.82 years. The mean disease duration was 8.29 ± 6.48 years. The mean weekly intake of methotrexate was 13.76 ± 3.91 mg. The mean methotrexate duration was 4.67 ± 4.24 years. The mean cumulative dose was 3508.87 ± 3390.48 mg. Hypoalbuminemia and metabolic syndrome were found in 34% and 25% of cases. We noted increased alkaline phosphatase levels in four cases. The mean liver stiffness was 4.50 ± 1.53 kPa. Nine patients had liver fibrosis, and four had significant fibrosis. Associated factors with liver fibrosis were as follows: age ≥ 60 years (OR:22.703; 95%CI [1.238-416.487]; p = 0.035), cumulated dose of methotrexate ≥ 3 g (OR: 76.501; 95%CI [2.383-2456.070]; p = 0.014), metabolic syndrome (OR: 42.743; 95%CI [1.728-1057.273]; p = 0.022), elevated alkaline phosphatase levels (OR: 28.252; 95%CI [1.306-611.007]; p = 0.033), and hypoalbuminemia (OR: 59.302; 95%CI [2.361-1489.718]; p = 0.013). CONCLUSION Cumulating more than 3 g of methotrexate was associated with liver fibrosis in rheumatoid arthritis patients. Having a metabolic syndrome, higher age, hypoalbuminemia, and elevated alkaline phosphatase levels were also likely to be independently associated with liver fibrosis. Key points • Rheumatoid arthritis patients require monitoring hepatic fibrosis when the cumulated dose of methotrexate is above 3 g. • Metabolic syndrome is a risk factor for liver fibrosis, suggesting that its management is necessary to prevent this complication. • Hypoalbuminemia and elevated alkaline phosphatase levels (twice the upper limit) in rheumatoid arthritis patients treated with methotrexate were associated with liver fibrosis.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
- University of Tunis El Manar, 1068, Tunis, Tunisia.
| | - Wided Lahmar
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Ghanem Mohamed
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Gastrology, Military Hospital, 1008, Tunis, Tunisia
| | - Omar Dhrif
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Internal Medicine, Military Hospital of Bizerta, 7000, Bizerta, Tunisia
| | - Rim Dhahri
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Hedia Bellali
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Epidemiology, Hbib Thameur Hospital, 1008, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Nabil Ebdelli
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Gastrology, Military Hospital, 1008, Tunis, Tunisia
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25
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Björnsson HK, Björnsson ES. Hepatotoxicity in inflammatory bowel disease: Immunomodulators, biologics, and beyond. Clin Liver Dis (Hoboken) 2024; 23:e0199. [PMID: 38881727 PMCID: PMC11177820 DOI: 10.1097/cld.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 06/18/2024] Open
Affiliation(s)
- Helgi K Björnsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Einar S Björnsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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26
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Zhi Y, Li T, Li Y, Zhang T, Du M, Zhang Q, Wang X, Hu G. Protective role of Cecropin AD against LPS-induced intestinal mucosal injury in chickens. Front Immunol 2023; 14:1290182. [PMID: 38162646 PMCID: PMC10757607 DOI: 10.3389/fimmu.2023.1290182] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Cecropin AD (CAD), a renowned antimicrobial peptide, has shown promising potential in treating various bacterial infections. This study investigates the protective effects of CAD against lipopolysaccharide (LPS)-induced intestinal adversities in chickens. Methods Sixty SPF-grade chicks were divided into groups and exposed to different dosages of CAD, followed by LPS administration. The study assessed the impact of CAD on intestinal mucosal injury markers, oxidative stress, and inflammation. Results LPS significantly increased Diamine oxidase (DAO) and D-lactate (D-LA) levels, both indicators of intestinal mucosal injury. CAD treatment substantially attenuated these elevations, particularly at higher dosages. Additionally, CAD markedly reduced oxidative stress in intestinal tissues, as shown by normalized antioxidant levels and decreased reactive oxygen species. Histological analysis supported these findings, showing better-preserved villi structures in CAD-treated groups. Furthermore, CAD significantly reduced IL-6 and IL-8 expression post-LPS stimulation and effectively regulated the NLRP3 inflammasome pathway, decreasing associated factors like NLRP3, Caspase-1, IL-1b, and IL-18. Discussion The study demonstrates CAD's therapeutic potential in alleviating LPS-induced intestinal injuries. The protective effects are primarily attributed to its anti-inflammatory and antioxidative actions and modulation of the NLRP3 inflammasome pathway.
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Affiliation(s)
- Yan Zhi
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Tingyu Li
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Yaxuan Li
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Tao Zhang
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Mengze Du
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Qian Zhang
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, the Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Ge Hu
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
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27
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Li Y, Guo D, Wang Q, Li A, Yin S, Li S, Li Y, Wang B, Guo T, Feng S. Benzoylaconitine Alleviates Progression of Psoriasis via Suppressing STAT3 Phosphorylation in Keratinocytes. Molecules 2023; 28:molecules28114473. [PMID: 37298949 DOI: 10.3390/molecules28114473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Psoriasis is a chronic and multifactorial skin disease which is caused by inflammatory infiltrates, keratinocyte hyperproliferation, and accumulation of immune cells. As part of the Aconitum species, Benzoylaconitine (BAC) shows potential antiviral, anti-tumor, and anti-inflammatory effects. In this study, we investigated the effects and mechanisms of BAC on tumor necrosis factor-alpha (TNF-α)/LPS-induced HaCaT keratinocytes in a imiquimod(IMQ)-induced mice model. The results showed that BAC could relieve the symptoms of psoriasis by inhibiting cell proliferation, the release of inflammatory factors, and the accumulation of Th17 cells, while no obvious effect on cell viability and safety was observed both in vitro and in vivo. Additionally, BAC can markedly inhibit the protein and mRNA levels of inflammatory cytokines in TNF-α/LPS-induced HaCaT keratinocytes by inhibiting the phosphorylation of STAT3. In brief, our data indicated that BAC could alleviate the progression of psoriasis and may be a potential therapeutic agent for treating psoriasis in clinical practice.
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Affiliation(s)
- Yuanbo Li
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Department of Neurobiology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
| | - Dandan Guo
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Qianqian Wang
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Aifang Li
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Sugai Yin
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Shuxuan Li
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Yalan Li
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Baiyan Wang
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Tao Guo
- Department of Pharmacy, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Shuying Feng
- Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
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28
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Di Martino V. Methotrexate-induced liver fibrosis: The end of a long-held belief. J Hepatol 2023; 78:896-897. [PMID: 36854346 DOI: 10.1016/j.jhep.2023.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Vincent Di Martino
- Department of Hepatology, CHRU Jean Minjoz, EA 4266 EPILAB, UFR Santé, University of Franche-Comté, INSERM UMR RIGHT 1098, Besançon, France.
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Andrade RJ, Björnsson ES. Liver fibrosis with methotrexate - an overestimated risk? Nat Rev Gastroenterol Hepatol 2023; 20:347-348. [PMID: 37069322 DOI: 10.1038/s41575-023-00782-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Raul J Andrade
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA-Plataforma BIONAND, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Malaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
| | - Einar S Björnsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Gastroenterology, Landspitali University Hospital Reykjavík, Reykjavík, Iceland
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