Role of Virus-Related Chronic Inflammation and Mechanisms of Cancer Immune-Suppression in Pathogenesis and Progression of Hepatocellular Carcinoma

Simple Summary

Hepatocellular carcinoma pathogenesis is dependent on a chronic inflammation caused by several factors, including hepatotropic viruses, such as HCV and HBV. This chronic inflammation is established in the context of the immunotolerogenic environment peculiar of the liver, in which the immune system can be stimulated by HCV and HBV viral antigens. This complex interaction can be influenced by direct-acting antiviral drug treatments, capable of (almost totally) rapidly eradicating HCV infection. The influence of anti-viral treatments on HCC pathogenesis and progression remains to be fully clarified.

Abstract

Hepatocellular carcinoma (HCC) can be classified as a prototypical inflammation-driven cancer that generally arises from a background of liver cirrhosis, but that in the presence of nonalcoholic steatohepatitis (NASH), could develop in the absence of fibrosis or cirrhosis. Tumor-promoting inflammation characterizes HCC pathogenesis, with an epidemiology of the chronic liver disease frequently encompassing hepatitis virus B (HBV) or C (HCV). HCC tumor onset and progression is a serial and heterogeneous process in which intrinsic factors, such as genetic mutations and chromosomal instability, are closely associated with an immunosuppressive tumor microenvironment (TME), which may have features associated with the etiopathogenesis and expression of the viral antigens, which favor the evasion of tumor neoantigens to immune surveillance. With the introduction of direct-acting antiviral (DAA) therapies for HCV infection, sustained virological response (SVR) has become very high, although occurrence of HCC and reactivation of HBV in patients with co-infection, who achieved SVR in short term, have been observed in a significant proportion of treated cases. In this review, we discuss the main molecular and TME features that are responsible for HCC pathogenesis and progression. Peculiar functional aspects that could be related to the presence and treatment of HCV/HBV viral infections are also dealt with.

The spectrum of left ventricular size in dilated cardiomyopathy: clinical correlates and prognostic implications. SPIC (Italian Multicenter Cardiomyopathy Study) Group

To address the issues of variability and prognostic role of left ventricular dimensions in dilated cardiomyopathy (DCM), 144 patients with DCM were studied. They were arbitrarily assigned to two groups according to an echocardiographic left ventricular end-diastolic diameter index < or = 15% (45 patients with mildly dilated cardiomyopathy) and above 15% (99 patients with typically dilated cardiomyopathy) of the upper normality range. Among the patients with mildly dilated cardiomyopathy, there were more men (89% vs 66%; p < 0.01). This group of patients also had a greater prevalence of atrial fibrillation (22% vs 3%; p < 0.001) higher left ventricular fractional shortening (15 +/- 6% vs 13 +/- 5%; p < 0.05), higher ejection fraction (28 +/- 8% vs 24 +/- 8%; p < 0.01), and a lower exercise tolerance (5 +/- 2 MET vs 6 +/- 2 MET; p < 0.05). At the time of follow-up examination (30 +/- 15 months), event-free survival was not significantly different between patients with mildly dilated cardiomyopathy and those with typically dilated cardiomyopathy. Pulmonary capillary wedge pressure (p < 0.001) and left atrial dimension index (p < 0.01) were significant predictors of prognosis as determined by Cox multivariate analysis. Minimal or mild ventricular dilatation is not uncommon in DCM, and it identifies a heterogenous group of patients--some who are in the early stages of disease and others with severe pump dysfunction and persistently small hearts. Ventricular dilatation is not an independent predictor of prognosis.

Relative bioavailability of fosfomycin and of trometamol after administration of single dose by oral route of fosfomycin trometamol in fasting conditions and after a meal

The pharmacokinetics of fosfomycin and trometamol after single oral dose of fosfomycin trometamol (Z 1282) was studied in healthy volunteers in fasting conditions and immediately after standard meal. The dose was of 1.876 g (equivalent to 1.0 g of fosfomycin). The parameters considered were: serum apparent elimination half-life (t1/2), maximum serum concentration (Cmax), time to Cmax (tmax), area under the curve of the serum concentrations from time 0 (zero) to infinity (AUC0-infinity) and urinary recovery in the first 48 h. The results confirm that fosfomycin trometamol allows high bioavailability of fosfomycin. The absorption and elimination rates of fosfomycin and trometamol in the serum were similar. A statistically significant difference was found between the Cmax values of fosfomycin in the 2 experimental conditions. Means +/- SE of Cmax (micrograms/ml) were 12.1 +/- 0.6 in fasting conditions and 7.8 +/- 1.6 after a meal. Urinary recovery of the antibiotic was high in both experimental conditions. The fraction of the dose recovered (the dose being taken as equal to 1) was on the average 0.58 in the first condition and 0.52 in the second. Urinary recoveries of trometamol in the 2 different conditions were similar.

[Dynamic electrocardiographic evaluation of the circadian rhythms of the ectopic ventricular beats in healthy and cardiopathic subjects]

The 24 hour study was carried out on 34 subjects, 17 cardiopathy 13 male and 4 female, mean age 56 +/- 14) and 17 normal (10 male and 7 female, mean age 41 +/- 18) with, on average, over 30 PVC/h in the dynamic ECG: no statistically significant difference in mean PVC/h was recorded between the two groups. Single cosinor analysis demonstrated a statistically significant circadian rhythm (p less than 0.05) in 11 cardiopathic (64.7%) and 13 normal subjects (76.4%). Population mean cosinor failed to demonstrate a significant rhythm in either of the two groups. Results suggest that personal circadian rhythms should be studied to identify the most appropriate antiarrhythmic treatment.

Ibopamine kinetics after a single oral dose in healthy volunteers

In order to describe kinetics after single administration and to test dose independence in the therapeutic dose range, ibopamine (SB-7505), the 3,4-diisobutyrylester of N-methyldopamine (epinine), was given orally to six healthy volunteers at multiple dose levels in a cross-over fashion. Doses employed were 50, 100 and 200 mg with a wash-out period of at least three days between doses. Plasma levels were studied after the 100 mg dose, and urinary recoveries of the major metabolites were measured after each dose. After oral intake of ibopamine, both conjugated and free epinine were detectable in plasma at the earliest sampling times (i.e. 5-10 min), with a hybrid absorption half-life of 0.25 h. Peak plasma concentration mean values of total and free epinine were 33 mumol/l and 35 nmol/l, respectively, and mean time to plasma peak concentration was 1.5 and 0.71 h, respectively. 24-h urinary recovery of conjugated epinine, homovanillic acid and dihydroxyphenylacetic acid accounted for about two thirds of the dose, without dose-dependent mechanisms affecting total elimination. Presystemic sulfate conjugation as a potentially saturable metabolic step at higher dose levels is discussed, although evidence was not found of its saturation in the studied dose range.

Treatment of chronic constipation by a bulk-forming laxative (Fibrolax)

Seventy-five patients affected by chronic constipation were treated for 4 weeks with an Ispaghula Husk preparation (Fibrolax), a bulk-forming laxative. Frequency, stool consistency, abdominal pain and signs of venous stasis improved after treatment. No important side-effect was recorded. Cholesterol, HDL-cholesterol and triglycerides did not show significant changes.

Double-blind controlled trial of the new preparation FZ. 560 in the symptomatic treatment of digestive disorders

A controlled double-blind clinical trial was carried out to compare the effects of a new combination FZ. 560 in the symptomatic treatment of digestive disorders including a wide variety of symptoms. The combination contained fentonium bromide, 10 mg, dehydrocholic acid, 25 mg, pancreatin 3FU, 50 mg, and lactulose, 200 mg; it was compared with fentonium bromide 10 mg, and the other components. The three treatment groups included 37 patients, treated for a maximum of 14 days. The severity of the painful and dyspeptic symptoms was recorded daily; the overall daily scores were analyzed using persistence curves. A 50% reduction of the initial overall scores was observed in all the 12 patients in the combination groups by the third treatment day, but not until the 13th day in the fentonium group, while a 50% reduction in symptom intensity was not achieved during the trial in 7.7% of the group treated with the other components. Statistical comparison with the Wilcoxon test showed in fact that the effects of FZ. 560 were significantly superior to those of the two control preparations which did not differ significantly. These results, therefore, demonstrate clearly the advantages of the new combination FZ. 560.