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Natusch D, Aust PW, Caraguel C, Taggart PL, Ngo VT, Alexander GJ, Shine R, Coulson T. Python farming as a flexible and efficient form of agricultural food security. Sci Rep 2024; 14:5419. [PMID: 38485710 PMCID: PMC10940618 DOI: 10.1038/s41598-024-54874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 02/17/2024] [Indexed: 03/18/2024] Open
Abstract
Diminishing natural resources and increasing climatic volatility are impacting agri-food systems, prompting the need for sustainable and resilient alternatives. Python farming is well established in Asia but has received little attention from mainstream agricultural scientists. We measured growth rates in two species of large pythons (Malayopython reticulatus and Python bivittatus) in farms in Thailand and Vietnam and conducted feeding experiments to examine production efficiencies. Pythons grew rapidly over a 12-month period, and females grew faster than males. Food intake and growth rates early in life were strong predictors of total lifetime growth, with daily mass increments ranging from 0.24 to 19.7 g/day for M. reticulatus and 0.24 to 42.6 g/day for P. bivittatus, depending on food intake. Pythons that fasted for up to 4.2 months lost an average of 0.004% of their body mass per day, and resumed rapid growth as soon as feeding recommenced. Mean food conversion rate for dressed carcasses was 4.1%, with useable products (dressed carcass, skin, fat, gall bladder) comprising 82% of the mass of live animals. In terms of food and protein conversion ratios, pythons outperform all mainstream agricultural species studied to date. The ability of fasting pythons to regulate metabolic processes and maintain body condition enhances food security in volatile environments, suggesting that python farming may offer a flexible and efficient response to global food insecurity.
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Affiliation(s)
- D Natusch
- School of Natural Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - P W Aust
- Department of Zoology, University of Oxford, Oxford, UK
- Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Caraguel
- School of Animal & Veterinary Science, The University of Adelaide, Adelaide, SA, 5371, Australia
| | - P L Taggart
- School of Animal & Veterinary Science, The University of Adelaide, Adelaide, SA, 5371, Australia
| | - V T Ngo
- National Key Laboratory, Institute of Tropical Biology, Vietnamese Academy of Sciences and Technology, 9/621 Hanoi Highway, Thu Duc City, Ho Chi Minh City, Vietnam
| | - G J Alexander
- Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Shine
- School of Natural Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - T Coulson
- Department of Zoology, University of Oxford, Oxford, UK
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Petford MA, Alexander GJ. Diel activity patterns of two syntopic range-restricted geckos suggest idiosyncratic responses to climate change. African Zoology 2021. [DOI: 10.1080/15627020.2021.1975560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- MA Petford
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - GJ Alexander
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Owen NE, Nyimanu D, Kuc RE, Upton PD, Morrell NW, Alexander GJ, Maguire JJ, Davenport AP. Plasma levels of apelin are reduced in patients with liver fibrosis and cirrhosis but are not correlated with circulating levels of bone morphogenetic protein 9 and 10. Peptides 2021; 136:170440. [PMID: 33171278 PMCID: PMC7883214 DOI: 10.1016/j.peptides.2020.170440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The peptide apelin is expressed in human healthy livers and is implicated in the development of hepatic fibrosis and cirrhosis. Mutations in the bone morphogenetic protein receptor type II (BMPR-II) result in reduced plasma levels of apelin in patients with heritable pulmonary arterial hypertension. Ligands for BMPR-II include bone morphogenetic protein 9 (BMP9), highly expressed in liver, and BMP10, expressed in heart and to a lesser extent liver. However, it is not known whether reductions in BMP9 and/or BMP10, with associated reduction in BMPR-II signalling, correlate with altered levels of apelin in patients with liver fibrosis and cirrhosis. METHODS Plasma from patients with liver fibrosis (n = 14), cirrhosis (n = 56), and healthy controls (n = 25) was solid-phase extracted using a method optimised for recovery of apelin, which was measured by ELISA. RESULTS Plasma apelin was significantly reduced in liver fibrosis (8.3 ± 1.2 pg/ml) and cirrhosis (6.5 ± 0.6 pg/ml) patients compared with controls (15.4 ± 2.0 pg/ml). There was no obvious relationship between apelin and BMP 9 or BMP10 previously measured in these patients. Within the cirrhotic group, there was no significant correlation between apelin levels and disease severity scores, age, sex, or treatment with β-blockers. CONCLUSIONS Apelin was significantly reduced in plasma of patients with both early (fibrosis) and late-stage (cirrhosis) liver disease. Fibrosis is more easily reversible and may represent a potential target for new therapeutic interventions. However, it remains unclear whether apelin signalling is detrimental in liver disease or is beneficial and therefore, whether an apelin antagonist or agonist have clinical use.
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Affiliation(s)
- Nicola E Owen
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Centre for Clinical Investigation, Box 110, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Duuamene Nyimanu
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Centre for Clinical Investigation, Box 110, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Rhoda E Kuc
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Centre for Clinical Investigation, Box 110, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Paul D Upton
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Graeme J Alexander
- Institute for Liver and Digestive Health, Upper 3rd Floor, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Janet J Maguire
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Centre for Clinical Investigation, Box 110, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Anthony P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Centre for Clinical Investigation, Box 110, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
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Owen NE, Alexander GJ, Sen S, Bunclark K, Polwarth G, Pepke-Zaba J, Davenport AP, Morrell NW, Upton PD. Reduced circulating BMP10 and BMP9 and elevated endoglin are associated with disease severity, decompensation and pulmonary vascular syndromes in patients with cirrhosis. EBioMedicine 2020; 56:102794. [PMID: 32454407 PMCID: PMC7248419 DOI: 10.1016/j.ebiom.2020.102794] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background BMP9, originating from the liver, and BMP10 are circulating BMPs that preserve vascular endothelial integrity. We assessed BMP9, BMP10 and soluble endoglin (sEng) levels and their relationships to liver disease severity and associated pulmonary vascular syndromes in a cohort of well-characterised liver disease patients. Methods Plasma samples from patients with liver disease (n = 83) and non-disease controls (n = 21) were assayed for BMP9, BMP10 and sEng. Levels were also assessed in a separate cohort of controls (n = 27) and PoPH patients (n = 8). Expression of mRNA and immunohistochemical staining was undertaken in liver biopsy specimens. Plasma BMP activity was assessed using an endothelial cell bioassay. Findings Plasma BMP9 and BMP10 levels were normal in patients with compensated cirrhosis or fibrosis without cirrhosis, but markedly reduced in patients with decompensated cirrhosis, including those with hepatopulmonary syndrome (HPS) or portopulmonary hypertension (PoPH). Liver biopsy specimens revealed reduced mRNA expression and immunostaining for these ligands. Patient plasma samples with reduced BMP9 and BMP10 levels exhibited low BMP activity that was restored with exogenous BMP9. Endoglin mRNA expression was increased in cirrhotic livers and elevated circulating sEng levels in PoPH and HPS patients suggested increased endothelial sEng shedding in these syndromes. Interpretation Plasma BMP9 and BMP10 levels are reduced in decompensated cirrhosis, leading to reduced circulating BMP activity on the vascular endothelium. The pulmonary complications of cirrhosis, PoPH and HPS, are associated with markedly reduced BMP9 and BMP10 and increased sEng levels, suggesting that supplementation with exogenous ligands might be a therapeutic approach for PoPH and HPS.
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Affiliation(s)
- Nicola E Owen
- Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Graeme J Alexander
- Institute for Liver and Digestive Health, University College London, Royal Free Hospital Pond St, Hampstead, London NW3 2QG, UK, Royal Free Hospital, London, United Kingdom
| | - Sambit Sen
- Luton and Dunstable Hospital NHS Foundation Trust, Luton, United Kingdom
| | | | - Gary Polwarth
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Anthony P Davenport
- Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, United Kingdom.
| | - Paul D Upton
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, United Kingdom.
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Williams R, Aithal G, Alexander GJ, Allison M, Armstrong I, Aspinall R, Baker A, Batterham R, Brown K, Burton R, Cramp ME, Day N, Dhawan A, Drummond C, Ferguson J, Foster G, Gilmore I, Greenberg J, Henn C, Jarvis H, Kelly D, Mathews M, McCloud A, MacGilchrist A, McKee M, Moriarty K, Morling J, Newsome P, Rice P, Roberts S, Rutter H, Samyn M, Severi K, Sheron N, Thorburn D, Verne J, Vohra J, Williams J, Yeoman A. Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK. Lancet 2020; 395:226-239. [PMID: 31791690 DOI: 10.1016/s0140-6736(19)32908-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.
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Affiliation(s)
- Roger Williams
- Institute of Hepatology, Foundation for Liver Research, London, UK.
| | - Guruprasad Aithal
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK; Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Graeme J Alexander
- UCL Institute for Liver & Digestive Health, University College London, London, UK
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Richard Aspinall
- Portsmouth Liver Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Alastair Baker
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Rachel Batterham
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Katrina Brown
- Cancer Intelligence Team, Cancer Research UK, London
| | | | - Matthew E Cramp
- Faculty of Health: Medicine, Dentistry and Human Sciences Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Natalie Day
- Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College Hospital, London, UK; National Addiction Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - James Ferguson
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham Foster
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Ian Gilmore
- Liver Centre for Alcohol Research, University of Liverpool, UK
| | | | | | - Helen Jarvis
- Institute of Health and Society, Newcastle University, Newcastle, UK; The Royal College of General Practitioners, London, UK
| | - Deirdre Kelly
- The Liver Unit Birmingham Women's and Children's Hospital, Birmingham, UK
| | | | - Annie McCloud
- Kent & Medway NHS and Social Care Partnership Trust, Gillingham, UK
| | | | - Martin McKee
- The London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joanne Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Philip Newsome
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Peter Rice
- Scottish Health Action on Alcohol Problems, Edinburgh, UK
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | | | - Nick Sheron
- European Public Health Alliance, Brussels, Belgium
| | | | | | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, London
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Petford MA, van Huyssteen R, Alexander GJ. Influences of ecology and climate on the distribution of restricted, rupicolous reptiles in a biodiverse hotspot. AFR J HERPETOL 2019. [DOI: 10.1080/21564574.2019.1681524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- MA Petford
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Soutpansberg Centre for Biodiversity and Conservation, Medike Nature Reserve, South Africa
| | - R van Huyssteen
- Soutpansberg Centre for Biodiversity and Conservation, Medike Nature Reserve, South Africa
| | - GJ Alexander
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hegade VS, Mells GF, Fisher H, Kendrick S, DiBello J, Gilchrist K, Alexander GJ, Hirschfield GM, Sandford RN, Jones DEJ. Pruritus Is Common and Undertreated in Patients With Primary Biliary Cholangitis in the United Kingdom. Clin Gastroenterol Hepatol 2019; 17:1379-1387.e3. [PMID: 30557739 DOI: 10.1016/j.cgh.2018.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 01/27/2018] [Revised: 11/13/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Little is known about the prevalence or treatment of pruritus associated with primary biliary cholangitis (PBC). We analyzed data from patients with PBC recruited from all clinical centers in the United Kingdom (UK) to characterize the prevalence, severity, progression, and treatment of pruritus. METHODS We performed cross-sectional and longitudinal studies of patients in the UK-PBC cohort to assess trajectories of pruritus. Data on pruritus frequency, severity, and therapy were collected via paper questionnaires completed by 2194 patients at their initial assessment in 2011 and then again in 2014 and 2017. Self-reported treatment data were validated against the prescription record of PBC cohort in the Clinical Practice Research Datalink, a primary care database. We defined persistent pruritus as itch that occurs frequently or all the time and severe pruritus as PBC-40 pruritus domain scores of 12 or more, throughout their disease course. Latent class mixed models were used to study pruritus trajectories and identify factors associated with high pruritus. RESULTS At initial assessment, 1613 (73.5%) patients had experienced pruritus at some point since their development of PBC-persistent pruritus was reported by 34.5% of the patients and severe pruritus by 11.7%. Only 37.4% of patients with persistent pruritus and 50% with severe pruritus reported ever receiving cholestyramine. Frequencies of rifampicin use were 11% in patients with persistent pruritus and 23% in patients with severe pruritus. Comparison of 2011 and 2014 surveys (comprising 1423 patients) showed consistent self-reported data on pruritus. Proportions of patients in the UK-PBC cohort treated with cholestyramine or naltrexone (37.4% and 4.4%) did not differ significantly from proportions treated in the Clinical Practice Research Datalink cohort (30.4% and 4.4%) (P = .07 for cholestyramine and P = .32 for naltrexone). Latent class mixed models (n = 1753) identified 3 different groups of pruritus. Multivariable analysis identified younger age at diagnosis and higher level of alkaline phosphatase at 12 months after diagnosis as factors significantly associated with persistent high pruritus. CONCLUSIONS In a large national cohort study of patients with PBC, we found a high prevalence of pruritus and inadequate guideline-recommended therapy. Patient-reported data used to determine pruritus prevalence and treatment are reliable. Younger age and levels of higher alkaline phosphatase were associated with persistent pruritus. We need to increase awareness and management of pruritus in PBC in the UK.
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Affiliation(s)
- Vinod S Hegade
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - George F Mells
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Holly Fisher
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stuart Kendrick
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; GlaxoSmithKline, Stevenage, United Kingdom
| | - Julia DiBello
- GlaxoSmithKline Research and Development, Collegeville, Pennsylvania
| | - Kim Gilchrist
- GlaxoSmithKline Research and Development, Collegeville, Pennsylvania
| | - Graeme J Alexander
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Gideon M Hirschfield
- Centre for Liver Research, National Institute for Health Research Biomedical Research Unit, University of Birmingham, Birmingham, United Kingdom
| | - Richard N Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - David E J Jones
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
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8
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Goode EC, Clark AB, Mells GF, Srivastava B, Spiess K, Gelson WT, Trivedi PJ, Lynch KD, Castren E, Vesterhus MN, Karlsen TH, Ji S, Anderson CA, Thorburn D, Hudson M, Heneghan MA, Aldersley MA, Bathgate A, Sandford RN, Alexander GJ, Chapman RW, Walmsley M, Hirschfield GM, Rushbrook SM. Factors Associated With Outcomes of Patients With Primary Sclerosing Cholangitis and Development and Validation of a Risk Scoring System. Hepatology 2019; 69:2120-2135. [PMID: 30566748 PMCID: PMC6519245 DOI: 10.1002/hep.30479] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 12/02/2018] [Indexed: 12/15/2022]
Abstract
We sought to identify factors that are predictive of liver transplantation or death in patients with primary sclerosing cholangitis (PSC), and to develop and validate a contemporaneous risk score for use in a real-world clinical setting. Analyzing data from 1,001 patients recruited to the UK-PSC research cohort, we evaluated clinical variables for their association with 2-year and 10-year outcome through Cox-proportional hazards and C-statistic analyses. We generated risk scores for short-term and long-term outcome prediction, validating their use in two independent cohorts totaling 451 patients. Thirty-six percent of the derivation cohort were transplanted or died over a cumulative follow-up of 7,904 years. Serum alkaline phosphatase of at least 2.4 × upper limit of normal at 1 year after diagnosis was predictive of 10-year outcome (hazard ratio [HR] = 3.05; C = 0.63; median transplant-free survival 63 versus 108 months; P < 0.0001), as was the presence of extrahepatic biliary disease (HR = 1.45; P = 0.01). We developed two risk scoring systems based on age, values of bilirubin, alkaline phosphatase, albumin, platelets, presence of extrahepatic biliary disease, and variceal hemorrhage, which predicted 2-year and 10-year outcomes with good discrimination (C statistic = 0.81 and 0.80, respectively). Both UK-PSC risk scores were well-validated in our external cohort and outperformed the Mayo Clinic and aspartate aminotransferase-to-platelet ratio index (APRI) scores (C statistic = 0.75 and 0.63, respectively). Although heterozygosity for the previously validated human leukocyte antigen (HLA)-DR*03:01 risk allele predicted increased risk of adverse outcome (HR = 1.33; P = 0.001), its addition did not improve the predictive accuracy of the UK-PSC risk scores. Conclusion: Our analyses, based on a detailed clinical evaluation of a large representative cohort of participants with PSC, furthers our understanding of clinical risk markers and reports the development and validation of a real-world scoring system to identify those patients most likely to die or require liver transplantation.
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Affiliation(s)
- Elizabeth C. Goode
- Norfolk and Norwich University HospitalNorwichUnited Kingdom,Academic Department of Medical GeneticsAddenbrooke's Hospital, University of CambridgeCambridgeUnited Kingdom,Wellcome Trust Sanger InstituteHinxton, CambridgeUnited Kingdom,Norwich Medical SchoolUniversity of East AngliaNorwichUnited Kingdom,Cambridge Transplant CentreAddenbrooke's HospitalCambridgeUnited Kingdom
| | - Allan B. Clark
- Norwich Medical SchoolUniversity of East AngliaNorwichUnited Kingdom
| | - George F. Mells
- Academic Department of Medical GeneticsAddenbrooke's Hospital, University of CambridgeCambridgeUnited Kingdom
| | - Brijesh Srivastava
- Academic Department of Medical GeneticsAddenbrooke's Hospital, University of CambridgeCambridgeUnited Kingdom
| | - Kelly Spiess
- Academic Department of Medical GeneticsAddenbrooke's Hospital, University of CambridgeCambridgeUnited Kingdom
| | | | - Palak J. Trivedi
- National Institute for Health Research (NIHR) Birmingham Biomedical Research CentreBirminghamUnited Kingdom,Institute of Immunology & ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom,Centre for Rare Diseases, Institute of Translational MedicineUniversity Hospitals BirminghamBirminghamUnited Kingdom
| | - Kate D. Lynch
- Translational Gastroenterology UnitJohn Radcliffe Hospital, and Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Edit Castren
- Norfolk and Norwich University HospitalNorwichUnited Kingdom
| | - Mette N. Vesterhus
- Norwegian PSC Research Center, Department of Transplantation MedicineOslo University Hospital RikshospitaletOsloNorway,Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Tom H. Karlsen
- Norwegian PSC Research Center, Department of Transplantation MedicineOslo University Hospital RikshospitaletOsloNorway,Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Sun‐Gou Ji
- Wellcome Trust Sanger InstituteHinxton, CambridgeUnited Kingdom
| | | | - Douglas Thorburn
- Sheila Sherlock Liver Centre, Royal Free HospitalLondonUnited Kingdom
| | - Mark Hudson
- Liver Medicine and Transplantation ServiceFreeman HospitalNewcastleUnited Kingdom
| | | | | | - Andrew Bathgate
- Scottish Liver Transplant UnitRoyal Infirmary of EdinburghEdinburghUnited Kingdom
| | - Richard N. Sandford
- Academic Department of Medical GeneticsAddenbrooke's Hospital, University of CambridgeCambridgeUnited Kingdom
| | - Graeme J. Alexander
- Cambridge Transplant CentreAddenbrooke's HospitalCambridgeUnited Kingdom,Sheila Sherlock Liver Centre, Royal Free HospitalLondonUnited Kingdom
| | - Roger W. Chapman
- Translational Gastroenterology UnitJohn Radcliffe Hospital, and Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | | | | | - Gideon M. Hirschfield
- National Institute for Health Research (NIHR) Birmingham Biomedical Research CentreBirminghamUnited Kingdom,Institute of Immunology & ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom,Centre for Rare Diseases, Institute of Translational MedicineUniversity Hospitals BirminghamBirminghamUnited Kingdom,Toronto Centre for Liver DiseaseUniversity Health Network and University of TorontoTorontoCanada
| | - Simon M. Rushbrook
- Norfolk and Norwich University HospitalNorwichUnited Kingdom,Norwich Medical SchoolUniversity of East AngliaNorwichUnited Kingdom
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9
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Darlay R, Ayers KL, Mells GF, Hall LS, Liu JZ, Almarri MA, Alexander GJ, Jones DE, Sandford RN, Anderson CA, Cordell HJ. Amino acid residues in five separate HLA genes can explain most of the known associations between the MHC and primary biliary cholangitis. PLoS Genet 2018; 14:e1007833. [PMID: 30507971 PMCID: PMC6292650 DOI: 10.1371/journal.pgen.1007833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/12/2018] [Revised: 12/13/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Abstract
Primary Biliary Cholangitis (PBC) is a chronic autoimmune liver disease characterised by progressive destruction of intrahepatic bile ducts. The strongest genetic association is with HLA-DQA1*04:01, but at least three additional independent HLA haplotypes contribute to susceptibility. We used dense single nucleotide polymorphism (SNP) data in 2861 PBC cases and 8514 controls to impute classical HLA alleles and amino acid polymorphisms using state-of-the-art methodologies. We then demonstrated through stepwise regression that association in the HLA region can be largely explained by variation at five separate amino acid positions. Three-dimensional modelling of protein structures and calculation of electrostatic potentials for the implicated HLA alleles/amino acid substitutions demonstrated a correlation between the electrostatic potential of pocket P6 in HLA-DP molecules and the HLA-DPB1 alleles/amino acid substitutions conferring PBC susceptibility/protection, highlighting potential new avenues for future functional investigation. Primary Biliary Cholangitis (PBC) is a chronic autoimmune liver disease that exhibits strong genetic associations, especially with variants in the human leukocyte antigen (HLA) gene region. Here we use dense single nucleotide polymorphism (SNP) data from the largest PBC study to date (2861 cases, 8514 controls) to investigate the likely underlying causes of this association, via performing imputation of HLA classical alleles and amino acids. We show that the HLA association can be largely explained by variation at five separate amino acid positions, one of which shows functional relevance to electrostatic potentials of HLA-DP molecules.
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Affiliation(s)
- Rebecca Darlay
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kristin L. Ayers
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - George F. Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Lynsey S. Hall
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jimmy Z. Liu
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Mohamed A. Almarri
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
- Department of Forensic Science and Criminology, Dubai Police HQ, Dubai, United Arab Emirates
| | - Graeme J. Alexander
- Department of Hepatology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - David E. Jones
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard N. Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Carl A. Anderson
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Heather J. Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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10
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Carbone M, Nardi A, Flack S, Carpino G, Varvaropoulou N, Gavrila C, Spicer A, Badrock J, Bernuzzi F, Cardinale V, Ainsworth HF, Heneghan MA, Thorburn D, Bathgate A, Jones R, Neuberger JM, Battezzati PM, Zuin M, Taylor-Robinson S, Donato MF, Kirby J, Mitchell-Thain R, Floreani A, Sampaziotis F, Muratori L, Alvaro D, Marzioni M, Miele L, Marra F, Giannini E, Gaudio E, Ronca V, Bonato G, Cristoferi L, Malinverno F, Gerussi A, Stocken DD, Cordell HJ, Hirschfield GM, Alexander GJ, Sandford RN, Jones DE, Invernizzi P, Mells GF. Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score. Lancet Gastroenterol Hepatol 2018; 3:626-634. [PMID: 30017646 DOI: 10.1016/s2468-1253(18)30163-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [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: 03/25/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment guidelines recommend a stepwise approach to primary biliary cholangitis: all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy and those with an inadequate biochemical response after 12 months are subsequently considered for second-line therapies. However, as a result, patients at the highest risk can wait the longest for effective treatment. We determined whether UDCA response can be accurately predicted using pretreatment clinical parameters. METHODS We did logistic regression analysis of pretreatment variables in a discovery cohort of patients in the UK with primary biliary cholangitis to derive the best-fitting model of UDCA response, defined as alkaline phosphatase less than 1·67 times the upper limit of normal (ULN), measured after 12 months of treatment with UDCA. We validated the model in an external cohort of patients with primary biliary cholangitis and treated with UDCA in Italy. Additionally, we assessed correlations between model predictions and key histological features, such as biliary injury and fibrosis, on liver biopsy samples. FINDINGS 2703 participants diagnosed with primary biliary cholangitis between Jan 1, 1998, and May 31, 2015, were included in the UK-PBC cohort for derivation of the model. The following pretreatment parameters were associated with lower probability of UDCA response: higher alkaline phosphatase concentration (p<0·0001), higher total bilirubin concentration (p=0·0003), lower aminotransferase concentration (p=0·0012), younger age (p<0·0001), longer interval from diagnosis to the start of UDCA treatment (treatment time lag, p<0·0001), and worsening of alkaline phosphatase concentration from diagnosis (p<0·0001). Based on these variables, we derived a predictive score of UDCA response. In the external validation cohort, 460 patients diagnosed with primary biliary cholangitis were treated with UDCA, with follow-up data until May 31, 2016. In this validation cohort, the area under the receiver operating characteristic curve for the score was 0·83 (95% CI 0·79-0·87). In 20 liver biopsy samples from patients with primary biliary cholangitis, the UDCA response score was associated with ductular reaction (r=-0·556, p=0·0130) and intermediate hepatocytes (probability of response was 0·90 if intermediate hepatocytes were absent vs 0·51 if present). INTERPRETATION We have derived and externally validated a model based on pretreatment variables that accurately predicts UDCA response. Association with histological features provides face validity. This model provides a basis to explore alternative approaches to treatment stratification in patients with primary biliary cholangitis. FUNDING UK Medical Research Council and University of Milan-Bicocca.
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Affiliation(s)
- Marco Carbone
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK; Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Rome, Italy
| | - Steve Flack
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | | | - Ann Spicer
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Jonathan Badrock
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Francesca Bernuzzi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Holly F Ainsworth
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Douglas Thorburn
- Sheila Sherlock Liver Centre, The Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Bathgate
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca Jones
- Liver Unit, St James's University Hospital, Leeds, UK
| | | | | | - Massimo Zuin
- Division of Internal Medicine and Liver Unit, Ospedale San Paolo, Milan, Italy
| | - Simon Taylor-Robinson
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, UK
| | - Maria F Donato
- CRC "AM e A Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - John Kirby
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Annarosa Floreani
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Fotios Sampaziotis
- Department of Surgery, Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
| | - Luigi Muratori
- Liver Unit, Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
| | - Domenico Alvaro
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Marco Marzioni
- Division of Gastroenterology and Hepatology, Ospedali Riuniti University Hospital, Ancona, Italy
| | - Luca Miele
- Department of Internal Medicine and Gastroenterology, Gemelli University Hospital, Rome, Italy
| | - Fabio Marra
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Edoardo Giannini
- Division of Gastroenterology, Department of Internal Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Eugenio Gaudio
- Department of Anatomy, Histology, Legal Medicine, and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Ronca
- Division of Internal Medicine and Liver Unit, Ospedale San Paolo, Milan, Italy
| | - Giulia Bonato
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Laura Cristoferi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Federica Malinverno
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Alessio Gerussi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Deborah D Stocken
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gideon M Hirschfield
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Richard N Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - David E Jones
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Pietro Invernizzi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - George F Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
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11
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Affiliation(s)
- Aloysious D Aravinthan
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Graeme J Alexander
- UCL Institute for Liver and Digestive Health, The Royal Free Trust, London, UK
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12
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Huang H, Duggal P, Thio CL, Latanich R, Goedert JJ, Mangia A, Cox AL, Kirk GD, Mehta S, Aneja J, Alric L, Donfield SM, Cramp ME, Khakoo SI, Tobler LH, Busch M, Alexander GJ, Rosen HR, Edlin BR, Segal FP, Lauer GM, Thomas DL, Daly MJ, Chung RT, Kim AY. Fine-mapping of genetic loci driving spontaneous clearance of hepatitis C virus infection. Sci Rep 2017; 7:15843. [PMID: 29158528 PMCID: PMC5696522 DOI: 10.1038/s41598-017-16011-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/09/2017] [Accepted: 11/06/2017] [Indexed: 12/17/2022] Open
Abstract
Approximately three quarters of acute hepatitis C (HCV) infections evolve to a chronic state, while one quarter are spontaneously cleared. Genetic predispositions strongly contribute to the development of chronicity. We have conducted a genome-wide association study to identify genomic variants underlying HCV spontaneous clearance using ImmunoChip in European and African ancestries. We confirmed two previously reported significant associations, in the IL28B/IFNL4 and the major histocompatibility complex (MHC) regions, with spontaneous clearance in the European population. We further fine-mapped the association in the MHC to a region of about 50 kilo base pairs, down from 1 mega base pairs in the previous study. Additional analyses suggested that the association in MHC is stronger in samples from North America than those from Europe.
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Affiliation(s)
- Hailiang Huang
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Priya Duggal
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Chloe L Thio
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Rachel Latanich
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20852, USA
| | - Alessandra Mangia
- IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Andrea L Cox
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Gregory D Kirk
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Shruti Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jasneet Aneja
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Laurent Alric
- Department of Medicine, Purpan Hospital, University of Toulouse III, Toulouse, France
| | | | - Matthew E Cramp
- South West Liver Unit, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Salim I Khakoo
- Henry Welcome Laboratories, Southampton General Hospital, Southampton, UK
| | - Leslie H Tobler
- University of California and Blood Systems Research Institute, San Francisco, CA, 94118, USA
| | - Michael Busch
- University of California and Blood Systems Research Institute, San Francisco, CA, 94118, USA
| | - Graeme J Alexander
- Cambridge University Hospitals NHS Foundation Trust and Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Hugo R Rosen
- University of Colorado, Aurora, Colorado, 90045, United States
| | - Brian R Edlin
- State University of New York Downstate College of Medicine, Brooklyn, New York, USA
| | - Florencia P Segal
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Georg M Lauer
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mark J Daly
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Raymond T Chung
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Arthur Y Kim
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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13
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Sampaziotis F, Justin AW, Tysoe OC, Sawiak S, Godfrey EM, Upponi SS, Gieseck RL, de Brito MC, Berntsen NL, Gómez-Vázquez MJ, Ortmann D, Yiangou L, Ross A, Bargehr J, Bertero A, Zonneveld MCF, Pedersen MT, Pawlowski M, Valestrand L, Madrigal P, Georgakopoulos N, Pirmadjid N, Skeldon GM, Casey J, Shu W, Materek PM, Snijders KE, Brown SE, Rimland CA, Simonic I, Davies SE, Jensen KB, Zilbauer M, Gelson WTH, Alexander GJ, Sinha S, Hannan NRF, Wynn TA, Karlsen TH, Melum E, Markaki AE, Saeb-Parsy K, Vallier L. Reconstruction of the mouse extrahepatic biliary tree using primary human extrahepatic cholangiocyte organoids. Nat Med 2017; 23:954-963. [PMID: 28671689 DOI: 10.1038/nm.4360] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 05/24/2017] [Indexed: 02/02/2023]
Abstract
The treatment of common bile duct (CBD) disorders, such as biliary atresia or ischemic strictures, is restricted by the lack of biliary tissue from healthy donors suitable for surgical reconstruction. Here we report a new method for the isolation and propagation of human cholangiocytes from the extrahepatic biliary tree in the form of extrahepatic cholangiocyte organoids (ECOs) for regenerative medicine applications. The resulting ECOs closely resemble primary cholangiocytes in terms of their transcriptomic profile and functional properties. We explore the regenerative potential of these organoids in vivo and demonstrate that ECOs self-organize into bile duct-like tubes expressing biliary markers following transplantation under the kidney capsule of immunocompromised mice. In addition, when seeded on biodegradable scaffolds, ECOs form tissue-like structures retaining biliary characteristics. The resulting bioengineered tissue can reconstruct the gallbladder wall and repair the biliary epithelium following transplantation into a mouse model of injury. Furthermore, bioengineered artificial ducts can replace the native CBD, with no evidence of cholestasis or occlusion of the lumen. In conclusion, ECOs can successfully reconstruct the biliary tree, providing proof of principle for organ regeneration using human primary cholangiocytes expanded in vitro.
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Affiliation(s)
- Fotios Sampaziotis
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.,Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Olivia C Tysoe
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Stephen Sawiak
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Edmund M Godfrey
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sara S Upponi
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard L Gieseck
- Immunopathogenesis Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, USA
| | - Miguel Cardoso de Brito
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Natalie Lie Berntsen
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - María J Gómez-Vázquez
- Cambridge Genomic Services, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Daniel Ortmann
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Loukia Yiangou
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Alexander Ross
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,University Department of Paediatrics, University of Cambridge, Cambridge, UK.,Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Johannes Bargehr
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Alessandro Bertero
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mariëlle C F Zonneveld
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
| | - Marianne T Pedersen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Matthias Pawlowski
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
| | - Laura Valestrand
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pedro Madrigal
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Wellcome Trust Sanger Institute, Hinxton, UK
| | - Nikitas Georgakopoulos
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Negar Pirmadjid
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Gregor M Skeldon
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - John Casey
- Department of Surgery, University of Edinburgh, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Wenmiao Shu
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Paulina M Materek
- NIHR Cambridge Biomedical Centre (BRC) hIPSCs Core Facility, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Kirsten E Snijders
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
| | - Stephanie E Brown
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Casey A Rimland
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.,Immunopathogenesis Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, USA.,University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Ingrid Simonic
- Medical Genetics Laboratories, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Susan E Davies
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kim B Jensen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthias Zilbauer
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - William T H Gelson
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graeme J Alexander
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Sanjay Sinha
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,University Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Nicholas R F Hannan
- Center for Biomolecular Sciences, University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Thomas A Wynn
- Immunopathogenesis Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, USA
| | - Tom H Karlsen
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Espen Melum
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Athina E Markaki
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Ludovic Vallier
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.,Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.,Wellcome Trust Sanger Institute, Hinxton, UK
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14
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Jamil KM, Hydes TJ, Cheent KS, Cassidy SA, Traherne JA, Jayaraman J, Trowsdale J, Alexander GJ, Little AM, McFarlane H, Heneghan MA, Purbhoo MA, Khakoo SI. STAT4-associated natural killer cell tolerance following liver transplantation. Gut 2017; 66:352-361. [PMID: 26887815 PMCID: PMC5284485 DOI: 10.1136/gutjnl-2015-309395] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 09/29/2015] [Accepted: 10/20/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Natural killer (NK) cells are important mediators of liver inflammation in chronic liver disease. The aim of this study was to investigate why liver transplants (LTs) are not rejected by NK cells in the absence of human leukocyte antigen (HLA) matching, and to identify a tolerogenic NK cell phenotype. DESIGN Phenotypic and functional analyses on NK cells from 54 LT recipients were performed, and comparisons made with healthy controls. Further investigation was performed using gene expression analysis and donor:recipient HLA typing. RESULTS NK cells from non-HCV LT recipients were hypofunctional, with reduced expression of NKp46 (p<0.05) and NKp30 (p<0.001), reduced cytotoxicity (p<0.001) and interferon (IFN)-γ secretion (p<0.025). There was no segregation of this effect with HLA-C, and these functional changes were not observed in individuals with HCV. Microarray and RT-qPCR analysis demonstrated downregulation of STAT4 in NK cells from LT recipients (p<0.0001). Changes in the expression levels of the transcription factors Helios (p=0.06) and Hobit (p=0.07), which control NKp46 and IFNγ expression, respectively, were also detected. Hypofunctionality of NK cells was associated with impaired STAT4 phosphorylation and downregulation of the STAT4 target microRNA-155. Conversely in HCV-LT NK cell tolerance was reversed, consistent with the more aggressive outcome of LT for HCV. CONCLUSIONS LT is associated with transcriptional and functional changes in NK cells, resulting in reduced activation. NK cell tolerance occurs upstream of major histocompatibility complex (MHC) class I mediated education, and is associated with deficient STAT4 phosphorylation. STAT4 therefore represents a potential therapeutic target to induce NK cell tolerance in liver disease.
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Affiliation(s)
- K M Jamil
- Department of Hepatology, Imperial College, London, UK
| | - T J Hydes
- Department of Hepatology, Southampton University, Southampton, UK
| | - K S Cheent
- Department of Hepatology, Imperial College, London, UK
| | - S A Cassidy
- Department of Hepatology, Imperial College, London, UK
| | - J A Traherne
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - J Jayaraman
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - J Trowsdale
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - G J Alexander
- Department of Hepatology, Addenbrookes Hospital, Cambridge, UK
| | - A-M Little
- Histocompatibility and Immunogenetics Service, Gartnavel General Hospital, Glasgow, UK
| | - H McFarlane
- Histocompatibility and Immunogenetics Service, Gartnavel General Hospital, Glasgow, UK
| | - M A Heneghan
- Institute of Liver Studies, Kings College Hospital London, London, UK
| | - M A Purbhoo
- Department of Hepatology, Imperial College, London, UK
| | - S I Khakoo
- Department of Hepatology, Imperial College, London, UK.,Department of Hepatology, Southampton University, Southampton, UK
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15
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Hegade VS, Kendrick SFW, Dobbins RL, Miller SR, Richards D, Storey J, Dukes G, Gilchrist K, Vallow S, Alexander GJ, Corrigan M, Hirschfield GM, Jones DEJ. BAT117213: Ileal bile acid transporter (IBAT) inhibition as a treatment for pruritus in primary biliary cirrhosis: study protocol for a randomised controlled trial. BMC Gastroenterol 2016; 16:71. [PMID: 27431238 PMCID: PMC4950723 DOI: 10.1186/s12876-016-0481-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pruritus (itch) is a symptom commonly experienced by patients with cholestatic liver diseases such as primary biliary cholangitis (PBC, previously referred to as primary biliary cirrhosis). Bile acids (BAs) have been proposed as potential pruritogens in PBC. The ileal bile acid transporter (IBAT) protein expressed in the distal ileum plays a key role in the enterohepatic circulation of BAs. Pharmacological inhibition of IBAT with GSK2330672 may reduce BA levels in the systemic circulation and improve pruritus. METHODS This clinical study (BAT117213 study) is sponsored by GlaxoSmithKline (GSK) with associated exploratory studies supported by the National Institute for Health Research (NIHR). It is a phase 2a, multi-centre, randomised, double bind, placebo controlled, cross-over trial for PBC patients with pruritus. The primary objective is to investigate the safety and tolerability of repeat doses of GSK2330672, and explore whether GSK2330672 administration for 14 days improves pruritus compared with placebo. The key outcomes include improvement in pruritus scores evaluated on a numerical rating scale and other PBC symptoms in an electronic diary completed twice daily by the patients. The secondary outcomes include the evaluation of the effect of GSK2330672 on total serum bile acid (BA) concentrations, serum markers of BA synthesis and steady-state pharmacokinetics of ursodeoxycholic acid (UDCA). DISCUSSION BAT117213 study is the first randomised controlled crossover trial of ileal bile acid transporter inhibitor, a novel class of drug to treat pruritus in PBC. The main strengths of the trial are utility of a novel, study specific, electronic symptom diary as patient reported outcome to measure the treatment response objectively and the crossover design that allows estimating the treatment effect in a smaller number of patients. The outcome of this trial will inform the trial design of future development phase of the IBAT inhibitor drug. The trial will also provide opportunity to conduct metabonomic and gut microbiome studies as explorative and mechanistic research in patients with cholestatic pruritus. TRIAL REGISTRATION EudraCT number: 2012-005531-84, ClinicalTrials.gov Identifier: NCT01899703 , registered on 3(rd) July 2013.
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Affiliation(s)
- Vinod S Hegade
- NIHR Newcastle Biomedical Research Centre and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. .,Institute of Cellular Medicine, William Leech Building, Framlington Place, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Stuart F W Kendrick
- NIHR Newcastle Biomedical Research Centre and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, UK
| | | | - Sam R Miller
- GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, UK
| | - Duncan Richards
- GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, UK
| | - James Storey
- GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, UK
| | - George Dukes
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Graeme J Alexander
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust Cambridge, Cambridge, UK
| | - Margaret Corrigan
- Centre for Liver Research, University of Birmingham and NIHR Birmingham Liver Biomedical Research Unit, Birmingham, UK
| | - Gideon M Hirschfield
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust Cambridge, Cambridge, UK
| | - David E J Jones
- NIHR Newcastle Biomedical Research Centre and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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16
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Cross TJS, Villanueva A, Shetty S, Wilkes E, Collins P, Adair A, Jones RL, Foxton MR, Meyer T, Stern N, Warshow U, Khan N, Prince M, Khakoo S, Alexander GJ, Khan S, Reeves H, Marshall A, Williams R. A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma. Frontline Gastroenterol 2016; 7:82-89. [PMID: 28840911 PMCID: PMC5369506 DOI: 10.1136/flgastro-2015-100617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/19/2015] [Accepted: 09/11/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings. DESIGN UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals. RESULTS Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%). CONCLUSIONS In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.
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Affiliation(s)
- T J S Cross
- Department of Hepatology, The Royal Liverpool Hospital, Liverpool, UK
| | - A Villanueva
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - S Shetty
- The Liver Unit, Queen Elizabeth Hospital II Hospital, Birmingham, UK
| | - E Wilkes
- Digestive Diseases Unit, Queens Medical Centre, Nottingham, UK
| | - P Collins
- Department of Hepatology, Bristol Royal Infirmary, Bristol, UK
| | - A Adair
- Scottish Liver Transplant Unit, Edinburgh, UK
| | - R L Jones
- Department of Hepatology and Liver Transplantation, St James University Hospital, Leeds, UK
| | - M R Foxton
- Department of Gastroenterology, Chelsea and Westminster Hospital, Liverpool, UK
| | - T Meyer
- Department of Oncology, The Royal Free Hospital, London, UK
| | - N Stern
- Department of Hepato-Biliary Medicine, Aintree University Hospital, Liverpool, UK
| | - U Warshow
- The Southwest Liver Unit, Derriford Hospital, Plymouth, UK
| | - N Khan
- The Royal Marsden Hospital, London, UK
| | - M Prince
- Department of Gastroenterology and Hepatology, Manchester, UK
| | - S Khakoo
- Department of Academic and Translational Medicine, University of Southampton, Southampton, UK
| | - G J Alexander
- Department of Hepatology and Liver Transplant Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - S Khan
- The Liver Unit, St Mary Hospital, London, UK
| | - H Reeves
- Department of Hepatology and Liver Transplantation, Freeman Hospital, Newcastle-on-Tyne, UK
| | - Aileen Marshall
- The Sheila Sherlock Liver Centre, The Royal Free Hospital, London, UK
| | - R Williams
- Institute of Hepatology, Foundation for Liver Research, London, UK
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17
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Carbone M, Sharp SJ, Flack S, Paximadas D, Spiess K, Adgey C, Griffiths L, Lim R, Trembling P, Williamson K, Wareham NJ, Aldersley M, Bathgate A, Burroughs AK, Heneghan MA, Neuberger JM, Thorburn D, Hirschfield GM, Cordell HJ, Alexander GJ, Jones DE, Sandford RN, Mells GF. The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis. Hepatology 2016; 63. [PMID: 26223498 PMCID: PMC6984963 DOI: 10.1002/hep.28017] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [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] [Indexed: 12/11/2022]
Abstract
UNLABELLED The biochemical response to ursodeoxycholic acid (UDCA)--so-called "treatment response"--strongly predicts long-term outcome in primary biliary cholangitis (PBC). Several long-term prognostic models based solely on the treatment response have been developed that are widely used to risk stratify PBC patients and guide their management. However, they do not take other prognostic variables into account, such as the stage of the liver disease. We sought to improve existing long-term prognostic models of PBC using data from the UK-PBC Research Cohort. We performed Cox's proportional hazards regression analysis of diverse explanatory variables in a derivation cohort of 1,916 UDCA-treated participants. We used nonautomatic backward selection to derive the best-fitting Cox model, from which we derived a multivariable fractional polynomial model. We combined linear predictors and baseline survivor functions in equations to score the risk of a liver transplant or liver-related death occurring within 5, 10, or 15 years. We validated these risk scores in an independent cohort of 1,249 UDCA-treated participants. The best-fitting model consisted of the baseline albumin and platelet count, as well as the bilirubin, transaminases, and alkaline phosphatase, after 12 months of UDCA. In the validation cohort, the 5-, 10-, and 15-year risk scores were highly accurate (areas under the curve: >0.90). CONCLUSIONS The prognosis of PBC patients can be accurately evaluated using the UK-PBC risk scores. They may be used to identify high-risk patients for closer monitoring and second-line therapies, as well as low-risk patients who could potentially be followed up in primary care.
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Affiliation(s)
- Marco Carbone
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom,Division of Gastroenterology and Hepatology, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Stephen J. Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Steve Flack
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Dimitrios Paximadas
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Kelly Spiess
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Carolyn Adgey
- Liver Unit, Royal Victoria Hospital, Belfast, United Kingdom
| | - Laura Griffiths
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Reyna Lim
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Paul Trembling
- Liver Unit, Barts and the London NHS Trust, London, United Kingdom
| | - Kate Williamson
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nick J. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark Aldersley
- Liver Unit, St James’s University Hospital, Leeds, United Kingdom
| | - Andrew Bathgate
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew K. Burroughs
- Sheila Sherlock Liver Center, The Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Michael A. Heneghan
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Douglas Thorburn
- Sheila Sherlock Liver Center, The Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Gideon M. Hirschfield
- Center for Liver Research and NIHR Biomedical Research Unit, University of Birmingham, Birmingham, United Kingdom
| | - Heather J. Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Graeme J. Alexander
- Division of Gastroenterology and Hepatology, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - David E.J. Jones
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard N. Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - George F. Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom,Division of Gastroenterology and Hepatology, Addenbrooke’s Hospital, Cambridge, United Kingdom
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18
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Hydes TJ, Moesker B, Traherne JA, Ashraf S, Alexander GJ, Dimitrov BD, Woelk CH, Trowsdale J, Khakoo SI. The interaction of genetic determinants in the outcome of HCV infection: evidence for discrete immunological pathways. Tissue Antigens 2015; 86:267-75. [PMID: 26381047 PMCID: PMC4858811 DOI: 10.1111/tan.12650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022]
Abstract
Diversity within the innate and adaptive immune response to hepatitis C is important in determining spontaneous resolution (SR) and treatment response. The aim of this study was to analyze how these variables interact in combination; furthering our understanding of the mechanisms that drive successful immunological clearance. Multivariate analysis was performed on retrospectively collected data for 357 patients previously genotyped for interferon (IFN)-λ3/4, killer cell immunoglobulin (KIR), human leukocyte antigen (HLA) class I and II and tapasin. High resolution KIR genotyping was performed for individuals with chronic infection and haplotypes determined. Outcomes for SR, IFN response and cirrhosis were examined. Statistical analysis included univariate methods, χ(2) test for trend, multivariate logistic regression, synergy and principal component analysis (PCA). Although KIR2DL3:HLA-C1C1 (P = 0.027), IFN-λ3/4 rs12979860 CC (P = 0.027), tapasin G in individuals with aspartate at residue 114 of HLA-B (TapG:HLA-B(114D) ) (P = 0.007) and HLA-DRB1*04:01 (P = 0.014) were associated with SR with a strong additive influence (χ(2) test for trend P < 0.0001); favorable polymorphisms did not interact synergistically, nor did patients cluster by outcome. In the treatment cohort, IFN-λ3/4 rs12979860 CC was protective in hepatitis C virus (HCV) G1 infection and KIR2DL3:HLA-C1 in HCV G2/3. In common with SR, variables did not interact synergistically. Polymorphisms predictive of viral clearance did not predict disease progression. In summary, different individuals resolve HCV infection using discrete and non-interacting immunological pathways. These pathways are influenced by viral genotype. This work provides novel insights into the complexity of the interaction between host and viral factors in determining the outcome of HCV infection.
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Affiliation(s)
- T J Hydes
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - B Moesker
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J A Traherne
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - S Ashraf
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - G J Alexander
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - B D Dimitrov
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C H Woelk
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Trowsdale
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - S I Khakoo
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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19
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Sampaziotis F, de Brito MC, Madrigal P, Bertero A, Saeb-Parsy K, Soares FAC, Schrumpf E, Melum E, Karlsen TH, Bradley JA, Gelson WTH, Davies S, Baker A, Kaser A, Alexander GJ, Hannan NR, Vallier L. Cholangiocytes derived from human induced pluripotent stem cells for disease modeling and drug validation. Nat Biotechnol 2015; 33:845-852. [PMID: 26167629 PMCID: PMC4768345 DOI: 10.1038/nbt.3275] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [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: 04/02/2015] [Accepted: 06/05/2015] [Indexed: 12/20/2022]
Abstract
The study of biliary disease has been constrained by a lack of primary human cholangiocytes. Here we present an efficient, serum-free protocol for directed differentiation of human induced pluripotent stem cells into cholangiocyte-like cells (CLCs). CLCs show functional characteristics of cholangiocytes, including bile acids transfer, alkaline phosphatase activity, γ-glutamyl-transpeptidase activity and physiological responses to secretin, somatostatin and vascular endothelial growth factor. We use CLCs to model in vitro key features of Alagille syndrome, polycystic liver disease and cystic fibrosis (CF)-associated cholangiopathy. Furthermore, we use CLCs generated from healthy individuals and patients with polycystic liver disease to reproduce the effects of the drugs verapamil and octreotide, and we show that the experimental CF drug VX809 rescues the disease phenotype of CF cholangiopathy in vitro. Our differentiation protocol will facilitate the study of biological mechanisms controlling biliary development, as well as disease modeling and drug screening.
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Affiliation(s)
- Fotios Sampaziotis
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Miguel Cardoso de Brito
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Pedro Madrigal
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Alessandro Bertero
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Filipa A. C. Soares
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Elisabeth Schrumpf
- Norwegian PSC Research Center, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- K.G. Jebsen Inflammation Research Centre, Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Melum
- Norwegian PSC Research Center, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- K.G. Jebsen Inflammation Research Centre, Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Tom H. Karlsen
- Norwegian PSC Research Center, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- K.G. Jebsen Inflammation Research Centre, Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J. Andrew Bradley
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - William TH Gelson
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susan Davies
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alastair Baker
- Child Health Clinical Academic Grouping, King’s Health Partners, Denmark Hill Campus, London, United Kingdom
| | - Arthur Kaser
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Graeme J. Alexander
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas R.F. Hannan
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Ludovic Vallier
- Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory for Regenerative Medicine, Department of Surgery, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
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20
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Cacciottolo TM, Kingdon A, Alexander GJ. Rifaximin is largely safe and well tolerated but caution is necessary when taken with statins. Clin Gastroenterol Hepatol 2014; 12:1765. [PMID: 24703862 DOI: 10.1016/j.cgh.2014.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Tessa M Cacciottolo
- Department of Hepatology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Arjun Kingdon
- Department of Hepatology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Graeme J Alexander
- Department of Hepatology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
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21
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Liu YL, Reeves HL, Burt AD, Tiniakos D, McPherson S, Leathart JBS, Allison MED, Alexander GJ, Piguet AC, Anty R, Donaldson P, Aithal GP, Francque S, Van Gaal L, Clement K, Ratziu V, Dufour JF, Day CP, Daly AK, Anstee QM. TM6SF2 rs58542926 influences hepatic fibrosis progression in patients with non-alcoholic fatty liver disease. Nat Commun 2014; 5:4309. [PMID: 24978903 PMCID: PMC4279183 DOI: 10.1038/ncomms5309] [Citation(s) in RCA: 399] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an increasingly common condition, strongly associated with the metabolic syndrome, that can lead to progressive hepatic fibrosis, cirrhosis and hepatic failure. Subtle inter-patient genetic variation and environmental factors combine to determine variation in disease progression. A common non-synonymous polymorphism in TM6SF2 (rs58542926 c.449 C>T, p.Glu167Lys) was recently associated with increased hepatic triglyceride content, but whether this variant promotes clinically relevant hepatic fibrosis is unknown. Here we confirm that TM6SF2 minor allele carriage is associated with NAFLD and is causally related to a previously reported chromosome 19 GWAS signal that was ascribed to the gene NCAN. Furthermore, using two histologically characterized cohorts encompassing steatosis, steatohepatitis, fibrosis and cirrhosis (combined n=1,074), we demonstrate a new association, independent of potential confounding factors (age, BMI, type 2 diabetes mellitus and PNPLA3 rs738409 genotype), with advanced hepatic fibrosis/cirrhosis. These findings establish new and important clinical relevance to TM6SF2 in NAFLD. Non-alcoholic fatty liver disease (NAFLD) is characterized by increased hepatic triglyceride content (HTGC) in the absence of high alcohol consumption. Here the authors show that a genetic variant in TM6SF2, which is known to be associated with HTGC, is a clinically relevant modifier of hepatic fibrogenesis and increases the risk of progressive NAFLD.
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Affiliation(s)
- Yang-Lin Liu
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Helen L Reeves
- Northern Institute for Cancer Research, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Alastair D Burt
- 1] Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK [2]
| | - Dina Tiniakos
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Stuart McPherson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Julian B S Leathart
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Michael E D Allison
- Liver Unit, Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Graeme J Alexander
- Liver Unit, Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Anne-Christine Piguet
- University Clinic of Visceral Surgery and Medicine, Inselspital Bern, 3010 Bern, Switzerland
| | - Rodolphe Anty
- 1] Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK [2] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Nice F-06204, Cedex 3, France
| | - Peter Donaldson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham NG7 2UH, UK
| | - Sven Francque
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium
| | - Luc Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium
| | - Karine Clement
- Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Vlad Ratziu
- Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Jean-Francois Dufour
- University Clinic of Visceral Surgery and Medicine, Inselspital Bern, 3010 Bern, Switzerland
| | - Christopher P Day
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Ann K Daly
- 1] Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK [2]
| | - Quentin M Anstee
- 1] Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK [2]
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22
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Gerada J, Ganeshanantham G, Dawwas MF, Winterbottom AP, Sivaprakasam R, Butler AJ, Alexander GJ. Infectious aortitis in a liver transplant recipient. Am J Transplant 2013; 13:2479-82. [PMID: 23919247 DOI: 10.1111/ajt.12353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/27/2013] [Indexed: 01/25/2023]
Abstract
The development of an abdominal aortic aneurysm secondary to infectious aortitis following solid organ transplantation is a rare event that in the absence of surgical intervention, can lead to uncontrolled sepsis, catastrophic hemorrhage and death. Arterial allografts have been a viable surgical option for the past 30 years, although operative modalities have undergone a paradigm shift in recent years. We describe the first case in the literature of a liver transplant recipient who developed an infrarenal aortic aneurysm secondary to Salmonella bacteraemia, which was treated successfully with aortic allograft transplantation.
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Affiliation(s)
- J Gerada
- Liver Transplant Unit, Addenbrooke's Hospital, Cambridge, UK
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23
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Mells GF, Pells G, Newton JL, Bathgate AJ, Burroughs AK, Heneghan MA, Neuberger JM, Day DB, Ducker SJ, Sandford RN, Alexander GJ, Jones DEJ. Impact of primary biliary cirrhosis on perceived quality of life: the UK-PBC national study. Hepatology 2013; 58:273-83. [PMID: 23471852 DOI: 10.1002/hep.26365] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [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: 12/25/2012] [Revised: 01/31/2013] [Accepted: 02/26/2013] [Indexed: 12/14/2022]
Abstract
UNLABELLED Primary biliary cirrhosis (PBC) has a complex clinical phenotype, with debate about the extent and specificity of frequently described systemic symptoms such as fatigue. The aim of this study was to use a national patient cohort of 2,353 patients recruited from all clinical centers in the UK to explore the impact of disease on perceived life quality. Clinical data regarding diagnosis, therapy, and biochemical status were collected and have been reported previously. Detailed symptom phenotyping using recognized and validated symptom assessment tools including the PBC-40 was also undertaken and is reported here. Perception of poor quality of life and impaired health status was common in PBC patients (35% and 46%, respectively) and more common than in an age-matched and sex-matched community control group (6% and 15%, P < 0.0001 for both). Fatigue and symptoms of social dysfunction were associated with impaired perceived quality of life using multivariate analysis. Fatigue was the symptom with the greatest impact. Depression was a significant factor, but appeared to be a manifestation of complex symptom burden rather than a primary event. Fatigue had its greatest impact on perceived quality of life when accompanied by symptoms of social dysfunction, suggesting that maintenance of social networks is critical for minimizing the impact of fatigue. CONCLUSION The symptom burden in PBC, which is unrelated to disease severity or ursodeoxycholic acid response, is significant and complex and results in significant quality of life deficit. The complexity of symptom burden, and its lack of relation to disease severity and treatment response, suggest that specific approaches to symptom management are warranted that address both symptom biology and social impact.
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Affiliation(s)
- George F Mells
- Department of Hepatology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
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Khandhadia S, Hakobyan S, Heng LZ, Gibson J, Adams DH, Alexander GJ, Gibson JM, Martin KR, Menon G, Nash K, Sivaprasad S, Ennis S, Cree AJ, Morgan BP, Lotery AJ. Age-related macular degeneration and modification of systemic complement factor H production through liver transplantation. Ophthalmology 2013; 120:1612-8. [PMID: 23562165 DOI: 10.1016/j.ophtha.2013.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/21/2012] [Accepted: 01/02/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate whether modification of liver complement factor H (CFH) production, by alteration of liver CFH Y402H genotype through liver transplantation (LT), influences the development of age-related macular degeneration (AMD). DESIGN Multicenter, cross-sectional study. PARTICIPANTS We recruited 223 Western European patients ≥ 55 years old who had undergone LT ≥ 5 years previously. METHODS We determined AMD status using a standard grading system. Recipient CFH Y402H genotype was obtained from DNA extracted from recipient blood samples. Donor CFH Y402H genotype was inferred from recipient plasma CFH Y402H protein allotype, measured using enzyme-linked immunosorbent assays. This approach was verified by genotyping donor tissue from a subgroup of patients. Systemic complement activity was ascertained by measuring levels of plasma complement proteins using an enzyme-linked immunosorbent assay, including substrates (C3, C4), activation products (C3a, C4a, and terminal complement complex), and regulators (total CFH, C1 inhibitor). MAIN OUTCOME MEASURES We evaluated AMD status and recipient and donor CFH Y402H genotype. RESULTS In LT patients, AMD was associated with recipient CFH Y402H genotype (P = 0.036; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.4) but not with donor CFH Y402H genotype (P = 0.626), after controlling for age, sex, smoking status, and body mass index. Recipient plasma CFH Y402H protein allotype predicted donor CFH Y402H genotype with 100% accuracy (n = 49). Plasma complement protein or activation product levels were similar in LT patients with and without AMD. Compared with previously reported prevalence figures (Rotterdam Study), LT patients demonstrated a high prevalence of both AMD (64.6% vs 37.1%; OR, 3.09; P<0.001) and the CFH Y402H sequence variation (41.9% vs 36.2%; OR, 1.27; P = 0.014). CONCLUSIONS Presence of AMD is not associated with modification of hepatic CFH production. In addition, AMD is not associated with systemic complement activity in LT patients. These findings suggest that local intraocular complement activity is of greater importance in AMD pathogenesis. The high AMD prevalence observed in LT patients may be associated with the increased frequency of the CFH Y402H sequence variation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Samir Khandhadia
- Clinical and Experimental Sciences, Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Carbone M, Mells GF, Alexander GJ, Westbrook RH, Heneghan MA, Sandford RN, Neuberger JM. Calcineurin inhibitors and the IL12A locus influence risk of recurrent primary biliary cirrhosis after liver transplantation. Am J Transplant 2013; 13:1110-1111. [PMID: 23433321 DOI: 10.1111/ajt.12132] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 01/25/2023]
Affiliation(s)
- M Carbone
- Academic Department of Medical Genetics, Cambridge University, Cambridge, UK.,Division of Gastroenterology and Hepatology, Cambridge University Department of Medicine, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - G F Mells
- Academic Department of Medical Genetics, Cambridge University, Cambridge, UK.,Division of Gastroenterology and Hepatology, Cambridge University Department of Medicine, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - G J Alexander
- Division of Gastroenterology and Hepatology, Cambridge University Department of Medicine, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - R H Westbrook
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M A Heneghan
- Institute of Liver Studies, King's College Hospital, London, UK
| | - R N Sandford
- Academic Department of Medical Genetics, Cambridge University, Cambridge, UK
| | - J M Neuberger
- Liver Unit, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK
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Carbone M, Mells GF, Pells G, Dawwas MF, Newton JL, Heneghan MA, Neuberger JM, Day DB, Ducker SJ, Sandford RN, Alexander GJ, Jones DEJ. Sex and age are determinants of the clinical phenotype of primary biliary cirrhosis and response to ursodeoxycholic acid. Gastroenterology 2013; 144:560-569.e7; quiz e13-4. [PMID: 23246637 DOI: 10.1053/j.gastro.2012.12.005] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [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: 06/01/2012] [Revised: 11/30/2012] [Accepted: 12/06/2012] [Indexed: 12/02/2022]
Abstract
UNLABELLED BACKGROUND, & AIMS: Studies of primary biliary cirrhosis (PBC) phenotypes largely have been performed using small and selected populations. Study size has precluded investigation of important disease subgroups, such as men and young patients. We used a national patient cohort to obtain a better picture of PBC phenotypes. METHODS We performed a cross-sectional study using the United Kingdom-PBC, patient cohort. Comprehensive data were collected for 2353 patients on diagnosis reports, response to therapy with ursodeoxycholic acid (UDCA), laboratory results, and symptom impact (assessed using the PBC-40 and other related measures). RESULTS Seventy-nine percent of the patients reported current UDCA, therapy, with 80% meeting Paris response criteria. Men were significantly less likely to have responded to UDCA than women (72% vs 80% response rate; P < .05); male sex was an independent predictor of nonresponse on multivariate analysis. Age at diagnosis was associated strongly and independently with response to UDCA; response rates ranged from 90% among patients who presented with PBC when they were older than age 70, to less than 50% for those younger than age 30 (P < .0001). Patients who presented at younger ages also were significantly more likely not to respond to UDCA therapy, based on alanine aminotransferase and aspartate aminotransferase response criteria, and more likely to report fatigue and pruritus. Women had mean fatigue scores 32% higher than men's (P < .0001). The increase in fatigue severity in women was related strongly (r = 0.58; P < .0001) to higher levels of autonomic symptoms (P < .0001). CONCLUSIONS Among patients with PBC, response to UDCA, treatment and symptoms are related to sex and age at presentation, with the lowest response rates and highest levels of symptoms in women presenting at younger than age 50. Increased severity of fatigue in women is related to increased autonomic symptoms, making dysautonomia a plausible therapeutic target.
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Affiliation(s)
- Marco Carbone
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Dawwas MF, Davies SE, Griffiths WJH, Lomas DA, Alexander GJ. Prevalence and Risk Factors for Liver Involvement in Individuals with PiZZ-related Lung Disease. Am J Respir Crit Care Med 2013; 187:502-8. [DOI: 10.1164/rccm.201204-0739oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Khandhadia S, Hakobyan S, Heng LZ, Gibson J, Adams DH, Alexander GJ, Gibson JM, Martin K, Menon G, Nash K, Sivaprasad S, Ennis S, Cree AJ, Morgan P, Lotery AJ. Local and not systemic factor H production dictates risk of age-related macular degeneration in liver transplant recipients. Immunobiology 2012. [DOI: 10.1016/j.imbio.2012.08.154] [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: 10/27/2022]
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Liu JZ, Almarri MA, Gaffney DJ, Mells GF, Jostins L, Cordell HJ, Ducker SJ, Day DB, Heneghan MA, Neuberger JM, Donaldson PT, Bathgate AJ, Burroughs A, Davies MH, Jones DE, Alexander GJ, Barrett JC, Sandford RN, Anderson CA. Dense fine-mapping study identifies new susceptibility loci for primary biliary cirrhosis. Nat Genet 2012; 44:1137-41. [PMID: 22961000 PMCID: PMC3459817 DOI: 10.1038/ng.2395] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [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: 01/17/2012] [Accepted: 08/09/2012] [Indexed: 12/12/2022]
Abstract
We genotyped 2,861 cases of primary biliary cirrhosis (PBC) from the UK PBC Consortium and 8,514 UK population controls across 196,524 variants within 186 known autoimmune risk loci. We identified 3 loci newly associated with PBC (at P<5×10(-8)), increasing the number of known susceptibility loci to 25. The most associated variant at 19p12 is a low-frequency nonsynonymous SNP in TYK2, further implicating JAK-STAT and cytokine signaling in disease pathogenesis. An additional five loci contained nonsynonymous variants in high linkage disequilibrium (LD; r2>0.8) with the most associated variant at the locus. We found multiple independent common, low-frequency and rare variant association signals at five loci. Of the 26 independent non-human leukocyte antigen (HLA) signals tagged on the Immunochip, 15 have SNPs in B-lymphoblastoid open chromatin regions in high LD (r2>0.8) with the most associated variant. This study shows how data from dense fine-mapping arrays coupled with functional genomic data can be used to identify candidate causal variants for functional follow-up.
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Affiliation(s)
- Jimmy Z Liu
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
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Miller AK, Erasmus BFN, Alexander GJ. Gut and intestinal passage time in the Rainbow Skink (Trachylepis margaritifer): implications for stress measures using faecal analysis. J Anim Physiol Anim Nutr (Berl) 2012; 97:960-70. [PMID: 22998669 DOI: 10.1111/jpn.12004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Stress levels in organisms provide a rapid measure for assessing population health. Handling and capture stress, however, cause error in blood measures, so this method is rapidly being replaced by assessing levels of stress metabolites in faeces. This eliminates the source of error because there is a lag period between stress perception and the resultant stress metabolite accumulation within faeces. This lag period is correlated with specific intestinal passage time, a measure that can vary greatly between taxa, particularly amongst ectotherms. Due to two deleterious consequences associated with extended exposure of the metabolites to the intestinal environment, species that exhibit long and variable intestinal passage times are not good candidates for metabolite studies. We measured gut and intestinal passage times in Trachylepis margaritifer to ascertain whether it would be an appropriate candidate for stress metabolite studies. We first tested if barium sulphate in the meal had an effect on gut passage time at three ambient temperatures (25, 27 and 32 °C). Barium sulphate had no effect; however, temperature had a significant effect with an unexpected pattern: gut passage time was fastest at 32 °C but was slower at 27 °C than at 25 °C. We then used X-ray technology and barium sulphate-loaded meals to measure gut and intestinal passage times at 25 and 27 °C. This allowed us to observe which parts of the digestive process were responsible for increased passage times at 27 °C: the faster passage time at 25 °C was due to faster intestinal passage time; there was no difference in gastric emptying time. We assess the species to be a suitable candidate for studies using faeces to measure stress. It is imperative however, that the effect of temperature on passage rates is known and taken into account in such studies.
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Affiliation(s)
- A K Miller
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B F N Erasmus
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - G J Alexander
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Srivastava B, Mells GF, Cordell HJ, Muriithi A, Brown M, Ellinghaus E, Franke A, Karlsen TH, Sandford RN, Alexander GJ, Chapman RW, Rushbrook SM, Melum E. Fine mapping and replication of genetic risk loci in primary sclerosing cholangitis. Scand J Gastroenterol 2012; 47:820-6. [PMID: 22554193 DOI: 10.3109/00365521.2012.682090] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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: 02/04/2023]
Abstract
BACKGROUND AND AIMS Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive inflammation and fibrosis of the bile ducts eventually leading to biliary cirrhosis. Recent genetic studies in PSC have identified associations at 2q13, 2q35, 3p21, 4q27, 13q31 and suggestive association at 10p15. The aim of this study was to further characterize and refine the genetic architecture of PSC. METHODS We analyzed previously reported associated SNPs at four of these non-HLA loci and 59 SNPs tagging the IL-2/IL-21 (4q27) and IL2RA (10p15) loci in 992 UK PSC cases and 5162 healthy UK controls. RESULTS The most associated SNPs identified were rs3197999 (3p21 (MST1), p = 1.9 × 10⁻⁶, OR(A vs G) = 1.28, 95% CI (1.16-1.42)); rs4147359 (10p15 (IL2RA), p = 2.6 × 10⁻⁴, OR(A vs G) = 1.20, 95% CI (1.09-1.33)) and rs12511287 (4q27 (IL-2/IL-21), p = 3.0 × 10⁻⁴, OR(A vs T) = 1.21, 95% CI (1.09-1.35)). In addition, we performed a meta-analysis for selected SNPs using published summary statistics from recent studies. We observed genome-wide significance for rs3197999 (3p21 (MST1), P (combined) = 3.8 × 10⁻¹²) and rs4147359 (10p15 (IL2RA), P (combined) = 1.5 × 10⁻⁸). CONCLUSION We have for the first time confirmed the association of PSC with genetic variants at 10p15 (IL2RA) locus at genome-wide significance and replicated the associations at MST1 and IL-2/IL-21 loci in a large homogeneous UK population. These results strongly implicate the role of IL-2/IL2RA pathway in PSC and provide further confirmation of MST1 association.
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Affiliation(s)
- Brijesh Srivastava
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
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Godfrey EM, Patterson AJ, Priest AN, Davies SE, Joubert I, Krishnan AS, Griffin N, Shaw AS, Alexander GJ, Allison ME, Griffiths WJH, Gimson AES, Lomas DJ. A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis. Eur Radiol 2012; 22:2790-7. [DOI: 10.1007/s00330-012-2527-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/22/2012] [Accepted: 04/01/2012] [Indexed: 02/06/2023]
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Chan K, Yam I, Yuen J, Yuen MF, Lai CL, Alexander GJ, Chan TK, Chan V. A comprehensive HBV array for the detection of HBV mutants and genotype. Clin Biochem 2011; 44:1253-60. [PMID: 21851814 DOI: 10.1016/j.clinbiochem.2011.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/12/2011] [Accepted: 07/24/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a comprehensive hepatitis B virus (HBV) array providing simultaneous analysis of 8 genotypes, 47 mutations of reverse-transcriptase polymerase gene and 18 mutations of S gene. METHOD Oligonucleotides corresponding to various HBV-normal and -mutant sequences were spotted onto pre-treated glass slides. Single-stranded templates of the HBV gene fragment were prepared from serum-DNA of HBV-infected patients by 2-staged PCR and subjected to allele-specific arrayed-primer extension with Cy5-dCTP. Fluorescein-labelled products were scanned at 670nm. RESULTS Comparative analysis of 100 unrelated samples using the array and a commercial kit, revealed 44 with additional mutations from the array, these were confirmed by sequencing. Analysis of 381 samples from 45 patients during 1-3 years of anti-viral therapy showed improved sensitivity with detection of drug-resistant mutations months before clinical relapse. The lower detection limit was 28 copies/mL. CONCLUSION The array is better than many existing methods as it provides both mutations and genotype data in a single analysis.
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Affiliation(s)
- Kaimin Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Griffin N, Addley H, Sala E, Shaw AS, Grant LA, Eldaly H, Davies SE, Prevost T, Alexander GJ, Lomas DJ. Vascular invasion in hepatocellular carcinoma: is there a correlation with MRI? Br J Radiol 2011; 85:736-44. [PMID: 21385912 DOI: 10.1259/bjr/94924398] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide. Prognosis is predicted by size at diagnosis, vascular invasion and tumour proliferation markers. This study investigates if MRI features of histologically proven HCCs correlate with vascular invasion. METHODS Between 2006 and 2008, 18 consecutive patients, with a total of 27 HCCs, had comprehensive MRI studies performed at our institution within a median of 36 days of histology sampling. Each lesion was evaluated independently on MRI by 3 radiologists (blinded to both the radiology and histopathology reports) using a 5-point confidence scale for 23 specific imaging features. The mean of the rating scores across readers was calculated to determine interobserver consistency. The most consistent features were then used to examine the value of features in predicting vascular invasion, using a χ(2 )test for trend, having eliminated those features without sufficient variability. RESULTS 22 of the 23 imaging features showed sufficient variability across lesions. None of these significantly correlated with the presence of vascular invasion, although a trend was identified with the presence of washout in the portal venous phase on MRI and the median size of lesions, which was greater with vascular invasion. CONCLUSION This study suggests that no single MRI feature accurately predicts the presence of vascular invasion in HCCs, although a trend was seen with the presence of washout in the portal venous phase post gadolinium. Larger prospective studies are required to investigate this further.
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Affiliation(s)
- N Griffin
- Department of Radiology, Guys and St Thomas' Hospital, London, UK
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Addley HC, Griffin N, Shaw AS, Mannelli L, Parker RA, Aitken S, Wood H, Davies S, Alexander GJ, Lomas DJ. Accuracy of hepatocellular carcinoma detection on multidetector CT in a transplant liver population with explant liver correlation. Clin Radiol 2011; 66:349-56. [PMID: 21295772 DOI: 10.1016/j.crad.2010.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/18/2010] [Accepted: 11/21/2010] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for hepatocellular carcinoma (HCC) in cirrhotic patients undergoing liver transplantation. Secondary aims were to examine the effect of radiologist experience and lesion size on diagnostic accuracy. MATERIALS AND METHODS Thirty-nine patients (72% male with a mean age of 56.5 years) underwent liver transplantation following preoperative triple-phase MDCT examination of the liver. MDCT examinations were retrospectively independently reviewed by three radiologists for the presence and location of suspected HCCs, with the diagnostic confidence recorded using a five-point confidence scale. MDCT examinations were compared with explant specimens for histopathological correlation. RESULTS Histopathological results demonstrated 46 HCCs in 29 of the 39 patients. Analysis demonstrated a sensitivity of 65-75% and specificity of 47-88% for detection of HCC lesions. The sensitivity dropped to 48-57% for lesions of size ≤20mm. As the diagnostic confidence increased, there was a further decrease in the sensitivity (4-26%). The radiologist with the greatest number of years experience was found to have a significantly higher accuracy of detection of HCC lesions compared with the least experienced radiologist. CONCLUSION Larger lesion size of HCC and greater number of years experience of the radiologist resulted in significantly higher accuracy of HCC lesion detection. The overall sensitivity and specificity results for MDCT detection of HCC are comparable to previous helical CT imaging.
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Affiliation(s)
- H C Addley
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Addley HC, Griffin N, Shaw AS, Mannelli L, Parker RA, Aitken S, Wood H, Davies S, Alexander GJ, Lomas DJ. Accuracy of hepatocellular carcinoma detection on multidetector CT in a transplant liver population with explant liver correlation. Clin Radiol 2011. [PMID: 21295772 DOI: 10.1016/j.card.2010.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for hepatocellular carcinoma (HCC) in cirrhotic patients undergoing liver transplantation. Secondary aims were to examine the effect of radiologist experience and lesion size on diagnostic accuracy. MATERIALS AND METHODS Thirty-nine patients (72% male with a mean age of 56.5 years) underwent liver transplantation following preoperative triple-phase MDCT examination of the liver. MDCT examinations were retrospectively independently reviewed by three radiologists for the presence and location of suspected HCCs, with the diagnostic confidence recorded using a five-point confidence scale. MDCT examinations were compared with explant specimens for histopathological correlation. RESULTS Histopathological results demonstrated 46 HCCs in 29 of the 39 patients. Analysis demonstrated a sensitivity of 65-75% and specificity of 47-88% for detection of HCC lesions. The sensitivity dropped to 48-57% for lesions of size ≤20mm. As the diagnostic confidence increased, there was a further decrease in the sensitivity (4-26%). The radiologist with the greatest number of years experience was found to have a significantly higher accuracy of detection of HCC lesions compared with the least experienced radiologist. CONCLUSION Larger lesion size of HCC and greater number of years experience of the radiologist resulted in significantly higher accuracy of HCC lesion detection. The overall sensitivity and specificity results for MDCT detection of HCC are comparable to previous helical CT imaging.
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Affiliation(s)
- H C Addley
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Miranda E, Pérez J, Ekeowa UI, Hadzic N, Kalsheker N, Gooptu B, Portmann B, Belorgey D, Hill M, Chambers S, Teckman J, Alexander GJ, Marciniak SJ, Lomas DA. A novel monoclonal antibody to characterize pathogenic polymers in liver disease associated with alpha1-antitrypsin deficiency. Hepatology 2010; 52:1078-88. [PMID: 20583215 DOI: 10.1002/hep.23760] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [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: 12/07/2022]
Abstract
UNLABELLED Alpha(1)-antitrypsin is the most abundant circulating protease inhibitor. The severe Z deficiency allele (Glu342Lys) causes the protein to undergo a conformational transition and form ordered polymers that are retained within hepatocytes. This causes neonatal hepatitis, cirrhosis, and hepatocellular carcinoma. We have developed a conformation-specific monoclonal antibody (2C1) that recognizes the pathological polymers formed by alpha(1)-antitrypsin. This antibody was used to characterize the Z variant and a novel shutter domain mutant (His334Asp; alpha(1)-antitrypsin King's) identified in a 6-week-old boy who presented with prolonged jaundice. His334Asp alpha(1)-antitrypsin rapidly forms polymers that accumulate within the endoplasmic reticulum and show delayed secretion when compared to the wild-type M alpha(1)-antitrypsin. The 2C1 antibody recognizes polymers formed by Z and His334Asp alpha(1)-antitrypsin despite the mutations directing their effects on different parts of the protein. This antibody also recognized polymers formed by the Siiyama (Ser53Phe) and Brescia (Gly225Arg) mutants, which also mediate their effects on the shutter region of alpha(1)-antitrypsin. CONCLUSION Z and shutter domain mutants of alpha(1)-antitrypsin form polymers with a shared epitope and so are likely to have a similar structure.
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Affiliation(s)
- Elena Miranda
- Department of Medicine, University of Cambridge, Cambridge Institute for Medical Research, Wellcome Trust/Medical Research Council Building, Cambridge, UK.
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Knapp S, Warshow U, Hegazy D, Brackenbury L, Guha IN, Fowell A, Little AM, Alexander GJ, Rosenberg WM, Cramp ME, Khakoo SI. Consistent beneficial effects of killer cell immunoglobulin-like receptor 2DL3 and group 1 human leukocyte antigen-C following exposure to hepatitis C virus. Hepatology 2010; 51:1168-75. [PMID: 20077564 PMCID: PMC4202114 DOI: 10.1002/hep.23477] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [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: 12/11/2022]
Abstract
UNLABELLED Natural killer cells are a key component in the immune control of viral infections. Their functions are controlled by inhibitory receptors for major histocompatability complex (MHC) class I, including the killer cell immunoglobulin-like receptors (KIR). KIR2DL3 in combination with its cognate human leukocyte antigen (HLA)-C ligand has been shown to be associated with spontaneous resolution of viremia following hepatitis C virus (HCV) infection. In order to determine if this gene combination is advantageous across all potential outcomes following HCV exposure, we studied individuals with apparent resistance to HCV infection who remain seronegative and aviremic despite long-term injection drug use and also individuals chronically infected with HCV who successfully clear HCV with treatment. Homozygosity for KIR2DL3 in combination with group 1 HLA-C allotypes was more frequent in exposed seronegative aviremic individuals as compared to those with chronic HCV (25.0% versus 9.7%, P = 0.003, odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.3-7.1) in a model similar to that found for those spontaneously resolving HCV. In individuals undergoing treatment for HCV, those with KIR2DL3 and group 1 HLA-C were more likely to make a sustained virological response (SVR) (P = 0.013, OR = 2.3, 95% CI = 1.1-4.5). KIR and HLA-C protection in both treatment response and spontaneously resolving HCV was validated at the allelic level, in which KIR2DL3-HLA-Cw*03 was associated with SVR (P = 0.004, OR = 3.4, 95% CI = 1.5-8.7) and KIR2DL3/KIR2DL3-HLA-Cw*03 was associated with spontaneous resolution of HCV infection (P = 0.01, OR = 2.3, 95% CI = 1.2-4.4). CONCLUSION KIR and HLA-C genes are consistently beneficial determinants in the outcome of HCV infection. This advantage extends to the allelic level for both gene families.
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Affiliation(s)
- Susanne Knapp
- Department of Hepatology, Division of Medicine, Imperial College London, UK
| | - Usama Warshow
- Hepatology Research Group, Peninsula Medical School and Hepatology Department Derriford Hospital, Plymouth, UK
| | - Doha Hegazy
- Hepatology Research Group, Peninsula Medical School and Hepatology Department Derriford Hospital, Plymouth, UK
| | - Louise Brackenbury
- Department of Hepatology, Division of Medicine, Imperial College London, UK
| | - I. Neil Guha
- Department of Hepatology, University of Southampton, Southampton, UK
| | - Andrew Fowell
- Department of Hepatology, University of Southampton, Southampton, UK
| | | | | | | | - Matthew E. Cramp
- Hepatology Research Group, Peninsula Medical School and Hepatology Department Derriford Hospital, Plymouth, UK
| | - Salim I. Khakoo
- Department of Hepatology, Division of Medicine, Imperial College London, UK
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39
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Affiliation(s)
- Muhammad F Dawwas
- Liver Transplant Unit, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.
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Watson CJE, Gimson AES, Alexander GJ, Allison MED, Gibbs P, Smith JC, Palmer CR, Bradley JA. A randomized controlled trial of late conversion from calcineurin inhibitor (CNI)-based to sirolimus-based immunosuppression in liver transplant recipients with impaired renal function. Liver Transpl 2007; 13:1694-702. [PMID: 18044728 DOI: 10.1002/lt.21314] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [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] [Indexed: 12/12/2022]
Abstract
Renal impairment is common in patients after liver transplantation and is attributable in large part to the use of calcineurin inhibitor (CNI)-based immunosuppression. We sought to determine whether conversion to sirolimus-based immunosuppression was associated with improved renal function. In a single-center, randomized, controlled trial, 30 patients at least 6 months post liver transplantation were randomized to remain on CNI-based immunosuppression or to switch to sirolimus-based immunosuppression. The primary outcome measure was change in measured glomerular filtration rate (GFR) between baseline and 12 months. Of 30 patients randomized, 3 were withdrawn at randomization, leaving 14 patients on CNI and 13 on sirolimus. There was a significant improvement in delta GFR following conversion to sirolimus at 3 months (7.7 mL/minute/1.73 m2; 95% confidence interval, 3.5-11.9) and 1 yr (6.1 mL/minute/1.73 m2; 95% confidence interval, 0.9-11.4). The difference in absolute GFR between the 2 study groups was significant at 3 months (P=0.02), but not at 12 months (P=0.07). The principal adverse events following conversion were the development of skin rash (9 of 13 patients, 69%) and mouth ulcers (5 of 13 patients, 38%). Two patients developed acute rejection at 2 and 3 months following conversion, 1 in association with low sirolimus levels and 1 having stopped the drug inadvertently. In conclusion, overall, this study suggests that conversion to sirolimus immunosuppression is associated with a modest improvement in renal function. Side effects were common, but tolerable in most patients and controlled with dose reduction.
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Abstract
Gilbert's syndrome (GS) is a benign and inherited state characterized by mild, lifelong, unconjugated hyperbilirubinaemia in the absence of haemolysis or evidence of liver disease. Its molecular basis, mutations in the TATA box upstream of the uridine diphosphoglucose glucuronyltransferase gene, leads to impaired bilirubin glucuronidation. This synopsis outlines the pathophysiology and investigation appropriate for this innocent anomaly.
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Affiliation(s)
- G M Hirschfield
- Department of Hepatology, Box 210, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
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Abstract
Reactivation of herpes simplex virus (HSV) after liver transplantation occurs but the incidence and clinical significance are unknown. We recruited 12 consecutive male patients listed for liver transplantation and positive for HSV antibody. HSV polymerase chain reaction was performed on mouth and penile swabs before and at days 5 and 10 after transplant. Data were recorded regarding clinical evidence of HSV infection, degree of immune suppression, length of intensive care stay, and use of antiviral agents. Five out of twelve patients (42%) had evidence of oral reactivation after transplant although only one had clinical manifestations. Genital reactivation was not seen. Reactivation did not correlate with immune suppression but duration of intensive care stay was a possible risk factor. Ganciclovir prescribed for cytomegalovirus prophylaxis in one patient was ineffective. Oral reactivation of HSV after liver transplantation is common; although clinical significance appears low in this small series, routine testing could be implemented readily.
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Khakoo SI, Thio CL, Martin MP, Brooks CR, Gao X, Astemborski J, Cheng J, Goedert JJ, Vlahov D, Hilgartner M, Cox S, Little AM, Alexander GJ, Cramp ME, O'Brien SJ, Rosenberg WMC, Thomas DL, Carrington M. HLA and NK Cell Inhibitory Receptor Genes in Resolving Hepatitis C Virus Infection. Science 2004; 305:872-4. [PMID: 15297676 DOI: 10.1126/science.1097670] [Citation(s) in RCA: 902] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Natural killer (NK) cells provide a central defense against viral infection by using inhibitory and activation receptors for major histocompatibility complex class I molecules as a means of controlling their activity. We show that genes encoding the inhibitory NK cell receptor KIR2DL3 and its human leukocyte antigen C group 1 (HLA-C1) ligand directly influence resolution of hepatitis C virus (HCV) infection. This effect was observed in Caucasians and African Americans with expected low infectious doses of HCV but not in those with high-dose exposure, in whom the innate immune response is likely overwhelmed. The data strongly suggest that inhibitory NK cell interactions are important in determining antiviral immunity and that diminished inhibitory responses confer protection against HCV.
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Affiliation(s)
- Salim I Khakoo
- Liver Group, Division of Infection, Inflammation, and Repair, Southampton University, Southampton 5016 6YD, UK.
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Taylor AL, Gibbs P, Sudhindran S, Key T, Goodman RS, Morgan CH, Watson CJE, Delriviere L, Alexander GJ, Jamieson NV, Bradley JA, Taylor CJ. Monitoring systemic donor lymphocyte macrochimerism to aid the diagnosis of graft-versus-host disease after liver transplantation. Transplantation 2004; 77:441-6. [PMID: 14966423 DOI: 10.1097/01.tp.0000103721.29729.fe] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The diagnosis of graft-versus-host disease (GvHD) after liver transplantation can be difficult because early symptoms are often nonspecific. In this study, the presence of donor lymphocyte macrochimerism in recipient peripheral blood was examined as a diagnostic aid for GvHD after cadaveric donor liver transplantation. METHODS Between 1996 and 2002, 33 liver transplant recipients with a clinical suspicion of GvHD (skin rash, diarrhea, pyrexia, pancytopenia, or anemia, without an obvious alternative cause) were investigated for peripheral blood donor lymphocyte macrochimerism. Donor macrochimerism was determined at the time of first clinical presentation by a low-sensitivity polymerase chain reaction (PCR) to detect donor human leukocyte antigen (HLA) alleles using genomic DNA extracted from recipient peripheral blood. Where donor HLA alleles were detected, the percentage of donor T cells was quantified by two-color flow cytometric analysis using antibodies specific for mismatched donor and recipient HLA alleles. The relationship between the presence or absence of donor lymphocyte macrochimerism and final diagnoses based on clinical and histological criteria was examined. RESULTS Seven of the 33 patients were PCR positive for donor HLA alleles. All had macrochimerism, with donor T lymphocyte levels ranging from 4% to 50% of circulating lymphocytes. All seven patients had normal liver function tests, skin rash, and diagnosis of GvHD histologically confirmed by skin or gut biopsies. Twenty-six patients were PCR negative, and, in 23, an alternative diagnosis was eventually established. The remaining three patients made a rapid and spontaneous recovery with no further symptoms suggestive of GvHD. CONCLUSIONS Donor lymphocyte macrochimerism was present in all patients in whom the diagnosis of GvHD was confirmed. In patients with symptoms consistent with GvHD and a negative PCR for donor HLA, an alternative diagnosis was eventually established or the patients recovered spontaneously. Detection of donor HLA alleles in recipient peripheral blood by PCR is a useful diagnostic tool for GvHD after liver transplantation.
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Affiliation(s)
- Anna L Taylor
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Teaching Hospitals Trust, Cambridge, UK
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McConnachie S, Alexander GJ. The effect of temperature on digestive and assimilation efficiency, gut passage time and appetite in an ambush foraging lizard, Cordylus melanotus melanotus. J Comp Physiol B 2004; 174:99-105. [PMID: 14598178 DOI: 10.1007/s00360-003-0393-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2003] [Indexed: 11/29/2022]
Abstract
In ectotherms, an increase in body temperature increases metabolic rate and may increase rates of digestive processes. We measured the thermal dependence of the apparent digestive and apparent assimilation efficiencies (ADE and AAE), gut passage time (GP) and appetite in Cordylus melanotus melanotus, a medium sized Crag Lizard, which is endemic to South Africa. Trials were conducted at 20, 22, 25, 30, 32 and 35 degrees C under controlled conditions. Trials lasted 14 days, during which, lizards were fed ca. 1 g mealworms per day. Glass beads were used as markers to determine GP at the beginning and end of trials. Faeces and urates were collected daily and oven dried at 50 degrees C. The energy content of egested matter was then measured using bomb calorimetry. ADE and AAE were not affected by temperature for either males or females. The mean+/-SE ADE and AAE were 94.4+/-0.3% and 87.2+/-0.6%, respectively. GP was not significantly different between males and females at any temperature, but decreased significantly with increasing temperature. Appetite was significantly different between the different temperatures measured. The decrease of gut passage time with increasing temperature was expected, since the digestive and assimilation efficiencies are similar over the range of temperatures tested. Lizards are thus assimilating a similar proportion of ingested energy, but at faster rates at higher temperatures. The results indicate that the digestive physiology of this species results in maximum energy gain per meal in environments where food is scarce.
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Affiliation(s)
- S McConnachie
- Ecophysiological Studies Research Programme, School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Private Bag 3, 2050 WITS, South Africa.
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Sudhindran S, Taylor A, Delriviere L, Collins VP, Liu L, Taylor CJ, Alexander GJ, Gimson AE, Jamieson NV, Watson CJE, Gibbs P. Treatment of graft-versus-host disease after liver transplantation with basiliximab followed by bowel resection. Am J Transplant 2003; 3:1024-9. [PMID: 12859540 DOI: 10.1034/j.1600-6143.2003.00108.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a serious complication with mortality rates over 80%. Two patients with established GVHD after OLT were treated with Basiliximab, a chimeric murine human monoclonal antibody which binds to the alpha-chain of interleukin-2 receptor (IL-2R). Two males, aged 45 and 56 years, presented after OLT with a clinical picture consistent with GVHD. Quantitative measurements of recipient peripheral blood donor lymphocyte chimerism were carried out by flow cytometric analysis, and showed peak chimerism levels of 5% and 8%, respectively. Treatment comprised 3 doses of 1 g methyl prednisolone followed by 2 doses of 20 mg of Basiliximab. In both, treatment resulted in complete disappearance of macro-chimerism in blood. There was resolution of skin rash by day 7; however, diarrhea persisted. White cell scan showed increased uptake in the terminal ileum and small-bowel resection was performed in both patients. One patient is alive and well 36 months after OLT. The other patient had resolution of GVHD, but died of recurrent hepatitis C 1 year after OLT. The combination of immunological and surgical treatment for GVHD following solid organ transplantation has not previously been described.
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Affiliation(s)
- S Sudhindran
- Departments of Transplantation, Department of Histopathology, and Department of Tissue Typing, Addenbrooke's NHS Trust, Cambridge, UK
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Shrotri M, Sudhindran S, Gibbs P, Watson CJ, Alexander GJ, Gimson AE, Jamieson NV, Delriviere L. Case report of cavoportal hemitransposition for diffuse portal vein thrombosis in liver transplantation. Transplant Proc 2003; 35:397-8. [PMID: 12591457 DOI: 10.1016/s0041-1345(02)03806-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Shrotri
- Liver Transplant Unit, Addenbrookes' NHS Trust, Hills Road, Cambridge, UK
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48
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Shrotri M, Fernando BS, Sudhindran S, Delriviere L, Watson CJ, Gibbs P, Alexander GJ, Gimson AE, Jamieson NV. Long-term outcome of liver transplantation for familial hypercholesterolemia. Transplant Proc 2003; 35:381-2. [PMID: 12591450 DOI: 10.1016/s0041-1345(02)03910-6] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Shrotri
- Liver Transplant Unit, Addenbrooke's NHS Trust, Cambridge, UK
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Abstract
Osteoporosis is a common complication of liver transplantation. Its pathogenesis is multifactorial, but preexisting bone disease in patients with chronic liver disease is likely to play an important role. The aim of this study was to evaluate bone mineral density in adult patients with chronic liver disease prior to liver transplantation. A total of 243 consecutive patients (128 male, 115 female; mean age 51.1years) with chronic liver disease undergoing assessment for transplantation, were recruited over a 4-year period. BMD measurements were made using dual energy X-ray absorptiometry in the lumbar spine (L1-L4) and femoral neck (FN). Osteoporosis and osteopenia were defined by WHO criteria. Osteoporosis at either L1-L4 or FN was present in 36.6%, osteopenia in 48.1%, and normal BMD in only 15.2% of patients. There was no difference in prevalence of osteoporosis between males and females (P = 0.442). Women with osteoporosis were on average 10 years older (56.2 +/- 1.4 years) than those with normal bone density (46.4 +/- 2.3 years) P = 0.002; in men, no statistically significant age effect was found. Patients with osteoporosis had on average lower body weight than those with normal bone density (64.9 +/- 1.8 kg vs 74.2 +/- 2.2 kg) P = 0.003. T-scores in patients with cholestatic liver disease were lower than in non-cholestatic disease and the lowest BMD values were found in patients with cystic fibrosis. Logistic regression revealed that in women, increasing age (P = 0.004; OR = 1.12; CI 1.04-1.21) and lower body weight (P = 0.01; OR = 0.95; CI 0.91-0.99) were significant independent risk factors for osteoporosis but menopausal status (P = 0.1; OR = 0.24; CI 0.05-1.32) and presence or absence of cholestasis (P = 0.326; OR = 1.54; CI 0.65-3.67) were not. There were no independent risk factors in men. This study demonstrates a high prevalence of osteoporosis in patients with chronic liver disease prior to liver transplantation, men and women being equally affected. With the exception of increasing age and lower body weight in women, no independent risk factors were found, emphasizing the importance of BMD measurements in these patients and the need for prophylactic measures to optimize bone health.
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Affiliation(s)
- M Ninkovic
- Department of Medicine, University of Cambridge School of Clinical Medicine, UK
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50
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Abstract
Hypercholesterolemia is a common complication of liver transplantation and is a risk factor for cardiovascular disease after renal and heart transplant. The effect of hyperlipidemia after liver transplantation is less certain, but a less favorable outcome is to be expected. 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins have proven efficacy in reducing serum cholesterol and mortality from cardiovascular disease in the general population. Early evidence shows that statins are safe and effective in treating hypercholesterolemia after liver transplantation. Studies in cardiovascular disease have shown that statins exhibit beneficial properties independent of lipid-lowering. These include anti-inflammatory effects and improvement in endothelial function. Recently, statins were shown to repress induction of major histocompatibility complex class II complexes by interferon-gamma, which in turn suppresses activation of T lymphocytes. Such effects may assume significance when using statins after solid-organ transplants. Pravastatin has been shown to reduce acute rejection after cardiac and renal transplantation and to also reduce natural killer cell cytotoxicity in these populations. It remains to be seen whether statins will demonstrate similar benefits after liver transplantation.
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Affiliation(s)
- D A Neal
- Department of Medicine, University of Cambridge, School of Clinical Medicine, Addenbrooke's NHS Trust, Cambridge, UK
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