Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions

Hydronidone for the Treatment of Liver Fibrosis Associated with Chronic Hepatitis B: Protocol for a Phase 3 Randomized Trial

Background and Aims

Liver fibrosis is a key process in the progression of chronic liver diseases. However, there are currently no drugs specifically designed to treat liver fibrosis. Our Phase 2 trial of hydronidone for the treatment of chronic hepatitis B (CHB)-associated liver fibrosis showed that adding hydronidone to entecavir resulted in significant reversal of liver fibrosis. To further evaluate the efficacy of a 270 mg/day dose of hydronidone for treating liver fibrosis associated with CHB, we conducted this Phase 3 trial.

Methods

This is a 52-week, randomized (1:1), double-blind, placebo-controlled, multicenter, entecavir-based Phase 3 clinical study conducted at 44 study centers across China. Adult patients aged 18 to 65 years with significant liver fibrosis (defined as an Ishak score ≥ 3 on liver biopsy) associated with CHB were included.

Results

The primary endpoint of the trial is to demonstrate the efficacy of fibrosis reversal, defined as a decrease in the Ishak stage score of liver fibrosis by ≥1 after 52 weeks of treatment, compared to baseline.

Conclusions

The results of this trial are expected to further support the antifibrotic indication for this novel drug.

Effect of switching from prior Nucleos(t)ide Analogue(s) to Tenofovir alafenamide on lipid profile and cardiovascular risk in patients with Chronic Hepatitis B

INTRODUCTION

Tenofovir alafenamide (TAF) is recommended for chronic hepatitis B (CHB) treatment in international guidelines according to its efficacy and safety. However, in phase III study, an increased LDL-c was observed in those who were switched from Tenofovir disoproxil fumarate (TDF) to TAF. Limited data exists on whether lipid profiles change only in individuals who switched to TAF from TDF or from any nucleoside/nucleotide analogues (NUC). We investigated how switching to TAF affected lipid and cardiovascular outcomes in Thai CHB patients.

MATERIALS AND METHODS

We conducted a prospective observational study including CHB patients who had to switch from their prior NUC to TAF according to the national reimbursement policy in late 2022. All enrolled patients had lipid tests and transient elastography (TE) done at 0 and 48-week post-switch to TAF. Demographic data, prior NUC, liver biochemistry, controlled attenuated parameter (CAP) and liver stiffness (elastic modulus; E) data measured by TE were collected. The changes in lipid, Thai cardiovascular (CV) risk score, and TE results between 0 and 48-week were compared.

RESULTS

A total of 110 patients who were switched to TAF and completed 48-week follow-up were analyzed. The prior NUCs were as follows: 47 Lamivudine (LAM), 22 Entecavir (ETV), and 41 TDF-based. Baseline characteristics were similar between the three groups except for underlying hypertension was more frequent and baseline total cholesterol was lower in the TDF-based group. At 48-week post-switch, the median LDL-c changes were -2.45, -5.9 and +8.8 mg/dL (p<0.001), and total cholesterol changes were -4.5, -4 and +17 mg/dL (p<0.001), in the ETV, LAM, and TDF-based group, respectively. Whereas the changes in hepatic steatosis (measured by CAP), and liver stiffness (measured by E) as well as Thai CV risk score were not significantly different. No cardiovascular events occurred during follow-up.

CONCLUSION

Significant increase in LDL-c and total cholesterol after switching to TAF were observed only in patients with prior TDF, but not in those with prior ETV or LAM. Careful monitoring of lipids after the switch may not be universally needed. Data regarding long-term cardiovascular outcomes are warrant.

Liver resection versus interventional treatments for hepatocellular carcinoma patients with hypohepatia: a multicenter study

BACKGROUND

Hypohepatia limits the feasibility of therapeutic options for hepatocellular carcinoma (HCC), negatively affecting patient prognosis. Established guidelines for the treatment strategies of HCC patients with hypohepatia are lacking. This study was performed to evaluate therapeutic benefits between liver resection (LR) and interventional treatments using ablation or transarterial chemoembolization (TACE) in such population.

METHODS

Survival analyses were performed using the Kaplan-Meier method and log-rank test. The Cox proportional hazards regression models were used to analyze potential risk factors associated with prognosis. Multivariate regression and propensity score regression adjustment analyses were applied to adjust for baseline confounding variables. Restricted cubic spline curves were used to assess the association between prognostic index and risk of death or progression on a continuous scale.

RESULTS

Of the enrolled 5774 HCC patients with hypohepatia, 506 (8.8%), 2326 (40.3%) and 2942 (51.0%) underwent ablation, LR and TACE, respectively. A tentative analysis of the overall cohort demonstrated that a high degree of heterogeneity existed in this population, while LR rendered a possible tendency to survival benefit over ablation and TACE through adjustment for baseline confounding variables. After categorizing the patients according to the indication of ablation treatment, the indisputable superiority of LR over ablation and TACE in terms of OS and DFS before and after adjustments were evident and the survival advantages of LR were consistent across all pre-specified subgroups. Individualized treatment decision analyses based on restricted cubic spline curves demonstrated that LR group presented the lowest risk of death and disease progression.

CONCLUSIONS

HCC patients with hypohepatia could obtain survival benefits through surgical and non-surgical treatment approaches. LR appears to confer a significant survival benefit compared with interventional treatments using ablation or TACE, even for selected intermediate and advanced populations.

Synergistic Cytotoxicity of Nano-titanium Dioxide and Phthalocyanine on HepG2 Cells via Sonophotodynamic Therapy

Hepatocellular carcinoma (HCC) presents a significant therapeutic challenge, necessitating novel approaches beyond conventional treatments. This study investigates the combined cytotoxic effects of nano-titanium dioxide (nano-TiO₂), copper (II) phthalocyanine (CuPc), and copper (II) phthalocyanine-modified nano-TiO₂-(nano-TiO₂/Pc) on HepG2 hepatocellular carcinoma cells using sonodynamic therapy (SDT), photodynamic therapy (PDT), and sonophotodynamic therapy (SPDT). The results show that individual treatments with nano-TiO₂ or CuPc alone did not induce significant cytotoxicity. However, when combined with SDT or PDT, a noticeable decrease in cell viability was observed. Strikingly, SPDT combined with nano-TiO₂/Pc demonstrated the most significant cytotoxic effect, achieving up to 83.80% apoptosis in HepG2 cells. This was associated with a marked reduction in Bcl-2 protein levels and an increase in cleaved caspase-3, cleaved caspase-9, cytochrome-c (cyt-c), and Bax indicating the activation of both intrinsic and extrinsic apoptotic pathways. Furthermore, SPDT-nano-TiO₂/Pc significantly increased oxidative stress, as evidenced by decreased levels of superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH), along with elevated levels of malondialdehyde (MDA). These findings suggest that phthalocyanine-mediated SPDT effectively enhances mitochondrial apoptosis and disrupts the tumor cytoplasmic membrane, highlighting the potential of combining SDT and PDT with nano-TiO₂/Pc as a promising strategy for cancer treatment.

Copper metabolism in hepatocellular carcinoma: from molecular mechanisms to therapeutic opportunities

Copper is a vital trace metal that facilitates cell proliferation, angiogenesis, and tumour spread. The liver is essential for copper metabolism, hence regulating copper levels is crucial for hepatic health. Hepatocellular carcinoma is a primary liver cancer characterised by a high death rate, and extensive research has shown the substantial impact of copper on its progression. This research primarily examines the molecular mechanisms involved, summarises the regulation of copper homeostasis, and addresses the role of copper metabolism in the promotion and inhibition of hepatocellular carcinoma development. Furthermore, it investigates prospective clinical approaches for targeting copper in the treatment of this disease, intending to establish a theoretical basis for the clinical use of copper in the management of hepatocellular carcinoma.

Characteristics of serum bile acid profiles among individuals with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the predominant chronic liver condition globally. Bile acid (BA) metabolism contributes significantly to MASLD progression. In this multicenter clinical study, we aimed to characterize serum BA profiles in patients with MASLD and identify specific alterations compared to healthy controls.

METHODS

All MASLD cases were sourced from the gastroenterology outpatient departments of Shanghai Baoshan Hospital of Integrated Chinese and Western Medicine, Shanghai Baoshan District Songnan Community Health Service Center, and Lianyungang Oriental Hospital between June 2015 and December 2019. The data were analyzed using SPSS version 26.0, with a p-value of less than 0.05 considered significant.

RESULTS

A total of 215 participants (35.3% women) with MASLD and 49 controls (44.9% women), aged 18-65 years, were included. MASLD patients showed higher levels of serum total BA (TBA), cholic acid (CA), chenodeoxycholic acid (CDCA), and ursodeoxycholic acid (UDCA) (p < 0.05, p < 0.01) when compared to controls. Furthermore, women patients with MASLD demonstrated notably higher levels of lithocholic acid (LCA), glycolithocholic acid (GLCA), and taurolithocholic acid (TLCA) than men patients with MASLD (p < 0.025, p < 0.01). Compared to women, men exhibited a higher proportion of primary to secondary BAs. Additionally, in men patients with MASLD, the serum concentrations of CA, CDCA, glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and taurochenodeoxycholic acid (TCDCA) exhibited significant negative correlations with ALT levels, while deoxycholic acid (DCA) and TLCA showed negative correlations with BMI.

CONCLUSIONS

Patients with MASLD exhibited notable variations in BA profiles, including sex-specific differences. This study provides corresponding evidence on the association between BAs and MASLD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, NO: ChiCTR-OOC-15006157, registration date: March 25, 2015.

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.

circCEP70 encoded protein inhibits the progression of hepatocellular carcinoma

Cirrhosis is closely related to hepatocellular carcinoma (HCC), however, the regulation of circular RNA (circRNA) in HCC with cirrhotic background has not yet been well illustrated. In this study, high throughput circRNA sequencing was applied to identified candidate circRNAs in HCC samples with cirrhotic background. The biological function of candidate circRNA was validated in both in vitro and in vivo settings. Additionally, Alphafold 3, mass spectrometry analysis and immunofluorescence were employed to investigate the underlying mechanisms involved. We found circCEP70 exhibited significantly higher expression levels in cirrhotic HCC samples and showed a positive correlation with improved prognosis. The RNA binding protein U2AF2 was found to suppress the expression of circCEP70 in cirrhosis patients. In vitro and in vivo experiments, including CCK-8, EdU, plate cloning, transwell, scratch, subcutaneous tumor formation, liver metastasis in situ, and lung metastasis assays confirmed the anti-carcinogenic effects. Mechanistically, circCEP70 encoded a novel protein named CEP70-160aa, which interacted with PKM2 and hindered its translocation into the nucleus. This interaction led to reduce STAT3 phosphorylation in the nucleus, thus inhibiting HCC proliferation and metastasis. In cirrhotic microenvironment, circCEP70 prevented HCC proliferation and metastasis through PKM2/STAT3 axis, and RNA binding protein U2AF2 could inhibit circCEP70 expression.

BIRC2 blockade facilitates immunotherapy of hepatocellular carcinoma

BACKGROUND

The effectiveness of immunotherapy in hepatocellular carcinoma (HCC) is limited, however, the molecular mechanism remains unclear. In this study, we identified baculoviral IAP repeat-containing protein 2 (BIRC2) as a key regulator involved in immune evasion of HCC.

METHODS

Genome-wide CRISPR/Cas9 screening was conducted to identify tumor-intrinsic genes pivotal for immune escape. In vitro and in vivo models demonstrated the role of BIRC2 in protecting HCC cells from immune killing. Then the function and relevant signaling pathways of BIRC2 were explored. The therapeutic efficacy of BIRC2 inhibitor was examined in different in situ and xenograft HCC models.

RESULTS

Elevated expression of BIRC2 correlated with adverse prognosis and resistance to immunotherapy in HCC patients. Mechanistically, BIRC2 interacted with and promoted the ubiquitination-dependent degradation of NFκB-inducing kinase (NIK), leading to the inactivation of the non-canonical NFκB signaling pathway. This resulted in the decrease of major histocompatibility complex class I (MHC-I) expression, thereby protecting HCC cells from T cell-mediated cytotoxicity. Silencing BIRC2 using shRNA or inhibiting it with small molecules increased the sensitivity of HCC cells to immune killing. Meanwhile, BIRC2 blockade improved the function of T cells both in vitro and in vivo. Targeting BIRC2 significantly inhibited tumor growth, and enhanced the efficacy of anti-programmed death protein 1 (PD-1) therapy.

CONCLUSIONS

Our findings suggested that BIRC2 blockade facilitated immunotherapy of HCC by simultaneously sensitizing tumor cells to immune attack and boosting the anti-tumor immune response of T cells.

Explainable and Robust Deep Learning for Liver Segmentation Through U-Net Network

Background/Objectives: Clinical imaging techniques, such as magnetic resonance imaging and computed tomography, play a vital role in supporting clinicians by aiding disease diagnosis and facilitating the planning of appropriate interventions. This is particularly important in malignant conditions like hepatocellular carcinoma, where accurate image segmentation, delineating the liver and tumor, is a critical initial step in optimizing diagnosis, staging, and treatment planning, including interventions like transplantation, surgical resection, radiotherapy, portal vein embolization, and other procedures. Therefore, effective segmentation methods can significantly influence both diagnostic accuracy and treatment outcomes. Method: In this paper, we propose a deep learning-based approach aimed at accurately segmenting the liver in medical images, thus addressing a critical need in hepatic disease diagnosis and treatment planning. We consider a U-Net architecture with residual connections to capture fine-grained anatomical details. We also take into account the prediction explainability, aiming to highlight, in the image under analysis, the areas that are symptomatic for a certain segmentation. In detail, by exploiting the U-Net architecture, two different models are trained with two annotated datasets of computed tomography medical images, resulting in four different experiments. Results: We consider two different datasets to improve robustness and generalization across diverse patient populations and imaging conditions. Experimental results demonstrate that the proposed method obtains interesting performances, with an accuracy ranging from 0.81 to 0.93. Conclusions: We thus show that the proposed method can provide a reliable and efficient solution for automated liver segmentation, promising significant advancements in clinical workflows and precision medicine.

Inhibition of HSC proliferation and hepatic fibrogenesis with Erythrocyte membrane coated Doxorubicin/Black phosphorus nanosheets

Rapid proliferation underlies the abnormal expansion of activated hepatic stellate cells (aHSCs) and thereby contributes to the development and progression of liver fibrosis, so inhibition of HSC proliferation serves as a good antifibrotic strategy. As a potent topoisomerase II inhibitor, doxorubicin (DOX), an antineoplastic drug, exhibits a significant antifibrotic activity in vitro via retarding the growth of aHSCs and reversing their myofibroblastic phenotype, but its severe hepatotoxicity, cardiotoxicity, and renal toxicity limit its wide clinical application. Therefore, enhancing the specificity and efficacy of DOX in targeting aHSCs to improve its therapeutic index and minimize its adverse effects has become a key point for the success of DOX in antifibrotic treatment. In this study aimed at liver fibrosis treatment, we combined the excellent drug-loading capability and good biocompatibility of black phosphorus nanosheets (BPNSs), the protective and camouflaging properties of red blood cell membrane encapsulation, and the HSCs-targetability provided by the surface modification with vitamin A derivatives, into the construction of HSCs-targeted BP/DOX nanovesicles (BP/DOX@RMV-VA). The obtained DOX nanovesicles exhibited a uniform particle size and spheroid morphology, excellent diffusion property and stability, and high DOX loading. Specifically, they demonstrated outstanding biosafety, effective HSCs-targetability both in vivo and in vitro, and markedly improved pharmacokinetic profile of DOX. BP/DOX@RMV-VA produced strong antiproliferative and MF-phenotype reverting activity both in cultured aHSCs and in mice chronically injured by CCl4. And accordingly, the administration of BP/DOX@RMV-VA to CCl4-injured mice effectively suppressed the expansion of aHSCs and fibrogenesis, and significantly improved liver structure and function without causing detectable cardiotoxicity. These results highly suggest the therapeutic potential of BP/DOX@RMV-VA in treating liver fibrosis and other fibrosis-associated liver diseases.

Neoadjuvant therapy: Dawn of reducing the high post-surgery recurrence rate of hepatocellular carcinoma

The high postoperative recurrence rate remains a major challenge in the treatment of hepatocellular carcinoma (HCC) following resection. Increasing research has been delved into investigating the role of neoadjuvant therapy on the prognosis of resectable HCC. Recent trends in combination therapy with molecularly targeted agents and immune checkpoint inhibitors have significantly improved the efficacy of systemic antitumor treatments, yielding survival benefits exceeding 40%. Neoadjuvant therapy for HCC, whether based on systemic antitumor treatments, locoregional therapies, or their combination, has emerged as a promising research direction. However, there remains a matter of debate on neoadjuvant therapy. In this review, we summarize and discuss the research progress and challenges of neoadjuvant therapy for HCC over the past five years from the perspective of Chinese guidelines to provide new insights and future directions in this field.

Hepatitis B surface antigen: carcinogenesis mechanisms and clinical implications in hepatocellular carcinoma

Liver cancer is the third leading cause of death globally, with hepatitis B virus (HBV) infection being identified as the primary risk factor for its development. The occurrence of HBV-related hepatocellular carcinoma (HCC) is attributed to various mechanisms, such as chronic inflammation and liver cell regeneration induced by the cytotoxic immune response triggered by the virus, abnormal activation of oncogenes arising from HBV DNA insertion mutations, and epigenetic alterations mediated by viral oncoproteins. The envelope protein of the HBV virus, known as hepatitis B surface antigen (HBsAg), is a key indicator of increased risk for developing HCC in HBsAg-positive individuals. The HBsAg seroclearance status is found to be associated with recurrence in HCC patients undergoing hepatectomy. Additional evidence indicates that HBsAg is essential to the entire process of tumor development, from initiation to advancement, and acts as an oncoprotein involved in accelerating tumor progression. This review comprehensively analyzes the extensive effects and internal mechanisms of HBsAg during the various stages of the initiation and progression of HCC. Furthermore, it highlights the importance and potential applications of HBsAg in the realms of HCC early diagnosis and personalized therapeutic interventions. An in-depth understanding of the molecular mechanism of HBsAg in the occurrence and development of HCC is provided, which is expected to develop more precise and efficient strategies for the prevention and management of HCC in the future.

Future perspectives on immunotherapy for hepatocellular carcinoma

In recent years, several global phase III trials have shown that combinations of immune checkpoint inhibitors (ICIs) offer superior efficacy and survival compared to multi-kinase inhibitors, establishing them as the gold standard for treating patients with advanced hepatocellular carcinoma (HCC). This success has led to investigations into expanding the use of immunotherapy into various other settings and populations, including neoadjuvant and adjuvant therapies, patients with decompensated liver function and those awaiting liver transplantation. Despite its proven efficacy, a significant number of patients still develop resistance to immunotherapy, highlighting the need for innovative strategies to address this challenge. Approaches aimed at enhancing tumour immunogenicity, such as combining immunotherapy with transarterial chemoembolization or radiation therapies, show significant promise. Additionally, novel immunotherapeutics - such as triplet therapy, bispecific antibodies, adoptive T-cell therapy and cancer vaccines - are in early development for HCC. These agents have demonstrated potential for synergistic effects with existing ICIs, with initial studies yielding positive outcomes. In this review, we offer our future perspective on immunotherapy, emphasizing emerging indications, novel combination strategies and the development of new immunotherapeutic agents. Overall, the future of immunotherapy in HCC is brimming with extraordinary potential, set to transform the treatment landscape and redefine the possibilities for managing this challenging disease.

HTRecNet: a deep learning study for efficient and accurate diagnosis of hepatocellular carcinoma and cholangiocarcinoma

Background

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) represent the primary liver cancer types. Traditional diagnostic techniques, reliant on radiologist interpretation, are both time-intensive and often inadequate for detecting the less prevalent CCA. There is an emergent need to explore automated diagnostic methods using deep learning to address these challenges.

Methods

This study introduces HTRecNet, a novel deep learning framework for enhanced diagnostic precision and efficiency. The model incorporates sophisticated data augmentation strategies to optimize feature extraction, ensuring robust performance even with constrained sample sizes. A comprehensive dataset of 5,432 histopathological images was divided into 5,096 for training and validation, and 336 for external testing. Evaluation was conducted using five-fold cross-validation and external validation, applying metrics such as accuracy, area under the receiver operating characteristic curve (AUC), and Matthews correlation coefficient (MCC) against established clinical benchmarks.

Results

The training and validation cohorts comprised 1,536 images of normal liver tissue, 3,380 of HCC, and 180 of CCA. HTRecNet showed exceptional efficacy, consistently achieving AUC values over 0.99 across all categories. In external testing, the model reached an accuracy of 0.97 and an MCC of 0.95, affirming its reliability in distinguishing between normal, HCC, and CCA tissues.

Conclusion

HTRecNet markedly enhances the capability for early and accurate differentiation of HCC and CCA from normal liver tissues. Its high diagnostic accuracy and efficiency position it as an invaluable tool in clinical settings, potentially transforming liver cancer diagnostic protocols. This system offers substantial support for refining diagnostic workflows in healthcare environments focused on liver malignancies.

CGREF1 facilitates the cell proliferation, migration and invasion of hepatocellular carcinoma cells via regulation of EIF3H/ Wnt/β-Catenin signaling axis

BACKGROUND

Although Cell growth regulator with EF-hand domain 1 (CGREF1) has been predicted to be upregulated in multiple cancer types, its definitive function role in carcinogenesis, particularly in hepatocellular carcinoma (HCC), remains poorly characterized.

METHODS

Comprehensive bioinformatics analysis was initially conducted using the University of ALabama at Birmingham CANcer data analysis Portal (UALCAN) and Gene Expression Profiling Interactive Analysis (GEPIA) databases to investigate CGREF1 mRNA expression patterns in HCC tissues and their clinical correlation with patient survival outcomes. Experimental validation was subsequently performed through real-time quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry (IHC), and Western blot techniques. Functional characterization studies employing genetic knockdown and overexpression models in HCC cell lines demonstrated CGREF1's regulatory effects on malignant phenotypes, as evidenced by 3-(4,5-dimethylthiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay, colony formation assay and Transwell migration and invasion assays. were adopted to investigate the role of CGREF1 in the proliferation, invasion, and migration of HCC cells. Mechanistic investigations integrating bioinformatics predictions with Western blot analysis revealed CGREF1 mediated-modulation of the Wnt/β-Catenin signaling axis, elucidating its molecular underpinnings in HCC progression.

RESULTS

The results demonstrated that CGREF1 is highly expressed in HCC tissues, and HCC patients with elevated CGREF1 expression exhibited significantly shorter survival times. Upregulation of CGREF1 promoted the proliferation, migration, and invasion of HCC cells, whereas inhibition of CGREF1 expression suppressed these phenotypes. Mechanistically, CGREF1 activates the Wnt/β-Catenin signaling pathway through the upregulation of eukaryotic translation initiation factor 3 H subunit (EIF3H). Furthermore, partial inhibition of EIF3H attenuated the effects of CGREF1 overexpression on the proliferation, migration, and invasion of HCC cells.

CONCLUSION

CGREF1 is upregulated in HCC and acted as an oncogene through the CGREF1/EIF3H/Wnt/β-Catenin signaling axis. These findings suggest that CGREF1 may emerge as a potential therapeutic target for HCC.

Research progress on AMPK in the pathogenesis and treatment of MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly known as non-alcoholic fatty liver disease, NAFLD) has become one of the most prevalent chronic liver diseases worldwide, with its incidence continuously rising alongside the epidemic of metabolic disorders. AMP-activated protein kinase (AMPK), as a key regulator of cellular energy metabolism, influences multiple pathological processes associated with MASLD. This review systematically summarizes the regulatory roles of AMPK in lipid metabolism, inflammatory response, cell apoptosis, and fibrosis. Additionally, it discusses the latest developments of AMPK activators from preclinical to clinical studies, while analyzing the major challenges currently faced and potential strategies for resolution. A deeper understanding of AMPK regulatory mechanisms will contribute to the development of more effective therapeutic approaches for MASLD.

Metabolic dysfunction-associated steatotic liver disease in adults

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the umbrella term that comprises metabolic dysfunction-associated steatotic liver, or isolated hepatic steatosis, through to metabolic dysfunction-associated steatohepatitis, the progressive necroinflammatory disease form that can progress to fibrosis, cirrhosis and hepatocellular carcinoma. MASLD is estimated to affect more than one-third of adults worldwide. MASLD is closely associated with insulin resistance, obesity, gut microbial dysbiosis and genetic risk factors. The obesity epidemic and the growing prevalence of type 2 diabetes mellitus greatly contribute to the increasing burden of MASLD. The treatment and prevention of major metabolic comorbidities such as type 2 diabetes mellitus and obesity will probably slow the growth of MASLD. In 2023, the field decided on a new nomenclature and agreed on a set of research and action priorities, and in 2024, the US FDA approved the first drug, resmetirom, for the treatment of non-cirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis. Reliable, validated biomarkers that can replace histology for patient selection and primary end points in MASH trials will greatly accelerate the drug development process. Additionally, noninvasive tests that can reliably determine treatment response or predict response to therapy are warranted. Sustained efforts are required to combat the burden of MASLD by tackling metabolic risk factors, improving risk stratification and linkage to care, and increasing access to therapeutic agents and non-pharmaceutical interventions.

Histidine metabolism drives liver cancer progression via immune microenvironment modulation through metabolic reprogramming

BACKGROUND

Histidine metabolism is crucial in role in tumor biology, contributing to tumor progression, immune regulation, and metabolic reprogramming. In hepatocellular carcinoma (HCC), dysregulated histidine metabolism may promote tumor growth and immune evasion, although the specific mechanisms remain poorly understood.

METHODS

Using single-cell RNA sequencing, the expression patterns of histidine metabolism-related genes were evaluated across different cell types in HCC samples. In vivo and in vitro experiments were conducted to validate how histidine treatment affects macrophage and T-cell function. Furthermore, the TCGA database was utilized to construct a prognostic model to identify the key gene BUD23 and to examine its correlation with metabolism and immune infiltration.

RESULTS

The proportion of parenchymal cells exhibiting high histidine metabolism was significantly increased, accompanied by a general reduction in immune and stromal cell infiltration. Notably, macrophages and T cells demonstrated impaired antitumor functions. In the high histidine metabolism group, multiple critical cell communication pathways (e.g., MIF, CLEC, MHC II) were downregulated, macrophages shifted toward immunosuppressive subpopulations, T cells exhibited an exhaustion phenotype, and CD8 + T-cell activation was diminished. Further in vivo and in vitro co-culture experiments confirmed that elevated histidine concentrations promoted M2 polarization in macrophages and weakened T-cell cytotoxicity, accelerating tumor proliferation. According to TCGA analyses, BUD23 was upregulated in the high histidine metabolism group and significantly negatively correlated with patient survival and immune cell infiltration. Silencing BUD23 boosted immune cell activation and cytotoxic effects, effectively reversing the immunosuppressive microenvironment. A multivariable Cox regression-based prognostic model indicated unfavorable outcomes in patients with high histidine metabolism.

CONCLUSION

Histidine metabolism drives tumor cell metabolic reprogramming and reshapes the tumor immune microenvironment through intercellular communication, thereby promoting tumor progression. BUD23 shows promise as a biomarker for prognosis and immune response prediction in liver cancer. This study provides new therapeutic targets and theoretical support for liver cancer treatment by targeting histidine metabolism.

A novel nomogram based on complement C3 to predict the overall survival of early-stage hepatocellular carcinoma patients with microvascular invasion-positive undergoing curative resection

Purpose

This investigation aimed to create a new nomogram based on complement C3 to forecast 1-, 3-, and 5-year overall survival (OS) rates in patients with early-stage hepatocellular carcinoma (HCC) exhibiting microvascular invasion (MVI) post-curative surgery.

Methods

This study encompassed 1234 patients treated with resection at the Affiliated Cancer Hospital of Guangxi Medical University. The cohort for primary included 865 patients from December 2015 to December 2019, while the validation cohort comprised 369 patients. Follow-ups were conducted regularly until December 2024. Variables predicting survival were identified using Cox regression analyses, and based on these, a nomogram was constructed. This nomogram's accuracy was assessed via time-dependent ROC curves, calibration curves and KM curve analyses.

Results

Investigations identified complement C3, PT, the presence of cirrhosis, tumor capsule, and MVI-M2 as distinct predictors of survival in HCC patients. Based on these findings, a predictive nomogram was constructed and validated, aimed at estimating the 1-, 3-, and 5-year OS. The efficacy of the nomogram was validated through analyses with ROC curves, calibration curves, each demonstrating positive outcomes. Additionally, KM curve analysis effectively separated the patient populations into two prognostic risk categories within both the primary and validation cohorts.

Conclusion

In conclusion, a new nomogram has been developed and corroborated through multivariate Cox regression analysis, aimed at estimating overall survival for patients in early stages of microvascular invasion following surgical resection. This tool has proven to be more effective in forecasting survival outcomes for such patients post-curative surgery.

Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment

Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.

Recent advances in self-targeting natural product-based nanomedicines

Natural products, recognized for their potential in disease prevention and treatment, have been integrated with advanced nano-delivery systems to create natural product-based nanomedicines, offering innovative approaches for various diseases. Natural products derived from traditional Chinese medicine have their own targeting effect and remarkable therapeutic effect on many diseases, but there are some shortcomings such as poor physical and chemical properties. The construction of nanomedicines using the active ingredients of natural products has become a key step in the modernization research process, which could be used to make up for the defects of natural products such as low solubility, large dosage, poor bioavailability and poor targeting. Nanotechnology enhances the safety, selectivity, and efficacy of natural products, positioning natural product-based nanomedicines as promising candidates in medicine. This review outlines the current status of development, the application in different diseases, and safety evaluation of natural product-based nanomedicines, providing essential insights for further exploration of the synergy between natural products and nano-delivery systems in disease treatment.

Comparison of NAFLD, MAFLD, and MASLD Prevalence and Clinical Characteristics in Asia Adults

Background/Aims

The principal limitations of the term non-alcoholic fatty liver disease (NAFLD) are the reliance on exclusionary confounder terms and the use of potentially stigmatizing language. Within three years, NAFLD went through two name changes, from NAFLD to metabolic-dysfunction-associated fatty liver disease (MAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). However, there is no Asian consensus statement on the renaming of MASLD, and evidence on the epidemiology and characteristics in the Asia population under different diagnostic criteria remain limited. This study aimed to fill these gaps by analyzing the prevalence and characteristics of MASLD, NAFLD, and MAFLD in an Asian population.

Methods

A retrospective, cross-sectional study was conducted in regional China with participants from the health management database in 2017-2022. Demographic and laboratory metabolic profile and body composition data were obtained. Hepatic steatosis were diagnosed by ultrasound. The likelihood of having fibrosis was assessed using the NAFLD fibrosis score (NFS). Recently proposed criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) were applied.

Results

A total of 20,226 subjects were included for final analysis. 7465 (36.91%) participants were categorized as MASLD patients, 10,726 (53.03%) participants were MAFLD, and 7333 (36.26%) participants were NAFLD. Compared with MAFLD, body composition of MASLD and NAFLD patients were obviously different. MASLD patients were older, had a higher body mass index and percentage of male gender, and had a higher ALT, diastolic blood pressure, triglyceride, and waist circumference but lower High-Density Lipoprotein Cholesterol (HDL-C) than non-MASLD patients. Using binary regression analysis, we found for the first time that putative bone mass (OR = 4.62, 95CI% 3.12-6.83) is associated with the risk of developing MASLD. The area under the receiver operating curve (AUC) for predicting cardiovascular outcomes (CV) was 0.644 for MAFLD and 0.701 for MASLD.

Conclusion

MASLD (36.91%) prevalence was closed to NAFLD (36.26%) and lower than MAFLD (53.03%). Presumed bone mass might be the predictor of disease progression in MASLD patients. MASLD better identifies patients likely to have a higher risk of metabolic disorders or CV events.

Exploring Circulating Tumor Cells: Detection Methods and Biomarkers for Clinical Evaluation in Hepatocellular Carcinoma

Circulating tumor cells (CTCs), originating from primary neoplastic tissues, infiltrate blood vessels, migrate through the bloodstream, and establish secondary tumor foci. The detection of CTCs holds significant promise for early-stage identification, diagnostic precision, therapeutic monitoring, and prognostic evaluation. It offers a non-invasive approach and has broad clinical relevance in cancer management. This comprehensive review primarily focused on CTCs as biomarkers in the diagnostic, therapeutic, and prognostic surveillance of hepatocellular carcinoma, compared their correlation with key clinical parameters and the identification of gene characteristics. It also highlighted current methodologies in CTC detection. Despite approval by the U.S. Food and Drug Administration for select malignancies, the comprehensive integration of CTCs into routine clinical practice requires procedural standardization and a deeper understanding of the underlying molecular intricacies. The challenges in CTC detection, including limited quantity, technical impediments, and cellular heterogeneity, call for concerted and further investigational efforts to advance precision in cancer diagnostics and prognostication, thus realizing the objectives of precise and personalized medicine.

Hepatocellular Carcinoma Immunotherapy: Predictors of Response, Issues, and Challenges

Immune checkpoint inhibitors (ICIs), such as durvalumab, tremelimumab, and atezolizumab, have emerged as a significant therapeutic option for the treatment of hepatocellular carcinoma (HCC). In fact, the efficacy of ICIs as single agents or as part of combination therapies has been demonstrated in practice-changing phase III clinical trials. However, ICIs confront several difficulties, including the lack of predictive biomarkers, primary and secondary drug resistance, and treatment-related side effects. Herein, we provide an overview of current issues and future challenges in this setting.