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Naganuma M, Nakamura N, Kunisaki R, Matsuoka K, Yamamoto S, Kawamoto A, Saito D, Kobayashi T, Nanki K, Narimatsu K, Shiga H, Esaki M, Yoshioka S, Kato S, Saruta M, Tanaka S, Yasutomi E, Yokoyama K, Moriya K, Tsuzuki Y, Ooi M, Fujiya M, Nakazawa A, Takagi T, Omori T, Tahara T, Hisamatsu T. Medical treatment selection and outcomes for hospitalized patients with severe ulcerative colitis as defined by the Japanese criteria. J Gastroenterol 2024; 59:302-314. [PMID: 38277006 DOI: 10.1007/s00535-024-02079-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Hospitalization for ulcerative colitis (UC) is potentially life-threatening. Severe disease in the Japanese criteria which modifies the Truelove-Witts' criteria might encompass more fulminant cases than the definition for acute severe UC. However, few studies have investigated the predictive factors for clinical remission (CR) after medical treatments for severe hospitalized patients by Japanese criteria. METHODS Medical treatment selection, CR rates, and factors contributing to CR on day 14 were assessed in severe patients by Japanese criteria. We also investigated whether the reduction rate in patient-reported outcome 2 (PRO2) on day 3 could predict short-term prognosis. RESULTS Eighty-five severe hospitalized patients were selected. Corticosteroids, tacrolimus, and infliximab were mainly selected as first-line treatments (76/85; 89.4%). The CR rates on day 14 were 26.8%, 21.4%, and 33.3% in patients receiving corticosteroids, tacrolimus, and infliximab, respectively. Extensive disease (odds ratio [OR] 0.022; 95% confidence interval [CI] 0.002-0.198), higher PRO2 (OR 0.306; 95% CI 0.144-0.821), and higher reduction rate in PRO2 on day 3 (OR 1.047; 95% CI 1.019-1.075) were independent factors predicting CR on day 14. If the cutoff value for the reduction rate in PRO2 on day 3 was 18.3%, sensitivity was 0.714 and specificity was 0.731 to predict CR on day 14. A higher reduction rate in PRO2 on day 3 (OR 0.922; 95% CI 0.853-0.995) was a negative factor to predict surgery within 28 days. CONCLUSIONS Tacrolimus and infliximab in addition to corticosteroids were used as first-line treatment in severe hospitalized patients. PRO2 on day 3 is a useful marker for switching to second-line therapy or colectomy.
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Affiliation(s)
- Makoto Naganuma
- Division of Gastroenterology and Hepatology, Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Naohiro Nakamura
- Division of Gastroenterology and Hepatology, Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuyoshi Matsuoka
- Department of Gastroenterology, Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan
| | - Shojiro Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Saito
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kosaku Nanki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defence Medical University, Tokorozawa, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinichiro Yoshioka
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Tanaka
- Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Eriko Yasutomi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kaoru Yokoyama
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Makoto Ooi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Atsushi Nakazawa
- Department of Gastroenterology, Saiseikai General Hospital, Tokyo, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teppei Omori
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Tahara
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka, Japan
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Moriya K, Hara R, Tomooka F, Shimozato N, Nishimura N, Kawaratani H, Yoshiji H. Concurrent Ulcerative Colitis in a Pregnant Patient with Rheumatoid Arthritis. Intern Med 2024; 63:385-391. [PMID: 37316274 PMCID: PMC10901711 DOI: 10.2169/internalmedicine.1833-23] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/09/2023] [Indexed: 06/16/2023] Open
Abstract
We herein report a rare concurrent case of ulcerative colitis (UC) in a pregnant woman with rheumatoid arthritis (RA), which was well managed by biologics. When a 32-year-old woman with seropositive RA became pregnant, she began experiencing hematochezia; colonoscopy revealed diffuse inflammation with multiple ulcers. Based on clinical examinations and pathological assessments, she was diagnosed with severe UC. Although prednisolone had no curative effect and infliximab caused an infusion reaction, golimumab successfully induced remission with normal delivery. This case report describes the successful treatment of a pregnant woman with UC and RA through biologics administration.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Ryota Hara
- Department of Orthopedic Surgery, Nara Medical University, Japan
| | - Fumimasa Tomooka
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Naotaka Shimozato
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
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Moriya K, Saeki K, Nishimura N, Sato S, Sawada Y, Takaya H, Kaji K, Kawaratani H, Namisaki T, Akahane T, Yoshiji H. Zinc Supplementation and an Improved Quality of Life in Patients with Autoimmune Hepatitis. Intern Med 2024; 63:145-152. [PMID: 37197963 PMCID: PMC10864085 DOI: 10.2169/internalmedicine.1817-23] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/30/2023] [Indexed: 05/19/2023] Open
Abstract
Objecive Patients with autoimmune hepatitis (AIH) reportedly have an impaired quality of life (QOL), mainly due to depression, even during remission. In addition, hypozincaemia has been demonstrated in patients with chronic liver disease, including AIH, and is known to be related to depression. Corticosteroids are known to cause mental instability. We therefore investigated the longitudinal association between zinc supplementation and changes in the mental status among AIH patients treated with corticosteroids. Materials This study enrolled 26 patients with serological remission of AIH routinely treated at our facility after excluding 15 patients who either discontinued polaprezinc (150 mg/day) within 24 months or interrupted treatment. Two questionnaires, the Chronic Liver Disease Questionnaire (CLDQ) and SF-36, were adopted to evaluate the QOL before and after zinc supplementation. Results Serum zinc levels were significantly elevated after zinc supplementation (p<0.0001). The CLDQ worry subscale significantly improved after zinc supplementation (p=0.017), but none of the SF-36 subscales was affected. Multivariate analyses demonstrated that daily prednisolone dosing was inversely related to both the CLDQ worry domain score (p=0.036) and the SF-36 mental health component (p=0.031). There was a significant negative correlation between the changes in the daily steroid dose and the CLDQ worry domain scores before and after zinc supplementation (p=0.006). No serious adverse events occurred during the observation period. Conclusion Zinc supplementation safely and efficiently improved mental impairment, possibly caused by continuous treatment with corticosteroids, in patients with AIH.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Shinya Sato
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Kosuke Kaji
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Takemi Akahane
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
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Kiyohara H, Yamazaki H, Moriya K, Akimoto N, Kawai S, Takenaka K, Fukuda T, Tominaga K, Umeno J, Shinzaki S, Honzawa Y, Takagi T, Ichikawa H, Endo T, Ozaki R, Andoh A, Matsuoka K, Hibi T, Kobayashi T. White Blood Cell Counts and Future Relapse in Ulcerative Colitis under Low-Dose Thiopurine Treatment in Real-World Practice: A 3-Year Japanese Multi-Center Retrospective Cohort Study. Inflamm Intest Dis 2024; 9:1-10. [PMID: 38298887 PMCID: PMC10830139 DOI: 10.1159/000535889] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/15/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Whether white blood cell (WBC) counts are predictors for the effectiveness of thiopurine treatment in ulcerative colitis (UC) has been inconclusive in previous studies with small sample sizes. We investigated the association between WBC counts and future relapses in UC patients in a large-scale multi-center study. Methods This retrospective cohort study enrolled a total of 723 UC patients in remission from 33 hospitals and followed up for 3 years. Relapse was defined as a need for treatment intensification. The risk of relapse was compared among patients with the baseline WBC counts <3,000/µL (N = 31), 3,000-4,000/µL (N = 167), 4,000-5,000/µL (N = 241), and ≥5,000/µL (N = 284) using a Cox regression model analysis. Moreover, exploratory analyses were conducted to identify other factors predicting relapse. Results During a median follow-up period of 1,095 (interquartile range, 1,032-1,119) days, relapse occurred in 17.2% (125/723). In a crude analysis, WBC counts were not associated with relapse; hazard ratios (HRs) (95% confidence interval [CI]) were 1.50 (0.74-3.06), 1.02 (0.66-1.59), and 0.67 (0.43-1.05) in WBC <3,000/µL, 3,000-4,000/µL, and 4,000-5,000/µL groups, respectively (WBC ≥5,000/µL group, as reference). Multivariable-adjusted analyses showed similar results; HRs (95% CI) were 1.21 (0.59-2.49), 1.08 (0.69-1.69), and 0.69 (0.44-1.07), in <3,000/µL, 3,000-4,000/µL, and 4,000-5,000/µL groups, respectively. In the exploratory analyses, thiopurine use <1 year and a mean corpuscular volume <90 fL were predictors for relapse. Discussion/Conclusion WBC counts were not predictors for future relapses in patients with UC treated with thiopurine as a maintenance therapy.
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Affiliation(s)
- Hiroki Kiyohara
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
| | - Naohiko Akimoto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shoichiro Kawai
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Fukuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan
| | - Yusuke Honzawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Ichikawa
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Toshiyuki Endo
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Ryo Ozaki
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akira Andoh
- Department of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - IBD Terakoya Group
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
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Naganuma M, Kobayashi T, Kunisaki R, Matsuoka K, Yamamoto S, Kawamoto A, Saito D, Nanki K, Narimatsu K, Shiga H, Esaki M, Yoshioka S, Kato S, Saruta M, Tanaka S, Yasutomi E, Yokoyama K, Moriya K, Tsuzuki Y, Ooi M, Fujiya M, Nakazawa A, Abe T, Hisamatsu T. Real-world efficacy and safety of advanced therapies in hospitalized patients with ulcerative colitis. J Gastroenterol 2023; 58:1198-1210. [PMID: 37831183 DOI: 10.1007/s00535-023-02048-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND This multicenter observational cohort study aimed to evaluate the utilization and short-term efficacy of advanced therapy (AT) in hospitalized patients with acute severe ulcerative colitis (ASUC). METHODS In total, 221 patients with ASUC were enrolled between August 2020 and July 2021. The primary endpoint was clinical remission (CR, defined as a patient-reported outcome score < 2 with no blood in the stool) rate on Day 7 and 14 in hospitalized patients who received corticosteroids (CS) and AT. RESULTS Among patients with ASUC, 120 and 101 patients received CS or any AT as first-line treatment, respectively. The CR rates on Day 7 and 14 were 22.5% and 35.0%, respectively, in hospitalized patients who received CS as first-line treatment. Most patients who used ATs had CS-dependent or frequent recurrences. Eight different ATs (apheresis, tacrolimus, infliximab, golimumab, tofacitinib, vedolizumab, ustekinumab, and cyclosporine) were used as first-line treatment in patients with ASUC, and the CR rates on Day 7 and 14 were 16.8% and 29.7%, respectively. Twenty-five patients received the second ATs after hospitalizations, and the CR rates on Day 7 and 14 were 0% and 12%, respectively. The CR rates on Day 14 were significantly higher in patients who changed to AT than in those whose dose of CS increased (34.0% vs 10.7%, p = 0.020) among patients who had already used CS before hospitalization. CONCLUSION Most first-use ATs were effective for patients with ASUC, while second-use ATs might have had limited benefits in inducing CR. These findings may contribute to considerations for the management of hospitalized patients.
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Affiliation(s)
- Makoto Naganuma
- Division of Gastroenterology and Hepatology, Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology, Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan
| | - Shojiro Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Saito
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka, Japan
| | - Kosaku Nanki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defence Medical University, Tokorozawa, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinichiro Yoshioka
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Tanaka
- Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Eriko Yasutomi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kaoru Yokoyama
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Makoto Ooi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Mikihiro Fujiya
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Atsushi Nakazawa
- Department of Gastroenterology, Saiseikai General Hospital, Tokyo, Japan
| | - Takayuki Abe
- School of Data Science, Yokohama City University, Yokohama, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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Moriya K, Nagamatsu S, Uejima M, Matsuo H. Increasing evidence for the efficacy of hepatic arterial infusion chemotherapy combined with systemic therapy for advanced hepatocellular carcinoma with macrovascular invasion: time to consider a more effective approach. J Gastrointest Oncol 2023; 14:2282-2286. [PMID: 37969841 PMCID: PMC10643572 DOI: 10.21037/jgo-23-760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Kei Moriya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara, Japan
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Japan
| | - Shinsaku Nagamatsu
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara, Japan
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Japan
| | - Masakazu Uejima
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Japan
| | - Hideki Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara, Japan
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Japan
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Watanabe K, Nojima M, Nakase H, Sato T, Matsuura M, Aoyama N, Kobayashi T, Sakuraba H, Nishishita M, Yokoyama K, Esaki M, Hirai F, Nagahori M, Nanjo S, Omori T, Tanida S, Yokoyama Y, Moriya K, Maemoto A, Handa O, Ohmiya N, Tsuchiya K, Shinzaki S, Kato S, Uraoka T, Tanaka H, Takatsu N, Nishida A, Umeno J, Nakamura M, Mishima Y, Fujiya M, Tsuchida K, Hiraoka S, Okabe M, Toyonaga T, Matsuoka K, Andoh A, Hirota Y, Hisamatsu T. Trajectory analyses to identify persistently low responders to COVID-19 vaccination in patients with inflammatory bowel disease: a prospective multicentre controlled study, J-COMBAT. J Gastroenterol 2023; 58:1015-1029. [PMID: 37561155 DOI: 10.1007/s00535-023-02029-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The degree of immune response to COVID-19 vaccination in inflammatory bowel disease (IBD) patients based on actual changes in anti-SARS-CoV-2 antibody titres over time is unknown. METHODS Data were prospectively acquired at four predetermined time points before and after two vaccine doses in a multicentre observational controlled study. The primary outcome was humoral immune response and vaccination safety in IBD patients. We performed trajectory analysis to identify the degree of immune response and associated factors in IBD patients compared with controls. RESULTS Overall, 645 IBD patients and 199 control participants were analysed. At 3 months after the second vaccination, the seronegative proportions were 20.3% (combination of anti-tumour necrosis factor [TNF]α and thiopurine) and 70.0% (triple combination including steroids), despite that 80.0% receiving the triple combination therapy were seropositive at 4 weeks after the second vaccination. Trajectory analyses indicated three degrees of change in immune response over time in IBD patients: high (57.7%), medium (35.6%), and persistently low (6.7%). In the control group, there was only one degree, which corresponded with IBD high responders. Older age, combined anti-TNFα and thiopurine (odds ratio [OR], 37.68; 95% confidence interval [CI], 5.64-251.54), steroids (OR, 21.47; 95%CI, 5.47-84.26), and tofacitinib (OR, 10.66; 95%CI, 1.49-76.31) were factors associated with persistently low response. Allergy history (OR, 0.17; 95%CI, 0.04-0.68) was a negatively associated factor. Adverse reactions after the second vaccination were significantly fewer in IBD than controls (31.0% vs 59.8%; p < 0.001). CONCLUSIONS Most IBD patients showed a sufficient immune response to COVID-19 vaccination regardless of clinical factors. Assessment of changes over time is essential to optimize COVID-19 vaccination, especially in persistently low responders.
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Affiliation(s)
- Kenji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan.
- Department of Internal Medicine for Inflammatory Bowel Disease, University of Toyama, 2630, Sugitani, Toyama, 930-0194, Japan.
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Japan
| | - Toshiyuki Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Shinkawa 6-20-2, Mitaka-shi, Mitaka, Tokyo, Japan
| | | | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Department of Gastroenterology, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, Japan
| | - Masakazu Nishishita
- Nishishita Gastrointestinal Hospital, 4-15, Kitakawahori-cho, Tennoji-ku, Osaka, Japan
| | - Kaoru Yokoyama
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, 1-1,5-Chome, Nabeshima, Saga, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, Japan
| | - Masakazu Nagahori
- Clinical Research Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Sohachi Nanjo
- Third Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, Japan
| | - Teppei Omori
- Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Tanida
- Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yoshihiro Yokoyama
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Atsuo Maemoto
- IBD Center, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-ku, Sapporo, Japan
| | - Osamu Handa
- Department of Internal Medicine, Division of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, Japan
| | - Shinichiro Shinzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, Japan
| | - Hiroki Tanaka
- Sapporo IBD Clinic, 1-18, Minami-19, Nishi-8, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Noritaka Takatsu
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, 1-1-1, Zokumyoin, Chikushino, Fukuoka, Japan
| | - Atsushi Nishida
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan
| | - Masanao Nakamura
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, 1060 Nishikawatsu-cho, Matsue,, Shimane, Japan
| | - Mikihiro Fujiya
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, Japan
| | - Kenji Tsuchida
- Gastroenterology, Nagoya City University West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, Aichi, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Makoto Okabe
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Takahiko Toyonaga
- Division of Internal Medicine, Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-19-18 Nishi-Shimbashi, Minato-ku, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, 564-1, Shimoshidu, Sakura, Chiba, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, SOUSEIKAI Medical Group (Medical Co. LTA), 3-6-1, Kashii-Teriha, Higashi-ku, Fukuoka, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Shinkawa 6-20-2, Mitaka-shi, Mitaka, Tokyo, Japan
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Moriya K, Nakakita T, Nakayama N, Matsuo Y, Komeda Y, Hanatani J, Kaya D, Nagamatsu S, Matsuo H, Uejima M, Nakamura F. SARS-CoV-2 Vaccination Response in Japanese Patients with Autoimmune Hepatitis: Results of Propensity Score-Matched Case-Control Study. J Clin Med 2023; 12:5411. [PMID: 37629453 PMCID: PMC10455609 DOI: 10.3390/jcm12165411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND/AIMS Although the World Health Organization declared the end of the public health emergency of international concern focusing on COVID-19 in May 2023, this bothersome virus continues to mutate, and the possibility of the emergence of mutant strains with high infectivity and severe disease rates has not disappeared. Thus, medical evidence must be accumulated, which is indispensable for protecting both patients under immunosuppressive treatments and the healthy population. This study examined SARS-CoV-2 vaccination responses in Japanese patients with autoimmune hepatitis (AIH) compared with healthy controls. METHODS This observational study registered 22 patients with histologically diagnosed AIH and 809 healthy controls in our hospital. Their Elecsys anti-SARS-CoV-2 spike antibody concentrations before and after vaccination were evaluated. RESULTS In this study, 72.7% and 18.2% of patients with AIH received steroids and azathioprine, respectively. Significant negative correlations were found between age and anti-SARS-CoV-2 spike antibody concentration in both groups; however, no sex differences were found. Although anti-SARS-CoV-2 spike antibody concentration was drastically augmented after the second vaccination (p < 0.05) in the AIH group, these levels were significantly lower than those in the controls (p < 0.05). In the age- and sex-matched analysis, the population ratio with a minimum response (≤100 binding antibody units (BAU/mL) was higher among patients with AIH than among controls 26 weeks after the second vaccination (44% vs. 7%, p < 0.05). CONCLUSIONS The anti-SARS-CoV-2 spike antibody concentration in AIH patients was significantly lower than that in controls after the second vaccination. Continued and widespread vaccination, particularly for patients requiring medical immunomodulation, is recommended.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Tomoko Nakakita
- Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Natsuki Nakayama
- Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Yuya Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
| | - Yusuke Komeda
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Junichi Hanatani
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Shinsaku Nagamatsu
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Hideki Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Nara 630-8581, Japan; (Y.M.)
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
| | - Masakazu Uejima
- Department of Gastroenterology, Nara Medical University, Nara 634-8521, Japan
- Department of Diabetes and Endocrinology, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Fumihiko Nakamura
- Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
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Moriya K, Sato S, Nishimura N, Kawaratani H, Takaya H, Kaji K, Namisaki T, Uejima M, Nagamatsu S, Matsuo H, Yoshiji H. Efficacy of Serum Ferritin-Zinc Ratio for Predicting Advanced Liver Fibrosis in Patients with Autoimmune Hepatitis. J Clin Med 2023; 12:4463. [PMID: 37445498 DOI: 10.3390/jcm12134463] [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] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Background/Aims: The search for noninvasive biomarkers that can efficiently estimate the extent of liver fibrosis progression is ongoing. Although Fibrosis-4 (FIB-4), the aspartate transaminase-to-platelet ratio index (APRI), and the Forns index have been reported as useful biomarkers, their investigation in autoimmune hepatitis (AIH) is limited. This study aimed to examine the usefulness of these serological indices and a newly developed index in predicting liver fibrosis progression in AIH. Methods: The study analyzed data from 190 patients diagnosed with AIH at our institution between 1990 and 2015. Their histological liver fibrosis progression and clinical long-term prognosis were evaluated retrospectively (cohort 1). In 90 patients, receiver operating characteristic (ROC) curves were compared to choose severe fibrosis cases with respect to existing indices (FIB-4, APRI, and Forns index) and the ferritin-zinc ratio (cohort 2). Results: In cohort 1, liver-related death and hepatocellular carcinoma rates were significantly higher in the severe (n = 27) than in the mild (n = 63) fibrosis group (p = 0.0001 and 0.0191, respectively). In cohort 2, liver-related death in the severe fibrosis group was significantly frequent (p = 0.0071), and their ferritin-zinc ratio was higher (median 2.41 vs. 0.62, p = 0.0011). ROC analyses were performed to compare the ability of the ferritin-zinc ratio, FIB-4, APRI, and the Forns index to predict severe and mild fibrosis. Accordingly, areas under the ROC were 0.732, 0.740, 0.721, and 0.729, respectively. Conclusions: The serum ferritin-zinc ratio can noninvasively predict liver fibrosis progression in AIH and be applied to predict long-term prognosis.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
- Department of Gastroenterology, Nara Prefecture General Medical Center, 897-5, 2-Chome, Shichijo-Nishimachi, Nara 630-8581, Japan
| | - Shinya Sato
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
| | - Masakazu Uejima
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
- Department of Gastroenterology, Nara Prefecture General Medical Center, 897-5, 2-Chome, Shichijo-Nishimachi, Nara 630-8581, Japan
| | - Shinsaku Nagamatsu
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
- Department of Gastroenterology, Nara Prefecture General Medical Center, 897-5, 2-Chome, Shichijo-Nishimachi, Nara 630-8581, Japan
| | - Hideki Matsuo
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
- Department of Gastroenterology, Nara Prefecture General Medical Center, 897-5, 2-Chome, Shichijo-Nishimachi, Nara 630-8581, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan
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Takaya H, Namisaki T, Enomoto M, Kubo T, Tsuji Y, Fujinaga Y, Nishimura N, Kaji K, Kawaratani H, Moriya K, Akahane T, Matsumoto M, Yoshiji H. The Ratio of von Willebrand Factor Antigen to ADAMTS13 Activity: Usefulness as a Prognostic Biomarker in Acute-on-Chronic Liver Failure. Biology (Basel) 2023; 12:biology12020164. [PMID: 36829443 PMCID: PMC9952680 DOI: 10.3390/biology12020164] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Acute-on-chronic liver failure (ACLF) has a high risk of short-term mortality. A disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) is a metalloproteinase that specifically cleaves multimeric von Willebrand factor (VWF). Imbalance between ADAMTS13 and VWF is associated with portal hypertension, which induces ACLF development. A previous study reported that ADAMTS13 activity (ADAMTS13:AC) and VWF antigen (VWF:Ag) are predictive biomarkers of ACLF development in patients with cirrhosis. This study investigated the changes in ADAMTS13:AC and VWF:Ag levels from before to after the development of ACLF to determine their usefulness as a prognostic biomarker in patients with ACLF. In total, 101 patients with cirrhosis were enrolled in this study. The level of ADAMTS13:AC and VWF:Ag was determined by an enzyme-linked immunosorbent assay. Cox proportional hazard regression analysis was conducted to determine independent prognostic factors for patients with liver cirrhosis in the post-ACLF group. ADAMTS13:AC levels gradually decreased in the order of non-ACLF group, pre-ACLF group, and finally post-ACLF group. VWF:Ag and the ratio of VWF:Ag to ADAMTS13:AC (VWF:Ag/ADAMTS13:AC) levels gradually increased in the order of non-ACLF group, pre-ACLF group, followed by post-ACLF group. VWF:Ag/ADAMTS13:AC and CLIF-C ACLF scores were associated with prognosis in the post-ACLF group in multivariate analysis. The cumulative survival of the post-ACLF group was significantly lower for patients with high VWF:Ag/ADAMTS13:AC (>9) compared with those with low VWF:Ag/ADAMTS13:AC (≤9) (HR: 10.72, 95% confidence interval: 1.39-82.78, p < 0.05). The VWF:Ag/ADAMTS13:AC increased according to the progression of ACLF in patients with cirrhosis and predicted prognosis in patients with cirrhosis with ACLF.
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Affiliation(s)
- Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
- Correspondence: ; Tel.: +81-744-22-3051; Fax: +81-744-24-7122
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Takahiro Kubo
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara 634-8522, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Japan
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Moriya K, Asada K, Suzuki S, Enomoto M, Fujinaga Y, Tsuji Y, Namisaki T, Yoshiji H. Benefit of glucosyl Hesperidin in patients with primary biliary cholangitis: A multicenter, open-label, randomized control study. Medicine (Baltimore) 2022; 101:e32127. [PMID: 36482520 PMCID: PMC9726400 DOI: 10.1097/md.0000000000032127] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Globally, the number of patients with primary biliary cholangitis (PBC) is increasing. Growing evidence suggests that oxidative stress plays a significant role in the pathogenesis of chronic liver disease regardless of its etiology. Hesperidin, a natural antioxidative substance derived from citrus peel, has been shown to have an anti-inflammatory effect in a rat arthritis model and may be a potential substance to attenuate intrahepatic inflammation in patients with PBC. In this study, the potential of glucosyl hesperidin as a therapeutic agent for PBC will be investigated through antioxidative stress mechanisms. METHODS Patients with PBC who are 20 years or older will be eligible to participate. Patients will be assigned to 1 of 2 groups and given either 500 or 1000 mg of glucosyl hesperidin per day. The primary endpoint is the ratio of changes in serum gamma-glutamyl transferase levels before and after 24 weeks of glucosyl hesperidin administration. The secondary endpoints are serum hepatobiliary enzyme levels (alkaline phosphatase, transaminase, and total bilirubin levels) and the protein expression levels of nuclear factor erythroid 2-related factor 2 and its target molecule 8, 16, and 24 weeks after administration compared to before administration. DISCUSSION The prospective clinical interventional study was designed to assess the supportive effect of glucosyl hesperidin on hepatic function in patients with PBC receiving basic ursodeoxycholic acid treatment.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyoshi Asada
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Nara, Japan
| | - Shota Suzuki
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Nara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Hepatology, Nara Medical University, Kashihara, Nara, Japan
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Hori D, Kobayashi R, Nakazawa A, Iwafuchi H, Klapper W, Osumi T, Fujita N, Mitsui T, Koga Y, Mori T, Fukano R, Ohki K, Kamei M, Mori T, Tanaka M, Tsuchimochi T, Moriya K, Tao K, Kada A, Sekimizu M. NON-GERMINAL CENTER B-CELL SUBTYPE OF PEDIATRIC DISFFUSE LARGE B-CELL LYMPHOMA IN JAPAN: A MULTI-CASE ANALYSIS. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Watanabe T, Kamimura K, Shirahata M, Moriya K. Continuous ulnar nerve block at the forearm for early active mobilisation following flexor tendon reconstruction. Anaesth Rep 2022; 10:e12180. [PMID: 36237495 PMCID: PMC9535094 DOI: 10.1002/anr3.12180] [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] [Accepted: 07/08/2022] [Indexed: 12/29/2022] Open
Abstract
A 63-year-old woman had sustained a subcutaneous rupture of the flexor digitorum profundus tendon of the little finger due to osteoarthritis of the pisotriquetral joint. She underwent excision of the pisiform bone and reconstruction of the flexor digitorum profundus tendon of the little finger using an autogenous palmaris longus tendon graft. After surgery, a continuous ulnar nerve block was performed at the forearm under ultrasound and nerve stimulator guidance. During rehabilitation, she could not actively extend her little finger independently due to the block; however, she could actively extend it when the dorsum of the metacarpophalangeal joint was pressed by the occupational therapist, resulting in successful early active mobilisation. A continuous ulnar nerve block at the forearm may help to facilitate early active mobilisation after reconstructive surgery for little finger flexor tendon rupture. However, it may restrict the active extension of the little finger because the block does not spare the innervation of the intrinsic muscles responsible for little finger extension.
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Affiliation(s)
- T. Watanabe
- Department of Anaesthesiology, Uonuma Institute of Community MedicineNiigata University Medical and Dental HospitalMinami‐UonumaNiigataJapan
| | - K. Kamimura
- Department of Orthopaedic SurgeryUonuma Kikan HospitalMinami‐UonumaNiigataJapan
| | - M. Shirahata
- Department of Orthopaedic SurgeryUonuma Kikan HospitalMinami‐UonumaNiigataJapan
| | - K. Moriya
- Niigata Hand Surgery FoundationSeiroNiigataJapan
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Namisaki T, Tsuji Y, Kitade M, Yorioka N, Fujinaga Y, Sawada Y, Nishimura N, Kitagawa K, Inoue T, Takaya H, Kaji K, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Endotoxin Activity Reflects an Increase in Body Temperature in Cirrhotic Patients With Ascites Undergoing Cell-free and Concentrated Ascites Reinfusion Therapy. In Vivo 2022; 36:1477-1484. [PMID: 35478114 DOI: 10.21873/invivo.12854] [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] [Received: 03/07/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ascites commonly complicates cirrhosis and is refractory to the vasopressin-2 antagonist tolvaptan and fluid restriction in approximately 60% of patients. We aimed to identify risk factors associated with adverse events following cell-free and concentrated ascites reinfusion therapy (CART) in patients with cirrhosis and ascites. PATIENTS AND METHODS We evaluated the efficacy and tolerability to the CART system in 18 patients with decompensated liver cirrhosis and ascites. We determined serum endotoxin activity using endotoxin activity (EA) assays and serum and ascitic fluid concentrations of interleukin 6 (IL6) and tumor necrosis factor-α (TNFα) before and after the CART procedures. RESULTS Body weight and waist circumference significantly decreased after CART (both p<0.001). Body temperature (BT) increased significantly at an average rate of 1.1°C during CART (p<0.001). The change in BT was correlated with EA and not interleukin IL6 or TNFα. The rise in BT was positively correlated with serum EA levels at baseline. The increase in BT was significantly higher in the group with high EA (≥0.37) than in the low EAA group (<0.37) (p=0.02). TNFα and serum IL6 levels in ascites were significantly increased during CART (both p<0.001). However, no significant differences in the EA, serum TNFα or IL6 levels were found in ascitic fluid before and after the CART procedures. CONCLUSION Although this discovery warrants further study, EA assay can indicate an increase in BT during effective CART in patients with cirrhosis and ascites.
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Affiliation(s)
- Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Nara, Japan;
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Mitsuteru Kitade
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Nobuyuki Yorioka
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | | | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
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15
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Kitagawa K, Mitoro A, Ozutsumi T, Furukawa M, Fujinaga Y, Seki K, Nishimura N, Sawada Y, Kaji K, Kawaratani H, Takaya H, Moriya K, Namisaki T, Akahane T, Yoshiji H. Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study. Clin Endosc 2022; 55:434-442. [PMID: 34706489 PMCID: PMC9178141 DOI: 10.5946/ce.2021.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/17/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND/AIMS Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs. METHODS To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems. RESULTS In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups. CONCLUSION The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.
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Affiliation(s)
- Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takahiro Ozutsumi
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Masanori Furukawa
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kenichiro Seki
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | | | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
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16
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Enomoto M, Takaya H, Namisaki T, Fujinaga Y, Nishimura N, Sawada Y, Kaji K, Kawaratani H, Moriya K, Akahane T, Inoue T, Matsumoto M, Yoshiji H. Ratio of von Willebrand factor antigen to ADAMTS13 activity is a useful biomarker for acute-on-chronic liver failure development and prognosis in patients with liver cirrhosis. Hepatol Res 2022; 52:390-400. [PMID: 34964539 DOI: 10.1111/hepr.13743] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/06/2021] [Accepted: 12/26/2021] [Indexed: 01/21/2023]
Abstract
AIM Acute-on-chronic liver failure (ACLF) is associated with a high risk of short-term mortality after progression to multiple organ failure. A disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) is a metalloproteinase that specifically cleaves multimeric von Willebrand factor (VWF). An imbalance between ADAMTS13 enzyme and VWF substrate is associated with liver cirrhosis progression that induces ACLF. This study examined the relationship between ADAMTS13 and VWF and ACLF development to determine whether ADAMTS13 and VWF are useful predictive biomarkers for ACLF development and prognosis of patients with liver cirrhosis. METHODS The study enrolled 67 patients with Child-Pugh class A and B liver cirrhosis. ADAMTS13 activity (ADAMTS13:AC) and VWF antigen (VWF:Ag) were measured using enzyme-linked immunosorbent assays. The ratio of VWF:Ag to ADAMTS13:AC (VWF:Ag/ADAMTS13:AC) was used to divide patients into two groups according to the classification and regression tree based on Gray model survival analysis. RESULTS Compared with patients with Child-Pugh class A liver cirrhosis, class B patients had a higher VWF:Ag/ADAMTS13:AC and a higher risk of ACLF development. Cumulative incidence of ACLF was significantly higher in patients with high (>7.9) versus low (≤7.9) VWF:Ag/ADAMTS13:AC (hazard ratio [HR], 6.50; 95% CI, 2.31-18.29; p < 0.001). Cumulative survival was significantly lower in cirrhotic patients with high versus low VWF:Ag/ADAMTS13:AC (HR 5.11; 95% CI, 1.85-14.14; p = 0.002). CONCLUSIONS For patients with liver cirrhosis, VWF:Ag/ADAMTS13:AC is associated with functional liver reserve and predicts the development of ACLF and the prognosis.
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Affiliation(s)
- Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
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17
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Murata K, Namisaki T, Fujimoto Y, Takeda S, Enomoto M, Takaya H, Tsuji Y, Shibamoto A, Suzuki J, Kubo T, Iwai S, Tomooka F, Tanaka M, Kaneko M, Asada S, Koizumi A, Yorioka N, Matsuda T, Ozutsumi T, Ishida K, Ogawa H, Takagi H, Fujinaga Y, Furukawa M, Sawada Y, Nishimura N, Kitagawa K, Sato S, Kaji K, Inoue T, Asada K, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Clinical Significance of Serum Zinc Levels on the Development of Sarcopenia in Cirrhotic Patients. Cancer Diagn Progn 2022; 2:184-193. [PMID: 35399181 PMCID: PMC8962814 DOI: 10.21873/cdp.10093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Sarcopenia increases the mortality in patients with cirrhosis. Approximately 60% of zinc is accumulated in skeletal muscle. We aimed to determine the role of subclinical zinc deficiency on sarcopenia development in patients with cirrhosis. PATIENTS AND METHODS We enrolled 151 patients with cirrhosis and divided them into the group with normal serum zinc levels (Group N: 80-130 μg/dl; n=38) and group with subclinical zinc deficiency (Group D: <80 μg/dl; n=113). The risk factors for sarcopenia were then investigated. RESULTS Group D had more sarcopenia cases than Group N (31.0% vs. 13.2%). In group D, HGS exhibited a weakly positive but significant correlation with serum zinc levels (R=0.287, p=0.00212), serum zinc levels negatively correlated with both ammonia and myostatin levels (R=-0.254, p=0.0078; R=-0.33, p<0.01), and low zinc levels were independently associated with sarcopenia development. CONCLUSION Patients with cirrhosis showing subclinical zinc deficiency have a significantly higher risk of developing sarcopenia.
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Affiliation(s)
- Koji Murata
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yuki Fujimoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Soichi Takeda
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Akihiko Shibamoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Junya Suzuki
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takahiro Kubo
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Satoshi Iwai
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Fumimasa Tomooka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Misako Tanaka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Miki Kaneko
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Shohei Asada
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Aritoshi Koizumi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Nobuyuki Yorioka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takuya Matsuda
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takahiro Ozutsumi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Koji Ishida
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hiroyuki Ogawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hirotetsu Takagi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Masanori Furukawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Shinya Sato
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Kiyoshi Asada
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Kei Moriya
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Akira Mitoro
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
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18
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Aihara Y, Moriya K, Ishida E. Rare case of early jejunal cancer with laterally spreading tumor-like appearance. Dig Endosc 2022; 34:246. [PMID: 34657334 DOI: 10.1111/den.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yosuke Aihara
- Department of, Gastroenterology and Hepatology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
| | - Eiwa Ishida
- Department of, Pathology, Nara Prefecture General Medical Center, Nara, Japan
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19
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Inoue T, Funatsu Y, Ohnishi M, Isogawa M, Kawashima K, Tanaka M, Moriya K, Kawaratani H, Momoda R, Iio E, Nakagawa H, Suzuki Y, Matsuura K, Fujiwara K, Nakajima A, Yoshiji H, Nakayama J, Tanaka Y. Bile acid dysmetabolism in the gut-microbiota-liver axis under hepatitis C virus infection. Liver Int 2022; 42:124-134. [PMID: 34411400 DOI: 10.1111/liv.15041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/10/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS We recently analysed and reported the features of the micro biome under hepatitis C virus (HCV) infection, but the effect of HCV infection on bile acid (BA) metabolism in the gut-liver axis remains poorly understood. The aim of this study was to clarify the characteristics of the gut-liver axis in HCV-infected patients. METHODS The faecal BAs composition and gut microbiota from 100 chronic hepatitis C (CHC) patients were compared with those from 23 healthy individuals. For transcriptional analysis of the liver, 22 mild CHC (fibrosis stages [F] 0-2) and 42 advanced CHC (F3-4) cases were compared with 12 healthy individuals. The findings were confirmed using chimeric mice with human hepatocytes infected with HCV HCR6. RESULTS Chronic hepatitis C patients, even at earlier disease stages, showed BA profiles distinct from healthy individuals, in which faecal deoxycholic acid (DCA) was significantly reduced and lithocholic acid or ursodeoxycholic acid became dominant. The decrease in faecal DCA was correlated with reduction in commensal Clostridiales and increase in oral Lactobacillales. Impaired biosynthesis of cholic acid (CA) was observed as a reduction in the transcription level of cytochrome P450 8B1 (CYP8B1), a key enzyme in CA biosynthesis. The reductions in faecal DCA and liver CYP8B1 were also observed in HCV-infected chimeric mice. CONCLUSIONS Chronic hepatitis C alters the intestinal BA profile, in association with the imbalance of BA biosynthesis, which differs from the pattern in NAFLD. These imbalances appear to drive disease progression through the gut-microbiome-liver axis.
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Affiliation(s)
- Takako Inoue
- Department of Clinical Laboratory Medicine, Nagoya City University Hospital, Nagoya, Japan
| | - Yui Funatsu
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Masaya Ohnishi
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masanori Isogawa
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keigo Kawashima
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaru Tanaka
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Rie Momoda
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Etsuko Iio
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidewaki Nakagawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yutaka Suzuki
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Kentaro Matsuura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kei Fujiwara
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Jiro Nakayama
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Yasuhito Tanaka
- Department of Clinical Laboratory Medicine, Nagoya City University Hospital, Nagoya, Japan.,Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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20
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Fujimoto Y, Kaji K, Nishimura N, Enomoto M, Murata K, Takeda S, Takaya H, Kawaratani H, Moriya K, Namisaki T, Akahane T, Yoshiji H. Dual therapy with zinc acetate and rifaximin prevents from ethanol-induced liver fibrosis by maintaining intestinal barrier integrity. World J Gastroenterol 2021; 27:8323-8342. [PMID: 35068872 PMCID: PMC8717023 DOI: 10.3748/wjg.v27.i48.8323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic overload of gut-derived lipopolysaccharide dictates the progression of alcoholic liver disease (ALD) by inducing oxidative stress and activating Kupffer cells and hepatic stellate cells through toll-like receptor 4 signaling. Therefore, targeting the maintenance of intestinal barrier integrity has attracted attention for the treatment of ALD. Zinc acetate and rifaximin, which is a nonabsorbable antibiotic, had been clinically used for patients with cirrhosis, particularly those with hepatic encephalopathy, and had been known to improve intestinal barrier dysfunction. However, only few studies focused on their efficacies in preventing the ALD-related fibrosis development.
AIM To investigate the effects of a combined zinc acetate with rifaximin on liver fibrosis in a mouse ALD model.
METHODS To induce ALD-related liver fibrosis, female C57BL/6J mice were fed a 2.5% (v/v) ethanol-containing Lieber-DeCarli liquid diet and received intraperitoneal carbon tetrachloride (CCl4) injection twice weekly (1 mL/kg) for 8 wk. Zinc acetate (100 mg/L) and/or rifaximin (100 mg/L) were orally administered during experimental period. Hepatic steatosis, inflammation and fibrosis as well as intestinal barrier function were evaluated by histological and molecular analyses. Moreover, the direct effects of both agents on Caco-2 barrier function were assessed by in vitro assays.
RESULTS In the ethanol plus CCl4-treated mice, combination of zinc acetate and rifaximin attenuated oxidative lipid peroxidation with downregulation of Nox2 and Nox4. This combination significantly inhibited the Kupffer cells expansion and the proinflammatory response with blunted hepatic exposure of lipopolysaccharide and the toll-like receptor 4/nuclear factor kB pathway. Consequently, liver fibrosis and hepatic stellate cells activation were efficiently suppressed with downregulation of Mmp-2, -9, -13, and Timp1. Both agents improved the atrophic changes and permeability in the ileum, with restoration of tight junction proteins (TJPs) by decreasing the expressions of tumor necrosis factor α and myosin light chain kinase. In the in vitro assay, both agents directly reinforced ethanol or lipopolysaccharide-stimulated paracellular permeability and upregulated TJPs in Caco-2 cells.
CONCLUSION Dual therapy with zinc acetate and rifaximin may serve as a strategy to prevent ALD-related fibrosis by maintaining intestinal barrier integrity.
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Affiliation(s)
- Yuki Fujimoto
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Koji Murata
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Soichi Takeda
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara 6348521, Nara, Japan
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21
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Akahane T, Kaya D, Noguchi R, Kaji K, Miyakawa H, Fujinaga Y, Tsuji Y, Takaya H, Sawada Y, Furukawa M, Kitagawa K, Ozutsumi T, Kawaratani H, Moriya K, Namisaki T, Yoshiji H. Association between Equol Production Status and Nonalcoholic Steatohepatitis. Int J Mol Sci 2021; 22:ijms222111904. [PMID: 34769332 PMCID: PMC8585044 DOI: 10.3390/ijms222111904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/30/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
Equol is a metabolite of daidzein, a major soybean isoflavone with estrogenic and antioxidant activities. As the production of equol depends on the presence of certain members of the intestinal microflora, not all individuals can produce equol. We examined the relationship between NASH histological features and equol production. In an animal model, obese OLETF rats were intraperitoneally injected with a porcine serum to augment liver fibrogenesis. Equol-rich soy product, SE5-OH was orally administered during the experimental period. Treatment with SE5-OH markedly attenuated the development of liver fibrosis and expression of alpha-smooth muscle actin. In clinical research, 38 NAFLD patients (13 men and 25 women) were included. The degree of fibrosis and ballooning in equol-nonproducers was significantly higher than in equol-producers in women. The percentage of nonproducers with NAFLD activity score (NAS) ≥ 5 was significantly higher than that of producers. None of the histological features were significantly different between nonproducers and producers in men. Decision tree analysis identified predictors for NAS ≥ 5 in women. The status of equol production was the strongest predictor, followed by fasting glucose. Since equol can be noninvasively detected in urine, it can be applied as a screening tool for the progression of NASH in women.
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Affiliation(s)
- Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Ryuichi Noguchi
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Haruna Miyakawa
- Saga Nutraceuticals Research Institute, Otsuka Pharmaceutical Co., Ltd., Saga 842-0195, Japan;
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Masanori Furukawa
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Takahiro Ozutsumi
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan; (D.K.); (R.N.); (K.K.); (Y.F.); (Y.T.); (H.T.); (Y.S.); (M.F.); (K.K.); (T.O.); (H.K.); (K.M.); (T.N.); (H.Y.)
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22
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Takeda S, Kaji K, Nishimura N, Enomoto M, Fujimoto Y, Murata K, Takaya H, Kawaratani H, Moriya K, Namisaki T, Akahane T, Yoshiji H. Angiotensin Receptor Blockers Potentiate the Protective Effect of Branched-Chain Amino Acids on Skeletal Muscle Atrophy in Cirrhotic Rats. Mol Nutr Food Res 2021; 65:e2100526. [PMID: 34687151 DOI: 10.1002/mnfr.202100526] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/11/2021] [Indexed: 12/11/2022]
Abstract
SCOPE This study investigated the combined effect of the angiotensin II (AT-II) receptor blocker losartan and branched-chain amino acids (BCAAs) on skeletal muscle atrophy in rats with cirrhosis and steatohepatitis. METHOD AND RESULTS Fischer 344 rats are fed a choline-deficient l-amino acid-defined (CDAA) diet for 12 weeks and treated with oral losartan (30 mg kg-1 day-1 ) and/or BCAAs (Aminoleban EN, 2500 mg kg-1 day-1 ). Treatment with losartan and BCAAs attenuated hepatic inflammation and fibrosis and improved skeletal muscle atrophy and strength in CDAA-fed rats. Both agents reduced intramuscular myostatin and pro-inflammatory cytokine levels, resulting in inhibition of the ubiquitin-proteasome system (UPS) through interference with the SMAD and nuclear factor-kappa B pathways, respectively. Losartan also augmented the BCAA-mediated increase of skeletal muscle mass by promoting insulin growth factor-I production and mitochondrial biogenesis. Moreover, losartan decreased the intramuscular expression of transcription factor EB (TFEB), a transcriptional inducer of E3 ubiquitin ligase regulated by AT-II. In vitro assays illustrated that losartan promoted mitochondrial biogenesis and reduced TFEB expression in AT-II-stimulated rat myocytes, thereby potentiating the inhibitory effects of BCAAs on the UPS and caspase-3 cleavage. CONCLUSION These results indicate that this regimen could serve as a novel treatment for patients with sarcopenia and liver cirrhosis.
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Affiliation(s)
- Soichi Takeda
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Yuki Fujimoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Koji Murata
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
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23
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Takaya H, Namisaki T, Takeda S, Kaji K, Ogawa H, Ishida K, Tsuji Y, Takagi H, Ozutsumi T, Fujinaga Y, Furukawa M, Kitagawa K, Nishimura N, Sawada Y, Shimozato N, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. The Combination of Albumin-Bilirubin Score and Prothrombin Time Is a Useful Tool for Predicting Liver Dysfunction after Transcatheter Arterial Chemoembolization in Child-Pugh Class A Patients with Hepatocellular Carcinoma within Up-to-Seven Criteria. J Clin Med 2021; 10:jcm10214838. [PMID: 34768358 PMCID: PMC8585112 DOI: 10.3390/jcm10214838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Mortality and recurrence rates of hepatocellular carcinoma (HCC) are high. Recent studies show that for patients with HCC beyond up-to-seven criteria, treatment with molecular-targeted agents (MTAs) is recommended because the treatment efficiency of transcatheter arterial chemoembolization (TACE) is poor; further, TACE increases decline in liver function. However, the relationship between TACE and liver function decline in patients with HCC within up-to-seven criteria has not been clarified. Hence, we aimed to investigate this relationship. This retrospective observational study included 189 HCC tumors within up-to-seven criteria in 114 Child–Pugh class A patients. Twenty-four (12.7%) tumors were changed from Child–Pugh class A to B after TACE, and 116 (61.4%) tumors exhibited recurrence within 6 months after TACE. Prothrombin time (PT) and albumin–bilirubin (ALBI) score before TACE were significantly associated with liver dysfunction from Child–Pugh class A to B. The combination of PT and ALBI score before TACE had high predictive ability for liver dysfunction from Child–Pugh class A to B after TACE (specificity = 100%, sensitivity = 91.7%). The combined use of pre-TACE PT and ALBI score has a high predictive ability for liver dysfunction after TACE for Child–Pugh class A patients with HCC within up-to-seven criteria.
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24
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Fujinaga Y, Namisaki T, Takaya H, Tsuji Y, Suzuki J, Shibamoto A, Kubo T, Iwai S, Tomooka F, Takeda S, Fujimoto Y, Enomoto M, Murata K, Ishida K, Ogawa H, Takagi H, Ozutsumi T, Furukawa M, Nishimura N, Sawada Y, Kitagawa K, Sato S, Kaji K, Kawaratani H, Moriya K, Noguchi R, Akahane T, Mitoro A, Yoshiji H. Enhanced liver fibrosis score as a surrogate of liver-related complications and mortality in primary biliary cholangitis. Medicine (Baltimore) 2021; 100:e27403. [PMID: 34596167 PMCID: PMC8483841 DOI: 10.1097/md.0000000000027403] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/16/2021] [Indexed: 01/05/2023] Open
Abstract
The presence of bridging fibrosis predicts survival of primary biliary cholangitis (PBC). This study aimed to compare serum parameters for the estimation of liver fibrosis and prediction of clinical outcomes in PBC.Out of 392 patients with PBC, 102 who underwent liver biopsy and in whom fibrosis indices, platelet count, hyaluronic acid, type IV collagen 7 second domain, procollagen type III amino-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, N-terminal type III collagen propeptide levels; fibrosis index based on 4 factors, aspartate aminotransferase-to-platelet ratio index, and enhanced liver fibrosis (ELF) score were determined, were included. The correlation of histological stages based on both Scheuer and Nakanuma classifications with fibrosis indices was investigated. The Nakanuma system comprises grading for liver fibrosis and bile duct loss. Diagnostic performances of 10 fibrosis indices were evaluated to identify patients with poor prognosis. Moreover, correlations of those with PBC clinical manifestation and survival were also investigated.Enhances liver fibrosis (ELF) score had the highest correlation coefficient for liver fibrosis evaluated according to either the Scheuer or Nakanuma classification among 10 serum fibrosis indices. It also had the highest diagnostic performance in estimating Scheuer stage III and Nakanuma fibrosis score 2, both of which represent portal-bridging fibrosis. Patients with an ELF score of ≥10.0 had shorter survival and presented more frequently clinical complications than those with an ELF score of <10.0.ELF score determines the severity of liver fibrosis and predicts the occurrence of complications and survival in patients with PBC.
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25
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Sato S, Namisaki T, Murata K, Fujimoto Y, Takeda S, Enomoto M, Shibamoto A, Ishida K, Ogawa H, Takagi H, Tsuji Y, Kaya D, Fujinaga Y, Furukawa M, Inoue T, Sawada Y, Nishimura N, Kitagawa K, Ozutsumi T, Takaya H, Kaji K, Shimozato N, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. The association between sarcopenia and endotoxin in patients with alcoholic cirrhosis. Medicine (Baltimore) 2021; 100:e27212. [PMID: 34516526 PMCID: PMC8428753 DOI: 10.1097/md.0000000000027212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/13/2021] [Indexed: 01/05/2023] Open
Abstract
We aimed to prospectively identify the risk factors of sarcopenia in patients with cirrhosis.Patients (n = 193) included in a discovery cohort (January 2011 and December 2014) were categorized into alcoholic (A1; n = 55) and non-alcoholic cirrhosis (NA; n = 138) groups, and those (n = 235) in a validation cohort (January 2015 to December 2019) were categorized into alcoholic (n = 92), non-alcoholic steatohepatitis-related (n = 27), and hepatitis C virus-related cirrhosis groups (n = 116). Skeletal muscle mass index (SMI) was determined using computed tomography (SMI-CT) and bioelectrical impedance analysis (SMI-BIA). Endotoxin activity (EA) was measured with an EA assay.SMI-CT correlated with grip strength in all the groups but significantly correlated with SMI-BIA of the men in group A1 (R = 0.64, P < .0001) and both sexes in group NA (male: R = 0.44, P = .0001; female: R = 0.35, P = .003). SMI-CT inversely correlated with the EA levels of the men in group A1 (R = -0.67, P < .0001) and myostatin levels in group NA (R = -0.53, P < .0001). Lower extremity SMI had a strong negative correlation with the EA levels of the men in group A1 (R = -0.58, P < .001), whereas upper extremity SMI showed an inverse trend with EA levels (R = -0.28, P = .08). SMI-CT also inversely correlated with the EA levels in groups A2 (R = -0.52, P = .003) and N (R = -0.67, P < .0001) and myostatin levels in group C (R = -0.65, P < .0001). Moreover, SMI-CT correlated with nutritional factors, including cholinesterase (R = 0.50, P = .005), zinc (R = 0.45, P = .01), branched amino acid-to-tyrosine ratio (R = 0.39, P = .02), and triglyceride (R = 0.33, P = .03) in group N.Sarcopenia risk factors differ among cirrhosis etiologies. Alcohol-induced, intestine-mediated peripheral endotoxemia could participate in sarcopenia development in patients with alcoholic cirrhosis.
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Affiliation(s)
- Shinya Sato
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Koji Murata
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuki Fujimoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Soichi Takeda
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Akihiko Shibamoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Koji Ishida
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Ogawa
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hirotetsu Takagi
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Masanori Furukawa
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Shijo-cho, Kashihara, Nara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Takahiro Ozutsumi
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Naotaka Shimozato
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
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26
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Moriya K, Kojima K, Kawaratani H, Noguchi R, Yoshiji H. A rare case of refractory and severe duodenal ulcers associated with olmesartan. Gastrointest Endosc 2021; 94:657-658. [PMID: 33965381 DOI: 10.1016/j.gie.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
| | - Kuniyuki Kojima
- Department of Internal Medicine, Heisei Memorial Hospital, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
| | - Ryuichi Noguchi
- Department of Internal Medicine, Heisei Memorial Hospital, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
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27
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Shibamoto A, Namisaki T, Suzuki J, Kubo T, Iwai S, Tomooka F, Takeda S, Fujimoto Y, Enomoto M, Murata K, Inoue T, Ishida K, Ogawa H, Takagi H, Kaya D, Tsuji Y, Ozutsumi T, Fujinaga Y, Furukawa M, Nishimura N, Sawada Y, Kitagawa K, Sato S, Takaya H, Kaji K, Shimozato N, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Clinical Significance of Gamma-Glutamyltranspeptidase Combined with Carbohydrate-Deficient Transferrin for the Assessment of Excessive Alcohol Consumption in Patients with Alcoholic Cirrhosis. Medicines (Basel) 2021; 8:medicines8070039. [PMID: 34357155 PMCID: PMC8307258 DOI: 10.3390/medicines8070039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
Background: This study aimed to compare the diagnostic performance of carbohydrate-deficient transferrin (CDT) and gamma-glutamyltranspeptidase (γ-GTP) to assess the single and combined benefits of these biological markers for the detection of chronic excessive alcohol consumption in patients with alcoholic cirrhosis. Methods: Biological markers were determined in blood samples from patients with alcoholic cirrhosis (drinking group, n = 35; nondrinking group, n = 81). The prediction accuracy of %CDT alone, γ-GTP alone, and their combination for the detection of excessive alcohol consumption was determined in patients with alcoholic cirrhosis. Results: Serum total bilirubin, alanine aminotransferase, aspartate aminotransferase, γ-GTP, and alkaline phosphatase levels and %CDT were significantly higher and serum albumin levels were significantly lower in the drinking group than in the nondrinking group. The combination of %CDT and γ-GTP compared with %CDT or γ-GTP alone showed a higher prediction accuracy. The combination of %CDT and γ-GTP exhibited a higher specificity than γ-GTP alone. However, in terms of sensitivity, no significant difference was found between single or combined markers. Conclusions: The combination of %CDT and γ-GTP is considered a useful biomarker of chronic excessive alcohol consumption in patients with alcoholic cirrhosis.
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Affiliation(s)
- Akihiko Shibamoto
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
- Correspondence: ; Tel.: +81-744-22-3015
| | - Junya Suzuki
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Takahiro Kubo
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Satoshi Iwai
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Fumimasa Tomooka
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Soichi Takeda
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Yuki Fujimoto
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Koji Murata
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan;
| | - Koji Ishida
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Hiroyuki Ogawa
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Hirotetsu Takagi
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Takahiro Ozutsumi
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Masanori Furukawa
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Shinya Sato
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Naotaka Shimozato
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (A.S.); (J.S.); (T.K.); (S.I.); (F.T.); (S.T.); (Y.F.); (M.E.); (K.M.); (K.I.); (H.O.); (H.T.); (D.K.); (Y.T.); (T.O.); (Y.F.); (M.F.); (N.N.); (Y.S.); (K.K.); (S.S.); (H.T.); (K.K.); (N.S.); (H.K.); (K.M.); (T.A.); (A.M.); (H.Y.)
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Nishimura N, Kaji K, Kitagawa K, Sawada Y, Furukawa M, Ozutsumi T, Fujinaga Y, Tsuji Y, Takaya H, Kawaratani H, Moriya K, Namisaki T, Akahane T, Fukui H, Yoshiji H. Intestinal Permeability Is a Mechanical Rheostat in the Pathogenesis of Liver Cirrhosis. Int J Mol Sci 2021; 22:ijms22136921. [PMID: 34203178 PMCID: PMC8267717 DOI: 10.3390/ijms22136921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Recent studies have suggested that an alteration in the gut microbiota and their products, particularly endotoxins derived from Gram-negative bacteria, may play a major role in the pathogenesis of liver diseases. Gut dysbiosis caused by a high-fat diet and alcohol consumption induces increased intestinal permeability, which means higher translocation of bacteria and their products and components, including endotoxins, the so-called "leaky gut". Clinical studies have found that plasma endotoxin levels are elevated in patients with chronic liver diseases, including alcoholic liver disease and nonalcoholic liver disease. A decrease in commensal nonpathogenic bacteria including Ruminococaceae and Lactobacillus and an overgrowth of pathogenic bacteria such as Bacteroidaceae and Enterobacteriaceae are observed in cirrhotic patients. The decreased diversity of the gut microbiota in cirrhotic patients before liver transplantation is also related to a higher incidence of post-transplant infections and cognitive impairment. The exposure to endotoxins activates macrophages via Toll-like receptor 4 (TLR4), leading to a greater production of proinflammatory cytokines and chemokines including tumor necrosis factor-alpha, interleukin (IL)-6, and IL-8, which play key roles in the progression of liver diseases. TLR4 is a major receptor activated by the binding of endotoxins in macrophages, and its downstream signal induces proinflammatory cytokines. The expression of TLR4 is also observed in nonimmune cells in the liver, such as hepatic stellate cells, which play a crucial role in the progression of liver fibrosis that develops into hepatocarcinogenesis, suggesting the importance of the interaction between endotoxemia and TLR4 signaling as a target for preventing liver disease progression. In this review, we summarize the findings for the role of gut-derived endotoxemia underlying the progression of liver pathogenesis.
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Moriya K, Nishimura N, Namisaki T, Takaya H, Sawada Y, Kawaratani H, Kaji K, Shimozato N, Sato S, Furukawa M, Douhara A, Akahane T, Mitoro A, Yamao J, Yoshiji H. Zinc Administration and Improved Serum Markers of Hepatic Fibrosis in Patients with Autoimmune Hepatitis. J Clin Med 2021; 10:2465. [PMID: 34199421 PMCID: PMC8199625 DOI: 10.3390/jcm10112465] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of the present study is to investigate the effect of long-term zinc supplementation, which is important for the activation of various enzymes that contribute to antioxidant and antifibrotic activities, on the improvement of serum fibrotic markers in patients with autoimmune hepatitis (AIH). METHODS A total of 38 patients with AIH under regular treatment at our hospital who provided their consent for being treated with polaprezinc (75 mg twice daily) were included and classified into 2 groups: the patients with zinc elevation (n = 27) and the patients without zinc elevation (n = 11). Serum biomarker of fibrosis, protein expression levels of matrix metalloproteinases (MMPs), and their inhibitors (TIMPs) were evaluated. RESULTS A significant difference was found between the variability of serum procollagen type Ⅲ and collagen type Ⅳ-7S between the 2 groups before and after zinc administration for more than 24 months (p = 0.043 and p = 0.049). In the patients with zinc elevation, no significant changes were found in collagenase (MMP-1 and MMP-13) before and after zinc administration, whereas a significant increase in the expression of gelatinase (MMP-2 and MMP-9) was found after administration (p = 0.021 and p = 0.005). As for the relative ratio of MMPs to TIMPs, only MMP-9 to TIMP-1 showed a significant increase (p = 0.004). CONCLUSIONS Long-term treatment with polaprezinc has been demonstrated to safely improve serum fibrosis indices through increases in MMP-2/-9 and MMP-9/TIMP-1 and is expected to be well combined with direct antifibrotic therapies such as molecularly targeted agents.
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Affiliation(s)
- Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Norihisa Nishimura
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Tadashi Namisaki
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Hiroaki Takaya
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Yasuhiko Sawada
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Hideto Kawaratani
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Kosuke Kaji
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Naotaka Shimozato
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Shinya Sato
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Masanori Furukawa
- Department of Endoscopy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (M.F.); (J.Y.)
| | - Akitoshi Douhara
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Takemi Akahane
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Akira Mitoro
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
| | - Junichi Yamao
- Department of Endoscopy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (M.F.); (J.Y.)
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Hepatology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (N.N.); (T.N.); (H.T.); (Y.S.); (H.K.); (K.K.); (N.S.); (S.S.); (A.D.); (T.A.); (A.M.); (H.Y.)
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Ogawa H, Kaji K, Nishimura N, Takagi H, Ishida K, Takaya H, Kawaratani H, Moriya K, Namisaki T, Akahane T, Yoshiji H. Lenvatinib prevents liver fibrosis by inhibiting hepatic stellate cell activation and sinusoidal capillarization in experimental liver fibrosis. J Cell Mol Med 2021; 25:4001-4013. [PMID: 33609067 PMCID: PMC8051749 DOI: 10.1111/jcmm.16363] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 12/14/2022] Open
Abstract
Molecular targeted agents are pharmacologically used to treat liver fibrosis and have gained increased attention. The present study examined the preventive effect of lenvatinib on experimental liver fibrosis and sinusoidal capillarization as well as the in vitro phenotypes of hepatic stellate cells. LX-2, a human stellate cell line, was used for in vitro studies. In vivo liver fibrosis was induced in F344 rats using carbon tetrachloride by intraperitoneal injection for 8 weeks, and oral administration of lenvatinib was started two weeks after initial injection of carbon tetrachloride. Lenvatinib restrained proliferation and promoted apoptosis of LX-2 with suppressed phosphorylation of extracellular signal-regulated kinase 1/2 and AKT. It also down-regulated COL1A1, ACTA2 and TGFB1 expressions by inhibiting the transforming growth factor-β1/Smad2/3 pathway. Treatment with lenvatinib also suppressed platelet-derived growth factor-BB-stimulated proliferation, chemotaxis and vascular endothelial growth factor-A production, as well as basic fibroblast growth factor-induced LX-2 proliferation. In vivo study showed that lenvatinib attenuated liver fibrosis development with reduction in activated hepatic stellate cells and mRNA expression of profibrogenic markers. Intrahepatic neovascularization was ameliorated with reduced hepatic expressions of Vegf1, Vegf2 and Vegfa in lenvatinib-treated rats. Collectively, these results suggest the potential use of lenvatinib as a novel therapeutic strategy for liver fibrosis.
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Affiliation(s)
- Hiroyuki Ogawa
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | | | - Hirotetsu Takagi
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Koji Ishida
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
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Furukawa M, Mitoro A, Ozutumi T, Fujinaga Y, Nakanishi K, Kitagawa K, Saikawa S, Sato S, Sawada Y, Takaya H, Kaji K, Kawaratani H, Namisaki T, Moriya K, Akahane T, Yamao J, Yoshiji H. Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor. Clin Endosc 2021; 54:371-378. [PMID: 33596634 PMCID: PMC8182245 DOI: 10.5946/ce.2020.147] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis.
Methods Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group.
Results The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors.
Conclusions UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
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Affiliation(s)
- Masanori Furukawa
- Division of Endoscopy, Nara Medical University Hospital, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takahiro Ozutumi
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Keisuke Nakanishi
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Soichiro Saikawa
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Sinya Sato
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Junichi Yamao
- Division of Endoscopy, Nara Medical University Hospital, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
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Namisaki T, Fujinaga Y, Moriya K, Yoshiji H. The association of histological progression with biochemical response to ursodeoxycholic acid in primary biliary cholangitis. Hepatol Res 2021; 51:31-38. [PMID: 33210415 DOI: 10.1111/hepr.13593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/21/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 02/08/2023]
Abstract
Primary biliary cholangitis (PBC) is currently diagnosed at an early stage; therefore, the number of patients with PBC without symptoms at the time of diagnosis is increasing. However, up to 30% of patients with PBC exhibit the suboptimal response to ursodeoxycholic acid (UDCA) and are at high risk of end-stage liver disease. Obeticholic acid is an approved second-line therapy for patients with PBC that are refractory to UDCA. Novel surrogate endpoints are required to identify individuals eligible for second-line therapies. An inadequate biochemical response to UDCA is a useful predictor of poor outcomes in patients with PBC. In addition to UDCA effects on biochemical parameters, histological outcomes could be considered as candidate surrogate endpoints. Alterations in liver histology are used as surrogate endpoints in clinical studies. However, current staging systems are insufficient to determine PBC disease severity and progression because of the pathological heterogeneity of the disease. Histological features at baseline and biochemical response to UDCA treatment can affect the disease course of PBC. Therefore, novel surrogate endpoints must be represented by parameters characterized by histological outcomes and treatment responses in PBC. In this review, we discuss the existing histological parameters and newly created factors to identify patients with PBC who are at a high risk of developing end-stage liver disease and, consequently, the potential need for additional treatments.
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Affiliation(s)
- Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
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Ishida K, Kaji K, Sato S, Ogawa H, Takagi H, Takaya H, Kawaratani H, Moriya K, Namisaki T, Akahane T, Yoshiji H. Sulforaphane ameliorates ethanol plus carbon tetrachloride-induced liver fibrosis in mice through the Nrf2-mediated antioxidant response and acetaldehyde metabolization with inhibition of the LPS/TLR4 signaling pathway. J Nutr Biochem 2020; 89:108573. [PMID: 33388347 DOI: 10.1016/j.jnutbio.2020.108573] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
Alcoholic liver disease (ALD)-related fibrosis results from a variety of mechanisms including the accumulation of acetaldehyde, reactive oxygen species, and hepatic overload of endogenous lipopolysaccharide (LPS). Alcohol cessation is the therapeutic mainstay for patients with all stages of ALD, whereas pharmacological strategies for liver fibrosis have not been established. Sulforaphane, a phytochemical found in cruciferous vegetables, activates nuclear factor erythroid 2-related factor 2 (Nrf2) and exerts anticancer, antidiabetic, and antimicrobial effects; however, few studies investigated its efficacy in the development of ALD-related fibrosis. Herein, we investigated the effect of sulforaphane on acetaldehyde metabolism and liver fibrosis in HepaRG and LX-2 cells, human hepatoma and hepatic stellate cell lines, respectively, as well as in a mouse model of alcoholic liver fibrosis induced by ethanol plus carbon tetrachloride (EtOH/CCl4). Sulforaphane treatment induced the activity of acetaldehyde-metabolizing mitochondrial aldehyde dehydrogenase in HepaRG cells and suppressed the acetaldehyde-induced proliferation and profibrogenic activity in LX-2 cells with upregulation of Nrf2-regulated antioxidant genes, including HMOX1, NQO1, and GSTM3. Moreover, sulforaphane attenuated the LPS/toll-like receptor 4-mediated sensitization to transforming growth factor-β with downregulation of NADPH oxidase 1 (NOX1) and NOX4. In EtOH/CCl4-treated mice, oral sulforaphane administration augmented hepatic acetaldehyde metabolism. Additionally, sulforaphane significantly inhibited Kupffer cell infiltration and fibrosis, decreased fat accumulation and lipid peroxidation, and induced Nrf2-regulated antioxidant response genes in EtOH/CCl4-treated mice. Furthermore, sulforaphane treatment blunted hepatic exposure of gut-derived LPS and suppressed hepatic toll-like receptor 4 signaling pathway. Taken together, these results suggest sulforaphane as a novel therapeutic strategy in ALD-related liver fibrosis.
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Affiliation(s)
- Koji Ishida
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan.
| | - Shinya Sato
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Ogawa
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hirotetsu Takagi
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan
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Takaya H, Namisaki T, Moriya K, Shimozato N, Kaji K, Ogawa H, Ishida K, Tsuji Y, Kaya D, Takagi H, Fujinaga Y, Nishimura N, Sawada Y, Kawaratani H, Akahane T, Matsumoto M, Yoshiji H. Association between ADAMTS13 activity–VWF antigen imbalance and the therapeutic effect of HAIC in patients with hepatocellular carcinoma. World J Gastroenterol 2020; 26:7232-7241. [PMID: 33362379 PMCID: PMC7723670 DOI: 10.3748/wjg.v26.i45.7232] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/09/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prediction of HAIC treatment response is important for improving the prognosis in patients with hepatocellular carcinoma (HCC). The progression of HCC is related to hypercoagulability and angiogenesis. It is known that ADAMTS13 and von Willebrand factor (VWF) are related to hypercoagulability. In addition, previous study reported that the association between ADAMTS13 and VWF, and angiogenesis via vascular endothelial growth factor (VEGF). Recently, ADAMTS13 and VWF have been associated with the prognosis in patients with various kinds of cancer undergoing chemotherapy.
AIM To investigate whether ADAMTS13 and VWF become useful biomarkers of treatment response in HCC patients before the initiation of HAIC treatment.
METHODS Seventy-two patients were enrolled in this study. ADAMTS13 activity (ADAMTS13:AC), VWF antigen (VWF:Ag) and VEGF levels were determined via enzyme-linked immunosorbent assay. Univariable and multivariable analyses were performed to determine the predictive factors of treatment response in patients with HCC undergoing HAIC treatment.
RESULTS ADAMTS13:AC levels in HCC patients with stable disease (SD) + partial response (PR) of HAIC treatment were significantly higher than those with progressive disease (PD) (P < 0.05). In contrast, VWF:Ag/ADAMTS13:AC ratio and VEGF levels in HCC patients with SD + PR were significantly lower than those with PD (both P < 0.05). Patients with high VWF:Ag/ADAMTS13:AC ratio (> 2.7) had higher VEGF levels than those with low ratio (≤ 2.7). Multivariable analysis revealed that VWF:Ag/ADAMTS13:AC ratio was a predictive factor of HAIC treatment response.
CONCLUSION VWF:Ag/ADAMTS13:AC ratio may become a useful biomarker of treatment response in HCC patients before the initiation of HAIC treatment.
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Affiliation(s)
- Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Naotaka Shimozato
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroyuki Ogawa
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Koji Ishida
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | | | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634-8522, Japan
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Kawaratani H, Moriya K, Namisaki T, Shimozato N, Kaji K, Takaya H, Fujinaga Y, Sawada Y, Sato S, Saikawa S, Kubo T, Akahane T, Fukui H, Yoshiji H. Ascites symptom inventory-7 is a valuable tool for evaluating the effectiveness of tolvaptan in patients with cirrhotic ascites. Exp Ther Med 2020; 21:30. [PMID: 33262816 DOI: 10.3892/etm.2020.9462] [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] [Received: 07/03/2019] [Accepted: 09/08/2020] [Indexed: 11/06/2022] Open
Abstract
Patients with liver cirrhosis frequently experience non-specific symptoms and report severe reductions in their quality of life (QOL). The underlying mechanisms of the disease are multifactorial that may be specific to the disease or directly related to the liver. The major concern of liver cirrhosis with ascites, however, is the decreased QOL. Therefore, in the present study, the Ascites Symptom Inventory-7 (ASI-7) questionnaire was applied to subjectively evaluate the symptoms in patients with cirrhotic ascites following tolvaptan administration. In total, 69 patients with liver cirrhosis with ascites hospitalized to Nara Medical University were evaluated after being treated with tolvaptan (3.75-7.5 mg/day) and conventional diuretics between December 2013 and April 2018. A follow-up assessment was conducted 7 days after tolvaptan treatment, whilst ASI-7 was used on days 1 and 8 of the study. After an uneventful 7-day tolvaptan treatment regimens, 49 patients (71.0%) lost >1.5 kg of their body weight, who were referred to as responders, with the change in the ASI-7 score being found to correlate with the body weight change. By contrast, changes in urine volume did not correlate with those in the ASI-7 score. The responders experienced a greater reduction in the ASI-7 score after 7 days compared with those in the non-responders (P<0.01). ASI-7 scores were also found to correlate with body weight after tolvaptan administration. In conclusion, ASI-7 accurately reflected changes in body weight but not urine volume and results of the study highlighted the value of ASI-7 in the evaluation of ascitic volume and effectiveness of tolvaptan in cirrhotic ascites. The present clinical trial was registered onto the UMIN-Clinical Trial Registry on 1st March 2014 (registration no. UMIN000013095).
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Affiliation(s)
- Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Soichiro Saikawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takuya Kubo
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroshi Fukui
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
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Ishida K, Namisaki T, Murata K, Fujimoto Y, Takeda S, Enomoto M, Ogawa H, Takagi H, Tsuji Y, Kaya D, Fujinaga Y, Furukawa M, Sawada Y, Kitagawa K, Sato S, Nishimura N, Takaya H, Kaji K, Shimozato N, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy. J Clin Med 2020; 9:jcm9113510. [PMID: 33138335 PMCID: PMC7692323 DOI: 10.3390/jcm9113510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022] Open
Abstract
A potential restriction of the Baveno VI consensus, which helps to avoid unnecessary endoscopies, is the limited availability of FibroScan. We aimed to identify serum fibrosis indices that might aid in ruling out the presence of high-risk varices in cirrhotic patients. This retrospective study included 541 consecutive patients with cirrhosis who underwent endoscopy and had data available for nine serum fibrosis indices, including platelet count, hyaluronic acid, 7S fragment of type 4 collagen, procollagen type III N-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, fibrosis index based on four factors (FIB-4), aspartate transaminase/platelet ratio index and enhanced liver fibrosis score. Optimal index cutoffs for predicting high-risk varices were calculated in an estimation cohort (n = 127) and evaluated in a validation cohort (n = 351). The diagnostic performance of the indices was assessed by receiver operating characteristic curve analysis. In the estimation cohort, a FIB-4 cutoff of 2.78 provided the greatest diagnostic accuracy in predicting both all-grade and high-risk varices. FIB-4 had a negative predictive value of 1.00 for high-risk varices in both cohorts, and 21.3% (27/127) and 14.8% (52/351) of the estimation and validation cohorts, respectively, avoided esophagogastroduodenoscopy; no high-risk varices were missed in either cohort. FIB-4 correctly identifies the absence of high-risk varices in patients with cirrhosis. Therefore, those with a FIB-4 of ≥2.78 should undergo esophagogastroduodenoscopy, and FIB-4 determination should be recommended every 6-12 months concurrently with the other blood tests until the index value reaches 2.78 in those with a FIB-4 of <2.78.
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Sato S, Namisaki T, Furukawa M, Saikawa S, Kawaratani H, Kaji K, Takaya H, Shimozato N, Sawada Y, Kitagawa K, Moriya K, Akahane T, Mitoro A, Hoki N, Ann T, Yoshiji H. Effect of L-carnitine on health-related quality of life in patients with liver cirrhosis. Biomed Rep 2020; 13:65. [PMID: 33149909 PMCID: PMC7605124 DOI: 10.3892/br.2020.1372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/25/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022] Open
Abstract
L-carnitine (4-N-trimethylammonium-3-hydroxybutyric acid) is the physiologically active form of carnitine and is a natural compound that has been shown to exhibit antioxidant activity. L-carnitine is used as a supplementary treatment in patients with cirrhosis with hepatic encephalopathy, hyperammonemia or muscle cramps. In the present study, the effect of L-carnitine supplementation on health-related quality of life in 30 patients with cirrhosis was prospectively examined. L-carnitine (1,800 mg/day) was administered orally for 6 months. To assess the effects of L-carnitine on chronic fatigue, patients filled out a self-report questionnaire regarding their physical and mental health. The levels of total and free carnitine, and acylcarnitine were found to be significantly higher 1, 3 and 6 months after therapy initiation compared with before treatment. Serum albumin levels were significantly increased 3 and 6 months after initiation of therapy. L-carnitine supplementation significantly increased the BAP/d-ROM ratio, a marker of antioxidant status in patients with cirrhosis. Changes in serum carnitine concentrations were positively correlated with changes in serum albumin levels (R2=0.369; P=0.012), but not with changes in serum ammonia levels (R2= 0.005; P=0.78). Total and mental health scores improved significantly, and physical scores improved marginally 3 and 6 months after initiation of L-carnitine. These findings may be attributed to the enhanced serum albumin levels and oxidative stress rather than the reduced serum ammonia levels. Based on these results, it is suggested that L-carnitine can potentially alleviate chronic fatigue, along with the increased BAP/d-ROM ratio, which were involved in increased oxidative stress in patients with cirrhosis. The specific mechanisms by which L-carnitine ameliorates chronic fatigue is not fully understood and requires further investigation.
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Affiliation(s)
- Shinya Sato
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Masanori Furukawa
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Soichiro Saikawa
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kosuke Kaji
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Naotaka Shimozato
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Koh Kitagawa
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kei Moriya
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takemi Akahane
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Akira Mitoro
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Noriyuki Hoki
- Department of Gastroenterology in Bellland General Hospital, Sakai, Osaka 599-8247, Japan
| | - Tatsuichi Ann
- Department of Gastroenterology in Bellland General Hospital, Sakai, Osaka 599-8247, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan
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Kawaratani H, Tsuji Y, Ishida K, Kaya D, Kubo T, Fujinaga Y, Sawada Y, Sato S, Takaya H, Kaji K, Namisaki T, Moriya K, Akahane T, Yoshiji H. Effect of three or more treatments with lusutrombopag in patients with cirrhotic thrombocytopenia: A retrospective single-center study. Hepatol Res 2020; 50:1101-1105. [PMID: 32558192 DOI: 10.1111/hepr.13536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/14/2019] [Revised: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
AIMS Thrombocytopenia is a common complication among patients with chronic liver disease (CLD). Lusutrombopag, an oral thrombopoietin receptor agonist, is used to reduce the risk of hemorrhage in patients with thrombocytopenia who are undergoing invasive procedures. Platelet transfusion was the standard treatment for thrombocytopenia; however, multiple platelet transfusions lead to the production of antiplatelet antibody. The effect of giving lusutrombopag three times or more has not been previously reported. In this study, we investigated the effect of lusutrombopag readministration in patients with thrombocytopenia. METHODS This study included 14 patients (total, 24 readministrations) who received lusutrombopag two times or more. Changes in platelet counts were evaluated. Treatment response was defined as an increased platelet count of ≥20 000/μL after lusutrombopag treatment. RESULTS Lusutrombopag was given twice in nine patients, three times in three patients, five times in one patient, and six times in one patient. An elevated platelet count of <20 000/μL was noted in only one of the 24 readministrations. There were no postoperative hemorrhagic complications, and no patient had an increased platelet count of >200 000/μL. One patient had a portal venous mural thrombus; however, he was asymptomatic, and the thrombus resolved after anticoagulant treatment, without recurrence. The comparison between the first, second, and third or more treatments showed there was no significant difference in platelet increase. CONCLUSION Repeated treatment of lusutrombopag is effective for CLD patients with thrombocytopenia. Moreover, three or more treatments with lusutrombopag showed equal effect compared with one and two treatments with the medication.
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Affiliation(s)
- Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yuki Tsuji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Koji Ishida
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Daisuke Kaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Takuya Kubo
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
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Fujinaga Y, Kawaratani H, Kaya D, Tsuji Y, Ozutsumi T, Furukawa M, Kitagawa K, Sato S, Nishimura N, Sawada Y, Takaya H, Kaji K, Shimozato N, Moriya K, Namisaki T, Akahane T, Mitoro A, Yoshiji H. Effective Combination Therapy of Angiotensin-II Receptor Blocker and Rifaximin for Hepatic Fibrosis in Rat Model of Nonalcoholic Steatohepatitis. Int J Mol Sci 2020; 21:ijms21155589. [PMID: 32759852 PMCID: PMC7432739 DOI: 10.3390/ijms21155589] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023] Open
Abstract
The progression of nonalcoholic steatohepatitis (NASH) is complicated. The multiple parallel-hits theory is advocated, which includes adipocytokines, insulin resistance, endotoxins, and oxidative stress. Pathways involving the gut–liver axis also mediate the progression of NASH. Angiotensin-II receptor blockers (ARB) suppress hepatic fibrosis via the activation of hepatic stellate cells (HSCs). Rifaximin, a nonabsorbable antibacterial agent, is used for the treatment of hepatic encephalopathy and has been recently reported to improve intestinal permeability. We examined the inhibitory effects on and mechanism of hepatic fibrogenesis by combining ARB and rifaximin administration. Fischer 344 rats were fed a choline-deficient/l-amino acid-defined (CDAA) diet for 8 weeks to generate the NASH model. The therapeutic effect of combining an ARB and rifaximin was evaluated along with hepatic fibrogenesis, the lipopolysaccharide–Toll-like receptor 4 (TLR4) regulatory cascade, and intestinal barrier function. ARBs had a potent inhibitory effect on hepatic fibrogenesis by suppressing HSC activation and hepatic expression of transforming growth factor-β and TLR4. Rifaximin reduced intestinal permeability by rescuing zonula occludens-1 (ZO-1) disruption induced by the CDAA diet and reduced portal endotoxin. Rifaximin directly affect to ZO-1 expression on intestinal epithelial cells. The combination of an ARB and rifaximin showed a stronger inhibitory effect compared to that conferred by a single agent. ARBs improve hepatic fibrosis by inhibiting HSCs, whereas rifaximin improves hepatic fibrosis by improving intestinal permeability through improving intestinal tight junction proteins (ZO-1). Therefore, the combination of ARBs and rifaximin may be a promising therapy for NASH fibrosis.
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Tsuji Y, Namisaki T, Kaji K, Takaya H, Nakanishi K, Sato S, Saikawa S, Sawada Y, Kitagawa K, Shimozato N, Kawaratani H, Moriya K, Noguchi R, Akahane T, Mitoro A, Yoshiji H. Comparison of serum fibrosis biomarkers for diagnosing significant liver fibrosis in patients with chronic hepatitis B. Exp Ther Med 2020; 20:985-995. [PMID: 32765655 PMCID: PMC7388477 DOI: 10.3892/etm.2020.8798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/24/2019] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic hepatitis B (CHB) virus continues to be a leading cause of morbidity and mortality worldwide. The diagnosis of liver fibrosis has a key role in selecting patients with CHB for antiviral treatment. However, serum biomarkers demonstrate limited diagnostic utility. The present study aimed to compare the performances of fibrosis biomarkers for diagnosing significant liver fibrosis that indicates the need for antiviral therapy in patients with CHB and to identify the most appropriate biomarker for these patients. The current study included 96 antiviral-naïve patients with CHB who underwent liver biopsy. METAVIR scoring system was used to assess liver fibrosis and necroinflammation. The diagnostic performances were evaluated of the platelet (PLT) count; the levels of hyaluronan, serum 7S domain of type 4 collagen, procollagen type III N-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer (M2BPGi) and N-terminal type III collagen propeptide (Pro-C3); the fibrosis index based on four factors; the aspartate aminotransferase-to-platelet ratio index; and enhanced liver fibrosis score for identifying significant liver fibrosis [≥fibrosis stage 2 (F2)]. All fibrosis biomarkers, except the Pro-C3 level, correlated with the fibrosis stage. M2BPGi was better than other biomarkers for diagnosing ≥F2, with the highest area under the curve of 0.902. M2BPGi demonstrated a higher diagnostic accuracy for significant fibrosis than mild/severe fibrosis or cirrhosis. However, no significant correlation was observed between the M2BPGi level and fibrosis stage in patients with CHB having significant liver necroinflammation defined as ≥ necroinflammatory activity 2. The M2BPGi level and PLT count were exclusively correlated with the fibrosis stage in 73 patients without significant liver necroinflammation. M2BPGi demonstrated the highest diagnostic performance for significant fibrosis in patients having significant liver fibrosis with no significant liver necroinflammation. In conclusion, the M2BPGi level can accurately diagnose significant liver fibrosis that indicates the need for antiviral therapy in patients with CHB.
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Affiliation(s)
- Yuki Tsuji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Keisuke Nakanishi
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Soichiro Saikawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kou Kitagawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Ryuichi Noguchi
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
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Noguchi R, Kaji K, Namisaki T, Moriya K, Kawaratani H, Kitade M, Takaya H, Aihara Y, Douhara A, Asada K, Nishimura N, Miyata T, Yoshiji H. Novel oral plasminogen activator inhibitor‑1 inhibitor TM5275 attenuates hepatic fibrosis under metabolic syndrome via suppression of activated hepatic stellate cells in rats. Mol Med Rep 2020; 22:2948-2956. [PMID: 32945412 PMCID: PMC7453658 DOI: 10.3892/mmr.2020.11360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/28/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
An orally bioavailable small molecule inhibitor of plasminogen activator inhibitor-1 (PAI-1) is currently being clinically assessed as a novel antithrombotic agent. Although PAI-1 is known to serve a key role in the pathogenesis of metabolic syndrome (MetS) including nonalcoholic steatohepatitis (NASH), the pharmacological action of an oral PAI-1 inhibitor against the development of MetS-related liver fibrosis remains unclear. The current study was designed to explicate the effect of TM5275, an oral PAI-1 inhibitor, on MetS-related hepatic fibrogenesis. The in vivo antifibrotic effect of orally administered TM5275 was investigated in two different rat MetS models. Fischer 344 rats received a choline-deficient L-amino-acid-defined diet for 12 weeks to induce steatohepatitis with development of severe hepatic fibrosis. Otsuka Long-Evans Tokushima Fatty rats, used to model congenital diabetes, underwent intraperitoneal injection of porcine serum for 6 weeks to induce hepatic fibrosis under diabetic conditions. In each experimental model, TM5275 markedly ameliorated the development of hepatic fibrosis and suppressed the proliferation of activated hepatic stellate cells (HSCs). Additionally, the hepatic production of tumor growth factor (TGF)-β1 and total collagen was suppressed. In vitro assays revealed that TGF-β1 stimulated the upregulation of Serpine1 mRNA expression, which was inhibited by TM5275 treatment in cultured HSC-T6 cells, a rat HSC cell line. Furthermore, TM5275 substantially attenuated the TGF-β1-stimulated proliferative and fibrogenic activity of HSCs by inhibiting AKT phosphorylation. Collectively, TM5275 demonstrated an antifibrotic effect on liver fibrosis in different rat MetS models, suppressing TGF-β1-induced HSC proliferation and collagen synthesis. Thus, PAI-1 inhibitors may serve as effective future therapeutic agents against NASH-based hepatic fibrosis.
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Affiliation(s)
- Ryuichi Noguchi
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Mitsuteru Kitade
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Yosuke Aihara
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Akitoshi Douhara
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Kiyoshi Asada
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
| | - Toshio Miyata
- United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980‑8575, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8522, Japan
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Moriya K, Nishimura Y, Nakamura M, Kon M, Kitta T, Araki A, Miyashita C, Ito S, Cho K, Mitsui T, Murai S, Nonomura K, Kishi R, Shinohara N. Establishment of nocturnal bladder control and behavioral sexual dimorphism in children. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Furukawa M, Moriya K, Nakayama J, Inoue T, Momoda R, Kawaratani H, Namisaki T, Sato S, Douhara A, Kaji K, Kitade M, Shimozato N, Sawada Y, Saikawa S, Takaya H, Kitagawa K, Akahane T, Mitoro A, Yamao J, Tanaka Y, Yoshiji H. Gut dysbiosis associated with clinical prognosis of patients with primary biliary cholangitis. Hepatol Res 2020; 50:840-852. [PMID: 32346970 DOI: 10.1111/hepr.13509] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 09/20/2019] [Revised: 03/26/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
AIM Although some relationships between gut microbiota and liver diseases have been reported, it remains uncertain whether changes in gut microbiota owing to differences in race, food and living environment have similar effects. Response to ursodeoxycholic acid (UDCA) may predict the long-term prognosis of patients with primary biliary cholangitis (PBC); however, little is known about the significance of the gut microbiome in patients with PBC. We elucidated the relationships among clinical profiles, biochemical response to UDCA and gut microbiome composition in patients with PBC. METHODS Fecal samples from 76 patients with PBC treated at our hospital were collected; patients whose UDCA intake period was <1 year were excluded. The microbiome structures of patients were determined using 16S ribosomal RNA gene sequencing and were statistically compared with those of healthy subjects. The structures of patients in the UDCA responder (n = 43) and non-responder (n = 30) groups were compared according to the Nara criteria (reduction rate of gamma-glutamyl transpeptidase, ≥69%, after 1 year). RESULTS Compared with healthy subjects, bacterial diversity was lower in patients with PBC, with a decreased abundance of the order Clostridiales and increased abundance of Lactobacillales. The UDCA non-responder group had a significantly lower population of the genus Faecalibacterium, known as butyrate-producing beneficial bacteria (P < 0.05), although no significant differences in gender, body mass index, medicated drugs or other serological data were indicated between these two groups. CONCLUSIONS Gut dysbiosis with loss of beneficial Clostridiales commensals was observed in patients with PBC. Decrease in Faecalibacterium abundance might predict the long-term prognosis of patients with PBC.
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Affiliation(s)
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University
| | - Jiro Nakayama
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University
| | - Takako Inoue
- Department of Clinical Laboratory Medicine, Nagoya City University Hospital
| | - Rie Momoda
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University
| | | | | | - Shinya Sato
- Department of Gastroenterology, Nara Medical University
| | | | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University
| | | | | | | | | | | | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University
| | | | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University
| | - Junichi Yamao
- Department of Gastroenterology, Nara Medical University
| | - Yasuhito Tanaka
- Department of Clinical Laboratory Medicine, Nagoya City University Hospital.,Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Japan
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Akahane T, Akahane M, Namisaki T, Kaji K, Moriya K, Kawaratani H, Takaya H, Sawada Y, Shimozato N, Fujinaga Y, Furukawa M, Kitagawa K, Ozutsumi T, Tsuji Y, Kaya D, Mitoro A, Yoshiji H. Association between Non-Alcoholic Fatty Liver Disease and Chronic Kidney Disease: A Cross-Sectional Study. J Clin Med 2020; 9:jcm9061635. [PMID: 32481684 PMCID: PMC7356359 DOI: 10.3390/jcm9061635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
It is unclear whether the link between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) is mediated by common risk factors. We aimed to elucidate the association between NAFLD and CKD using propensity score (PS)-matched analysis. We assessed 3725 Japanese individuals, excluding those with hepatitis B or C infection and men and women who consumed >30 and >20 g/day of alcohol, respectively. Of these, we enrolled 1097 Japanese subjects with NAFLD diagnosed by ultrasonography and 1097 PS-matched subjects without NAFLD. The prevalence of CKD was higher in subjects with NAFLD than in those without NAFLD before PS matching, but there was no significant difference between these groups in terms of CKD prevalence after PS matching. There was no difference in the prevalence of CKD between those with and without NAFLD in the subgroup analyses. Logistic regression analysis demonstrated that obesity, hypertension, and hyperuricemia were independent predictors of CKD, but NAFLD was not independently associated with CKD. In subjects with NAFLD, obesity, hypertension, and hyperuricemia were independent predictors of CKD. Thus, the link between NAFLD and CKD may be mediated by common risk factors. We recommend screening for CKD when patients with NAFLD have the aforementioned comorbidities.
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Affiliation(s)
- Takemi Akahane
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
- Correspondence: ; Tel.: +81-7-4422-3051; Fax: +81-7-4424-7122
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0197, Japan;
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Kei Moriya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Naotaka Shimozato
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Masanori Furukawa
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Takahiro Ozutsumi
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.N.); (K.K.); (K.M.); (H.K.); (H.T.); (Y.S.); (N.S.); (Y.F.); (M.F.); (K.K.); (T.O.); (Y.T.); (D.K.); (A.M.); (H.Y.)
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Takaya H, Namisaki T, Sato S, Kaji K, Tsuji Y, Kaya D, Fujinaga Y, Sawada Y, Shimozato N, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Increased Endotoxin Activity Is Associated with the Risk of Developing Acute-on-Chronic Liver Failure. J Clin Med 2020; 9:jcm9051467. [PMID: 32422875 PMCID: PMC7290888 DOI: 10.3390/jcm9051467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/17/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Acute-on-chronic liver failure (ACLF) leads to systematic inflammatory response syndrome and multiple organ failure. This study investigated the relationship between endotoxin (Et) and ACLF with the aim of determining whether Et activity (EA) is useful as a predictive biomarker of ACLF development and whether rifaximin treatment decreased the risk of ACLF development. Two hundred forty-nine patients with liver cirrhosis were enrolled in this study. Et concentration was determined in the whole blood by a semiquantitative EA assay. Predictive factors of ACLF development and the risk of ACLF development with and without rifaximin treatment were identified by univariate and multivariate analysis using Fine and Gray’s proportional subhazards model. EA level was higher in Child-Pugh class B than in class A patients, and class B patients had an increased risk of ACLF development compared with class A patients. Multivariate analysis showed that EA level was a predictive factor independently associated with ACLF development. Rifaximin decreased EA level and the risk of ACLF development in Child-Pugh class B patients. Et levels were associated with functional liver capacity and were predictive of ACLF development in cirrhotic patients. Rifaximin decreased Et level and the risk of ACLF development in advanced cirrhotic patients.
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Sawada Y, Kawaratani H, Kubo T, Fujinaga Y, Furukawa M, Saikawa S, Sato S, Takaya H, Kaji K, Shimozato N, Moriya K, Namisaki T, Akahane T, Mitoro A, Yoshiji H. Effect of furosemide on muscle cramps in patients with liver cirrhosis. J Gastroenterol Hepatol 2020; 35:76-81. [PMID: 31385352 DOI: 10.1111/jgh.14820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/14/2019] [Revised: 06/04/2019] [Accepted: 07/21/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Patients with cirrhosis usually experience muscle cramps of varying severity. Although diuretics have been reported to cause muscle cramps, clinical evidence is limited. Also, it has been pointed out that the use of diuretics is associated with the progression of sarcopenia in patients with cirrhosis. We conducted a questionnaire survey to clarify the effects of diuretics and skeletal muscle loss on muscle cramps. METHODS Overall, we enrolled 152 adults with cirrhosis in this study. Cramp questionnaires were obtained after informed consent. Study variables (demographics, physical findings, serum metabolic panel, and drugs taken that affect muscle cramps) were extracted from medical records. Body composition, including muscle volume, was analyzed using a bioelectrical impedance analysis method, and muscle strength (handgrip) was evaluated at enrollment. Cross-sectional skeletal muscle area was evaluated on computed tomography imaging at the L3 vertebral level to investigate the relationship between muscle cramps and sarcopenia. RESULTS The proportion of furosemide administration was higher in patients with cramping compared with those without. On a multivariate logistic regression analysis, furosemide use was a significant factor in the presence of muscle cramps. Furthermore, regarding factors contributing to muscle cramp severity, furosemide use was extracted by multivariate logistic regression analysis. In the presence or severity of muscle cramps, skeletal muscles did not show any significant difference. CONCLUSIONS Furosemide use for patients with cirrhosis was considered a risk factor for occurrence and severity of muscle cramps. On the other hand, skeletal muscle mass loss was not associated with muscle cramps.
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Affiliation(s)
- Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Takuya Kubo
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Masanori Furukawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Soichiro Saikawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
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Inoue T, Nakayama J, Moriya K, Kawaratani H, Momoda R, Ito K, Iio E, Nojiri S, Fujiwara K, Yoneda M, Yoshiji H, Tanaka Y. Gut Dysbiosis Associated With Hepatitis C Virus Infection. Clin Infect Dis 2019; 67:869-877. [PMID: 29718124 DOI: 10.1093/cid/ciy205] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 03/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background Little is known about the effect of hepatitis C virus (HCV) infection on gut microbiota and the relationship between alteration of gut microbiota and chronic hepatitis C (CHC) progression. We performed a comparative study of gut microbiota composition between CHC patients and healthy individuals. Methods Fecal samples from 166 CHC patients were compared with those from 23 healthy individuals; the gut microbiota community was analyzed using 16S ribosomal RNA gene sequencing. CHC patients were diagnosed with persistently normal serum alanine aminotransferase without evidence of liver cirrhosis (LC) (PNALT, n = 18), chronic hepatitis (CH, n = 84), LC (n = 40), and hepatocellular carcinoma in LC (n = 24). Results Compared with healthy individuals, bacterial diversity was lower in persons with HCV infection, with a decrease in the order Clostridiales and an increase in Streptococcus and Lactobacillus. Microbiota dysbiosis already appeared in the PNALT stage with the transient increase in Bacteroides and Enterobacteriaceae. Predicted metagenomics of microbial communities showed an increase in the urease gene mainly encoded by viridans streptococci during CHC progression, consistent with a significantly higher fecal pH in CH and LC patients than in healthy individuals or those in the PNALT stage. Conclusions HCV infection is associated with gut dysbiosis, even in patients with mild liver disease. Additionally, overgrowth of viridans streptococci can account for hyperammonemia in CH and LC. Further studies would help to propose a novel treatment strategy because the gut microbiome can be therapeutically altered, potentially reducing the complications of chronic liver disease.
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Affiliation(s)
- Takako Inoue
- Department of Clinical Laboratory Medicine, Nagoya City University Hospital
| | - Jiro Nakayama
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara
| | - Rie Momoda
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute
| | - Etsuko Iio
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Shunsuke Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Kei Fujiwara
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara
| | - Yasuhito Tanaka
- Department of Clinical Laboratory Medicine, Nagoya City University Hospital.,Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Japan
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Tsuji Y, Kawaratani H, Ishida K, Kaya D, Kubo T, Fujinaga Y, Sawada Y, Takaya H, Shimozato N, Kaji K, Namisaki T, Moriya K, Akahane T, Yoshiji H. Effectiveness of Lusutrombopag in Patients with Mild to Moderate Thrombocytopenia. Dig Dis 2019; 38:329-334. [PMID: 31655803 DOI: 10.1159/000504044] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/10/2019] [Indexed: 02/02/2023]
Abstract
AIMS Thrombocytopenia is a common complication among patients with chronic liver disease (CLD). To increase platelet counts, lusutrombopag, a small-molecule, second-generation thrombopoietin receptor agonist, was developed in September 2015. Lusutrombopag is mainly used in patients with platelet counts <50,000/µL. However, its usefulness in patients with platelet counts ≥50,000/µL remains unknown. We studied the effectiveness of lusutrombopag administration in patients with platelet counts of ≥50,000/µL. METHODS We evaluated 36 patients who received lusutrombopag for CLD. Changes in platelet counts were evaluated. A treatment response was defined as an increasing platelet count ≥20,000/µL from baseline after drug administration. The differences related to these changes between platelet counts ≥50,000 and <50,000/µL were evaluated. RESULTS Of the patients, 25 had platelet counts ≥50,000/µL. The increase in platelet count and the date in which it reached a maximum did not significantly differ between the groups. The effectiveness of lusutrombopag did not significantly differ between the groups. In both groups, no adverse reaction was observed during lusutrombopag administration. CONCLUSION In this study, we showed the effectiveness of lusutrombopag, which had no complications. This study is the first to report that the effectiveness of lusutrombopag was the same for patients with platelet counts ≥50,000/µL and <50,000/µL.
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Affiliation(s)
- Yuki Tsuji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan,
| | - Koji Ishida
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Kaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Takuya Kubo
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
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Takaya H, Namisaki T, Kitade M, Kaji K, Nakanishi K, Tsuji Y, Shimozato N, Moriya K, Seki K, Sawada Y, Saikawa S, Sato S, Kawaratani H, Akahane T, Noguchi R, Matsumoto M, Yoshiji H. VWF/ADAMTS13 ratio as a potential biomarker for early detection of hepatocellular carcinoma. BMC Gastroenterol 2019; 19:167. [PMID: 31638892 PMCID: PMC6802329 DOI: 10.1186/s12876-019-1082-1] [Citation(s) in RCA: 15] [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: 11/21/2018] [Accepted: 09/20/2019] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the von Willebrand factor to ADAMTS13 ratio as a potential biomarker for early detection of hepatocellular carcinoma (HCC) in cirrhosis. Methods Serum levels of alpha-fetoprotein, des-γ-carboxy prothrombin, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (alpha-fetoprotein-L3%), vascular endothelial growth factor, and vascular endothelial growth factor receptor-2, as well as the plasma levels of von Willebrand factor antigen (von Willebrand factor: Ag) and ADAMTS13 activity (ADAMTS13:AC), were evaluated in 41 cirrhotic patients with HCC undergoing radiofrequency ablation and in 20 cirrhotic patients without HCC. The diagnostic accuracy of each biomarker was evaluated using the receiver operating characteristic curve analysis. Results The von Willebrand factor: Ag and von Willebrand factor: Ag/ADAMTS13:AC ratios were significantly higher in cirrhotic patients with HCC than in those without HCC (p < 0.05 and p < 0.01, respectively), whereas ADAMTS13:AC was significantly lower in those with HCC than those without HCC (p < 0.05). However, no relationship was observed between the von Willebrand factor: Ag/ADAMTS13:AC ratio and serum tumor markers such as alpha-fetoprotein, des-γ-carboxy prothrombin, and alpha-fetoprotein-L3%. Multivariate regression analysis identified von Willebrand factor: Ag/ADAMTS13:AC ratio and alpha-fetoprotein-L3% as significant factors of HCC development. Receiver operating characteristic analysis showed that the von Willebrand factor: Ag/ADAMTS13:AC ratio and alpha-fetoprotein-L3% had a better performance than alpha-fetoprotein, des-γ-carboxy prothrombin, alpha-fetoprotein-L3%, vascular endothelial growth factor, and vascular endothelial growth factor receptor-2, von Willebrand factor: Ag, and ADAMTS13:AC. The von Willebrand factor: Ag/ADAMTS13:AC ratio was exclusively correlated with tumor volume and stage as well as serum vascular endothelial growth factor levels. Conclusions The von Willebrand factor: Ag/ADAMTS13:AC ratio can potentially serve as a novel biomarker for early diagnosis of HCC in cirrhotic patients.
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Affiliation(s)
- Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan.
| | - Mitsuteru Kitade
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Keisuke Nakanishi
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Yuki Tsuji
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Kenichiro Seki
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Soichiro Saikawa
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Ryuichi Noguchi
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
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50
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Takaya H, Namisaki T, Kitade M, Shimozato N, Kaji K, Tsuji Y, Nakanishi K, Noguchi R, Fujinaga Y, Sawada Y, Saikawa S, Sato S, Kawaratani H, Moriya K, Akahane T, Yoshiji H. Acylcarnitine: Useful biomarker for early diagnosis of hepatocellular carcinoma in non-steatohepatitis patients. World J Gastrointest Oncol 2019; 11:887-897. [PMID: 31662827 PMCID: PMC6815927 DOI: 10.4251/wjgo.v11.i10.887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Early diagnosis of hepatocellular carcinoma (HCC) is necessary to improve the prognosis of patients. However, the currently available tumor biomarkers are insufficient for the early detection of HCC. Acylcarnitine is essential in fatty acid metabolic pathways. A recent study reported that a high level of acylcarnitine may serve as a useful biomarker for the early diagnosis of HCC in steatohepatitis (SH) patients. In contrast, another study reported that the level of acetylcarnitine (AC2) - one of the acylcarnitine species - in non-SH patients with HCC was decreased vs that reported in those without HCC.
AIM To investigate the usefulness of acylcarnitine as a biomarker for the early diagnosis of HCC in non-SH patients.
METHODS Thirty-three non-SH patients (14 with HCC and 19 without HCC) were enrolled in this study. Blood samples were obtained from patients at the time of admission. The levels of acylcarnitine and AC2 in the serum were determined through tandem mass spectrometry. The levels of vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2) were determined by enzyme-linked immunosorbent assay. Univariate and multivariate analyses were used to determine early diagnostic factors of HCC.
RESULTS The level of acylcarnitine was significantly lower in non-SH patients with HCC vs those without HCC (P < 0.05). In contrast, the level of lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP) - AFP-L3% - was significantly higher in non-SH patients with HCC vs those without HCC (P < 0.05). However, the levels of total carnitine, free carnitine, AFP, des-γ-carboxy prothrombin, VEGF, and VEGFR-2 were not different between patients with and without HCC. The multivariate analysis showed that a low level of acylcarnitine was the only independent factor for the early diagnosis of HCC. The patients with a low level of AC2 had a significantly higher level of VEGF vs those with a high level of AC2 (P < 0.05).
CONCLUSION The metabolic pathways of fatty acids may differ between SH HCC and non-SH HCC. Further studies are warranted to investigate these differences.
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Affiliation(s)
- Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Mitsuteru Kitade
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Yuki Tsuji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Keisuke Nakanishi
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Ryuichi Noguchi
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Soichiro Saikawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan
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