What Makes Cirrhosis Irreversible?-Consideration on Structural Changes

Diagnostic and prognostic biomarkers in autoimmune hepatitis-associated cirrhosis: insights into TBil, CD38, IL-22, TSP-1, GAL-3, and Cyc-C

Background

Autoimmune hepatitis (AIH) is a chronic inflammatory disease that can progress to cirrhosis and liver failure. While various biomarkers have been associated with AIH progression and prognosis, their specific roles in diagnosing, predicting, and managing cirrhosis, particularly in compensated cirrhosis, remain unclear. Accurately predicting 2-year survival and clinical outcomes for patients with compensated cirrhosis is a critical challenge.

Methods

This study analyzed clinical data from non-cirrhotic and cirrhotic AIH patients to identify factors influencing cirrhosis development and prognosis. Serum and nutritional indices were compared between groups with differing prognoses. The diagnostic efficacy of TSP-1, Gal-3, Cys-C, AIb, and PA was evaluated in compensated cirrhosis patients, and their prognostic value was validated using linear regression and Cox proportional hazards models.

Results

No significant differences in gender, age, BMI, hypertension, diabetes history, or AMA positivity were observed between the non-cirrhotic AIH and cirrhotic AIH groups. However, TBil levels were significantly higher, and CD38 and IL-22 levels were significantly lower in the cirrhosis group. Multivariate logistic regression identified elevated TBil and reduced CD38 and IL-22 levels were associated with increased cirrhosis risk. Prognosis analysis revealed that patients with good outcomes had significantly lower TSP-1, Gal-3, and Cys-C levels and higher AIb and PA levels than those with poor outcomes. Cox proportional hazards modeling identified TSP-1, Gal-3, and Cys-C as independent risk factors and AIb and PA as protective factors influencing 2-year survival.

Conclusion

This study underscores the critical roles of TBil, CD38, and IL-22 in cirrhosis development among AIH patients and validates the diagnostic and prognostic significance of TSP-1, Gal-3, Cys-C, AIb, and PA in compensated cirrhosis. These biomarkers facilitate early risk identification and inform clinical decision-making, contributing to improved management and outcomes for AIH patients.

Role of PNPLA3 in Hepatic Stellate Cells and Hepatic Cellular Crosstalk

AIMS

Since its discovery, the patatin-like phospholipase domain containing 3 (PNPLA3) (rs738409 C>G p.I148M) variant has been studied extensively to unravel its molecular function. Although several studies proved a causal relationship between the PNPLA3 I148M variant and MASLD development and particularly fibrosis, the pathological mechanisms promoting this phenotype have not yet been fully clarified.

METHODS

We summarise the latest data regarding the PNPLA3 I148M variant in hepatic stellate cells (HSCs) activation and macrophage biology or the path to inflammation-induced fibrosis.

RESULTS

Elegant but contradictory studies have ascribed PNPLA3 a hydrolase or an acyltransferase function. The PNPLA3 I148M results in hepatic lipid accumulation, which predisposes the hepatocyte to lipotoxicity and lipo-apoptosis, producing DAMPs, cytokines and chemokines leading to recruitment and activation of macrophages and HSCs, propagating fibrosis. Recent studies showed that the PNPLA3 I148M variant alters HSCs biology via attenuation of PPARγ, AP-1, LXRα and TGFβ activity and signalling.

CONCLUSIONS

The advent of refined techniques in isolating HSCs has made PNPLA3's direct role in HSCs for liver fibrosis development more apparent. However, many other mechanisms still need detailed investigations.

Evolutionary View of Liver Pathology

Evolutionary medicine emerged in the late twentieth century, integrating principles of natural selection and adaptation with the health sciences. Today, with a rapidly widening gap between the biology of Homo sapiens and its environment, maladaptation or maladaptive disorders can be detected in almost all diseases, including liver dysfunction. However, in hepatology, as in most medical specialties, evolutionary considerations are neglected because the majority of the medical community is not familiar with evolutionary principles. The aim of this brief review is to highlight an evolutionary approach that may facilitate understanding various liver diseases.

Pathophysiological Relationship between Type 2 Diabetes Mellitus and Metabolic Dysfunction-Associated Steatotic Liver Disease: Novel Therapeutic Approaches

Type 2 diabetes mellitus (T2DM), often featuring hyperglycemia or insulin resistance, is a global health concern that is increasing in prevalence in the United States and worldwide. A common complication is metabolic dysfunction-associated steatotic liver disease (MASLD), the hepatic manifestation of metabolic syndrome that is also rapidly increasing in prevalence. The majority of patients with T2DM will experience MASLD, and likewise, individuals with MASLD are at an increased risk for developing T2DM. These two disorders may act synergistically, in part due to increased lipotoxicity and inflammation within the liver, among other causes. However, the pathophysiological mechanisms by which this occurs are unclear, as is how the improvement of one disorder can ameliorate the other. This review aims to discuss the pathogenic interactions between T2D and MASLD, and will highlight novel therapeutic targets and ongoing clinical trials for the treatment of these diseases.

Identification of Early Stage Liver Fibrosis by Modifications in the Interstitial Space Diffusive Microenvironment Using Fluorescent Single-Walled Carbon Nanotubes

During liver fibrosis, recurrent hepatic injuries lead to the accumulation of collagen and other extracellular matrix components in the interstitial space, ultimately disrupting liver functions. Early stages of liver fibrosis may be reversible, but opportunities for diagnosis at these stages are currently limited. Here, we show that the alterations of the interstitial space associated with fibrosis can be probed by tracking individual fluorescent single-walled carbon nanotubes (SWCNTs) diffusing in that space. In a mouse model of early liver fibrosis, we find that nanotubes generally explore elongated areas, whose lengths decrease as the disease progresses, even in regions where histopathological examination does not reveal fibrosis yet. Furthermore, this decrease in nanotube mobility is a purely geometrical effect as the instantaneous nanotube diffusivity stays unmodified. This work establishes the promise of SWCNTs both for diagnosing liver fibrosis at an early stage and for more in-depth studies of the biophysical effects of the disease.