From bed to bench: which attitude towards the laboratory liver tests should health care practitioners strike?

There is a general consensus in re-interpreting the so-called liver function tests in the light of novel discoveries. At the same time, recent evidence favours the use of different laboratory data to assess liver damage, fibrosis or regenerative process, but this point is not always shared. Actually, balancing the need for diagnosis, prognostic evaluation and therapy response of liver disease with a good cost/benefit ratio is very difficult. New tests are probably not needed but the aim should be for better utilization of existing tests to contain the increasing cost of health care.

Phenotyping of CYP 4501A2 Activity by Total Overnight Salivary Caffeine Assessment (TOSCA) in Patients on Warfarin Treatment: A Cross-Sectional Study

Warfarin is an oral anticoagulant, commonly used for primary and secondary prevention of venous and arterial thromboembolic events. The drug is characterized by narrow therapeutic index, widespread individual variability in clinical response, and high rates of adverse events, particularly bleeding complications. For these reasons, a close monitoring of the dosage, using the frequent assessment of coagulation status by means of International Normalized Ratio value, is mandatory. Warfarin is metabolized by hepatic cytochrome P-450. High CYP 450 activity may lead to low drug concentration and requires high warfarin doses to reach efficacy; conversely, low CYP 450 activity is responsible for high drug concentration and needs for low doses to avoid potential toxicity risks. The major isoforms of CYP involved in the metabolism of warfarin sodium are CYP1A2 (for the R-warfarin) and CYP2C9 (for the S-warfarin). The probes for testing CYP1A2 are phenacetin and caffeine while for CYP2C9 tolbutamide. Although S-warfarin has major activity, it was decided to exclude its phenotyping for ethical issues, being mandatory to use a drug (tolbutamide). Instead, it was chosen to test the 1A2 isoform, as the activity of the latter isoform could be investigated by using caffeine contained in the caffeinated beverages. Specifically, a single-point concentration of salivary caffeine (total overnight salivary caffeine assessment [TOSCA]) after an overnight period of the caffeinated beverages abstinence was utilized. In the present study, 75 nonsmoker patients regularly receiving warfarin sodium were enrolled. The results have showed a significant association of the warfarin dose with TOSCA values (coefficient = -0.15, standard error = 0.04, 95% confidence interval = -0.24 to -0.06, t = -3.23, P = .002). In conclusion, the phenotyping of CYP1A2 by TOSCA could be useful, if further proven, to help manage patients on warfarin in order to lessen severe adverse events.

Corrigendum to "Circulating Levels of Sirtuin 4, a Potential Marker of Oxidative Metabolism, Related to Coronary Artery Disease in Obese Patients Suffering from NAFLD, with Normal or Slightly Increased Liver Enzymes"

[This corrects the article DOI: 10.1155/2014/920676.].

Could Adverse Effects of Antibiotics Due to Their Use/Misuse Be Linked to Some Mechanisms Related to Nonalcoholic Fatty Liver Disease?

Nonalcoholic fatty liver disease, recently re-named metabolic dysfunction-associated steatotic fatty liver disease, is considered the most prevalent liver disease worldwide. Its molecular initiation events are multiple and not always well-defined, comprising insulin resistance, chronic low-grade inflammation, gut dysbiosis, and mitochondrial dysfunction, all of them acting on genetic and epigenetic grounds. Nowadays, there is a growing public health threat, which is antibiotic excessive use and misuse. This widespread use of antibiotics not only in humans, but also in animals has led to the presence of residues in derived foods, such as milk and dairy products. Furthermore, antibiotics have been used for many decades to control certain bacterial diseases in high-value fruit and vegetables. Recently, it has been emphasised that antibiotic-induced changes in microbial composition reduce microbial diversity and alter the functional attributes of the microbiota. These antibiotic residues impact human gut flora, setting in motion a chain of events that leads straight to various metabolic alterations that can ultimately contribute to the onset and progression of NAFLD.

What are the common downstream molecular events between alcoholic and nonalcoholic fatty liver?

Liver fat storage, also called hepatic steatosis, is increasingly common and represents a very frequent diagnosis in the medical field. Excess fat is not without consequences. In fact, hepatic steatosis contributes to the progression toward liver fibrosis. There are two main types of fatty liver disease, alcoholic fatty liver disease (AFLD) and nonalcoholic fatty liver disease (NAFLD). Although AFLD and NAFLD are similar in their initial morphological features, both conditions involve the same evolutive forms. Moreover, there are various common mechanisms underlying both diseases, including alcoholic liver disease and NAFLD, which are commonalities. In this Review, the authors explore similar downstream signaling events involved in the onset and progression of the two entities but not completely different entities, predominantly focusing on the gut microbiome. Downstream molecular events, such as the roles of sirtuins, cytokeratins, adipokines and others, should be considered. Finally, to complete the feature, some new tendencies in the therapeutic approach are presented.

Crosstalk Between the Spleen and Other Organs/Systems: Downstream Signaling Events

The aim of this review was to gather pieces of information from available critically evaluated published articles concerning any interplay in which the spleen could be involved. For many years, the spleen has been alleged as an unnecessary biological structure, even though splenomegaly is an objective finding of many illnesses. Indeed, the previous opinion has been completely changed. In fact, the spleen is not a passive participant in or a simple bystander to a relationship that exists between the immune system and other organs. Recently, it has been evidenced in many preclinical and clinical studies that there are close associations between the spleen and other parts of the body, leading to various spleen–organ axes. Among them, the gut–spleen axis, the liver–spleen axis, the gut–spleen–skin axis, the brain–spleen axis, and the cardio-splenic axis are the most explored and present in the medical literature. Such recent sources of evidence have led to revolutionary new ideas being developed about the spleen. What is more, these observations may enable the identification of novel therapeutic strategies targeted at various current diseases. The time has come to make clear that the spleen is not a superfluous body part, while health system operators and physicians should pay more attention to this organ. Indeed, much work remains to be performed to assess further roles that this biological structure could play.

Sleep Quality Associated with the Onset of NAFLD: Suggested Hypotheses

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Could chronic opioid use be an additional risk of hepatic damage in patients with previous liver diseases, and what is the role of microbiome?

Among illicit drugs, addiction from opioids and synthetic opioids is soaring in an unparalleled manner with its unacceptable amount of deaths. Apart from these extreme consequences, the liver toxicity is another important aspect that should be highlighted. Accordingly, the chronic use of these substances, of which fentanyl is the most frequently consumed, represents an additional risk of liver damage in patients with underlying chronic liver disease. These observations are drawn from various preclinical and clinical studies present in literature. Several downstream molecular events have been proposed, but recent pieces of research strengthen the hypothesis that dysbiosis of the gut microbiota is a solid mechanism inducing and worsening liver damage by both alcohol and illicit drugs. In this scenario, the gut flora modification ascribed to non-alcoholic fatty liver disease performs an additive role. Interestingly enough, HBV and HCV infections impact gut-liver axis. In the end, the authors tried to solicit the attention of operators on this major healthcare problem.

Recreational drugs: a new health hazard for patients with concomitant chronic liver diseases

Our purpose in this article is to review the effects of recreational drugs, used either on their own but principally combined with alcohol consumption, in determining hepatic injury or influencing the evolution of some chronic diseases of the liver, specifically HCV infection and NAFLD. A deleterious role of daily use of recreational drugs, in particularly cannabis, has been shown to demonstrate clearly a rapid progression of fibrosis and steatosis, leading to a major severity in patients with chronic hepatitis C. On the other hand, the effects of the misuse of these substances on NAFLD, the main obesity-related comorbidity, leading to addiction, is still to be elucidated even though some clues to the recreational drugs hepatotoxicity are already present in the literature. This short review aims at raising awareness about this topic.

Which Surrogate Marker of Insulin Resistance Among Those Proposed in the Literature Better Predicts the Presence of Non-Metastatic Bladder Cancer?

Background: Recent evidence has shown that insulin resistance (IR), a hallmark of nonalcoholic fatty liver disease, predicts bladder cancer (BC) presence. However, the best surrogate marker of IR in predicting BC is still unclear. This study examined the relationships among ten surrogate markers of IR and the presence of BC. Methods: Data from 209 patients admitted to two urology departments from September 2021 to October 2024 were retrospectively analyzed. Individuals (median age 70 years) were divided into two groups (123 and 86 patients, respectively) based on the presence/absence after cystoscopy/TURB of non-metastatic BC. Univariate logistic regression was used to determine the relationships between groups, and the following IR parameters: Triglyceride-Glucose (TyG) index, TyG-BMI, HOMA-IR HOMAB, MetS-IR, Single Point Insulin Sensitivity Estimator, Disposition Index, non-HDL/HDL, TG/HDL-C ratio and Lipoprotein Combine Index. Stepwise logistic regressions were carried out to evaluate the significant predictions and LASSO regression to confirm any significant variable(s). The predictive value of the index test for coexistent BC was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). Results: The univariate analysis revealed that the TyG index and MetS-IR were associated with the BC presence. Specifically, the associations of the TyG index and MetS-IR were more significant in participants =/> 65 years old. In multivariate analysis, the stepwise logistic regression, evaluating the most representative variables at univariate analysis, revealed a prediction of BC by only TyG index (OR 2.51, p = 0.012), confirmed by LASSO regression, with an OR of 3.13, p = 0.004). Assessing the diagnostic reliability of TyG, it showed an interesting predictive value for the existence of BC (AUC = 0.60; 95% CI, 0.51-0.68, cut-off 8.50). Additionally, a restricted cubic spline model to fit the dose-response relationship between the values of the index text (TyG) and the BC evidenced the presence of a non-linear association, with a high predictive value of the first knot, corresponding to its 10th percentile. The decision curve analysis confirmed that the model (TyG) has utility in supporting clinical decisions. Conclusions: Compared to other surrogate markers of IR, the TyG index is effective in identifying individuals at risk for BC. A TyG threshold of 8.5 was highly sensitive for detecting BC subjects and may be suitable as an auxiliary diagnostic criterion for BC in adults, mainly if less than 65 years old.

[Recent experience in the short-term etizolam treatment of irritable colon syndrome]

Twenty-two subjects (8 males, 14 females, mean age 36 years, range 21-57) with symptoms of diffuse pain or fullness in a lower abdominal quadrant, without repercussions on general health but with chronic anxiety of which the subjects complained or which emerged during confidential conversation with the physicians, were enrolled in our outpatient department for liver and gastroenterologic pathology at the Institute of Internal Medicine and Metabolic Disorders, II Faculty of Medicine, Naples University. After an average 30-day wash-out period, patients were treated with etizolam, a new psychoactive drug for somatized anxiety. Mean dosage and duration of treatment were 1 tablet twice daily for 25 days. Painful symptoms disappeared in 16.3% of patients, decreased in 38.3% and remained stationary in 22.7% and became worse in 22.7%. Number of bowel motions decreased in 14 patients (63.6%, from an average of 2.04 to 1.56). It can therefore be concluded that etizolam treatment was effective in subjects with colon disorders accompanied by chronic anxiety syndrome or that became acute as result of stressful socio-economic or affective situations or personal disappointment.

[Uridine diphosphate glucose (UDPG) in the treatment of hepatic disease from chronic alcohol abuse]

Fatty liver can be determined by chronic abuse of alcohol, by means of direct action of the same on the level of membrane's proteins. The UDPG restores the levels of a membrane's component, the phosphoribosylpyrophosphate (PRPP), which normally results reduced in cellular cultures of rat's liver, after the addition of alcohol. It has been made a study on 40 patients (27 men and 13 women age medium 54 years) alcoholics for at least 1 year with a quantity of ethanol ingested less than 1 g gamma/die/kg of body weight with alternated values of serum GOT, GPT and gamma-GT and clinical aspects of a modest alcoholic hepatopathy, assigning through, at random in double blind, two groups of treatment: the first one with UDPG (400 mg/im/die for 30 days) the second one with placebo. It has been considered like variable of therapeutic effect the difference between basal value and the result at the end of treatment of these serum enzymes, it has been applied the Student's t test for the evaluation of the difference between treatments. It has been shown in the groups of patients analyzed with UDPG (not the group of placebo) reduction extremely significant for the gamma-GT (p = 0.00032) and GOT (p = 0.0138). In 5 treated cases, after an hepatic ultrasound imaging of comparison, at the end of the treatment, it has been demonstrated an apparent improvement of thickening of the echos; only 3/40 of the patients have certainly stopped to ingest alcoholic drinks.

Therapy of chronic non-A, non-B hepatitis with alpha interferon. A comparison between natural and recombinant alpha interferon

We studied the effects of two different types of interferon alpha (natural interferon from human leukocytes vs. recombinant interferon 2b) in 64 patients with chronic Non-A, Non-B hepatitis; other finalities were: definition of the optimal duration of therapy with interferon alpha (IFN alpha), entity of side effects, cost-benefit ratio. Patients were randomly assigned to one of three groups, according to duration of IFN alpha treatment: Group I was treated for 12 months, Group II for six months, Group III for 3 months. Each group consisted of two subgroups, divided on the basis of the type of IFN used: subgroup A was administered natural IFN alpha, and subgroup B received recombinant IFN alpha 2b. Each patients was given 3 million units of IFN alpha by intramuscular injection on alternate days. At the end of treatment, a decrease in serum ALT activity was achieved in 39 cases (65%). The response rate was higher in Group I (89%) than in Group II (54%) and Group III (55%). Natural and recombinant IFN alpha 2b induced similar effects in patients treated for twelve months (Group I); recombinant IFN was more effective than natural IFN alpha in patients treated for six and three months. We conclude that the 12-month treatment with 3 million units of intramuscular recombinant IFN alpha, administered on alternate days, might be the optimal therapy schedule. This proposal is also supported by the evaluation of the cost benefit ratio.(ABSTRACT TRUNCATED AT 250 WORDS)