1
|
Di Cola S, Gazda J, Lapenna L, Ceccarelli G, Merli M. Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis. JHEP Rep 2023; 5:100703. [PMID: 36844944 PMCID: PMC9938945 DOI: 10.1016/j.jhepr.2023.100703] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Background & Aims Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection prevention and control programme and coronavirus disease 2019 (COVID-19) measures on the incidence of hospital-acquired infections and a set of secondary outcomes, including the prevalence of multidrug-resistant organisms, empiric antibiotic treatment failure, and development of septic states in patients with cirrhosis. Methods The infection prevention and control programme was a complex strategy based on antimicrobial stewardship and the reduction of patient's exposure to risk factors. The COVID-19 measures presented further behavioural and hygiene restrictions imposed by the Hospital and Health Italian Sanitary System recommendations. We performed a combined retrospective and prospective study in which we compared the impact of extra measures against the hospital standard. Results We analysed data from 941 patients. The infection prevention and control programme was associated with a reduction in the incidence of hospital-acquired infections (17 vs. 8.9%, p <0.01). No further reduction was present after the COVID-19 measures had been imposed. The impact of the infection prevention and control programme remained significant even after controlling for the effects of confounding variables (odds ratio 0.44, 95% CI 0.26-0.73, p = 0.002). Furthermore, the adoption of the programme reduced the prevalence of multidrug-resistant organisms and decreased rates of empiric antibiotic treatment failure and the development of septic states. Conclusions The infection prevention and control programme decreased the incidence of hospital-acquired infections by nearly 50%. Furthermore, the programme also reduced the prevalence of most of the secondary outcomes. Based on the results of this study, we encourage other liver centres to adopt infection prevention and control programmes. Impact and implications Infections are a life-threatening problem for patients with liver cirrhosis. Moreover, hospital-acquired infections are even more alarming owing to the high prevalence of multidrug-resistant bacteria. This study analysed a large cohort of hospitalised patients with cirrhosis from three different periods. Unlike in the first period, an infection prevention programme was applied in the second period, reducing the number of hospital-acquired infections and containing multidrug-resistant bacteria. In the third period, we imposed even more stringent measures to minimise the impact of the COVID-19 outbreak. However, these measures did not result in a further reduction in hospital-acquired infections.
Collapse
Key Words
- ALD, alcoholic liver disease
- Antibiotic resistance
- Antimicrobial stewardship
- BB, beta-blockers
- Bacterial infections
- C19MC, COVID-19 measures cohort
- CA, community acquired
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- EATF, empiric antibiotic treatment failure
- Empiric antibiotic failure
- HAI, hospital-acquired infection
- HCA, healthcare-associated
- IPCC, infection prevention and control cohort
- IPCP, infection prevention and control programme
- Liver cirrhosis
- MAP, mean arterial pressure
- MDR, multidrug-resistant
- MELD, model for end-stage liver disease
- Multidrug-resistant bacteria
- NASH, non-alcoholic steatohepatitis
- Nosocomial infections
- OR, odds ratio
- PDR, pandrug-resistant
- PPI, proton pump inhibitor
- SARS-CoV-2
- SBP, spontaneous bacterial peritonitis
- SMC, standard measures cohort
- UTI, urinary tract infection
- WBC, white blood cell
- XDR, extensively drug-resistant
Collapse
Affiliation(s)
- Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovakia
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Internal Medicine, Endocrinology and Metabolic Science and Infectious Diseases, University Hospital Policlinico Umberto I, Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Corresponding author. Address: Department of Translational and Precision Medicine, ‘Sapienza’ University of Rome, Viale dell’Universita’ 37, 00185 Rome, Italy. Tel.: +39-064-997-2001..
| |
Collapse
|
2
|
Ahmed HS, Gangasani N, Jayanna MB, Long MT, Sanchez A, Murali AR. The NAFLD Decompensation Risk Score: External Validation and Comparison to Existing Models to Predict Hepatic Events in a Retrospective Cohort Study. J Clin Exp Hepatol 2023; 13:233-240. [PMID: 36950488 PMCID: PMC10025751 DOI: 10.1016/j.jceh.2022.11.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background The NAFLD decompensation risk score (the Iowa Model) was recently developed to identify patients with nonalcoholic fatty liver disease (NAFLD) at highest risk of developing hepatic events using three variables-age, platelet count, and diabetes. Aims We performed an external validation of the Iowa Model and compared it to existing non-invasive models. Methods We included 249 patients with NAFLD at Boston Medical Center, Boston, Massachusetts, in the external validation cohort and 949 patients in the combined internal/external validation cohort. The primary outcome was the development of hepatic events (ascites, hepatic encephalopathy, esophageal or gastric varices, or hepatocellular carcinoma). We used Cox proportional hazards to analyze the ability of the Iowa Model to predict hepatic events in the external validation (https://uihc.org/non-alcoholic-fatty-liver-disease-decompensation-risk-score-calculator). We compared the performance of the Iowa Model to the AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and the FIB-4 index in the combined cohort. Results The Iowa Model significantly predicted the development of hepatic events with hazard ratio of 2.5 [95% confidence interval (CI) 1.7-3.9, P < 0.001] and area under the receiver operating characteristic curve (AUROC) of 0.87 (CI 0.83-0.91). The AUROC of the Iowa Model (0.88, CI: 0.85-0.92) was comparable to the FIB-4 index (0.87, CI: 0.83-0.91) and higher than NFS (0.66, CI: 0.63-0.69) and APRI (0.76, CI: 0.73-0.79). Conclusions In an urban, racially and ethnically diverse population, the Iowa Model performed well to identify NAFLD patients at higher risk for liver-related complications. The model provides the individual probability of developing hepatic events and identifies patients in need of early intervention.
Collapse
Key Words
- A1AT, alpha-1-antitrypsin
- AASLD, the American Association for the Study of Liver Disease
- ALD, alcoholic liver disease
- ALT, alanine aminotransferase
- APRI, AST-to-Platelet Ratio Index
- AST, aspartate aminotransferase
- AUROC, area under the receiver operating characteristic curve
- BMI, body mass index
- CT, computed tomography
- HCV, hepatitis C infection
- HE, hepatic encephalopathy
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- SAS, Statistical Analysis Software
- VCTE, vibration-controlled transient elastography
- cirrhosis
- fatty liver
- nonalcoholic fatty liver disease
- risk assessment
Collapse
Affiliation(s)
- Heidi S. Ahmed
- Boston University School of Medicine, Section of Gastroenterology, Boston, MA, USA
| | - Nikitha Gangasani
- Boston University School of Medicine, Department of Internal Medicine, Boston, MA, USA
| | - Manju B. Jayanna
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Michelle T. Long
- Boston University School of Medicine, Section of Gastroenterology, Boston, MA, USA
| | - Antonio Sanchez
- The University of Iowa Hospitals and Clinics, Department of Internal Medicine, Gastroenterology and Hepatology, Iowa City, IA, USA
| | - Arvind R. Murali
- The University of Iowa Hospitals and Clinics, Department of Internal Medicine, Gastroenterology and Hepatology, Iowa City, IA, USA
| |
Collapse
|
3
|
Kalapala R, Rughwani H, Reddy DN. Artificial Intelligence in Hepatology- Ready for the Primetime. J Clin Exp Hepatol 2023; 13:149-161. [PMID: 36647407 PMCID: PMC9840075 DOI: 10.1016/j.jceh.2022.06.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
Artificial Intelligence (AI) is a mathematical process of computer mediating designing of algorithms to support human intelligence. AI in hepatology has shown tremendous promise to plan appropriate management and hence improve treatment outcomes. The field of AI is in a very early phase with limited clinical use. AI tools such as machine learning, deep learning, and 'big data' are in a continuous phase of evolution, presently being applied for clinical and basic research. In this review, we have summarized various AI applications in hepatology, the pitfalls and AI's future implications. Different AI models and algorithms are under study using clinical, laboratory, endoscopic and imaging parameters to diagnose and manage liver diseases and mass lesions. AI has helped to reduce human errors and improve treatment protocols. Further research and validation are required for future use of AI in hepatology.
Collapse
Key Words
- ACLF, acute on chronic liver failure
- AI, artificial intelligence
- ALD, alcoholic liver disease
- ALT, alanine transaminase
- ANN, artificial neural network
- AST, aspartate aminotransferase
- AUD, alcohol use disorder
- CHB, chronic hepatitis B
- CHC, chronic hepatitis C
- CLD, chronic liver disease
- CNN, convolutional neural network
- DL, deep learning
- FIB-4, fibrosis-4 score
- GGTP, gamma glutamyl transferase
- HCC, hepatocellular carcinoma
- HDL, high density lipoprotein
- ML, machine learning
- MLR, multi-nomial logistic regressions
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NLP, natural language processing
- RF, random forest
- RTE, real-time tissue elastography
- SOLs, space-occupying lesions
- SVM, support vector machine
- artificial intelligence
- deep learning
- hepatology
- machine learning
Collapse
Affiliation(s)
- Rakesh Kalapala
- Department of Gastroenterology, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, India
| | - Hardik Rughwani
- Department of Gastroenterology, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, India
| | | |
Collapse
|
4
|
Chand PK, Panda U, Mahadevan J, Murthy P. Management of Alcohol Withdrawal Syndrome in Patients with Alcoholic Liver Disease. J Clin Exp Hepatol 2022; 12:1527-1534. [PMID: 36340306 PMCID: PMC9630022 DOI: 10.1016/j.jceh.2022.03.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/13/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol withdrawal syndrome (AWS) is a common condition that is seen in treatment-seeking patients with Alcohol use disorder (AUD) and alcoholic liver disease (ALD). AWS, which typically starts within 4-6 h of the last alcohol use, can range from mild symptoms such as insomnia, tremors, and autonomic hyperactivity to more severe symptoms such as seizures and delirium tremens. Clinical Institute Withdrawal Assessment Scale-Alcohol Revised (CIWA-Ar) is the most commonly used scale to assess AWS in clinical practice. The presence of moderate withdrawal as indicated by a score of more than 8 is an indication for pharmacotherapy. Lorazepam and oxazepam are preferred agents for the management of AWS in the setting of ALD. In severe ALD, benzodiazepines should be used cautiously with monitoring due to the risk of excessive sedation or precipitating hepatic encephalopathy.
Collapse
Key Words
- ALD, alcoholic liver disease
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- AUD, alcohol use disorder
- AUDIT – C, Alcohol Use Disorder Identification Test – Consumption
- AUDIT, Alcohol Use Disorder Identification Test
- AWS, alcohol withdrawal syndrome
- CIWA – Ar, Clinical Institute Withdrawal Assessment for Alcohol Revised
- CNS, central nervous system
- EtG, ethyl glucuronide
- EtS, ethyl sulphate
- GABA, gamma-aminobutyric acid
- GGT, gamma glutamyl transferase
- HE, hepatic encephalopathy
- MCV, mean corpuscular volume
- NMDA, N-methyl-d-aspartate
- alcohol
- alcoholic liver disease
- assessment
- treatment
- withdrawal
Collapse
Affiliation(s)
- Prabhat Kumar Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Udit Panda
- Kalinga Institute of Medical Sciences, Bhubaneshwar, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
| |
Collapse
|
5
|
Kumar A, Saraswat V, Pande G, Kumar R. Does Treatment of Erectile Dysfunction With PDE 5 Inhibitor Tadalafil Improve Quality of Life in Male Patients With Compensated Chronic Liver Disease? A Prospective Pilot Study. J Clin Exp Hepatol 2022; 12:1083-1090. [PMID: 35814506 PMCID: PMC9257884 DOI: 10.1016/j.jceh.2022.01.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Erectile dysfunction (ED) is common in patients with compensated cirrhosis but its impact on the quality of life (QOL) is usually overlooked. This study aimed at determining the frequency of ED in male patients with compensated chronic liver disease (CLD), assessing their QOL and the response to treatment with tadalafil. A secondary aim was to assess the effect of the tadalafil therapy on liver fibrosis, if any. METHODS Consecutive patients with compensated CLD and advanced liver fibrosis were screened at the baseline with the International Index of Erectile Function-5 (IIEF-5), QOL questionnaire (WHOQOL-BREF), liver stiffness measurements (LSM) made with Fibroscan™ (Echosens, France), and fibrosis index based on 4 factors (FIB-4) scores. Patients with ED meeting eligibility criteria were prescribed PDE5 inhibitor tadalafil 20 mg on alternate days. During the follow-up, IIEF-5, LSM, and FIB-4 were monitored after 3 and 6 months while the WHOQOL-BREF questionnaire was administered at the baseline and at 6 months. RESULTS Among 89 patients with CLD and advanced liver fibrosis, ED was present in 43 (48%) and tadalafil was prescribed to 34 patients (38%) meeting exclusion and inclusion criteria. At 3 months follow-up, the mean IIEF 5 score increased from 15.57 ± 4 to 20.78 ± 3.6, (P = 0.0001) and the improvement persisted at 6 months (IIEF-5 score 21.87 ± 2.2; P = 0.12). The physical, social relationships, and environment domains in the WHOQOL-BREF questionnaire showed significant improvement at six months (P < 0.05) but not the psychological domain (P = ns). From a baseline value of 12.69 ± 3.1 kPa, the mean LSM decreased to 11.37 ± 3.9 kPa, (P = 0.02) after 3 months on tadalafil. After 6 months, the LSM further decreased from 11 ± 0.9 to 8.2 ± 3.2 kPa (P = 0.034). FIB-4 values showed a decline from the baseline at 3 months, from 1.52 ± 0.58 to 1.32 ± 0.55, P < 0.05 and at 6 months, from 1.25 ± 0.53 to 0.97 ± 0.36, P > 0.05. The CAP values did not show any significant change. There was an insignificant decline in the SGOT and SGPT levels (P > 0.05) with no significant change in CTP or MELD scores. CONCLUSIONS In the short term, tadalafil improves ED and QOL in patients with CLD and advanced liver fibrosis. It may also reduce liver fibrosis in them. Further studies that include liver histology are needed to confirm this preliminary observation of a possible antifibrotic effect.
Collapse
Key Words
- ALD, alcoholic liver disease
- CLD, chronic liver disease
- ED, Erectile dysfunction
- FIB-4
- FIB-4, fibrosis index based on 4 factors
- HRQOL, health-related quality of life
- IIEF-5
- IIEF-5, the International Index of Erectile Function-5
- LC, liver cirrhosis
- LSM, liver stiffness measurement
- MAP, mean arterial pressure
- PDE-5 I
- PDE5-I, phosphodiesterase inhibitors
- PDEs, phosphodiesterases
- PPH, porto-pulmonary hypertension
- QOL, quality of life
- SMT, standard medical therapy
- TAA, thioacetamide
- TE, transient elastography
- WHOQOL-BREF
- cAMP, cyclic adenosine monophosphate
- cGMP, cyclic guanosine monophosphate
- erectile dysfunction
Collapse
Affiliation(s)
- Alok Kumar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Vivek Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India,Address for correspondence: Vivek A. Saraswat, Head, Department of Hepatology, Pancreatobiliary Sciences and Liver Transplantation Mahatma Gandhi Medical College and Hospital, Jaipur, 302022, Rajasthan, India
| | - Gaurav Pande
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Rajesh Kumar
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, JH, India
| |
Collapse
|
6
|
Bhatti S, Lizaola-Mayo B, Al-Shoha M, Garcia-Saenz-de-Sicilia M, Habash F, Ayoub K, Karr M, Ahmed Z, Borja-Cacho D, Duarte-Rojo A. Use of Computed Tomography Coronary Calcium Score for Coronary Artery Disease Risk Stratification During Liver Transplant Evaluation. J Clin Exp Hepatol 2022; 12:319-328. [PMID: 35535104 PMCID: PMC9077224 DOI: 10.1016/j.jceh.2021.08.015] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background End-stage liver disease (ESLD) is not considered a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, lifestyle characteristics commonly associated with increased ASCVD risk are highly prevalent in ESLD. Emerging literature shows a high burden of asymptomatic coronary artery disease (CAD) in patients with ESLD and a high ASCVD risk in liver transplantation (LT) recipients. Coronary artery calcium score (CAC) is a noninvasive test providing reliable CAD risk stratification. We implemented an LT evaluation protocol with CAC playing a central role in triaging and determining the need for further CAD assessment. Here, we inform our results from this early experience. Methods Patients with ESLD referred for LT evaluation were prospectively studied. We compared accuracy of CAC against that of CAD risk factors/scores, troponin I, dobutamine stress echocardiogram (DSE), and single-photon emission computed tomography (SPECT) to detect coronary stenosis ≥70 (CAD ≥ 70) per left heart catheterization (LHC). Thirty-day post-LT cardiac outcomes were also analyzed. Results One hundred twenty-four of 148 (84%) patients underwent CAC, 106 (72%) DSE/SPECT, and 50 (34%) LHC. CAC ≥ 400 was found in 35 (28%), 100 to 399 in 17 (14%), and <100 in 72 (58%). LHC identified CAD ≥ 70% in 8 of 29 (28%), 2 of 9 (22%), and 0 of 4, respectively. Two acute coronary syndromes occurred after LT in a patient with CAC 811 (CAD < 70%), and one with CAC 347 (CAD ≥ 70%). No patients with CAC < 100 presented with acute coronary syndrome after LT. When using CAD ≥ 70% as primary endpoint of LT evaluation, CAC ≥ 346 was the only test showing predictive usefulness (negative predictive value 100%). Conclusions CAC is a promising tool to guide CAD risk stratification and need for LHC during LT evaluation. Patients with a CAC < 100 can safely undergo LT without the need for LHC or cardiac stress testing, whereas a CAC < 346 accurately rules out significant CAD stenosis (≥70%) on LHC, outperforming other CAD risk-stratification strategies.
Collapse
Key Words
- ACS, Acute coronary syndromes
- ALD, alcoholic liver disease
- ASCVD, Atherosclerotic cardiovascular disease
- ASCVD, atherosclerosis cardiovascular disease risk
- BMI, Body mass index
- CABG, Coronary angioplasty bypass surgery
- CAC, Coronary calcium score
- CAD, Coronary artery disease
- CKD, chronic kidney disease
- DSE/SPECT, Dobutamine stress echocardiogram or single-photon emission computed tomography
- ESLD, End-stage liver disease
- HCV, hepatitis C virus
- IQR, Interquartile range
- LCx, left circumflex
- LHC, Left heart catheterization
- LT, liver transplantation
- MELD, model for end stage liver disease
- MESA, Multi-Ethnic Study of Atherosclerosis
- METs, Metabolic equivalents
- NPV, negative predictive value
- OM, obtuse marginal
- OPTN, Organ Procurement and Transplantation Network
- PCI, Percutaneous coronary intervention
- PDA, posterior descending artery
- POBA, plain old balloon angioplasty
- PPV, positive predictive value
- RCA, right coronary artery
- RI, ramus intermedius
- ROC, Receiver operating characteristic
- RPL, right posterolateral
- SD, Standard deviation
- VT, Ventricular tachycardia
- agatston score
- angiogram
- cardiac stress test
- cirrhosis
- end-stage liver disease
Collapse
Affiliation(s)
- Sabha Bhatti
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Blanca Lizaola-Mayo
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, United States
| | - Mohammad Al-Shoha
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | | | - Fuad Habash
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Karam Ayoub
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Michael Karr
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Zubair Ahmed
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Daniel Borja-Cacho
- Division of Transplant Surgery, Northwestern University, 676 N Saint Clair, Chicago, IL, 60611, United States
| | - Andres Duarte-Rojo
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
- Thomas E. Starzl Transplantation Institute and Division of Gastroenterology, Hepatology and Nutrition; University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA, 15213, United States
- Address for correspondence: Andres Duarte-Rojo, MD, MS, DSc, Starzl Transplantation Institute and Center for Liver Diseases, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA, 15213, United States. Tel.: +1 412 647-1170; fax: +1 412 647 9268
| |
Collapse
|
7
|
Kaushal K, Agarwal S, Sharma S, Goswami P, Singh N, Sachdev V, Poudel S, Das P, Yadav R, Kumar D, Pandey G, Gunjan D, Saraya A. Demonstration of Gut-Barrier Dysfunction in Early Stages of Non-alcoholic Fatty Liver Disease: A Proof-Of-Concept Study. J Clin Exp Hepatol 2022; 12:1102-1113. [PMID: 35814507 PMCID: PMC9257921 DOI: 10.1016/j.jceh.2022.01.006] [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: 09/12/2021] [Accepted: 01/17/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIMS Gut-barrier dysfunction is well recognized in pathogenesis of both non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD). However, comparison of components of this dysfunction between the two etiologies remains unexplored especially in early stages of NAFLD. METHODS Components of gut-barrier dysfunction like alterations in intestinal permeability (IP) by lactulose mannitol ratio (LMR) in urine, systemic endotoxemia (IgG and IgM anti-endotoxin antibodies), systemic inflammation (serum tumor necrosis factor alpha [TNF-α] and interleukin-1 [IL-1] levels), tight junction (TJ) proteins expression in duodenal biopsy and stool microbiota composition using Oxford Nanopore MinION device were prospectively evaluated in patients with NAFLD (n = 34) with no cirrhosis, ALD (n = 28) and were compared with disease free controls (n = 20). RESULTS Patients with ALD had more advanced disease than those with NAFLD (median liver stiffness -NAFLD:7.1 kPa [5.9-8.9] vs. ALD:14.3 kPa [9.6-24], P < 0.001]. Median LMR was significantly higher in NAFLD and ALD group when compared to controls (NAFLD 0.054 [0.037-0.17] vs. controls 0.027 [0.021-0.045] (P = 0.001)) and ALD 0.043 [0.03-0.068] vs. controls 0.027 [0.021-0.045] (P = 0.019)]. Anti-endotoxin antibody titer (IgM) (MMU/mL) was lowest in NAFLD 72.9 [3.2-1089.5] compared to ALD 120.6 [20.1-728]) (P = 0.042) and controls 155.3 [23.8-442.9]) (P = 0.021). Median TNF-α (pg/mL) levels were elevated in patients with NAFLD (53.3 [24.5-115]) compared to controls (16.1 [10.8-33.3]) (P < 0.001) and ALD (12.3 [10.1-42.7]) (P < 0.001). Expression of zonulin-1 and claudin-3 in duodenal mucosa was lowest in NAFLD. On principal co-ordinate analysis (PCoA), the global bacterial composition was significantly different across the three groups (PERMANOVA test, P < 0.001). CONCLUSION While remaining activated in both etiologies, gut-barrier dysfunction abnormalities were more pronounced in NAFLD at early stages compared to ALD despite more advanced disease in the latter.
Collapse
Key Words
- ALD, alcoholic liver disease
- ALT, alanine transaminase
- AST, aspartate transaminase
- IL-1, interleukin-1
- IP, intestinal permeability
- KFT, kidney function test
- LFT, liver function test
- LMR, lactulose mannitol ratio
- NAFLD, non-alcoholic fatty liver disease
- TNF, tumor necrosis factor
- alcoholic liver disease
- endotoxemia
- intestinal permeability
- non-alcoholic fatty liver disease
- tight junction protein
Collapse
Affiliation(s)
- Kanav Kaushal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Sanchit Sharma
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Pooja Goswami
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Vikas Sachdev
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Shekhar Poudel
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Dinesh Kumar
- Centre of Biomedical Research, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Gaurav Pandey
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India,Address for correspondence: Anoop Saraya, Professor and Head, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029 , India.
| |
Collapse
|
8
|
Schneekloth TD, Arab JP, Simonetto DA, Petterson TM, Niazi SK, Hall-Flavin DK, Karpyak VM, Kolla BP, Roth JE, Kremers WK, Rosen CB. Factors Having an Impact on Relapse and Survival in Transplant Recipients With Alcohol-Induced Liver Disease. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1153-1164. [PMID: 34938953 PMCID: PMC8666351 DOI: 10.1016/j.mayocpiqo.2021.10.005] [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] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the impact of standardized pretransplant alcohol abstinence and treatment guidelines on liver transplant outcomes. Methods This study assessed the posttransplant relapse and survival associated with a pretransplant guideline mandating alcohol abstinence, addiction treatment, and Alcoholics Anonymous (AA) attendance. This retrospective cohort study included liver recipients with alcohol-induced liver disease transplanted between January 1, 2000, and December 31, 2012, at a Midwest transplant center. Cox regression models tested for associations between pretransplant treatment, demographic and clinical characteristics, and outcome measures. Results Of 236 liver recipients (188 [79.7%] male; 210 [89%] white; mean follow-up, 88.6±55.0 months), 212 (90.2%) completed pretransplant treatment and 135 (57.2%) attended AA weekly. At 5 years, 16.3% and 8.2% had relapsed to any alcohol use and to high-dose drinking, respectively. Smoking during the 6 months before transplant was associated with any relapse (P=.0002) and high-dose relapse (P<.0001), and smoking at transplant was associated with death (P=.001). High-dose relapse was associated with death (hazard ratio, 3.5; P<.0001). Conclusion A transplant center with a guideline requiring abstinence, treatment, and AA participation experienced lower posttransplant relapse rates from those previously reported in comparable large US transplant programs. Smoking cessation may further improve posttransplant outcomes.
Collapse
Affiliation(s)
| | - Juan P Arab
- Department of Gastroenterology and Hepatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.,William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN
| | - Tanya M Petterson
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Shehzad K Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | | | - Victor M Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Bhanu P Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Walter K Kremers
- William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.,Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Charles B Rosen
- William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.,Department of Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
9
|
Laschtowitz A, Zachou K, Lygoura V, Pape S, Derben F, Jaeckel E, Oller-Moreno S, Weidemann S, Krech T, Piecha F, Schön G, Liebhoff AM, Al Tarrah M, Heneghan M, Drenth JP, Dalekos G, Taubert R, Lohse AW, Schramm C. Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. JHEP Rep 2021; 3:100321. [PMID: 34381983 PMCID: PMC8333110 DOI: 10.1016/j.jhepr.2021.100321] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND & AIMS In autoimmune hepatitis (AIH), normal levels of transaminases and IgG define biochemical remission and are considered the best surrogate markers for histological remission. This study assessed whether this also applies to patients with AIH cirrhosis. METHODS In this European multicentric study, we included 125 biopsies from 113 patients with AIH and histologically proven cirrhosis; 105 biopsies from 104 patients with AIH without cirrhosis served as controls. Biochemical parameters were available within 4 weeks of biopsy. AIH activity was graded according to the modified Hepatitis Activity Index (mHAI), with mHAI ≥4/18 considered to indicate risk of disease progression. RESULTS In total, 47 out of 125 liver biopsies were obtained from patients with AIH cirrhosis and normal ALT levels at time of biopsy. Only 26% (12/47) of those livers showed histological remission (mHAI <4/18), whereas 36% (17/47) showed moderate to high histological activity (mHAI ≥6/18). In patients with noncirrhotic AIH, 88% (46/52 biopsies) of cases with normal ALT levels had histological remission and only 4% (2/52) had an mHAI ≥6/18 (p <0.001). The addition of IgG to define complete biochemical remission only slightly improved the association with histological remission in the limited number of patients with AIH cirrhosis available for analysis [29% (5/17) of biopsies with mHAI <4/18]. ALT correlated closely with mHAI in AIH without cirrhosis but poorly in AIH with cirrhosis. CONCLUSIONS In contrast to patients with noncirrhotic AIH, in patients with AIH cirrhosis, who are at risk of disease progression, normal ALT levels and potentially also complete biochemical remission are poor surrogate markers of histological remission. Thus, new biomarkers are needed to monitor disease activity and progression in patients with AIH cirrhosis. LAY SUMMARY Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that usually responds to immunosuppressive therapy. Serum transaminases and IgG levels within the normal ranges define complete biochemical remission and are considered as surrogate markers for histological disease activity. Here, we show that those biochemical markers are not sufficient to indicate low disease activity in patients with AIH and already established cirrhosis. Consequently, until better biomarkers for disease activity are found, only liver biopsy can reliably indicate disease activity in the presence of cirrhosis. Additional investigations, such as measurements of liver stiffness, should be undertaken to monitor non-invasively for disease progression in patients with AIH and established cirrhosis.
Collapse
Key Words
- AIH, autoimmune hepatitis
- ALD, alcoholic liver disease
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Autoimmune hepatitis
- Biochemical remission
- Cirrhosis
- EASL, European Association for the Study of the Liver
- Histological activity
- ICC, intraclass correlation coefficient
- INR, international normalised ratio
- LLN, lower limit of normal
- Liver biopsy
- MELD, model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- TE, transient elastography
- TIPS, transjugular intrahepatic portosystemic shunt
- ULN, upper limit of normal
- gamma-GT, gamma glutamyl transferase
- mHAI
- mHAI, modified Hepatitis Activity Index
Collapse
Affiliation(s)
- Alena Laschtowitz
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
| | - Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Vasiliki Lygoura
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Simon Pape
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Finn Derben
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sergio Oller-Moreno
- Institute of Medical Systems Biology, Centre for Molecular Neurobiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sören Weidemann
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Till Krech
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Piecha
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Maria Liebhoff
- Institute of Medical Systems Biology, Centre for Molecular Neurobiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Munira Al Tarrah
- Institute of Liver Studies and Transplantation, King´s College Hospital, London, UK
| | - Michael Heneghan
- Institute of Liver Studies and Transplantation, King´s College Hospital, London, UK
| | - Joost P.H. Drenth
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - George Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Richard Taubert
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ansgar Wilhelm Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Hamburg Centre for Translational Immunology (HCTI), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER)
- Hamburg Centre for Translational Immunology (HCTI), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
10
|
Zhang H, Fu L. The role of ALDH2 in tumorigenesis and tumor progression: Targeting ALDH2 as a potential cancer treatment. Acta Pharm Sin B 2021; 11:1400-11. [PMID: 34221859 DOI: 10.1016/j.apsb.2021.02.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
A major mitochondrial enzyme for protecting cells from acetaldehyde toxicity is aldehyde dehydrogenase 2 (ALDH2). The correlation between ALDH2 dysfunction and tumorigenesis/growth/metastasis has been widely reported. Either low or high ALDH2 expression contributes to tumor progression and varies among different tumor types. Furthermore, the ALDH2∗2 polymorphism (rs671) is the most common single nucleotide polymorphism (SNP) in Asia. Epidemiological studies associate ALDH2∗2 with tumorigenesis and progression. This study summarizes the essential functions and potential ALDH2 mechanisms in the occurrence, progression, and treatment of tumors in various types of cancer. Our study indicates that ALDH2 is a potential therapeutic target for cancer therapy.
Collapse
Key Words
- 4-HNE, 4-hydroxy-2-nonenal
- ALD, alcoholic liver disease
- ALDH2
- ALDH2, aldehyde dehydrogenase 2
- AMPK, AMP-activated protein kinase
- Acetaldehyde
- BCa, bladder cancer
- COUP-TF, chicken ovalbumin upstream promoter-transcription factor
- CRC, colorectal cancer
- CSCs, cancer stem cells
- Cancer
- Cancer therapy
- DFS, disease-free survival
- EC, esophageal cancer
- FA, Fanconi anemia
- FANCD2, Fanconi anemia protein
- GCA, gastric cancer
- HCC, hepatocellular carcinoma
- HDACs, histone deacetylases
- HNC, head and neck cancer
- HNF-4, hepatocyte nuclear factor 4
- HR, homologous recombination
- LCSCs, liver cancer stem cells
- MDA, malondialdehyde
- MDR, multi-drug resistance
- MN, micronuclei
- Metastasis
- NAD, nicotinamide adenine dinucleotide
- NCEs, normochromic erythrocytes
- NER, nucleotide excision repair pathway
- NF-κB, nuclear factor-κB
- NHEJ, non-homologous end-joining
- NRF2, nuclear factor erythroid 2 (NF-E2)-related factor 2
- NRRE, nuclear receptor response element
- NSCLC, non-small-cell lung
- NeG, 1,N2-etheno-dGuo
- OPC, oropharyngeal cancer
- OS, overall survival
- OvCa, ovarian cancer
- PBMC, peripheral blood mononuclear cell
- PC, pancreatic cancer
- PdG, N2-propano-2′-deoxyguanosine
- Polymorphism
- Progression
- REV1, Y-family DNA polymerase
- SCC, squamous cell carcinoma
- TGF-β, transforming growth factor β
- Tumorigenesis
- VHL, von Hippel-Lindau
- ccRCC, clear-cell renal cell carcinomas
- εPKC, epsilon protein kinase C
Collapse
|
11
|
de Avila V, Paik JM, de Avila L, Henry L, Mohess D, Roche-Green A, Younossi ZM. Hospice care utilisation among elderly patients who died with hepatocellular carcinoma in the United States. JHEP Rep 2021; 3:100236. [PMID: 33748729 PMCID: PMC7970151 DOI: 10.1016/j.jhepr.2021.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND & AIMS The benefits of hospice care in Medicare recipients with hepatocellular carcinoma (HCC) have not been fully evaluated, which we aimed to study. METHODS We used nationally representative samples of the Medicare beneficiaries in the USA (2011-2016) to assess the impact of hospice care on the outcomes of patients with HCC. Hospice care benefits on the survival time, length of stay (LOS), 30-day readmissions, and daily charges during the last year and month of life were assessed by logistic regression and generalised linear regression. RESULTS Among 2,230 Medicare beneficiaries with HCC (mean age, 74.9 years; non-Hispanic White 79.1%; male 66.6%), median survival from HCC diagnosis was 68 days; 556 (24.9%) received hospice services; median hospice LOS was 12 days (4-35 days). Hospice users increased from 20.1% to 31.1% over time, driven by enrolment ≤15 days (45.1-59.2%, respectively). In the last year of life, hospice users (vs. no hospice care) had longer median survival time (76.5 vs. 66 days), lower in-hospital mortality (1.1% vs. 25.5%) and lower median daily charges ($951 vs. $1,004) despite more inpatient admissions and higher comorbid diseases. Hospice enrolment was associated with 48.6% reduction in daily charges (95% CI: -54.9% to -41.5%). Longer hospice LOS was associated with lower rates of healthcare utilisation. Patients with chronic liver disease were less likely to enrol in hospice care (odds ratio = 0.18, 95% CI: 0.14-0.24). CONCLUSIONS Although hospice provides a significant decrease in healthcare utilisation and some benefit in survival, most care is given in the last 2 weeks of life. Efforts to encourage earlier use of hospice services must continue. LAY SUMMARY The purpose of hospice care is to provide comfort and lessen suffering at the end of life. Hospice care allows one to die outside the hospital environment which is the wish of most people. However, we found that among persons aged 65 years and older who were diagnosed with liver cancer (which has a poor prognosis), only 25% were enrolled in hospice care and the majority used a hospice only in the last weeks of life. This is a disheartening finding as liver cancer patients with longer hospice enrolment had lower costs and improved survival. We suggest that healthcare practitioners consider discussion of palliative and hospice care routinely with patients suffering from liver cancer.
Collapse
Affiliation(s)
- Victor de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - James M. Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - Denise Mohess
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Alva Roche-Green
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
- Inova Medicine, Inova Health Systems, Falls Church, VA, USA
| |
Collapse
|
12
|
Olafsson S, Rögnvaldsson S, Bergmann OM, Jonasson JG, Benitez Hernandez U, Björnsson ES. A nationwide population-based prospective study of cirrhosis in Iceland. JHEP Rep 2021; 3:100282. [PMID: 34041467 PMCID: PMC8141932 DOI: 10.1016/j.jhepr.2021.100282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background & Aims The incidence of cirrhosis in Iceland has been the lowest in the world with only 3 cases per 100,000 inhabitants. Alcohol consumption has almost doubled in Iceland from 1980 to 2016. Obesity has also risen and hepatitis C virus has spread among people who inject drugs in Iceland. The aim of this study was to evaluate the effects of these risk factors on the incidence and aetiology of cirrhosis in Iceland. Methods The study included all patients diagnosed with cirrhosis for the first time during 2010–2015. Diagnosis was based on liver histology or 2 of 4 criteria: cirrhosis on imaging, ascites, varices, and/or elevated INR. Results Overall, 157 patients were diagnosed, 105 (67%) males, mean age 61 years. The overall incidence was 9.7 cases per 100,000 inhabitants annually. Alcohol was the only underlying cause in 48/157 (31%), non-alcoholic fatty liver disease (NAFLD) in 34/157(22%), and alcohol and hepatitis C together in 23/157(15%) were the most common causes. Only 6% of patients had an unknown cause of cirrhosis. Upon diagnosis, the median model for end-stage liver disease score was 11 (IQR 8–15), 53% were of Child-Pugh class A whereas 61 (39%) had ascites, 11% encephalopathy, and 8% variceal bleeding. In all, 25% of deaths were from HCC and 25% from liver failure. Conclusion A major increase in incidence of cirrhosis has occurred in Iceland associated with increases in alcohol consumption, obesity, and hepatitis C. In a high proportion NAFLD was the aetiology and very few had unknown cause of cirrhosis. The highest death rate was from HCC. Lay summary In a nationwide population-based study from Iceland, including all patients diagnosed with cirrhosis of the liver over a period of 5 years, we found the incidence of new cases had increased 3-fold compared with a previous study 20 years ago. The increase is attributable to increased alcohol consumption, an epidemic of diabetes and obesity, and infection with the hepatitis C virus. Furthermore, we found that with thorough investigations, a specific cause for cirrhosis could be found in 94% of patients. Patients with cirrhosis frequently die of liver cancer and other complications related to their liver disease. The incidence of cirrhosis in Iceland has been the lowest among western countries. In this nationwide prospective study, all patients diagnosed with cirrhosis of the liver in Iceland over a period of 5 years were included. The incidence of cirrhosis had increased 3-fold compared with a study 10 years earlier owing to increased alcohol consumption, obesity, and hepatitis C. With thorough investigations a specific cause for cirrhosis could be found in 94% of patients.
Collapse
Key Words
- AIH, autoimmune hepatitis
- ALD, alcoholic liver disease
- Aetiology of cirrhosis
- Alcohol
- CIF, cumulative incidence function
- CRR, competing-risks regression
- Cirrhosis
- HCC, hepatocellular carcinoma
- Hepatitis C
- Incidence of cirrhosis
- MELD, model for end-stage liver disease
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NALD, non-alcoholic liver disease
- NASH, non-alcoholic steatohepatitis
- PBC, primary biliary cirrhosis
- PSC, primary sclerosing cholangitis
- SHRs, subhazard ratios
Collapse
Affiliation(s)
- Sigurdur Olafsson
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Corresponding author. Address: The National University Hospital of Iceland, Hringbraut, 101 Reykjavik, Iceland. Tel.: +354 543 1000; fax: +354-543-6907
| | - Sigurjon Rögnvaldsson
- Department of Surgery, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Ottar M. Bergmann
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Jon G. Jonasson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Pathology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Ubaldo Benitez Hernandez
- Department of Science/Biostatistics, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Einar S. Björnsson
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
13
|
Luo P, Zheng M, Zhang R, Zhang H, Liu Y, Li W, Sun X, Yu Q, Tipoe GL, Xiao J. S-Allylmercaptocysteine improves alcoholic liver disease partly through a direct modulation of insulin receptor signaling. Acta Pharm Sin B 2021; 11:668-679. [PMID: 33777674 PMCID: PMC7982498 DOI: 10.1016/j.apsb.2020.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022] Open
Abstract
Alcoholic liver disease (ALD) causes insulin resistance, lipid metabolism dysfunction, and inflammation. We investigated the protective effects and direct regulating target of S-allylmercaptocysteine (SAMC) from aged garlic on liver cell injury. A chronic ethanol-fed ALD in vivo model (the NIAAA model) was used to test the protective functions of SAMC. It was observed that SAMC (300 mg/kg, by gavage method) effectively ameliorated ALD-induced body weight reduction, steatosis, insulin resistance, and inflammation without affecting the health status of the control mice, as demonstrated by histological, biochemical, and molecular biology assays. By using biophysical assays and molecular docking, we demonstrated that SAMC directly targeted insulin receptor (INSR) protein on the cell membrane and then restored downstream IRS-1/AKT/GSK3β signaling. Liver-specific knock-down in mice and siRNA-mediated knock-down in AML-12 cells of Insr significantly impaired SAMC (250 μmol/L in cells)-mediated protection. Restoration of the IRS-1/AKT signaling partly recovered hepatic injury and further contributed to SAMC's beneficial effects. Continuous administration of AKT agonist and recombinant IGF-1 in combination with SAMC showed hepato-protection in the mice model. Long-term (90-day) administration of SAMC had no obvious adverse effect on healthy mice. We conclude that SAMC is an effective and safe hepato-protective complimentary agent against ALD partly through the direct binding of INSR and partial regulation of the IRS-1/AKT/GSK3β pathway.
Collapse
Key Words
- ADIPOQ, adiponectin
- AKT
- ALD, alcoholic liver disease
- ALDH2, aldehyde dehydrogenase 2
- ALT, alanine aminotransferase
- AMPK, adenosine 5′-monophosphate (AMP)-activated protein kinase
- AST, aspartate aminotransferase
- ATGL, adipose triglyceride lipase
- Alcoholic liver disease
- CPT1, carnitine palmitoyltransferase I
- CYP2E1, cytochrome P450 2E1
- FDA, U.S. Food and Drug Administration
- FFA, free fatty acids
- GRB14, growth factor receptor-bound protein 14
- GSK3β
- GSK3β, glycogen synthase kinase 3 beta
- GTT, glucose tolerance test
- HSL, hormone sensitive lipase
- IGF-1, insulin-like growth factors-1
- IL, interleukin
- INSR, insulin receptor
- IRS, insulin receptor substrate
- IRS-1
- IRTK, insulin receptor tyrosine kinase
- Insulin receptor
- Insulin resistance
- LDLR, low-density lipoprotein receptor
- LRP6, low-density lipoprotein receptor related protein 6
- MTT, 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide
- NAC, N-acetyl-cysteine
- NAFLD, non-alcoholic fatty liver disease
- NAS, NAFLD activity score
- NF-κB, nuclear factor kappa B
- NIAAA, National Institute on Alcohol Abuse and Alcoholism
- NRF2, nuclear factor erythroid 2-related factor 2
- ORF, open reading frame
- PA, palmitate acid
- PPARα, peroxisome proliferator-activated receptor alpha
- RER, respiratory exchange ratio
- S-Allylmercaptocysteine
- SAMC, S-allylmercaptocysteine
- SPR, surface plasmon resonance
- SREBP-1c, sterol regulatory element-binding protein 1c
- Safety
- TC, total cholesterol
- TCF/LEF, T-cell factor/lymphoid enhancer factor
- TG, triglyceride
- TNF, tumor necrosis factor
- TSA, thermal shift assay
- WAT, white adipose tissues
- WT, wild-type
Collapse
|
14
|
Shirazi F, Wang J, Wong RJ. Nonalcoholic Steatohepatitis Becomes the Leading Indication for Liver Transplant Registrants Among US Adults Born Between 1945 and 1965. J Clin Exp Hepatol 2020; 10:30-36. [PMID: 32025164 PMCID: PMC6995884 DOI: 10.1016/j.jceh.2019.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/05/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Improved efforts in screening and treating chronic hepatitis C virus (HCV) infection are expected to reduce its burden among adults on the liver transplantation (LT) waitlist (WL). We aim to evaluate birth cohort-specific liver disease etiology trends in US adults listed for and receiving LT. METHODS We evaluated 2005-2016 United Network for Organ Sharing LT registry data to evaluate birth cohort-specific trends in LT WL registrants and recipients in the US. Annual trends in etiology of liver disease at listing were compared between the 1945-1965 birth cohort and the non-1945-1965 birth cohort, were stratified by presence of hepatocellular carcinoma (HCC vs. non-HCC), and were focused on the four leading indications for LT in the US, nonalcoholic steatohepatitis (NASH), HCV infection, alcoholic liver disease (ALD), and those with combined alcoholic cirrhosis with HCV (HCV/ALD). RESULTS From 2005 to 2016, although HCV infection was a leading indication for LT WL registration among the 1945-1965 birth cohort patients until 2015, NASH overtook HCV infection as the leading indication in 2016. When stratified by HCC status, both ALD and NASH surpassed HCV infection as the leading indication among 1945-1965 birth cohort WL registrants without HCC, whereas HCV infection remained the leading indication among patients with HCC. When evaluating trends in patients who received LT, HCV infection remained the leading indication among the 1945-1965 birth cohort patients. CONCLUSION In 2016, NASH surpassed HCV infection as the leading indication for WL registration among the 1945-1965 birth cohort patients. Improved HCV screening, increased availability of effective HCV infection treatment, and rising prevalence of nonalcoholic fatty liver disease may explain changes in LT indication among this group.
Collapse
Affiliation(s)
- Farah Shirazi
- Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Jennifer Wang
- Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Alameda Health System – Highland Hospital, Oakland, CA, USA,Address for correspondence: Robert J. Wong, MD, MS, Assistant Clinical Professor of Medicine, Director of Research and Education, Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, 1411 East 31st Street, Highland Hospital, Highland Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA.
| |
Collapse
|
15
|
Doycheva I, Zhang T, Amjad W, Thuluvath PJ. Diabetes and Hepatocellular Carcinoma: Incidence Trends and Impact of Liver Disease Etiology. J Clin Exp Hepatol 2020; 10:296-303. [PMID: 32655232 PMCID: PMC7335702 DOI: 10.1016/j.jceh.2019.11.004] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) remains the leading cause of cancer-related death among patients with type 2 diabetes mellitus (T2DM). We aimed to assess the independent role of T2DM on HCC risk among patients with different liver disease etiologies. METHODS We analyzed the United Network for Organ Sharing database of all adults registered for liver transplantation (LT) between February 27, 2002 and December 31, 2017. For initial analyses, patients were divided into four groups: nonalcoholic steatohepatitis (NASH) and all other etiologies with or without T2DM. For additional analyses, we divided them based on underlying etiology. Logistic regression was used to evaluate the impact of T2DM with NASH and other etiologies on HCC risk. RESULTS Overall, 24,149 (21.6%) of the listed patients had HCC. Of those, 23.9% had T2DM. When compared with nondiabetics, patient with NASH and T2DM had the highest risk of HCC (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.52-1.86), followed by patients with other etiologies and diabetes. After adjusting for other risk factors, these associations remained unchanged. Registrants with T2DM and NASH, cryptogenic cirrhosis, hepatitis C, and alcoholic liver disease were at higher risk of HCC than those without diabetes, but in patients with chronic hepatitis B or primary biliary cholangitis, diabetes did not increase the HCC risk. Between 2004 and 2016, the annual percentage change of HCC incidence increased for all patients with NASH and hepatitis C regardless of their diabetes status. For those with hepatitis B, this trend was significant only for diabetics. CONCLUSIONS The additive risk of T2DM for HCC development was highest in patients with NASH. HCC risk may vary depending on the underlying etiology.
Collapse
Key Words
- ALD, alcoholic liver disease
- APC, annual percentage change
- CI, confidence interval
- HBV, hepatitis B virus
- HCC incidence
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- LT, liver transplantation
- MELD, Model for End-Stage Liver Disease
- NAFLD, nonalcoholic liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- PBC, primary biliary cholangitis
- T2DM, type 2 diabetes mellitus
- UNOS
- UNOS, United Network for Organ Sharing
- fatty liver
- liver cancer
Collapse
Affiliation(s)
- Iliana Doycheva
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Talan Zhang
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Waseem Amjad
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Paul J. Thuluvath
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA,University of Maryland School of Medicine, Baltimore, MD, USA,Address for correspondence. Paul J Thuluvath, Institute of Digestive Health and Liver Diseases Mercy Medical Center, 301 St. Paul Place, Baltimore, MD, 21202, USA.
| |
Collapse
|
16
|
Zeng X, Li X, Xu C, Jiang F, Mo Y, Fan X, Li Y, Jiang Y, Li D, Huang M, Bi H. Schisandra sphenanthera extract (Wuzhi Tablet) protects against chronic-binge and acute alcohol-induced liver injury by regulating the NRF2-ARE pathway in mice. Acta Pharm Sin B 2017; 7:583-92. [PMID: 28924552 DOI: 10.1016/j.apsb.2017.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/15/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023] Open
Abstract
Alcohol abuse leads to alcoholic liver disease and no effective therapy is currently available. Wuzhi Tablet (WZ), a preparation of extract from Schisandra sphenanthera that is a traditional hepato-protective herb, exerted a significant protective effect against acetaminophen-induced liver injury in our recent studies, but whether WZ can alleviate alcohol-induced toxicity remains unclear. This study aimed to investigate the contribution of WZ to alcohol-induced liver injury by using chronic-binge and acute models of alcohol feeding. The activities of ALT and AST in serum were assessed as well as the level of GSH and the activity of SOD in the liver. The expression of CYP2E1 and proteins in the NRF2-ARE signaling pathway including NRF2, GCLC, GCLM, HO-1 were measured, and the effect of WZ on NRF2 transcriptional activity was determined. We found that both models resulted in liver steatosis accompanied by increased transaminase activities, but that liver injury was significantly attenuated by WZ. WZ administration also inhibited CYP2E1 expression induced by alcohol, and elevated the level of GSH and the activity of SOD in the liver. Moreover, the NRF2-ARE signaling pathway was activated by WZ and the target genes were all upregulated. Furthermore, WZ significantly activated NRF2 transcriptional activity. Collectively, our study demonstrates that WZ protected against alcohol-induced liver injury by reducing oxidative stress and improving antioxidant defense, possibly by activating the NRF2-ARE pathway.
Collapse
Key Words
- ALD, alcoholic liver disease
- ALT, alanine aminotransferase
- ARE, antioxidant response element
- AST, aspartate aminotransferase
- Alcoholic liver injury
- CYP2E1, cytochrome P450 2E1 enzyme
- EtOH, ethanol
- GCLC, glutamate–cysteine ligase catalytic subunit
- GCLM, glutamate–cysteine ligase modifier subunit
- GSH, glutathione
- H&E, hematoxylin and eosin
- HO-1, heme oxygenase-1
- NRF2, nuclear factor erythroid 2-related factor 2
- NRF2-ARE
- Oxidative stress
- SOD, superoxide dismutase
- Schisandra sphenanthera
- WZ, Wuzhi Tablet.
- Wuzhi Tablet
Collapse
|
17
|
Owens RE, Snyder HS, Twilla JD, Satapathy SK. Pharmacologic Treatment of Alcoholic Hepatitis: Examining Outcomes Based on Disease Severity Stratification. J Clin Exp Hepatol 2016; 6:275-281. [PMID: 28003716 PMCID: PMC5157883 DOI: 10.1016/j.jceh.2016.07.003] [Citation(s) in RCA: 5] [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: 02/09/2016] [Accepted: 07/12/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Maddrey discriminant function (MDF) score is a measure of disease prognosis in alcoholic hepatitis (AH) used to identify patients at highest risk of mortality and determine the need for initiation of pharmacologic treatment. The purpose of this study was to evaluate the effects of pharmacologic therapy for hospitalized AH patients as stratified by MDF score. METHODS A retrospective review of patients with an AH diagnosis admitted to a Methodist LeBonheur Healthcare adult hospital between 06/2009 and 06/2014 was conducted. Patients ≥18 years of age with an ICD-9 code for AH were evaluated. RESULTS Of the 493 patients screened, 234 met the inclusion criteria, comprised of 62 patients with an MDF ≥ 32 (treatment, n = 42 vs. no treatment, n = 20) and 172 patients with an MDF < 32 (treatment, n = 15 vs. no treatment, n = 157). For the patients with an MDF ≥ 32, there was no statistically significant difference between the treatment group vs. non-treatment group regarding 28-day mortality (31% vs. 11%, respectively; P = 0.18) and 6-month mortality (45% treatment vs. 38% non-treatment; P = 0.75). For the patients with an MDF <32, there was no statistically significant difference between the treatment group vs. non-treatment group regarding 28-day mortality (0% vs. 7%, respectively; P > 0.99) and 6-month mortality (11% treatment vs. 13% non-treatment; P > 0.99). There was no difference in incidence of acute kidney injury, hepatorenal syndrome, development of infection or hepatic encephalopathy between the treatment vs. non-treatment groups. CONCLUSIONS Pharmacologic treatment showed no survival benefit, regardless of disease severity. Given the mortality risk seen in mild-moderate AH patients not receiving treatment and concern for a possible treatment ceiling effect in severe AH patients, more data are needed to adequately assess the utility of MDF in selecting appropriate candidates for AH treatment.
Collapse
Key Words
- AASLD, American Association for the Study of Liver Diseases
- AH, alcoholic hepatitis
- AKI, acute kidney injury
- ALD, alcoholic liver disease
- ARR, absolute risk reduction
- GI, gastrointestinal
- HRS, hepatorenal syndrome
- INR, international normalized ratio
- MDF, Maddrey discriminant function
- MELD, Model for End-Stage Liver Disease
- Maddrey discriminant function
- PT, prothrombin time
- SCr, serum creatinine
- SD, standard deviation
- eGFR, estimated glomerular filtration rate
- pentoxifylline
- prednisolone
Collapse
Affiliation(s)
- Ryan E. Owens
- University of Oklahoma College of Pharmacy, Department of Pharmacy, Clinical and Administrative Sciences, 1110 North Stonewall Avenue, Oklahoma City, OK 73117, USA,Address for correspondence: Ryan E. Owens, Department of Pharmacy, Clinical and Administrative Sciences, 1110 North Stonewall Avenue, Oklahoma City, OK 73117, USA.Department of Pharmacy, Clinical and Administrative Sciences1110 North Stonewall AvenueOklahoma CityOK73117USA
| | - Heather S. Snyder
- Methodist University Hospital, Department of Pharmacy, 1265 Union Avenue, Memphis, TN 38104, USA
| | - Jennifer D. Twilla
- Methodist University Hospital, Department of Pharmacy, 1265 Union Avenue, Memphis, TN 38104, USA
| | - Sanjaya K. Satapathy
- Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Division of Surgery, Transplant Hepatology, 1265 Union Avenue, Memphis, TN 38104, USA
| |
Collapse
|
18
|
Chen WY, Zhang J, Ghare S, Barve S, McClain C, Joshi-Barve S. Acrolein Is a Pathogenic Mediator of Alcoholic Liver Disease and the Scavenger Hydralazine Is Protective in Mice. Cell Mol Gastroenterol Hepatol 2016; 2:685-700. [PMID: 28119953 PMCID: PMC5042858 DOI: 10.1016/j.jcmgh.2016.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Alcoholic liver disease (ALD) remains a major cause of morbidity and mortality, with no Food and Drug Administration-approved therapy. Chronic alcohol consumption causes a pro-oxidant environment and increases hepatic lipid peroxidation, with acrolein being the most reactive/toxic by-product. This study investigated the pathogenic role of acrolein in hepatic endoplasmic reticulum (ER) stress, steatosis, and injury in experimental ALD, and tested acrolein elimination/scavenging (using hydralazine) as a potential therapy in ALD. METHODS In vitro (rat hepatoma H4IIEC cells) and in vivo (chronic+binge alcohol feeding in C57Bl/6 mice) models were used to examine alcohol-induced acrolein accumulation and consequent hepatic ER stress, apoptosis, and injury. In addition, the potential protective effects of the acrolein scavenger, hydralazine, were examined both in vitro and in vivo. RESULTS Alcohol consumption/metabolism resulted in hepatic accumulation of acrolein-protein adducts, by up-regulation of cytochrome P4502E1 and alcohol dehydrogenase, and down-regulation of glutathione-s-transferase-P, which metabolizes/detoxifies acrolein. Alcohol-induced acrolein adduct accumulation led to hepatic ER stress, proapoptotic signaling, steatosis, apoptosis, and liver injury; however, ER-protective/adaptive responses were not induced. Notably, direct exposure to acrolein in vitro mimicked the in vivo effects of alcohol, indicating that acrolein mediates the adverse effects of alcohol. Importantly, hydralazine, a known acrolein scavenger, protected against alcohol-induced ER stress and liver injury, both in vitro and in mice. CONCLUSIONS Our study shows the following: (1) alcohol consumption triggers pathologic ER stress without ER adaptation/protection; (2) alcohol-induced acrolein is a potential therapeutic target and pathogenic mediator of hepatic ER stress, cell death, and injury; and (3) removal/clearance of acrolein by scavengers may have therapeutic potential in ALD.
Collapse
Key Words
- ADH, alcohol dehydrogenase
- ALD, alcoholic liver disease
- ALDH, aldehyde dehydrogenase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- ATF, activating transcription factor
- Apoptosis
- CHOP
- CHOP, CCAAT/enhancer-binding protein homologous protein
- CYP2E1, cytochrome P4502E1
- ER, endoplasmic reticulum
- FDP-lysine, Nε-(3-formyl-3,4-dehydropiperidino)lysine
- GRP, glucose regulated protein
- GSTP, glutathione-s-transferase-Pi
- IRE1, inositol-requiring enzyme 1
- JNK, cJun N-terminal kinase
- LPO, lipid peroxidation
- Lipid Peroxidation
- NIAAA, National Institute on Alcohol Abuse and Alcoholism
- PERK, protein kinase RNA-like endoplasmic reticulum kinase
- PUFA, polyunsaturated fatty acids
- TRAF, TNF receptor-associated factor
- TUNEL, terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling
- Therapeutic
- UPR, unfolded protein response
- XBP1, X-box binding protein-1
- mRNA, messenger RNA
- siRNA, small interfering RNA
Collapse
Affiliation(s)
- Wei-Yang Chen
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Alcohol Research Center, University of Louisville, Louisville, Kentucky
| | - Jingwen Zhang
- Alcohol Research Center, University of Louisville, Louisville, Kentucky
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Smita Ghare
- Alcohol Research Center, University of Louisville, Louisville, Kentucky
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Shirish Barve
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Alcohol Research Center, University of Louisville, Louisville, Kentucky
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Craig McClain
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Alcohol Research Center, University of Louisville, Louisville, Kentucky
- Department of Medicine, University of Louisville, Louisville, Kentucky
- Robley Rex Veterans Affairs Medical Center, University of Louisville, Louisville, Kentucky
| | - Swati Joshi-Barve
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Alcohol Research Center, University of Louisville, Louisville, Kentucky
- Department of Medicine, University of Louisville, Louisville, Kentucky
- Correspondence Address correspondence to: Swati Joshi-Barve, PhD, Departments of Medicine, and Pharmacology and Toxicology, University of Louisville, 505 South Hancock Street, Room 505 Clinical Translational Research Building, Louisville, Kentucky 40202. fax: (502) 852-8927.Departments of Medicine, and Pharmacology and ToxicologyUniversity of Louisville505 South Hancock StreetRoom 505 Clinical Translational Research BuildingLouisvilleKentucky 40202
| |
Collapse
|
19
|
Choudhary NS, Kumar N, Saigal S, Rai R, Saraf N, Soin AS. Liver Transplantation for Alcohol-Related Liver Disease. J Clin Exp Hepatol 2016; 6:47-53. [PMID: 27194896 PMCID: PMC4862016 DOI: 10.1016/j.jceh.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/30/2015] [Accepted: 02/18/2016] [Indexed: 12/12/2022] Open
Abstract
Alcoholic liver disease (ALD) is a common indication for liver transplantation. It is a much debated indication for deceased donor liver transplantation due to organ shortage and potential of alcohol relapse after liver transplantation. A six-month abstinence before liver transplantation is required at most centers to decrease chances of alcohol relapse after liver transplantation. However, this rule is not relevant for patients with severe alcoholic hepatitis or severely decompensated patients who are unlikely to survive till 6 months. Long-term care of these patients after liver transplantation includes assessment of relapse, smoking, and surveillance of de novo malignancies. Current review discusses role of abstinence, factors affecting alcohol relapse, liver transplantation for alcoholic hepatitis, role of living donor liver transplantation, and long-term care of ALD patients who undergo liver transplantation.
Collapse
Affiliation(s)
| | | | - Sanjiv Saigal
- Address for correspondence: Sanjiv Saigal, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Medanta The Medicity hospital, sector 38, Gurgaon, Delhi (NCR), India. Tel.: +91 9811552928.Sanjiv Saigal, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Medanta The Medicity hospitalsector 38GurgaonDelhi (NCR)India
| | | | | | | |
Collapse
|
20
|
Pati GK, Singh A, Misra B, Misra D, Das HS, Panda C, Singh SP. Acute-on-Chronic Liver Failure (ACLF) in Coastal Eastern India: "A Single-Center Experience". J Clin Exp Hepatol 2016; 6:26-32. [PMID: 27194893 DOI: 10.1016/j.jceh.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 08/10/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute-On-Chronic liver failure (ACLF) is an emerging entity. The present study was undertaken to analyze the clinical profile and natural course of ACLF patients. PATIENTS AND METHODS ACLF was defined as per Asia Pacific Association for the Study of Liver consensus criteria 2009. Patients fulfilling these criteria with some deviations were included and prospectively evaluated for clinical profile, etiologies of acute decompensation (AD) and underlying chronic liver disease, and short-term natural course [3 months]. RESULTS Out of 123 patients with ACLF (mean age: 45.83 ± 12.05 years; male:female 109:14), 45.53% cases had prior history of AD, and 54.47% presented for the first time as ACLF. Etiologies of cirrhosis were alcohol, cryptogenic, and chronic hepatitis B virus infection in 65.04%, 23.57%, and 11.38% cases, respectively. Recent history of alcohol intake (within 4 weeks) [42.27%] followed by bacterial infections [36.58%] were the common etiologic precipitants for AD. Only 87 (70.73%) out of 123 cases could be followed up for a duration of 3 months; 62 (71.26%) cases died by 3 months. Most deaths occurred in the alcoholics compared to nonalcoholics [(43/53) 81.13% vs. (19/34) 55.88%; P = 0.01]. No significant difference in mortality rate was observed between ACLF cases with history of prior AD compared to newly diagnosed ACLF cases [30/40 (75%) vs. 32/47 (68.09%); P = 0.477]. The prognostic markers [MELD, MELD-Na, CTP] were not significantly different between survivors and nonsurvivors. CONCLUSION ACLF patients in our population had high short-term mortality rates with majority of deaths in alcoholics. Alcohol intake and bacterial infections were mainly responsible for AD in our study.
Collapse
Key Words
- ACLF, acute-on-chronic liver failure
- AD, acute decompensation
- ALD, alcoholic liver disease
- ALT, alanine transaminase
- APASL, Asian Pacific Association for the Study of the Liver
- CLD, chronic liver disease
- CTP, Child-Turcotte-Pugh
- EASL-AASLD, European Association for the Study of the Liver-American Association for the Study of Liver Diseases
- HBV, hepatitis B virus
- HE, hepatic encephalopathy
- HEV, hepatitis E virus
- HRS, hepatorenal syndrome
- INR, International Normalized Ratio
- MELD, Model for End-Stage Liver Disease
- MELD-Na, Model for End-Stage Liver Disease Sodium
- PT, prothrombin time
- SD, standard deviation
- SIRS, systemic inflammatory response syndrome
- ascites
- encephalopathy
- hepatic decompensation
- renal failure
- sepsis
Collapse
|
21
|
Fernández Del Río R, O'Hara ME, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Volatile Biomarkers in Breath Associated With Liver Cirrhosis - Comparisons of Pre- and Post-liver Transplant Breath Samples. EBioMedicine 2015; 2:1243-50. [PMID: 26501124 PMCID: PMC4588000 DOI: 10.1016/j.ebiom.2015.07.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 06/09/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background The burden of liver disease in the UK has risen dramatically and there is a need for improved diagnostics. Aims To determine which breath volatiles are associated with the cirrhotic liver and hence diagnostically useful. Methods A two-stage biomarker discovery procedure was used. Alveolar breath samples of 31 patients with cirrhosis and 30 healthy controls were mass spectrometrically analysed and compared (stage 1). 12 of these patients had their breath analysed after liver transplant (stage 2). Five patients were followed longitudinally as in-patients in the post-transplant period. Results Seven volatiles were elevated in the breath of patients versus controls. Of these, five showed statistically significant decrease post-transplant: limonene, methanol, 2-pentanone, 2-butanone and carbon disulfide. On an individual basis limonene has the best diagnostic capability (the area under a receiver operating characteristic curve (AUROC) is 0.91), but this is improved by combining methanol, 2-pentanone and limonene (AUROC curve 0.95). Following transplant, limonene shows wash-out characteristics. Conclusions Limonene, methanol and 2-pentanone are breath markers for a cirrhotic liver. This study raises the potential to investigate these volatiles as markers for early-stage liver disease. By monitoring the wash-out of limonene following transplant, graft liver function can be non-invasively assessed. Breath volatiles were compared for cirrhotic patients and controls and pre- and post-liver transplant. Three volatiles (limonene, methanol, 2-pentanone) have been found to have excellent diagnostic capabilities. Limonene shows washout characteristics following transplant supporting a hypothesis that it accumulates in fat.
There are numerous previous studies investigating breath volatiles in patients with liver disease but with conflicting results. It is impossible to tell which volatiles from previous studies may be false discoveries, and which are actually associated with the disease. We measured breath samples in patients and controls and in patients after transplant. Methanol, 2-pentanone and limonene show differences not only between patients and controls but also in cases pre- and post-transplant and have excellent diagnostic capabilities. We show evidence that limonene accumulates in the body, probably because the cirrhotic liver fails to metabolise dietary limonene.
Collapse
Key Words
- AID, autoimmune liver disease
- ALD, alcoholic liver disease
- AUROC, area under receiver operator curve
- BMI, body mass index
- Breath analysis
- CD, cryptogenic disease
- Cirrhosis
- Diagnosis limonene
- GC, gas chromatography
- HBV, hepatitis B virus
- HCC, hepatocellular cancer
- HCV, hepatitis C virus
- ITU, intensive treatment unit
- LQ, lower quartile
- Liver transplant
- MS, mass spectrometry
- OPU, out-patient clinic
- PBC, primary biliary cirrhosis
- PSC, primary sclerosing cholangitis
- PTR-MS
- PTR-MS, proton transfer reaction mass spectrometry
- ROC, Receiver operating characteristics
- TAC, transplant assessment clinic
- TE, transient elastography
- UKELD, United Kingdom model for end-stage liver disease
- UQ, upper quartile
- VMR, volume mixing ratio
- VOC, volatile organic compounds
- Volatile organic compounds
- ppbv, parts per billion by volume
- ppmv, parts per million by volume
Collapse
Affiliation(s)
- R Fernández Del Río
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| | - A Holt
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - P Pemberton
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Shah
- Department of Hepatology, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - T Whitehouse
- Critical Care and Anaesthesia, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - C A Mayhew
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
| |
Collapse
|
22
|
Joshi-Barve S, Kirpich I, Cave MC, Marsano LS, McClain CJ. Alcoholic, Nonalcoholic, and Toxicant-Associated Steatohepatitis: Mechanistic Similarities and Differences. Cell Mol Gastroenterol Hepatol 2015; 1:356-367. [PMID: 28210688 PMCID: PMC5301292 DOI: 10.1016/j.jcmgh.2015.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/27/2015] [Indexed: 12/12/2022]
Abstract
Hepatic steatosis and steatohepatitis are common histologic findings that can be caused by multiple etiologies. The three most frequent causes for steatosis/steatohepatitis are alcohol (alcoholic steatohepatitis, ASH), obesity/metabolic syndrome (nonalcoholic steatohepatitis, NASH), and environmental toxicants (toxicant-associated steatohepatitis, TASH). Hepatic steatosis is an early occurrence in all three forms of liver disease, and they often share common pathways to disease progression/severity. Disease progression is a result of both direct effects on the liver as well as indirect alterations in other organs/tissues such as intestine, adipose tissue, and the immune system. Although the three liver diseases (ASH, NASH, and TASH) share many common pathogenic mechanisms, they also exhibit distinct differences. Both shared and divergent mechanisms can be potential therapeutic targets. This review provides an overview of selected important mechanistic similarities and differences in ASH, NASH, and TASH.
Collapse
Key Words
- ALD, alcoholic liver disease
- ALT, alanine aminotransferase
- ASH, alcoholic steatohepatitis
- AST, aspartate transaminase
- Alcoholic Steatohepatitis
- BMI, body mass index
- CYP2E1, cytochrome P450 isoform 2E1
- ECM, extracellular matrix
- ER, endoplasmic reticulum
- HCC, hepatocellular carcinoma
- HDAC, histone deacetylase
- HSC, hepatic stellate cell
- IL, interleukin
- LA, linoleic acid
- LPS, lipopolysaccharide
- Mechanisms
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- NK, natural killer
- NKT, natural killer T
- Nonalcoholic Steatohepatitis
- OXLAM, oxidized linoleic acid metabolite
- PAI-1, plasminogen activator inhibitor-1
- PCB153, 2,2′,4,4′,5,5′-hexachlorobiphenyl
- PPAR, peroxisome proliferator-activated receptor
- RNS, reactive nitrogen species
- SNP, single-nucleotide polymorphism
- TAFLD, toxicant-associated fatty liver disease
- TASH, toxicant-associated steatohepatitis
- TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin
- TH, helper T cell
- TLR, Toll-like receptor
- TNF, tumor necrosis factor
- Toxicant-Associated Steatohepatitis
- VA, U.S. Department of Veterans Affairs/Veterans Administration
- miR, microRNA
Collapse
Affiliation(s)
- Swati Joshi-Barve
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Irina Kirpich
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Matthew C. Cave
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, Kentucky,Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky
| | - Luis S. Marsano
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky
| | - Craig J. McClain
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, Kentucky,Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky,Correspondence Address correspondence to: Craig J. McClain, MD, University of Louisville, 505 South Hancock Street, Louisville, Kentucky 40292. fax: (502) 852-8927.
| |
Collapse
|
23
|
Manley S, Ding W. Role of farnesoid X receptor and bile acids in alcoholic liver disease. Acta Pharm Sin B 2015; 5:158-67. [PMID: 26579442 PMCID: PMC4629219 DOI: 10.1016/j.apsb.2014.12.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/20/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023] Open
Abstract
Alcoholic liver disease (ALD) is one of the major causes of liver morbidity and mortality worldwide. Chronic alcohol consumption leads to development of liver pathogenesis encompassing steatosis, inflammation, fibrosis, cirrhosis, and in extreme cases, hepatocellular carcinoma. Moreover, ALD may also associate with cholestasis. Emerging evidence now suggests that farnesoid X receptor (FXR) and bile acids also play important roles in ALD. In this review, we discuss the effects of alcohol consumption on FXR, bile acids and gut microbiome as well as their impacts on ALD. Moreover, we summarize the findings on FXR, FoxO3a (forkhead box-containing protein class O3a) and PPARα (peroxisome proliferator-activated receptor alpha) in regulation of autophagy-related gene transcription program and liver injury in response to alcohol exposure.
Collapse
Key Words
- 6ECDCA, 6α-ethyl-chenodeoxycholic acid
- ADH, alcohol dehydrogenase
- AF, activation function
- AKT, protein kinase B
- ALD, alcoholic liver disease
- ALT, alanine aminotransferase
- ASBT, apical sodium dependent bile acid transporter
- Alcoholic liver disease
- Atg, autophagy-related
- Autophagy
- BAAT, bile acid CoA:amino acid N-acyltransferase
- BACS, bile acid CoA synthetase
- BSEP, bile salt export pump
- Bile acids
- CA, cholic acid
- CB1R, cannabinoid receptor type 1
- CDCA, chenodeoxycholic acid
- CREB, cAMP response element-binding protein
- CREBH, cAMP response element-binding protein, hepatocyte specific
- CRTC2, CREB regulated transcription coactivator 2
- CYP, cytochrome P450
- DCA, deoxycholic acid
- DR1, direct repeat 1
- FGF15/19, fibroblast growth factor 15/19
- FGFR4, fibroblast growth factor receptor 4
- FXR, farnesoid X receptor
- Farnesoid X receptor
- FoxO3
- FoxO3a, forkhead box-containing protein class O3a
- GGT, gamma-glutamyltranspeptidase
- HCC, hepatocellular carcinoma
- IR-1, inverted repeat-1
- KO, knockout
- LC3, light chain 3
- LRH-1, liver receptor homolog 1
- LXR, liver X receptor
- MRP4, multidrug resistance protein 4
- NAD+, nicotinamide adenine dinucleotide
- NTCP, sodium taurocholate cotransporting polypeptide
- OSTα/β, organic solute transporter α/β
- PE, phosphatidylethanolamine
- PPARα, peroxisome proliferator-activated receptor alpha
- ROS, reactive oxygen species
- RXRα, retinoid X receptor-alpha
- SHP, small heterodimer partner
- SQSTM, sequestome-1
- SREBP1, sterol regulatory element-binding protein 1
- Sirt1, sirtuin 1
- TCA, taurocholic acid
- TFEB, transcription factor EB
- TLR4, toll-like receptor 4
- TUDCA, tauro-ursodeoxycholic acid
- UDCA, ursodeoxycholic acid
- WAY, WAY-362450
- WT, wild type
Collapse
Affiliation(s)
| | - Wenxing Ding
- Corresponding author. Tel.: +1 913 5889813; fax: +1 913 5887501.
| |
Collapse
|
24
|
Shenoy KT, Balakumaran LK, Mathew P, Prasad M, Prabhakar B, Sood A, Singh SP, Rao NP, Zargar SA, Bignamini AA. Metadoxine Versus Placebo for the Treatment of Non-alcoholic Steatohepatitis: A Randomized Controlled Trial. J Clin Exp Hepatol 2014; 4:94-100. [PMID: 25755546 PMCID: PMC4116708 DOI: 10.1016/j.jceh.2014.03.041] [Citation(s) in RCA: 13] [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: 01/08/2014] [Accepted: 03/03/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE AND DESIGN The study aimed at assessing the therapeutic efficacy and safety of metadoxine versus placebo on the ultrasonographic and histological features of non-alcoholic steatohepatitis (NASH). SUBJECTS 134 subjects with biopsy-confirmed NASH were randomized to receive metadoxine 500 mg two times daily (n = 75) or placebo (n = 59) added to the standard of care, over 16 weeks. EFFICACY ENDPOINTS Originally, the primary efficacy endpoint was the composite of: reduction in the steatosis by ≥1 grade, reduction in hepatic necro-inflammation by ≥1 grade and ALT normalization. Since >50% of patients refused the second biopsy, it was decided to analyze only the individual parameters. RESULTS There was no significant difference between the treatment and the placebo groups in either liver histology or ALT or AST. Overall, as expected both groups showed reduction in serum ALT and AST compared to baseline. Compared to placebo (9 out 54), patients on metadoxine (34 out of 75) had significantly higher rates of improvement in 1-point in steatosis grade on ultrasound (P-value <0.001). Safety and tolerability did not differ between treatments. CONCLUSION Metadoxine is not effective in improvement of liver histology or serum ALT or AST in patients with NASH. However, there was significant improvement of steatosis assessed by ultrasound. To properly estimate the effects on histology and transaminases, further studies of longer duration and at higher doses are needed.
Collapse
Key Words
- ALD, alcoholic liver disease
- ALT, alanine transaminase
- ANCOVA, analysis of covariance
- AST, aspartate transaminase
- ATP, adenosine triphosphate
- GGT, gamma-glutamyl transferase
- GSH, glutathione
- HOMA-IR, homeostasis model assessment for insulin resistance
- ITT, intention to treat
- MRI, magnetic resonance imaging
- MRS, MR spectroscopy
- NADH, nicotinamide adenine dinucleotide
- NAFLD, non-alcoholic fatty liver disease
- NASH
- NASH, non-alcoholic steatohepatitis
- PDFF, proton-density fat-fraction
- RCTs, randomized clinical trials
- RIQ, range interquartile
- TNF, tumor necrosis factors
- controlled clinical trial
- metadoxine
Collapse
Affiliation(s)
- Kotacherry T. Shenoy
- Sree Gokulam Medical College and Research Foundation, Trivandrum, India,Population Health and Research Institute, Trivandrum, India,Address for correspondence: Prof. Kotacherry T. Shenoy, Sree Gokulam Medical College and Research Foundation Trivandrum India.
| | | | | | - Mohan Prasad
- G. Hospital & Post Graduate Institute, Coimbatore, India
| | | | - Ajit Sood
- Dayanand Medical College & Hospital, Ludhiana, India
| | | | | | | | | |
Collapse
|
25
|
Keane FM, Yao TW, Seelk S, Gall MG, Chowdhury S, Poplawski SE, Lai JH, Li Y, Wu W, Farrell P, Vieira de Ribeiro AJ, Osborne B, Yu DMT, Seth D, Rahman K, Haber P, Topaloglu AK, Wang C, Thomson S, Hennessy A, Prins J, Twigg SM, McLennan SV, McCaughan GW, Bachovchin WW, Gorrell MD. Quantitation of fibroblast activation protein (FAP)-specific protease activity in mouse, baboon and human fluids and organs. FEBS Open Bio 2013; 4:43-54. [PMID: 24371721 PMCID: PMC3871272 DOI: 10.1016/j.fob.2013.12.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 09/30/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 02/08/2023] Open
Abstract
The protease fibroblast activation protein (FAP) is a specific marker of activated mesenchymal cells in tumour stroma and fibrotic liver. A specific, reliable FAP enzyme assay has been lacking. FAP's unique and restricted cleavage of the post proline bond was exploited to generate a new specific substrate to quantify FAP enzyme activity. This sensitive assay detected no FAP activity in any tissue or fluid of FAP gene knockout mice, thus confirming assay specificity. Circulating FAP activity was ∼20- and 1.3-fold less in baboon than in mouse and human plasma, respectively. Serum and plasma contained comparable FAP activity. In mice, the highest levels of FAP activity were in uterus, pancreas, submaxillary gland and skin, whereas the lowest levels were in brain, prostate, leukocytes and testis. Baboon organs high in FAP activity included skin, epididymis, bladder, colon, adipose tissue, nerve and tongue. FAP activity was greatly elevated in tumours and associated lymph nodes and in fungal-infected skin of unhealthy baboons. FAP activity was 14- to 18-fold greater in cirrhotic than in non-diseased human liver, and circulating FAP activity was almost doubled in alcoholic cirrhosis. Parallel DPP4 measurements concorded with the literature, except for the novel finding of high DPP4 activity in bile. The new FAP enzyme assay is the first to be thoroughly characterised and shows that FAP activity is measurable in most organs and at high levels in some. This new assay is a robust tool for specific quantitation of FAP enzyme activity in both preclinical and clinical samples, particularly liver fibrosis. A novel synthetic fluorogenic substrate is proven to be FAP-specific. Mice have higher levels of circulating FAP activity compared to baboons or humans. No FAP activity was detected in urine or bile but bile contained high DPP4 activity. FAP activity is greatest in pancreas, uterus, salivary gland, skin and lymph node. FAP activity and protein is elevated in both serum and liver in human liver disease.
Collapse
Key Words
- ALD, alcoholic liver disease
- AMC, amino-4-methylcoumarin
- Biomarker
- DMSO, dimethyl sulfoxide
- DPP4, dipeptidyl peptidase 4
- Dipeptidyl peptidase
- EDTA, ethylene diamine tetra acetic acid
- FAP, fibroblast activation protein-α
- Fibroblast
- Fibrosis
- HCV, hepatitis C virus
- LDS, lithium dodecyl sulphate
- LN, lymph node
- Liver disease
- ND, non-diseased
- PBC, primary biliary cirrhosis
- PBMC, peripheral blood mononuclear cells
- PBS, phosphate-buffered saline
- PEP, prolyl endopeptidase
- PVDF, polyvinylidene fluoride
- Protease activity
- Protease substrates
- STLV, simian T-cell lymphotrophic virus
- gko, gene knock out
- het, heterozygous
- mAb, monoclonal antibody
- wt, wild type
- yrs, years
Collapse
Affiliation(s)
- Fiona M Keane
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - Tsun-Wen Yao
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | | | - Margaret G Gall
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - Sumaiya Chowdhury
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - Sarah E Poplawski
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Jack H Lai
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Youhua Li
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Wengen Wu
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Penny Farrell
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ana Julia Vieira de Ribeiro
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - Brenna Osborne
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - Denise M T Yu
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - Devanshi Seth
- Centenary Institute, Camperdown, NSW, Australia ; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Khairunnessa Rahman
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Paul Haber
- Sydney Medical School, University of Sydney, NSW, Australia ; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - A Kemal Topaloglu
- Pediatric Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Chuanmin Wang
- Sydney Medical School, University of Sydney, NSW, Australia ; Collaborative Transplantation Research Group, Bosch Institute, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sally Thomson
- Sydney Medical School, University of Sydney, NSW, Australia ; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Annemarie Hennessy
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia ; School of Medicine, University of Western Sydney, NSW, Australia
| | - John Prins
- Mater Medical Research Institute, University of Queensland, and Department of Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Stephen M Twigg
- Sydney Medical School, University of Sydney, NSW, Australia ; Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Susan V McLennan
- Sydney Medical School, University of Sydney, NSW, Australia ; Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Geoffrey W McCaughan
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| | - William W Bachovchin
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Mark D Gorrell
- Centenary Institute, Camperdown, NSW, Australia ; Sydney Medical School, University of Sydney, NSW, Australia
| |
Collapse
|
26
|
Mir HM, Stepanova M, Afendy H, Cable R, Younossi ZM. Association of Sleep Disorders with Nonalcoholic Fatty Liver Disease (NAFLD): A Population-based Study. J Clin Exp Hepatol 2013; 3:181-5. [PMID: 25755498 PMCID: PMC3940103 DOI: 10.1016/j.jceh.2013.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 04/10/2013] [Accepted: 06/17/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease. In smaller studies, sleep apnea has been previously associated with NAFLD. The aim of this study was to assess the prevalence and independent associations of sleep disorders in patients with NAFLD using recent population-based data. METHODS Three cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2010 were used. The diagnosis of NAFLD was established as elevated liver enzymes in the absence of all other causes of chronic liver disease. Sleep disorders were diagnosed using sleep disorder questionnaires completed by NHANES participants, and included self-reported history of sleep apnea, insomnia, and restless leg syndrome. The prevalence of sleep disorders was compared between those with and without NAFLD. RESULTS A total of 10,541 adult NHANES participants with complete demographic, clinical, and laboratory data were included. Of those, 15.0% had NAFLD and 7.2% reported having sleep disorders. Of those with sleep disorders, 64.7% reported history of sleep apnea, 16.0% had history of insomnia, and 4.0% had restless leg syndrome. Individuals with NAFLD were more likely to be male (53.8% vs. 45.7%, P < 0.0001), obese (50.1% vs. 33.4%, P < 0.0001) and had higher prevalence of sleep disorders (9.1% vs. 6.9%, P = 0.0118). In multivariate analysis, having any sleep disorder, sleep apnea and insomnia were all independently associated with NAFLD [OR (95% CI) = 1.40 (1.11-1.76), OR = 1.39 (0.98-1.97), and OR = 2.17 (1.19-3.95); respectively)]. CONCLUSIONS This large population-based data suggests that NAFLD is associated with sleep disorders. Although the exact mechanism is unknown, this association is most likely through metabolic conditions associated with NAFLD.
Collapse
Affiliation(s)
- Heshaam M. Mir
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Diseases, Department of Medicine Inova Fairfax Hospital, Falls Church, VA, USA
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Hena Afendy
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Rebecca Cable
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Diseases, Department of Medicine Inova Fairfax Hospital, Falls Church, VA, USA
- Address for correspondence: Zobair M. Younossi, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042, USA. Tel.: +1 703 776 2540; fax: +1 703 776 4386.
| |
Collapse
|
27
|
Abstract
MicroRNAs (miRs) are small non-coding RNAs that negatively regulate gene expression by pairing with partially complementary target sequences in the 3'UTRs of mRNAs to promote degradation and/or block translation. Aberrant miR expression is associated with development of multiple diseases including hepatic diseases. The role of miRs in the regulation of gene expression and rapid progress in the field of microRNA research are resulting in momentum toward development of diagnostic markers and novel therapeutic strategies for human liver diseases. Recent studies provide clear evidence that miRs are abundant in the liver and modulate a diverse spectrum of biological functions, thereby supporting an association between alterations of miR homeostasis and pathological liver diseases. Here we review the role of miRs in liver as their physiological and pathological importance has been demonstrated in metabolism, immunity, viral hepatitis, oncogenesis, fatty liver diseases (alcoholic and non-alcoholic), drug-induced liver injury, fibrosis as well as acute liver failure.
Collapse
Key Words
- ALD, alcoholic liver disease
- ALF, acute liver failure
- DILI, drug-induced liver injury
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HSC, hepatic stellate cell
- IFN, interferon
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PPAR γ, peroxisome proliferator-activated receptor γ
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- UTR, untranslated region
- down-regulation
- liver
- miR-122
- miRs/miRNA, microRNA
- microRNA
- up-regulation
Collapse
Affiliation(s)
- Nihar Shah
- Liver Center of Excellence, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, United States
| | - James E. Nelson
- Benaroya Research Institute, Virginia Mason Medical Center, Seattle, WA, United States
| | - Kris V. Kowdley
- Liver Center of Excellence, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, United States,Benaroya Research Institute, Virginia Mason Medical Center, Seattle, WA, United States,Address for correspondence: Kris V. Kowdley, MD, 1201 9th Ave., Seattle, WA 98101, United States. Tel.: +1 (206) 287 1083; fax: +1 (206) 341 1934.
| |
Collapse
|
28
|
Abstract
Skin functions as a window to our overall health and a number of systemic diseases result in various cutaneous changes. Knowledge of these manifestations helps in suspecting an underlying systemic illness. Cutaneous abnormalities are quite common in patients with liver diseases and this article aims to focus on these dermatoses. Cutaneous manifestations seen in patients with liver disease though common are nonspecific. They can also be seen in patients without liver diseases and generally do not indicate about a specific underlying hepatic disorder. The presence of a constellation of signs and symptoms is more useful in pointing toward an underlying hepatobiliary condition. The commonest symptom in patients with liver disease is pruritus which is often protracted and disabling. Other common features include spider angiomas, palmar erythema, paper money skin, xanthelasmas, pigmentary changes, and nutritional deficiencies. In this article, first the common cutaneous manifestations that may be associated with liver disorders are discussed and then common liver diseases with their specific cutaneous findings are discussed. Cutaneous abnormalities may be the first clue to the underlying liver disease. Identifying them is crucial for early diagnosis and better management.
Collapse
Affiliation(s)
- Sunil Dogra
- Address for correspondence: Sunil Dogra, Associate Professor, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
| | | |
Collapse
|