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Bucurica S, Lupanciuc M, Ionita-Radu F, Stefan I, Munteanu AE, Anghel D, Jinga M, Gaman EL. Estrobolome and Hepatocellular Adenomas-Connecting the Dots of the Gut Microbial β-Glucuronidase Pathway as a Metabolic Link. Int J Mol Sci 2023; 24:16034. [PMID: 38003224 PMCID: PMC10671049 DOI: 10.3390/ijms242216034] [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: 10/08/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Hepatocellular adenomas are benign endothelial tumors of the liver, mostly associated with female individual users of estrogen-containing medications. However, the precise factors underlying the selective development of hepatic adenomas in certain females remain elusive. Additionally, the conventional profile of individuals prone to hepatic adenoma is changing. Notably, male patients exhibit a higher risk of malignant progression of hepatocellular adenomas, and there are instances where hepatic adenomas have no identifiable cause. In this paper, we theorize the role of the human gastrointestinal microbiota, specifically, of bacterial species producing β-glucuronidase enzymes, in the development of hepatic adenomas through the estrogen recycling pathway. Furthermore, we aim to address some of the existing gaps in our knowledge of pathophysiological pathways which are not yet subject to research or need to be studied further. As microbial β-glucuronidases proteins recycle estrogen and facilitate the conversion of inactive estrogen into its active form, this process results in elevated levels of unbound plasmatic estrogen, leading to extended exposure to estrogen. We suggest that an imbalance in the estrobolome could contribute to sex hormone disease evolution and, consequently, to the advancement of hepatocellular adenomas, which are estrogen related.
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Affiliation(s)
- Sandica Bucurica
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Mihaela Lupanciuc
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Florentina Ionita-Radu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Ion Stefan
- Department of Infectious Diseases, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania; (A.E.M.); (D.A.)
| | - Alice Elena Munteanu
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania; (A.E.M.); (D.A.)
- Department of Cardiology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Daniela Anghel
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania; (A.E.M.); (D.A.)
- Department of Internal Medicine, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Mariana Jinga
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Elena Laura Gaman
- Department of Biochemistry, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
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Demory A, Péron JM, Calderaro J, Selves J, Mokrane FZ, Amaddeo G, Paradis V, Ziol M, Sutter O, Blaise L, Ganne-Carrié N, Vilgrain V, Cauchy F, Zucman-Rossi J, Ronot M, Nault JC. Body weight changes and duration of estrogen exposure modulate the evolution of hepatocellular adenomas after contraception discontinuation. Hepatology 2023; 77:430-442. [PMID: 35980227 DOI: 10.1002/hep.32734] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS The natural history of hepatocellular adenomas (HCAs) remains to be better described, especially in nonresected patients. We aim to identify the predictive factors of HCA evolution after estrogen-based contraception discontinuation. APPROACH AND RESULTS We retrospectively included patients with a histological diagnosis of HCA from three centers. Clinical, radiological, and pathological data were collected to identify predictive factors of radiological evolution per Response Evaluation Criteria in Solid Tumors, version 1.1, and occurrence of complications (bleeding, malignant transformation). We built a score using variables that modulate estrogen levels: body mass index and duration of estrogen-based contraception. An external cohort was used to validate this score. 183 patients were included in the cohort, including 161 women (89%) using estrogen-based contraception for a median of 12 years. Thirty percent of patients had at least one HNF1A -inactivated HCA, 45.5% at least one inflammatory HCA, and 11% at least one HCA with activation of β-catenin (bHCA). Twenty-one symptomatic bleedings (11%) and eleven malignant transformations (6%) occurred. Ages < 37 years old ( p = 0.004) and HCA > 5 cm at imaging were independently associated with symptomatic bleeding ( p = 0.003), whereas a bHCA was associated with malignant transformation ( p < 0.001). After a median follow-up of 5 years, radiological regression was observed in 31%, stabilization in 47%, and progression in 22% of patients. Weight loss was associated with regression ( p < 0.0001) and weight gain with progression ( p = 0.02). The estrogen exposure score predicted radiological regression (odds ratio, 2.33; confidence interval 95%, 1.29-4.19; p = 0.005) with a linear relationship between the rate of estrogen exposure and the probability of regression. This result was confirmed in an external cohort of 72 female patients ( p = 0.003). CONCLUSION Weight variation is strongly associated with radiological evolution after oral contraception discontinuation. A score of estrogen exposure, easily assessable in clinical practice at diagnosis, predicts regression of HCA.
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Affiliation(s)
- Alix Demory
- Service d'hépatologie , Hôpital Avicenne , Hôpitaux Universitaires Paris-Seine-Saint-Denis , Assistance-Publique-Hôpitaux de Paris , Bobigny , France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine , Université Paris Nord , Paris , France.,Centre de Recherche des Cordeliers , Inserm, Sorbonne Université, Université Paris, INSERM, Functional Genomics of Solid Tumors laboratory , Paris , France
| | - Jean-Marie Péron
- Service d'hépatogastroentérologie , hôpital Rangueil , CHU Toulouse Assistance , Toulouse , France
| | - Julien Calderaro
- Department of Pathology , Publique-Hôpitaux de Paris , Henri Mondor-Albert Chenevier University Hospital , Créteil , France.,Université Paris Est Créteil , INSERM, IMRB , Créteil , France.,INSERM, Unit U955, Team 18 , Créteil , France
| | - Janick Selves
- Service d'anatomopathologie , hôpital Rangueil , CHU Toulouse Assistance , Toulouse , France
| | - Fatima-Zohra Mokrane
- Service de radiologie , hôpital Rangueil , CHU Toulouse Assistance , Toulouse , France
| | - Giuliana Amaddeo
- Assistance Publique-Hôpitaux de Paris , Hôpital Henri Mondor, Service d'Hépatologie , Créteil , France.,Université Paris Est Créteil, INSERM, IMRB , Créteil , France.,INSERM, U955, Equipe 18 "Physiopathologie et Thérapeutiques des Hépatites Virales Chroniques et des cancers liés" , Créteil , France
| | - Valérie Paradis
- Assistance Publique-Hôpitaux de Paris , Hôpital Beaujon, Service d'anatomopathologie , Clichy , France.,Université de Paris Cité, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252 , Paris , France
| | - Marianne Ziol
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine , Université Paris Nord , Paris , France.,Centre de Recherche des Cordeliers , Inserm, Sorbonne Université, Université Paris, INSERM, Functional Genomics of Solid Tumors laboratory , Paris , France.,Service d'anatomopathologie , Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique-Hôpitaux de Paris , Bobigny , France
| | - Olivier Sutter
- Service de radiologie , Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique-Hôpitaux de Paris , Bobigny , France
| | - Lorraine Blaise
- Service d'hépatologie , Hôpital Avicenne , Hôpitaux Universitaires Paris-Seine-Saint-Denis , Assistance-Publique-Hôpitaux de Paris , Bobigny , France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie , Hôpital Avicenne , Hôpitaux Universitaires Paris-Seine-Saint-Denis , Assistance-Publique-Hôpitaux de Paris , Bobigny , France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine , Université Paris Nord , Paris , France.,Centre de Recherche des Cordeliers , Inserm, Sorbonne Université, Université Paris, INSERM, Functional Genomics of Solid Tumors laboratory , Paris , France
| | - Valérie Vilgrain
- Assistance Publique-Hôpitaux de Paris , Hôpital Beaujon, Service de radiologie , Clichy , France.,INSERM U1149 "Centre de Recherche Sur L'inflammation" , CRI, Université Paris Cité , Paris , France
| | - François Cauchy
- INSERM U1149 "Centre de Recherche Sur L'inflammation" , CRI, Université Paris Cité , Paris , France.,Assistance Publique-Hôpitaux de Paris , Hôpital Beaujon, Service de chirurgie hépato-biliaire , Clichy , France
| | - Jessica Zucman-Rossi
- Centre de Recherche des Cordeliers , Inserm, Sorbonne Université, Université Paris, INSERM, Functional Genomics of Solid Tumors laboratory , Paris , France.,Assistance Publique-Hôpitaux de Paris , Service d'Oncologie Médicale, Hôpital Européen Georges Pompidou , Paris , France
| | - Maxime Ronot
- Assistance Publique-Hôpitaux de Paris , Hôpital Beaujon, Service de radiologie , Clichy , France.,INSERM U1149 "Centre de Recherche Sur L'inflammation" , CRI, Université Paris Cité , Paris , France
| | - Jean-Charles Nault
- Service d'hépatologie , Hôpital Avicenne , Hôpitaux Universitaires Paris-Seine-Saint-Denis , Assistance-Publique-Hôpitaux de Paris , Bobigny , France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine , Université Paris Nord , Paris , France.,Centre de Recherche des Cordeliers , Inserm, Sorbonne Université, Université Paris, INSERM, Functional Genomics of Solid Tumors laboratory , Paris , France
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Bioulac-Sage P, Gouw ASH, Balabaud C, Sempoux C. Hepatocellular Adenoma: What We Know, What We Do Not Know, and Why It Matters. Histopathology 2021; 80:878-897. [PMID: 34856012 DOI: 10.1111/his.14605] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
In the last 2 decades there has been significant progress in research and diagnosis of hepatocellular adenoma (HCA), resulting in the establishment of a molecular and immunohistological HCA classification. This review aims to fine-tune the current expertise in order to enhance the histopathological diagnostic possibilities, by refining issues that are already known, addressing diagnostic difficulties and identifying still unknown aspects of HCA. We will discuss novel methods to identify HCA subtypes, in particular the sonic hedgehog HCAs and the interpretation of glutamine synthetase patterns for the recognition of beta-catenin mutated HCAs. The major complications of HCAs, bleeding and malignant transformation, will be considered, including the dilemmas of atypical and borderline lesions. Paragraphs on HCAs in different clinical and geographical settings, e.g. pregnancy, cirrhosis and non-western countries are included. The natural history of the different HCA subtypes in relation with age, sex and risk factors is a feature still insufficiently investigated. This is also true for the risks of clinical bleeding and malignant transformation in association with HCA subtypes. As HCA is a relatively rare tumor, a multicenter and multidisciplinary approach across geographical boundaries will be the appropriate method to establish prospective programs to identify, classify and manage HCAs, focusing on several aspects, e.g. etiology, underlying liver disease, complications, regression and growth. Updating what we know, identifying and addressing features that we do not know matters to warrant optimal patient management.
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Affiliation(s)
| | - Annette S H Gouw
- Departement of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Christine Sempoux
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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