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Hirode G, Choi HSJ, Chen CH, Su TH, Seto WK, Van Hees S, Papatheodoridi M, Lens S, Wong G, Brakenhoff SM, Chien RN, Feld J, Sonneveld MJ, Chan HLY, Forns X, Papatheodoridis GV, Vanwolleghem T, Yuen MF, Hsu YC, Kao JH, Cornberg M, Hansen BE, Jeng WJ, Janssen HLA. Off-Therapy Response After Nucleos(t)ide Analogue Withdrawal in Patients With Chronic Hepatitis B: An International, Multicenter, Multiethnic Cohort (RETRACT-B Study). Gastroenterology 2022; 162:757-771.e4. [PMID: 34762906 DOI: 10.1053/j.gastro.2021.11.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Functional cure, defined based on hepatitis B surface antigen (HBsAg) loss, is rare during nucleos(t)ide analogue (NA) therapy and guidelines on finite NA therapy have not been well established. We aim to analyze off-therapy outcomes after NA cessation in a large, international, multicenter, multiethnic cohort of patients with chronic hepatitis B (CHB). METHODS This cohort study included patients with virally suppressed CHB who were hepatitis B e antigen (HBeAg)-negative and stopped NA therapy. Primary outcome was HBsAg loss after NA cessation, and secondary outcomes included virologic, biochemical, and clinical relapse, alanine aminotransferase flare, retreatment, and liver-related events after NA cessation. RESULTS Among 1552 patients with CHB, cumulative probability of HBsAg loss was 3.2% at 12 months and 13.0% at 48 months of follow-up. HBsAg loss was higher among Whites (vs Asians: subdistribution hazard ratio, 6.8; 95% confidence interval, 2.7-16.8; P < .001) and among patients with HBsAg levels <100 IU/mL at end of therapy (vs ≥100 IU/mL: subdistribution hazard ratio, 22.5; 95% confidence interval, 13.1-38.7; P < .001). At 48 months of follow-up, Whites with HBsAg levels <1000 IU/mL and Asians with HBsAg levels <100 IU/mL at end of therapy had a high predicted probability of HBsAg loss (>30%). Incidence rate of hepatic decompensation and hepatocellular carcinoma was 0.48 per 1000 person-years and 0.29 per 1000 person-years, respectively. Death occurred in 7/19 decompensated patients and 2/14 patients with hepatocellular carcinoma. CONCLUSIONS The best candidates for NA withdrawal are virally suppressed, HBeAg- negative, noncirrhotic patients with CHB with low HBsAg levels, particularly Whites with <1000 IU/mL and Asians with <100 IU/mL. However, strict surveillance is recommended to prevent deterioration.
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Affiliation(s)
- Grishma Hirode
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - Hannah S J Choi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Tung-Hung Su
- National Taiwan University Hospital, Taipei, Taiwan
| | - Wai-Kay Seto
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Sabela Lens
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Grace Wong
- The Chinese University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Sylvia M Brakenhoff
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Linkou, Taiwan
| | - Jordan Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Henry L Y Chan
- The Chinese University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Xavier Forns
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | | | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Man-Fung Yuen
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Yao-Chun Hsu
- E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany Centre for Individualized Infection Medicine, Hannover, Germany
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Linkou, Taiwan
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada.
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Kim HY, Lampertico P, Nam JY, Lee HC, Kim SU, Sinn DH, Seo YS, Lee HA, Park SY, Lim YS, Jang ES, Yoon EL, Kim HS, Kim SE, Ahn SB, Shim JJ, Jeong SW, Jung YJ, Sohn JH, Cho YK, Jun DW, Dalekos GN, Idilman R, Sypsa V, Berg T, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Janssen HLA, Jang MJ, Lee YB, Kim YJ, Yoon JH, Papatheodoridis GV, Lee JH. An artificial intelligence model to predict hepatocellular carcinoma risk in Korean and Caucasian patients with chronic hepatitis B. J Hepatol 2022; 76:311-318. [PMID: 34606915 DOI: 10.1016/j.jhep.2021.09.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Several models have recently been developed to predict risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Our aims were to develop and validate an artificial intelligence-assisted prediction model of HCC risk. METHODS Using a gradient-boosting machine (GBM) algorithm, a model was developed using 6,051 patients with CHB who received entecavir or tenofovir therapy from 4 hospitals in Korea. Two external validation cohorts were independently established: Korean (5,817 patients from 14 Korean centers) and Caucasian (1,640 from 11 Western centers) PAGE-B cohorts. The primary outcome was HCC development. RESULTS In the derivation cohort and the 2 validation cohorts, cirrhosis was present in 26.9%-50.2% of patients at baseline. A model using 10 parameters at baseline was derived and showed good predictive performance (c-index 0.79). This model showed significantly better discrimination than previous models (PAGE-B, modified PAGE-B, REACH-B, and CU-HCC) in both the Korean (c-index 0.79 vs. 0.64-0.74; all p <0.001) and Caucasian validation cohorts (c-index 0.81 vs. 0.57-0.79; all p <0.05 except modified PAGE-B, p = 0.42). A calibration plot showed a satisfactory calibration function. When the patients were grouped into 4 risk groups, the minimal-risk group (11.2% of the Korean cohort and 8.8% of the Caucasian cohort) had a less than 0.5% risk of HCC during 8 years of follow-up. CONCLUSIONS This GBM-based model provides the best predictive power for HCC risk in Korean and Caucasian patients with CHB treated with entecavir or tenofovir. LAY SUMMARY Risk scores have been developed to predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. We developed and validated a new risk prediction model using machine learning algorithms in 13,508 antiviral-treated patients with chronic hepatitis B. Our new model, based on 10 common baseline characteristics, demonstrated superior performance in risk stratification compared with previous risk scores. This model also identified a group of patients at minimal risk of developing HCC, who could be indicated for less intensive HCC surveillance.
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Affiliation(s)
- Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College, Republic of Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young-Suk Lim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Eun Sun Jang
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Jin Jung
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki "Hippokratio", Thessaloniki, Greece
| | - Spilios Manolakopoulos
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Hippokratio", Athens, Greece
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Li C, Zhang W, Shi B, Chen G, Zheng Y, An Y, Sun M, Feng Y, Shang Q, Zhang X. Evaluation of the in situ assay for HBV DNA: An observational real-world study in chronic hepatitis B. Medicine (Baltimore) 2021; 100:e27220. [PMID: 34664859 PMCID: PMC8448054 DOI: 10.1097/md.0000000000027220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/28/2021] [Indexed: 02/06/2023] Open
Abstract
The visualization of intrahepatic hepatitis B virus (HBV) DNA by in situ hybridization (ISH) has uncovered some interesting aspects of HBV life cycle at the single-cell level. In the current study, we intend to evaluate the reliability and robustness of this assay in the real-world clinical scenario and its relationship with currently available clinical biomarkers in chronic hepatitis B (CHB) patients.In this cross-sectional study, 94 CHB patients and 10 patients with non-HBV related liver diseases were enrolled. Liver biopsies and routine histopathology analysis were performed. Intrahepatic HBV DNA and viral antigens (HBsAg and HBcAg) were detected by ISH and immunohistochemistry (IHC), respectively. The basic biochemical and virological parameters such as alanine transaminase, serum HBV DNA, and serum HBsAg were measured.The HBV DNA-ISH assay showed 55.8% (53/94 cases) positive rate in CHB patients, no false positive was found in non-HBV related hepatitis. The IHC of HBsAg and HBcAg showed a positive rate of 94.7% (89/94 cases) and 19.5% (17/87 cases), respectively. Quantification of HBV DNA-ISH signal showed a significant correlation with serum HBV DNA (rs = 0.6223, P < .0001). In addition, the staining pattern of HBV DNA in situ in the context of collagen deposition informed the histopathological progression of chronic liver disease.The application of this ISH assay in evaluating intrahepatic viral replication in real-world CHB patients showed favorable performance. It can be a complementation to conventional liver histopathology examination and IHC detection of viral antigens. This methodology provides an intuitive assessment of virological and pathological state of CHB patients, and further supports clinical diagnosis and management.
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Affiliation(s)
- Chang Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Zhang
- Chinese PLA Diagnosis and Treatment Center for Liver Diseases, The 960th Hospital of Chinese PLA Joint Logistics Support Force, Tai’an, Shandong, China
| | - Bisheng Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Gang Chen
- Chinese PLA Diagnosis and Treatment Center for Liver Diseases, The 960th Hospital of Chinese PLA Joint Logistics Support Force, Tai’an, Shandong, China
| | - Ye Zheng
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yong An
- Chinese PLA Diagnosis and Treatment Center for Liver Diseases, The 960th Hospital of Chinese PLA Joint Logistics Support Force, Tai’an, Shandong, China
| | - Mimi Sun
- Chinese PLA Diagnosis and Treatment Center for Liver Diseases, The 960th Hospital of Chinese PLA Joint Logistics Support Force, Tai’an, Shandong, China
| | - Yanling Feng
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qinghua Shang
- Chinese PLA Diagnosis and Treatment Center for Liver Diseases, The 960th Hospital of Chinese PLA Joint Logistics Support Force, Tai’an, Shandong, China
| | - Xiaonan Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Centre for Research in Therapeutic Solutions, Biomedical Sciences, Faculty of Science and Technology, University of Canberra, ACT, Australia
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Boyd A, Dezanet LNC, Lacombe K. Functional Cure of Hepatitis B Virus Infection in Individuals With HIV-Coinfection: A Literature Review. Viruses 2021; 13:1341. [PMID: 34372547 PMCID: PMC8309973 DOI: 10.3390/v13071341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
In individuals infected with hepatitis B virus (HBV), the loss of hepatitis B surface antigen (HBsAg) is the ultimate therapeutic goal, which defines "functional cure." For individuals living with human immunodeficiency virus (HIV), functional cure occurs roughly 2 per 100 person-years during potent anti-HBV containing antiretroviral therapy. Although this rate may be higher than expected in treated HBV mono-infected individuals, rates of functional cure widely vary between studies (0.6-10.5 per 100 person-years). Similar to HBV mono-infection, the phase of HBV infection, HBV (sub-)genotypes and hepatitis B "e" Ag-negative variants are associated with functional cure in treated HIV-HBV co-infection. In specifically HIV-HBV co-infected individuals, strong increases in CD4+ T cell counts after treatment initiation have also been linked to functional cure, yet this finding is inconsistent across studies. Several markers directly or indirectly reflecting HBV activity are being developed to predict functional cure, such as quantification of HBsAg, hepatitis B core-related antigen, HBsAg protein composition, anti-hepatitis B core antibodies and interferon-gamma-inducible protein 10. Few have been assessed during treatment in HIV-HBV co-infected individuals and none have been validated to predict functional cure. Novel therapeutics for HBV cure are essential for individuals with HIV-HBV co-infection and need to be separately evaluated in this population.
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Affiliation(s)
- Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
| | - Lorenza N. C. Dezanet
- Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM, IPLESP, Sorbonne Université, 75012 Paris, France; (L.N.C.D.); (K.L.)
| | - Karine Lacombe
- Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM, IPLESP, Sorbonne Université, 75012 Paris, France; (L.N.C.D.); (K.L.)
- APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, 75012 Paris, France
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Boglione L, Caccia C, Civra A, Cusato J, D'Avolio A, Biasi F, Lembo D, Di Perri G, Poli G, Leoni V. Trend of 25-hydroxycholesterol and 27-hydroxycholesterol plasma levels in patients affected by active chronic hepatitis B virus infection and inactive carriers. J Steroid Biochem Mol Biol 2021; 210:105854. [PMID: 33631373 DOI: 10.1016/j.jsbmb.2021.105854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/19/2021] [Accepted: 02/19/2021] [Indexed: 01/16/2023]
Abstract
Hepatitis B virus (HBV) infection is a global health problem with different immunological phases and therapeutic approaches. The serological condition of inactive carrier (IC) was recently well defined as a clinical and virological stable status, in which specific treatment is usually deferred, while the active chronic hepatitis B (CHB) condition requires an immediate treatment strategy. Recently, a possible broad antiviral effect of oxysterols, in particular 25-hydroxycholesterol (25OHC) and 27-hydroxycholesterol (27OHC), was observed, as most likely linked to the positive modulation of innate immunity, but no clear evidence is available about their possible role in chronic HBV infection. Thus, we examined the relationship between the plasma levels of oxysterols and the disease condition of 40 HBV patients, without treatment at the start of the study. Of these, 33 were ICs and 7 were active CHB subjects. A marked reduction of 25OHC and 27OHC plasma levels was detectable in all active CHB recruited patients, while the plasma values observed in ICs all remained within the physiological range. No difference was observed between the two groups of patients with regard to the plasma levels of 24-hydroxycholesterol (24OHC). Further, the plasma level of 27OHC ≥ 140 μg/L was shown to be predictive of an inactive carrier status. This cohort study points to 27OHC as a good candidate biomarker to differentiate active and inactive CHB status. An increasing bulk of research reports is supporting the very likely contribution of this oxysterol to the immunological control of chronic hepatitis B.
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Affiliation(s)
- Lucio Boglione
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
| | - Claudio Caccia
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Civra
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Jessica Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Turin, Italy
| | - Fiorella Biasi
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - David Lembo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Turin, Italy
| | - Giuseppe Poli
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
| | - Valerio Leoni
- Laboratory of Clinical Chemistry, Hospital of Desio, ASST-Monza and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
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Abstract
Coronavirus disease 2019 (COVID-19) has become a global pandemic and garnered international attention. The causative pathogen of COVID-19 is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel, highly contagious coronavirus. Numerous studies have reported that liver injury is quite common in patients with COVID-19. Hepatitis B has a worldwide distribution as well as in China. At present, hepatitis B virus (HBV) remains a leading cause of cirrhosis, liver failure, and hepatocellular carcinoma. Because both viruses challenge liver physiology, it raises questions as to how coinfection with HBV and SARS-CoV-2 affect disease progression and mortality. Is there an increased risk of COVID-19 in patients with HBV infection? In this review, we summarize the current reports of SARS-CoV-2 and HBV coinfection and elaborate the interaction of the two diseases. The emphasis was placed on evaluating the impact of HBV infection on disease severity and clinical outcomes in patients with COVID-19 and discussing the potential mechanism behind this effect.
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Affiliation(s)
- Tian-Dan Xiang
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xin Zheng
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Medhioub M, Ben Salah W, Khsiba A, Ouni A, Hamzaoui L, Azouz MM. Performance of FIB4 and APRI scores for the prediction of fibrosis in patients with chronic hepatitis B virus infection. Tunis Med 2020; 98:998-1004. [PMID: 33480003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The evaluation of hepatic fibrosis is essential in the therapeutic management of chronic hepatitis B virus infection. The development of non-invasive tests for liver fibrosis assessement has allowed to avoid liver biops in some cases. AIM To assess the performance of the scores APRI and FIB-4 in the assessment of significant fibrosis in chronic hepatitis B virus infection. METHODS Evaluation study, including patients with chronic hepatitis B virus infection who had a liver biopsy. The accuracy of APRI and FIB4 for the detection of significant fibrosis was compared with the liver biopsy data. RESULTS One hundred and one patients were included. Significant fibrosis was found in 10.9% of patients. For a cut-off value of 0.49, the APRI score predicted significant fibrosis with a sensitivity of 54%, a specificity of 93% and a negative predictive value of 94%. For a cut-off value of 1.01, the FIB-4 score predicted significant fibrosis with a sensitivity of 64%, a specificity of 84% and a negative predictive value of 95%. Performance of both scores was influenced by age, the body mass index, and cytolysis. CONCLUSION The APRI and FIB-4 scores had a good accuracy to exclude significant fibrosis in chronic hepatitis B virus infection.
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Baskiran A, Akbulut S, Sahin TT, Koc C, Karakas S, Ince V, Yurdaydin C, Yilmaz S. Effect of HBV-HDV co-infection on HBV-HCC co-recurrence in patients undergoing living donor liver transplantation. Hepatol Int 2020; 14:869-880. [PMID: 32895876 DOI: 10.1007/s12072-020-10085-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the effect of hepatitis D virus (HDV) on hepatitis B virus-hepatocellular carcinoma (HBV-HCC) co-recurrence in patients undergoing living donor liver transplantation (LDLT) for HBV alone or HBV-HDV coinfection. METHODS Between 2002 and 2019, 254 HBV-HCC patients underwent LDLT. The patients were divided into two groups after the application of the exclusion criteria: HBV-HCC (Group B; n = 163) and HBV-HDV-HCC (Group D; n = 31). First, the B and D groups were compared in terms of demographic and clinical parameters. Second, patients with (n = 16) and without (n = 178) post-transplant HBV-HCC co-recurrences were grouped and compared in terms of the same parameters. RESULTS Although the risk of HBV-HCC co-recurrence in group D was 4.99-fold higher than in group B, the risk of HBV recurrence alone in group D was 12.5-fold lower than in group B. The AFP (OR = 4.4), Milan criteria (beyond; OR = 18.8), and HDV (OR = 8.1) were identified as the independent risk factors affecting post-transplant HBV-HCC co-recurrence. The Milan criteria (OR = 2.1) and HBV-HCC co-recurrence (OR = 10.9) were identified as the risk factors affecting post-transplant mortality. HBV-HCC co-recurrence developed in 26.5% of patients in Group B and 100% in Group D (OR = 40; p = 0.001). HCC recurrence alone developed in 10% of patients without HBV recurrence in group B and 0% of patients without HBV recurrence in group D (OR = 5.7). CONCLUSION This study showed that the risk of HBV recurrence alone was reduced by 12.5-fold in the presence of HDV; however, the HCC recurrence occurred in all patients with HDV when HBV recurrence developed.
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Affiliation(s)
- Adil Baskiran
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Serdar Karakas
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Volkan Ince
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Faculty of Medicine, Koc University, 34450, Istanbul, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
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9
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Abstract
Chronic hepatitis B infection (CHB) is a condition that needs ongoing care such as monitoring for liver enzymes (ALT) and HBV DNA tests in treated and untreated patients, and annual imaging evaluation for liver cancer. Although follow-up care and treatment might seem straight forward, an estimated two-thirds of those who are aware of their infection are not seeing a health care provider, and more than half of those who are eligible for treatment do not receive it. This study aimed to compile and examine studies related to the barriers of disease monitoring, treatment, and liver cancer surveillance for CHB patients in the United States (US). A total of 4439 studies on monitoring and surveillance of CHB published between 2007 and 2018 were identified through a search of electronic databases. After critical assessment, the authors included 42 studies, divided into categories: 'patient-related barriers'; 'provider-related barriers'; and 'system-related barriers'. Among the patient-related barriers, one of the most frequent factors invoked in failing to have adequate surveillance was lack of patient's knowledge. In the provider-related barrier category, a lack of disease knowledge and adherence to guidelines was frequently reported. For the system-related barrier category, the only recurrent mention was a lack of clarity in guidelines or lack of guidelines from certain national institutions. This review summarizes and highlights the need for long-term disease management improvement of chronic hepatitis B infection for patients and healthcare providers that care for them.
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Affiliation(s)
- Simona Ispas
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA, 94304-5787, USA
| | - Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA, 94304-5787, USA
| | - Mehlika Toy
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, CJ 130, Palo Alto, CA, 94304-5787, USA.
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10
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Ganesan M, Eikenberry A, Poluektova LY, Kharbanda KK, Osna NA. Role of alcohol in pathogenesis of hepatitis B virus infection. World J Gastroenterol 2020; 26:883-903. [PMID: 32206001 PMCID: PMC7081008 DOI: 10.3748/wjg.v26.i9.883] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) and alcohol abuse often contribute to the development of end-stage liver disease. Alcohol abuse not only causes rapid progression of liver disease in HBV infected patients but also allows HBV to persist chronically. Importantly, the mechanism by which alcohol promotes the progression of HBV-associated liver disease are not completely understood. Potential mechanisms include a suppressed immune response, oxidative stress, endoplasmic reticulum and Golgi apparatus stresses, and increased HBV replication. Certainly, more research is necessary to gain a better understanding of these mechanisms such that treatment(s) to prevent rapid liver disease progression in alcohol-abusing HBV patients could be developed. In this review, we discuss the aforementioned factors for the higher risk of liver diseases in alcohol-induced HBV pathogenies and suggest the areas for future studies in this field.
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Affiliation(s)
- Murali Ganesan
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68105, United States
| | - Allison Eikenberry
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68105, United States
| | - Larisa Y Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Kusum K Kharbanda
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68105, United States
| | - Natalia A Osna
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68105, United States
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11
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Irham LM, Wong HSC, Perwitasari DA, Chou WH, Yang HI, Chang WC. Single-nucleotide polymorphism of rs7944135 (macrophage-expressed gene 1) is associated with hepatitis B surface antigen seroclearance in chronic hepatitis B infection: A cohort study. Medicine (Baltimore) 2019; 98:e17936. [PMID: 31860948 PMCID: PMC6940119 DOI: 10.1097/md.0000000000017936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Clearance of the hepatitis B surface antigen (HBsAg) is the ultimate aim of treatment for patients with chronic hepatitis B (CHB) infection. Genetic, factor age, and gender were reported to be involved in the clearance of HBsAg. However, the rate of HBsAg seroclearance in CHB patients is still low globally and few of the single-nucleotide polymorphism (SNP) had been identified to associated with HBsAg seroclearance in CHB patients.Recently, 3 associated SNPs (rs7944135, rs171941, and rs6462008) were reported in the clearance of HBsAg in the Korean population. However, these SNPs have not been investigated in the CHB Taiwanese population. In present study, these 3 SNPs were genotyped in 2565 Taiwanese CHB patients including 493 CHB patients with HBsAg seroclearance and 2072 without HBsAg seroclearance.We observed that SNP rs7944135 was solely associated with HBsAg seroclearance. Subjects with the AA genotype at rs7944135 of macrophage-expressed gene 1 had a higher susceptibility to HBsAg clearance, compared to those with the AG or GG genotype under the genotypic model (odds ratio [OR] = 1.76. 95% confidence interval [CI] = 1.14-2.72, P = .045). Furthermore, we found a 1.74-fold increased risk of acquiring HBsAg seroclearance associated with the AA genotype compared to AG + GG of rs7944135 under the recessive model (OR = 1.74. 95% CI = 1.13-2.66, P = .014). According to the cumulative fraction curve with the log-rank test revealed that patients with the AA genotype of rs7944135 showed higher susceptibility to occur HBsAg seroclearance (P = .039) and HBV DNA undetectable (P = .0074) compared to those with the AG or GG genotype.This study examined the associations of 3 SNPs (rs7944135, rs171941, and rs6462008) with HBsAg seroclearance, and we identified that rs7944135 is solely associated with HBsAg seroclearance in Taiwanese CHB patients.
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Affiliation(s)
- Lalu Muhammad Irham
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Faculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia
| | - Henry Sung-Ching Wong
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | | | - Wan-Hsuan Chou
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica
- Institute of Clinical Medicine, National Yang-Ming University
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Genomics Research Center, Academia Sinica
- Integrative Research Center for Critical Care, Wan fang Hospital, Taipei Medical University, Taipei
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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12
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Tran QV, Vo TQ. Health-related quality of life (HRQoL) and health state utilities with chronic hepatitis-B (CHB): A population-based survey in Vietnam. J PAK MED ASSOC 2019; 69(Suppl 2):S80-S86. [PMID: 31369538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Hepatitis-B infection is a worldwide consideration despite of vaccination availability. Chronic Hepatitis-B (CHB) results in various complications and the impairment of health-related quality of life (HRQoL). Health state utilities and HRQoL are the fundamental input to decision models as well as economic evaluation analysis. Although the effect of CHB on the HRQoL and health state utilities is well-known, the results remain uncertain. The objective is to measure health state utilities and HRQoL among CHB patients at two provincial hospitals in southern Vietnam using both preference-based and non-preference-based tools. METHODS A cross-sectional survey was conducted from August 2017 to July 2018 in Dongnai and Kiengiang General Hospitals (DNGH and KGGH). Patients with the ICD-10 code of B18 was enrolled using convenience sampling method. Each respondent was experienced a face-to-face interview with four health measurement instruments. SPSS 20.0 software was used for data analsysis. RESULTS The total research population included 546 patients at DNGH and 338 patients at KGGH, each of them was classified in to one of four stages of the disease. The majority were male, well-educated and alcohol-consumers. The average physical component score was highest in patients with compensated cirrhosis at KGGH (58.7}0.9). The average mental component score was highest in patients with noncirrhotic CHB at DNGH (60.3}0.2). In both hospitals, patients with noncirrhotic chronic Hepatitis B had the highest mean score of EuroQoL 5 dimensions questions; patients with decompensated cirrhosis had the lowest mean score of visual analogue scale. CONCLUSIONS This is the first study in Vietnam which used both preference-based and non-preference-based insstrument to measure the HRQoL in HBV-infected patients. The results from different instruments were similar. These findings were promised to be a fundamental input for future cost-effectiveness analysis in the same field.
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Affiliation(s)
- Quang Vinh Tran
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Trung Quang Vo
- Department of Economic and Administrative Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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13
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Anabire NG, Aryee PA, Abdul-Karim A, Quaye O, Awandare GA, Helegbe GK. Impact of malaria and hepatitis B co-infection on clinical and cytokine profiles among pregnant women. PLoS One 2019; 14:e0215550. [PMID: 31002731 PMCID: PMC6474591 DOI: 10.1371/journal.pone.0215550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background The overlap of malaria and chronic hepatitis B (CHB) is common in endemic regions, however, it is not known if this co-infection could adversely influence clinical and immunological responses. This study investigated these interactions in pregnant women reporting to antenatal clinics in Ghana. Methods Clinical parameters (hemoglobin, liver function biomarker, peripheral malaria parasitemia, and hepatitis B viremia) and cytokine profiles were assayed and compared across four categories of pregnant women: un-infected, mono-infected with Plasmodium falciparum (Malaria group), mono-infected with chronic hepatitis B virus (CHB group) and co-infected (Malaria+CHB group). Results Women with Malaria+CHB maintained appreciably normal hemoglobin levels (mean±SEM = 10.3±0.3 g/dL). That notwithstanding, Liver function test showed significantly elevated levels of alanine aminotransferase, aspartate aminotransferase and total bilirubin [P<0.001 for all comparisons]. Similarly, the Malaria+CHB group had significantly elevated pro-inflammatory cytokines, including tumour necrosis factor alpha (TNF-α), interleukin (IL)-1β, and IL-6 [P<0.05 for all comparisons]. In women with Malaria+CHB, correlation analysis showed significant negative association of the pro-inflammatory cytokines responses with malaria parasitemia [IL-1β (P<0.001; r = -0.645), IL-6 (P = 0.046; r = -0.394) and IL-12 (P = 0.011; r = -0.49)]. On the other hand, the pro-inflammatory cytokine levels positively correlated with HBV viremia [TNF-α (P = 0.004; r = 0.549), IL-1β (P<0.001; r = 0.920), IL-6 (P<0.001; r = 0.777), IFN-γ (P = 0.002; r = 0.579), IL-2 (P = 0.008; r = 0.512) and IL-12 (P<0.001; r = 0.655)]. Also, for women in the Malaria+CHB group, parasitemia was observed to diminish HBV viremia [P = 0.003, r = -0.489]. Conclusion Put together the findings suggests that Malaria+CHB could exacerbate inflammatory cytokine responses and increase susceptibility to liver injury among pregnant women in endemic settings.
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Affiliation(s)
- Nsoh Godwin Anabire
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon- Accra, Ghana
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Legon- Accra, Ghana
- Department of Biochemistry & Molecular Medicine, School of Medicine and Health Sciences, University for Development Studies, amale- Ghana
| | - Paul Armah Aryee
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale- Ghana
| | - Abass Abdul-Karim
- Zonal Public Health Laboratory, Tamale Teaching Hospital, Tamale- Ghana
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon- Accra, Ghana
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Legon- Accra, Ghana
| | - Gordon Akanzuwine Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon- Accra, Ghana
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Legon- Accra, Ghana
| | - Gideon Kofi Helegbe
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon- Accra, Ghana
- Department of Biochemistry & Molecular Medicine, School of Medicine and Health Sciences, University for Development Studies, amale- Ghana
- * E-mail:
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14
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Abstract
The stimulator of interferon genes (STING) plays a crucial role in the recognition of a viral infection and subsequent stimulation of an immune response. However, it is unclear whether methylation of the STING promoter affects STING transcription and response to antiviral therapy. The present study determined the methylation status of the STING promoter in patients with chronic hepatitis B (CHB).This study included 198 participants, of which 159 participants had CHB and 39 were healthy controls (HCs). Methylation-specific polymerase chain reaction was performed to detect the methylation status of the STING promoter. Reverse transcription-quantitative polymerase chain reaction was performed to determine STING mRNA level in peripheral blood mononuclear cells.The methylation frequency of the STING promoter was significantly higher and STING mRNA level was lower in the patients with CHB than in the HCs. Presence of hepatitis B virus (HBV) DNA was independently correlated with an increased risk of STING promoter methylation. Virological response frequency was higher in the patients with CHB receiving entecavir (ETV) than in those receiving adefovir (ADV). In the ETV group, the virological response frequency was evidently lower in the patients with CHB having methylated STING promoters than in those having unmethylated STING promoters. However, there was no significant difference in the virological response frequency between ADV-treated patients having methylated and unmethylated STING promoters.These results indicate that the hypermethylation of the STING promoter and thus the transcriptional repression of STING weaken the effect of STING in inhibiting HBV replication and decreases the effectiveness of antiviral therapy.
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Affiliation(s)
- Chen-Si Wu
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Qian Zhao
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Jun Zhang
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Jing-Wen Wang
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Yu Qian
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Yu-Chen Fan
- Department of Hepatology, Qilu Hospital of Shandong University
- Institute of Hepatology, Shandong University, Jinan, China
| | - Kai Wang
- Department of Hepatology, Qilu Hospital of Shandong University
- Institute of Hepatology, Shandong University, Jinan, China
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15
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Abstract
BACKGROUND Hepatitis B is one of the most common infectious diseases in China, and it is necessary to study biochemical indicators of HBV infected patients. METHODS Biochemical and basic features of 1765 HBV infected patients and 840 general controls were collected and analyzed from Southwest China. RESULTS A total of 23.5% of the patients were children or young persons (less than 40 years old). The co-infected rate was only 0.3% for those who were co-infected with Hepatitis C virus (HCV) or Treponema pallidum (TPa). Most of patients (1081 individuals) were under convalescent condition, and 4.2% and 34.6% HBV patients were at acute and chronic phase, respectively. The indicators of liver function were significantly different between HBV patients and normal controls. In order to further study the variation of biochemical features in HBV patients in different phase, they were divided into three groups (sample #1: patients in acute infected phase; sample #2: patients in chronic infected phase; and sample #3: patients in convalescent condition). Excluding total protein and globin, all other indicators of liver function were statically different among the three groups. Total protein and albumin gradually decreased from convalescent patients, chronic HBV-infected patients, to acute HBV-infected patients. CONCLUSIONS Biochemical features could be used to evaluate the progress and therapeutic effects of HBV-infection. Our analysis firstly reported basic and biochemical information of HBV patients in Southwest China.
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16
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Yuan L, Liu X, Zhang L, Zhang Y, Chen Y, Li X, Wu K, Cao J, Hou W, Que Y, Zhang J, Zhu H, Yuan Q, Tang Q, Cheng T, Xia N. Optimized HepaRG is a suitable cell source to generate the human liver chimeric mouse model for the chronic hepatitis B virus infection. Emerg Microbes Infect 2018; 7:144. [PMID: 30097574 PMCID: PMC6086841 DOI: 10.1038/s41426-018-0143-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/30/2018] [Accepted: 07/06/2018] [Indexed: 12/11/2022]
Abstract
The human liver chimeric mouse with primary human hepatocytes (PHHs) engraftment has been demonstrated to be a useful animal model to study hepatitis B virus (HBV) pathogenesis and evaluate anti-HBV drugs. However, the disadvantages of using PHHs include the inability for cellular expansion in vitro, limited donor availability, individual differences, and ethical issues, necessitating the development of alternatives. To obtain in vitro expandable hepatocytes, we optimized the hepatic differentiation procedure of the human liver progenitor cell line, HepaRG, using four functional small molecules (4SM) and enriched the precursor hepatocyte-like cells (HLCs). HepaRG cells of different hepatic differentiation states were engrafted to immunodeficient mice (FRGS) with weekly 4SM treatment. The HepaRG-engrafted mice were challenged with HBV and/or treated with several antivirals to evaluate their effects. We demonstrated that the 4SM treatment enhanced hepatic differentiation and promoted cell proliferation capacity both in vitro and in vivo. Mice engrafted with enriched HepaRG of prehepatic differentiation and treated with 4SM displayed approximately 10% liver chimerism at week 8 after engraftment and were maintained at this level for another 16 weeks. Therefore, we developed a HepaRG-based human liver chimeric mouse model: HepaRG-FRGS. Our experimental results showed that the liver chimerism of the mice was adequate to support chronic HBV infection for 24 weeks and to evaluate antivirals. We also demonstrated that HBV infection in HepaRG cells was dependent on their hepatic differentiation state and liver chimerism in vivo. Overall, HepaRG-FRGS mice provide a novel human liver chimeric mouse model to study chronic HBV infection and evaluate anti-HBV drugs.
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Affiliation(s)
- Lunzhi Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Xuan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Liang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Yali Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Yao Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Xiaoling Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Kun Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Jiali Cao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Wangheng Hou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Yuqiong Que
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
| | - Hua Zhu
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, 225 Warren Street, Newark, NJ, 070101, USA
| | - Quan Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China.
| | - Qiyi Tang
- Department of Microbiology, Howard University College of Medicine, Washington, DC, 20059, USA.
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China.
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science, School of Public Health, Xiamen University, 361102, Xiamen, P. R. China
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17
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Abstract
BACKGROUND Long-term safety of treatment with hepatitis B virus (HBV) polymerase inhibitors is a concern. Adefovir dipivoxil (ADV) and/or interferon alfa (IFN-α) therapies have previously been associated with impairment of renal function. Limited data are available on the safety of combination therapy with nucleos (t)ide analogues (NAs) and IFN-α. The aim of this analysis was to assess the renal function during combined therapy with pegylated interferon α-2b (PEG-IFN-α-2b) and ADV versus PEG-IFN-α-2b alone in patients with chronic hepatitis B (CHB). METHODS We performed a multicenter, prospective, open-label, randomized-controlled trial of renal function data to investigate the efficacy of 48 weeks of therapy with PEG-IFN-α-2b and ADV versus PEG-IFN-α-2b alone in 102 patients with CHB in Anhui, China. Glomerular filtration rates (GFRs) were calculated by Cockcroft-Gault (CG), abbreviated Modification of Diet in Renal Disease (MDRD) study, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and were tested by repeated-measures 1-way analysis of variance within groups. A linear mixed effects model for repeated measures was also used to evaluate the association between baseline information and estimated glomerular filtration rate (eGFR) changes overtime in all enrolled patients. The model considered the baseline age, sex, HBV DNA, aminotransferase, treatment group, time, and group-by-time interaction as fixed effects and incorporated random effects for individual subjects. RESULTS After 48 weeks of therapy and further 24 weeks of follow-up, the eGFR decreased both in patients given PEG-IFN-α-2b single therapy and combined therapy. Age, HBV DNA, and combined therapy were significant negative predictive factors for eGFR changes. CONCLUSION The incidence of renal adverse events in both groups was low, and the combination therapy may have delayed, but reversible renal impairment.
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Affiliation(s)
- Qian Su
- Department of Infectious Diseases, First Affiliated Hospital of Anhui Medical University
| | - Yanyan Liu
- Department of Infectious Diseases, First Affiliated Hospital of Anhui Medical University
| | - Jiabin Li
- Department of Infectious Diseases, First Affiliated Hospital of Anhui Medical University
- Department of Infectious Diseases, Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
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18
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Kim TH, Lee EJ, Choi JH, Yim SY, Lee S, Kang J, Lee YR, Lee HA, Choi HS, Kim ES, Keum B, Seo YS, Yim HJ, Jeen YT, Chun HJ, Lee HS, Kim CD, Woo HG, Um SH. Identification of novel susceptibility loci associated with hepatitis B surface antigen seroclearance in chronic hepatitis B. PLoS One 2018; 13:e0199094. [PMID: 29975729 PMCID: PMC6033413 DOI: 10.1371/journal.pone.0199094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS The seroclearance of hepatitis B virus (HBV) surface antigen (HBsAg) is regarded as a functional cure of chronic hepatitis B (CHB) although it occurs rarely. Recently, several genome-wide association studies (GWASs) revealed various genetic alterations related to the clinical course of HBV infection. However, all of these studies focused on the progression of HBV infection to chronicity and had limited application because of the heterogeneity of HBV genotypes. In the present study, we aimed to determine susceptibility genetic markers for seroclearance of HBsAg in CHB patients with a homogenous viral genotype. METHODS One hundred patients with CHB who had experienced HBsAg seroclearance before 60 years of age and another 100 with CHB showing high serum levels of HBsAg even after 60 years of age were enrolled. Extreme-phenotype GWAS was conducted using blood samples of participants. RESULTS We identified three single nucleotide polymorphisms, rs7944135 (P = 4.17 × 10-6, odds ratio [OR] = 4.16, 95% confidence interval [CI] = 2.27-7.63) at 11q12.1, rs171941 (P = 3.52×10-6, OR = 3.69, 95% CI = 2.13-6.42) at 5q14.1, and rs6462008 (P = 3.40×10-6, OR = 0.34, 95% CI = 0.22-0.54) at 7p15.2 as novel susceptibility loci associated with HBsAg seroclearance in patients with CHB. The flanking genes at these loci including MPEG1, DTX4, MTX3, and HOXA13 were suggested to have functional significance. In addition, through functional analysis, CXCL13 was also presumed to be related. CONCLUSIONS To the best of our knowledge, this study is the first GWAS regarding the seroclearance of HBsAg in CHB patients. We identify new susceptibility loci for cure of CHB, providing new insights into its pathophysiology.
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Affiliation(s)
- Tae Hyung Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun-Ju Lee
- Department of Physiology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Hye Choi
- Department of Physiology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Science, Graduate School, Ajou University, Suwon, Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sunwon Lee
- Department of Computer Science and Engineering, Korea University College of Informatics, Seoul, Korea
| | - Jaewoo Kang
- Department of Computer Science and Engineering, Korea University College of Informatics, Seoul, Korea
| | - Yoo Ra Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bora Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hong Sik Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Duck Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun Goo Woo
- Department of Physiology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Science, Graduate School, Ajou University, Suwon, Korea
- * E-mail: (HGW); (SHU)
| | - Soon Ho Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- * E-mail: (HGW); (SHU)
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Huang Y, Zhang Y, Lin Z, Han M, Cheng H. Altered serum copper homeostasis suggests higher oxidative stress and lower antioxidant capability in patients with chronic hepatitis B. Medicine (Baltimore) 2018; 97:e11137. [PMID: 29901643 PMCID: PMC6023651 DOI: 10.1097/md.0000000000011137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/24/2018] [Indexed: 02/05/2023] Open
Abstract
Copper homeostasis can be altered by inflammation. This study aimed to investigate the alteration of serum copper homeostasis and to explore its clinical significance in patients with chronic hepatitis B (CHB).Thirty-two patients with CHB and 10 aged- and sex-matched healthy controls were recruited. Analyses included serum levels of total copper (TCu), copper ions (Cu), small molecule copper (SMC), ceruloplasmin (CP), Cu/Zn superoxide dismutase 1 (SOD1), urinary copper, and the activities of serum CP and SOD1.The serum TCu and urinary copper levels in patients with CHB were significantly higher than the controls (P = .04 and .003), while the serum Cu was lower than the controls (P = .0002). CP and SOD1 activities in the serum were significantly lower in patients with CHB compared to controls (P = .005) despite higher serum concentrations. In addition, serum alanine aminotransferase inversely correlated with serum CP activity (P = .0318, r = -0.4065).Serum copper homeostasis was altered in this cohort of patients with CHB. The results suggest increased oxidative stress and impaired antioxidant capability in patients with CHB, in addition to necroinflammation. These results may provide novel insights into the diagnosis and treatment of patients with CHB.
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Affiliation(s)
| | - Yuan Zhang
- Bio-analytical Laboratory, Shantou University Medical College, Shantou, China
| | - Zhexuan Lin
- Bio-analytical Laboratory, Shantou University Medical College, Shantou, China
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Lee IC, Chau GY, Yeh YC, Chao Y, Huo TI, Su CW, Lin HC, Hou MC, Huang YH. Risk of recurrence in chronic hepatitis B patients developing hepatocellular carcinoma with antiviral secondary prevention failure. PLoS One 2017; 12:e0188552. [PMID: 29176777 PMCID: PMC5703552 DOI: 10.1371/journal.pone.0188552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/06/2017] [Indexed: 12/26/2022] Open
Abstract
Background Nucleos(t)ide analogues (NUCs) treatment can reduce the risk of hepatocellular carcinoma (HCC) development and recurrence in chronic hepatitis B (CHB) patients. However, the risk of recurrence in CHB patients who develop HCC despite NUC treatment remains unclear. Methods 167 consecutive CHB patients receiving curative resection for HCC with NUC therapy after surgery were retrospectively enrolled. Thirty-eight patients who developed HCC despite NUC therapy for more than 1 year were defined as secondary prevention failure. The other 129 patients started NUC therapy after surgery. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were evaluated. Results The 5-year RFS and OS rates were 44.7% and 77.3%, respectively. Sex, BMI, BCLC stage, AFP levels and cirrhosis status were the independent predictors of RFS, while microvascular invasion was the independent predictor of OS. The RFS was comparable between patients with and without NUC secondary prevention. In the subgroup analysis, the RFS was significantly worse in cirrhotic patients with secondary prevention failure (hazard ratio = 2.373, p = 0.009). Secondary prevention failure did not have adverse impact on OS. Among 84 patients with recurrence, 58.3% of the cases remained in BCLC stage A, and 53.6% received a second curative treatment. Long-term NUC therapy may lead to a decline of non-invasive indices of hepatic fibrosis in HCC patients. Conclusions In general, the risk of recurrence and survival are comparable between patients with and without secondary prevention failure. However, a higher risk of recurrence was observed in cirrhotic patients with secondary prevention failure.
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Affiliation(s)
- I-Cheng Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Gar-Yang Chau
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yee Chao
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ia Huo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Chen YJ, Chen KW, Shih YL, Su FY, Lin YP, Meng FC, Lin F, Yu YS, Han CL, Wang CH, Lin JW, Hsieh TY, Li YH, Lin GM. Chronic hepatitis B, nonalcoholic steatohepatitis and physical fitness of military males: CHIEF study. World J Gastroenterol 2017; 23:4587-4594. [PMID: 28740347 PMCID: PMC5504374 DOI: 10.3748/wjg.v23.i25.4587] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/24/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the association of chronic hepatitis B and nonalcoholic steatohepatitis with physical fitness in a Taiwanese military male cohort.
METHODS We made a cross-sectional examination of this association using 3669 young adult military males according to cardiorespiratory fitness and hospitalization events recorded in the Taiwan Armed Forces study. Cases of chronic hepatitis B (n = 121) were defined by personal history and positive detection of hepatitis B surface antigen. Cases of nonalcoholic steatohepatitis (n = 129) were defined by alanine transaminase level > 60 U/L, liver ultrasound finding of steatosis, and absence of viral hepatitis A, B or C infection. All other study participants were defined as unaffected (n = 3419). Physical fitness was evaluated by performance in 3000-m run, 2-min sit-ups, and 2-min push-ups exercises, with all the procedures standardized by a computerized scoring system. Multiple linear regression analysis was used to determine the relationship.
RESULTS Chronic hepatitis B negatively correlated with 2-min push-up numbers (β = -2.49, P = 0.019) after adjusting for age, service specialty, body mass index, systolic and diastolic blood pressures, current cigarette smoking, alcohol intake status, serum hemoglobin, and average weekly exercise times. Nonalcoholic steatohepatitis was borderline positively correlated with 3000-m running time (β = 11.96, P = 0.084) and negatively correlated with 2-min sit-up numbers (β = -1.47, P = 0.040).
CONCLUSION Chronic hepatitis B viral infection and nonalcoholic steatohepatitis affects different physical performances in young adult military males, and future study should determine the underlying mechanism.
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Sun J, Robinson L, Lee NL, Welles S, Evans AA. No contribution of lifestyle and environmental exposures to gender discrepancy of liver disease severity in chronic hepatitis b infection: Observations from the Haimen City cohort. PLoS One 2017; 12:e0175482. [PMID: 28453511 PMCID: PMC5409078 DOI: 10.1371/journal.pone.0175482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous studies have noted significant gender difference in the risk of liver cancer among hepatitis B chronic infection patients. Some indicated that it might be due to lifestyle-related differences. This paper tests whether or not such a gender discrepancy among the chronic hepatitis B population is confounded by lifestyle and environment related exposures. METHODS We retrieved a sample of 1863 participants from a prospective cohort in Haimen City, China in 2003. Liver disease severity was categorized as "normal", "mild", "moderate", and "severe" based on a clinical diagnosis. Lifestyle and environmental exposures were measured by questionnaires. We used factor analysis and individual variables to represent lifestyle and environmental exposures. We applied the cumulative logit models to estimate the effect of gender on liver disease severity and how it was impacted by lifestyle and environmental exposures. RESULTS Gender and HBeAg positivity were independent risk factors for more severe liver disease. Compared to females, males were 2.08 times as likely to develop more severe liver disease (95% CI: 1.66-2.61). Participants who were HBeAg positivite were 2.19 times (95% CI: 1.61-2.96) as likely to develop more severe liver disease compared to those who were negative. Controlling for lifestyle and environmental exposures did not change these estimations. CONCLUSIONS Males in the HBV infected population have an increased risk of severe liver disease. This gender effect is independent of the lifestyle and environmental exposures addressed in this study. Our findings support the hypothesis that gender discrepancies in HCC risk are attributable to intrinsic differences between males and females.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lucy Robinson
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, Philadelphia, Pennsylvania, United States of America
| | - Nora L. Lee
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, Philadelphia, Pennsylvania, United States of America
| | - Seth Welles
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, Philadelphia, Pennsylvania, United States of America
| | - Alison A. Evans
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, Philadelphia, Pennsylvania, United States of America
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Saffari M, Pakpour AH, Al Zaben F, Koenig HG. Is there an association between Health Related Quality of Life, socio-demographic status and Fatigue in Patients with Chronic Hepatitis B? Acta Gastroenterol Belg 2017; 80:229-236. [PMID: 29560687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic hepatitis B (CHB) is a serious and prevalent disease which may negatively influence health related quality of life (HRQOL) and fatigue. The aim of the present study was to examine the relationship between demographic variables, HRQOL, and fatigue. METHODS A cross-sectional study was conducted involving 418 Iranian patients with CHB (average age 44.1 years, majority males). Participants completed a multidimensional fatigue inventory, chronic liver disease questionnaire, Euro quality of life-five dimensions questionnaire, and demographic information. Bivariate analyses were conducted using the Spearman correlation and Mann-Whitney U test. Hierarchical logistic regression modeling identified independent predictors of fatigue. RESULTS The most prevalent problems related to HRQOL were anxiety/depression and pain/discomfort. Except for reduced motivation other dimensions of fatigue were significantly higher among those with CHB compared to healthy controls (p<0.05). Age, sex, education, employment, disease stage and all HRQOL subscales were significantly related to fatigue level. The Nagelkerke R Square for the logistic regression model was 0.542. CONCLUSIONS Poor HRQOL and fatigue are widespread among patients with CHB. Given these associations between demographic, psychological, and other HRQOL dimensions and fatigue, interventions that address these factors may help to reduce fatigue in patients with CHB.
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Affiliation(s)
- M Saffari
- Health Research Center, Baqiyatallah University of Medical Sciences Tehran, Iran
- Health Education Department, School of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - A H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, School of Health and Welfare, Jönkoping University, Jönkoping, Sweden
| | - F Al Zaben
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - H G Koenig
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
- Adjunct Professor, King Abdulaziz University, Jeddah, Saudi Arabia
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Abstract
Various viral kinetics among patients with acute hepatitis B (AHB) have been observed in clinical practice. This study investigated the virological, biochemical, and serological characteristics of AHB in adults.A total of 192 adult patients with AHB were recruited between December 2010 and January 2014. The quantification of biochemical and serologic markers for hepatitis B virus (HBV) infection was monitored from the onset.Of the 192 patients, 113 patients were followed up. One patient died due to acute liver failure, 2 developed chronic HBV infection. Clinical recovery was observed in 110 patients; 92.7% (102/110) achieved clinical recovery within 24 weeks, and 7.3% (8/110) between 24 and 44 weeks. There were 3 different viral kinetics patterns among the patients with AHB: the clearance of HBV DNA preceded hepatitis B e antigen (HBeAg) and hepatitis B surface antigen (HBsAg), the clearance of HBeAg preceded HBV DNA and HBsAg, the clearance of HBsAg preceded HBV DNA and HBeAg.In the absence of HBV DNA clearance within 13 weeks, the risk of development of chronic HBV infection increased. The serologic HBV markers clearance occurred between 24 and 44 weeks (6-11 months) from the onset in 8 of the AHB patients, which was longer than 6 months. Thus, AHB may be redefined as HBV DNA undetectable, HBsAg and HBeAg seroconversion within 44 weeks.
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Tasneem AA, Luck NH. Acute-On-Chronic Liver Failure: Causes, Clinical Characteristics and Predictors of Mortality. J Coll Physicians Surg Pak 2017; 27:8-12. [PMID: 28292360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the causes, characteristics and predictors of mortality in patients with acute-on-chronic liver failure (ACLF). STUDY DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from July 2014 to June 2016. METHODOLOGY All patients with acute-on-chronic liver disease (ACLD) with ages > 12 were included. Patients with ACLF, as defined by the Asian Pacific Association for the Study of Liver (APASL, 2014) were identified. Predictors of mortality were identified using chi-square or Fisher's exact test. RESULTS Included in the study were 72 patients with mean age of 36.71 years, 46 (63.9%) being males. Among them, 61 developed ACLF. Commonest causes of chronic liver disease (CLD) were chronic viral hepatitis (37, 51.4%) and autoimmune hepatitis (14, 19.4%). Commonest causes of acute liver injury (ALI) were acute viral hepatitis (24, 33.3%) and drug induced liver injury (DILI) (17, 23.6%). Among those with ACLF, 24 (39.3%) patients died with median survival of 17.1 ±13.5 days. Mortality was significantly associated with Child Turcotte Pugh (CTP) score ≥13 (p=0.010), model for end-stage liver disease (MELD) score ≥30 (p=0.001), age >40 years (p=0.036), organ failures (OF) ≥3 (p <0.0001), portosystemic encephalopathy (PSE) (p <0.0001), renal failure (p <0.0001) and urosepsis (p <0.0001). CONCLUSION Acute viral hepatitis and DILI are commonest causes of ACLF. Mortality is high in ACLF patients having OF ≥3, CTP ≥13, MELD ≥30, age >40 years, PSE, renal failure and urosepsis.
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Affiliation(s)
- Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi
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Ohkoshi S, Hirono H, Watanabe K, Hasegawa K, Kamimura K, Yano M. Natural regression of fibrosis in chronic hepatitis B. World J Gastroenterol 2016; 22:5459-5466. [PMID: 27350724 PMCID: PMC4917606 DOI: 10.3748/wjg.v22.i24.5459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/20/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
The fibrosis of liver cirrhosis was considered to be irreversible before the anti-viral drugs showed that it is reversible when they lead to continuous suppression of viral replication and inflammation. However, several reports previously showed that fibrosis of type B liver cirrhosis was almost completely absorbed after the natural remission of chronic inflammation. This phenomenon might not be limited to exceptional patients, but rather occur commonly, considering the dynamic clinical features of chronic hepatitis B (CHB), where inactive carrier stage normally follows aggravation of hepatitis and progression of fibrosis at the time of HBeAg seroconversion. Thus, fibrosis levels of CHB as a hepatocellular carcinoma (HCC)-surveillance marker, particularly those of the inactive stage, could be underestimated, because some of them might have been (pre)cirrhotic in the past and recovered with the natural regression of fibrosis. We argue that cirrhosis-induced HCC mechanisms, rather than direct action of viral genome, may be more common than generally considered in CHB patients. This may have some impact on reconsidering the surveillance rationale for HCC in CHB, from where advanced HCCs tended to be missed. In addition, a molecular marker to assess the cancer-prone characteristics of the liver will definitely be needed to resolve the issue.
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Chan HLY, Shaikh J, Gupta S, Hamed K. Renal Function in Nucleos(t)ide Analog-Treated Patients With Chronic Hepatitis B: A Systematic Literature Review and Network Meta-Analysis. Adv Ther 2016; 33:862-75. [PMID: 27146675 PMCID: PMC4882346 DOI: 10.1007/s12325-016-0337-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Renal safety is an important factor in selecting the most appropriate nucleos(t)ide analog (NA) treatment for patients with chronic hepatitis B (CHB). This systematic literature review and network meta-analysis aimed to assess renal function associated with telbivudine treatment compared to other NAs in patients with CHB. METHODS A systematic literature search via Medline, Medline In-Process, Embase, and the Cochrane library for publications of randomized controlled trials and observational studies was conducted. Network meta-analysis was performed to compare renal function with telbivudine treatment versus other NAs after 1 year of therapy. RESULTS Overall, 40 (six randomized controlled and 34 observational) studies were included for review. Telbivudine consistently showed an improvement in renal function as measured by an estimated glomerular filtration rate (eGFR) over various time points regardless of the method of measurement. Changes in eGFR (mL/min) from baseline and corresponding 95% credible intervals with various NAs were as follows: monotherapies (telbivudine: 7.78 [6.91, 8.65], entecavir: -1.07 [-4.80, 2.62], lamivudine: -6.08 [-13.35, 1.15], tenofovir: -9.53 [-14.31, -4.89]) and combination therapies (telbivudine + adefovir: 8.37 [-34.00, 50.34], telbivudine + tenofovir: 8.29 [-0.05, 16.64], entecavir + adefovir: 4.15 [-38.55, 46.37], telbivudine + lamivudine: 0.51 [-11.77, 12.96], and lamivudine + adefovir: -0.39 [-42.48, 41.21]). At 1 year, the change in eGFR from baseline was significantly higher with telbivudine compared to other NAs. CONCLUSION The systematic literature review and network meta-analysis provide evidence that telbivudine is associated with significant improvement in renal function in patients with CHB, either alone or in combination with other NAs. FUNDING Novartis Pharma AG.
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Affiliation(s)
- Henry L Y Chan
- Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
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Chou SL, Chou MY, Wang YH, Kuo FC, Kao WF. The impact of chronic carrier of hepatitis B virus on liver function in a 7-day ultramarathon race. J Chin Med Assoc 2016; 79:179-84. [PMID: 26809857 DOI: 10.1016/j.jcma.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Several changes in physiological characteristics occur during long-distance and 24-hour ultramarathons, including hyponatremia, skeletal muscle breakdown, plasma volume changes, iron depletion, anemia, and possible hepatic damage. The purpose of this study was to investigate the impact of hepatitis B virus (HBV) carrier status on liver function during multi-day races. METHODS This prospective study recruited 10 Taiwanese runners who were scheduled to participate in the 7-day 2008 Athens Ultramarathon Festival Race, and three of them were chronic carriers of HBV. Blood samples were collected before, during, and 3 days after the race, including alkaline phosphatase (ALP), albumin (ALB), total protein (TP) levels, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (T-BIL) RESULTS: Ten Taiwanese runners (40% female; average age 52.3 ± 7.9 years) who all planned to run in the race were recruited. Three runners were chronic carriers of HBV (HBV carrier), and all participants were anti-HCV antibody-negative and anti-hepatitis A virus (HAV) IgG-positive. There were no significant time-by-group effects on ALP, ALB, and TP levels, but the change over time effects were significant (p < 0.001, p = 0.001 and p = 0.010, respectively). ALT, AST, and T-BIL increased significantly to markedly higher levels in the HBV carrier group compared to the non-carrier group (group effect p = 0.009, p = 0.004, and p = 0.05, respectively), and the time-by-group interaction was also significant for these liver function markers (p < 0.001, p < 0.001, and p = 0.001, respectively). CONCLUSION Compared to their counterparts, runners who are HBV carriers had significantly greater increases in levels of ALT, AST, and T-BIL during a 7-day ultramarathon, indicating that the liver function of carriers is more highly impacted in these races.
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Affiliation(s)
- Shang-Lin Chou
- Department of Emergency Medicine, Fooyin University Hospital, Pingtung, Taiwan, ROC
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Hsuan Wang
- Department of Nursing, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Fon-Chu Kuo
- Department of Computer Science and Information Management, Soochow University, Taipei, Taiwan, ROC
| | - Wei-Fong Kao
- Department of Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
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Shaukat AA, Zar A, Zuhaid M, Afridi SS. Correlation Of Deviance In Arterial Oxygenation With Severity Of Chronic Liver Disease. J Ayub Med Coll Abbottabad 2016; 28:331-336. [PMID: 28718564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Hepatitis B and C related chronic liver diseases have led to development of a serious threat to the people of South Asia. The main aim of this study was to evaluate the correlation of magnitude of arterial deoxygention to the severity of liver disease. METHODS It was a hospital based cross-sectional descriptive study, carried out in the Medical Department of Khyber Teaching Hospital Peshawar. All in all 115 patients were assessed for the severity of the liver diseases and were correlated with arterial deoxygenation using linear regression models. RESULTS Male to female ratio was 1.5:1. Males infected with hepatitis B, hepatitis C and both were 9, 60 and 1, while females suffered from hepatitis B, Hepatitis C and both were 2, 42 and 1 respectively. The linear relationship between A-a DO2 with severity of liver disease showed positive correlation while PO2 showed negative correlation with severity of liver disease. CONCLUSIONS There was a positive correlation between A-a DO2 and severity of liver diseases while PO2 and severity of liver diseases showed negative correlation.
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Affiliation(s)
- Al-Aman Shaukat
- Department of Medicine, Rehman Medical Institute, Peshawar, Pakistan
| | - Adnan Zar
- Department of Medicine, Rehman Medical Institute, Peshawar, Pakistan
| | - Muhammad Zuhaid
- Department of Medicine, Rehman Medical Institute, Peshawar, Pakistan
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Tsai MC, Chen CH, Tseng PL, Hung CH, Chiu KW, Chang KC, Yen YH, Lin MT, Hu TH. Does Nucleos(t)ide Analogues Treatment Affect Renal Function in Chronic Hepatitis B Patients Who Have Already Decreased eGFR? A Longitudinal Study. PLoS One 2016; 11:e0149761. [PMID: 26964034 PMCID: PMC4786133 DOI: 10.1371/journal.pone.0149761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/04/2016] [Indexed: 01/10/2023] Open
Abstract
This study aimed to assess the renal function in chronic hepatitis B (CHB) patients who received nucleos(t)ide analogues (NAs) therapy using estimated glomerular filtration rate (eGFR) titer. We performed a longitudinal observational study of 37 tenofovir-, 42 telbivudine-, and 62 entecavir-naïve CHB patients, who had impaired renal function (eGFR, 90-30 ml/min/1.73m2) without history of diabetes, hypertension, and chemotherapy. Calculation and evaluation of eGFR was performed with the Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration, and Cockcroft-Gault formula at pretreatment, at baseline, and after the 1st and 2nd year of treatment. The eGFR was significantly increased in patients given telbivudine or entecavir (p = 0.003 and p = 0.012, respectively), but the eGFR was decreased in patients given tenofovir (p = 0.001) after 2 years of treatment. Of all patients, eGFR was stable one year prior to treatment. If we analyzed the renal function by change of chronic kidney disease (CKD) category with a change of 25% of eGFR, the proportion of uncertain drop (drop in CKD category with <25% decrease in eGFR) and certain drop (drop in CKD category with ≧25% decrease in eGFR) in tenofovir group was smaller (5.4%) than those of telbivudine (12.9%) or entecavir (6.5%). Furthermore, telbivudine had the lowest stable rate (76.2%), the highest certain rise rate (9.5%), and certain drop rate (7.1%) compared to the other groups (p = 0.049). In conclusion, in NAs-naïve CHB patients with impaired renal function, telbivudine and entecavir resulted in a significant increase in eGFR while tenofovir resulted in a significant decrease after a 2-year treatment. Interestingly, TDF had the lowest proportion of patients reclassified to certain and uncertain drop groups; in contrast, LdT had a higher proportion in both raise and drop groups. The outcomes of this renal effect remain to be determined.
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Affiliation(s)
- Ming-Chao Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Lin Tseng
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - King-Wah Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chin Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hao Yen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Tsung Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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Bunchorntavakul C, Taweewattanakitbavorn V, Atsawarungruangkit A. Bone Mineral Density and Renal Function in Chronic Hepatitis B Patients Receiving Nucleotide versus Nucleoside Analogs: A Pilot Prospective Study. J Med Assoc Thai 2016; 99 Suppl 2:S1-S8. [PMID: 27266210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The use of nucleotide analogs (NTAs) can be associated with negative effects on renal function and bone mineral density (BMD) due to proximal tubular dysfunction and hypophosphatemia; however, prospective data assessing the bone and renal safety of these agents are limited. OBJECTIVE This study aimed to evaluate the prevalence of bone diseases among chronic hepatitis B (CHB) patients without cirrhosis and the changes in BMD and glomerular filtration rate (GFR) between patients receiving NTAs versus nucleoside analogs (NSAs). MATERIAL AND METHOD We prospectively collected data from non-cirrhotic CHB patients who had been treated for < 1 year in Rajavithi Hospital (Bangkok, Thailand) between 2012 and 2014. Patients with significant comorbidities or those being treated for bone diseases were excluded. BMD assessment was performed at the lumbar spine (LS) and femoral neck (FN). BMD T-scores were used to define osteopenia (-2.5 to -1) and osteoporosis (< -2.5), and the GFR was estimated using the Cockcroft-Gault method. RESULTS Twenty patients were included: 65% were men; 40% were HBeAg positive; and the median age was 42.7 (25.6-64.2) years. Ten patients had been treated with NTAs (7 with tenofovir 3 with adefovir) and 10 patients had been treated with NSAs (8 with lamivudine, 2 with entecavir), with a median follow-up period of 1.5 years (1.2-1.6). At baseline, the overall prevalence of osteopenia was 45% and the median GFR was 94 (51-144) mL/min. BMD in CHB patients was slightly lower than in an age-matched population based on Z-scores. Changes in LS-BMD and FN-BMD were not significantly different between groups. The annual reduction in GFR was more pronounced in the NTA group (-7.4% vs. -1.39%, p = 0.018). CONCLUSION Osteopenia is common in CHB patients without cirrhosis. Changes in BMD were not significantly different between groups. The annual reduction in GFR was more pronounced in the NTA group.
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Dudanova OP, Shubina ME, Belavina IA, Elpaeva EA, Pisareva MM, Grudinin MP, Kiselev OI. CHRONIC HEPATITIS WITH DOUBLE B/C INFECTION: VIROLOGICAL, CLINICAL, MORPHOLOGICAL CHARACTERISTICS. Klin Med (Mosk) 2016; 94:289-294. [PMID: 28957609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To estimate the r, virological and clinical characteristics of chronic viral hepatitis (CVH) with double B/C infection. MATERIALS AND METHODS We examined 282 patients with CVH. Genomes of hepatitis B virus (HBV) and hepatitis C virus (HCV) were studied by PCR in blood and liver (AmpliSens HBV and Amplisens HCV Russia), nuclear proteins (HBcorAg HBV and NS3 HCV) were determined by immunohistochemical method (Novocastra, UK), HBVgenome was sequenced by the Sanger method using ABI prism BigDye Terminator v3.1 kits and ABIPRISM 3100 analyzer (AppliedBiosystems, USA). Indices of histological activity (HAI), fibrosis, and portal vein (PV) congestion index (CI) were calculated by formula CI=SBB/LB V where S is P V cross section area in cm2 and LB V - linear blood flow velocity in cm/s (Vivid Pro- 7 apparatus, USA). RESULTS CVH with double B/C infection was diagnosed in 85 (30.1%) patients including 44.7% with viral genomes and proteins in the live; 42.4% with HCVviremia, and 12.9% with HBJV/HCVviremia. Maximum CVH activity was documented in patients with latent HBV/HCVviremia (ALT 157.2±59.2 U/, HAI 11.6±1.3,fibrosis 2.8±0.7, C1 0.059±0.005); it was minimal inpatients.without viremia (Alt 76.25±63.0 U/I, HAI 6.7+-0.6,fibrosis 1.7±0.5, CI 0.042±0.001;p <0.05). Patients with latent HBV infection had precore/ore and pres/s mutations in HBVgenome and cytoplasmic localization ofHBcorAg. CONCLUSION Double B/C infection was diagnosed in 30.1% of the patients with CVH dominated by HCV Patients with latent HBVhadprecore/ore and pres/s mutations. The highest intensity of hepatic cellular inflamation,fibrosis, and PV congestion was associated with HBV/HCV viremia and the lowest with intrahepatic localization of both viruses.
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Zampino R, Coppola N, Cirillo G, Boemio A, Grandone A, Stanzione M, Capoluongo N, Marrone A, Macera M, Sagnelli E, Adinolfi LE, del Giudice EM. Patatin-Like Phospholipase Domain-Containing 3 I148M Variant Is Associated with Liver Steatosis and Fat Distribution in Chronic Hepatitis B. Dig Dis Sci 2015; 60:3005-10. [PMID: 25986529 DOI: 10.1007/s10620-015-3716-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/10/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The patatin-like phospholipase domain-containing 3 gene (PNPLA3) has been associated with liver steatosis and disease progression in nonalcoholic steatohepatitis and chronic hepatitis C. AIMS The aim of the present study was to evaluate the influence of the PNPLA3 I148M polymorphisms on the clinical, histological, viral, and host parameters in Italian patients with chronic hepatitis B (CHB). METHODS Ninety-nine patients with CHB entered the study and underwent a clinical, histological, virological, and biochemical evaluation. PNPLA3 (p.I148M) variants were genotyped. RESULTS PNPLA3 rare variant (148M) was significantly associated with liver steatosis (p = 0.0019) and cholesterol (p = 0.04) levels, but not with fibrosis or histological activity index. The 13 patients with severe liver steatosis (score > 3) (38%) were more frequently homozygous for PNPLA3 148M variant than the 86 without (6%, p = 0.003). At logistic regression analysis, severe steatosis was independently associated with the rare allele (p = 0.001) and waist circumference, but not with body mass index (BMI). CONCLUSIONS In our CHB patients, the PNPLA3 polymorphisms influenced the development of liver steatosis, but not fibrosis status. The association of PNPLA3 p.I148M with liver steatosis increased with the greater amount of abdominal fat, irrespective of BMI.
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Affiliation(s)
- Rosa Zampino
- Internal Medicine and Hepatology, Second University of Naples, Via Pansini, 5-Edificio 3, 80131, Naples, Italy.
| | - Nicola Coppola
- Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Grazia Cirillo
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Adriana Boemio
- Internal Medicine and Hepatology, Second University of Naples, Via Pansini, 5-Edificio 3, 80131, Naples, Italy
| | - Anna Grandone
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Maria Stanzione
- Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Nicolina Capoluongo
- Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Aldo Marrone
- Internal Medicine and Hepatology, Second University of Naples, Via Pansini, 5-Edificio 3, 80131, Naples, Italy
| | - Margherita Macera
- Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Evangelista Sagnelli
- Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Luigi Elio Adinolfi
- Internal Medicine and Hepatology, Second University of Naples, Via Pansini, 5-Edificio 3, 80131, Naples, Italy
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Gu J, Sun R, Shen S, Yu Z. The curative effect of adefovir dipivoxil treating HBeAg negative chronic hepatitis B and treating HBeAg positive chronic hepatitis B combining interferon α-2b. Pak J Pharm Sci 2015; 28:1493-1497. [PMID: 26431662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aimed to research the efficiency of adefovir dipivoxil in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B treatment and in combination with α-2b interferon in the treatment of HBeAg-positive chronic hepatitis B. A total of 102 cases of adult patients with HBeAg chronic hepatitis B were selected for testing. HBeAg negative chronic hepatitis B patients took 10mg adefovir dipivoxil capsules once daily, while positive chronic hepatitis B patients were randomly divided into either a treatment group or a control group. The treatment group was administrated with 10mg adefovir dipivoxil capsules, 1 time daily, and injected with 5 million U Recombinant Human Interferon α-2b through muscle every other day. The control group was treated with 10mg adefovir dipivoxil capsules, 1 time per day. We examined alanine aminotransferase (ALT) normalization and the Hepatitis B Virus (HBV)-DNA negative rate (undetectable rate), as well as, HBeAg / hepatitis B e antibody (HBeAb) sero-conversion rate to detect treatment effects. The results proved that after 6 months of medication therapy, the ALT normalization rate was 49.9% and the HBV-DNA negative conversion rate was 54.3%. 18 months into the treatment, showed an ALT normalization rate of 73.2%, while the HBV-DNA negative conversion rate grew to 76.8%. The use of adefovir dipivoxil treatment of the negative chronic HBV has a certain extent combined with α-2b Interferon therapy in treatment of HbeAg positive chronic hepatitis B. After a 48-week observation period, ALT normalization and HBV-DNA rate could not be measured, HBeAg/HBeAb sero-conversion rose higher, indicating that the treatment of the combined drugs is more efficient than taking adefovir dipivoxil by itself, and the data were comparable with the control group (P<0.05). Thus adefovir dipivoxil can greatly improve the restrain function to HBV-DNA and improve the immunity and control ability of the body, with obvious short-term effects, in combination with Interferon.
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Affiliation(s)
- Junsheng Gu
- Department of Infectious Diseases, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Ranran Sun
- Department of Infectious Diseases, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Shen Shen
- Department of Infectious Diseases, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Zujiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
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Xiong QF, Zhong YD, Hu ZL, Yang YF. Successful treatment of occult hepatitis B virus infection related membranous nephropathy after entecavir therapy. Acta Clin Belg 2015; 70:223-5. [PMID: 25510219 DOI: 10.1179/2295333714y.0000000108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We have reported a case of occult hepatitis B virus infection (OBI) associated membranous nephropathy (MN) with complete remission under an ongoing 3.5-year entecavir monotherapy. A 59-year-old man with a 3-year history of liver cirrhosis was introduced to our department because of oliguria, proteinuria and microscopic haematuria. He, with negative serum HBV surface antigen, was not detected HBV DNA in his serum. Renal biopsy was performed and was compatible with a diagnosis of hepatitis B virus-related membranous nephropathy (HBV-MN). The patient was prescribed diuretics and intravenous albumin, and his ascites and oedema remitted gradually. At the same time, entecavir 0.5 mg per day was started. Entecavir treatment was continuing for 3.5 years and finally resulted in complete remission of proteinuria. This suggests that entecavir monotherapy may induce and maintain complete remission of MN associated with OBI.
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Li HM, Ye ZH, Zhang J, Gao X, Chen YM, Yao X, Gu JX, Zhan L, Ji Y, Xu JL, Zeng YH, Yang F, Xiao L, Sheng GG, Xin W, Long Q, Zhu QJ, Shi ZH, Ruan LG, Yang JY, Li CC, Wu HB, Chen SD, Luo XL. Clinical trial with traditional Chinese medicine intervention ''tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment'' for chronic hepatitis B-associated liver failure. World J Gastroenterol 2014; 20:18458-18465. [PMID: 25561817 PMCID: PMC4277987 DOI: 10.3748/wjg.v20.i48.18458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 07/03/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the clinical efficacy of traditional Chinese medicine (TCM) intervention “tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment” (“TTK”) for treating liver failure due to chronic hepatitis B.
METHODS: We designed the study as a randomized controlled clinical trial. Registration number of Chinese Clinical Trial Registry is ChiCTR-TRC-12002961. A total of 144 patients with liver failure due to infection with chronic hepatitis B virus were enrolled in this randomized controlled clinical study. Participants were randomly assigned to the following three groups: (1) a modern medicine control group (MMC group, 36 patients); (2) a “tonifying qi and detoxification” (“TQD”) group (72 patients); and (3) a “tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment” (“TTK”) group (36 patients). Patients in the MMC group received general internal medicine treatment; patients in the “TQD” group were given a TCM formula “tonifying qi and detoxification” and general internal medicine treatment; patients in the “TTK” group were given a TCM formula of “TTK” and general internal medicine treatment. All participants were treated for 8 wk and then followed at 48 wk following their final treatment. The primary efficacy end point was the patient fatality rate in each group. Measurements of various virological and biochemical indicators served as secondary endpoints. The one-way analysis of variance and the t-test were used to compare patient outcomes in the different treatment groups.
RESULTS: At the 48-wk post-treatment time point, the patient fatality rates in the MMC, “TQD”, and “TTK” groups were 51.61%, 35.38%, and 16.67%, respectively, and the differences between groups were statistically significant (P < 0.05). However, there were no significant differences in the levels of hepatitis B virus DNA or prothrombin activity among the three groups (P > 0.05). Patients in the “TTK” group had significantly higher levels of serum total bilirubin compared to MMC subjects (339.40 μmol/L ± 270.09 μmol/L vs 176.13 μmol/L ± 185.70 μmol/L, P = 0.014). Serum albumin levels were significantly increased in both the “TQD” group and “TTK” group as compared with the MMC group (31.30 g/L ± 4.77 g/L, 30.72 g/L ± 2.89 g/L vs 28.57 g/L ± 4.56 g/L, P < 0.05). There were no significant differences in levels of alanine transaminase among the three groups (P > 0.05). Safety data showed that there was one case of stomachache in the “TQD” group and one case of gastrointestinal side effect in the “TTK” group.
CONCLUSION: Treatment with “TTK” improved the survival rates of patients with liver failure due to chronic hepatitis B. Additionally, liver tissue was regenerated and liver function was restored.
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Philips CA, Sarin SK. Potent antiviral therapy improves survival in acute on chronic liver failure due to hepatitis B virus reactivation. World J Gastroenterol 2014; 20:16037-16052. [PMID: 25473156 PMCID: PMC4239490 DOI: 10.3748/wjg.v20.i43.16037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/02/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
Acute on chronic liver failure (ACLF) is a disease entity with a high mortality rate. The acute event arises from drugs and toxins, viral infections, bacterial sepsis, interventions (both surgical and non-surgical) and vascular events on top of a known or occult chronic liver disease. ACLF secondary to reactivation of chronic hepatitis B virus is a distinct condition; the high mortality of which can be managed in the wake of new potent antiviral therapy. For example, lamivudine and entecavir use has shown definite short-term survival benefits, even though drug resistance is a concern in the former. The renoprotective effects of telbivudine have been shown in a few studies to be useful in the presence of renal dysfunction. Monotherapy with newer agents such as tenofovir and a combination of nucleos(t)ides is promising for improving survival in this special group of liver disease patients. This review describes the current status of potent antiviral therapy in patient with acute on chronic liver failure due to reactivation of chronic hepatitis B, thereby providing an algorithm in management of such patients.
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Lv B, Zhao H, Bai X, Huang S, Fan Z, Lu J, Tang R, Yin K, Gao P, Liu B, Cheng J. Entecavir promotes CD34⁺ stem cell proliferation in the peripheral blood and liver of chronic hepatitis B and liver cirrhosis patients. Discov Med 2014; 18:227-236. [PMID: 25425463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Entecavir (ETV) has been used for more than 2 decades in treating hepatitis B virus (HBV) infections. It has shown significant anti-HBV effect and has led to histological improvement in the liver of chronic hepatitis B (CHB) patients. In patients treated with ETV for over two years, reversal of cirrhosis to normal tissue has also been observed. However, the mechanisms of these tissue repairing or recovery processes are not yet clear. In order to determine the roles that bone marrow and liver stem/progenitor cells play in these processes, we evaluated the CD34⁺ and CD133⁺ stem/progenitor cells in peripheral blood from 292 patients and liver tissues from 43 patients who had received therapies with and without ETV. A significant increase in both CD34⁺ and CD133⁺ cells was found in CHB and cirrhosis patients compared to the healthy controls. In patients treated with ETV, CD34⁺ cells increased 2 and 4 fold in peripheral blood and liver tissues, respectively, while their CD4⁺ and CD8⁺ cells remained the same. On the other hand, CD133⁺ cells did not change or even slightly decreased with ETV treatment. Results from immunohistochemistry staining, real time RT-PCR, and the enzyme-linked immunosorbent assay also revealed the same level of CD34⁺ cell increase and CD133⁺ cell decrease (or no change) in ETV treated patients, compared to patients without ETV therapies. Liver functions in patients with ETV treatment improved in general, but one liver cirrhosis patient with high expression of CD133 in liver tissue developed hepatocellular carcinoma (HCC). In summary, ETV may have differential effects on various stem cell subtypes. ETV-activated stem cells in bone marrow and liver tissues may contribute to the recovery from injuries caused by HBV infection. They also contribute to the regeneration of normal tissue and the recovery of normal liver function. Meanwhile, ETV does not activate stem cells that may participate in the initiation of HCC.
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MESH Headings
- AC133 Antigen
- Adolescent
- Adult
- Aged
- Antigens, CD/metabolism
- Antigens, CD34/blood
- Antigens, CD34/genetics
- Antigens, CD34/metabolism
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- Cell Count
- Cell Proliferation/drug effects
- Down-Regulation/drug effects
- Enzyme-Linked Immunosorbent Assay
- Female
- Flow Cytometry
- Glycoproteins/metabolism
- Guanine/analogs & derivatives
- Guanine/pharmacology
- Hepatitis B, Chronic/blood
- Hepatitis B, Chronic/immunology
- Hepatitis B, Chronic/pathology
- Hepatitis B, Chronic/physiopathology
- Humans
- Immunohistochemistry
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/metabolism
- Liver/drug effects
- Liver/pathology
- Liver/physiopathology
- Liver Cirrhosis/blood
- Liver Cirrhosis/immunology
- Liver Cirrhosis/pathology
- Liver Cirrhosis/physiopathology
- Liver Function Tests
- Male
- Middle Aged
- Peptides/metabolism
- Stem Cells/cytology
- Stem Cells/drug effects
- Up-Regulation/drug effects
- Young Adult
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Affiliation(s)
- Bei Lv
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hong Zhao
- Department of Gastroenterology, Wenzhou Medical College, Wenzhou, China
| | - Xue Bai
- Department of Gastroenterology, Jiamusi Medical College, Jiamusi University, Jiamusi, China
| | - Shaoping Huang
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhenyu Fan
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jihua Lu
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Rong Tang
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Keshan Yin
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Peter Gao
- Division of Metabolism and Health Effects, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD 20852, USA
| | - Baoling Liu
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jilin Cheng
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Feng C, Wu B, Fan H, Li C, Meng S. [NF-kappaB-induced gp96 up-regulation promotes hepatocyte growth, cell cycle progression and transition]. Wei Sheng Wu Xue Bao 2014; 54:1212-1220. [PMID: 25803899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the mechanism of gp96 raised during hepatitis B virus (HBV) infection and the pathological mechanism. METHODS The mechanism of NF-KB activating gp96 expression was determined by bioinformatics analysis, luciferase reporter assay, real-time PCR and Western blot. The effect of over-expression and knockdown gp96 expression by transfection or RNA interference on hepatocyte proliferation, apoptosis and cell cycle was examined by CCK-8 and flow cytometry. The role of gp96 for HCC development was determined by epithelial-mesenchymal transition (EMT) and colony formation assay. RESULTS NF-kB significantly increased the gp96 expression by binding to the NF-kappaB binding site. Over-expression and knockdown studies both show that gp96 promoted hepatocyte proliferation, inhibited apoptosis, and induced G0/G1 to S phase cell cycle progression. Moreover, gp96 induced epithelial-mesenchymal transition and increased colony formation ability of hepatocytes. CONCLUSION Our results therefore provide insights in chronic HBV infection-induced gp96 expression, and indicate that elevated gp96 may contribute to HCC development during chronic inflammation.
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Tangpradabkiet W, Praneenararat S, Chamroonkul N, Witeerungrot T, Piratvisuth T. Influence of meal intake on liver stiffness in patients with chronic hepatitis B and C. J Med Assoc Thai 2014; 97:1033-1039. [PMID: 25632619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Transient elastography (TE) is a non-invasive test for evaluation of fibrosis in chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Meal intake has been found to affect liver stiffness (LS) values in CHC patients, but there is still lack of data in CHB patients. OBJECTIVE Evaluate the influence of meal intake on LS values by TE in non-cirrhotic CHB patients and compare its effect with non-cirrhotic CHC patients. MATERIAL AND METHOD Forty-five CHB patients and 37 CHC patients were included LS measurements by TE were done at three different times including 4-hour fasting immediately, and 60 minutes after finishing 500 kcal meal. RESULTS Mean fasting LS values in CHB patients were 5.40--1.7 kPa. LS values in CHB patients significantly increased at both immediately and 60 minutes after finishing meal by 0.31?0.1 kPa (p = 0.035) and 0.33 +/- 0.1 kPa (p = 0.018), respectively Difference in the peak changes of LS values after meal were not significant between CHB and CHC patients (CHB 0.72 +/- 0.1 vs. CHC 1.16 +/- 0.1, p = 0.076). No other variables associated with the changes ofLS values after meal in either CHB patients or CHC patients. CONCLUSION Meal intake significantly increases LS values in CHB and CHC patients. It was considered to be a confounding factor in LS measurements. An appropriate time offasting should be done before LS measurement in both CHB and CHC patients.
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Liu Y, Fan R, Chen J, Zheng Z, Liao B, Liang X, Yin J, Zhou Q, Sun J. [Assessment of renal function and risk factors for renal impairment in patients with hepatitis B virus-related liver cirrhosis]. Nan Fang Yi Ke Da Xue Xue Bao 2014; 34:472-476. [PMID: 24752090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the renal function in treatment-naive patients with hepatitis B virus (HBV) related cirrhosis and to identify the risk factors for renal impairment. METHODS We collected the data of 860 HBV-related cirrhosis patients hospitalized in our unit between Jan 1, 2011 and Dec 31, 2011. Liver function of the patients was assessed with Child-Pugh score system, and the renal function with estimated glomerular filtration rate (eGFR) calculated by Modification of Diet in Renal Disease (MDRD) equation recommended by Kidney Disease Outcomes Quality Initiative (K/DOQI). We investigated the prevalence of renal impairment (eGFR>60 ml/min/1.73 m(2)) among these patients and explored the risk factors for renal impairment. RESULTS Of the 860 patients, 296 had complete clinical data and were included in our analysis. The overall incidence of renal impairment among the enrolled patients was 8.45% (25/296). Patients with Child-Pugh stage C showed a significantly higher incidence of renal impairment than those with stages B and A (17.17% [17/99] vs 6.67%[7/105] vs 1.09% [1/92], P<0.001). Age, history of hyperuricemia, and Child-Pugh score were identified as the risk factors for renal impairment in these patients. CONCLUSION In patients with HBV-related liver cirrhosis, the incidence of renal impairment increases significantly with deterioration of the liver function, and renal function should be regularly monitored in these patients for appropriate antiviral treatment.
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Affiliation(s)
- Ying Liu
- Hepatology Center and Department of Infectious Disease, Southern Medical University, Guangzhou 510515, China.E-mail:
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Fiorino S, Bacchi-Reggiani L, Pontoriero L, Gallo C, Chili E, Masetti M, Zanini N, Grondona A, Silvestri T, Deleonardi G, Fornelli A, Bondi A, de Biase D, Baccarini P, Tallini G, Tropeano A, Quartuccio V, Cuppini A, Castellani G, Jovine E. Tensegrity model hypothesis: may this paradigm be useful to explain hepatic and pancreatic carcinogenesis in patients with persistent hepatitis B or hepatitis C virus infection? JOP 2014. [PMID: 24618442 DOI: 10.6092/1590-8577%2f2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Hepatitis B (HBV) and hepatitis C virus (HCV) possess well-known oncogenic properties and may promote carcinogenesis in liver. However antigens and replicative sequences of HBV/HCV have been also detected in different extra-hepatic tissues, including the pancreas. Although epidemiological studies and meta-analyses have recently suggested that HBV/HCV may be also risk factors for pancreatic cancer and several researches have investigated the possible mechanisms and intra-/extra-cellular paths involved in pancreatic and hepatic carcinogenesis, to date, these complex processes remain largely unexplained. OBJECTIVES In our paper, we aimed to propose a comprehensive and qualitative hypothetical model, describing how HBV/HCV may exert their oncogenic role. METHODS We performed a systematic research of scientific literature, by searching MEDLINE, the Cochrane Library and EMBASE databases. The used keywords were: "chronic HBV/HCV", "pancreatic cancer", "liver carcinoma", "carcinogenesis mechanisms", "tensional integrity", "cytoskeleton", and "extracellular matrix". RESULTS Taking advantage from available studies, we suggest an unifying hypothesis based on results and data, obtained from different areas of research. In particular we considered the well-defined model of tensional integrity and correlated it to changes induced by HBV/HCV in viscoelastic properties/stiffness of cellular/extracellular microenvironments. These events perturb the tightly-regulated feedback loop, which usually couples the intracellular-generated forces to substrate rigidity of extracellular compartments. Therefore, such a change strongly affects intracellular functions and cellular fate, by promoting a substantial deregulation of critical intracellular biochemical activities and genome expression. CONCLUSIONS Our hypothesis might provide for the first time a reliable system, which correlates tensional integrity model with intra-/extra-cellular modifications, occurring in liver and pancreas during HBV/HCV-induced carcinogenesis. This approach might improve our understanding of pathogenetic mechanisms involved in the development of pancreatic and hepatic carcinogenesis , enhancing the possibility of their treatment. Furthermore, should the usefulness of this model be definitively confirmed, it might be also helpful to extend its field of application to other viruses-related cancers.
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Affiliation(s)
- Sirio Fiorino
- Unit of Internal Medicine, Hospital of Budrio. Budrio, BO, Italy.
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Hu X, Xu X, Zhang Q, Zhang H, Liu J, Qian L. Indirect prediction of liver fibrosis by quantitative measurement of spleen stiffness using the FibroScan system. J Ultrasound Med 2014; 33:73-81. [PMID: 24371101 DOI: 10.7863/ultra.33.1.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate quantitative measurement of spleen stiffness for indirect assessment of liver fibrosis in patients with chronic hepatitis B and to correlate spleen stiffness with liver stiffness using pathologic examination as a reference standard. METHODS Sixty patients with clinically confirmed chronic hepatitis B (n = 54) and liver cirrhosis (n = 6) were enrolled. Quantitative stiffness measurements (kilopascals) were obtained from spleen and liver parenchyma with the FibroScan system (Echosens, Paris, France). Correlation analyses were performed between spleen and liver stiffness and between spleen stiffness and liver fibrosis stages. The diagnostic performance of spleen stiffness for indirect prediction of liver fibrosis was estimated by receiver operating characteristic curves. RESULTS Both spleen and liver stiffness increased as liver fibrosis progressed. Spleen stiffness values had a positive correlation with liver stiffness values in all patients (Pearson r = 0.810; P < .001). The correlation between spleen stiffness and fibrosis stages was statistically significant (Spearman r = 0.833; P < .001). The areas under the receiver operating characteristic curves for spleen stiffness were 0.902 (95% confidence interval [CI], 0.825-0.978) for stage S1 (fibrous portal expansion and limited perisinusoidal or lobular fibrosis) or higher, 0.927 (95% CI, 0.852-1.0) for S2 (periportal fibrosis and few fibrous septa but intact architecture) or higher, 0.962 (95% CI, 0.918-1.0) for S3 (numerous fibrous septa with architectural distortion but no obvious cirrhosis) or higher, and 0.983 (95% CI, 0.957-1.0) for S4 (cirrhosis) (all P < .001). The differences between the areas under the curves for spleen and liver stiffness in liver fibrosis staging were not statistically significant (P = .115-.756). CONCLUSIONS Quantitative measurement of spleen stiffness is a feasible and promising technique for estimating liver fibrosis. The overall diagnostic performance of spleen stiffness for liver fibrosis staging is comparable with that of liver stiffness.
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Affiliation(s)
- Xiangdong Hu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Rd, 100050 Beijing China.
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Qian YS, Li L. [The therapeutic effects of pegasys in chronic hepatitis B patients with low-level ALT]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2013; 27:196-198. [PMID: 24319955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To observe the therapeutic effects of Pegasys (pegylated interferon alpha-2a) in chronic hepatitis B (CHB) patients with low-level alanine transaminase (ALT) < 2 x upper limit of normal (ULN). METHODS One hundred and seven CHB patients were randomized enrolled including 52 with ALT < 2 x ULN and liver tissues inflammation activity > or = G2 as observational group and 55 with ALT > 2 x ULN as control group. All the enrolled patients received pegasys treatment for 48 weeks and the responses between two groups were compared. Measurement data were analyzed using t test and numeration data were analyzed using chi square test. RESULTS The reductions of HBV DNA in observational group at different time points were all less than control group (all P < 0.05). At the end of treatment, the HBV DNA negative rate, HBeAg seroconversion rate and HBsAg loss rate in the observational group were 51.9%, 48.8% and 1.9% , respectively, which were all lower than control group (67.3% , 66.7% and 7. 3% , respectivley) ( all P <0. 05). The ALT normalization rates of two groups were 75% and 76.4% (P > 0. 05). CONCLUSION Pegasys is efficient for CHB patients with ALT < 2 x ULN and liver tissues inflammation activity > or = G2, while it is still inferior to those with ALT > 2 x ULN.
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Affiliation(s)
- Yun-Song Qian
- The Second Hospital of Zhejiang, Ningbo 315000, China
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Spearman CWN, Sonderup MW, Botha JF, van der Merwe SW, Song E, Kassianides C, Newton KA, Hairwadzi HN. South African guideline for the management of chronic hepatitis B: 2013. S Afr Med J 2013; 103:337-349. [PMID: 23967497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Hepatitis B remains a significant yet preventable health issue in South Africa. The introduction of the hepatitis B vaccine into the country some 18 years ago has demonstrated benefit, but the exposure to, and prevalence of chronic HBsAg positivity remain unacceptably high. Those with chronic hepatitis B virus infection have an elevated risk of developing cirrhosis with end-stage liver disease and a markedly elevated risk of hepatocellular carcinoma, independent of the presence of cirrhosis. The challenge in South Africa remains prevention through the universal vaccination coverage of all children and the identification of those with chronic hepatitis B virus infection. Over the last decade our understanding of hepatitis B and its behaviour and natural history in those with chronic infection has significantly improved. This understanding is key to identifying those who warrant further evaluation and therapy. A number of global societies have updated their guidelines in recent years. This document draws on these guidelines and serves to contextualise, for South Africa, practice guidelines for the management of chronic hepatitis B.
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Affiliation(s)
- C W N Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa.
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Xia L, Huang W, Tian D, Zhu H, Qi X, Chen Z, Zhang Y, Hu H, Fan D, Nie Y, Wu K. Overexpression of forkhead box C1 promotes tumor metastasis and indicates poor prognosis in hepatocellular carcinoma. Hepatology 2013; 57:610-24. [PMID: 22911555 DOI: 10.1002/hep.26029] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/09/2012] [Indexed: 02/05/2023]
Abstract
UNLABELLED Recurrence and metastasis remain the most common causes of lethal outcomes in hepatocellular carcinoma (HCC) after curative resection. Thus, it is critical to discover the mechanisms underlying HCC metastasis. Forkhead box C1 (FoxC1), a member of the Fox family of transcription factors, induces epithelial-mesenchymal transition (EMT) and promotes epithelial cell migration. However, the role of FoxC1 in the progression of HCC remains unknown. Here, we report that FoxC1 plays a critical role in HCC metastasis. FoxC1 expression was markedly higher in HCC tissues than in adjacent noncancerous tissues. HCC patients with positive FoxC1 expression had shorter overall survival times and higher recurrence rates than those with negative FoxC1 expression. FoxC1 expression was an independent, significant risk factor for recurrence and survival after curative resection. FoxC1 overexpression induced changes characteristic of EMT and an increase in HCC cell invasion and lung metastasis. However, FoxC1 knockdown inhibited these processes. FoxC1 transactivated Snai1 expression by directly binding to the Snai1 promoter, thereby leading to the inhibition of E-cadherin transcription. Knockdown of Snai1 expression significantly attenuated FoxC1-enhanced invasion and lung metastasis. FoxC1 expression was positively correlated with Snai1 expression, but inversely correlated with E-cadherin expression in human HCC tissues. Additionally, a complementary DNA microarray, serial deletion, site-directed mutagenesis, and a chromatin immunoprecipitation assay confirmed that neural precursor cell expressed, developmentally down-regulated 9 (NEDD9), which promotes the metastasis of HCC cells, is a direct transcriptional target of FoxC1 and is involved in FoxC1-mediated HCC invasion and metastasis. CONCLUSIONS FoxC1 may promote HCC metastasis through the induction of EMT and the up-regulation of NEDD9 expression. Thus, FoxC1 may be a candidate prognostic biomarker and a target for new therapies.
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Affiliation(s)
- Limin Xia
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
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Tanashchuk EL, Smitienko IO, Baĭkova TA. [Aortoarteritis in HBV-associated liver cirrhosis: diagnostics, therapeutic strategy, and prognosis]. Klin Med (Mosk) 2013; 91:68-72. [PMID: 24417072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A case of decompensated liver cirrhosis in a women with a long silent period of HBV infection is presented. The first manifestation was generalized vasculitis involving small and medium-size vessels and elastic-type arteries with the development of aortoarteritis. Proper interpretation of manifestations of viral liver cirrhosis allowed for immunosuppressive treatment in combination with effective antiviral drugs. As a result, aviremia, regression of vasculitis and portal hypertension along with considerable improvement of the prognosis were achieved.
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Studach LL, Menne S, Cairo S, Buendia MA, Hullinger RL, Lefrançois L, Merle P, Andrisani OM. Subset of Suz12/PRC2 target genes is activated during hepatitis B virus replication and liver carcinogenesis associated with HBV X protein. Hepatology 2012; 56:1240-51. [PMID: 22505317 PMCID: PMC3417088 DOI: 10.1002/hep.25781] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED Chronic hepatitis B virus (HBV) infection is a major risk factor for developing liver cancer, and the HBV X protein (pX) has been implicated as a cofactor in hepatocyte transformation. We have shown that HBV replication as well as in vitro transformation by pX are associated with induction of the mitotic polo-like kinase 1 (Plk1) and down-regulation of the chromatin remodeling components Suz12 and Znf198. Herein, we demonstrate the same inverse relationship between Plk1 and Suz12/Znf198 in liver tumors from X/c-myc bitransgenic mice and woodchuck hepatitis virus (WHV)-infected woodchucks. Employing these animal models and the HBV replicating HepAD38 cells we examined the effect of Suz12/Znf198 down-regulation on gene expression. Genes analyzed include hepatic cancer stem cell markers BAMBI, DKK1,2, DLK1, EpCAM, MYC, and proliferation genes CCNA1, CCND2, IGFII, MCM4-6, PLK1, RPA2, and TYMS. Suz12 occupancy at the promoters of BAMBI, CCND2, DKK2, DLK1, EpCAM, and IGFII was demonstrated by chromatin immunoprecipitation in untransformed hepatocytes, but was markedly reduced in pX-transformed and Suz12 knockdown cells. Accordingly, we refer to these genes as "Suz12 repressed" genes in untransformed hepatocytes. The Suz12 repressed genes and proliferation genes were induced in HBV-replicating HepAD38 cells and, interestingly, they exhibited distinct expression profiles during hepatocellular carcinoma (HCC) progression in X/c-myc bitransgenics. Specifically, CCND2, EpCAM, and IGFII expression was elevated at the proliferative and preneoplastic stages in X/c-myc bitransgenic livers, whereas BAMBI and PLK1 were overexpressed in hepatic tumors from X/c-myc bitransgenics and WHV-infected woodchucks. Importantly, most of these genes were selectively up-regulated in HBV-induced HCCs. CONCLUSION The distinct expression profile of the identified Suz12 repressed genes in combination with the proliferation genes hold promise as biomarkers for progression of chronic HBV infection to HCC.
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MESH Headings
- Animals
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/virology
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/pathology
- Cells, Cultured
- Disease Models, Animal
- Down-Regulation
- Gene Expression Regulation, Viral
- Hepatitis B virus/genetics
- Hepatitis B, Chronic/genetics
- Hepatitis B, Chronic/physiopathology
- Hepatocytes/pathology
- Liver Neoplasms/genetics
- Liver Neoplasms/virology
- Marmota
- Mice
- Mice, Transgenic
- Polycomb Repressive Complex 2/genetics
- Polycomb Repressive Complex 2/metabolism
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Random Allocation
- Sensitivity and Specificity
- Trans-Activators/genetics
- Trans-Activators/metabolism
- Transcriptional Activation
- Viral Regulatory and Accessory Proteins
- Virus Replication/genetics
- Polo-Like Kinase 1
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Affiliation(s)
- Leo L. Studach
- Department of Basic Medical Sciences and Purdue University Center for Cancer Research, West Lafayette, IN, USA
| | - Stephan Menne
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, USA
| | - Stefano Cairo
- XenTech, Research and Development Department, Genopole Campus 3 Evry, France
| | - Marie Annick Buendia
- Inserm U785 Unit, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Ronald L. Hullinger
- Department of Basic Medical Sciences and Purdue University Center for Cancer Research, West Lafayette, IN, USA
| | - Lydie Lefrançois
- Inserm U1052, Centre de Recherche en Cancérologie de Lyon, Hepatocarcinogenesis and Viral Infection, Lyon Cedex 03 France
| | - Philippe Merle
- Inserm U1052, Centre de Recherche en Cancérologie de Lyon, Hepatocarcinogenesis and Viral Infection, Lyon Cedex 03 France
| | - Ourania M. Andrisani
- Department of Basic Medical Sciences and Purdue University Center for Cancer Research, West Lafayette, IN, USA
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Zhu MF, Qian JC, Lu L, Yan FL, Shi JP, Lou GQ. [Three-year efficacy and side effect of adefovir dipivoxil for the treatment of the old patients with chronic hepatitis B virus infection]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2012; 26:379-381. [PMID: 23547463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate 3-year antiviral efficacy and side effect of adefovir dipivoxil (ADV) on the old patients with hepatitis B chronic infection. METHODS 31 HBeAg-negative chronic hepatitis B virus infected old patients (include 8 patients with chronic hepatitis B and 23 patients with liver cirrhosis) with serum HBV DNA levels > 1000 copies/ml, and ALT > 2 times the upper limit of normal, without company with other liver diseases, cancer, renal dysfunction, and autoimmune disease. All the patients were treated with ADV orally (10 mg once daily) for 36 months. HBV DNA and biochemical and blood routine indexes were checked after treated. RESULT Serum total bilirubin, direct bilirubin, alamine aminotransferase, aspartate aminotransferase and load of HBV DNA decrease significantly after therapy (P < 0. 001). Other biochemical indexs and blood routine are no significant changes (P > 0.05). CONCLUSION The way to treat with ADV is safe and effective for old patients with chronic hepatitis B virus infection.
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Affiliation(s)
- Meng-Fei Zhu
- Zhejiang Chinese Medical University, Hangzhou 310053, China
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50
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Chen K, Min H, Wu X, Zhu X, Li Z, Li H, Liu Y. JAK1 gene polymorphisms are associated with the outcomes of hepatitis B virus infection, but not with α interferon therapy response in a Han Chinese population. Genet Test Mol Biomarkers 2012; 16:1206-10. [PMID: 22901011 DOI: 10.1089/gtmb.2012.0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS Janus kinase 1 (JAK1) is a key member in the interferon (IFN) signaling pathway. Recent studies suggested single-nucleotide polymorphisms (SNPs) in IFN pathway genes are associated with outcomes of hepatitis B virus (HBV) infection and response to IFNα therapy. The aim of the study is to investigate whether SNPs in JAK1 were associated with outcomes of HBV infection and response to IFNα therapy. METHODS We enrolled 395 chronic hepatitis B (CHB) patients and 251 subjects with the inactive carrier state, and 256 CHB patients who received IFNα treatment, with therapy efficacy evaluated. Twelve SNPs: rs310227, rs7531799, rs7546545, rs17127174, rs3790541, rs10493373, rs2780898, rs310247, rs310196, rs2780895, rs4244165, and rs17127024 in JAK1, which could represent all SNPs with minor allele frequency >0.2 recorded in the HapMap database were genotyped using a polymerase chain reaction-restriction fragment length polymorphism protocol and the TaqMan method. RESULTS SNP rs17127024 was associated with outcomes of HBV infection in an allele frequency (p=0.014) and genotype distributions (p=0.031), while SNP rs4244165 was associated with outcomes of HBV infection only in genotype distributions (p=0.008). There were no significant differences in allele frequencies and genotype distributions of these SNPs between the response group and the nonresponse group to IFNα therapy. CONCLUSIONS SNPs rs4244165 and rs17127024 in JAK1 were associated with outcomes of HBV infection, but not with response to IFNα therapy.
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Affiliation(s)
- Kangmei Chen
- National Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, P.R. China
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