Construction of a novel highly selective NIR probe for monitoring the changes of glutathione levels in drug-induced liver injury

Drug-induced liver injury (DILI) is a leading cause of acute liver failure, which is closely associated with oxidative stress. Glutathione (GSH), a vital sulfhydryl peptide, maintains cellular redox balance and signaling. In this study, we have successfully developed a highly selective near-infrared fluorescent probe, AH-F, which exhibits a 357-fold enhancement in fluorescence upon detection of GSH. With the aid of AH-F, the pertinent physiological parameters in a murine model were characterized by cellular and drug-induced liver injury, concurrently allowing for the assessment of the therapeutic efficacy of relevant pharmaceutical interventions.

Drug-Induced Liver Injury

Drug-induced liver injury (DILI) is an underrecognized cause of hepatic disease in dogs and cats. Successful identification of cases requires an initial suspicion by the practitioner, a thorough drug exposure history, and knowledge of the toxic potential for common veterinary drugs. This article reviews the pathogenesis, classification, and diagnosis of DILI in small animals. It also discusses the clinical presentation, prevalence, and outcomes of DILI for several drugs important in veterinary medicine including azathioprine, azole antifungals, carprofen, diazepam, doxycycline, lomustine, methimazole, phenobarbital, rifampin, sulfonamide antibiotics, and zonisamide, as well as the toxic potential for nutraceuticals and herbal preparations.

FTY720 alleviates HBV-mediated inflammatory liver injury through a dual role of inhibiting lymphocyte trafficking and viral replication

BACKGROUND

The host immune response plays a critical role in clearing hepatitis B virus infection. However, in chronic hepatitis B, this response fails to eliminate the virus, leading to recurrent inflammation, liver tissue damage, and a gradual progression from hepatitis to fibrosis, and eventually, hepatocellular carcinoma. Reducing liver injury while enhancing antiviral efficacy remains a key objective in hepatitis B virus treatment development. Our previous research revealed a close association between hepatitis B virus infection and the sphingosine 1-phosphate signaling pathway. Consequently, this study aims to explore the dual role of FTY720, an immune modulator that targets sphingosine- 1-phosphate receptor, in hepatitis B virus-related liver injury.

METHODS

In this study, The peripheral blood leukocyte count and the expression of sphingosine 1-phosphate receptor on lymphocytes were compared between chronic hepatitis B patients and healthy controls. In vitro experiments were conducted to evaluate the direct antiviral effects of FTY720 on two hepatitis B virus models: HepG2.2.15 and Huh7 cells transfected with pUC19-HBV1.3. Additionally, the study investigated the influence of FTY720 on the chemotaxis of peripheral blood mononuclear cells induced by the supernatant of hepatitis B virus-infected HepG2-NTCP cells. An in vivo model using hepatitis B virus hyperbaric hydrodynamic injection in mice was also employed to assess the impact of FTY720 on both HBV replication and hepatic lymphocyte infiltration.

RESULTS

Peripheral blood lymphocyte counts were reduced, while sphingosine 1-phosphate receptor expression was elevated in chronic hepatitis B patients compared to healthy controls. Simultaneously, antiviral therapy solely utilizing nucleotide analogues could not fully restore the peripheral blood lymphocyte count in patients with chronic hepatitis B. In vitro, FTY720 effectively inhibited hepatitis B virus replication in two models: HepG2.2.15 cells containing hepatitis B virus virions and pUC19-HBV1.3-transfected Huh7 cells. Furthermore, supernatants from hepatitis B virus-infected HepG2-NTCP cells induced increased lymphocyte chemotaxis, which was suppressed by FTY720. In a hepatitis B virus mouse model, FTY720 significantly reduced viral DNA and protein levels, while also decreasing inflammatory hepatocyte necrosis, liver lymphocyte infiltration, and sphingosine 1-phosphate receptor expression on circulating lymphocytes.

CONCLUSIONS

These findings suggest that FTY720 can inhibit both hepatitis B virus replication and hepatitis B virus-related liver damage by modulating lymphocyte migration. Further investigation into the specific mechanisms underlying the interaction between FTY720 and hepatitis B virus is warranted.

TeleHCV: A single-visit protocol and minimal passive remote monitoring are sufficient to achieve high SVR with a sofosbuvir-velpatasvir regimen

AIM

Chronic Hepatitis-C Virus (HCV) treatment has evolved significantly in recent years with Direct-Acting Antivirals (DAAs). The traditional care cascade includes several steps that limit its impact, and simplification protocols have emerged. Therefore, the authors explore a simplified treatment strategy for HCV in a healthcare system with limited access to specialized care.

SUBJECT AND METHODS

Chronic HCV, DAA-naïve patients waiting for in-person specialized care were invited to a single-arm non-inferiority trial to evaluate a simplified treatment protocol with a single face-to-face appointment and minimal monitoring of antiviral therapy. The unique visit consisted of an HCV presentation followed by individual medical consultation, blood tests, and delivery of sofosbuvir-velpatasvir pills for a 12-week treatment. Patients were remotely monitored without scheduled on-treatment appointments or phone calls. After treatment, teleconsultation using video was offered. The primary outcome was Sustained Virological Response (SVR) 12-weeks post-treatment. It was analyzed with Intention-To-Treat (ITT) and Per-Protocol (PP) approaches.

CLINICALTRIALS

gov: NCT04039698.

RESULTS

The authors included 144 patients, of which 54.2 % were male, mean age was 52 years. Most individuals (84.7 %) had an APRI score < 1. All patients received at least one dose of DAA, 139 completed antiviral therapy, and 131 had SVR evaluation. The ITT SVR rate was 90.3 % (130/144 patients; 95 % CI 84.2 %‒94.6 %), and the PP SVR was 99.2 % (130/131 patients; 95 % CI 95.8 %‒100 %). Eighty-three adverse events were reported, and 93 % were handled with remote care.

CONCLUSION

This simplified strategy achieved a high SVR rate in a population with restricted access to specialized care. Telehealth tools and minimal monitoring are promising components for policies aimed at HCV elimination.

Enhancing public health surveillance: SARIMAX model incorporating Baidu search index for HCV prediction in China

BACKGROUND

Hepatitis C virus (HCV) has become a serious global public health issue. Existing study has confirmed the potential role of internet search data in the prediction of infectious diseases. This study aims to explore predictive models suitable for HCV, providing references and recommendations for actively responding to the World Health Organization's strategy to eliminate HCV by 2030.

METHODS

We collected the publicly available daily reported case numbers of HCV and the daily search volume of HCV-related keywords in Baidu Search Index (BSI) from January 2011 to September 2023. Identify keywords highly correlated with HCV using Spearman rank correlation and time series cross-correlation analysis to construct a comprehensive search index. Finally, seasonal autoregressive integrated moving average (SARIMA) and seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) models were developed based on monthly HCV case numbers and the comprehensive search index (CSI). The performance of these predictive models was evaluated using mean absolute error (MAE), root mean square error (RMSE), and mean absolute percentage error (MAPE).

RESULTS

From January 2011 to September 2023, China reported a cumulative total of 2,949,160 HCV cases, with a monthly average case number of 19,276. The incidence of HCV is highest in March each year, with a slight decrease in February, exhibiting a seasonal cycle pattern. Influenced by the COVID-19 pandemic, the incidence of HCV showed a notable decrease in 2020 and 2022, but overall, it has been on an upward trend. After correlation analysis, a total of five keywords were included, with a potential time lag of 0 months for the keywords. The selected SARIMA(0,1,1)(2,1,1)(12) + CSI(Lag = 0) model produced lower errors in both fitting and forecasting than the SARIMA(0,1,1)(2,1,1)(12) model: MAE (706.7052 versus 759.1066 and 1754.05 versus 3940.86), RMSE (973.3811 versus 1123.343 and 2733.02 versus 4846.49), MAPE (3.72% versus 4.08% and 0.12% versus 0.24%).

CONCLUSIONS

The findings suggest that the SARIMA(0,1,1)(2,1,1)(12) + CSI(Lag = 0) model exhibits superior predictive performance, maintaining accuracy even when faced with the public health emergency of COVID-19. The proposed SARIMAX model in the study will provide more robust support for achieving the 2030 HCV dynamic zero strategy.

Hepatitis C testing and linkage to care in a safety-net hospital emergency department

BACKGROUND AND PURPOSE

In 2020, the CDC expanded hepatitis C (HCV) screening recommendations to include universal screening for persons 18 and older. We implemented universal screening in the emergency department (ED) within a safety-net health system. We aimed to measure HCV prevalence and linkage to care (LTC) outcomes in the ED and compare them to the outpatient clinics within the same health system.

METHODS

Patients aged 18-79 without HCV qualified for screening. We measured prevalence of both anti-HCV+ (exposure) and HCV RNA+ (active infection). Those with active HCV were flagged for LTC and their charts were followed for outcomes. HCV prevalence and LTC in the ED were compared to those in outpatient clinics over the same time.

RESULTS

9511 patients were screened for HCV from 2019 to 2022 in the ED. 6.9 % (659) were anti-HCV+. 54.9 % (320 of 582) of anti-HCV+ individuals or 3.4 % of those screened (320 of 9511) were HCV RNA+. The LTC rate was 24.1 % (77 of 320) and a total of 56 individuals (17.8 % of all HCV RNA+ ED patients, 72.7 % of those linked) initiated treatment. HCV prevalence was higher in the ED compared to the outpatient clinic setting. Demographics and LTC rates also significantly differed between these two cohorts.

CONCLUSIONS

We identified a higher HCV prevalence in the ED relative to the outpatient clinic setting and significant need for improvement in LTC and HCV treatment initiation. Our findings suggest universal screening is an important tool to diagnose HCV infections but may require novel strategies for improved LTC and treatment initiation.

Histopathology of Autoimmune Hepatitis: An Update

Autoimmune hepatitis (AIH) is a rare immune-mediated chronic liver disease that is diagnosed based on a combination of biochemical, immunologic, and histologic features and the exclusion of other causes of liver disease. According to the new consensus criteria of the International Autoimmune Hepatitis Pathology Group (IAIHPG), the likely histologic features include a chronic hepatitis pattern of injury with a lymphoplasmacytic portal infiltrate, interface activity, and portal-based fibrosis. More than mild lobular hepatitis with any of the above features can also be diagnosed as likely AIH in the absence of features of another liver disease. Centrilobular injury with prominent hepatocellular necrosis and mononuclear inflammation may represent an acute-onset disease and indicate possible AIH in the absence of concurrent liver disease. Kupffer cell hyaline bodies and portal lymphocyte apoptosis are significantly associated with AIH, whereas emperipolesis and hepatocellular rosette formation are nonspecific features indicative of disease severity. Liver histology is an integral part of the clinical diagnostic scoring system and is required to confirm or support AIH diagnosis. Substitution of the histologic component of the simplified AIH scoring system with the consensus IAIHPG criteria has been proposed to optimize clinical diagnosis. This review explores the significant role of histopathology in AIH by analyzing its main features and current histologic diagnostic criteria, different AIH presentations, differential diagnosis, assessment of concurrent liver disease, and identification of AIH variants with primary cholangiopathy.

Effect of social influence on antiviral therapy behavior among chronic hepatitis B patients with different disease knowledge levels

BACKGROUND

Chronic hepatitis B (CHB) is a global health challenge with low rates of diagnosis and treatment worldwide. Since social factors and individual cognition significantly influence antiviral therapy adherence in CHB patients, both of which are shaped by patients' understanding of hepatitis B, this study aimed to investigate the effects of social influences on antiviral therapy behavior among CHB patients with different levels of disease knowledge.

METHODS

From March to October 2023, a survey was conducted among CHB patients in Fuqing City, Fujian Province. A self-designed scale was developed based on the attitude-social influence-efficacy (ASE) model, prototype willingness model (PWM), and theory of planned behavior (TPB). Using the mean score as the cutoff point, CHB patients were divided into high and low knowledge levels. Multi-group structural equation modeling (SEM) was used to validate the hypotheses and determine the mechanism of antiviral therapy behavior.

RESULTS

A total of 611 individuals were ultimately included. Multi-group structural equation modeling (SEM) analyses revealed significant differences between patients with high and low disease knowledge levels across three pathways: social support towards self-efficacy (CR = -2.839, P < 0.05), social support towards attitude (CR = 2.142, P < 0.05), and self-efficacy towards behavior (CR = 3.720, P < 0.001). Social support had a stronger influence on self-efficacy in CHB patients with low disease knowledge compared to those with high disease knowledge. Among patients with higher disease knowledge, social support exerted a greater impact on treatment attitudes, while self-efficacy demonstrated a stronger influence on treatment behaviors.

CONCLUSION

To enhance the motivation and adherence of CHB patients to antiviral therapy, healthcare providers could implement tailored health education strategies based on patients' varying levels of knowledge. Additionally, dynamic health goal-setting should be integrated to drive continuous health management. Furthermore, establishing a multi-tiered social support network that incorporates family involvement, community support groups, and healthcare institution collaboration is essential.

Prevalence of Hepatitis C viral infection in Ghana: A systematic review and meta-analysis protocol

Background Hepatitis C virus (HCV) infection remains a major public health concern for many countries. A recent survey report in Ghana revealed a national HCV prevalence rate of 4.6% in a population of 35 million but with notably higher regional variations ranging from 8.6 to 14.4%. Considering that Ghana is targeting micro-elimination of HCV as part of the STOP Hepatitis C project, it is prudent to estimate the current epidemiological burden of hepatitis C for evidence-based policymaking, public health research, and program direction. An initial search of the literature showed a previous review that spanned from 1995 to 2015. The gap of almost 10 years may not reflect the current burden of hepatitis C in Ghana, hence this review. A systematic literature search will be performed in the major electronic databases and search engines including PubMed, Embase, Web of Science, CINAHL, and African Journals Online (AJOL). There will be a search for articles reporting on the prevalence of hepatitis C in Ghana from 2016 to 2024 in these databases. The protocol is registered with PROSPERO (CRD42024592505).

Mapping the knowledge domains of literature on hepatocellular carcinoma and liver failure: a bibliometric approach

Background

Hepatocellular carcinoma (HCC) accounts for 75-85% of primary liver cancers, with its incidence continually rising, posing a threat to socio-economic development. Currently, liver resection is the standard treatment for HCC. However, post-hepatectomy liver failure (PHLF) is a severe and formidable postoperative complication that increases patients' medical expenses and mortality risk. Additionally, liver failure can occur at any stage of HCC development, severely affecting patients' quality of life and prognosis.

Method

Using the Web of Science Core Collection, this bibliometric study analyzed English articles and reviews on HCC and liver failure from 2003 to 2023. Bibliometric tools like CiteSpace, VOSviewer, and R-studio were employed for data visualization and analysis, focusing on publication trends, citation metrics, explosive intensity, and collaborative networks. Use the Comparative Toxicogenomics and Genecards databases to screen for genes related to liver failure, and perform enrichment analyses using Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and PubMed on the identified differentially expressed genes.

Results

The study identified a significant increase in publications on HCC and liver failure, with key contributions from journals such as the World Journal of Gastroenterology and the Journal of Hepatology. The United States, China, and Japan were the leading countries in research output. Prominent authors and institutions, including Kudo Masatoshi and Sun Yat-sen University, were identified. Enrichment analysis showed drug metabolism, oxidative stress, lipid metabolism, and other pathways are closely related to this field. Research hotspots included risk prediction models and novel therapies.

Conclusion

This bibliometric analysis highlights the growing research interest and advancements in HCC and liver failure. Future research should focus on improving risk prediction, developing new therapies, and enhancing international collaboration to address these critical health issues.

TRIB3 Is a Hub Gene in Steatohepatitis and Aggravates Lipid Deposition and Inflammation in Hepatocytes

Background

Non-alcoholic fatty liver disease (NAFLD), also known as Metabolic dysfunction-associated fatty liver disease (MASLD), has become one of the most common chronic liver diseases worldwide, approximately 30% of adults and 70%~80% of patients with obesity and diabetes suffer from NAFLD.

Objective

We attempted to find a potential hub gene in NAFLD hepatocyte cell model induced by palmitic acid and oil acid (PAOA), and investigated the function of the hub-gene.

Methods

We searched and downloaded the GSE122660 dataset from GEO-DataSets, and differentially expressed genes (DEGs) were analyzed using R software. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to identify the significantly activated signaling pathways in steatohepatitis. A protein-protein interaction (PPI) network was constructed to identify hub genes among the DEGs. qRT-PCR, Western blotting, and Oil Red O staining were used to explore the function of hub genes in PAOA-induced hepatocytes in vitro.

Results

A total of 255 DEGs were identified in the GSE122660 dataset and were primarily associated with inflammation-and lipid metabolism-related pathways. The tribbles pseudokinase 3 (TRIB3) was highlighted as a hub gene. We found that TRIB3 was upregulated in CDHFDinduced NAFLD mouse liver tissue and hepatocyte cell models. Furthermore, TRIB3 aggravated PAOA-induced lipid accumulation and inflammation in hepatocytes in vitro.

Conclusion

The present study identified TRIB3 as a hub gene for steatohepatitis and aggravated lipid accumulation and inflammation in vitro. Therefore, targeting TRIB3 could be a potential pharmacological strategy for NAFLD treatment.

Investigation of Hepatitis C, D, and HIV Seroprevalence and Evaluation of APRI and FIB-4 Scores in HbsAg-Positive Patients

This study aimed to assess the prevalence of HDV (hepatitis delta virus), HCV (hepatitis C virus), and HIV (human immunodeficiency virus) coinfections among HBsAg-positive patients and to determine the severity of liver fibrosis and biochemical markers. Furthermore, the study sought to evaluate the noninvasive fibrosis scores (APRI and FIB4) in predicting the severity of liver disease in patients with hepatitis B. A retrospective analysis of 1434 patients with chronic HBV admitted between January 2020 and December 2024 was conducted at Sincan Tertiary Hospital. The positivity rates of the following antibodies were the focus of the study: anti-HDV, anti-HCV, and anti-HIV. In addition to these, the levels of HIV-RNA, HCV-RNA and HBV-DNA, as well as several biochemical markers (ALT, AST, INR, albumin, bilirubin and platelet count) were also evaluated. The APRI and FIB-4 scores were calculated. Of the 1434 patients, 49 (3.4%) tested positive for anti-HDV, 784 were screened for anti-HCV, and 749 were screened for anti-HIV. The positivity rates were 3.4% (27/784) and 3.4% (26/749), respectively. According to ROC analysis, the FIB-4 score had a statistically significant effect on predicting anti-HDV negativity (AUC = 0.59, p = 0.031). However, the APRI score was not a significant predictor for anti-HDV positivity (AUC = 0.53, p > 0.05). APRI and FIB-4 scores did not have a statistically significant discriminatory power in predicting anti-HCV and anti-HIV positivity (p > 0.05). The cut-off value for the FIB-4 score in predicting anti-HDV positivity was 1.72, with a sensitivity of 61.4% and a specificity of 42.9% (p = 0.031). Among the HCV/RNA-positive patients (n = 5), all were male, and two also had positive anti-HBe results with undetectable HBV/DNA levels. One HIV/RNA-positive patient, a foreign national, was confirmed to have HIV/HBV/HDV infection. All HBsAg-positive patients should undergo routine anti-HDV testing. Vaccination programmes are vital in preventing the spread of HDV. Dual screening strategies are essential for identifying infected individuals and developing prevention and treatment programmes. Anti-HDV positivity indicates advanced liver fibrosis, emphasising the importance of screening and monitoring. However, the limited accuracy of the APRI and FIB-4 scores for detecting coinfections highlights the need to integrate noninvasive methods with molecular diagnostics for precise management.

Immune checkpoint inhibitors plus anti-angiogenesis in patients with resected high-risk hepatitis B virus-associated hepatocellular carcinoma

BACKGROUND

Currently, there is a lack of effective adjuvant therapies for patients at high-risk of recurrent hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) after radical resection. Given the efficacy of anti-programmed death 1/anti-programmed death ligand 1 plus anti-vascular endothelial growth factor receptor agents in advanced HCC, we conducted this study to investigate the efficacy of this combination regimen in the postoperative adjuvant treatment of patients with HBV-HCC.

AIM

To evaluate the value of postoperative combined therapy (PCT) with anti-programmed death 1/anti-programmed death ligand 1 and anti-vascular endothelial growth factor receptor agents in patients with HBV-HCC.

METHODS

Patients with HBV-HCC who underwent radical resection surgery at Anhui Provincial Hospital Affiliated to Anhui Medical University between July 2020 and April 2023 were included. Recurrence-free survival (RFS) and overall survival were assessed using propensity score matching and inverse probability of treatment weighting. Cox regression analysis was used to identify factors affecting recurrence, and subgroup analysis was conducted to investigate the impact of medications on different populations. Treatment-related adverse events and liver function measurements were evaluated.

RESULTS

A total of 150 patients were recruited, of whom 30 underwent PCT and 120 did not. After adjusting for confounders, patients who underwent PCT had better RFS at 6 and 12 months than those who did not (P > 0.05). Similar results were observed in the Kaplan-Meier curves after propensity score matching or inverse probability of treatment weighting, although the difference was not statistically significant (P > 0.05). A maximum diameter of > 5 cm, vascular invasion, satellite nodules, and high gamma-glutamyl transferase levels were independent risk factors for recurrence (P < 0.05). No significant interaction effects were observed in subgroup analyses. The most prevalent adverse event was hypertension (66.7%). PCT was associated with an increased risk of hepatic impairment which may predict RFS rates (P = 0.041).

CONCLUSION

The recurrence rate was not significantly reduced in patients who underwent PCT. Hepatic impairment during treatment may indicate recurrence, and close monitoring of liver function and HBV infection is recommended.

Update on hepatitis C virus management

PURPOSE OF REVIEW

Despite the efficacy of direct-acting antiviral (DAA) therapy, hepatitis C virus (HCV) remains a significant contributor to liver-related morbidity and mortality. This review summarizes the approach to HCV treatment, the simplified treatment algorithm for most patients, the management of special populations, and future directions for HCV interventions.

RECENT FINDINGS

Pan genotypic DAA regimens have high cure rates and can be managed by nonspecialist providers, and the simplified treatment approach provides a clear algorithm for workup and treatment decisions among treatment-naive patients without decompensated cirrhosis. Additionally, advancements in point of care diagnostics have the potential to further expand access to screening and linkage to care. Despite these breakthroughs, barriers to accessing care and the stigmatization of high-risk populations continue to undercut progress towards HCV elimination. Continued implementation of innovative screening and treatment strategies are required to overcome rising HCV prevalence.

SUMMARY

HCV cure is achievable for nearly all patients, but reaching HCV elimination goals will require a comprehensive approach that increases screening, expands access to simplified treatment, and avoids stigmatization of at-risk populations. Targeting healthcare disparities and removing barriers to treatment uptake are crucial to achieving elimination targets.

Advancing precision medicine in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has become a pressing global health concern. The complexity of MASLD and the lack of universally effective treatments expose the limitations of current interventions, which focus mainly on lifestyle modifications. Here, we explore the multilayered nature of MASLD, emphasizing its pathophysiology in shaping future medical and lifestyle interventions from a personalized medicine perspective, based on individual molecular profiles. Additionally, we address the limitations of current animal models in reflecting human metabolic syndrome and sex-specific differences. We argue that a holistic approach, integrating social determinants of health, patient preferences, and adherence patterns, is essential for advancing MASLD management effectively.

Comparison of liver injury and inflammatory response following conventional and drug-eluting bead transcatheter chemoembolization in hepatocellular carcinoma

OBJECTIVE

This study aimed to compare the extent of liver injury and the inflammatory response in patients with hepatocellular carcinoma (HCC) following conventional transarterial chemoembolization (cTACE) and drug-eluting bead transarterial chemoembolization (DEB-TACE).

METHODS

Clinical data from October 2018 to October 2019 were prospectively collected to establish a database. The baseline clinical and demographic characteristics of patients in the two groups were matched using propensity score matching (PSM). Serum levels of hepatic function indicators and inflammatory cytokines were evaluated before treatment and five days post-treatment.

RESULTS

A total of 134 participants were included in the analysis. Following 1:1 PSM, 43 patients remained in each group, with no significant differences observed in baseline characteristics. The median absolute concentration of aspartate aminotransferase (AST) was significantly lower in the DEB-TACE group five days after treatment. Among 18 patients who experienced idiosyncratic drug-induced liver injury, the DEB-TACE group exhibited a significantly lower proportion of cases. The alanine aminotransferase/alkaline phosphatase (ALT/ALP) ratio was notably higher in the cTACE group, while cholestatic-type liver injuries were predominant in the DEB-TACE group. Levels of MCP-1, IL-6, and IL-1β were lower in the DEB-TACE group five days post-treatment. Additionally, MCP-1 levels were significantly correlated with ALT levels and the type of liver injury. Similarly, IL-6 levels showed significant correlations with ALT, AST, and the type of liver injury.

CONCLUSIONS

DEB-TACE was associated with reduced acute liver injury, characterized primarily by cholestatic injury, and a milder inflammatory response compared to cTACE. Post-treatment levels of MCP-1 and IL-6 levels were correlated with aminotransferase levels and the type of liver injury.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-1800017781. Register URL link: https://www.chictr.org.cn/showproj.html?proj=30041 . Register date: 2018-8-14.

Protective effect of Leuco-methylene blue against acetaminophen-induced liver injury: an experimental study

Acetaminophen is a commonly used drug for mild to moderate pain relief; however, acetaminophen toxicity due to the formation of toxic metabolites is a major cause of drug-induced liver injury. Methylene blue is an FDA-approved drug for the treatment of methemoglobinemia and has potential applications in the treatment of carbon monoxide and cyanide poisoning. Leuco-methylene blue, a colorless form of methylene blue, is more effective in entering cells and counteracting oxidative stress, making it a valuable option in regulating mitochondrial function and ATP production. In this study, we aimed to evaluate the effect of LMB on liver damage caused by acetaminophen toxicity. Thirty-six rats were divided into six groups: control, APAP, NAC, LMB, MB, and NAC+LMB. All groups except the control received acetaminophen (1500 mg/kg), followed by treatments with NAC (100 mg/kg), LMB (5 mg/kg), MB (5 mg/kg), and NAC+LMB after 3 hours. The rats were sacrificed 24 hours post-acetaminophen administration. LMB significantly reduced serum levels of liver enzymes (ALT, AST, and ALP) and increased the expression of genes involved in mitochondrial biogenesis and antioxidant defense (PGC-1, Nrf2, and Tfam). Additionally, LMB significantly increased total antioxidant capacity and glutathione reductase levels, decreased the prooxidant-antioxidant balance (PAB), and reduced the expression of inflammatory cytokines (IL-6 and TNF-α) in the liver tissue. LMB effectively reduced the severity of acetaminophen-induced liver damage through antioxidant and anti-inflammatory effects. LMB can effectively ameliorate APAP-induced toxicity in rats, with comparable efficacy to N-acetylcysteine with respect to most complications of acetaminophen-induced toxicity in rats.

Efficacy and safety of PPAR agonists in primary biliary cholangitis: a systematic review and meta-analysis of Randomized Controlled Trials

BACKGROUND AND AIMS

Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease. Some patients with PBC do not adequately respond to Ursodeoxycholic acid (UDCA) as a first-line treatment, putting them at an increased risk of disease progression. Peroxisome Proliferator-Activated Receptor (PPAR) agonists are emerging as promising therapeutic options for PBC. We aim to investigate the efficacy and safety of PPAR agonists in treating PBC patients.

METHODS

PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov were searched for Randomized Controlled Trials (RCTs) investigating the use of PPAR agonists in combination with UDCA in patients with PBC, compared to UDCA alone. Mean differences (MD) for continuous variables and risk ratios (RR) for dichotomous variables were calculated to compare treatment response endpoints.

RESULTS

A total of 17 studies with 1219 PBC cases were included in the current review. Alkaline phosphatase (ALP) levels had a significantly greater decline in PPAR and UDCA arms than in UDCA alone (MD - 131.15, 95% CI - 155.95 to - 106.36). Furthermore, in combination therapy arms, gamma-glutamyl transferase (GGT) (MD - 55.69, 95% CI - 76.26 to - 35.13) and total bilirubin (MD - 0.08, 95% CI - 0.14 to - 0.03) were significantly lower than in the UDCA alone group.

CONCLUSIONS

The current study demonstrates that combining UDCA and PPAR agonists effectively reduces ALP, GGT, and Bilirubin levels, crucial markers for effective therapy in PBC patients.

Epidemiological trends of hepatitis C incidence and death in Mainland China between 2004 and 2018 and its predictions to 2030

INTRODUCTION

This study aimed to evaluate the epidemiological trends and spatial-temporal distribution of hepatitis C virus (HCV) in mainland China.

METHODS

HCV monthly incidence surveillance data from 2004 to 2018 was mainly available from the Public Health Sciences Data Center of China. Five models (Bayesian age-period-cohort, BAPC; Auto-regressive integrated moving average, Auto_arima; Exponential smoothing, ETS; Prophet; Earth) were used to forecast the incidence. Temporal-spatial scanning analysis was conducted to visualize the grading of hepatitis C incidence in mainland China.

RESULTS

This study observed 180 months of data from January 2004 and December 2018. A total of 2,278,280 hepatitis C cases and 1771 deaths were reported, with an average annual reported incidence rate of 11.24/100,000. The BAPC model indicated that the indexes (mean absolute error, MAE; mean absolute percentage error, MAPE; mean squared error, MSE; root mean square error, RMSE) in the BAPC model were better than those of the other models (4.33 × 10- 6, 0.03, 2.34 × 10- 11, 4.84 × 10- 6), and annual reported HCV incidence in mainland China would remain at a high level of 17.92/100,000 until 2030. Spatial-temporal aggregation analysis indicated that the time range of the first-class aggregation area was from January 1, 2012 to December 31, 2018, and the aggregation area was in Xinjiang, Qinghai, Gansu, Tibet, Ningxia, Inner Mongolia, Sichuan, Shaanxi, Shanxi, Chongqing, Hebei, Beijing, Henan and Yunnan provinces (relative risk, RR = 2.15, log-likelihood ratio, LLR = 129946.01, P < 0.001).

CONCLUSIONS

In summary, this study showed that the incidence of HCV in mainland China continued to be high, and BAPC model suggested that this trend will continue until at least 2030. In order to effectively control the HCV epidemic, it was necessary to strengthen blood safety management, expand screening for high-risk population, improve public awareness of HCV, and provide timely and effective antiviral treatment in potentially high-risk areas.

Blood-Borne Infection Prevention in Combat Sports: Position Statement of the Association of Ringside Physicians

ABSTRACT

The Association of Ringside Physicians (ARP) emphasizes the importance of screening combat sports athletes for blood-borne infections, including hepatitis B, HIV, and hepatitis C, to mitigate transmission risks and ensure participant safety. Although transmission of hepatitis B and C and HIV in combat sports is rare, protecting athletes is of utmost importance. It is the recommendation of the ARP that all fighters participating in combat sports, in which the presence of blood is a common occurrence and is allowed during competition, should undergo testing for HIV, hepatitis B (HBV), and hepatitis C (HCV). Testing should be conducted using serum samples, because rapid tests are not considered acceptable for accurate results. Testing for HBV, HCV, and HIV should optimally be done within 3 months of competition, but within 6 months is acceptable. Athletes whose tests suggest active HBV, HCV, or HIV infection should be disqualified from competition in sports where blood is common and allowed. Athletes with cured prior HCV infection may be cleared for competition in all combat sports. Athletes with prior HBV infection and no detectable HBV DNA in blood can be cleared for competition in all combat sports. Athletes with latent HBV infection with detectable HBV DNA in blood have a small risk of disease reactivation, so they should not be cleared.

Estimated number of people infected with hepatitis B and C virus in Germany in 2013: a baseline prevalence estimate using the workbook method

Introduction

Hepatitis B (HBV) and hepatitis C (HCV) viral infections are uncommon in Germany, though these infections have a higher prevalence among certain subpopulations, such as some first-generation migrant groups, people who inject drugs (PWID), and HIV-positive men who have sex with men (HIV+MSM). Repeated estimates of the number of people infected with HBV and HCV are essential to facilitate the monitoring and elimination efforts by 2030. We estimated the total number of people infected with HBV and HCV in Germany, and the number in each specific subpopulation. We based our calculations on data from 2013, a year that we strategically chose to coincide with the availability of data from serological surveys, the advent of highly effective antiviral therapy for HCV, and significant migrant flows in the following years.

Methods

We used the workbook method, a technique that combines subpopulation size and prevalence data. We included different population groups (general population excluding vulnerable groups, migrants stratified by nationality, people who inject opioids (PWIO) and HIV+MSM). We estimated the number of people infected with HBV and the number of people infected with HCV. Estimates of the number of people infected with HBV and HCV are reported with the lower and upper confidence limits.

Results

We estimated 228,000 (179,000-291,000) HBV-infected adults (≥ 18 years of age) in Germany in 2013, of whom 41% (n = 93,000 [52,000-169,000]) were in the general population excluding vulnerable groups. Another 58% (132,000; 126,000-137,000) were migrants, 1.0% (2,400; 900-6,200) PWIO and 0.4% (1,000; 800-1,400) were HIV+MSM. We estimated 214,000 (135,000-340,000) HCV-infected adults in Germany in 2013, of whom 47% (100,000; 38,000-267,000) were in the general population excluding vulnerable groups, 26.0% (56,000; 47,000-66,000) were migrants, 26% (56,000; 50,000-62,000) were PWIO, and 1.0% (2,500; 2,200-2,800) were HIV+MSM, respectively.

Discussion

Our results indicate that more than half of HBV-infected individuals were migrants, and more than half of HCV-infected individuals were PWIO or migrants. This highlights the importance of including relevant subpopulations in national estimates, surveillance, prevention, and therapy. Our estimates serve as a baseline reference for subsequent updates and ongoing monitoring of HBV and HCV epidemiology in Germany.

The role of Seladelpar in primary biliary cholangitis: a systematic review and meta-analysis

INTRODUCTION

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive bile duct destruction, leading to cholestasis and, if untreated, liver failure. Although ursodeoxycholic acid (UDCA) remains the first-line treatment, many patients exhibit an inadequate response, necessitating alternative therapeutic options. Seladelpar, a peroxisome proliferator-activated receptor delta (PPAR-δ) agonist, has emerged as a promising alternative due to its anti-inflammatory and anti-fibrotic properties.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to evaluate the efficacy and safety of Seladelpar in patients with PBC. A comprehensive database search was performed to identify studies comparing Seladelpar with placebo. Primary and secondary outcomes, including alkaline phosphatase (ALP) normalization, biochemical response, and adverse events, were analyzed.

RESULTS

Three RCTs, comprising 496 patients, were included. Seladelpar significantly improved ALP normalization and biochemical response compared to placebo. Additionally, it effectively reduced ALP and ALT levels from baseline to follow-up. Adverse events, including abdominal pain and headache, were reported, with a higher incidence observed in the Seladelpar group, while other adverse events showed no significant differences between groups.

CONCLUSION

Seladelpar appears to be an effective treatment for PBC, demonstrating significant improvements in key liver function markers. While it has shown therapeutic benefits, further research is warranted to evaluate its long-term safety, particularly regarding adverse event incidence, and to determine its efficacy across different dosages.

Identification of patients at risk for pancreatic cancer in a 3-year timeframe based on machine learning algorithms

Early detection of pancreatic cancer (PC) remains challenging largely due to the low population incidence and few known risk factors. However, screening in at-risk populations and detection of early cancer has the potential to significantly alter survival. In this study, we aim to develop a predictive model to identify patients at risk for developing new-onset PC at two and a half to three year time frame. We used the Electronic Health Records (EHR) of a large medical system from 2000 to 2021 (N = 537,410). The EHR data analyzed in this work consists of patients' demographic information, diagnosis records, and lab values, which are used to identify patients who were diagnosed with pancreatic cancer and the risk factors used in the machine learning algorithm for prediction. We identified 73 risk factors of pancreatic cancer with the Phenome-wide Association Study (PheWAS) on a matched case-control cohort. Based on them, we built a large-scale machine learning algorithm based on EHR. A temporally stratified validation based on patients not included in any stage of the training of the model was performed. This model showed an AUROC at 0.742 [0.727, 0.757] which was similar in both the general population and in a subset of the population who has had prior cross-sectional imaging. The rate of diagnosis of pancreatic cancer in those in the top 1 percentile of the risk score was 6 folds higher than the general population. Our model leverages data extracted from a 6-month window of time in the electronic health record to identify patients at nearly sixfold higher than baseline risk of developing pancreatic cancer 2.5-3 years from evaluation. This approach offers an opportunity to define an enriched population entirely based on static data, where current screening may be recommended.

Direct-acting antivirals (DAA) positively affect depression and cognitive function in patients with chronic hepatitis C

The aim of the study was to determine how depression and cognitive dysfunction in patients with chronic hepatitis C virus (HCV) infection are affected by treatment with direct-acting antivirals (DAA). Fifty-two chronic hepatitis C patients underwent neurocognitive and psychological evaluation before therapy and 5-6 months later. Depression was measured by Beck Depression Inventory (BDI), anxiety by State-Trait Anxiety inventory (STAI), neuroticism by Eysenck Personality Inventory (N/EPO-R), while Ruff Figural Fluency Test (RFFT), Wisconsin Card Sorting Test (WCST), The Grooved Pegboard Test (GPT), and California Verbal Learning Test (CVLT) were used to assess neurocognitive function. There was significant positive change in BDI scores (8.8 ± 6.6 vs 6.1 ± 6.1; p < 0.0001) while the most striking improvement in cognitive tests was observed for CVLT sum of immediate recall from Trial-1 to Trial-5 (50.9 ± 10.0 to 54.1 ± 10.0; p = 0.0005) and RFFT, where the number of unique designs increased from 77.2 ± 21.0 to 86.1 ± 28.3 (p < 0.0001). These differences remained significant when patients with advanced (METAVIR grade F3/F4) and those with mild (grade F0/F1/F2) liver disease were analyzed separately, although in general the improvements were more pronounced in the former group. In conclusion, in chronic HCV infection the brain function is markedly improved by DAA treatment.

Effectiveness and safety of tenofovir amibufenamide and tenofovir alafenamide in treating elderly patients diagnosed with decompensated hepatitis B cirrhosis: a retrospective cohort study

Background/aim

Tenofovir amibufenamide (TMF) has demonstrated significant antiviral activity and safety in individuals with chronic hepatitis B (CHB) in randomized clinical trials. The purpose of this study was to investigate the effectiveness and safety disparities between TMF and Tenofovir alafenamide (TAF) in treating elderly patients with decompensated hepatitis B cirrhosis in real-world settings.

Methods

A retrospective cohort analysis of elderly patients with decompensated hepatitis B cirrhosis who were treated with TMF or TAF in our hospital's outpatient department between January 2022 and December 2023 was the focus of this study. Following a 24-week treatment period, this study evaluated the disparities between the TMF and TAF groups in terms of primary efficacy endpoints (virologic response rate, VR rate), secondary efficacy endpoints (normalization rate of ALT, HBsAg and HBeAg clearance rate, HBsAg and HBeAg seroconversion rates), as well as safety endpoints related to renal function and blood lipids.

Results

The study included 171 patients (93 in the experimental group and 78 in the control group). Following a 24-week treatment period, HBV DNA, HBsAg, ALT, AST, and TBIL had significantly decreased compared to the baseline level, and the differences were statistically difference. Cr, eGFR, triglyceride, and TG had no significant changes compared with the baseline level, and the differences were no statistical difference. The virologic response rate in the experimental group was 70.97% (33/93), and that in the control group was 73.08% (57/78), with no statistical difference observed between the two groups (P = 0.760). ALT normalization rate was 83.33% in the experimental group and that was 100% in the control group, and there was not a statistically significant distinction between the two groups (P = 0.229). Compared with baseline data, Cr and eGFR of the experimental group increased (2.97 ± 14.66 μmol/L, P = 0.867; 0.29 ± 6.76 mL/min/1.72 m2, P = 0.680), TC and TG decreased (-0.5 ± 1.30 mmol/L, P = 0.589; -0.006 ± 0.23 mmol/L, P = 0.986), however, no statistical difference was observed. Compared with the control group, the change of safety dates was also no statistical difference.

Conclusion

TMF treatment in elderly patients with decompensated hepatitis B cirrhosis had a good antiviral effect, no adverse drug reaction on renal function and blood lipids, and high safety. TMF is not inferior to TAF in antiviral efficacy and safety.

Identification of key immune genes of drug-induced liver injury induced by tolvaptan based on bioinformatics

Drug-induced liver injury (DILI) poses critical challenges in preclinical drug development and is a primary reason for candidate drug attrition. The incidence of DILI has risen in recent years. While immune-related genes (IRGs) are crucial in immune infiltration, their expression and regulatory mechanisms in tolvaptan-induced DILI remain largely uncharacterized. RNA sequencing data related to DILI and associated clinical data were sourced from the Gene Expression Omnibus (GEO), and IRGs were obtained from the ImmPort database. Differentially expressed genes (DEGs) from DILI and IRGs were intersected to identify differentially expressed immune-related genes (DEIRGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were used to elucidate the biological functions of DEIRGs. In addition, a protein-protein interaction (PPI) network of DEIRGs was constructed. Immunocytes and immune regulation analyses were conducted using the CIBERSORT tool. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic accuracy of individual DEIRGs. Networks of transcription factor and microRNA co-regulation were constructed using the NetworkAnalyst database. The expression of DEIRGs in DILI samples was quantified with RT-qPCR. From GSE99878, 204 DEGs were identified, with 23 matching IRGs exhibiting significant expression differences in 17 DEIRGs. The ROC curve analysis suggested satisfactory diagnostic values for six DEIRGs. The potential gene regulatory network comprised 214 microRNAs, 257 transcription factors, and 23 DEIRGs. Finally, RT-qPCR confirmed the expression levels of nine DEIRGs, aligning with public database results. The study revealed numerous immune-related biomarkers, verifying expression in five pivotal genes (ICAM1, CXCL10, IGF1, CX3CL1, and EGFR) and highlighting four genes with notable diagnostic potential (TNFAIP3, BDNF, NR1D2, and PPARA). Additionally, it explored the roles of key biomarkers in inflammatory responses, relevant signaling pathways, and interaction networks, offering new insights into DILI diagnosis, mechanistic understanding, and treatment strategies.

Temporal and geospatial patterns of hepatitis C virus prevalence: a longitudinal examination using national health insurance service data in the Republic of Korea (2005-2022)

BACKGROUND

Viral hepatitis, recognized as a significant global public health threat by the World Health Organization (WHO), has spurred efforts to establish elimination goals by 2030. In Republic of Korea (Korea), the prevalence of Hepatitis C virus (HCV) infection exhibits significant regional disparities, necessitating tailored infection control measures at the regional level. This study aimed to analyze the HCV prevalence trend by area (region/town) in Korea, from 2005 to 2022, and identify the areas requiring priority management.

METHODS

A comprehensive analysis of HCV prevalence trends across different geographical regions and towns from 2005 to 2022 was conducted. Using data from the National Health Insurance Service, individuals diagnosed with acute or chronic HCV during this period were included in the analysis. HCV prevalence was adjusted by area, year, sex, and age. Additionally, trends in annual percent changes (APC) and average APC (AAPC) in HCV prevalence were examined using Joinpoint regression analysis.

RESULTS

Age, sex, and region adjusted HCV prevalence per 100,000 people declined from 151 in 2005 to 98 in 2022. During the 18 years, the highest HCV prevalence was recorded in the southern regions of Korea (Busan, Jeonnam, and Gyeongnam) and in the towns of Namhae-gun of Gyeongnam, Boeun-gun of Chungbuk, and Sunchang-gun of Jeonbuk. The age-, sex-, and region-adjusted annual HCV prevalence decreased significantly at an APC of -2.5% (95% confidence interval [CI]: -3.5, -1.4) and AAPC of -2.7% (95%CI: -4.3, -1.0). By town, the prevalence decreased the most in Boeun-gun of Chungbuk (AAPC: -23.7%; 95%CI: -30.2, -16.5) and increased the most in Gunwi-gun of Gyeongbuk (AAPC: 3.0%; 95%CI: 1.1, 4.9).

CONCLUSIONS

Over 18 years, a notable decline in HCV prevalence was observed in Korea, although this trend exhibited regional disparities. To effectively achieve the WHO hepatitis elimination goals by 2030, targeted interventions should prioritize areas with persistent or emerging prevalence.

Causal Relationships between Iron Status and Nonalcoholic Fatty Liver Disease: Two-Sample, Multivariable, and Two-Step Mendelian Randomization

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) was clinically documented to be accompanied by iron homeostasis imbalances, however, the causal relationship between them remains unclear. Therefore, this study aimed to examine the relationship between iron homeostasis indicators (serum iron, ferritin, transferrin, total iron binding capacity (TIBC), and transferrin saturation (TSAT)) and NAFLD risk.

METHODS

We applied two-sample Mendelian randomization (MR) to assess the effects of genetic liability to iron homeostasis indicators (N = 43,220-246,139) on NAFLD risk (N = 377,988) in individuals of European ancestry. Reverse direction MR, multivariable MR, and two-step MR were performed to estimate reverse association, causal effects independent of smoking or drinking, and the mediating effect of lipid metabolism, respectively. Smoking and drinking as confounders were considered confounders.

RESULTS

Genetically predicted serum iron, ferritin, and TSAT were significantly associated with a higher risk of NAFLD (odds ratio (OR): 1.286, 95% confidence interval (CI): 1.075-1.539; p = 0.0059; OR: 1.260, 95% CI: 1.050-1.500, p = 0.0195; and OR: 1.223, 95% CI: 1.067-1.402; p = 0.0039, respectively). Reverse direction MR analysis suggested that genetic liability to NAFLD had no significant causal effect on iron homeostasis. Sex-specific MR exhibited a stronger effect size for the association of elevated ferritin with NAFLD risk in males (OR: 1.723, 95% CI: 1.338-2.219; p = 2.48 × 10-5). Two-step MR revealed that elevated triglycerides (TGs) mediated approximately 3%-5% of the observed effect of serum iron and TSAT on NAFLD risk, while decreased low-density lipoprotein cholesterol (LDL-C) mediated 9%-10%.

CONCLUSION

Genetic liability to iron status imbalance may causally affect NAFLD. This evidence may support the clinical treatment of NAFLD in the target population.

Influencing factors of HCV testing willingness among men who have sex with men in China: A structural equation modeling analysis

BACKGROUND

Men who have sex with men (MSM) are a population with greater likelihood of the hepatitis C virus (HCV). Early detection of HCV status is beneficial to therapy and prevention of the further transmit of HCV. The testing rate of HCV in MSM is low, so it is important to investigate the factors that influence testing willingness in order to increase the testing rate.

OBJECTIVES

Based on the health belief model (HBM), this study investigated the influencing factors of HCV testing willingness among MSM, and provided a basis for promoting HCV testing among MSM.

METHODS

Non-probability sampling was employed to collect samples, and electronic questionnaires were used to perform cross-sectional surveys on the samples, including socio-demographic characteristics, sexual behavior characteristics, HCV testing willingness and HBM scale. The data was evaluated with a structural equation model (SEM).

RESULTS

Result of the 857 MSM, 55.7% had ever undergone HCV testing, 90.9% were willing to undergo HCV testing in the future, and 71.7% were anticipated to undergo HCV testing within the next six months. The SEM's findings demonstrated that behavioral intention was positively impacted by self-efficacy (β =  0.482, p <  0.001) and perceived susceptibility (β =  0.312, p <  0.001), while behavioral intention was negatively impacted by perceived barriers (β =  -0.254, p <  0.001). Furthermore, behavioral intention was indirectly impacted by perceived benefits (β =  0.309, p <  0.001) and perceived barriers (β =  -0.139, p <  0.001), with self-efficacy acting as a mediating factor.

CONCLUSION

Self-efficacy, perceived susceptibility, benefits, and barriers predict behavioral intention. These findings can inform the development of methods to increase MSM willingness to identify HCV.

IQ DILI Consensus Opinion: Best Practices for Rechallenge Following Suspected Drug-Induced Liver Injury in Clinical Trials

Rechallenge with study drug after suspected drug-induced liver injury (DILI) during drug development requires a comprehensive assessment of risks and benefits. Lack of universal consensus or societal guidelines makes this decision-making process more challenging and difficult to manage in clinical development. The sparse published literature is biased towards reporting cases of positive rechallenge (recurrent DILI), often with adverse outcomes. The heterogeneity of available data and inconsistent approaches to drug rechallenge likely lead to bias in our perception of the risks of rechallenge, ultimately leaving this topic controversial. The IQ DILI Causality Assessment Working Group, in collaboration with academic and regulatory experts, developed this manuscript with the following objectives: (1) understand and describe current practices via literature review and survey of practices and opinions among drug developers, academic experts, and regulators; (2) propose a consistent and structured approach to decision-making and managing the rechallenge process; (3) facilitate better understanding of the risks and benefits of rechallenge via a standardized approach to collecting rechallenge data, including outcomes and the importance of publishing rechallenge data; and (4) the role of obtaining a liver biopsy, guidance on when a biopsy might be considered, and what histologic findings can assist in making the rechallenge decision. Lastly, knowledge gaps in the drug rechallenge paradigm are highlighted alongside the proposal to standardize the collection and publication of rechallenge data to help address these gaps. This consensus expert opinion does not encourage rechallenge but provides guidance for drug developers to apply a consistent approach to rechallenge.

Expanding treatment indications in chronic hepatitis B: Should we treat all patients?

Nucleos(t)ide analogues (NUCs) are first-line agents for chronic hepatitis B (CHB). Current guidelines provide recommendations for NUC initiation, yet the guidelines are complex and restrictive. Accumulating data on hepatitis B virus (HBV) replication and HBV integration suggests that there are no real quiescent disease phases in CHB, and treatment-ineligible patients in current guidelines still have substantial risks of cirrhosis and hepatocellular carcinoma. Expanding CHB treatment indications can effectively reduce the risks of liver-related complications. Furthermore, treatment indication expansion can be cost-effective, and can simplify care pathways to remove treatment barriers. Potential caveats for treatment expansion include risks of non-compliance, long-term side effects from NUCs, and poor patient acceptability. Nonetheless, these caveats are not insurmountable, and the benefits of treatment expansion outweigh the disadvantages. There is consensus among hepatologists in supporting treatment indication expansion, although expert panels have varying recommendations on treatment strategies. A treat-all approach, which involves treating all CHB patients, has also been proposed. A treat-all strategy is straightforward, and should yield the greatest benefits from a population health perspective. However, the feasibility of new treatment strategies, especially the treat-all approach, is influenced by multiple factors including local epidemiology, healthcare resource availability, and socioeconomic factors. A one-size-fits-all approach is not optimal, and treatment expansion strategies that are tailored based on local data should yield the greatest impact toward hepatitis elimination.

Association Between Elevation of Serum Alanine Aminotransferase and HBsAg Seroclearance After Nucleos(t)ide Analog Withdrawal

BACKGROUND

Alanine aminotransferase (ALT) frequently elevates in chronic hepatitis B patients stopping nucleos(t)ide analogs (NAs).

AIMS

To clarify the association between ALT elevation and HBsAg seroclearance after NA withdrawal.

METHODS

This multicenter cohort study reviewed consecutive patients discontinuing NA between 2004/04/01 and 2022/05/24. Treatment initiation and discontinuation generally followed the Asian-Pacific guidelines. Eligible patients had negative HBeAg and undetectable HBV DNA before treatment cessation, without malignancy, organ transplant or autoimmune disorders. We used competing risk analysis to estimate HBsAg seroclearance incidence and a time-dependent model to investigate post-cessation ALT elevation.

RESULTS

Among 841 patients (74.7% male; median age, 53.2 years; median treatment duration, 34.7 months), 38 patients cleared HBsAg over a median follow-up of 3.7 years, with a 10-year cumulative incidence of 12.4%. The median peak ALT level was significantly lower in patients achieving HBsAg seroclearance versus not (93 vs. 127 U/L; p < 0.001). Hepatitis flare after NA cessation (> 5 times upper limit) was inversely associated with HBsAg seroclearance in the univariable analysis (sub-distribution hazard ratio [SHR], 0.31; 95% confidence interval [CI], 0.13-0.73; p = 0.007), and the association was not significant (adjusted SHR, 0.42; 95% CI, 0.09-2.01; p = 0.28) in the multivariable analysis adjusted for pretreatment HBV DNA. Consistent results were observed in the sensitivity analyses with different ALT cutoffs and subgroup analysis adjusted for HBsAg levels at treatment cessation.

CONCLUSION

ALT elevation after NA cessation is not associated with HBsAg seroclearance following NA withdrawal, suggesting cytolytic pathways are not essential for a functional cure.

Lack of Pharmacokinetic Drug-Drug Interactions Between Bepirovirsen and Nucleos(t)ide Analogs

Bepirovirsen is an antisense oligonucleotide currently in Phase 3 development to treat chronic hepatitis B virus (HBV) infection. Given the importance of coadministration of bepirovirsen and standard-of-care nucleos(t)ide analogs (NAs), we evaluated drug-drug interactions (DDIs) between bepirovirsen, entecavir (ETV), and tenofovir (TFV) using in vitro and clinical data obtained through innovative study design and sampling strategy. Static models employing in vitro data indicated that bepirovirsen is not a direct inhibitor or inducer of most drug-metabolizing enzymes or an inhibitor or substrate of drug transporters and poses no clinical DDI risk against NAs. Bepirovirsen plasma pharmacokinetic parameters and concentration-time profiles in patients with chronic HBV in the CS3 study (NCT02981602) were similar with or without ETV or TFV coadministration, indicating no effect of NA coadministration on bepirovirsen pharmacokinetics. In patients with chronic HBV receiving both bepirovirsen and ETV or TFV in the B-Clear study (NCT04449029), NA plasma concentrations and pharmacokinetic parameters were similar to those published without bepirovirsen coadministration, suggesting no effect of bepirovirsen coadministration on NA pharmacokinetics. This analysis demonstrated no DDI potential between bepirovirsen and NAs, suggesting that dedicated clinical DDI studies are not required. Bepirovirsen is currently being evaluated in Phase 3 studies in combination with NA.

The steatotic liver disease burden paradox: unravelling the key role of alcohol

The classification of steatotic liver disease (SLD) has evolved, incorporating all conditions characterized by hepatic lipid accumulation. SLD represents a continuum of disorders that are shaped by the dynamic factors of alcohol intake and cardiometabolic risk factors. This updated classification has profound implications for both the management and research of SLD, especially with the new distinct category of patients with both metabolic and alcohol-related liver disease. In this Perspective, we highlight the pivotal role of alcohol within the SLD framework. We introduce the 'SLD burden paradox': a concept illustrating the disparity in which metabolic dysfunction-associated steatotic liver disease is more prevalent, yet individuals with SLD and excessive alcohol intake (such as in metabolic and alcohol-related liver disease and in alcohol-related liver disease) account for greater global liver-related morbidity and mortality. We explore strategies to mitigate the effect of SLD on morbidity and mortality, emphasizing the importance of early detection and reducing stigma associated with alcohol intake. Our discussion extends to methods for assessing and monitoring alcohol intake together with the critical role of managing cardiometabolic risk factors in patients across the SLD spectrum. Conclusively, we advocate for a coordinated care framework that adopts a person-centric approach when managing SLD, aiming to improve outcomes and patient care.

Efficacy and safety of ritlecitinib in Asian patients with alopecia areata: A subgroup analysis of the ALLEGRO phase 2b/3 trial

This subgroup analysis of the ALLEGRO phase 2b/3 study (NCT3732807) assessed the efficacy and safety of multiple doses of ritlecitinib, an oral JAK3/TEC family kinase inhibitor, in Asian patients with alopecia areata (AA). Patients aged ≥12 years with AA and ≥50% scalp hair loss received once-daily ritlecitinib 50 or 30 mg (with or without 4-week 200-mg loading dose ["200/50" or "200/30"]) or 10 mg or placebo for 24 weeks, followed by a 24-week extension, in which patients initially assigned to placebo switched to 200/50 or 50 mg. In this subgroup analysis, Asian patients with response based on achieving a Severity of Alopecia Tool (SALT) score ≤20, SALT ≤10, ≥2-grade improvement or normal score on the eyebrow assessment (EBA) scale, and ≥2-grade improvement or normal score on the eyelash assessment (ELA) scale were evaluated through week 48. Safety was monitored throughout. In total, 186 Asian patients were randomized to ritlecitinib 200/50 mg (n = 33), 200/30 mg (n = 28), 50 mg (n = 43), 30 mg (n = 34), 10 mg (n = 17), placebo to 200/50 mg (n = 14), or placebo to 50 mg (n = 17). The proportions of patients treated with ritlecitinib ≥30 mg achieving a SALT score ≤20 response were 9.1%-36.4% at week 24 vs 0% for the 10-mg group and 3.2% for placebo. At week 48, 26.5%-55.6% of patients treated with ritlecitinib ≥30 mg achieved a SALT ≤20 response. At week 48, the proportions of patients treated with ritlecitinib ≥30 mg with EBA response were 41.9%-71.1% and with ELA response were 40.7%-57.9%. The most common adverse events were nasopharyngitis, folliculitis, upper respiratory tract infection, and urticaria. No serious or opportunistic infections, major adverse cardiovascular events, thromboembolic events, malignancies, or deaths were reported. Ritlecitinib demonstrated clinical efficacy and acceptable safety over 48 weeks in Asian patients ≥12 years with AA and ≥50% hair loss. Results for the Asian subpopulation were consistent with the overall population in the ALLEGRO-2b/3 study.

Direct Antivirals Can Achieve a Cure in All Patients With Chronic Hepatitis C due to Genotype 5: A French Multicentre Study

BACKGROUND

Hepatitis C virus genotype 5 (HCV-GT-5) is found mainly in South Africa. In our area in central France, the prevalence of HCV-GT-5 is 14%.

METHODS AND RESULTS

Here we evaluated sustained virological response at week 12 post-treatment (SVR12) in 147 HCV-GT-5 patients from 14 French university hospitals (2014-2021) treated with direct-acting antivirals (DAA) in real-life. Patients had mainly received sofosbuvir/ledipasvir ± ribavirin, sofosbuvir/velpatasvir, and glecaprevir/pibrentasvir. Overall SVR12 was 98% (144/147). Two patients experienced relapse: one was successfully retreated with the same DAAs (sofosbuvir/ledipasvir) plus ribavirin, and the other refused further DAA treatment. One patient with virological failure (sofosbuvir/velpatasvir) had received a second treatment (sofosbuvir/velpatasvir/voxilaprevir) and progressed to cure.

CONCLUSIONS

HCV-GT-5 patients treated with a DAA regimen had a 99% SVR12 in intention-to-treat (including initial therapy and retreatment) and 100% SVR12 per protocol. Sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, and glecaprevir/pibrentasvir show very good efficacy in real-world HCV-GT-5 patients.

A Programme of Hepatitis C Surveillance With Active Linkage to Care (HEAL) for Inpatients in Two Tertiary Hospitals in Jiangsu, China

Hepatitis C virus (HCV) infection is a major public health burden in China, affecting more than 10 million individuals. We aimed to evaluate the effectiveness of a hospital-based intervention programme for HCV Surveillance with linkage to care (HEAL) in a prospective cohort. The HEAL programme was carried out targeting inpatients from non-infectious departments of two tertiary hospitals in Jiangsu, China. It consisted of an educational campaign to raise awareness of physicians from non-IDs to promote HCV surveillance, a patient-navigator-centred clinical algorithm responsible for the efficient follow-up of patients with positive HCV antibody, including comprehensive testing, diagnosis and treatment. We characterised the rate of linkage to HCV diagnosis, care and treatment during the pre-intervention period (from 1 July 2016 and June 30, 2018) and after the intervention (from March 2019 to May 2021). During the pre-intervention period, 89,303 (45.3%) out of 196,780 non-ID inpatients were screened for anti-HCV, and 631 patients were tested positive. One hundred and fifty-six (24.7%) patients was followed up for HCV RNA confirmatory testing, and 58 (37.1%) of patients further were diagnosed with chronic HCV infection (CHC). Only 18 (31.3%) of the diagnosed patients with CHC were linked to hepatitis C clinics for treatment, 10 (55.6%) patients received antiviral regimen. Among them, two (11.1%) received DAA treatment, while eight (44.4%) adopted peginterferon/ribavirin regimen. During the intervention period, 232,275 patients were hospitalised in non-infectious department and 151,203 (65.1%) were screened for anti-HCV. Of these, 960 patients tested positive for HCV antibodies, resulting in a prevalence of anti-HCV positivity of 0.63%. Six hundred and seventy (69.8%) patients were enrolled, and 100% were followed up for HCV RNA confirmatory testing. Two hundred and ninety-one (43.4%) individuals with active HCV were identified. Two hundred and thirty-eight (81.8%) of HCV-infected individuals were linked to HCV care, and 157 (65.9%) were linked to treatment. Compared to the pre-intervention period, there was a 2.61-fold increase in the percentage of patients linked to care and a 5.94-fold increase in the proportion of patients who started DAAs therapy. This HEAL programme achieved enhanced HCV Surveillance with linkage to care, which has been demonstrated as an effective strategy in the hospital setting to improve the hepatitis C care continuum by identifying inpatients unaware of their HCV status and facilitating their access to HCV treatment.

The liver as a central "hub" of the immune system: pathophysiological implications

The purpose of this review is to describe the immune function of the liver, guiding the reader from the homeostatic tolerogenic status to the aberrant activation demonstrated in chronic liver disease. An extensive description of the pathways behind the inflammatory modulation of the healthy liver will be provided focusing on the complex immune cell network residing within the liver. The limit of tolerance will be presented in the context of organ transplantation, seizing the limits of homeostatic mechanisms that fail in accepting the graft, progressing eventually toward rejection. The triggers and mechanisms behind chronic activation in metabolic liver conditions and viral hepatitis will be discussed. The last part of the review will be dedicated to one of the greatest paradoxes for a tolerogenic organ, developing autoimmunity. Through the description of the three most common autoimmune liver diseases, the autoimmune reaction against hepatocytes and biliary epithelial cells will be dissected.

Epidemiology and Risk Determinants of Drug-Induced Liver Injury: Current Knowledge and Future Research Needs

AIMS

Drug-induced liver injury (DILI) is a major global health concern resulting from adverse reactions to medications, supplements or herbal medicines. The relevance of DILI has grown with an aging population, the rising prevalence of chronic diseases and the increased use of biologics, including checkpoint inhibitors. This article aims to summarise current knowledge on DILI epidemiology and risk factors.

METHODS

This review critically appraises available evidence on DILI frequency, outcomes and risk determinants, focusing on drug properties and non-genetic host factors that may influence susceptibility.

RESULTS

DILI incidence varies across populations, with hospitalised patients experiencing notably higher rates than outpatients or the general population. Increased medication use, particularly among older adults and women, may partly explain age- and sex-based disparities in DILI incidence and reporting. Physiological changes associated with aging likely increase susceptibility to DILI in older adults, though further exposure-based studies are needed for definitive conclusions. Current evidence does not strongly support that women are inherently more susceptible to DILI than men; rather, susceptibility appears to depend on specific drugs. However, once DILI occurs, older age and female sex are associated with greater severity and poorer outcomes. Other less-studied host-related risk factors are also discussed based on available evidence.

CONCLUSIONS

This article summarises existing data on DILI frequency, outcomes, drug properties affecting hepatotoxicity and non-genetic host risk factors while identifying critical knowledge gaps. Addressing these gaps through future research could enhance understanding and support preventive measures.

A class of MicroRNAs as diagnostic biomarkers and therapeutic strategies in non-alcoholic fatty liver disease: A review

MicroRNAs (miRNAs), small and noncoding RNAs that regulate gene expression through hybridization to messenger RNA, play a crucial role in the prevention or progression of non-alcoholic fatty liver disease (NAFLD). There is an urgent demand for the improvement of diagnostic tools and effective pharmacotherapies for the treatment of NAFLD, which can advance to cirrhosis and liver cancer. MiRNAs act as regulatory factors and noninvasive diagnostic agents for NAFLD, enabling the staging of the disorder, prognosis, and identification of pharmaco-therapeutic targets. NAFLD causes alterations in the expression patterns of hepatocyte miRNAs, with some specific miRNAs related to the upgrade from NAFLD to non-alcoholic steatohepatitis (NASH). These miRNAs can activate certain signaling cascade and exacerbate or improve NAFLD, additionally, act as hepatocellular signals or second messengers that transmit information between the liver and other systems. This study provides a comprehensive review of the most important miRNAs and their involvement in the pathophysiology and cellular signaling pathways related to NAFLD.

Retrospective evaluation of medication appropriateness in older adults with hepatic cirrhosis

ObjectiveTo assess medication appropriateness using the medication appropriateness index (MAI) criteria, the prevalence of potentially inappropriate medication (PIM) prescribing, and factors associated with increased PIM use in elderly ambulatory patients with cirrhosis.MethodsA cross-sectional study of 70 elderly ambulatory patients with cirrhosis (≥65 years old), from January to December 2021. Two clinical pharmacists evaluated medication appropriateness using the MAI tool. Data were analyzed using SPSS version 27.0. Descriptive statistics were used to present patient demographics, clinical characteristics, and MAI responses. Regression analysis was used to identify predictive factors for PIM prescribing. The kappa statistic was used to assess interrater agreement.ResultsAll participants had at least one medication with ≥ 1 inappropriate MAI criterion, with the most common issue being incorrect treatment duration (18%). Of 610 evaluated medications, 44.1% were classified as PIMs. The mean MAI scores per patient and per medication were 15.97 (±10.48) and 1.83 (±3.18), respectively, consistent with other studies. However, the prevalence of PIMs was higher, likely due to the specific disease population studied, as this is the first study to evaluate medication appropriateness in cirrhotic patients. Good interrater agreement was observed (kappa = 0.74), indicating good interrater reliability. Increased inappropriate prescribing was associated with the number of medications, age and severe renal impairment.ConclusionsPIMs are common in elderly patients with cirrhosis, highlighting the need for better prescribing practices to ensure medication safety. Involving clinical pharmacists with geriatrics expertise and using medication appropriateness tools can reduce PIMs and drug-related problems. Further, healthcare team training is essential to improve prescribing practices. Assessing PIMs in this population could enhance clinical outcomes, reduce adverse drug reactions, and lower healthcare costs. Incorporating comprehensive medication management into routine care for elderly cirrhotic patients is a key strategy to improve patient safety and quality of life.

Quantitative Change of Hepatitis B Surface Antigen Leading to Final Hepatitis B Surface Antigen Loss in Patients with Chronic Hepatitis B Receiving Nucleos(t)ide Analogs in China

INTRODUCTION

Loss of hepatitis B surface antigen (HBsAg) is the pivotal component of functional cure in patients suffering from chronic hepatitis B (CHB). The predictive value of quantitative HBsAg (qHBsAg) in HBsAg loss among those undergoing nucleos(t)ide analog (NAs) therapy is an area of ongoing investigation.

METHODS

A retrospective cohort study using electronic medical records was performed. CHB patients with NAs treatment between January 1, 2012, and December 31, 2020 were enrolled and followed up until discontinuation of NAs, as indicated by a gap more than 12 months in prescription refills, past medical record, or study end. Patients were grouped into NAs treatment-naïve cohort and treatment-experienced cohort. In both cohorts, Cox regression models assessed associations between 12-month reduction in qHBsAg, baseline qHBsAg, and HBsAg loss.

RESULTS

Overall, 2,627 CHB patients with NAs treatment was identified, including 1,179 in treatment-naïve cohort and 1,448 in treatment-experienced cohort. In treatment-naïve cohort, 9 patients had HBsAg loss (0.51/100 person-years). In treatment-experienced cohort, 30 patients had HBsAg loss (1.03/100 person-years). HBsAg loss was significantly associated with a 0.5-1 log10 (treatment-naïve: adjusted hazard ratio [aHR] 8.06, 95% confidence interval [CI] 1.29-50.40; treatment-experienced: aHR 4.34, 95% CI 1.40-13.47) and >1 log10 qHBsAg decrease (treatment-naïve: aHR 9.19, 95% CI 1.47-57.65; treatment-experienced: aHR 8.02, 95% CI 1.76-36.57) compared with qHBsAg not reduced. HBsAg loss was significantly associated with lower baseline qHBsAg in treatment-experienced cohort, while such difference was not significant in treatment-naïve cohort.

DISCUSSION

A rapid decline of qHBsAg in 12 months during NAs therapy, as opposed to merely maintaining a low level of qHBsAg, was associated with HBsAg loss.

Secondary Sclerosing Cholangitis due to Drugs With a Special Emphasis on Checkpoint Inhibitors

BACKGROUND

Secondary sclerosing cholangitis (SSC), is one of the phenotypes of DILI first described in the 1980s. Check point inhibitors (CPIs) are currently the most frequent cause of SCC.

AIMS

To describe the epidemiology, clinical and biochemical features at presentation, differential diagnoses, pathophysiology, imaging, histological characteristics and management associated with SSC.

MATERIALS AND METHODS

A language and date-unrestricted Medline literature search was conducted to identify case reports and clinical series on SSC with special emphasis on CPIs (2007-2023).

RESULTS

We identified 19 different drugs that have been shown to induce SSC. A total of 64 cases with SSC due to CPIs are presented. This was mostly seen in patients treated with anti-Programmed cell death (PD)-1/PD-L1 inhibitors. The most frequent presenting signs and symptoms were abdominal pain and jaundice. Large-duct cholangitis induced by CPIs is a very rare condition while small-duct cholangitis is more common. Nivolumab and pembrolizumab were the most commonly implicated agents. Biopsies have revealed predominant CD8+ T cell infiltration in biliary strictures. Corticosteroids is linked to a low frequency of success and is the only agent recommended to begin the treatment.

CONCLUSIONS

CPIs-induced SSC seems to affect the entire biliary system. Clinicians should consider and suspect SSC when a probable CPIs-induced hepatitis does not respond to corticosteroids. Additionally, further randomized, controlled trials should prospectively investigate alternative therapies for treatment.

Clinical Trial to Assess the Safety and Tolerability of Anti-IL 23 Monoclonal Antibody Guselkumab in Patients With Alcohol-Associated Liver Disease

BACKGROUND

There are no FDA-approved therapies for alcohol-associated liver disease (ALD). Preclinical studies indicate that blocking IL-23/IL-17 signalling may reverse liver injury. Guselkumab, an IL-23-specific antibody approved for psoriasis, may be beneficial for ALD.

AIMS

We aimed to assess the safety and tolerability of guselkumab in patients with ALD.

METHODS

This phase-1 dose-escalation study included patients with ≥ 2 DSM-5 criteria for alcohol use disorder, significant steatosis (MRI-PDFF ≥ 8%) and MRE < 3.63 kPa (to exclude advanced disease). Guselkumab was given subcutaneously on Days 1 and 29 in 30, 70 or 100 mg dose cohorts. Primary endpoints were adverse events (AEs) and dose-limiting toxicity.

RESULTS

We enrolled 13 patients (three 30 mg, three 70 mg, and seven 100 mg). Eleven completed the study and two early discontinued in the 100 mg group. Of them, 77% were men, and the median age was 53 [IQR 49-61] years. The median MRI-PDFF and MRE were 18.4% [IQR 8.4%-34.0%] and 2.5 [2.2-2.6] kPa, respectively. The most frequent AEs were hyperuricemia (13%, mild only) and elevated lipase (11%, mild and moderate). There were no serious adverse events or significant variations in liver enzymes. There was a suppression of peripheral interleukin (IL)-17, IL-23, IL-1b and TNF-α in the 70 and 100 mg groups, and a significant decrease in alcohol consumption over time (AUDIT-C: 6 [3-7] vs. 5 [1-6], p = 0.023).

CONCLUSIONS

Guselkumab is safe in doses up to 100 mg and may reduce inflammation markers in ALD. These findings support further phase 2 studies to evaluate the efficacy of guselkumab in ALD, particularly in patients with severe phenotypes.

Effects of induced molting on lipid accumulation in liver of aged laying hens

As the age of laying increases, the metabolic capacity of the liver decreases, leading to excessive lipid accumulation, which seriously affects the laying performance of laying hens. Induced molting (IM) can rejuvenate the reproductive system of older laying hens, allowing them to enter a new laying cycle. However, it remains unclear whether induced molting can enhance lipid accumulation in the liver of aged laying hens and what the underlying mechanism might be. In this study, fasting-induced molting was performed on 70-week-old Hy-line brown laying hens, and the resulting metabolic changes were analyzed using non-targeted metabolomics. Serum lipid levels, liver oxidative stress, and inflammation were measured using kits, while autophagy and lipid metabolism-related factors were assessed through immunofluorescence and western blotting. The results showed that IM could promote hepatic lipid deposition in aged laying hens, reduce hepatic steatosis and injury, lower the blood lipid level, improve hepatic antioxidant capacity and increase egg production rate. During the fasting period, the hepatic autophagic system was activated in laying hens and the level of hepatic autophagy increased. Additionally, AMPK phosphorylation levels increased, while the expression of fatty acid synthesis genes SREBP-1C, ACC, and FASN decreased (P < 0.01). The expression of PPARα, PGC 1α and CPT1A, which are associated with fatty acid oxidation, was upregulated (P < 0.01). In conclusion, IM enhanced lipid metabolism, increased liver autophagy, and improved liver function in aged laying hens.

Early antiviral treatment with tenofovir alafenamide to prevent serious clinical adverse events in adults with chronic hepatitis B and moderate or high viraemia (ATTENTION): interim results from a randomised controlled trial

BACKGROUND

Current guidelines for chronic hepatitis B recommend antiviral therapy for individuals with non-cirrhotic chronic hepatitis B only if they have significant liver fibrosis or elevated alanine aminotransferase (ALT) concentrations. We aimed to assess the efficacy of early antiviral treatment in preventing serious liver-related adverse events in individuals with non-cirrhotic chronic hepatitis B and moderate or high viraemia but normal or mildly elevated ALT concentrations.

METHODS

ATTENTION is an ongoing randomised controlled trial being conducted at 22 centres in South Korea and Taiwan. Adults aged 40-80 years with non-cirrhotic chronic hepatitis B and serum hepatitis B virus (HBV) DNA concentrations between 4 log10 IU/mL and 8 log10 IU/mL, and ALT concentrations lower than 70 U/L for males and 50 U/L for females were recruited and randomly assigned (1:1) to receive either oral tenofovir alafenamide (25 mg daily) or no antiviral treatment (observation). The primary endpoint was a composite of hepatocellular carcinoma, hepatic decompensation (eg, development of portal hypertensive complications including ascites, gastro-oesophageal varices, or Child-Pugh score of ≥7), liver transplantation, or death from any cause, analysed in the intention-to-treat population. The safety population comprised all randomly assigned participants who received at least one dose of the study treatment. This interim analysis was prespecified at 4 years after enrolment of the first participant. This study is registered with ClinicalTrials.gov, NCT03753074.

FINDINGS

Between Feb 8, 2019 and Oct 17, 2023 (the cutoff date for the first interim analysis), 798 individuals were screened and 734 were randomly assigned (369 to tenofovir alafenamide and 365 to observation). At a median follow-up of 17·7 months (IQR 8·3-24·4), the primary endpoint occurred in 11 participants: two in the tenofovir alafenamide group (both hepatocellular carcinoma) and nine in the observation group (seven hepatocellular carcinoma, one hepatic decompensation, and one death), corresponding to an incidence rate of 0·33 per 100 person-years in the tenofovir alafenamide group and 1·57 per 100 person-years in the observation group (hazard ratio 0·21 [97·5% CI 0·04-1·20]; p=0·027). The difference between the two groups did not surpass the prespecified boundaries required to stop the trial early. Serious adverse events, excluding primary endpoints, were reported in 23 (6%) participants in the tenofovir alafenamide group and 24 (7%) in the observation group.

INTERPRETATION

The results of this interim analysis suggest that early treatment with tenofovir alafenamide reduces the risk of liver-related serious adverse events compared with observation in adults with non-cirrhotic chronic hepatitis B and moderate or high viraemia but normal or mildly elevated ALT concentrations. Although these findings await confirmation in planned future analyses, they suggest that existing guidelines could be expanded to allow early antiviral therapy in patients with a moderate or high HBV viral load, irrespective of ALT concentrations.

FUNDING

Government of South Korea and Gilead Sciences.

Health position paper and redox perspectives - Bench to bedside transition for pharmacological regulation of NRF2 in noncommunicable diseases

Nuclear factor erythroid 2-related factor 2 (NRF2) is a redox-activated transcription factor regulating cellular defense against oxidative stress, thereby playing a pivotal role in maintaining cellular homeostasis. Its dysregulation is implicated in the progression of a wide array of human diseases, making NRF2 a compelling target for therapeutic interventions. However, challenges persist in drug discovery and safe targeting of NRF2, as unresolved questions remain especially regarding its context-specific role in diseases and off-target effects. This comprehensive review discusses the dualistic role of NRF2 in disease pathophysiology, covering its protective and/or destructive roles in autoimmune, respiratory, cardiovascular, and metabolic diseases, as well as diseases of the digestive system and cancer. Additionally, we also review the development of drugs that either activate or inhibit NRF2, discuss main barriers in translating NRF2-based therapies from bench to bedside, and consider the ways to monitor NRF2 activation in vivo.

Thrombospondin 2 as a Predictive Biomarker for HCC in Hepatitis C Patients: A Longitudinal Study Following DAA Therapy

This multicentre study investigated the dynamics of thrombospondin 2 (TSP2) levels during direct-acting antiviral (DAA) therapy in hepatitis C virus (HCV) infected patients and evaluated TSP2's potential as a predictive marker for hepatocellular carcinoma (HCC). All 134 participants achieved sustained virological response at 12 weeks (SVR12) with DAA therapy, and serum TSP2 levels significantly decreased from before and after treatment (p < 0.001). During the median follow-up period of 6.0 years, HCC after DAA therapy was observed in 16 patients (11.9%). Patients with serum TSP2 High (≥ 32 ng/mL) at SVR12 had a significantly higher cumulative occurrence of HCC than did those without (26.5% vs. 7.0%, p = 0.0033). A multivariate Cox proportional hazards model identified male gender (HR 4.84, p = 0.005), HCC history (HR 4.61, p = 0.017) and TSP2 High (HR 3.93, p = 0.009) as significant independent predictors of HCC occurrence after DAA therapy. The model had a high concordance index of 0.878. Additionally, combining TSP2 High and FIB-4 High (≥ 3.538) at SVR12 yielded high specificity and negative predictive value (0.941 and 0.917, respectively) for predicting HCC. Kaplan-Meier analysis showed a higher HCC incidence in the TSP2 High + FIB-4 High group (log-rank p < 0.0001). In conclusion, TSP2 may be a promising biomarker for personalised HCC surveillance in DAA-treated hepatitis C patients.

Acute kidney injury in severe alcohol-associated hepatitis treated with anakinra plus zinc or prednisone

BACKGROUND AND AIMS

In a recent trial, patients with severe alcohol-associated hepatitis treated with anakinra plus zinc (A+Z) had lower survival and higher acute kidney injury (AKI) rates versus prednisone (PRED). We characterize the clinical factors and potential mechanisms associated with AKI development in that trial.

APPROACH AND RESULTS

Data from 147 participants in a multicenter randomized clinical trial (74 A+Z, 73 PRED) were analyzed. AKI, AKI phenotypes, and kidney injury biomarkers were compared between participants who did/did not develop AKI in the 2 treatment arms. Multivariable competing risk analyses were performed to identify baseline risk factors for incident AKI, with death treated as a competing event. Risk factors considered were age, sex, mean arterial pressure, white blood cell count, albumin, MELD, ascites, HE, and treatment arm. At baseline, no participants had AKI; 33% (n=49) developed AKI during follow-up. AKI incidence was higher in A+Z than in PRED (45% [n=33] versus 22% [n=16], p =0.001). AKI phenotypes were similar between the 2 treatment arms ( p =0.361), but peak AKI severity was greater in A+Z than PRED (stage 3 n=21 [63.6%] vs. n=8 [50.0%], p =0.035). At baseline, urine-neutrophil-gelatinase-associated lipocalin levels were similar between participants who developed AKI in both treatment arms ( p =0.319). However, day 7 and 14 urine-neutrophil-gelatinase-associated lipocalin levels were significantly elevated in participants treated with A+Z who developed AKI versus participants treated with PRED who developed AKI ( p =0.002 and 0.032, respectively). On multivariable competing risk analysis, only A+Z was independently associated with incident AKI (subdistribution hazard ratio 2.35, p =0.005).

CONCLUSIONS

AKI occurred more frequently and was more severe in participants treated with A+Z. A+Z-treated participants with AKI had higher urine-neutrophil-gelatinase-associated lipocalin, suggesting that A+Z maybe nephrotoxic in patients with severe alcohol-associated hepatitis.