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Parker R, Cabezas J, Altamirano J, Arab JP, Ventura-Cots M, Sinha A, Dhanda A, Arrese M, McCune CA, Rowe IA, Schnabl B, Mathurin P, Shawcross D, Abraldes JG, Lucey MR, Garcia-Tsao G, Verna E, Brown RS, Bosques-Padilla F, Vargas V, Louvet A, Holt AP, Bataller R. Trajectory of Serum Bilirubin Predicts Spontaneous Recovery in a Real-World Cohort of Patients With Alcoholic Hepatitis. Clin Gastroenterol Hepatol 2022; 20:e289-e297. [PMID: 33516950 PMCID: PMC9188123 DOI: 10.1016/j.cgh.2021.01.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments. METHODS We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment. RESULTS data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: 'fast fallers' (bilirubin <0.8 x admission value at day 7), 'static' (bilirubin of >0.9 - <1.2 x admission value) and 'rapid risers' (bilirubin of ≥1.2 x admission bilirubin). Fast fallers had significantly better 90-day survival compared to other groups (log rank p < .001), and showed no benefit of corticosteroid therapy (OR for survival at 28 days of treatment, 0.94, 95% CI 0.06 - 8.41). These findings remained even amongst patients with severe disease based on initial DF, GAHS or MELD scores. CONCLUSIONS We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy.
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Affiliation(s)
- Richard Parker
- Leeds Liver Unit, St James's University Hospital, Leeds, United Kingdom.
| | - Joaquin Cabezas
- Department of Gastroenterology and Hepatology, University Hospital Marques de Valdecilla, Valdecilla Research Institute, Santander, Spain; Liver Center, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jose Altamirano
- Internal Medicine Department, Hospital Quirónsalud, Barcelona, Spain
| | - Juan Pablo Arab
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Meritxell Ventura-Cots
- Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ashish Sinha
- Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ashwin Dhanda
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Envejecimiento y Regeneración, Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Anne McCune
- Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ian A Rowe
- Leeds Liver Unit, St James's University Hospital, Leeds, United Kingdom
| | - Bernd Schnabl
- Department of Medicine, VA San Diego Healthcare System, University of California, San Diego, La Jolla, California
| | - Phillipe Mathurin
- Service des Maladies de l'Appareil Digestif et Unité, French Institute of Health and Medical Research, Hôpital Huriez, Lille, France
| | - Debbie Shawcross
- Liver Sciences, Dept of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Juan G Abraldes
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), Centre of Excellence Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta, Canada
| | - Michael R Lucey
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University, New Haven, Connecticut; Section of Digestive Diseases, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Elizabeth Verna
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | | | - Victor Vargas
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma Barcelona, CIBEREHD, Barcelona, Spain
| | - Alexandre Louvet
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Andrew P Holt
- Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Holt AP, Fragiadakis D, Roland CM. Dynamic Properties of Supercooled Chlorinated Biphenyls. J Phys Chem B 2020; 124:5073-5078. [PMID: 32432473 DOI: 10.1021/acs.jpcb.0c02601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A study of the dynamics of a series of biphenyl compounds having varying chlorine levels was carried out. Increasing the chlorine content increases the glass transition temperature and makes the dynamics substantially more sensitive to density changes. Nonetheless, in the vicinity of their respective glass transitions, the different liquids display very similar extents of dynamic correlation and dynamic heterogeneity. The slight narrowing of the relaxation peak with increasing chlorine follows the general trend of the effect of increasing molecular polarity. This relationship between the peak breadth and dipole moment was reproduced in molecular dynamics simulations of a simplified model of the Aroclor molecule.
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Affiliation(s)
- A P Holt
- Chemistry Division, Code 6105, Naval Research Laboratory, Washington, D.C. 20375-4032, United States
| | - D Fragiadakis
- Chemistry Division, Code 6105, Naval Research Laboratory, Washington, D.C. 20375-4032, United States
| | - C M Roland
- Chemistry Division, Code 6105, Naval Research Laboratory, Washington, D.C. 20375-4032, United States
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3
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Holt AP, Fragiadakis D, Roland CM. Pressure densified 1,3,5-tri(1-naphthyl)benzene glass. I. Volume recovery and physical aging. J Chem Phys 2019; 151:184502. [PMID: 31731837 DOI: 10.1063/1.5122765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The effects of pressure densification on 1,3,5-tri(1-naphthyl)benzene (TNB) are assessed from volumetric and calorimetric measurements. The pressure densified glass (PDG) has higher density than conventional glass (CG), but unlike ultrastable TNB glass prepared using vapor deposition which also has elevated density, TNB PDG exhibits higher enthalpy and lower thermal stability than when formed at ambient pressure. PDG also exhibits anomalous physical aging. Rather than evolving monotonically toward the equilibrium density, there is an overshoot to a lower density state. Only when the density of the PDG becomes equivalent to the corresponding CG does the density begin a slow approach toward equilibrium.
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Affiliation(s)
- A P Holt
- Naval Research Laboratory, Chemistry Division, Washington, DC 20375-5342, USA
| | - D Fragiadakis
- Naval Research Laboratory, Chemistry Division, Washington, DC 20375-5342, USA
| | - C M Roland
- Naval Research Laboratory, Chemistry Division, Washington, DC 20375-5342, USA
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Ransom TC, Casalini R, Fragiadakis D, Holt AP, Roland CM. Comment on "Experimental Evidence for a State-Point-Dependent Density-Scaling Exponent of Liquid Dynamics". Phys Rev Lett 2019; 123:189601. [PMID: 31763906 DOI: 10.1103/physrevlett.123.189601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 06/10/2023]
Affiliation(s)
- T C Ransom
- Chemistry Division, Naval Research Laboratory, Washington, DC 20375-5342, USA
| | - R Casalini
- Chemistry Division, Naval Research Laboratory, Washington, DC 20375-5342, USA
| | - D Fragiadakis
- Chemistry Division, Naval Research Laboratory, Washington, DC 20375-5342, USA
| | - A P Holt
- Chemistry Division, Naval Research Laboratory, Washington, DC 20375-5342, USA
| | - C M Roland
- Chemistry Division, Naval Research Laboratory, Washington, DC 20375-5342, USA
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5
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Gainaru C, Stacy EW, Bocharova V, Gobet M, Holt AP, Saito T, Greenbaum S, Sokolov AP. Mechanism of Conductivity Relaxation in Liquid and Polymeric Electrolytes: Direct Link between Conductivity and Diffusivity. J Phys Chem B 2016; 120:11074-11083. [PMID: 27681664 DOI: 10.1021/acs.jpcb.6b08567] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Combining broadband impedance spectroscopy, differential scanning calorimetry, and nuclear magnetic resonance we analyzed charge and mass transport in two polymerized ionic liquids and one of their monomeric precursors. In order to establish a general procedure for extracting single-particle diffusivity from their conductivity spectra, we critically assessed several approaches previously employed to describe the onset of diffusive charge dynamics and of the electrode polarization in ion conducting materials. Based on the analysis of the permittivity spectra, we demonstrate that the conductivity relaxation process provides information on ion diffusion and the magnitude of cross-correlation effects between ionic motions. A new approach is introduced which is able to estimate ionic diffusivities from the characteristic times of conductivity relaxation and ion concentration without any adjustable parameters. This opens the venue for a deeper understanding of charge transport in concentrated and diluted electrolyte solutions.
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Affiliation(s)
- C Gainaru
- Department of Chemistry, University of Tennessee , Knoxville, Tennessee 37996, United States.,Fakultät Physik, Technische Universität Dortmund , D-44221 Dortmund, Germany
| | - E W Stacy
- Department of Physics and Astronomy, University of Tennessee , Knoxville, Tennessee 37996, United States
| | - V Bocharova
- Chemical Sciences Division, Oak Ridge National Laboratory , Oak Ridge, Tennessee 37831, United States
| | - M Gobet
- Department of Physics & Astronomy, Hunter College of The City University of New York , New York, New York 10065, United States
| | - A P Holt
- Department of Physics and Astronomy, University of Tennessee , Knoxville, Tennessee 37996, United States
| | - T Saito
- Chemical Sciences Division, Oak Ridge National Laboratory , Oak Ridge, Tennessee 37831, United States
| | - S Greenbaum
- Department of Physics & Astronomy, Hunter College of The City University of New York , New York, New York 10065, United States
| | - A P Sokolov
- Department of Chemistry, University of Tennessee , Knoxville, Tennessee 37996, United States.,Chemical Sciences Division, Oak Ridge National Laboratory , Oak Ridge, Tennessee 37831, United States
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7
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Claridge LC, Dobson C, Kanji H, Neil D, Timms JM, Holt AP. Acute liver failure secondary to opportunistic viral infection in adult solid organ transplant recipients. QJM 2012; 105:879-82. [PMID: 21771853 DOI: 10.1093/qjmed/hcr117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- L C Claridge
- Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK.
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Abstract
Ultrasonic backscatter techniques offer a promising new approach for detecting changes in bone caused by osteoporosis. However, several challenges impede clinical implementation of backscatter techniques. This study examines how the dense outer surface of bone (the cortex) affects backscatter measurements of interior regions of porous (cancellous) bone tissue. Fifty-two specimens of bone were prepared from 13 human femoral heads so that the same region of cancellous bone could be ultrasonically interrogated through the cortex or along directions that avoided the cortex. Backscatter signals were analyzed over a frequency range of 0.8-3.0 MHz to determine two ultrasonic parameters: apparent integrated backscatter (AIB) and frequency slope of apparent backscatter (FSAB). The term 'apparent' means that the parameters are sensitive to the frequency-dependent effects of diffraction and attenuation. Significant (p < 0.001) changes in AIB and FSAB indicated that measurements through the cortex decreased the apparent backscattered power and increased the frequency dependence of the power. However, the cortex did not affect the correlation of AIB and FSAB with the x-ray bone mineral density of the specimens. This suggests that results from many previous in vitro backscatter studies of specimens of purely cancellous bone may be extrapolated with greater confidence to in vivo conditions.
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9
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Claridge LC, Eksteen B, Smith A, Shah T, Holt AP. [Acute liver failure after administration of paracetamol at the maximum recommended daily dose in adults]. Praxis (Bern 1994) 2011; 100:923-926. [PMID: 21792808 DOI: 10.1024/1661-8157/a000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Affiliation(s)
- Lee C Claridge
- Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
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11
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Aspinall AI, Curbishley SM, Lalor PF, Weston CJ, Blahova M, Liaskou E, Adams RM, Holt AP, Adams DH. CX(3)CR1 and vascular adhesion protein-1-dependent recruitment of CD16(+) monocytes across human liver sinusoidal endothelium. Hepatology 2010; 51:2030-9. [PMID: 20512991 PMCID: PMC2919204 DOI: 10.1002/hep.23591] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED The liver contains macrophages and myeloid dendritic cells (mDCs) that are critical for the regulation of hepatic inflammation. Most hepatic macrophages and mDCs are derived from monocytes recruited from the blood through poorly understood interactions with hepatic sinusoidal endothelial cells (HSECs). Human CD16(+) monocytes are thought to contain the precursor populations for tissue macrophages and mDCs. We report that CD16(+) cells localize to areas of active inflammation and fibrosis in chronic inflammatory liver disease and that a unique combination of cell surface receptors promotes the transendothelial migration of CD16(+) monocytes through human HSECs under physiological flow. CX(3)CR1 activation was the dominant pertussis-sensitive mechanism controlling transendothelial migration under flow, and expression of the CX(3)CR1 ligand CX(3)CL1 is increased on hepatic sinusoids in chronic inflammatory liver disease. Exposure of CD16(+) monocytes to immobilized purified CX(3)CL1 triggered beta1-integrin-mediated adhesion to vascular cell adhesion molecule-1 and induced the development of a migratory phenotype. Following transmigration or exposure to soluble CX(3)CL1, CD16(+) monocytes rapidly but transiently lost expression of CX(3)CR1. Adhesion and transmigration across HSECs under flow was also dependent on vascular adhesion protein-1 (VAP-1) on the HSECs. CONCLUSION Our data suggest that CD16(+) monocytes are recruited by a combination of adhesive signals involving VAP-1 and CX(3)CR1 mediated integrin-activation. Thus a novel combination of surface molecules, including VAP-1 and CX(3)CL1 promotes the recruitment of CD16(+) monocytes to the liver, allowing them to localize at sites of chronic inflammation and fibrosis.
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Affiliation(s)
| | - Stuart M. Curbishley
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
| | - Patricia F. Lalor
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
| | - Chris J. Weston
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
| | - Miroslava Blahova
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
| | - Evaggelia Liaskou
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
| | - Rebecca M Adams
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
| | - Andrew P. Holt
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT,The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - David H. Adams
- Centre for Liver Research and NIHR Biomedical Research Unit, College of Medicine and Dentistry, Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. B15 2TT
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Holt AP, Haughton EL, Lalor PF, Filer A, Buckley CD, Adams DH. Liver myofibroblasts regulate infiltration and positioning of lymphocytes in human liver. Gastroenterology 2009; 136:705-14. [PMID: 19010327 DOI: 10.1053/j.gastro.2008.10.020] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 10/01/2008] [Accepted: 10/09/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The recruitment of lymphocytes to tissues via endothelium has been studied extensively but less is known about the signals that direct migration and positioning within tissues. Liver myofibroblasts associate with lymphocytes in hepatitis and are positioned below the sinusoidal endothelium, through which lymphocytes are recruited to the liver. We investigated whether activated human liver myofibroblasts (aLMF) affect the migration and accumulation of lymphocytes within the inflamed liver. METHODS The ability of human aLMF and hepatic stellate cells to promote lymphocyte chemotaxis, adhesion, and migration was studied in vitro. RESULTS When cultured in vitro, aLMF from diseased human liver and hepatic stellate cells from noninflamed liver secrete a distinct profile of cytokines comprising interleukin (IL)-6, IL-12, hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and the chemokines CCL2, CCL3, CCL5, CXCL8, CXCL9, and CXCL10. aLMF-conditioned media had chemotactic activity for lymphocytes, which partially was inhibited by pertussis toxin. IL-6, HGF, and VEGF all contributed to G-protein-coupled receptor-independent chemotaxis of lymphocytes. Lymphocytes adhered to aLMF via intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 and a proportion of adherent cells migrated through the fibroblast monolayer, mediated by IL-6, HGF, and VEGF. CONCLUSIONS Human aLMF support G-protein coupled receptor-dependent and -independent lymphocyte adhesion and migration and thereby regulate the recruitment and positioning of lymphocytes in chronic hepatitis.
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Affiliation(s)
- Andrew P Holt
- Liver Research Group, Institute of Biomedical Research, Division of Medicine, University of Birmingham, Birmingham, United Kingdom
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Abstract
INTRODUCTION Early recognition and identification of the underlying cause of acute liver injury (ALI) is crucial in instituting medical treatment and assessing the need for liver transplantation. Haematological malignancies have been reported to present as ALI with progression to acute liver failure but experience is limited. AIM Review our experience of ALI secondary to haematological malignancies. PATIENTS AND METHODS Patients admitted to the liver unit with ALI secondary to a haematological malignancy between 1996 and 2006 were identified. A retrospective review was made of their case notes and our database. RESULTS Of the 752 cases of ALI, six cases of ALI secondary to haematological malignancy were identified. Common features were a prodromal illness (median duration of 5 weeks; range 2-6 weeks) and jaundice (median bilirubin 208 micromol/l; range 112-238 micromol/l). The majority of patients (5/6) had hepatomegaly. Liver biopsy was performed in two patients and confirmed the diagnosis in both cases. In other cases, the diagnosis was made following lymph node biopsy (1), bone marrow examination (2) or from post-mortem examination (1). Median time from jaundice to encephalopathy was 12 days; range 1-22 days. A single patient underwent liver transplantation but died in the immediate post-operative period. All patients died soon after admission with a median survival of 8 days (range 3-26 days). CONCLUSION Haematological malignancy should be considered in ALI patients presenting with a prodromal illness, jaundice and hepatomegaly. Biopsy is essential to confirm the diagnosis but the benefit of definitive therapy such as chemotherapy and/or transplantation in this setting is unclear and survival is poor.
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Affiliation(s)
- S Shetty
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
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14
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Abstract
Liver cirrhosis is caused by iterative cycles of tissue injury, inflammation, and repair. Although most causes of acute hepatitis resolve without scarring, chronic hepatitis is associated with persistent inflammation and matrix remodeling, which leads to fibrosis and, eventually, cirrhosis. The mechanisms that govern wound healing involve interactions between the innate and adaptive immune systems and stromal cells within a microenvironment composed of cytokines, growth factors, and modified matricellular proteins. The immune system plays a central role in the regulation of fibrosis, tissue repair, and recovery that is vital for the maintenance of tissue homeostasis. Chronic inflammation and fibrosis are inextricably linked and the cellular interactions between immune effector cells, local fibroblasts, and tissue macrophages at sites of scar formation determine the outcome of liver injury and the development of scarring.
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Affiliation(s)
- Andrew P Holt
- Honorary Clinical Fellow in Hepatology, Liver Research Group, MRC Centre for Immune Regulation, University of Birmingham, Birmingham. U.K
| | - Mike Salmon
- Professor of Experimental Rheumatology, MRC Centre for Immune Regulation, University of Birmingham, UK
| | - Christopher D Buckley
- ARC Professor of Rheumatology, MRC Centre for Immune Regulation, University of Birmingham, UK
| | - David H Adams
- Professor of Hepatology, Liver Research Group, MRC Centre for Immune Regulation, University of Birmingham, Birmingham. U.K
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15
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Dowman JK, Holt AP, Newsome PN, Adams DH. Emerging drugs for complications of end-stage liver disease. Expert Opin Emerg Drugs 2008; 13:159-74. [PMID: 18321155 DOI: 10.1517/14728214.13.1.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The prevalence of end-stage liver disease is rising rapidly and constitutes a major healthcare burden currently. Many cases are diagnosed at a later stage when liver transplantation is the only effective treatment option. There is thus an urgent need for novel treatments to reverse the earlier stages of cirrhosis as well as to treat the many associated life-threatening complications. OBJECTIVES To review the current drugs available for treating the complications of advanced liver disease. To address novel treatment strategies that are in development, with particular reference to the rapidly developing area of antifibrotic therapy. To assess how the obstacles that have so far impeded the development of effective new drugs for end-stage liver disease may be overcome in the future. METHODS The literature was reviewed to define current therapies and therapies in clinical trials. We used the current models of the molecular basis of liver fibrogenesis to determine potential new therapeutic targets for antifibrotic therapy. CONCLUSIONS Insights into the pathogenesis of liver injury and fibrosis have opened up new avenues for therapy and there are now candidates and targets with real potential for the development of a new generation of antifibrotic therapies.
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Affiliation(s)
- Joanna K Dowman
- The University of Birmingham Medical School, Liver Research Group, MRC Centre for Immune Regulation, Institute of Biomedical Research, 5th Floor, Wolfson Drive, Edgbaston, Birmingham B15 2TT, UK
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16
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Abstract
Diseases with different pathogeneses share common pathways of immune-mediated injury. Autoreactive T cells destroy hepatocytes or cholangiocytes in autoimmune disease and virus-specific T cells destroy infected hepatocytes in viral hepatitis. In these conditions, antigen-specific mechanisms can be implicated but immune-mediated injury is central to diseases where there is a less-defined role for specific antigens. In all these diseases, "bystander cells" activated by the local microenvironment rather than a specific antigen are major players and amplify effector responses by recruiting natural killer and natural killer T cells, macrophages, neutrophils, eosinophils, and even platelets. Immune-mediated liver injury is driven by repeated cycles of inflammation and damage sustained by continuing recruitment, retention, and survival of effector leukocytes within the inflamed liver. These processes depend on complex interactions involving epithelial cells, stromal cells, and leukocytes shaped by the local cytokine microenvironment. Understanding these interactions will elucidate the pathogenesis of liver disease and suggest new therapies.
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Affiliation(s)
- Bertus Eksteen
- Liver Research Group, MRC Centre for Immune Regulation, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
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17
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Abstract
There is currently insufficient evidence to support the use of COX‐2 inhibitors in treating chronic hepatitis or in preventing liver fibrosis
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Affiliation(s)
- Andrew P Holt
- Liver Research Group, 5th Floor IBR, The University of Birmingham Medical School, Wolfson Drive, Edgbaston, Birmingham B152TT, UK
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Johnson LA, Clasper S, Holt AP, Lalor PF, Baban D, Jackson DG. An inflammation-induced mechanism for leukocyte transmigration across lymphatic vessel endothelium. J Biophys Biochem Cytol 2006. [DOI: 10.1083/jcb1755oia11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Johnson LA, Clasper S, Holt AP, Lalor PF, Baban D, Jackson DG. An inflammation-induced mechanism for leukocyte transmigration across lymphatic vessel endothelium. J Exp Med 2006; 203:2763-77. [PMID: 17116732 PMCID: PMC2118156 DOI: 10.1084/jem.20051759] [Citation(s) in RCA: 257] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 10/26/2006] [Indexed: 12/12/2022] Open
Abstract
The exit of antigen-presenting cells and lymphocytes from inflamed skin to afferent lymph is vital for the initiation and maintenance of dermal immune responses. How such an exit is achieved and how cells transmigrate the distinct endothelium of lymphatic vessels are unknown. We show that inflammatory cytokines trigger activation of dermal lymphatic endothelial cells (LECs), leading to expression of the key leukocyte adhesion receptors intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin, as well as a discrete panel of chemokines and other potential regulators of leukocyte transmigration. Furthermore, we show that both ICAM-1 and VCAM-1 are induced in the dermal lymphatic vessels of mice exposed to skin contact hypersensitivity where they mediate lymph node trafficking of dendritic cells (DCs) via afferent lymphatics. Lastly, we show that tumor necrosis factor alpha stimulates both DC adhesion and transmigration of dermal LEC monolayers in vitro and that the process is efficiently inhibited by ICAM-1 and VCAM-1 adhesion-blocking monoclonal antibodies. These results reveal a CAM-mediated mechanism for recruiting leukocytes to the lymph nodes in inflammation and highlight the process of lymphatic transmigration as a potential new target for antiinflammatory therapy.
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Affiliation(s)
- Louise A Johnson
- Medical Research Council Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, and Institute of Biomedical Research, MRC Centre for Immune Regulation, University of Birmingham Medical School, UK
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20
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Affiliation(s)
- Andrew P Holt
- Liver Research Laboratory, MRC Centre for Immune Regulation, University of Birmingham, UK
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21
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Abstract
Carbamazepine is a widely used drug. It is commonly associated with hepatic abnormalities, ranging from an asymptomatic rise in liver function tests to acute liver failure. The most severe reaction occurs as part of a generalised hypersensitivity reaction, also known as drug reaction, eosinophilia and systemic symptoms (DRESS). We describe a case of a young adult who presented with non-specific symptoms, which progressed to fulminant hepatic failure, displaying the hallmarks of DRESS. We highlight the need for awareness of such an association.
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Affiliation(s)
- W-K Syn
- Liver and Hepatobiliary Unit,Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
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22
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Abstract
BACKGROUND Gastroduodenal obstruction is a common preterminal event for patients with gastric and pancreatic cancer who often undergo palliative surgical bypass. Endoscopic palliation with self-expanding metallic stents has emerged as a safe and an effective alternative to surgery, but experience with the technique remains limited. METHODS Twenty-eight patients hospitalized with GI obstruction because of incurable gastric or pancreatic cancer were recruited for a prospective study of palliation with self-expanding metallic stents. Complications and clinical outcomes were assessed. OBSERVATIONS Stent insertion was technically successful in 26 patients. Thereafter, 24 patients resumed an adequate liquid or semisolid diet. Stent insertion facilitated hospital discharge for 20 patients. Occlusion of the stent because of tumor ingrowth occurred in 3 patients, but there was no complication related to stent insertion or the stent itself. CONCLUSIONS Endoscopic placement of a self-expanding metallic stent is a simple, effective means of palliation for patients with malignant gastroduodenal obstruction.
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Affiliation(s)
- Andrew P Holt
- Liver Transplant and Hepato-biliary Unit, Queen Elizabeth Hospital, Birmingham, UK
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