Pathway to hepatitis C elimination: insights from a large tertiary hospital in South China

BACKGROUND

Although the introduction of direct-acting antiviral drugs (DAAs) has greatly enhanced the prognosis for hepatitis C, the timely diagnosis and treatment of hepatitis C virus (HCV) infection remain a severe challenge in China.

METHODS

This retrospective study involved 368,577 patients tested for hepatitis C antibodies from 2020 to 2023 at a large tertiary hospital in South China. It primarily focused on analyzing the prevalence of Anti-HCV and HCV RNA and further evaluated the impact of the 'Hepatitis C-Free Hospital' initiative.

RESULTS

Between 2020 and 2023, this large tertiary hospital in South China reported an overall Anti-HCV positivity rate of 1.08%, with males (1.06%) higher than females (0.57%). In particular, the highest rates were observed in males aged 40-49 (2.24%) and females aged 60-69 (1.00%). There was a gradual decline in the Anti-HCV positivity rate over time. As for HCV RNA testing, it indicated an overall positivity rate of 30.95%, more prevalent in males. Significantly, the 'Hepatitis C-Free Hospital' initiative increased HCV RNA testing and treatment completion rates, with sustained virological response (SVR) rates escalating from 92.86% to 99.61%.

CONCLUSIONS

This study identified specific patient groups with high HCV positivity rates. Additionally, the 'Hepatitis C-Free Hospital' initiative significantly increased HCV RNA testing and treatment rates, providing a feasible model for regional HCV elimination.

Seroprevalence of antibodies to hepatitis A, B and C viruses across all age groups in Chonburi Province, Thailand, 2022-2023

Viral hepatitis is a global challenge, particularly in low- and middle-income countries. The World Health Organization aims to eliminate HBV and HCV by 2030, targeting HBsAg prevalence below 0.1% in children under 5. This study analyzed sera from 1,459 participants of all ages in Chonburi province, Thailand, between October 2022 and January 2023 to assess whether this target has been met and to evaluate the seroprevalence of anti-HBs, anti-HBc, anti-hepatitis A virus (HAV), and anti-HCV in this population. Participants were healthy individuals with no immunosuppressed status. Results indicated a 0% HBsAg seroprevalence rate among children under 5, while those born before the universal immunization program had a seroprevalence rate of 5.6%. The lowest rate of anti-HBs seropositivity (anti-HBs ≥10 mIU/mL) was observed among adolescents aged 11-20 (31.7%). The anti-HBc seropositivity rate increased with age, following a pattern similar to HBsAg trends. Only a small percentage of subjects (0.3%) tested positive for anti-HCV. The seroprevalence of anti-HAV was below 20% in individuals under 40. These findings suggest that Thailand has met the regional HBsAg seroprevalence targets for children under 5 due to high HepB vaccination coverage and timely birth doses.

Machine learning-based analyses of contributing factors for the development of hypertension: a comparative study

OBJECTIVES

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

METHODS

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

RESULTS

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

CONCLUSIONS

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

GSK621 ameliorates lipid accumulation via AMPK pathways and reduces oxidative stress in hepatocytes in vitro and in obese mice in vivo

INTRODUCTION

Metabolic-dysfunction-associated fatty liver disease (MAFLD) represents a broad spectrum of liver lipid metabolism disorders associated with metabolic homeostasis, inflammation, oxidative stress, and fibrogenesis. The incidence of MAFLD has increased in recent years, but there is a lack of effective treatment strategies. GSK621 shows potential as a novel adenosine-monophosphate-activated protein kinase (AMPK) agonist; however, its function in lipid metabolism has not yet been confirmed.

OBJECTIVES

This study aimed to determine the effects of GSK621 on liver lipid accumulation in vitro and vivo and explore the underlying mechanism of these effects.

METHODS

The function of GSK621 in lipid deposition was investigated in vitro with HepG2 cells and normal mouse liver cells (AML12), and in vivo using C57BL/6 J mice fed with a high-fat diet (60 % fat) for 8 weeks to establish a model of MAFLD, followed by GSK621 treatment for a further 8 weeks.

RESULTS

GSK621 treatment significantly improved hepatocyte steatosis via the AMPK-carnitine palmitoyl transferase 1 (CPT1A) pathway and decreased levels of reactive oxygen species (ROS) in cells, accompanied by elevated expression of antioxidative stress proteins. MAFLD mice showed significant improvements in liver steatosis after GSK621 treatment, as well as increased expression of liver proteins related to the AMPK pathway and antioxidative stress.

CONCLUSION

GSK621 can improve hepatocytes steatosis in vitro and vivo via the AMPK-CPT1A pathway by increasing lipid metabolism and augmenting expression of antioxidant-stress-related proteins to reduce ROS deposition.

A GWAS of angiotensin-converting enzyme inhibitor-induced angioedema in a South African population

Background

Angiotensin-converting enzyme inhibitor-induced angioedema (AE-ACEI) is a life-threatening adverse event; globally, it is the most common cause of emergency presentations with angioedema. Several genome-wide association studies (GWASs) have found genomic associations with AE-ACEI. However, despite African Americans having a 5-fold increased risk of AE-ACEI, there are no published GWASs from Africa.

Objective

The aim of this study was to conduct a GWAS of AE-ACEI in a South African population and perform a meta-analysis with an African American and European American population.

Methods

The GWAS included 202 South African adults with a history of AE-ACEI and 513 controls without angioedema following angiotensin-converting enzyme inhibitor (ACEI) treatment for at least 2 years. A meta-analysis was conducted with GWAS summary statistics from an African American and European American cohort (from the Vanderbilt-Marshfield cohort, which consisted of 174 case patients and 489 controls).

Results

No single-nucleotide polymorphisms (SNPs) attained genome-wide significance; however, 26 SNPs in the postimputation standard GWAS of the South African cohort and 73 SNPs in the meta-analysis attained suggestive thresholds (P < 5.0 × 10-06). Some of these SNPs were found to be located close to the genes PRKCQ (protein kinase C theta), RAD51B (RAD51 Paralog B), and RIMS1 (regulating synaptic membrane exocytosis 1), which were previously linked with drug-induced angioedema, and also close to the CSMD1 (CUB and sushi multiple domains 1) gene, which has been linked to ACEI cough, providing replication at the gene level but with novel lead SNPs. The study also replicated SNP rs500766 on chromosome 10, which was previously found to be associated with AE-ACEI.

Conclusions

Our results highlight the importance of African populations for detection of novel variants in replication studies. Further increased sampling across the continent and matched functional work are needed to confirm the importance of genetic variation in understanding the biology of AE-ACEI.

Bavachinin causes cholestasis by down-regulating BAAT expression and disrupting glycocholic acid synthesis in human liver organoids

Psoraleae Fructus (Bu Gu Zhi, BGZ) is extensively utilized for dermatological and osseous disorders in China. BGZ-induced liver injury has become one of the major concerns, which predominantly cause cholestasis, with the pathogenesis not being fully elucidated. Currently, studies on hepatotoxic mechanisms of BGZ have mainly been conducted on 2D cell culture systems or rodent models, which may not fully encapsulate human pathophysiology. Therefore, we generated human liver organoids (HLOs) from healthy donor(s) for living-related liver transplantation to explore the hepatotoxic mechanism. We identified bavachinin (BVC) as the most hepatotoxic component for cholestasis. After validating by CLF tests, we identified BVC caused cholestasis by down-regulating BAAT, which catalyzes the amidation of bile acids. We also found that up-regulating BAAT with harmaline could mitigate cholestasis and enhance cell viabilities in HLOs. We further demonstrated that glycocholic acid (GCA) levels decreased in BVC-treated HLOs. Supplementation of GCA to BVC-treated HLOs significantly improved cell viabilities. Collectively, our data suggested that BVC impaired the GCA synthesis by down-regulating the expression of BAAT, thereby inducing cholestasis.

Evaluation of an anti-HCV chemiluminescence assay: Enhancing diagnostic accuracy and reducing false positives in hepatitis C screening

OBJECTIVES

Detection of antibodies is recommended for the diagnosis and effective treatment of hepatitis C. This study evaluated the performance of a new chemiluminescence assay for detecting hepatitis C virus (HCV) antibodies and compared it with previous assays using a comprehensive set of routine and borderline samples.

METHODS

A total of 2,216 serum samples were included in this study, comprising of 2,121 routine clinical samples and 95 borderline cases (COI range: 0.9-5.0). We compared the Anti-HCV-2 assay's (Mindray Diagnostics, Shenzhen, China) performance with the Anti-HCV-1 assay, assessing key parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Precision was tested using replicate samples, and accuracy was validated through confirmatory RIBA (Mikrogen GmbH, Neuried, Germany) and Elecsys Anti-HCV assays (Roche Diagnostics, Mannheim, Germany). Interference testing was conducted to assess the assay's robustness against common substances found in clinical samples.

RESULTS

The Anti-HCV-2 assay demonstrated high sensitivity (98.2 %), specificity (99.1 %), and accuracy (98.7 %) in routine clinical samples. For borderline cases, the accuracy of Anti-HCV-2 was significantly higher (96.84 %) compared to Anti-HCV-1 (3.16 %). Precision testing showed a coefficient of variation (CV) of <2 %, indicating excellent reproducibility. Anti-interference testing confirmed that the Anti-HCV-2 assay performed consistently across samples with common interferences, such as hemolysis and lipemia.

CONCLUSION

The Anti-HCV-2 assay outperforms the Anti-HCV-1 assay in terms of accuracy, reproducibility, and reliability, especially in the range of borderline, making it a valuable tool for routine HCV screening.

No Differences in Risk of Cirrhosis or Hepatocellular Carcinoma Among Treatment Naïve Chronic Hepatitis B Patients by Baseline Hepatitis B Viral Load: A Propensity Score Weighted Analysis

BACKGROUND AND OBJECTIVES

Previous studies among Korean adults with treatment-naïve chronic hepatitis B (CHB) observed paradoxical relationships between baseline hepatitis B virus (HBV) DNA and risk of hepatocellular carcinoma (HCC). However, these observations have not been validated in Western cohorts. We aim to evaluate the longitudinal risk of cirrhosis or HCC among a national cohort of treatment-naïve patients with noncirrhotic chronic HBV.

METHODS

Using a national cohort of U.S. Veterans with CHB (with baseline HBV DNA ≥2000 IU/mL) from 1/1/2020 to 3/31/2024, we evaluated the long-term risk of cirrhosis or HCC stratified by baseline high HBV DNA (>6.00 log10 IU/mL) or moderate HBV DNA (2000-6.00 log10 IU/mL). We applied propensity score weighting methods to adjust for baseline differences between the two groups.

RESULTS

A total of 1198 noncirrhotic treatment-naïve CHB patients with HBV DNA ≥2000 IU/mL were identified (90.7% were men, 41.7% African American, 29.6% non-Hispanic white, 18.2% Asian, mean age was 54.7 years, 27.9% were HBeAg positive). After propensity score weighting was applied, no significant differences in the incidence of cirrhosis or HCC were observed between CHB patients with moderate vs. high baseline HBV DNA (cirrhosis: 1.02 (95% CI: 0.83-1.25) vs. 1.19 per 100 person-years (95% CI: 0.94-1.51); HR 0.93, 95% CI: 0.68-1.28, P = 0.66; HCC: 0.34 (95% CI: 0.24-0.48) vs. 0.29 per 100 person-years (95% CI: 0.18-0.46); HR 1.02, 95% CI: 1.83, P = 0.95).

CONCLUSIONS

Among a national cohort of Western, predominantly non-Asian patients with treatment-naïve CHB, no significant differences in risk of cirrhosis or HCC were observed by baseline HBV DNA. These data suggest that some epidemiological trends and associations observed in Asian CHB populations may not necessarily be generalizable to non-Asian cohorts with different modes of transmission, risk factors, and virus-specific characteristics.

Methyl supplemented diet reduces liver pathology in lupus-prone MRL/lpr mice

Genetic predisposition is a necessary but not sufficient requirement for the development of a pathological immune response in systemic lupus erythematosus (SLE). Various environmental factors and nutrition in particular also play a key role in the pathogenesis of SLE. In the present study, we evaluated the effect of a specific diet containing additional amounts of methyl donors on the development of pathological changes in the liver of lupus-prone MRL/lpr mice. The results showed that long-term administration of the diet reduced the level of inflammation and the number of inflammatory cells in the liver of the treated mice compared to the control group. These data point to methyl-containing micronutrients as a potential immunomodulatory tool and suggest the application of a methyl-supplemented diet as a novel approach to manipulate the course of liver disease in SLE.

Gut-vascular barrier mediated Tripterygium wilfordii-induced liver injury: the synergism between triptolide and celastrol via intestinal FXR-ET-1 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Therapy based on Tripterygium wilfordii Hook F (TWHF) is considered as one of the most effective and vital treatments for managing rheumatoid arthritis. It induces significant liver toxicities in 11.4 % of the patients, but the mechanisms not well known.

AIM OF THE STUDY

This study examined the mechanisms of the drug interaction between Cela and Trip which mediate the hepatotoxicity of TWHF.

METHODS

Pathological and biochemical methods were utilized to evaluated liver damage. The metabolic alterations occurring in the serum and liver were assessed via metabolism. Transmission electron microscope, Evans blue infiltrating, LPS and DAO activity were used to evaluate GVB. Fxr-knockout mice, intestinal FXR agonists and inhibitors were used to reveal the critical role of intestinal FXR in liver injury. Endothelin-1 (ET-1) inhibitors and over-expression vector were applied to evaluate the regulatory role of FXR-ET-1 in GVB.

RESULTS

The synergistic actions of triptolide (Trip) and celastrol (Cela), two major components in TWHF, led to liver injury, which involved sequential events of FXR inhibition, ET-1 up-regulation, and then GVB disruption. The intestinal FXR inhibition by Cela and probe inhibitor, and FXR knockout significantly aggravated liver injury induced by Trip. Activation of intestinal FXR alleviated liver injury via down-regulating ET-1 and improving GVB integrity. And ET-1 was found to mediate the normal structure and function of GVB. In HUVECs, FXR inhibition by Cela potentiated the ET-1 increase and activation of JNK-Caspase3-GSDME by Trip.

CONCLUSIONS

Thus, Cela as an identified intestinal FXR antagonist up-regulated ET-1 expression, thereby disrupted GVB. This interaction between Cela and Trip mediated TWHF-induced liver injury. Activation of intestinal FXR and protection of GVB were suggested to be strategies for the treatment of DILI.

Advancing care in primary biliary cholangitis: emerging insights and novel therapies

INTRODUCTION

- Primary biliary cholangitis (PBC) is a chronic, cholestatic liver disease, is associated with fatigue and pruritus and can progress to cirrhosis if left untreated. Ursodeoxycholic acid (UDCA) has been the mainstay of therapy for over 40 years. However, 30-40% of PBC patients do not adequately respond to UDCA or have risk factors for disease progression and require second-line treatment.

AREAS COVERED

- Recent international cohort analyses have provided new insights that enable early identification of high-risk PBC patients and suggest that stricter treatment goals may lower mortality and reduce the need for liver transplantation. Alongside established second-line agents, several promising substances have progressed to phase 2 and 3 trials. Notably, seladelpar and elafibranor, two selective agonists of peroxisome proliferator-activated receptors, achieved high rates of biochemical response and good tolerability, leading to their recent approval for second-line treatment of PBC. Moreover, dedicated clinical trials addressed fatigue and pruritus, the two main symptoms of PBC.

EXPERT OPINION

- Personalized treatment approaches for PBC are both feasible and essential to improve biochemical response, extend transplant-free survival and alleviate symptom burden. Well-tolerated novel therapies are poised to reshape the treatment landscape in the near future.

Drug metabolizing enzymes and transporters, and their roles for the development of drug-induced liver injury

INTRODUCTION

Drug-induced liver injury (DILI) poses a significant challenge to drug development and human healthcare. The complex mechanisms underlying DILI make it challenging to accurately predict its occurrence, often leading to substantial financial losses from failed drug development projects and drug withdrawals. Growing evidence suggests that drug-metabolizing enzymes and transporters (DMETs) play a critical role in the development of DILI.

AREAS COVERED

In this review, we explore findings about the contributions of DMETs to DILI, with a focus on the studies examining genetic polymorphisms and their interactions with drugs. Additionally, we highlight the roles of DMETs in the development of predictive models for assessing DILI potential and in uncovering the mechanisms involved in DILI.

EXPERT OPINION

As new approach methods (NAMs) for assessing and predicting drug toxicity gain more prominence, it is imperative to better understand the adverse outcome pathways (AOPs) that underpin these methods. DMETs largely play a pivotal role in the molecular initiating events of DILI-related AOPs. Further research is needed to characterize DILI-related AOP networks and enhance the predictive performance of NAMs for assessing DILI risk.

Performance of the cobas 5800 System for Hepatitis B virus DNA and Hepatitis C virus RNA quantification

Hepatitis B and C infections are an underdiagnosed global health problem. Measurement of HBV DNA or HCV RNA levels using nucleic acid-based molecular diagnostic assays has been established as the standard of care for assessing diagnosis, guiding the treatment decision, and evaluating responses to antiviral therapy. In the present study, we examined the performance of the cobas 5800 System for HBV DNA and HCV RNA quantification in a large series of patients chronically infected. Specificity of the cobas HBV and HCV Tests on the 5800 System was high (99.1 % and 100 %, respectively). Linearity using the AcroMetrix panels was excellent. Repeatability and intermediate precision coefficients of variation were within 5 %. Of the 334 clinical specimens tested in parallel on the cobas 5800 and cobas 4800 Systems for HBV and the m2000 RealTime or Alinity m Systems for HCV, only 12 (3.6 %) yielded discrepant results that were at or near the limit of quantification of the cobas 5800 assays. The correlation between viral load results was extremely high, and only weak bias were observed across the entire range of concentrations tested without clinical impact in patients who are eligible for antiviral therapy. This comparison study demonstrated equivalent performance of the new cobas 5800 System compared with other molecular platforms widely used in clinical practice for HBV DNA and HCV RNA quantification. The cobas 5800 System can be confidently used in clinical practice. A few clinical specimens with low viral loads may be missed. Further studies are warranted to confirm or refute this finding.

Pharmacogenomic Considerations in Antibiotic Therapy: A Pathway to Personalized Medicines with Antibiotic Use

Antibiotics have revolutionized medicine, but their use is not without challenges. The efficacy and safety of antibiotics can vary significantly among individuals due to genetic differences. Genetic variation can influence the risk of antibiotic-related adverse effects, and understanding genetics can improve our ability to identify and manage these risks. Pharmacogenomics, the study of how genes affect a person's response to drugs, is emerging as a crucial field in optimizing antibiotic therapy. Pharmacogenomic elements may have a potential role in optimizing drug therapy and reducing adverse drug reactions.

Management of metabolic dysfunction-associated steatotic liver disease (MASLD)-An expert consensus statement from Indian diabetologists' perspective

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high-risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high-risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non-invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well-planned study design that could enhance the scientific value of these statements.

An 11-year retrospective study on hepatitis C in Saudi Arabia: Seroconversion, recovery rates, and viral genotype distribution

Hepatitis C virus (HCV) infection remains a global health concern. This study analyzed 95,864 plasma samples from Saudi patients between 2011 and 2022 to examine HCV seroconversion, viral load, and genotype distribution. Serological screening was performed using the ARCHITECT anti-HCV assay, and HCV RNA levels were quantified with real-time RT-PCR. Of the 970 HCV-positive cases, 47.9 % experienced spontaneous recovery, while 52.1 % had persistent infection. The annual seropositivity rate declined significantly from 2.05 % in 2011 to 0.34 % in 2022. Genotyping of 107 persistently infected samples showed genotypes 4 (49.5 %) and 1a (17.8 %) as the most common, with other genotypes appearing less frequently. Additionally, 13 (12.1 %) samples had untypable genotypes. This study highlights the decrease in HCV infection rates, the high rate of spontaneous recovery, and the predominance of genotypes 4 and 1a. Ongoing surveillance and genotyping, including untypable cases, are essential for effective HCV management in Saudi Arabia.

Impaired mitochondrial degradation of CHCHD2 promotes metabolic dysfunction-associated steatohepatitis-related hepatocellular carcinoma by upregulating VEGFA

Metabolic dysfunction-associated steatohepatitis (MASH) is the fastest-growing cause of liver cancer. The liver microenvironment of patients with MASH supports the development of hepatocellular carcinoma (HCC). Coiled-coil-helix-coiled-coil-helix domain-containing 2 (CHCHD2), which is located in both the mitochondria and nucleus, is increased in MASH liver. Its role in the development of MASH-HCC remain unknown. In this study, we found CHCHD2 protein levels were elevated in both tumor and para-tumor tissues of patients with MASH-HCC and diethylnitrosamine- and high-fat diet-induced MASH-HCC mice. Chchd2-knockout mice were generated. CHCHD2 was overexpressed in hepatocytes using AAV with TBG promoter. Chchd2 knockout inhibited the progression of MASH-HCC in mice. CHCHD2 protein-targeted ChIP-sequencing data revealed that CHCHD2 target genes encoding secretory proteins were enriched in cancer pathways. Among these genes, vascular endothelial growth factor A (VEGFA) level increased in CHCHD2-overexpressing livers and hepatocytes. Chchd2 knockdown reduced palmitate-induced VEGFA expression. Palmitate-treated hepatocyte increased the angiogenic activity of endothelial cells in a paracrine manner, and this was suppressed by Chchd2 knockdown in hepatocytes. CHCHD2-overexpressing hepatocytes promoted the angiogenic activity of endothelial cells. We futher employed an orthotopic murine model of HCC to demonstrate that elevated CHCHD2 protein levels in para-tumor tissues support HCC growth. In addition, we found that the degradation of CHCHD2 was primarily mediated by mitochondrial protease ClpXP, which was repressed in the MASH liver. In conclusion, the mitochondrial degradation of CHCHD2 is impaired in MASH, and elevated CHCHD2 levels in hepatocytes promote VEGFA transcription and support the growth of HCC.

The mediating role of BMI in alcohol-linked liver enzyme elevation among adults at a tertiary care hospital in South India

BACKGROUND

Excessive alcohol consumption is a major risk factor for liver disease, with significant variations in its impact across populations. BMI has been identified as a potential mediator in alcohol-related liver damage. This study aimed to examine the association between alcohol consumption and liver function and to explore the mediating role of BMI in a population from India, where both are rising public health concerns.

MATERIALS AND METHODS

A cross-sectional study was conducted using data from adult participants. Liver function was assessed using serum levels of gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Alcohol consumption was self-reported, and BMI was calculated AST from height and weight measurements. Multiple linear regression models were used to evaluate the relationship between alcohol consumption and liver enzymes while adjusting for BMI as a mediator. Statistical significance was set at P  < 0.05.

RESULTS

The results indicated that higher alcohol consumption was significantly associated with elevated levels of GGT, ALT, and AST. BMI was found to mediate this relationship, with individuals having higher BMI showing a greater increase in liver enzyme levels in response to alcohol consumption. However, no significant association was observed for ALP. BMI also independently correlated with higher levels of GGT, ALT, and AST.

CONCLUSION

This study highlights the mediating role of BMI in alcohol-induced liver dysfunction in the Indian population. Public health interventions focusing on both reducing alcohol intake and managing obesity may help mitigate the risk of liver disease in this high-risk population.

Diosgenin alleviates lipid accumulation in NAFLD through the pathways of ferroptosis defensive and executive system

The most prevalent liver condition globally is non-alcoholic fatty liver disease (NAFLD), for which no approved therapies currently exist. Diosgenin, an important component in plants from the Leguminosae, Dioscoreaceae, and Solanaceae families, has demonstrated considerable anti-inflammatory and antioxidant effects. Nonetheless, the specific mechanism by which it may act in managing NAFLD remains unclear. Our research aims to explore the effects and molecular mechanisms of DG on NAFLD by utilizing both in vivo and in vitro experimental approaches. To investigate the effect of DG on hepatic steatosis, we used Sprague-Dawley rats induced by a high-fat diet (HFD) and HepG2 cells exposed to free fatty acids. Oil red O staining and hematoxylin-eosin (H&E) staining were used to explore lipid accumulation and hepatic degeneration. ROS staining, SOD, MDA, and Fe2+kits were used to detect the indexes related to oxidative stress in ferroptosis in hepatic tissues and cells. IFSP1 and pcDNA3.1-ACSL4 plasmid were used to knock down Ferroptosis suppressor protein1 (FSP1) and promote the expression of acyl-CoA synthetase long-chain family member 4 (ACSL4) in HepG2 cells. DG improved lipid metabolism disorders and liver damage induced by a high-fat diet in rats with NAFLD. Furthermore, the administration of DG notably decreased oxidative stress levels and liver Fe2+ concentrations in rats. Additionally, in vitro experiments demonstrated that DG treatment markedly attenuated ferroptosis and ROS accumulation in HepG2 cells induced by FFAs. Moreover, overexpression of hepatic ACSL4 expression by pcDNA3.1-ACSL4 plasmid promoted the regulatory effects of DG on LPCAT3 and ALOX15. Our research shows that DG can alleviate NAFLD by regulating the FSP1/COQ10 pathway of the ferroptosis defense system and the ACSL4/LPCAT3/ALOX15 pathway of the ferroptosis execution system. Therefore, DG may serve as a novel inhibitor of ferroptosis for the treatment of NAFLD.

Hepatitis B and C Screening and Linkage to Care in Migrants From Endemic Countries in Barcelona Through a Community Action

BACKGROUND AND AIMS

Migrants from endemic areas are key populations for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection screening in Europe. This study assessed the feasibility and outcomes of a community action that combined education, screening, and simplified access to care for migrants in Barcelona.

METHODS

Adult migrants from Pakistan, Romania, and Senegal were included from 2021 to 2023, through a community action involving education, an epidemiological questionnaire, and rapid testing for HBV surface antigen (HBsAg) and HCV antibodies. If positive, DBS samples were collected for laboratory confirmation. Viremic cases were referred to an International Health Unit (IHU).

RESULTS

Overall, 786 participants were included (346 from Pakistan, 304 from Senegal and 136 from Romania). Previous screening for HBV and HCV was 8.0% and 7.7%, respectively. HBsAg prevalence was 0.9% for migrants from Pakistan, 8.2% for those from Senegal and 1.4% for those from Romania (n = 30/786, 23 new diagnoses). Among these, 69.6% attended the IHU and were HBV-DNA positive, but none met treatment criteria. Anti-HCV prevalence was 3.5%, 0.7% and 1.4% for migrants from Pakistan, Senegal and Romania, respectively (n = 16/768, 12 new diagnoses), and HCV-RNA prevalence was 0.9%, 0.3% and 0.7%, respectively (N = 6, all new diagnoses); 4 (66.6%) cases were linked to treatment and two were cured.

CONCLUSIONS

This novel community action successfully reached migrants in a situation of vulnerability and provided them access to testing and care. The high prevalence observed and the limited self-knowledge of their HBV and HCV status justify targeted screening in these groups.

DILI prediction in drug development: present and future

INTRODUCTION

Idiosyncratic drug-induced liver injury (iDILI) results in significant patient morbidity and significantly increases the risk of drug development. The current methods to screen for iDILI risk are inadequate.

AREAS COVERED

The general mechanism of iDILI and the current methods to screen for iDILI are reviewed. Then the potential for new biomarkers is explored.

EXPERT OPINION

Better biomarkers of iDILI risk should be based on the mechanism of iDILI. In general, it is an adaptive immune response, specifically CD8+ cytotoxic T cells, that is responsible for hepatocyte cell death, not direct toxicity of the drug. Therefore, in vitro cytotoxicity assays represent an artifact not the mechanism of iDILI. Activation of the adaptive immune response leading to iDILI requires an innate immune response, in particular activation of antigen presenting cells. The innate immune response is immediate and unlikely to be idiosyncratic. For example, studies have found that incubation of hepatocytes with drugs causes the release of molecules that activate THP-1-derived macrophages. The response of hepatocytes, the release of damage-associated molecular pattern molecules (DAMPs), especially in extracellular vesicles, and the response of antigen presenting cells (APCs) are likely to provide better biomarkers of iDILI risk.

"It's not just running the test": Operator experiences of implementing a decentralised hepatitis C point-of-care testing program in Australia

BACKGROUND

The decentralisation of hepatitis C virus (HCV) point-of-care testing is a core part of Australia's strategy to meet WHO elimination targets. However, little is known about the experiences of providers implementing these interventions and thus what is needed to improve integration. The study aim was to understand operator experiences, including the challenges and enablers, of implementing point-of-care testing as part of a National Point-of-Care Testing Program.

METHODS

Providers who were enrolled in the National Program and qualified to perform point-of-care testing were invited to participate in semi-structured qualitative interviews between April and August 2023. Data were analysed according to iterative categorisation and themes were organised according to Service delivery, Resources, and Governance-elements of the Health Systems Dynamics Framework.

RESULTS

Of the 31 participants, most were from New South Wales (n = 17), were practicing clinicians (n = 18), worked in outpatient or community health clinics (n = 21), and had no previous experience using a molecular point-of-care testing device (n = 24). Many participants struggled to deliver HCV testing and treatment according to national HCV management guidelines. Some participants avoided using the point-of-care testing device altogether. Others found it challenging to manage the administrative load of delivering the National Program, including planning outreach and following-up clients. These challenges were exacerbated by workforce shortages, difficult-to-navigate IT systems, and a lack of specific implementation advice from Program leadership.

CONCLUSIONS

This study illustrates several challenges to and enablers of adopting a decentralised HCV point-of-care testing program, highlighting the need to further explore what providers require to effectively implement these interventions.

Emerging fluorescent probes for bioimaging of drug-induced liver injury biomarkers: Recent advances

Drug-induced liver injury (DILI) has emerged as a significant concern in clinical settings, being one of the leading causes of acute liver failure. However, the specific pathogenesis of DILI remains unclear, and there is currently a lack of effective targeted therapies. Numerous studies have demonstrated that the occurrence and progression of DILI involve complex pathological processes, closely linked with various cellular substrates and microenvironments. Thus, developing non-invasive, highly sensitive, specific, and reliable methods to detect changes in biomarkers and microenvironments in situ would greatly aid in the precise diagnosis of DILI and help guide therapeutic interventions. Fortunately, fluorescence imaging technology has shown great promise in detecting biological species, microenvironments, and diagnosing DILI due to its superior detection capabilities. In this context, this review described the design strategies, working principles, and practical applications of small molecule fluorescent probes for monitoring biological species and microenvironments in DILI. Importantly, this review highlighted current limitations and future development directions, which may help uncover the underlying relationships between biological species, microenvironments, and DILI. This understanding could lead to potential diagnostic protocols and establish a platform for evaluating treatments and drug efficacy in DILI.

Immunosenescence and immunotherapy in elderly patients with hepatocellular carcinoma

Liver cancer, more specifically hepatocellular carcinoma (HCC), is a global health issue and one of the dominant causes of cancer death around the world. In the past few decades, remarkable advances have been achieved in the systemic therapy of HCC. Immune checkpoint inhibitors (ICIs) have become a therapy mainstay for advanced HCC and have shown promise in the neoadjuvant therapy before resection. Despite these significant advancements, the compositions and functions of the immune system occur various alterations with age, called "immunosenescence", which may affect the antitumor effects and safety of ICIs, thus raising concerns that immunosenescence may impair elderly patients' response to ICIs. Therefore, it is important to learn more about the immunosenescence characteristics of elderly patients. However, the real-world elderly HCC patients may be not accurately represented by the elderly patients included in the clinical trials, affecting the generalizability of the efficacy and safety profiles from the clinical trials to the real-world elderly patients. This review summarizes the characteristics of immunosenescence and its influence on HCC progression and immunotherapy efficacy as well as provides the latest progress in ICIs available for HCC and discusses their treatment efficacy and safety on elderly patients. In the future, more studies are needed to clarify the mechanisms of immunosenescence in HCC, and to find sensitive screening tools or biomarkers to identify the patients who may benefit from ICIs.

Natural History of Idiosyncratic Drug-Induced Liver Injury and Prognostic Models

BACKGROUND AND AIMS

Drug-induced liver injury (DILI) remains a leading cause of acute liver failure worldwide. Drugs such as isoniazid, alone or in combination with other anti-tuberculosis drugs, as well as a growing number of herbal and complementary medicines, have been implicated in most cases of acute liver failure in registry studies.

METHODS

This review summarizes current knowdledge on the acute and chronic outcomes in patients with idiosyncratic DILI and discusses several of the existing prognostic models.

RESULTS AND CONCLUSIONS

The reasons why some individuals progress from DILI to end-stage liver disease are still largely unknown. However, collaborative efforts over the past few decades have provided figures on the relative incidence of drug-induced acute liver failure and allowed the development of prognostic models to predict this worse outcome at the onset of the event. The outcome of chronic DILI is less well characterised due to the lack of sufficient follow-up in cohort studies, but several phenotypes of DILI can progress to chronicity, and specific drugs such as nitrofurantoin or amiodarone are classic examples of agents leading to chronic forms of DILI. Therapy for drug-induced acute liver failure and chronic DILI is mainly supportive, although some randomised clinical trials have shown beneficial effects of N-acetylcysteine and corticosteroids.

Histologic Features of Liver Injury Associated With SARS-CoV-2 Messenger RNA Vaccines

CONTEXT.—

Many drugs can induce liver injury; however, vaccine-induced liver injury is a rare phenomenon. SARS-CoV-2 messenger RNA (mRNA) vaccines are now widely administered, and clinical evidence of liver injury has been reported.

OBJECTIVE.—

To characterize the histologic features of SARS-CoV-2 mRNA vaccine-associated liver injury.

DESIGN.—

Thirteen liver biopsies from 12 patients with elevated liver enzymes clinically favored to be secondary to SARS-CoV-2 mRNA vaccine were identified between 2021 and 2022. Demographics, clinical information, and histologic features of liver biopsies were reviewed.

RESULTS.—

All patients (median age, 58 years; M:F = 4:8) received at least 1 dose of SARS-CoV-2 mRNA vaccines (7 Pfizer and 5 Moderna). Four patients had a history of liver disease. Nine patients developed symptoms between 1 day and 2 months after receiving the vaccine dose. Viral serologies were negative. Drug-induced liver injury was thought to be less likely clinically in the 3 patients who had started new medications. Autoimmune antibodies were detected in 9 patients. Moderate to severe active hepatitis was the dominant histologic pattern of injury (9 of 13 biopsies; 69%). Resolving hepatitis, cholestatic hepatitic injury, and bile duct injury were identified in 1 biopsy each. All patients recovered spontaneously or with steroid therapy, except one patient who developed autoimmune hepatitis.

CONCLUSIONS.—

Moderate to severe active hepatitis is commonly observed in SARS-CoV-2 mRNA vaccine-associated liver injury, and female patients may be more susceptible to injury. Liver injury resolves spontaneously or with steroid treatment. In rare cases, these vaccines may trigger an underlying immune condition.

Drug Reaction With Eosinophilia and Systemic Symptoms and Severe Drug-Induced Liver Injury After Off-Label Zonisamide Use for Weight Loss

Drug-related eosinophilia with systemic symptoms (DRESS) is a drug-induced hypersensitivity reaction causing rash and systemic symptoms. Associated liver injury ranges from abnormal laboratory results to liver failure. We report a case of zonisamide-induced DRESS with severe liver injury, characterized by vanishing bile duct syndrome. Despite stopping zonisamide and initiating immunosuppressive therapy, the patient's hepatic function remained abnormal. After a prolonged course, the patient died from pneumonia and Hodgkin lymphoma. This case highlights the gravity of DRESS syndrome and drug-induced liver injury along with the risks of immunosuppressive therapies.

Short communication: miRNA122 interrogation via PCR-Free method to track liver recovery

There is currently a need to investigate new biomarkers of acute liver injury (ALI) that are highly specific to the liver and capable of detecting early-stage liver damage. In this regard, circulating microRNAs (miRNAs), particularly microRNA122 (miRNA122), have recently been proposed as promising new candidate biomarkers. However, the quantification of miRNAs is not a standardized technique and presents several challenges that hinder its routine use. The aim of this work is to validate the innovative Dynamic Chemical Labeling (DCL) PCR-Free technology for its ability to detect miRNA122 in patient samples using Luminex xMAP platforms. The DCL PCR-Free technology was used to directly measure and monitor miRNA122 levels in serum samples from patients with ALI. Patients were monitored throughout the recovery process from liver injury, from the time of detection and for up to 30 days afterwards, with follow-up over three separate visits. The results demonstrate the robustness of the method, with sensitivity of 3.36% and precision of 99.80%, and show a high correlation between miRNA122 and traditional liver injury markers such as ALT (r = 0.8150, p = 0.0001), AST (r = 0.7895, p = 0.0002) and TBL (r = 0.2646, p = 0.3406) throughout the ALI recovery process. In conclusion, measuring miRNA122 levels using the DCL PCR-Free method provides a distinctive approach, not only for diagnosing ALI patients but also for effectively monitoring disease progression, tracking liver recovery, and evaluating treatment effectiveness.

The effect and mechanism of Germacrone in ameliorating alcoholic fatty liver by inhibiting Nrf2/Rbp4

BACKGROUND

Alcohol-related liver disease (ALD) is an important cause of the increase in liver disease-related morbidity and mortality worldwide. Its core pathological features are oxidative stress imbalance and lipid metabolism disorders. Nuclear factor E2-related factor 2 (Nrf2), a key regulator of oxidative stress, maintains cellular redox balance by activating antioxidant genes. However, over-activated Nrf2 may further exacerbate lipid accumulation. Retinol-binding protein 4 (Rbp4) is a key regulator of lipid metabolism, and its abnormal expression is closely related to hepatic steatosis. Therefore, regulating the balance between Nrf2 and Rbp4 may be an effective strategy to improve ALD. This study aims to explore the therapeutic effect of Germacrone on ALD and further reveal the molecular mechanism of Germacrone's improvement of oxidative stress and lipid metabolism disorder by regulating the Nrf2/Rbp4 signaling pathway.

METHODS

An alcohol-induced ALD model was established in C57BL/6 mice. After continuous administration of Germacrone (21 days), the effect of Germacrone on liver lipid accumulation, oxidative stress, and pathological injury was evaluated. The core components and targets of JGST were screened by proteomics and network pharmacology, and the improvement effect of Germacrone on ALD was observed by H&E and oil red O staining, serum biochemical indices, and Western blot analysis. Subsequently, the binding of Nrf2 in the Rbp4 promoter region was analyzed by ChIP experiment. Finally, through in vivo and in vitro experiments, Nrf2 nuclear translocation and downstream target gene Rbp4 expression changes were detected, and Nrf2 knockdown or overexpression experiments were conducted to further verify its regulatory effect on Rbp4.

RESULTS

Proteomic analysis showed that the expressions of HO-1, Gsta1 and Rbp4 in the ALD model were significantly increased, and Rbp4 expression was positively correlated with liver triglyceride (TG) level. Network pharmacological predictions found that Germacrone is the core component of JGST to improve ALD. Germacrone can significantly reduce alcohol-induced liver lipid deposition, oxidative stress, and histopathological damage and significantly reduce the abnormal expression of Nuclear Nrf2 and Rbp4. ChIP experiment results showed that Nrf2 could significantly bind the Rbp4 promoter region - 1534 to - 1473 bp and transcriptionally activate its expression. Meanwhile, In vitro and in vivo experiments further verified that overexpression or activation of Nrf2 could significantly up-regulate Rbp4 expression, while knockdown or inhibition of Nrf2 could significantly decrease Rbp4 expression.

CONCLUSION

Germacrone can protect the liver by inhibiting the Nrf2/Rbp4 signaling pathway, improving oxidative stress and lipid metabolism disorder in the ALD model. Rbp4 is a novel downstream target gene of Nrf2. As a potential drug candidate, Germacrone has great clinical application value.

Integration of bioinformatics and identification of the role of m6A genes in NAFLD

Non-alcoholic fatty liver disease (NAFLD) is prevalent worldwide and seriously affects health. M6A methylation is crucial in its pathogenesis. In this study, a thorough analysis of three gene expression datasets identified nine key differentially expressed genes DEGs associated with m6A methylation in NAFLD that are involved in important biological processes. Subsequently, functional enrichment analysis, weighted gene co-expression network analysis (WGCNA), gene set variation analysis (GSVA) and immune infiltration analysis were conducted to explore the molecular mechanism and gene expression patterns. The LASSO risk model contains a total of 5 m6A-related differentially expressed genes (m6A-RDEGs)(RBM15, IGF2BP2, EIF3B, YTHDC1, WTAP), and the diagnostic model based on these key genes has high accuracy. Among them, YTHDC1 and WTAP are used as prominent biomarkers. In addition, an interaction network between mRNA and miRNA, RNA-binding protein (RBP), transcription factor (TF) and drugs is also constructed. Finally, the animal model of NAFLD was successfully established and validated by RT-qPCR and western blot. This study provides a valuable tool for clinical diagnosis and drives the progress of NAFLD research.

Acute liver failure from anti-tuberculosis drug-induced liver injury: An update

Tuberculosis (TB) is still a major public health issue in developing countries, where it causes a heavy disease burden. Although current anti-TB treatment regimens demonstrate high efficacy, the hepatotoxic potential of first-line anti-TB drugs (ATDs) - particularly isoniazid, rifampicin, and pyrazinamide—poses a considerable risk, as these agents are associated with a significant incidence of ATD-induced liver injury (AT-DILI). The clinical presentation of AT-DILI can range from asymptomatic elevations in serum transaminases, which may resolve spontaneously due to hepatic adaptation, to acute liver failure (ALF), a potentially life-threatening condition. A recent meta-analysis reported a global incidence of AT-DILI of 11.5%, with rates varying from 2% to 28%. Approximately 7% of patients with AT-DILI progress to ALF, a condition characterized by a poor survival rate with medical therapy. ATD-induced ALF (AT-ALF) is clinically indistinguishable from ALF due to other causes and disproportionately affects young female patients, typically within eight weeks of treatment initiation. Emergency liver transplantation has become an effective therapeutic option for AT-ALF, although outcomes are generally poorer compared to elective transplantation. This minireview provides a comprehensive overview of AT-ALF, covering its epidemiology, risk factors, clinical presentation, prognosis, and treatment options.

Mechanism-guided drug development and treatment for liver fibrosis: a clinical perspective

Liver fibrosis is a common response to chronic liver injury due to multiple etiologies and plays a crucial in the progression of chronic liver disease to cirrhosis, hepatocellular carcinoma, and other liver-related clinical outcomes. Currently, available treatments to block liver fibrosis are designed to eliminate the underlying causes of liver disease. The lack of truly effective drugs to regress or reverse fibrosis is a major unmet clinical need. In this context, this article briefly describes the pathological process of hepatic fibrosis and focuses on reviewing the progress of clinical studies on mechanism-based anti-fibrotic drug development and therapy, highlighting that the positive effect of thyroid hormone receptor-β (THR-β) analogs, fibroblast growth factor 21 (FGF21) analogues, Glucagon-like peptide 1 receptor (GLP-1R) agonists, pan-peroxisome proliferator-activated receptor (pan-PPAR) agonists, fatty acid synthase (FASN) inhibitors, and hydronidone in reducing liver fibrosis caused by specific etiologies. Moreover, multi-pathway guided combination therapy or traditional Chinese medicine demonstrate significant advantages in combating liver fibrosis. Finally, new technologies and approaches affecting the clinical development of anti-hepatic fibrosis drugs were discussed.

Endometriosis-like lesions induced by phthalates: new phytotherapic applications to complement traditional cares: a PNRR 2023 project

BACKGROUND

Endometriosis (E) is an oestrogen-dependent, multifactorial, inflammatory disease causing pelvic pain and infertility. Several concerns have been raised about the role of food contaminants, in particular Bis(2-ethylhexyl) phthalate (DEHP), potentially involved in the onset and propagation of E. Conventional therapies- which have considerable side effects - focus on reducing levels of oestrogens and counteracting inflammation. The potential preventive/protective role of plant extracts (PEs) on phthalate (PH) -induced E is studied by a stepwise approach.

METHODS

(i) raw material identification, extraction and phytochemical characterization; (ii) in vitro tests to evaluate pharmacokinetics and organotropism; (iii) in vitro screening on 2 human endometrial cell lines and in vivo toxicokinetic to select the PEs/BCs in comparison with non-steroidal anti-inflammatory drugs; (iv) in vivo juvenile toxicity study to test the PE/BC activity on DEHP induced E-like lesions and (v) ex vivo and in vitro studies on human E primary cells obtained by patients with E to be subjected to scheduled surgical procedures and human non-cancerous cells, to investigate the DEHP and metabolite concentration and PE/BC effects, respectively.

DISCUSSION

The project aims to provide data and tools to develop a new strategy based on herbal medicine- especially polyphenolic compounds for their pleiotropic activities - to mitigate the E symptoms and to prevent and/or to protect population - including susceptible sub-groups - from the onset of E. The outcomes of the project will support the Italian National Health System in the development of complementary alternative/preventive strategies for E and to set clinical studies on humans also considering the potential role of environmental contaminants in E pathogenesis.

CLINICAL TRIAL NUMBER

Not applicable.

Mechanisms of drug induced liver injury

Drug induced liver injury (DILI) is a serious and potentially life-threatening condition resulting from an adverse drug reaction. Both the clinical manifestations and pathological mechanisms of DILI vary depending on drug characteristics, dose, duration of exposure as well as host specific factors. Disease onset can occur within days or months after the introduction of a drug. This has challenged identification of disease specific biomarkers and resulted in delayed and even erroneous diagnosis of patients. Apart from discontinuation of current pharmacotherapy, options for DILI patients are scarce and the condition can sometimes continue or worsen after drugs are discontinued or result in irreversible liver damage such as cirrhosis. This illustrates the need to uncover relevant pathological pathways that will pave the road for targeted interventions. In an effort to accommodate these needs, novel insights from preclinical and cellular disease modeling have allowed coupling of specific drugs to potential mechanisms of toxicity. This review outlines three signaling pathways of DILI: organelle stress, cholestasis, and immune responses, discusses their interplay with oxidative stress, and provides examples of drugs specifically targeting one or more steps in these pathways. A systematic approach identifying specific mechanisms of DILI could allow for the assembly of large databases, in turn enabling advanced computational modelling to provide accurate predictions of the DILI potential of both known drugs and future drug candidates.

Impact of novel aldose reductase inhibitor drug on gut microbiota composition and metabolic health in ZDF 'lean' rats

A novel multi-target drug, cemtirestat, inhibiting aldose reductase (ALR2) has been developed to prevent secondary diabetic complications and act as an antioxidant against hyperglycemia-related processes. This study examines cemtirestat's impact on gut microbiome composition, drug metabolism, and therapeutic efficacy in male Zucker diabetic fatty (ZDF) "Lean" rats. Rats were divided into the control group (C) and the treated group (T), which received 7.7 mg/kg/day cemtirestat for two months, with weekly monitoring of food, fluid intake, and weight gain. Stool, urine, and plasma samples were analyzed biochemically, and fecal DNA was sequenced using Oxford Nanopore Technology. Treated rats exhibited less weight gain, likely due to cemtirestat's antioxidant effects. Biochemical analyses revealed no significant changes in glucose, liver enzymes, or cholesterol. Although there was a slight increase in alanine aminotransferase (ALT), our study found that levels of other liver enzymes such as aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin remained within normal limits, suggesting the observed increase in ALT was not indicative of drug-induced liver injury. LefSe microbiome analysis revealed an enrichment of beneficial bacteria like Blautia and Faecalibacterium in treated rats. Microbial community structure did not distinctly separate treated from control groups, but differences emerged over time. DeSeq2 analysis identified varying genera abundances over weeks, with treated samples enriched in beneficial bacteria by Week 8. Correlation analysis linked plasma insulin levels positively with Prevotella and negatively with Clostridium and Lactobacillus. Cemtirestat's impact on weight and microbiota suggests the potential to improve gut health. Further research is required to uncover cemtirestat's mechanism in diabetes management, drug metabolism, and therapeutic efficacy.

Acceptability and usability of oral fluid HCV self-testing among health-facility users from Brazil: a cross-sectional study of 685 participants

INTRODUCTION AND OBJECTIVES

HCV Self-Testing (HCVST) can be used to uptake HCV testing. We aimed to evaluate the acceptability/usability and re-reading/re-testing agreement of oral fluid HCVST among health-facility users in the Primary Care Systemin Brazil.

MATERIALS AND METHODS

Consecutive people aged 18‒79 years using the Primary Care System (PCS) from 04-July-2022 to 30-September-2022 were invited for this cross-sectional study. The professional use OraQuick® HCV Rapid Antibody Test was used as a HCVST prototype. Oral fluid HCVST was performed relying on a step-by-step video and written/pictorial instructions. Usability was assessed by observed errors and documented need of assistance by a Healthcare Worker (HCW). After HCVST, a second HCV test was performed by the HCW using the same test-kit. Re-reading and re-testing concordances were evaluated (Cohen's kappa, κ). Post-testing participant's perspectives were assessed.

RESULTS

685 participants (74.5% female; median age = 52 [IQR 39‒61] years, 52.5% with schooling ≤ 10 years) were included. Major observed errors [%(95%CI)] were incorrect sample collection [32.8% (29.4‒36.5)] and wrong placing the test device in the tube [15.0% (12.6‒17.9)]. A total of 35.6% (95% CI 32.1‒39.3) of participants needed assistance in at least one step of HCVST. Re-reading and re-testing agreements were 95.2% (κ = 0.56) and 99.7% (κ = 0.67; n = 626 excluding invalid tests), respectively. After HCVST, 93% felt safe, 99% would be willing to test again, and 99% would recommend HCVST. Most participants rated the HCVST experience as easy (73%) or very easy (24%).

CONCLUSION

Oral-fluid HCVST was feasible and well-accepted among users of the PCS in Brazil. HCVST can be an alternative to scale-up HCV testing.

Association between Triglyceride-Glucose index and onset of type 2 diabetes in metabolic Dysfunction-Associated steatotic liver disease population

Previous studies have demonstrated a strong correlation between the Triglyceride-Glucose Index(TyG) index and diabetes mellitus; however, limited research has focused on the relationship between the TyG index and the incidence of diabetes mellitus in the Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) population. This study aims to investigate the association between the TyG index and the occurrence of diabetes mellitus in the MASLD population in Japan. This retrospective cohort study included 2,741 patients with MASLD from Murakami Memorial Hospital in Japan, spanning the years 2004 to 2015. The primary method employed to investigate the relationship between the TyG index and the occurrence of diabetes was Cox proportional hazards regression. Additionally, a Generalized Additive Model and a two-piecewise linear regression model were utilized to assess whether a linear relationship exists between the TyG index and the development of diabetes, as well as to calculate threshold effects. After adjusting for variables that may potentially influence the occurrence of diabetes, we found that the TyG index was positively correlated with diabetes incidence (HR = 1.43, 95% CI: 1.03, 1.98) in MASLD population overall. Further in-depth analysis revealed a nonlinear relationship between the TyG index and the occurrence of diabetes. When the TyG index was less than 7.95, it exhibited a negative correlation (HR = 0.22, 95% CI: 0.07, 0.66); however, when the TyG index exceeded 7.95, it showed a positive correlation (HR = 1.68, 95% CI: 1.20, 2.36). Additionally, we conducted a subject working curve analysis on the TyG index and the two components used to calculate it, fasting blood glucose and triglycerides, and found that the TyG index demonstrated higher sensitivity and specificity in predicting the occurrence of diabetes in the MASLD population. TyG index exhibits a nonlinear relationship with the incidence of diabetes in the MASLD population, and its sensitivity and specificity are superior to those of fasting blood glucose and triglycerides.

Prevalence-based screening by anti-HCV reflex HCV antigen test and accessible post-screening care towards elimination of hepatitis C in rural villages

BACKGROUND

One major barrier to the goals of hepatitis C virus (HCV) elimination is identification and linkage-to-care for those with HCV infection. The aim of this research was to develop a strategy to help achieve HCV elimination in remote rural villages.

METHODS

According to the maps of the township- and village-specific testing rates and prevalence rates of anti-HCV produced by the Public Health Bureau of Yunlin County, a high anti-HCV prevalent township Sihhu and four nearby villages were selected for an intensive screening with anti-HCV reflex HCV antigen test. A temporary outreach hepatology clinic was set in Sihhu Township Health Center to enhance accessibility for post-screening care of those positive for HCV antigen.

RESULTS

The population aged ≥ 40 years of the included villages at time of survey was 18,018 with 5,343 (29.7%, range 18.8-39.7%) having ever been previously screened, and 1,503 responded to this screening. The crude screening coverage rate increased to 38.0% (range 27.6-47.2%) after this screening campaign. The prevalence rates of anti-HCV and HCV antigen were 17.3% and 8.3% respectively, with the rate of antigenemia (HCV antigen/anti-HCV) being 48.1%. The number needed to test (NNT) to find a candidate for anti-viral treatment was 12. Patients can choose any medical institution for consultation based on their preference. The local health centers could trace the consultation status of all 125 HCV patients, with 119 of them receiving direct-acting antiviral (DAA) treatment. Out of the 125 patients with positive HCV antigen, 75 were evaluated at the outreach clinic, with 70 ultimately receiving DAA treatment at the outreach clinic and 5 receiving treatment at other hospitals. Evaluable sustained virological response rate for the 70 patients was 97%.

CONCLUSION

Prevalence-based screening and accessible outreach clinic can help accelerate HCV elimination in rural villages.

Therapeutic potential of fisetin in hepatic steatosis: Insights into autophagy pathway regulation and endoplasmic reticulum stress alleviation in high-fat diet-fed mice

Non-alcoholic fatty liver disease (NAFLD) is a common condition with limited FDA-approved treatments due to its complex pathogenesis. Metabolic stress-induced lipotoxicity triggers the unfolded protein response, leading to the development of NAFLD through inflammation and apoptosis. Moreover, metabolic dysregulation compromises autophagic capacity, impairing effective ERphagy and lipophagy in the liver. Fisetin (FSN), a flavonoid present in various fruits and vegetables, has demonstrated the ability to regulate the processes mentioned above and possesses a range of biological properties. In this study using a high-fat diet-induced NAFLD mouse model, treatment with FSN at a dosage of 80 mg/kg per day for eight weeks resulted in reduced hepatic lipid accumulation. This effect was mediated by modulating ER stress through enhancing autophagic activity, as indicated by decreased expression of GRP78, elf2a, ATF4, and CHOP genes, along with increased AMPK phosphorylation, decreased mTOR expression, and elevated levels of ULK1, ATG5, and Beclin1. Additionally, there was an increase in the LCII/LC3I ratio and a reduction in p62 levels in hepatic tissue. Our findings suggest that FSN exerts its effects by activating the AMPK/mTOR signaling pathway and its downstream targets, underscoring its potential therapeutic advantages in managing NAFLD by targeting autophagy and ER stress pathways.

High fat diet (HFD) induced hepatic lipogenic metabolism and lipotoxicity via Parkin-dependent mitophagy and Errα signal of Pelteobagrus fulvidraco

BACKGROUND

Mitophagy is an essential cellular autophagic process which maintains mitochondrial homeostasis, but its role in high fat diet (HFD)-induced lipid accumulation is unclear in the yellow catfish. Thus, this study aimed to elucidate mechanism of mitochondria mediating HFD-induced hepatic fat accumulation.

RESULTS

In the present study, yellow catfish were fed three diets with dietary fat at 6.31% (low fat; LFD, control), 12.03% (middle fat; MFD) and 15.32% (high fat; HFD), respectively, for 8 weeks. High dietary fat addition raised hepatic lipid accumulation, and declined mRNA and protein levels of Parkin-dependent mitophagy, down-regulated the Parkin protein expression and the estrogen-related receptor alpha (Errα) ubiquitination, and induced Errα protein levels; fatty acid (FA) incubation reduced Parkin-dependent mitophagy, inhibited Errα ubiquitination and increased Errα protein expression, and raised TG accumulation. Furthermore, yellow catfish hepatocytes were isolated and cultured. Nicotinamide mononucleotide, N-acetyl-L-cysteine, Parkin and errα siRNA knockdown were used under FA incubation, respectively. Parkin downregulation mediated FA incubation-induced TG accumulation and mitoautophagic inhibition; Parkin ubiquitinated Errα, and K63 was an important ubiquitination site for deubiquitinating Parkin activity; Errα targets fas, acca and pparγ genes, whose activation contributed to FA-induced lipogenesis and lipid accumulation. Thus, high fat diet (HFD) and FA incubation inhibited Parkin activity, suppressed mitophagy and activated Errα pathway, and induced hepatic lipogenic metabolism and lipotoxicity.

CONCLUSIONS

Overall, our study provided new targets against HFD-induced hepatic lipid accumulation and non-alcoholic fatty liver disease in the vertebrates.

Clinical Trials for Hepatitis Delta Virus in the WHO African region: A neglected virus among neglected viruses

OBJECTIVES

We set out to evaluate the extent to which Hepatitis Delta Virus (HDV) Clinical Trials (CT) include populations from the World Health Organisation (WHO) African region, aiming to highlight inequities and advocate for global investment in inclusive HDV research.

METHODS

We screened the clinicaltrial.gov and the WHO International Clinical Trials Registry Platform (ICTRP) repositories for 'Hepatitis Delta virus' and 'HDV' related CT. Datasets were merged using R v.4.2.1. We classified studies according to location and associated WHO region.

RESULTS

We identified a total of 47 CT on HDV, mainly conducted in Europe (69.3%), Western Pacific (19.6%) and the Americas (8.5%). Despite the highest estimated anti-HDV seroprevalence in the general population, there were no CT registered in the WHO African region. CT are still predominantly done in the regions of initial drug discovery, as seen with bulevirtide (Europe) and lonafarnib (Americas).

CONCLUSION

HDV-focused CT are needed in the WHO African region, as the region with the highest disease burden, and unique genotypes (5-8); to evaluate efficacy of novel anti-HDV compounds and to ensure that new treatments can be distributed and deployed as they become available.

Hemophagocytic Lymphohistiocytosis Complicating a Case of Drug-Induced Liver Injury Precipitated by Cephalexin: A Rare Consequence of Commonly Prescribed Medications

Drug-induced liver injury (DILI) is a relatively rare clinical syndrome that accounts for a significant proportion of acute liver failure progressing to transplant in the United States. Some drugs such as acetaminophen are classically associated with a predictable pattern of DILI that can often be reversed with prompt administration of guideline-directed therapeutics. In other cases, commonly prescribed medications can lead to an unpredictable variant of DILI in certain vulnerable populations for which few guidelines on management exist, likely in part due to the heterogeneity of precipitating toxins. We report a case of idiosyncratic DILI caused by cephalexin that progressed to fulminant hemophagocytic lymphohistiocytosis (HLH) in a young and previously healthy patient, alongside our experiences with therapeutic management and outcomes guided by a multidisciplinary team.

Immune-mediated adverse events following atezolizumab and bevacizumab in a multinational Latin American cohort of unresectable hepatocellular carcinoma

AIMS

Latin America has been underrepresented in trials evaluating immunotherapy for hepatocellular carcinoma (HCC). We aimed to describe the incidence of immune-related adverse events (irAEs) and their impact on outcomes in a Latin American cohort.

METHODS

A multicenter prospective study was conducted in Argentina, Brazil, Chile, and Colombia, including patients who received atezolizumab plus bevacizumab. A time-covarite proportional hazard analysis evaluated the effect of irAEs.

RESULTS

99 patients were included. The median treatment duration was 6 months, with a median survival of 17.0 months (95% CI: 12.6-19.8). The irAE incidence rate was 2.1 cases per 100 persons-months (cumulative incidence 18.1% (95% CI: 11.1-27.2%)). Median time to irAE was 2.3 months (range 1.4-4.8), most frequently hepatitis (n = 6), thyroiditis (n = 5), and 8/18 required steroids. Follow-up, treatment duration, and overall survival were similar regardless of the occurrence of irAEs (HR = 1.71, 95% CI: 0.76-3.86; P = 0.19). Baseline alpha-feto protein ≥400 ng/ml (HR: 2.9 (95% CI: 1.1-7.6)) was independently associated with irAE.

CONCLUSION

The incidence of irAEs in this cohort is lower than reported in controlled trials, withouut impact on survival outcomes. Education and early recognition are crucial to ensure that these events are identified and addressed.

Causal relationship between metabolic dysfunction-associated fatty liver disease and endotoxin biomarkers: A Mendelian randomization study

Although the relationship among lipopolysaccharides (LPS), LPS-binding proteins, and metabolic dysfunction-associated fatty liver disease (MAFLD) is widely studied, no conclusive evidence is available. In this study, we used mendelian randomization (MR) to study the causal relationship of LPS, LPS-binding proteins, and MAFLD. Using bidirectional two-sample MR method, we evaluated data from the genome wide association study; for this analysis, nonalcoholic fatty liver disease (NAFLD), liver fat percentage, and other metabolic syndromes were employed as outcomes. Furthermore, MR analysis mainly involved the inverse variance weighted method. Heterogeneity and pleiotropy tests were also conducted. LPS was found to have a causal relationship with NAFLD, obesity, high density lipoprotein cholesterol, and TG levels. Furthermore, TG levels and LBP had significant causal relationships. This study mainly concluded that LPS is a risk factor for NAFLD, obesity, high density lipoprotein cholesterol, and TG, corroborating it's the LPS role in MAFLD pathogenesis. Hence, optimizing the gut microbiota using proper diet, probiotics, or fecal microbiota transplantation may help to reduce inflammation and (IR), thereby improving lipid and glucose metabolism disorders. Although a causal relationship between TG and LBP was observed, further studies are required to determine a specific mechanism.

Deciphering the Language of Intestinal Microbiota Associated with Sepsis, Organ Failure, and Mortality in Patients with Alcohol-Related Acute-on-Chronic Liver Failure (ACLF): A Pioneer Study in Latin America

ACLF is a severe stage of liver cirrhosis, characterized by multiple organ failure, systemic inflammation, and high short-term mortality. The intestinal microbiota (IM) influences its pathophysiology; however, there are currently no studies in Latin American populations. Therefore, we analyzed IM and its relationships with sepsis, organ failure, and mortality. In parallel, we quantified serum lipopolysaccharides as a marker of bacterial translocation. Fecal samples from 33 patients and 20 healthy controls (HCs) were obtained. The IMs were characterized by 16S-rRNA amplicon sequencing, the metagenomic functional predictive profiles were analyzed by PICRUSt2, and LPS quantification was performed by ELISA. Patients with ACLF showed significant alterations in alpha and beta diversity compared to the HCs. A strong dominance index accurately predicted 28-day and 90-day mortalities. The IMs showed a polarization toward Proteobacteria associated with increased LPS. The LPS correlated with clinical severity, organ dysfunction, and higher pathogenic taxa. The Klebsiella/Faecalibacterium ratio showed good performance in identifying sepsis (AUROC = 0.83). Furthermore, Morganella, Proteus, and Klebsiella were enriched in patients with multiorgan failure. Lactobacillus, Escherichia/Shigella, Veillonella, and Ruminococcus gnavus exhibited potential in predicting 28- and 90-day mortalities. The IM alterations in ACLF may be useful as clinical biomarkers of poor prognosis, primarily for mortality and sepsis. These findings are representative of western Mexico.