Multi-omics reveals the associations among the fecal metabolome, intestinal bacteria, and serum indicators in patients with hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC), the predominant form of primary liver cancer, is a key contributor to cancer-related deaths globally. However, HCC diagnosis solely based on blood biochemical markers lacks both sensitivity and specificity.

AIM

To investigate alterations of the fecal metabolome and intestinal bacteria and reveal the correlations among differential metabolites, distinct bacteria, and serum indicators.

METHODS

To uncover potentially effective therapeutic targets for HCC, we utilized non-targeted liquid chromatography-mass spectrometry and high-throughput DNA sequencing targeting the 16S rRNA gene. This comprehensive approach allowed us to investigate the metabolome and microbial community structure of feces samples obtained from patients with HCC. Furthermore, we conducted an analysis to assess the interplay between the fecal metabolome and intestinal bacterial population.

RESULTS

In comparison to healthy controls, a notable overlap of 161 differential metabolites and 3 enriched Kyoto Encyclopedia of Genes and Genomes pathways was observed in the HCC12 (comprising patients with stage I and II HCC) and HCC34 groups (comprising patients with stage III and IV HCC). Lachnospira, Streptococcus, and Veillonella had significant differences in abundance in patients with HCC. Notably, Streptococcus and Veillonella exhibited significant correlations with serum indicators such as alpha-fetoprotein (AFP). Meanwhile, several differential metabolites [e.g., 4-keto-2-undecylpyrroline, dihydrojasmonic acid, 1,8-heptadecadiene-4,6-diyne-3,10-diol, 9(S)-HOTrE] also exhibited significant correlations with serum indicators such as γ-glutamyl transferase, total bilirubin, AFP, aspartate aminotransferase, and albumin. Additionally, these two genera also had significant associations with differential metabolites such as 1,2-Dipentadecanoyl-rac-glycerol (15:0/20:0/0:0), arachidoyl ethanolamide, and 4-keto-2-undecylpyrroline.

CONCLUSION

Our results suggest that the metabolome of fecal samples and the composition of intestinal bacteria hold promise as potential biomarkers for HCC diagnosis.

Management of hepatic encephalopathy following transjugular intrahepatic portosystemic shunts: Current strategies and future directions

Transjugular intrahepatic portosystemic shunts (TIPSs) are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis. However, hepatic encephalopathy (HE), which impairs neuropsychiatric function and motor control, remains the primary adverse effect of TIPS, limiting its utility. Prompt prevention and treatment of post-TIPS HE are critical, as they are strongly associated with readmission rates and poor quality of life. This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE, explores advanced biomarkers and predictive tools, and discusses current management strategies and future directions to prevent or reverse HE following TIPS. These strategies include preoperative patient assessment, individualized shunt diameter optimization, spontaneous portosystemic shunt embolization during the TIPS procedure, postoperative preventive and therapeutic measures such as nutrition management, medical therapy, fecal microbiota transplantation, and stent reduction.

Rhapontin activates nuclear factor erythroid 2-related factor 2 to ameliorate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced gastrointestinal dysfunction in Parkinson's disease mice

BACKGROUND

Parkinson's disease (PD)-a progressive neurodegenerative disorder-is characterized by motor and gastrointestinal dysfunction. The exploration of novel therapeutic strategies for PD is vital.

AIM

To investigate the potential mechanism of action of rhapontin-a natural compound with known antioxidant and anti-inflammatory properties-in the context of PD.

METHODS

Network pharmacology was used to predict the targets and mechanisms of action of rhapontin in PD. Behavioral tests and tyrosine hydroxylase immunofluorescence analysis were used to assess the effect of rhapontin on symptoms and pathology in MPTP-induced mice. Interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, and IL-10 levels in tissues were measured using an enzyme-linked immunosorbent assay (ELISA). Additionally, nuclear factor erythroid 2-related factor 2 (NRF2) activation was confirmed using western blotting.

RESULTS

NRF2 was predicted to be the key transcription factor underlying the therapeutic effects of rhapontin in PD, and its anti-PD action may be associated with its anti-inflammatory and antioxidant properties. Rhapontin ameliorated the loss of dopaminergic neurons and gastrointestinal dysfunction in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mice by activating NRF2. Additionally, rhapontin treatment significantly decreased pro-inflammatory cytokines (IL-6, TNF-α, IL-1β) in the substantia nigra, striatum, and colon, whereas it increased anti-inflammatory cytokine (IL-10) levels only in the colon, indicating the involvement of gut–brain axis in its neuroprotective potential. Finally, NRF2 was identified as a key transcription factor activated by rhapontin, particularly in the colon.

CONCLUSION

We elucidated the effects of rhapontin in MPTP-induced PD mouse models using a combination of network pharmacology analysis, behavioral assessments, immunofluorescence, ELISA, and Western blotting. Our findings revealed the multifaceted role of rhapontin in ameliorating PD through its anti-inflammatory and antioxidant properties, particularly by activating NRF2, paving the way for future research into targeted therapies for PD.

Rethinking carnitine palmitoyltransferase II and liver stem cells in metabolic dysfunction-associated fatty liver disease-related hepatocellular carcinoma

This article discusses a recent study by Wang et al that sheds light on the metabolic and immunological mechanisms driving the progression of metabolic dysfunction-associated fatty liver disease (MAFLD) to hepatocellular carcinoma (HCC). The study highlights the role of mitochondrial carnitine palmitoyltransferase II (CPT II) inactivity, which activates liver cancer stem cells marked by cluster of differentiation 44 (CD44) and CD24 expression, promoting HCC development. Using dynamic mouse models and clinical samples, Wang et al identified CPT II downregulation, mitochondrial membrane potential alterations, and reduced intrahepatic CD4⁺ T cell as key drivers of disease progression. The findings link these changes to steroid biosynthesis and p53 signaling, contributing to T-cell dysfunction and immunosuppression. This article emphasizes the relevance of these results in understanding MAFLD pathogenesis and discusses potential therapeutic strategies targeting CPT II activity, mitochondrial function, and immune surveillance to prevent or mitigate HCC development in advanced MAFLD.

Predictive models and clinical manifestations of intrapulmonary vascular dilatation and hepatopulmonary syndrome in patients with cirrhosis: Prospective comparative study

BACKGROUND

Patients with cirrhosis with hepatopulmonary syndrome (HPS) have a poorer prognosis. The disease has a subtle onset, symptoms are easily masked, clinical attention is insufficient, and misdiagnosis rates are high.

AIM

To compare the clinical characteristics of patients with cirrhosis, cirrhosis combined with intrapulmonary vascular dilatation (IPVD), and HPS, and to establish predictive models for IPVD and HPS.

METHODS

Patients with cirrhosis were prospectively screened at a liver-specialized university teaching hospital. Clinical information and blood samples were collected, and biomarker levels in blood samples were measured. Patients with cirrhosis were divided into three groups: Those with pure cirrhosis, those with combined IPVD, and those with HPS based on contrast-enhanced transthoracic echocardiography results and the pulmonary alveolar-arterial oxygen gradient values. Univariate logistic regression and Least Absolute Shrinkage and Selection Operator (LASSO) regression methods were utilized to identify risk factors for IPVD and HPS, and nomograms were constructed to predict IPVD and HPS.

RESULTS

A total of 320 patients were analyzed, with 101 diagnosed with IPVD, of whom 54 were diagnosed with HPS. There were statistically significant differences in clinical parameters among these three groups of patients. Among the tested biomarkers, sphingosine 1 phosphate, angiopoietin-2, and platelet-derived growth factor BB were significantly associated with IPVD and HPS in patients with cirrhosis. Following LASSO logistic regression screening, prediction models for IPVD and HPS were established. The area under the receiver operating characteristic curve for IPVD prediction was 0.792 (95% confidence interval [CI]: 0.737-0.847), and for HPS prediction was 0.891 (95%CI: 0.848-0.934).

CONCLUSION

This study systematically compared the clinical characteristics of patients with cirrhosis, IPVD, and HPS, and constructed predictive models for IPVD and HPS based on clinical parameters and laboratory indicators. These models showed good predictive value for IPVD and HPS in patients with cirrhosis. They can assist clinicians in the early prognosis assessment of patients with cirrhosis, ultimately benefiting the patients.

Conversion treatment for advanced intrahepatic cholangiocarcinoma: Opportunities and challenges

The prevalence of intrahepatic cholangiocarcinoma (ICC) is increasing globally. Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades, the prognosis for ICC remains poor. Owing to the high degree of malignancy and insidious onset of ICC, numerous cases are detected at intermediate or advanced stages of the disease, hence eliminating the chance for surgical intervention. Moreover, because of the highly invasive characteristics of ICC, recurrence and metastasis postresection are prevalent, leading to a 5-year survival rate of only 20%-35% following surgery. In the past decade, different methods of treatment have been investigated, including transarterial chemoembolization, transarterial radioembolization, radiotherapy, systemic therapy, and combination therapies. For certain patients with advanced ICC, conversion treatment may be utilized to facilitate surgical resection and manage disease progression. This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC.

Early detection of gastroparesis with diabetic ketoacidosis as initial manifestation: A case-control study

BACKGROUND

Gastroparesis may repeatedly induce diabetic ketoacidosis (DKA), and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms. If DKA is accompanied by gastroparesis, patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA. Misdiagnosis results in poor treatment outcomes and prognosis. We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA + gastroparesis to facilitate early screening.

AIM

To achieve early detection and diagnosis of DKA + gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing re-induction of DKA.

METHODS

We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023 (DKA + gastroparesis group) were included. Then, we selected 60 DKA patients without DKA as a control group (DKA alone group) based on gender, age, disease course, and diabetes subtype in a 1:4 matching ratio. Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.

RESULTS

The DKA + gastroparesis group was composed of nine males and six females, with a mean age of 35 ± 11 years, while the DKA alone group included 34 males and 26 females, with a mean age of 34 ± 17 years. In the DKA + gastroparesis group, urine ketone levels normalized, while gastrointestinal symptoms persisted despite treatment, and the tests indicated lower glycosylated hemoglobin levels (HbA1c; 7.07% vs 11.51%, P < 0.01), largest amplitude of glycemic excursions (5.86 vs 17.41, P < 0.01), standard deviation of blood glucose (SDBG; 2.69 vs 5.83, P < 0.01), and coefficient of blood glucose variation (0.31 vs 0.55, P = 0.014) compared with the DKA alone group. Probable gastroparesis was considered at HbA1c < 8.55%. Besides, the patients in the DKA + gastroparesis group had lower body mass index (19.28 kg/m²vs 23.86 kg/m², P = 0.02) and higher high density lipoprotein cholesterol level (2.34 mmol/L vs 1.05 mmol/L, P = 0.019) compared to the DKA alone group, but no difference was observed in the remaining lipid profiles between the two groups.

CONCLUSION

Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction, particularly when the HbA1c level is < 8.55%.

Prognostic value of the triglyceride-glucose index in advanced gastric cancer: A call for further exploration

Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, necessitating the identification of reliable prognostic indicators to enhance treatment outcomes. Recent research has highlighted the triglyceride-glucose (TyG) index as a potential surrogate marker for insulin resistance, which may significantly influence the prognosis of patients undergoing immunotherapy combined with chemotherapy. In this context, the study by Yao et al demonstrates that a high TyG index correlates with improved overall survival and progression-free survival in advanced GC patients receiving sintilimab and chemotherapy. Specifically, patients in the high TyG group had a significantly longer median progression-free survival of 9.8 months [95% confidence interval (CI): 9.2-10.9] compared to 8.0 months (95%CI: 7.5-8.5) in the low TyG group (hazard ratio = 0.58, 95%CI: 0.43-0.79, P < 0.001). Similarly, the median overall survival was significantly longer in the high TyG group at 23.1 months (95%CI: 21.2-NA) vs 16.5 months (95%CI: 13.9-18.3) in the low TyG group (hazard ratio = 0.30, 95%CI: 0.21-0.42, P < 0.001). These findings underscore the strong prognostic potential of the TyG index in guiding treatment strategies for advanced GC. These findings underscore the need for further investigation into the TyG index’s role as a prognostic tool and its underlying mechanisms in influencing treatment efficacy. We advocate for additional multicenter studies to validate these results and explore the TyG index’s applicability across diverse patient populations, ultimately aiming to refine treatment strategies and improve patient outcomes in advanced GC.

Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis

BACKGROUND

Acute pancreatitis (AP) is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment. An accurate assessment and precise staging of severity are essential in initial intensive therapy.

AIM

To explore the prognostic value of inflammatory markers and several scoring systems [Acute Physiology and Chronic Health Evaluation II, the bedside index of severity in AP (BISAP), Ranson’s score, the computed tomography severity index (CTSI) and sequential organ failure assessment] in severity stratification of early-phase AP.

METHODS

A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study. Inflammation marker and scoring system levels were calculated and compared between different severity groups. Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models. Predictive ability was estimated using receiver operating characteristic curves.

RESULTS

Of the 463 patients, 50 (10.80%) were classified as having severe AP (SAP). The results revealed that the white cell count significantly increased, whereas the prognostic nutritional index measured within 48 hours (PNI₄₈) and calcium (Ca²⁺) were decreased as the severity of AP increased (P < 0.001). According to multivariate logistic regression, C-reactive protein measured within 48 hours (CRP₄₈), Ca²⁺ levels, and PNI₄₈ were independent risk factors for predicting SAP. The area under the curve (AUC) values for the CRP₄₈, Ca²⁺, PNI₄₈, Acute Physiology and Chronic Health Evaluation II, sequential organ failure assessment, BISAP, CTSI, and Ranson scores for the prediction of SAP were 0.802, 0.736, 0.871, 0.799, 0.783, 0.895, 0.931 and 0.914, respectively. The AUC for the combined CRP₄₈ + Ca²⁺ + PNI₄₈ model was 0.892. The combination of PNI₄₈ and Ranson achieved an AUC of 0.936.

CONCLUSION

Independent risk factors for developing SAP include CRP₄₈, Ca²⁺, and PNI₄₈. CTSI, BISAP, and the combination of PNI₄₈ and the Ranson score can act as reliable predictors of SAP.

Arachidonate 15-lipoxygenase: A promising therapeutic target for alleviating inflammation in acute pancreatitis

This article discusses the significant findings from the study on the transfection of arachidonate 15-lipoxygenase (ALOX15) and its therapeutic potential in managing acute pancreatitis (AP). The research highlights the role of ALOX15 in attenuating inflammatory responses, apoptosis, and autophagy in a cerulein-induced AP murine model. By using a recombinant lentiviral vector for efficient gene delivery, the study provides compelling evidence for the protective effects of ALOX15 transfection on pancreatic tissue. The authors demonstrate that ALOX15 reduces the expression of key inflammatory markers like interleukin-β and tumor necrosis factor α while promoting apoptosis through caspase-3 activation. Furthermore, the modulation of autophagy and structural preservation of pancreatic acinar cells suggest that ALOX15 could be a promising therapeutic target for AP. The implications of these findings are discussed, emphasizing the potential for future clinical translation and further research to explore the molecular mechanisms and therapeutic applications of ALOX15 in inflammatory diseases.

Delaying liver aging: Analysis of structural and functional alterations

This article is based on a recent bibliometric analysis of research progress on liver aging. The liver is notable for its extraordinary ability to rejuvenate, thereby safeguarding and maintaining the organism’s integrity. With advancing age, there is a noteworthy reduction in both the liver’s size and blood circulation. Furthermore, the wide range of physiological alterations driven on by aging may foster the development of illnesses. Previous studies indicate that liver aging is linked to impaired lipid metabolism and abnormal gene expression associated with chronic inflammation. Factors such as mitochondrial dysfunction and telomere shortening accumulate, which may result in increased hepatic steatosis, which impacts liver regeneration, metabolism, and other functions. Knowing the structural and functional changes could help elderly adults delay liver aging. Increasing public awareness of anti-aging interventions is essential. Besides the use of dietary supplements, alterations in lifestyle, including changes in dietary habits and physical exercise routines, are the most efficacious means to decelerate the aging process of the liver. This article highlights recent advances in the mechanism research of liver aging and summarizes the promising intervention options to delay liver aging for preventing related diseases.

Strain- and sex-dependent variability in hepatic microcirculation and liver function in mice

BACKGROUND

The integrity and functionality of the hepatic microcirculation are essential for maintaining liver health, which is influenced by sex and genetic background. Understanding these variations is crucial for addressing disparities in liver disease outcomes.

AIM

To investigate the sexual dimorphism and genetic heterogeneity of liver microcirculatory function in mice.

METHODS

We assessed hepatic microhemodynamics in BALB/c, C57BL/6J, and KM mouse strains using laser Doppler flowmetry and wavelet analysis. We analyzed the serum levels of alanine transaminase, glutamic acid aminotransferase, total bile acid, total protein, alkaline phosphatase, and glucose. Histological and immunohistochemical staining were employed to quantify microvascular density and the expression levels of cluster of differentiation (CD) 31, and estrogen receptor α, and β. Statistical analyses, including the Mantel test and Pearson correlation, were conducted to determine the relationships among hepatic function, microcirculation, and marcocirculation between different sexes and across genetic backgrounds.

RESULTS

We identified sex-based disparities in hepatic microhemodynamics across all strains, with males exhibiting higher microvascular perfusion and erythrocyte concentration, but lower blood velocity. Strain-specific differences were evident, particularly in the endothelial oscillatory characteristics of the erythrocyte concentration. No sex-dependent differences in estrogen receptor expression were observed, while significant variations in CD31 expression and microvascular density were observed. The correlations highlighted relationships between hepatic microhemodynamics and liver function indicators.

CONCLUSION

Our findings indicate the influence of genetic and sex differences on hepatic microcirculation and liver function, highlighting the necessity of incorporating both genetic background and sex into hepatic physiology studies and potential liver disease management strategies.

Interplay of genetic and clinical factors in cancer-associated thrombosis: Deciphering the prothrombotic landscape of colorectal cancer

Colorectal cancer (CRC), the third most prevalent cancer globally, exhibits a notable association with venous thromboembolism (VTE), significantly impacting patient morbidity and mortality. We delve into the complex pathogenesis of cancer-associated thrombosis (CAT) in CRC, highlighting the interplay of clinical risk factors and tumor-specific mechanisms. Our comprehensive review synthesizes the current understanding of CRC's pro-thrombotic tendencies, examining both general clinical factors (e.g., age, gender, obesity, prior VTE history) and tumor-specific aspects (e.g., tumor location, stage, targeted therapies). Key findings illustrate how CRC cells themselves actively contribute to coagulation cascade activation through various procoagulant elements such as tissue factor, cancer procoagulant, and extracellular vesicles. We also explore how CRC influences host cells to adopt a procoagulant phenotype, thereby exacerbating thrombotic risks. This review underscores the role of genetic mutations in CRC (e.g., KRAS, p53) in modulating coagulation-related protein expression and thrombosis risks. An in-depth understanding of the genetic landscape specific to CRC subtypes is essential for developing targeted anticoagulation strategies and could significantly advance thrombosis prevention while improving the overall management of patients with CRC. This highlights the urgent need for precision in addressing CAT within clinical settings.

Chinese patent medicine: Opening new perspectives for treatment of post-endoscopic submucosal dissection esophageal stricture in esophageal cancer patients

Endoscopic submucosal dissection (ESD) is an effective technique for treating early esophageal cancer, and the prevention of postoperative esophageal stricture has emerged as a significant research topic. Zhou et al utilized an experimental minipig model to demonstrate that Kangfuxin (KFX) can improve postoperative esophageal stricture following ESD by inhibiting transforming growth factor-β1-driven fibrosis and the downstream fibrotic mediators Smad2/3. In this letter, we primarily discuss recent advancements in the treatment of esophageal stricture, the clinical applications of KFX, and the mechanisms involved in alleviating postoperative esophageal stricture, aiming to provide insights for advancing clinical practice and research in esophageal stricture after ESD.

Clinical, genetic and functional perspectives on ATP-binding cassette subfamily B member 4 variants in five cholestasis adults

BACKGROUND

ATP-binding cassette subfamily B member 4 (ABCB4) deficiency is associated with cholestatic liver disease primarily because of missense mutations, and many variants remain unidentified. Here, we validate the pathogenicity and mechanism of ABCB4 variants in clinical and in vitro trials, hypothesizing that these variants are responsible for impaired biliary function and contribute to the development of cholestatic liver diseases.

AIM

To clarify the functional features and pathogenicity of ABCB4 variants.

METHODS

Clinical data were collected from five patients with cholestatic liver disease that was initially not detected by routine examinations. Later, whole-exome sequencing confirmed ABCB4 variants and the patients were treated from January 2017 to December 2023. Pathogenic mechanisms were analyzed using bioinformatics tools, and a cell model in vitro was established to investigate ABCB4 mRNA expression, multidrug resistance protein 3 (MDR3) expression, cellular localization, and phosphatidylcholine secretion. Results were compared using Student's t-tests.

RESULTS

Five missense variants (c.1757T>A, c.1865G>A, c.2362C>T, c.2777C>T and c.3250C>T), one intron variant (c.537-32G>T), and one synonymous (c.C504T) variant were identified. Three of the five patients had various degrees of cholestasis, two presented with liver cirrhosis, and all had elevated gamma-glutamyl transferase. Three of the four patients who underwent a liver biopsy had bile duct dilation, and one had gallstones. Two of the four patients had normal and reduced MDR3 immunohistochemical levels. Bioinformatic analysis indicated that these variants were likely pathogenic except c.C504T variant. None of the missense variants influenced subcellular MDR3 Localization in vitro. However, the c.1865G>A variant significantly decreased ABCB4 mRNA values, and all missense variants down-regulated phosphatidylcholine secretion.

CONCLUSION

This study uncovered new ABCB4 variants and emphasized the pathogenic potential of specific variants. The findings from five patients provided insight into the pathogenic mechanisms underlying ABCB4-related diseases.

Using vaporized hydrogen peroxide for anhydrous disinfection of gastrointestinal endoscopes

BACKGROUND

Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.

AIM

To achieve the objectives of efficiency, speed, and cost-effectiveness, this study utilized vaporized hydrogen peroxide (VHP) generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.

METHODS

The experimental device rapidly converts sodium percarbonate granules into VHP, and performs disinfection experiments on gastrointestinal endoscope models, disposable endoscopes, and various types of reusable gastrointestinal endoscopes. Variables such as the intraluminal flow rate (FR), relative humidity (RH), exposure dosage, and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.

RESULTS

The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes. RH, exposure dosage, and organic burden significantly affect the disinfection efficacy of VHP, whereas the intraluminal FR does not significantly impact disinfection efficacy. All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results. Furthermore, when this device was used to treat various types of reusable endoscopes, the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines (using peracetic acid disinfectant solution) (P > 0.05), and the economic cost of disinfectant required per endoscope was lower (1.5 China Yuan), with a shorter disinfection time (30 minutes).

CONCLUSION

The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes, as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.

Hepatic-specific vitamin D receptor downregulation alleviates aging-related metabolic dysfunction-associated steatotic liver disease

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the abnormal lipid deposition in hepatocytes. The prevalence of MASLD is significantly increased in the elderly population, suggesting that aging may be related to the occurrence of MASLD. Emerging evidences suggest that vitamin D receptor (VDR) may be implicated in the progression of MASLD. Therefore, additional researches are warranted to elucidate whether VDR plays a role in aging-related MASLD.

AIM

To investigate the relationship between aging and MASLD and explore the role and related mechanisms of VDR in aging-related MASLD.

METHODS

Cellular senescence models were established, and the senescence phenotype of telomerase RNA component knockout mice was validated. These mice were then used as a senescence model for subsequent studies. Changes in VDR expression in the livers of aging mice were examined. VDR knockdown models, including cell knockdown models and hepatic-specific VDR knockout mice, were constructed, and MASLD was established in these models. Additionally, vitamin D (VD)-supplemented models, including senescent liver cell lines and senescent mice, were constructed.

RESULTS

The steatosis in senescent liver cells was more severe than in normal cells (P < 0.05). Moreover, hepatic steatosis was significantly more pronounced in senescence model mice compared to control group when the MASLD model was successfully induced (P < 0.05). Therefore, we concluded that aging aggravated hepatic steatosis. The hepatic expression of VDR increased after aging. VDR knockdown in senescent liver cells and senescent mice alleviated hepatic steatosis (P < 0.05). When senescent liver cells were stimulated with VD, cellular steatosis was aggravated (P < 0.05). However, VD supplementation had no effect on aging mice.

CONCLUSION

Aging can lead to increased hepatic steatosis, and the hepatic-specific knockdown of VDR alleviated aging-related MASLD. VDR could serve as a potential molecular target for aging-related MASLD.

Immune therapies in intermediate-advanced unresectable hepatocellular carcinoma: Changing the therapeutic landscape

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. A substantial proportion of patients are diagnosed with advanced or intermediate-advanced stage disease at presentation and are often ineligible for curative surgery. The mainstay of treatment of this unique intermediate-advanced stage patients who have a liver-limited disease but unresectable due to large tumor burden, number of lesions or technical difficulties, have traditionally been locoregional therapies. However, the response has not been satisfactory in the majority of patients. With the advent of immune therapies and the remarkable progress it has made over the past decade, the management of intermediate-advanced HCC has undergone a paradigm change. Till 2020, sorafenib, a multi-targeted inhibitor of vascular endothelial growth factor, platelet-derived growth factor and rapidly accelerated fibrosarcoma was the one approved immune therapy. However, since 2021, nine more drugs have been approved, based on studies showing improved survival in advanced-stage HCC patients. However, the challenge clinicians face now is to determine the best choice/combination of available drugs to achieve long-term success and survival while maintaining preserved liver function. In light of emerging literature concerning immune therapies, including the relevant randomized controlled trial by Han et al, this editorial aims to review the currently available treatment strategies for the intermediate-advanced stage HCC.

Mixed lineage kinase domain-like protein in liver diseases: Cell-type-specific functions and dual roles

In this letter, we comment on the article by Xuan Yuan et al, published in the recent issue of the World Journal of Gastroenterology. Mixed lineage kinase domain-like protein (MLKL) exhibits cell-type-specific functions in liver parenchymal and non-parenchymal cells, playing dual roles in the pathogenesis of liver diseases. In hepatocytes, MLKL primarily mediates necroptosis and inhibits autophagy, thereby exacerbating liver injury. Conversely, in non-parenchymal liver cells, MLKL modulates inflammatory responses and promotes fibrotic processes, thereby driving disease progression. Notably, MLKL also demonstrates protective functions under specific conditions. For instance, MLKL can inhibit intracellular bacterial replication, promote endosomal trafficking, and facilitate the generation and release of extracellular vesicles, potentially exerting hepatoprotective effects. Understanding these cell-type-specific mechanisms of MLKL action, including its dual roles in promoting injury and providing protection, is crucial for elucidating the complex pathogenesis of liver diseases and developing targeted therapeutic strategies.

Clinical settings in which human leukocyte antigen typing is still useful in the diagnosis of celiac disease

Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten ingestion ingenetically predisposed individuals. It is characterized by intestinal histological damage and the production of specific autoantibodies. The latest European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2020 guidelines have excluded human leukocyte antigen (HLA) genotyping from the no-biopsy diagnostic approach due to its weak positive predictive value, limited availability, and high cost in some countries. However, HLA genetic testing remains valuable in certain clinical contexts. This study provided practical indications for when to request and how to interpret HLA genotyping, emphasizing its continued relevance for CD diagnosis in specific cases. We also proposed a strategy for monitoring the risk of developing type 1 diabetes (T1D) in patients with CD, based on the risk stratification carried by different HLA genotypes. A retrospective analysis of 746 patients with CD and 627 controls was conducted at our hospital starting in 2012, when HLA genotyping became mandatory for the diagnosis of CD. We identified key clinical scenarios where HLA testing remains useful. Several high risk HLA-DQ genotypes strongly associated with CD were highlighted, including HLA-DQ2.5/HLA-DQ2.2 and HLA-DQ2.5/HLA-DQ2.5. Notably, while the HLA-DQ2.5/HLA-DQ2.2 genotype is linked to CD, it appears to confer protection against T1D. To support clinical practice, we presented a table clarifying commonly used HLA terminology, and another summarized the main clinical situations in which HLA genotyping should still be considered. These findings underscore the dual role of HLA testing: Not only can it help rule out CD in selected cases, but it also identifies patients with CD at risk for T1D, guiding personalized monitoring strategies.

Prognostic scoring system using inflammation- and nutrition-related biomarkers to predict prognosis in stage I-III colorectal cancer patients

BACKGROUND

Colorectal cancer (CRC) is a common malignancy that has become a global burden. The prognostic prediction of CRC patients on the basis of inflammatory biomarkers and nutritional biomarkers has shown some potential but has not been fully explored.

AIM

To develop and validate a prognostic model for CRC based on inflammation and nutrition-related biomarkers and to evaluate its predictive value for patient outcomes.

METHODS

Patients were randomized at a 3:2 ratio into a training cohort (n = 282) or a validation cohort (n = 188). To identify the optimal prognostic factors for constructing the risk score (RS), LASSO Cox regression analysis was conducted. The association between the RS and overall survival (OS) was evaluated using receiver operating characteristic (ROC) curves and Kaplan-Meier (K-M) survival analysis. Independent risk factors were screened by multivariate Cox regression analysis. Nomograms were constructed and validated on the basis of these factors.

RESULTS

In the training cohort, univariate analysis of all the inflammatory and nutritional biomarkers demonstrated some predictive value. A LASSO-Cox analysis included four biomarkers and constructed an RS. Through ROC analysis, the area under the prognostic curve was 0.795. K-M survival curve analyses revealed that the five-year OS was significantly greater in the Low-RS group than in the High-RS group (P < 0.001). Multivariate analysis demonstrated that the degree of differentiation (P = 0.001), degree of nerve invasion (P = 0.022), and RS (P < 0.001) were independent risk factors. We constructed a nomogram to predict the OS of CRC patients and validated it in a separate cohort. The calibration curve showed high accuracy. Additionally, decision curve analysis for 1-year, 3-year, and 5-year survival probabilities indicated significant clinical utility in predicting survival outcomes.

CONCLUSION

This study developed a nomogram based on the RS to predict the OS of CRC patients. This nomogram can guide treatment decisions and enable the formulation of personalized follow-up strategies on the basis of predicted recurrence risk, aiming to improve long-term prognosis.

Study of the relationship between iron metabolism disorders and sepsis-associated liver injury: A prospective observational study

BACKGROUND

Sepsis-associated liver injury (SALI) refers to secondary liver function impairment caused by sepsis, patients with SALI often have worse clinical outcomes. The early identification and assessment of the occurrence and progression of SALI are pressing issues that urgently need to be resolved.

AIM

To investigate the relationship between iron metabolism and SALI.

METHODS

In this prospective study, 139 patients were recruited, with 53 assigned to the SALI group. The relationships between SALI and various iron metabolism-related biomarkers were examined. These biomarkers included serum iron (SI), total iron-binding capacity (TIBC), serum ferritin, transferrin, and transferrin saturation. To identify independent risk factors for SALI, both univariate and multivariate logistic regression analyses were performed. Additionally, receiver operating characteristic curve analysis was utilized to assess the predictive value of these biomarkers for the occurrence of SALI.

RESULTS

There were no statistically significant differences in age, sex, body mass index, Sequential Organ Failure Assessment scores (excluding liver function), or APACHE II scores between the two groups of patients. Compared with the sepsis group, the SALI group presented significantly higher SI (P < 0.001), TIBC (P < 0.001), serum ferritin (P = 0.001), transferrin (P = 0.005), and transferrin saturation levels (P < 0.001). Multivariate logistic regression analysis revealed that SI (odds ratio = 1.24, 95% confidence interval: 1.11-1.40, P < 0.001) and TIBC levels (odds ratio = 1.13, 95% confidence interval: 1.05-1.21, P < 0.001) were independent predictors of SALI. Receiver operating characteristic curve analysis revealed that SI and TIBC had areas under the curve of 0.816 and 0.757, respectively, indicating moderate predictive accuracy for SALI.

CONCLUSION

Iron metabolism disorders are closely associated with the development of SALI, and SI and TIBC may serve as potential predictive biomarkers. The combined use of SI and TIBC has superior diagnostic efficacy for SALI. These findings provide valuable insights for the early identification and management of SALI among patients with sepsis.

Efficacy of recombinant human thrombopoietin in patients with acute-on-chronic liver failure and thrombocytopenia: A prospective, open-label study

BACKGROUND

Patients with acute-on-chronic liver failure (ACLF) have a high mortality rate, poor prognosis, and often experience concurrent thrombocytopenia and bleeding events.

AIM

To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) in patients with ACLF with concomitant severe thrombocytopenia.

METHODS

This was a prospective, open-label study. We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and control group, with 35 patients in each group. Patients in the rhTPO group received subcutaneous injections of rhTPO at a dose of 15000 IU/day for 7 consecutive days, while patients in the control group did not receive rhTPO treatment. The primary endpoint was the proportion of patients with platelet count > 50 × 109/L on day 14.

RESULTS

The proportion of patients with platelet count > 50 × 109/L on day 14 was 60.7% in the rhTPO group, which was significantly higher than that (12.0%) in the control group (P < 0.001). The platelet count in the rhTPO group on day 14 was 64 × 109/L, exceeding the baseline of 28 × 109/L. Compared to the control group, the rhTPO group exhibited a significant increase in platelet count from baseline (P < 0.05). Model for end-stage liver disease score, albumin level and international normalized ratio improved significantly from baseline on day 14 after rhTPO injection. The concentrations of serum thrombopoietin and hepatocyte growth factor in the rhTPO group after 7 days were 143.7 and 195.4 pg/mL, respectively, showing a significant increase from baseline (P < 0.05). Eight (22.9%) patients had bleeding events in the control group compared with four (11.4%) in the rhTPO group. The incidence of 90-day mortality was also higher in the control group (6, 17.1%) than that in the rhTPO group (3, 8.6%).

CONCLUSION

rhTPO significantly increased the platelet count in ACLF patients with thrombocytopenia and reduce the occurrence of bleeding events, with a good safety profile.

Gut microbiota plays a key role in the development of colorectal cancer

This letter addresses the recently published manuscript by Darnindro et al, which investigates the diversity and composition of colonic mucosal microbiota in Indonesian patients with and without colorectal cancer (CRC). Although the analysis revealed no statistically significant differences in alpha diversity between the CRC and non-CRC groups, the authors identified notable distinctions in the composition and diversity of colonic mucosal microbiota among patients with CRC compared to those without. At the genus level, a statistically significant difference in microbiota composition was documented between the two cohorts. Specifically, the genera Bacteroides, Campylobacter, Peptostreptococcus, and Parvimonas were found to be elevated in individuals with CRC, while Faecalibacterium, Haemophilus, and Phocaeicola were more prevalent in the non- CRC group.

Rapid pathologic grading-based diagnosis of esophageal squamous cell carcinoma via Raman spectroscopy and a deep learning algorithm

BACKGROUND

Esophageal squamous cell carcinoma is a major histological subtype of esophageal cancer. Many molecular genetic changes are associated with its occurrence. Raman spectroscopy has become a new method for the early diagnosis of tumors because it can reflect the structures of substances and their changes at the molecular level.

AIM

To detect alterations in Raman spectral information across different stages of esophageal neoplasia.

METHODS

Different grades of esophageal lesions were collected, and a total of 360 groups of Raman spectrum data were collected. A 1D-transformer network model was proposed to handle the task of classifying the spectral data of esophageal squamous cell carcinoma. In addition, a deep learning model was applied to visualize the Raman spectral data and interpret their molecular characteristics.

RESULTS

A comparison among Raman spectral data with different pathological grades and a visual analysis revealed that the Raman peaks with significant differences were concentrated mainly at 1095 cm-1 (DNA, symmetric PO, and stretching vibration), 1132 cm-1 (cytochrome c), 1171 cm-1 (acetoacetate), 1216 cm-1 (amide III), and 1315 cm-1 (glycerol). A comparison among the training results of different models revealed that the 1D-transformer network performed best. A 93.30% accuracy value, a 96.65% specificity value, a 93.30% sensitivity value, and a 93.17% F1 score were achieved.

CONCLUSION

Raman spectroscopy revealed significantly different waveforms for the different stages of esophageal neoplasia. The combination of Raman spectroscopy and deep learning methods could significantly improve the accuracy of classification.