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Shan S, Zhao X, Wood-Trageser MA, Hu D, Liu L, Qi B, Jian J, Wang P, Lv W, Hu C. Obliteration of portal venules contributes to portal hypertension in biliary cirrhosis. J Pathol 2024; 263:178-189. [PMID: 38551075 DOI: 10.1002/path.6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/05/2024] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
The effects of the obliteration of portal venules (OPV) in cirrhotic portal hypertension are poorly understood. To investigate its contribution to portal hypertension in biliary cirrhosis and its underlying mechanism, we evaluated OPV using two-dimensional (2D) histopathology in liver explants from patients with biliary atresia (BA, n = 63), primary biliary cholangitis (PBC, n = 18), and hepatitis B-related cirrhosis (Hep-B-cirrhosis, n = 35). Then, three-dimensional (3D) OPV was measured by X-ray phase-contrast CT in two parallel models in rats following bile duct ligation (BDL) or carbon tetrachloride (CCl4) administration, representing biliary cirrhosis and post-necrotic cirrhosis, respectively. The portal pressure was also measured in the two models. Finally, the effects of proliferative bile ducts on OPV were investigated. We found that OPV was significantly more frequent in patients with biliary cirrhosis, including BA (78.57 ± 16.45%) and PBC (60.00 ± 17.15%), than that in Hep-B-cirrhotic patients (29.43 ± 14.94%, p < 0.001). OPV occurred earlier, evidenced by the paired liver biopsy at a Kasai procedure (KP), and was irreversible even after a successful KP in the patients with BA. OPV was also significantly more frequent in the BDL models than in the CCl4 models, as shown by 2D and 3D quantitative analysis. Portal pressure was significantly higher in the BDL model than that in the CCl4 model. With the proliferation of bile ducts, portal venules were compressed and irreversibly occluded, contributing to the earlier and higher portal pressure in biliary cirrhosis. OPV, as a pre-sinusoidal component, plays a key role in the pathogenesis of portal hypertension in biliary cirrhosis. The proliferated bile ducts and ductules gradually take up the 'territory' originally attributed to portal venules and compress the portal venules, which may lead to OPV in biliary cirrhosis. © 2024 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Shan Shan
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis and National Clinical Research Center of Digestive Disease, Beijing, PR China
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis and National Clinical Research Center of Digestive Disease, Beijing, PR China
| | | | - Doudou Hu
- The Second Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong, PR China
| | - Liwei Liu
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Beining Qi
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, PR China
| | - Jianbo Jian
- Department of Radiation Oncology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Ping Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Wenjuan Lv
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, PR China
| | - Chunhong Hu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, PR China
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2
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Liu HZ, Song XQ, Zhang H. Sugar-coated bullets: Unveiling the enigmatic mystery 'sweet arsenal' in osteoarthritis. Heliyon 2024; 10:e27624. [PMID: 38496870 PMCID: PMC10944269 DOI: 10.1016/j.heliyon.2024.e27624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Glycosylation is a crucial post-translational modification process where sugar molecules (glycans) are covalently linked to proteins, lipids, or other biomolecules. In this highly regulated and complex process, a series of enzymes are involved in adding, modifying, or removing sugar residues. This process plays a pivotal role in various biological functions, influencing the structure, stability, and functionality of the modified molecules. Glycosylation is essential in numerous biological processes, including cell adhesion, signal transduction, immune response, and biomolecular recognition. Dysregulation of glycosylation is associated with various diseases. Glycation, a post-translational modification characterized by the non-enzymatic attachment of sugar molecules to proteins, has also emerged as a crucial factor in various diseases. This review comprehensively explores the multifaceted role of glycation in disease pathogenesis, with a specific focus on its implications in osteoarthritis (OA). Glycosylation and glycation alterations wield a profound influence on OA pathogenesis, intertwining with disease onset and progression. Diverse studies underscore the multifaceted role of aberrant glycosylation in OA, particularly emphasizing its intricate relationship with joint tissue degradation and inflammatory cascades. Distinct glycosylation patterns, including N-glycans and O-glycans, showcase correlations with inflammatory cytokines, matrix metalloproteinases, and cellular senescence pathways, amplifying the degenerative processes within cartilage. Furthermore, the impact of advanced glycation end-products (AGEs) formation in OA pathophysiology unveils critical insights into glycosylation-driven chondrocyte behavior and extracellular matrix remodeling. These findings illuminate potential therapeutic targets and diagnostic markers, signaling a promising avenue for targeted interventions in OA management. In this comprehensive review, we aim to thoroughly examine the significant impact of glycosylation or AGEs in OA and explore its varied effects on other related conditions, such as liver-related diseases, immune system disorders, and cancers, among others. By emphasizing glycosylation's role beyond OA and its implications in other diseases, we uncover insights that extend beyond the immediate focus on OA, potentially revealing novel perspectives for diagnosing and treating OA.
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Affiliation(s)
- Hong-zhi Liu
- Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin-qiu Song
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Hongmei Zhang
- Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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3
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Martini A, Turato C, Cannito S, Quarta S, Biasiolo A, Ruvoletto M, Novo E, Marafatto F, Guerra P, Tonon M, Clemente N, Bocca C, Piano SS, Guido M, Gregori D, Parola M, Angeli P, Pontisso P. The polymorphic variant of SerpinB3 (SerpinB3-PD) is associated with faster cirrhosis decompensation. Aliment Pharmacol Ther 2024; 59:380-392. [PMID: 37990490 DOI: 10.1111/apt.17804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/24/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND SerpinB3 is a cysteine protease inhibitor involved in liver disease progression due to its proinflammatory and profibrogenic properties. The polymorphic variant SerpinB3-PD (SB3-PD), presents a substitution in its reactive centre loop, determining the gain of function. AIMS To disclose the clinical characteristics of a cohort of patients with cirrhosis in relation to the presence of SB3-PD and to assess the effect of this genetic variant on fibrogenic and inflammatory cytokines in vitro. METHODS We assessed SB3 polymorphism in 90 patients with cirrhosis, prospectively followed up in our referral centre. We used HepG2 and HuH-7 cells transfected to overexpress either wild-type SB3 (SB3-WT) or SB3-PD to assess their endogenous effect, while LX2 and THP-1 cells were treated with exogenous SB3-WT or SB3-PD proteins. RESULTS Patients carrying SB3-PD had more severe portal hypertension and higher MELD scores, than patients carrying SB3-WT. In multivariate analysis, SB3-PD was an independent predictor of cirrhosis complications. Patients with SB3-PD polymorphism presented with more severe liver fibrosis and inflammatory features. Hepatoma cells overexpressing SB3-PD showed higher TGF-β1 expression than controls. The addition of recombinant SB3-PD induced an up-regulation of TGF-β1 in LX2 cells and a more prominent inflammatory profile in THP-1 cells, compared to the effect of SB3-WT protein. CONCLUSIONS The polymorphic variant SB3-PD is highly effective in determining activation of TGF-β1 and inflammation in vitro. Patients with cirrhosis who carry SB3-PD polymorphism may be more prone to develop severe liver disease progression. However, further validation studies are warranted to support the in vivo relevance of this polymorphism.
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Affiliation(s)
- Andrea Martini
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Cristian Turato
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Stefania Cannito
- Unit of Experimental Medicine and Clinical Pathology, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Santina Quarta
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Alessandra Biasiolo
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Mariagrazia Ruvoletto
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Erica Novo
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Filippo Marafatto
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Pietro Guerra
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Marta Tonon
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Nausicaa Clemente
- Department of Health Science, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, Novara, Italy
| | - Claudia Bocca
- Unit of Experimental Medicine and Clinical Pathology, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Salvatore Silvio Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Maria Guido
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Maurizio Parola
- Unit of Experimental Medicine and Clinical Pathology, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
| | - Patrizia Pontisso
- Unit of Internal Medicine and Hepatology, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
- European Reference Network - ERN RARE-LIVER, Department of Medicine, Azienda Ospedaliera-Università, Padova, Italy
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Noureddin M, Goodman Z, Tai D, Chng ELK, Ren Y, Boudes P, Shlevin H, Garcia-Tsao G, Harrison SA, Chalasani NP. Machine learning liver histology scores correlate with portal hypertension assessments in nonalcoholic steatohepatitis cirrhosis. Aliment Pharmacol Ther 2023; 57:409-417. [PMID: 36647687 PMCID: PMC10107331 DOI: 10.1111/apt.17363] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/07/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS In cirrhotic nonalcoholic steatohepatitis (NASH) clinical trials, primary efficacy endpoints have been hepatic venous pressure gradient (HVPG), liver histology and clinical liver outcomes. Important histologic features, such as septa thickness, nodules features and fibrosis area have not been included in the histologic assessment and may have important clinical relevance. We assessed these features with a machine learning (ML) model. METHODS NASH patients with compensated cirrhosis and HVPG ≥6 mm Hg (n = 143) from the Belapectin phase 2b trial were studied. Liver biopsies, HVPG measurements and upper endoscopies were performed at baseline and at end of treatment (EOT). A second harmonic generation/two-photon excitation fluorescence provided an automated quantitative assessment of septa, nodules and fibrosis (SNOF). We created ML scores and tested their association with HVPG, clinically significant HVPG (≥10 mm Hg) and the presence of varices (SNOF-V). RESULTS We derived 448 histologic variables (243 related to septa, 21 related to nodules and 184 related to fibrosis). The SNOF score (≥11.78) reliably distinguished CSPH at baseline and in the validation cohort (baseline + EOT) [AUC = 0.85 and 0.74, respectively]. The SNOF-V score (≥0.57) distinguished the presence of varices at baseline and in the same validation cohort [AUC = 0.86 and 0.73, respectively]. Finally, the SNOF-C score differentiated those who had >20% change in HVPG against those who did not, with an AUROC of 0.89. CONCLUSION The ML algorithm accurately predicted HVPG, CSPH, the development of varices and HVPG changes in patients with NASH cirrhosis. The use of ML histology model in NASH cirrhosis trials may improve the assessment of key outcome changes.
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Affiliation(s)
- Mazen Noureddin
- Houston Methodist Hospital and Houston Research Institute, Houston, Texas, USA
| | | | - Dean Tai
- HistoIndex Pte. Ltd., Singapore, Singapore
| | | | - Yayun Ren
- HistoIndex Pte. Ltd., Singapore, Singapore
| | - Pol Boudes
- Galectin Therapeutics Inc., Norcross, USA
| | | | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University and CT-VA Healthcare System, New Haven, Connecticut, USA
| | | | - Naga P Chalasani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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5
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Romero-Cristóbal M, Clemente-Sánchez A, Peligros MI, Ramón E, Matilla AM, Colón A, Alonso S, Catalina MV, Fernández-Yunquera A, Caballero A, García R, López-Baena JÁ, Salcedo MM, Bañares R, Rincón D. Liver and spleen volumes are associated with prognosis of compensated and decompensated cirrhosis and parallel its natural history. United European Gastroenterol J 2022; 10:805-816. [PMID: 36065767 PMCID: PMC9557954 DOI: 10.1002/ueg2.12301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/14/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Cirrhosis is characterized by the complex interplay among biological, histological and haemodynamic events. Liver and spleen remodelling occur throughout its natural history, but the prognostic role of these volumetric changes is unclear. We evaluated the relationship between volumetric changes assessed by multidetector computerised tomography (MDCT) and landmark features of cirrhosis. Methods We included consecutive cirrhotic patients who underwent liver transplantation (LT) or hepatocellular carcinoma (HCC) resection in whom dynamic MDCT was available. Different volumetric indices were calculated. Fibrosis was evaluated by the collagen proportional area and Laennec sub‐stages. Correlation and logistic regression analysis were performed to explore associations of volumetric indexes and fibrosis with key prognostic features across the clinical stages of cirrhosis. Results 185 patients were included (146 LT; 39 HCC); the predominant aetiology was viral hepatitis (51.35%); 65.9% had decompensated disease and 85.08% clinically significant portal hypertension (CSPH). The standardised liver volume and liver‐spleen volume ratio negatively correlated with Model for End‐stage Liver Disease (MELD), albumin and hepatic venous pressure gradient (HVPG) and were significantly lower in decompensated patients. The liver segmental volume ratio (segments I–III/segments IV–VIII) best captured the characteristic features of the compensated phase, showing a positive correlation with HVPG and a good discrimination between patients with and without CSPH and varices. Volumetric changes and fibrosis severity were independently associated with key prognostic events, with no association between these two parameters. Conclusions Liver and spleen volumetric indices evolve differently along the natural history of cirrhosis and are associated with key prognostic factors in each phase, regardless of fibrosis severity and portal hypertension.
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Affiliation(s)
| | - Ana Clemente-Sánchez
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Ramón
- Department of Radiology, H.G.U, Gregorio Marañón, Madrid, Spain
| | - Ana-María Matilla
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Colón
- Liver Transplant and Hepatobiliary Surgery Unit, H.G.U, Gregorio Marañón, Madrid, Spain
| | - Sonia Alonso
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Aranzazu Caballero
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain
| | - Rita García
- CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,Department of Internal Medicine, H.G.U, Gregorio Marañón, Madrid, Spain
| | | | - María-Magdalena Salcedo
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
| | - Rafael Bañares
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
| | - Diego Rincón
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
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6
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Kennedy P, Stocker D, Carbonell G, Said D, Bane O, Hectors S, Abboud G, Cuevas J, Bolster BD, Friedman SL, Lewis S, Schiano T, Bhattacharya D, Fischman A, Thung S, Taouli B. MR elastography outperforms shear wave elastography for the diagnosis of clinically significant portal hypertension. Eur Radiol 2022; 32:8339-8349. [PMID: 35727321 PMCID: PMC10149092 DOI: 10.1007/s00330-022-08935-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Portal hypertension (PH) is associated with complications such as ascites and esophageal varices and is typically diagnosed through invasive hepatic venous pressure gradient (HVPG) measurement, which is not widely available. In this study, we aim to assess the diagnostic performance of 2D/3D MR elastography (MRE) and shear wave elastography (SWE) measures of liver and spleen stiffness (LS and SS) and spleen volume, to noninvasively diagnose clinically significant portal hypertension (CSPH) using HVPG measurement as the reference. METHODS In this prospective study, patients with liver disease underwent 2D/3D MRE and SWE of the liver and spleen, as well as HVPG measurement. The correlation between MRE/SWE measures of LS/SS and spleen volume with HVPG was assessed. ROC analysis was used to determine the utility of MRE, SWE, and spleen volume for diagnosing CSPH. RESULTS Thirty-six patients (M/F 22/14, mean age 55 ± 14 years) were included. Of the evaluated parameters, 3D MRE SS had the strongest correlation with HVPG (r = 0.686, p < 0.001), followed by 2D MRE SS (r = 0.476, p = 0.004). 3D MRE SS displayed the best performance for diagnosis of CSPH (AUC = 0.911) followed by 2D MRE SS (AUC = 0.845) and 3D MRE LS (AUC = 0.804). SWE SS showed poor performance for diagnosis of CSPH (AUC = 0.583) while spleen volume was a fair predictor (AUC = 0.738). 3D MRE SS was significantly superior to SWE LS/SS (p ≤ 0.021) for the diagnosis of CSPH. CONCLUSION SS measured with 3D MRE outperforms SWE for the diagnosis of CSPH. SS appears to be a useful biomarker for assessing PH severity. These results need further validation. KEY POINTS • Spleen stiffness measured with 2D and 3D MR elastography correlates significantly with hepatic venous pressure gradient measurement. • Spleen stiffness measured with 3D MR elastography demonstrates excellent performance for the diagnosis of clinically significant portal hypertension (AUC 0.911). • Spleen stiffness measured with 3D MR elastography outperforms liver and spleen stiffness measured with shear wave elastography for diagnosis of clinically significant portal hypertension.
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Affiliation(s)
- Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Guillermo Carbonell
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Universidad de Murcia, Murcia, Spain
| | - Daniela Said
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Universidad de los Andes, Santiago, Chile
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghadi Abboud
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan Cuevas
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Scott L Friedman
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas Schiano
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dipankar Bhattacharya
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Fischman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
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7
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Evaluation of hepatic hemodynamics (hepatic venous pressure gradient) during right heart catheterization: a comprehensive review. Curr Probl Cardiol 2022; 47:101278. [DOI: 10.1016/j.cpcardiol.2022.101278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 01/01/2023]
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8
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Venkatesh SK, Torbenson MS. Liver fibrosis quantification. Abdom Radiol (NY) 2022; 47:1032-1052. [PMID: 35022806 DOI: 10.1007/s00261-021-03396-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
Liver fibrosis (LF) is the wound healing response to chronic liver injury. LF is the endpoint of chronic liver disease (CLD) regardless of etiology and the single most important determinant of long-term liver-related clinical outcomes. Quantification of LF is important for staging, to evaluate response to treatment and to predict outcomes. LF is traditionally staged by liver biopsy. However, liver biopsy is invasive and suffers from sampling errors when biopsy size is inadequate; therefore, non-invasive tests (NITs) have found important roles in clinical care. NITs include simple laboratory-based serum tests, panels of serum tests, and imaging biomarkers. NITs are validated against the liver biopsy and will be used in the future for evaluation of nearly all CLDs with invasive liver biopsy reserved for some cases. Both serum tests and some imaging biomarkers such as elastography are currently used clinically as surrogate markers for LF. Several other imaging biomarkers are still considered research and awaiting clinical application in the future. As the evaluation of imaging biomarkers will likely become the norm in the future, understanding pathogenesis of LF is important. Knowledge of properties measured by imaging biomarkers and its correlation with LF is important to understand the application of NITs by abdominal radiologists. In this review, we present a brief overview of pathogenesis of LF, spatiotemporal evolution of LF in different CLD, and severity assessment with liver biopsy. This will be followed by a brief discussion on properties measured by imaging biomarkers and their relationship to the LF.
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Affiliation(s)
- Sudhakar K Venkatesh
- Abdominal Imaging Division, Department of Radiology, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA.
| | - Michael S Torbenson
- Anatomic Pathology Division, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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9
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Liu Y, Tang T, Örmeci N, Huang Y, Wang J, Li X, Li Z, An W, Liu D, Zhang C, Liu C, Liu J, Liu C, Wang G, Mosconi C, Cappelli A, Bruno A, Akçalar S, Çelebioğlu E, Üstüner E, Bilgiç S, Ellik Z, Asiller ÖÖ, Li L, Zhang H, Kang N, Xu D, He R, Wang Y, Bu Y, Gu Y, Ju S, Golfieri R, Qi X. Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study. J Clin Transl Hepatol 2021; 9:818-827. [PMID: 34966645 PMCID: PMC8666380 DOI: 10.14218/jcth.2021.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/29/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS This study aimed to determine the performance of the non-invasive score using noncontrast-enhanced MRI (CHESS-DIS score) for detecting portal hypertension in cirrhosis. METHODS In this international multicenter, diagnostic study (ClinicalTrials.gov, NCT03766880), patients with cirrhosis who had hepatic venous pressure gradient (HVPG) measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China (n=4) and Turkey (n=1) between December 2018 and April 2019. A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017. After segmentation of the liver on fat-suppressed T1-weighted MRI maps, CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity. RESULTS A total of 149 patients were included, of which 124 were from four Chinese hospitals (training cohort) and 25 were from two international hospitals (validation cohort). A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36 (p<0.0001) and 0.55 (p<0.01) for the training and validation cohorts, respectively. The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension (CSPH) was 0.81 and 0.9 in the training and validation cohorts, respectively. The intraclass correlation coefficients for assessing the inter- and intra-observer agreement were 0.846 and 0.841, respectively. CONCLUSIONS A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG. Besides, this score could be used to detect CSPH in patients with cirrhosis.
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Affiliation(s)
- Yanna Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
- Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Tianyu Tang
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Necati Örmeci
- Istanbul Health and Technology University, Zytinburnu/İstanbul, Turkey
| | - Yifei Huang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jitao Wang
- CHESS Working Party, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Xiaoguo Li
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zhiwei Li
- Department of Hepatobiliary Surgery, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Weimin An
- Department of Radiology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dengxiang Liu
- CHESS Working Party, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Chunqing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Changchun Liu
- Department of Radiology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jinqiang Liu
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Chuan Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Guangchuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
| | - Antonio Bruno
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
| | - Seray Akçalar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Emrecan Çelebioğlu
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Üstüner
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sadık Bilgiç
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Özgün Ömer Asiller
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Lei Li
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Haijun Zhang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ning Kang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Dan Xu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ruiling He
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yan Wang
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
| | - Yang Bu
- Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Ye Gu
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
- Correspondence to: Xiaolong Qi, CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, China. ORCID: https://orcid.org/0000-0002-3559-5855. Tel: +86-18588602600, Fax: +86-931-8619-797, E-mail: ; Rita Golfieri, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ORCID: https://orcid.org/0000-0001-8809-9989. Tel: +39-51-2142-311, Fax: +39-51-6362-699, E-mail: ; Shenghong Ju, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China. ORCID: https://orcid.org/0000-0001-5041-7865. Tel/Fax: +86-25-8327-2121, E-mail:
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
- Correspondence to: Xiaolong Qi, CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, China. ORCID: https://orcid.org/0000-0002-3559-5855. Tel: +86-18588602600, Fax: +86-931-8619-797, E-mail: ; Rita Golfieri, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ORCID: https://orcid.org/0000-0001-8809-9989. Tel: +39-51-2142-311, Fax: +39-51-6362-699, E-mail: ; Shenghong Ju, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China. ORCID: https://orcid.org/0000-0001-5041-7865. Tel/Fax: +86-25-8327-2121, E-mail:
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
- Correspondence to: Xiaolong Qi, CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, China. ORCID: https://orcid.org/0000-0002-3559-5855. Tel: +86-18588602600, Fax: +86-931-8619-797, E-mail: ; Rita Golfieri, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ORCID: https://orcid.org/0000-0001-8809-9989. Tel: +39-51-2142-311, Fax: +39-51-6362-699, E-mail: ; Shenghong Ju, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China. ORCID: https://orcid.org/0000-0001-5041-7865. Tel/Fax: +86-25-8327-2121, E-mail:
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10
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Bosch J, Chung C, Carrasco-Zevallos OM, Harrison SA, Abdelmalek MF, Shiffman ML, Rockey DC, Shanis Z, Juyal D, Pokkalla H, Le QH, Resnick M, Montalto M, Beck AH, Wapinski I, Han L, Jia C, Goodman Z, Afdhal N, Myers RP, Sanyal AJ. A Machine Learning Approach to Liver Histological Evaluation Predicts Clinically Significant Portal Hypertension in NASH Cirrhosis. Hepatology 2021; 74:3146-3160. [PMID: 34333790 DOI: 10.1002/hep.32087] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The hepatic venous pressure gradient (HVPG) is the standard for estimating portal pressure but requires expertise for interpretation. We hypothesized that HVPG could be extrapolated from liver histology using a machine learning (ML) algorithm. APPROACH AND RESULTS Patients with NASH with compensated cirrhosis from a phase 2b trial were included. HVPG and biopsies from baseline and weeks 48 and 96 were reviewed centrally, and biopsies evaluated with a convolutional neural network (PathAI, Boston, MA). Using trichrome-stained biopsies in the training set (n = 130), an ML model was developed to recognize fibrosis patterns associated with HVPG, and the resultant ML HVPG score was validated in a held-out test set (n = 88). Associations between the ML HVPG score with measured HVPG and liver-related events, and performance of the ML HVPG score for clinically significant portal hypertension (CSPH) (HVPG ≥ 10 mm Hg), were determined. The ML-HVPG score was more strongly correlated with HVPG than hepatic collagen by morphometry (ρ = 0.47 vs. ρ = 0.28; P < 0.001). The ML HVPG score differentiated patients with normal (0-5 mm Hg) and elevated (5.5-9.5 mm Hg) HVPG and CSPH (median: 1.51 vs. 1.93 vs. 2.60; all P < 0.05). The areas under receiver operating characteristic curve (AUROCs) (95% CI) of the ML-HVPG score for CSPH were 0.85 (0.80, 0.90) and 0.76 (0.68, 0.85) in the training and test sets, respectively. Discrimination of the ML-HVPG score for CSPH improved with the addition of a ML parameter for nodularity, Enhanced Liver Fibrosis, platelets, aspartate aminotransferase (AST), and bilirubin (AUROC in test set: 0.85; 95% CI: 0.78, 0.92). Although baseline ML-HVPG score was not prognostic, changes were predictive of clinical events (HR: 2.13; 95% CI: 1.26, 3.59) and associated with hemodynamic response and fibrosis improvement. CONCLUSIONS An ML model based on trichrome-stained liver biopsy slides can predict CSPH in patients with NASH with cirrhosis.
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Affiliation(s)
- Jaime Bosch
- Department of Biomedical Research, University of Bern, Bern, Switzerland
- University of Barcelona-IDIBAPS and CIBERehd, Barcelona, Spain
| | | | | | | | | | | | - Don C Rockey
- Medical University of South Carolina, Charleston, SC
| | | | | | | | | | | | | | | | | | - Ling Han
- Gilead Sciences, Inc, Foster City, CA
| | | | | | - Nezam Afdhal
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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11
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Frangakis C, Sohn JH, Bas A, Chapiro J, Schernthaner RE, Lin M, Hamilton JP, Pawlik TM, Hong K, Duran R. Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure. Front Oncol 2021; 11:639235. [PMID: 34804911 PMCID: PMC8602787 DOI: 10.3389/fonc.2021.639235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/22/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Investigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension. Methods Retrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient. Results No significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%). Conclusion Repeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.
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Affiliation(s)
- Constantine Frangakis
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jae Ho Sohn
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ahmet Bas
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Ruediger E Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - MingDe Lin
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Wu PS, Hsieh YC, Lee KC, Huang YH, Hou MC, Lin HC. Mac-2 binding protein glycosylation isomer is a potential biomarker to predict portal hypertension and bacterial infection in cirrhotic patients. PLoS One 2021; 16:e0258589. [PMID: 34648567 PMCID: PMC8516253 DOI: 10.1371/journal.pone.0258589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel plasma biomarker for liver fibrosis, but less is known about its role in portal hypertension. We aimed to evaluate the association between M2BPGi and hepatic venous pressure gradient (HVPG) and to investigate its predictive value on prognosis of cirrhotic patients. Methods Forty-eight cirrhotic patients who underwent HVPG measurement in Taipei Veterans General hospital were retrospectively enrolled. The Spearman’s correlation test was used to analyze the correlation between plasma M2BPGi levels and HVPG and other parameters. Cox proportional hazards regression models were used to identify predictors for clinical outcomes. Results Plasma M2BPGi levels were higher in cirrhotic patients than healthy subjects and significantly correlated with HVPG levels (rs = 0.45, p = 0.001). On multivariate Cox regression analysis, higher plasma M2BPGi levels [≥ 6 cut-off index (C.O.I)] did not predict mortality within five years for cirrhotic patients and the result was similar in patients without hepatocellular carcinoma. Interestingly, M2BPGi ≥ 6 C.O.I was a potential predictor of bacterial infection within five years [Hazar ratio (HR) = 4.51, p = 0.003]. However, M2BPGi failed to predict occurrence of other cirrhosis-related complications, including variceal bleeding, ascites formation, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatic encephalopathy. Conclusion Plasma M2BPGi levels positively correlated with HVPG and higher serum M2BPGi levels might have a potential role in predicting development of bacterial infection for cirrhotic patients with portal hypertension.
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Affiliation(s)
- Pei-Shan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Cheng Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (KCL); (HCL)
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (KCL); (HCL)
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13
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Jain D, Sreenivasan P, Inayat I, Deng Y, Ciarleglio MM, Garcia-Tsao G. Thick Fibrous Septa on Liver Biopsy Specimens Predict the Development of Decompensation in Patients With Compensated Cirrhosis. Am J Clin Pathol 2021; 156:802-809. [PMID: 33940622 DOI: 10.1093/ajcp/aqab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In compensated cirrhosis, thick fibrous septa and small nodules on liver biopsy specimens correlate with the presence of clinically significant portal hypertension (CSPH). In turn, CSPH is the strongest predictor of cirrhosis decompensation. The aim of the study was to correlate liver biopsy specimen characteristics with the development of decompensation in patients with compensated cirrhosis. METHODS Patients with compensated cirrhosis and a concurrent liver biopsy specimen were reviewed. Semiquantitative grading of septal thickness and nodule size was performed. Primary end point was development of clinical decompensation. In total, 168 patients (median age, 49 years; 76% men) were included in the study; the most common etiology was viral. RESULTS In a median follow-up of 50 months, 43 (26%) patients developed clinical decompensation (60% ascites, 16% encephalopathy, 12% variceal hemorrhage, 7% jaundice, and 5% mixed). On univariate analysis, septal width was significantly associated with decompensation, but nodule size was not. On multivariate analysis including model for end-stage liver disease score, serum albumin, and septal width, albumin and septal width were independent predictors of decompensation. CONCLUSIONS Histologic cirrhosis in compensated patients can be subclassified by severity based on septal thickness, with thick septa denoting worse prognosis.
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Affiliation(s)
- Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Prithvi Sreenivasan
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA
| | - Irteza Inayat
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Maria M Ciarleglio
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA
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14
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Zheng M, Zhao Y, Han S, Ji D, Li Y, Lv W, Xin X, Zhao X, Hu C. Iterative reconstruction algorithm based on discriminant adaptive-weighted TV regularization for fibrous biological tissues using in-line X-ray phase-contrast imaging. BIOMEDICAL OPTICS EXPRESS 2021; 12:2460-2483. [PMID: 33996241 PMCID: PMC8086461 DOI: 10.1364/boe.418898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 05/07/2023]
Abstract
In-line X-ray phase-contrast computed tomography (IL-PCCT) can produce high-contrast and high-resolution images of biological samples, and it has a great advantage with regard to imaging the microstructures and morphologies of fibrous biological tissues (FBTs). Filtered back projection (FBP) is widely used in ILPCCT. However, it requires long scanning times and high radiation doses to produce high-quality CT images, and this restricts its applicability in biomedical and preclinical studies on FBTs. To solve this problem, a novel IL-PCCT reconstruction algorithm is proposed to decrease the radiation dose by reducing the number of projections and reconstruct high-quality CT images of FBTs. The proposed algorithm incorporates the FBP method into the iterative reconstruction framework. Considering the area types and anisotropic edge properties of FBTs, a discriminant adaptive-weighted total variation model is introduced to optimize the intermediate reconstructed images. A fibrous phantom simulation and real experiment were performed to assess the performance of the proposed algorithm. Simulation and experimental results demonstrated that the proposed algorithm is an effective IL-PCCT reconstruction method for FBTs with incomplete projection data, and it has a great ability to suppress artifacts and preserve the edges of fibrous structures.
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Affiliation(s)
- Mengting Zheng
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
- These authors contributed equally to this work
| | - Yuqing Zhao
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
- These authors contributed equally to this work
| | - Shuo Han
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
| | - Dongjiang Ji
- The School of Science, Tianjin University of Technology and Education, Tianjin 300222, China
| | - Yimin Li
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
| | - Wenjuan Lv
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
| | - Xiaohong Xin
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Chunhong Hu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
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15
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Hiroyama S, Rokugawa T, Ito M, Iimori H, Morita I, Maeda H, Fujisawa K, Matsunaga K, Shimosegawa E, Abe K. Quantitative evaluation of hepatic integrin α vβ 3 expression by positron emission tomography imaging using 18F-FPP-RGD 2 in rats with non-alcoholic steatohepatitis. EJNMMI Res 2020; 10:118. [PMID: 33026561 PMCID: PMC7541810 DOI: 10.1186/s13550-020-00704-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background Integrin αvβ3, which are expressed by activated hepatic stellate cells in non-alcoholic steatohepatitis (NASH), play an important role in the fibrosis. Recently, we reported that an RGD peptide positron emission tomography (PET) probe is useful as a predictor of hepatic fibrosis. Kinetic analysis of the RGD PET probe has been performed in tumours, but not in hepatic fibrosis. Therefore, we aimed to quantify hepatic integrin αvβ3 in a model of NASH by kinetic analysis using 18F-FPP-RGD2, an integrin αvβ3 PET probe. Methods 18F-FPP-RGD2 PET/CT scans were performed in control and NASH rats. Tissue kinetic analyses were performed using a one-tissue, two-compartment (1T2C) and a two-tissue, three-compartment (2T3C) model using an image-derived input function (IDIF) for the left ventricle. We then conducted correlation analysis between standard uptake values (SUVs) or volume of distribution (VT), evaluated using compartment kinetic analysis and integrin αv or β3 protein expression. Results Biochemical and histological evaluation confirmed the development of NASH rats. Integrin αvβ3 protein expression and hepatic SUV were higher in NASH- than normal rats. The hepatic activity of 18F-FPP-RGD2 peaked rapidly after administration and then gradually decreased, whereas left ventricular activity rapidly disappeared. The 2T3C model was found to be preferable for 18F-FPP-RGD2 kinetic analysis in the liver. The VT (IDIF) for 18F-FPP-RGD2, calculated using the 2T3C model, was significantly higher in NASH- than normal rats and correlated strongly with hepatic integrin αv and β3 protein expression. The strengths of these correlations were similar to those between SUV60–90 min and hepatic integrin αv or β3 protein expression. Conclusions We have demonstrated that the VT (IDIF) of 18F-FPP-RGD2, calculated using kinetic modelling, positively correlates with integrin αv and β3 protein in the liver of NASH rats. These findings suggest that hepatic VT (IDIF) provides a quantitative assessment of integrin αvβ3 protein in liver.
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Affiliation(s)
- Shuichi Hiroyama
- Translational Research Unit, Biomarker R&D Department, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan.
| | - Takemi Rokugawa
- Translational Research Unit, Biomarker R&D Department, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
| | - Miwa Ito
- Translational Research Unit, Biomarker R&D Department, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
| | - Hitoshi Iimori
- Research Laboratory for Development, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
| | - Ippei Morita
- Laboratory for Advanced Medicine Research, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
| | - Hiroki Maeda
- Laboratory for Innovative Therapy Research, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
| | - Kae Fujisawa
- Research Laboratory for Development, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
| | - Keiko Matsunaga
- Department of Molecular Imaging in Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kohji Abe
- Translational Research Unit, Biomarker R&D Department, Shionogi & Co., Ltd., 3-1-1 Futaba-cho, Toyonaka, Osaka, 561-0825, Japan
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Souhami A, Sartoris R, Rautou PE, Cauchy F, Bouattour M, Durand F, Giannelli V, Gigante E, Castera L, Valla D, Soubrane O, Vilgrain V, Ronot M. Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma. JHEP Rep 2020; 2:100147. [PMID: 32885156 PMCID: PMC7452899 DOI: 10.1016/j.jhepr.2020.100147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND & AIMS We compare the performance of liver surface nodularity (LSN) and liver stiffness measurements (LSM) using transient elastography (TE) for the detection of clinically significant portal hypertension (CSPH) in patients with cirrhosis and hepatocellular carcinoma (HCC). METHODS All patients with cirrhosis and HCC who underwent computed tomography, LSM and hepatic venous pressure gradient (HVPG) measurements within 30 days between 2015 and 2018 were included. The estimation of CSPH by LSN and LSM, and the LSM-spleen-size-to-platelet ratio score (LSPS) were evaluated and compared. RESULTS In total, 140 patients were included (109 men [78%], mean age 63 ± 9 years old), including 39 (28%) with CSPH. LSN measurements were valid in 130 patients (93%) and significantly correlated with HVPG (r = 0.68; p <0.001). Patients with CSPH had higher LSN measurements compared with those without [3.1 ± 0.4 vs. 2.5 ± 0.3, p <0.001; area under the receiver operating characteristic (AUROC): 0.87 ± 0.31]. LSM and LSPS were valid in 132 patients (94%) and significantly correlated with HVPG (r = 0.75, p <0.001; AUROC 0.87 ± 0.04 and r = 0.68, p <0.001; AUROC 0.851 ± 0.04, respectively). There was no significant difference in the diagnostic performance between LSN and LSM-LSPS (DeLong, p = 0.28, 0.37, and 0.65, respectively) in patients with both valid tests (n = 122). LSN <2.50 had a 100% negative predictive value for CSPH. A 2-step algorithm combining LSN and LSPS for the diagnosis of CSPH classified 108/140 patients (77%) with an 8% error. CONCLUSIONS The diagnostic performance and feasibility of LSN measurements were similar to those of LSM for the detection of CSPH in patients with compensated cirrhosis and HCC. Combining LSN and LSPS accurately detected CSPH in >75% of patients. Such a combination could be useful in centres where the HVPG measurement is unavailable. LAY SUMMARY The diagnostic performance and feasibility of liver surface nodularity was similar to that of liver stiffness measurement (LSM) for the detection of clinically significant portal hypertension in patients with compensated cirrhosis. Thus, liver surface nodularity could be an option for the preoperative detection of clinically significant portal hypertension in patients with hepatocellular carcinoma. Combining liver surface nodularity with LSM-spleen-size-to-platelet ratio score resulted in the accurate detection of clinically significant portal hypertension in >75% of patients, thus limiting the need for HVPG measurements.
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Key Words
- AUROC, area under the receiver operating characteristic
- CSPH, clinically significant portal hypertension
- HCC, hepatocellular carcinoma
- HPV, hepatic venous pressure
- HVPG, hepatic venous pressure gradient
- LSM, liver stiffness measurements
- LSN, liver surface nodularity
- LSPS, LSM-spleen-size-to-platelet ratio score
- NRI, Net Classification Index Improvement
- PHT, portal hypertension
- TE, transient elastography
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Affiliation(s)
- Alexandra Souhami
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Riccardo Sartoris
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Pierre-Emmanuel Rautou
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
- Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases (FILFOIE), European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Mohamed Bouattour
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - François Durand
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
| | - Valerio Giannelli
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - Elia Gigante
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - Laurent Castera
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - Dominique Valla
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
- INSERM U1149, CRI, Paris, France
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Appraising diagnostic performance of ELF test by pathological staging and digital quantification of liver fibrosis. Ann Hepatol 2020; 18:833-840. [PMID: 31558418 DOI: 10.1016/j.aohep.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES A crucial issue when appraising the performance of non-invasive markers is the limitations of the reference standard they are compared to. Digital image analysis (DIA) was suggested as a reproducible approach expressing fibrosis numerically as a proportionate area (PA) (%). We aimed to evaluate ELF test with direct reference to PA (%), thereby explore the improvement in accuracy to discriminate significant fibrosis which may actually have been underestimated by categorical pathological staging. MATERIALS AND METHODS PA (%) data were obtained by DIA of trichrome-stained liver biopsies of 52 chronic hepatitis patients. Paired serum samples of patients and additional 36 controls were performed to measure ELF test. Diagnostic performance characteristics of ELF test was derived in predicting significant fibrosis in the patient cohort, and also, in distinguishing healthy controls from patients with significant fibrosis. RESULTS We found an AUROC value of 0.73 for ELF to predict significant fibrosis as assessed by DIA and a lower AUROC value of 0.66 when assessed by conventional pathology. Importantly, ELF test provided considerably high diagnostic accuracy to discriminate healthy controls from patients with significant fibrosis defined by Ishak F≥2 and TPA≥5% (AUROCs 0.93 and 0.94, respectively) with optimal ELF cut-off point of 8.4 for both. CONCLUSIONS Digital quantification could represent a better reference standard than conventional pathology allowing a better discriminatory capability for ELF test. ELF test provided high diagnostic accuracy to discriminate healthy controls from patients with significant fibrosis suggesting a role as a screening strategy in the community setting.
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Hobeika C, Cauchy F, Sartoris R, Beaufrère A, Yoh T, Vilgrain V, Rautou PE, Paradis V, Bouattour M, Ronot M, Soubrane O. Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma. Br J Surg 2020; 107:878-888. [PMID: 32118298 DOI: 10.1002/bjs.11511] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Quantification of liver surface nodularity (LSN) on routine preoperative CT images allows detection of cirrhosis and clinically significant portal hypertension. This study aimed to assess the relevance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC). METHODS All patients undergoing hepatectomy for HCC between 2012 and 2017 were analysed retrospectively. LSN was assessed at the liver-fat interface on the left liver lobe on preoperative CT images. The feasibility of LSN quantification was assessed. The association between LSN and outcomes (severe complications and posthepatectomy liver failure (PHLF)) was evaluated by multivariable analysis and after propensity score matching. RESULTS Among 210 patients, LSN measurement was successful in 187 (89·0 per cent). Among these, the median LSN score was 2·42 (i.q.r. 2·21-2·66) and 52·9 per cent had severe fibrosis, including 33·7 per cent with cirrhosis. LSN score increased with hepatic venous pressure gradient (P = 0·048), severity of steatosis (P = 0·011) and fibrosis grade (P = 0·001). LSN score was independently associated with severe complications (odds ratio (OR) 5·25; P = 0·006) and PHLF (OR 6·78; P = 0·003). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, patients with a LSN score of 2·63 or higher retained an increased risk of PHLF (OR 5·81; P = 0·018). In the subgroup of patients without severe fibrosis, LSN was accurate in predicting severe complications (P = 0·005). Patients with (P = 0·039) or without (P = 0·018) severe fibrosis with increased LSN score had a higher comprehensive complication index score. Among patients with cirrhosis who had clinically significant portal hypertension, a LSN value below 2·63 ruled out the risk of PHLF. CONCLUSION LSN measurement represents a practical tool that may allow improvement in the preoperative evaluation and management of patients with HCC.
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Affiliation(s)
- C Hobeika
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Cauchy
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - R Sartoris
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - A Beaufrère
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - T Yoh
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - V Vilgrain
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - P E Rautou
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - V Paradis
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - M Bouattour
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - M Ronot
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - O Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
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Gawrieh S, Sethunath D, Cummings OW, Kleiner DE, Vuppalanchi R, Chalasani N, Tuceryan M. Automated quantification and architectural pattern detection of hepatic fibrosis in NAFLD. Ann Diagn Pathol 2020; 47:151518. [PMID: 32531442 DOI: 10.1016/j.anndiagpath.2020.151518] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023]
Abstract
Accurate detection and quantification of hepatic fibrosis remain essential for assessing the severity of non-alcoholic fatty liver disease (NAFLD) and its response to therapy in clinical practice and research studies. Our aim was to develop an integrated artificial intelligence-based automated tool to detect and quantify hepatic fibrosis and assess its architectural pattern in NAFLD liver biopsies. Digital images of the trichrome-stained slides of liver biopsies from patients with NAFLD and different severity of fibrosis were used. Two expert liver pathologists semi-quantitatively assessed the severity of fibrosis in these biopsies and using a web applet provided a total of 987 annotations of different fibrosis types for developing, training and testing supervised machine learning models to detect fibrosis. The collagen proportionate area (CPA) was measured and correlated with each of the pathologists semi-quantitative fibrosis scores. Models were created and tested to detect each of six potential fibrosis patterns. There was good to excellent correlation between CPA and the pathologist score of fibrosis stage. The coefficient of determination (R2) of automated CPA with the pathologist stages ranged from 0.60 to 0.86. There was considerable overlap in the calculated CPA across different fibrosis stages. For identification of fibrosis patterns, the models areas under the receiver operator curve were 78.6% for detection of periportal fibrosis, 83.3% for pericellular fibrosis, 86.4% for portal fibrosis and >90% for detection of normal fibrosis, bridging fibrosis, and presence of nodule/cirrhosis. In conclusion, an integrated automated tool could accurately quantify hepatic fibrosis and determine its architectural patterns in NAFLD liver biopsies.
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Affiliation(s)
- Samer Gawrieh
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Deepak Sethunath
- Department of Computer and Information Science, Indiana University Purdue University, Indianapolis, IN, United States of America
| | - Oscar W Cummings
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, United States of America
| | - Raj Vuppalanchi
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Mihran Tuceryan
- Department of Computer and Information Science, Indiana University Purdue University, Indianapolis, IN, United States of America
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Performance of liver surface nodularity quantification for the diagnosis of portal hypertension in patients with cirrhosis: comparison between MRI with hepatobiliary phase sequences and CT. Abdom Radiol (NY) 2020; 45:365-372. [PMID: 31797023 DOI: 10.1007/s00261-019-02355-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess and compare the performance of liver surface nodularity (LSN) quantification using Gd-BOPTA-enhanced MRI and contrast-enhanced CT for the diagnosis of clinically significant portal hypertension (CSPH) in patients with cirrhosis. METHODS This retrospective study included 30 patients with compensated histologically proven cirrhosis who underwent hepatic venous pressure gradient (HVPG), abdominal CT and Gd-BOPTA-MRI within a 60-day interval during pre-surgery workup for hepatocellular carcinoma (HCC) between January 2016 and August 2018. LSN score was derived from CT portal venous phase (PVP), axial T2- and T1-weighted PVP and hepatobiliary phase (HBP). Accuracy for the detection of CSPH was evaluated for each set of images by ROC curve analysis. Intra-observer, inter-observer and inter-method reproducibilities were assessed by the intraclass correlation coefficient (ICC) and coefficient of variation (CV). RESULTS Thirty patients were analysed (23 men [77%], mean age 60 ± 11 years old), including 15 (50%) with CSPH. All CT- and MRI-derived LSN quantifications were correlated to HVPG (CT-PVP: r = 0.63, p = 0.001, AUROC = 0.908 ± 0.06; T1-w-PVP: r = 0.43, p = 0.028, AUROC = 0.876 ± 0.07; T1-w-HBP: r = 0.50, p = 0.012, AUROC = 0.823 ± 0.08; T2-w: r = 0.51, p = 0.007, AUROC = 0.801 ± 0.09). There was no significant difference in AUROC pairwise comparisons (p = 0.12-0.88). Patients with CSPH had higher LSN than those without (CT-PVP: 3.2 ± 0.6 vs 2.4 ± 0.5, p < 0.001; T1-w-PVP: 2.7 ± 0.4 vs 2.2 ± 0.4, p = 0.002; T1-w-HBP: 3.0 ± 0.6 vs 2.3 ± 0.3, p < 0.001; T2-w: 3.0 ± 0.6 vs 2.2 ± 0.3, p = 0.001) and 86%, 82%, 85% and 82% of patients were correctly classified, respectively. Reproducibility of inter-image set comparisons was excellent (ICC = 0.84-0.96 and CV = 8.3-14.2%). CONCLUSION The diagnostic performance of MRI-based LSN for detecting CSPH is strong and similar to that of CT-based LSN.
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Hua X, Wang YY, Jia P, Xiong Q, Hu Y, Chang Y, Lai S, Xu Y, Zhao Z, Song J. Multi-level transcriptome sequencing identifies COL1A1 as a candidate marker in human heart failure progression. BMC Med 2020; 18:2. [PMID: 31902369 PMCID: PMC6943904 DOI: 10.1186/s12916-019-1469-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Heart failure (HF) has been recognized as a global pandemic with a high rate of hospitalization, morbidity, and mortality. Although numerous advances have been made, its representative molecular signatures remain largely unknown, especially the role of genes in HF progression. The aim of the present prospective follow-up study was to reveal potential biomarkers associated with the progression of heart failure. METHODS We generated multi-level transcriptomic data from a cohort of left ventricular heart tissue collected from 21 HF patients and 9 healthy donors. By using Masson staining to calculate the fibrosis percentage for each sample, we applied lasso regression model to identify the genes associated with fibrosis as well as progression. The genes were further validated by immunohistochemistry (IHC) staining in the same cohort and qRT-PCR using another independent cohort (20 HF and 9 healthy donors). Enzyme-linked immunosorbent assay (ELISA) was used to measure the plasma level in a validation cohort (139 HF patients) for predicting HF progression. RESULTS Based on the multi-level transcriptomic data, we examined differentially expressed genes [mRNAs, microRNAs, and long non-coding RNAs (lncRNAs)] in the study cohort. The follow-up functional annotation and regulatory network analyses revealed their potential roles in regulating extracellular matrix. We further identified several genes that were associated with fibrosis. By using the survival time before transplantation, COL1A1 was identified as a potential biomarker for HF progression and its upregulation was confirmed by both IHC and qRT-PCR. Furthermore, COL1A1 content ≥ 256.5 ng/ml in plasma was found to be associated with poor survival within 1 year of heart transplantation from heart failure [hazard ratio (HR) 7.4, 95% confidence interval (CI) 3.5 to 15.8, Log-rank p value < 1.0 × 10- 4]. CONCLUSIONS Our results suggested that COL1A1 might be a plasma biomarker of HF and associated with HF progression, especially to predict the 1-year survival from HF onset to transplantation.
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Affiliation(s)
- Xiumeng Hua
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 10037, China
| | - Yin-Ying Wang
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA
| | - Peilin Jia
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA
| | - Qing Xiong
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA
| | - Yiqing Hu
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 10037, China
| | - Yuan Chang
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 10037, China
| | - Songqing Lai
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 10037, China
| | - Yong Xu
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA. .,Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX, 77030, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.
| | - Jiangping Song
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 10037, China.
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Patients With Signs of Advanced Liver Disease and Clinically Significant Portal Hypertension Do Not Necessarily Have Cirrhosis. Clin Gastroenterol Hepatol 2019; 17:2101-2109.e1. [PMID: 30625404 DOI: 10.1016/j.cgh.2018.12.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/11/2018] [Accepted: 12/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with hepatic venous pressure gradients (HVPGs) of 10 mm Hg or greater and chronic liver disease often are assumed to have cirrhosis. We investigated the association between HVPGs and cirrhosis, using histologic findings as the reference standard. We also assessed the prevalence and characteristics of patients with HVPGs of 10 mm Hg or greater without cirrhosis. METHODS We performed a retrospective analysis of 157 consecutive patients, 89 with suspected cirrhosis and hepatic hemodynamic data collected from 2015 through 2017. Biopsy specimens collected had 10 or more portal tracts from each patient and were analyzed for features of cirrhosis. Biopsy specimens with histologic features of cirrhosis were excluded and the remaining biopsy specimens were re-reviewed by an expert pathologist. The fibrosis area was calculated digitally by image analysis. RESULTS HVPG identified patients with cirrhosis with an area under the receiver operating characteristic curve of 0.879: 14 of 89 patients with HVPG of 10 mm Hg or greater (16%) had no histologic features of cirrhosis (METAVIR scores <4 and Ishak scores <6). The median HVPG was 11 mm Hg (range, 10-22 mm Hg). Based on METAVIR scores, 7 patients had fibrosis stage F3, 4 patients had fibrosis stage F2, and 3 patients had fibrosis stages F0 or F1. The mean area of fibrosis in livers was 16.2% ± 6.5%. All 14 patients had perisinusoidal fibrosis and 8 patients had hepatocyte ballooning. The most common diagnoses were nonalcoholic steatohepatitis (n = 5) and nodular regenerative hyperplasia (n = 4). An HVPG cut-off value of 12 mm Hg identified patients with cirrhosis with 92% specificity, misclassifying 5 patients with different etiologies of liver disease. CONCLUSIONS In a retrospective analysis of 89 consecutive patients with chronic liver disease and an HVPG of 10 mm Hg or greater, 16% were not found to have cirrhosis upon biopsy analysis. Most of these patients had nonalcoholic steatohepatitis or nodular regenerative hyperplasia. Perisinusoidal fibrosis and hepatocyte ballooning might increase sinusoidal pressure. An HVPG cut-off value of 12 mm Hg or greater identified patients with cirrhosis with 92% specificity.
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Phase-contrast computed tomography: A correlation study between portal pressure and three dimensional microvasculature of ex vivo liver samples from carbon tetrachloride-induced liver fibrosis in rats. Microvasc Res 2019; 125:103884. [DOI: 10.1016/j.mvr.2019.103884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 12/17/2022]
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Zhao Y, Ji D, Chen Y, Jian J, Zhao X, Zhao Q, Lv W, Xin X, Yang T, Hu C. A new in-line X-ray phase-contrast computed tomography reconstruction algorithm based on adaptive-weighted anisotropic TpV regularization for insufficient data. JOURNAL OF SYNCHROTRON RADIATION 2019; 26:1330-1342. [PMID: 31274462 DOI: 10.1107/s1600577519005095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/13/2019] [Indexed: 06/09/2023]
Abstract
In-line X-ray phase-contrast computed tomography (IL-PCCT) is a valuable tool for revealing the internal detailed structures in weakly absorbing objects (e.g. biological soft tissues), and has a great potential to become clinically applicable. However, the long scanning time for IL-PCCT will result in a high radiation dose to biological samples, and thus impede the wider use of IL-PCCT in clinical and biomedical imaging. To alleviate this problem, a new iterative CT reconstruction algorithm is presented that aims to decrease the radiation dose by reducing the projection views, while maintaining the high quality of reconstructed images. The proposed algorithm combines the adaptive-weighted anisotropic total p-variation (AwaTpV, 0 < p < 1) regularization technique with projection onto convex sets (POCS) strategy. Noteworthy, the AwaTpV regularization term not only contains the horizontal and vertical image gradients but also adds the diagonal image gradients in order to enforce the directional continuity in the gradient domain. To evaluate the effectiveness and ability of the proposed algorithm, experiments with a numerical phantom and synchrotron IL-PCCT were performed, respectively. The results demonstrated that the proposed algorithm had the ability to significantly reduce the artefacts caused by insufficient data and effectively preserved the edge details under noise-free and noisy conditions, and thus could be used as an effective approach to decrease the radiation dose for IL-PCCT.
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Affiliation(s)
- Yuqing Zhao
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Dongjiang Ji
- The School of Science, Tianjin University of Technology and Education, Tianjin 300222, People's Republic of China
| | - Yingpin Chen
- School of Physics and Information Engineering, Minnan Normal University, 363000 Fujian, People's Republic of China
| | - Jianbo Jian
- Radiation Oncology Department, Tianjin Medical University General Hospital, Tianjin 300070, People's Republic of China
| | - Xinyan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, People's Republic of China
| | - Qi Zhao
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Wenjuan Lv
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Xiaohong Xin
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Tingting Yang
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, People's Republic of China
| | - Chunhong Hu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, People's Republic of China
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Hepatic Venous Pressure Gradient Measurements in Children: Correlation With Hepatic Histology and Clinical Indicators of Portal Hypertension. J Pediatr Gastroenterol Nutr 2019; 68:788-792. [PMID: 30921261 PMCID: PMC6534464 DOI: 10.1097/mpg.0000000000002327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children. METHODS Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data. RESULTS Forty-one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal hypertension (n = 7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4-12) and chronic liver disease (7 mmHg, range 1-12). HVPG measurements did not correlate with the histological severity of fibrosis (ρ = 0.23, P = 0.14) or portal inflammation (ρ = 0.24, P = 0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (P = 0.43). CONCLUSIONS HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.
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D’Amico G, Perricone G. Prediction of Decompensation in Patients with Compensated Cirrhosis: Does Etiology Matter? ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11901-019-00473-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Our aim was to explore the relationship between liver cirrhosis (LC), portal hypertension (PH), and diabetes mellitus (DM). LC displayed hemodynamic alterations reflected by signs and symptoms of hypertension and hyperdynamic circulation. Portal hypertension also caused splenomegaly because of the blood flow into the spleen from the portal vessels and portal flow. The alcoholic cirrhosis displayed abnormal values (AST, ALT, AST/ALT, albumin, ammonia, bilirubin, blood platelet, erythrocytes, glucose, Hb, international normalized ratio (INR), PT, prothrombin index (PI), thymol test, white blood cell (WBC) count), which demonstrated the presence of portal hypertension, ascites, DM, infection, and coagulopathy. The evaluation of liver enzymes and other laboratories data helped to determine the severity of the condition and prognosis. Diabetes appeared to be less affecting the prognosis of patients with cirrhosis than LC itself, showing that hepatocellular failure was largely responsible for patients’ mortality rather than diabetes and its complications. Patients displayed a BMI correlating obesity, although affected by concomitant diseases that commonly cause a severe weight loss. The elevated BMI in this case was accentuated by the presence of ascitic fluid, which is responsible for the increase in weight and the inaccurate BMI evaluation. Ascites affect patients’ recovery from liver diseases. Obese patients with cirrhosis can be related to have a large amount of ascites and that physicians should be expecting to notice changes in their BMI pre- and postoperatively, subsequently making a prior classification as obese inappropriate. Disease severity could be assessed through the evaluation of PH stage, which was characterized by a significant depletion of WBC and as well as platelet counts.
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Wang B, Sun Y, Zhou J, Wu X, Chen S, Wu S, Liu H, Wang T, Ou X, Jia J, You H. Advanced septa size quantitation determines the evaluation of histological fibrosis outcome in chronic hepatitis B patients. Mod Pathol 2018; 31:1567-1577. [PMID: 29785021 DOI: 10.1038/s41379-018-0059-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/08/2023]
Abstract
Hepatitis B (HBV)-related fibrosis can be reversed after effective antiviral therapy. However, detailed changes of collagen characteristics during fibrosis regression remain unclear. Paired biopsy samples obtained from chronic hepatitis B patients were imaged with second harmonic generation/two photon excitation fluorescence (SHG/TPEF)-based microscopy to identify and quantify collagen features in portal, septal, and fibrillar areas. According to the changes of Ishak stage and qFibrosis score, a total of 117 patients with paired liver biopsy appeared to have four different outcomes after 78-week antiviral therapy: fast reverse (9%), reverse (63%), stable (15%), or progress (13%) on fibrosis. Among 71 collagen features identified by SHG/TPEF analysis, the most prominent fibrosis reversion occurred in the "septal" area, followed by the "fibrillar" area, but not in the "portal" area (P < 0.001). Further analysis of 1060 individual septa identified four parameters that correlated with fibrosis reversion: average width, maximum width, number of fibers, and number of cross-link fibers (P < 0.001). Average septal width was independently associated with regressive septa (odds ratio (OR) = 5.22, 95% confidence interval (CI): 4.17-6.53; P < 0.001), with an AUROC of 0.96 (95% CI: 0.95-0.97). The threshold used to discriminate reversal of fibrosis was 30 μm. In conclusion, septal collagen was determined to be the most useful histological feature for evaluation of dynamic changes in liver fibrosis. Septal width was the most predictive indicator of prognosis in liver fibrosis.
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Affiliation(s)
- Bingqiong Wang
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yameng Sun
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jialing Zhou
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoning Wu
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuyan Chen
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shanshan Wu
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Department Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tailing Wang
- Department Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojuan Ou
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong You
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Kimer N, Gudmann NS, Pedersen JS, Møller S, Nielsen MJ, Leeming DJ, Karsdal MA, Møller HJ, Bendtsen F, Grønbæk H. No effect of rifaximin on soluble CD163, mannose receptor or type III and IV neoepitope collagen markers in decompensated cirrhosis: Results from a randomized, placebo controlled trial. PLoS One 2018; 13:e0203200. [PMID: 30183743 PMCID: PMC6124759 DOI: 10.1371/journal.pone.0203200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Macrophages play a significant role in chronic liver disease as reflected by elevated soluble (s)CD163 and mannose receptor (sMR) levels and associated with liver disease severity and prognosis. Extracellular matrix remodelling associated with fibrogenesis may be affected by systemic inflammation induced by bacterial translocation. Therefore, we aimed to investigate the effect of rifaximin-α, an antibiotic with effect on gut bacteria, on sCD163, sMR, and collagen metabolites. METHODS Fifty-four clinically stable patients with decompensated cirrhosis were randomized to 4 weeks treatment with rifaximin-α (n = 36) or placebo (n = 18). Macrophage markers sCD163, sMR and markers of collagen fibrogenesis (C3M and C4M) and formation (PRO-C3 and P4NPS7) were analysed in plasma before and after treatment. RESULTS sCD163 and sMR levels were associated with liver disease severity (MELD score, sCD163 rho = 0.47, p<0.001 and sMR rho = 0.37, p = 0.005). There was no effect of Rifaximin-α on sCD163 levels (median (range) sCD163 5.64(2.02 to 10.8) at baseline versus 4.42(1.98 to 8.92) at follow-up in the rifaximin-α group and 4.85 (2.29 to 12.1) at baseline versus 4.32 (1.98 to 12.4) at follow-up in the placebo-group), p = 0.34); nor sMR levels, p = 0.34. Also in patients with elevated lipopolysaccharide binding protein (> 5.9 μg/ml, 38 patients) there was no effect of rifaximin-α on sCD163 (p = 0.49) or sMR levels (p = 0.32). CONCLUSION We confirmed that macrophage activation markers sCD163 and sMR are directly associated to liver disease severity (MELD score). However, rifaximin-α has no effect on sCD163, sMR or collagen markers in decompensated cirrhosis and does therefore not seem to interfere with macrophage activation or fibrogenesis.
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Affiliation(s)
- Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
- Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Julie Steen Pedersen
- Gastro Unit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
| | - Søren Møller
- Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | | | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
| | - Henning Grønbæk
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Sartoris R, Rautou PE, Elkrief L, Pollorsi G, Durand F, Valla D, Spahr L, Terraz S, Soubrane O, Cauchy F, Vilgrain V, Ronot M. Quantification of Liver Surface Nodularity at CT: Utility for Detection of Portal Hypertension. Radiology 2018; 289:698-707. [PMID: 30179109 DOI: 10.1148/radiol.2018181131] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To determine whether quantification of liver surface nodularity (LSN) provides an estimate of the presence of clinically significant portal hypertension (CSPH) in patients with cirrhosis. Materials and Methods This retrospective study included a training cohort (n = 189) and separate external validation cohort (n = 78), both composed of patients with cirrhosis who underwent abdominal CT and hepatic venous pressure gradient (HVPG) measurement between 2010 and 2016. The LSN score, liver and spleen volumes, liver-to-spleen volume ratio, platelet count to spleen diameter ratio, Iranmanesh score, aspartate amino transferase-to-platelet ratio index, and Fibrosis-4 index were derived from CT images and serum laboratories. The accuracy of the various tests for predicting CSPH was evaluated with area under the receiver operating characteristic curve (AUROC) and compared by using the DeLong test. Student t test and Pearson correlation coefficient were used. Results One hundred eighty-nine patients were analyzed (119 men [mean age ± standard deviation, 57 years ± 11; range, 29-81 years] and 70 women [mean age, 61 years ± 10; range, 34-83 years]; overall mean age, 58 years ± 10; range, 29-83 years). A total of 102 patients (54%) had CSPH. LSN score correlated with HVPG (r = 0.75; P < .001). Patients with CSPH had a higher LSN score than did those without CSPH (3.2 ± 0.6 vs 2.4 ± 0.3; P < .001). A cutoff value of 2.8 had a positive predictive value of 88% for CSPH; the AUROC of LSN was 0.88 ± 0.03. This was higher than that of other available noninvasive tests (DeLong, all P < .001). In the validation cohort, LSN score of 2.8 had a positive predictive value of 86% for CSPH; the AUROC was 0.87 ± 0.04. Conclusion The CT-based liver surface nodularity score demonstrated high diagnostic performance for detecting clinically significant portal hypertension and outperformed multiple other noninvasive tests. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Riccardo Sartoris
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Pierre-Emmanuel Rautou
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Laure Elkrief
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Gaia Pollorsi
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - François Durand
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Dominique Valla
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Laurent Spahr
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Sylvain Terraz
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Olivier Soubrane
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - François Cauchy
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Valérie Vilgrain
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Maxime Ronot
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
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D'Amico G, Morabito A, D'Amico M, Pasta L, Malizia G, Rebora P, Valsecchi MG. Clinical states of cirrhosis and competing risks. J Hepatol 2018; 68:563-576. [PMID: 29111320 DOI: 10.1016/j.jhep.2017.10.020] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
Abstract
The clinical course of cirrhosis is mostly determined by the progressive increase of portal hypertension, hyperdynamic circulation, bacterial translocation and activation of systemic inflammation. Different disease states, encompassing compensated and decompensated cirrhosis and a late decompensated state, are related to the progression of these mechanisms and may be recognised by haemodynamic or clinical characteristics. While these disease states do not follow a predictable sequence, they correspond to varying mortality risk. Acute-on-chronic liver failure may occur either in decompensated or in compensated cirrhosis and is always associated with a high short-term mortality. The increasing severity of these disease states prompted the concept of clinical states of cirrhosis. A multistate approach has been considered to describe the clinical course of the disease. Such an approach requires the assessment of the probabilities of different outcomes in each state, which compete with each other to occur first and mark the transition towards a different state. This requires the use of competing risks analysis, since the traditional Kaplan-Meier analysis should only be used in two-state settings. Accounting for competing risks also has implications for prognosis and treatment efficacy research. The aim of this review is to summarise relevant clinical states and to show examples of competing risks analysis in multistate models of cirrhosis.
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Affiliation(s)
- Gennaro D'Amico
- Gastroenterology Unit, Ospedale V. Cervello, Via Trabucco 180, Palermo, Italy.
| | | | - Mario D'Amico
- Radiology Department, Università di Palermo, Palermo, Italy
| | - Linda Pasta
- Gastroenterology Unit, Ospedale V. Cervello, Via Trabucco 180, Palermo, Italy
| | - Giuseppe Malizia
- Gastroenterology Unit, Ospedale V. Cervello, Via Trabucco 180, Palermo, Italy
| | - Paola Rebora
- Dipartimento di Medicina e Chirurgia Università di Milano-Bicocca, Milano, Italy
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32
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Ratziu V. A critical review of endpoints for non-cirrhotic NASH therapeutic trials. J Hepatol 2018; 68:353-361. [PMID: 29223369 DOI: 10.1016/j.jhep.2017.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Abstract
Non-alcoholic steatohepatitis is a disease without a single, specific, diagnostic marker, hence multiple indicators are required to measure therapeutic efficacy. Moreover, drug candidates for non-alcoholic steatohepatitis target many distinct mechanisms that are believed to promote hepatic injury. Therefore, a wide range of endpoints must be reached, sequentially, as required by the drug development process. Some of these endpoints validate the mechanism of action, others are used to anticipate histological efficacy. Histological endpoints are still considered the best predictors of clinical outcome, but they can only be reliably tested in larger, late phase trials. Herein, we will review the rationale and clinical data supporting the use of specific endpoints at different stages of therapeutic trials. We will also discuss the validity and limitations of current phase IIb histological endpoints, particularly a one stage reduction in fibrosis, for their ability to predict progression to cirrhosis, which is the ultimate outcome measure in therapeutic trials.
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Affiliation(s)
- Vlad Ratziu
- Hospital Pitié-Salpêtrière, Insitute for Cardiometabolism and Nutrition and Université Pierre et Marie Curie, Sorbonne Universités, Paris, France.
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33
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Wang Y, Huang W, Li R, Yun Z, Zhu Y, Yang J, Liu H, Liu Z, Feng Q, Hou J. Systematic quantification of histological patterns shows accuracy in reflecting cirrhotic remodeling. J Gastroenterol Hepatol 2017; 32:1631-1639. [PMID: 28068755 DOI: 10.1111/jgh.13722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/06/2016] [Accepted: 01/04/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM There still lacks a tool for precisely evaluating cirrhotic remodeling. Histologic distortion characterized in cirrhosis (i.e. cirrhotic patterns) has a validated pathophysiological meaning and potential relevance to clinical complications. We aimed to establish a new tool to quantify the cirrhotic patterns and test it for reflecting the cirrhotic remodeling. METHODS We designed a computerized algorithm, named qCP, dedicated for the analysis of liver images acquired by second harmonic microscopy. We evaluated its measurement by using a cohort of 95 biopsies (Ishak staging F4/5/6 = 33/35/27) of chronic hepatitis B and a carbon tetrachloride-intoxicated rat model for simulating the bidirectional cirrhotic change. RESULTS QCP can characterize 14 histological cirrhosis parameters involving the nodules, septa, sinusoid, and vessels. For chronic hepatitis B biopsies, the mean overall intra-observer and inter-observer agreement was 0.94 ± 0.08 and 0.93 ± 0.09, respectively. The robustness in resisting sample adequacy-related scoring error was demonstrated. The proportionate areas of total (collagen proportionate area), septal (septal collagen proportionate area [SPA]), sinusoidal, and vessel collagen, nodule area, and nodule density (ND) were associated with Ishak staging (P < 0.01 for all). But only ND and SPA were independently associated (P ≤ 0.001 for both). A histological cirrhosis parameters-composed qCP-index demonstrated an excellent accuracy in quantitatively diagnosing evolving cirrhosis (areas under receiver operating characteristic curves 0.95-0.92; sensitivity 0.93-0.82; specificity 0.94-0.85). In the rat model, changes in collagen proportionate area, SPA, and ND had strong correlations with both cirrhosis progression and regression and faithfully characterized the histological evolution. CONCLUSIONS QCP preliminarily demonstrates potential for quantitating cirrhotic remodeling with high resolution and accuracy. Further validation with in-study cohorts and multiple-etiologies is warranted.
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Affiliation(s)
- Yan Wang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research; Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Biomedical Research Center, Southern Medical University, Guangzhou, China
| | - Wei Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Ruhua Li
- Biomedical Research Center, Southern Medical University, Guangzhou, China
| | - Zhaoqiang Yun
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Youfu Zhu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research; Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinlian Yang
- Biomedical Research Center, Southern Medical University, Guangzhou, China
| | - Hailin Liu
- School of Clinical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhipeng Liu
- School of Clinical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Jinlin Hou
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research; Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
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34
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Abstract
BACKGROUND Hepatic venous pressure gradient (HVPG) measurement correlates with staging of liver fibrosis. Patients with nonalcoholic steatohepatitis (NASH) have a different pattern of fibrosis compared with hepatitis C virus (HCV) with possible alterations in pressures. AIM The aim of this study was to compare portal pressures with the stage of fibrosis in NASH in comparison with other liver diseases. PATIENTS AND METHODS Records of all patients who had undergone transjugular liver biopsy with pressure measurements between January 2001 and June 2013 were reviewed. Wedge hepatic venous pressure (WHVP) and HVPG were compared with stages of fibrosis in liver diseases of different etiologies. RESULTS Among 142 patients included in this study, the liver disease etiology was as follows: HCV (26.6%) and NASH (24.6%), with the remaining (38.7%) grouped under other categories. The mean age of the patients was 51.2±11.5 years, with more men with HCV (73.1%) compared with NASH (51.4%) in terms of etiology (P=0.046). There were strong correlations between the stage of fibrosis with both the HVPG (r=0.64; P<0.0001) and the WHVP (r=0.63; P<0.0001) in NASH patients. Compared with HCV patients, NASH patients had a lower HVPG (3.4±2.4 vs. 7.5±11 mmHg/stage; P=0.01) with a coefficient estimate of -0.24 (P=0.017) and WHVP (9.6±5.5 vs. 14.6±15.2 mmHg/stage; P=0.03) for the stage of fibrosis. CONCLUSION HVPG and WHVP measurements were strongly correlated with stages of fibrosis in NASH. Patients with NASH had lower HVPG and WHVP for each stage of fibrosis compared with HCV patients. This raises the concern of underestimation of pressures by HVPG in NASH etiology for the stage of disease or increased fibrosis despite lower pressures in them.
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35
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Kimer N, Pedersen JS, Busk TM, Gluud LL, Hobolth L, Krag A, Møller S, Bendtsen F. Rifaximin has no effect on hemodynamics in decompensated cirrhosis: A randomized, double-blind, placebo-controlled trial. Hepatology 2017; 65:592-603. [PMID: 27775818 DOI: 10.1002/hep.28898] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/08/2016] [Accepted: 10/12/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Decompensated cirrhosis is characterized by disturbed systemic and splanchnic hemodynamics. Bacterial translocation from the gut is considered the key driver in this process. Intestinal decontamination with rifaximin may improve hemodynamics. This double-blind, randomized, controlled trial (clinicaltrials.gov, NCT01769040) investigates the effects of rifaximin on hemodynamics, renal function, and vasoactive hormones. We randomized 54 stable outpatients with cirrhosis and ascites to rifaximin 550 mg twice a day (n = 36) or placebo twice a day (n = 18). Forty-five patients were male, mean age 56 years (±8.4), average Child score 8.3 (±1.3), and Model for End-Stage Liver Disease score 11.7 (±3.9). Measurements of hepatic venous pressure gradient, cardiac output, and systemic vascular resistance were made at baseline and after 4 weeks. The glomerular filtration rate and plasma renin, noradrenaline, lipopolysaccharide binding protein, troponin T, and brain natriuretic peptide levels were measured. Rifaximin had no effect on hepatic venous pressure gradient, mean 16.8 ± 3.8 mm Hg at baseline versus 16.6 ± 5.3 mm Hg at follow-up, compared to the placebo, mean 16.4 ± 4 mm Hg at baseline versus 16.3 ± 4.4 mm Hg at follow-up, P = 0.94. No effect was found on cardiac output, mean 6.9 ± 1.7 L/min at baseline versus 6.9 ± 2.3 L/min at follow-up, compared to placebo, mean 6.6 ± 1.9 L/min at baseline compared to 6.5 ±2.1 L/min at follow-up, P = 0.66. No effects on the glomerular filtration rate, P = 0.14, or vasoactive hormones were found. Subgroup analyses on patients with increased lipopolysaccharide binding protein and systemic vascular resistance below the mean (1,011 dynes × s/cm5 ) revealed no effect of rifaximin. CONCLUSION Four weeks of treatment with rifaximin did not reduce the hepatic venous pressure gradient or improve systemic hemodynamics in patients with cirrhosis and ascites; rifaximin did not affect glomerular filtration rate or levels of vasoactive hormones. (Hepatology 2017;65:592-603).
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Affiliation(s)
- Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark.,Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Julie Steen Pedersen
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Troels Malte Busk
- Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lise Lotte Gluud
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lise Hobolth
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Gastroenterology and Hepatology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Møller
- Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
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36
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Agrawal S, Hoad CL, Francis ST, Guha IN, Kaye P, Aithal GP. Visual morphometry and three non-invasive markers in the evaluation of liver fibrosis in chronic liver disease. Scand J Gastroenterol 2017; 52:107-115. [PMID: 27617532 DOI: 10.1080/00365521.2016.1233578] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Liver fibrosis is traditionally graded into categorical stages with cirrhosis as the highest stage. However, cirrhosis stage may vary between individuals widely in terms of the amount of fibrosis which is not assessed by traditional staging systems. We aimed to utilise visual morphometry to quantify the amount of fibrosis in liver biopsy and compare how non-invasive methods of quantifying liver fibrosis correlated with histological measures. MATERIALS AND METHODS Liver biopsy specimens from 115 consecutive chronic liver disease patients were assessed by a single pathologist for fibrosis stage by the Clinical Research Network and METAVIR systems as well as percentage fibrosis by visual morphometry. Liver T1 relaxation times, liver stiffness measurement (LSM) by transient elastography and enhanced liver fibrosis (ELF) score were compared between fibrosis stages. In addition, these parameters were correlated with pathologist's visual estimate of percentage fibrosis and their predictive ability for advanced fibrosis and cirrhosis assessed by area under receiver operating curve (AUROC). RESULTS All four parameters increased sequentially from fibrosis stage F0 to F4 (p<.001 for each). AUROCs for advanced fibrosis and cirrhosis were 0.931 and 1.000 respectively for pathologist's estimate of fibrosis, 0.707 and 0.926 for ELF score, 0.763 and 0.972 for T1 and 0.881 and 0.989 for LSM. LSM, ELF score and T1 correlated significantly with pathologist's estimate of percentage fibrosis. CONCLUSION Non-invasive markers of fibrosis LSM, ELF and T1 relaxation time provide continuous surrogates for categorical histopathological staging of fibrosis which can be useful as markers of progression and regression of fibrosis on follow-up.
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Affiliation(s)
- Swastik Agrawal
- a NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - Caroline L Hoad
- a NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - Susan T Francis
- a NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - Indra N Guha
- a NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - Philip Kaye
- a NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - Guruprasad P Aithal
- a NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
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Ramachandran P, Henderson NC. Antifibrotics in chronic liver disease: tractable targets and translational challenges. Lancet Gastroenterol Hepatol 2016; 1:328-340. [PMID: 28404203 DOI: 10.1016/s2468-1253(16)30110-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 12/30/2022]
Abstract
Chronic liver disease prevalence is increasing globally. Iterative liver damage, secondary to any cause of liver injury, results in progressive fibrosis, disrupted hepatic architecture, and aberrant regeneration, which are defining characteristics of liver cirrhosis. Liver transplantation is an effective treatment for end-stage liver disease; however, demand greatly outweighs donor organ supply, and in many parts of the world liver transplantation is unavailable. Hence, effective antifibrotic therapies are urgently required. In the past decade, rapid progress has been made in our understanding of the pathophysiology of liver fibrosis and a large number of potential cellular and molecular antifibrotic targets have been identified. This has led to numerous clinical trials of antifibrotic agents in patients with chronic liver disease. However, none of these have resulted in a robust and reproducible effect on fibrosis. It is therefore imperative that the ongoing translational challenges are addressed, to convert scientific discoveries into potent antifibrotics and enable bridging of the translational gap between putative therapeutic targets and effective treatments for patients with chronic liver disease.
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Affiliation(s)
- Prakash Ramachandran
- Medical Research Council (MRC) Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neil C Henderson
- Medical Research Council (MRC) Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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38
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Kimer N, Wiese S, Mo S, Møller S, Bendtsen F. Advances in the treatment of portal hypertension in cirrhosis. Expert Rev Gastroenterol Hepatol 2016; 10:961-9. [PMID: 26982499 DOI: 10.1586/17474124.2016.1166952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-selective beta-blockers and handling of esophageal varices has been key elements in the treatment of portal hypertension in recent decades. Liver vein catheterization has been essential in diagnosis and monitoring of portal hypertension, but ongoing needs for noninvasive tools has led to research in areas of both biomarkers, and transient elastography, which displays promising results in discerning clinically significant portal hypertension. Novel research into the areas of hepatic stellate cell function and the dynamic components of portal hypertension has revealed promising areas of treatment modalities, targeting intestinal decontamination, angiogenesis, inflammation and oxidative stress. Future studies may reveal if these initiatives lead to developments of new drugs for treatment of portal hypertension.
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Affiliation(s)
- N Kimer
- a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark.,b Center for Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - S Wiese
- a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark.,b Center for Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - S Mo
- a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - S Møller
- b Center for Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - F Bendtsen
- a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
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39
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Yegin EG, Yegin K, Ozdogan OC. Digital image analysis in liver fibrosis: basic requirements and clinical implementation. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1181989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ender Gunes Yegin
- Department of Gastroenterology, Bozyaka State Hospital, Izmir, Turkey
| | - Korkut Yegin
- Electrical and Electronics Engineering Department, Ege University, Izmir, Turkey
| | - Osman Cavit Ozdogan
- Faculty of Medicine, Department of Gastroenterology, Marmara University, Istanbul, Turkey
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40
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Wang Y, Hou JL. Fibrosis assessment: impact on current management of chronic liver disease and application of quantitative invasive tools. Hepatol Int 2016; 10:448-61. [DOI: 10.1007/s12072-015-9695-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/07/2015] [Indexed: 12/15/2022]
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41
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Rókusz A, Nagy E, Gerlei Z, Veres D, Dezső K, Paku S, Szücs A, Hajósi-Kalcakosz S, Pávai Z, Görög D, Kóbori L, Fehérvári I, Nemes B, Nagy P. Quantitative morphometric and immunohistochemical analysis and their correlates in cirrhosis--A study on explant livers. Scand J Gastroenterol 2016; 51:86-94. [PMID: 26166621 DOI: 10.3109/00365521.2015.1067902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reproducible structural analysis was made on cirrhotic human liver samples in order to reveal potential connections between morphological and laboratory parameters. MATERIAL AND METHODS Large histological samples were taken from segment VII of 56 cirrhotic livers removed in connection with liver transplantation. Picro Sirius red and immunohistochemically (smooth muscle actin [SMA], cytokeratin 7 [CK7], Ki-67) stained sections were digitalized and morphometric evaluation was performed. RESULTS The Picro Sirius-stained fibrotic area correlated with the average thickness of the three broadest septa, extent of SMA positivity, alkaline phosphatase (ALP) values and it was lower in the viral hepatitis related cirrhoses than in samples with non-viral etiology. The extent of SMA staining increased with the CK7-positive ductular reaction. The proliferative activity of the hepatocytes correlated positively with the Ki-67 labeling of the ductular cells and inversely with the septum thickness. These data support the potential functional connection among different structural components, for example, myofibroblasts, ductular reaction and fibrogenesis but challenges the widely proposed role of ductular cells in regeneration. CONCLUSION Unbiased morphological characterization of cirrhotic livers can provide valuable, clinically relevant information. Similar evaluation of routine core biopsies may increase the significance of this 'Gold Standard' examination.
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Affiliation(s)
- András Rókusz
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Eszter Nagy
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Zsuzsanna Gerlei
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Dániel Veres
- c 3 Department of Biophysics and Radiation Biology, Semmelweis University , 1094, Tűzoltó utca 37-47, Budapest, Hungary
| | - Katalin Dezső
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Sándor Paku
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary.,d 4 Tumor Progression Research Group, Joint Research Organization of the Hungarian Academy of Sciences and Semmelweis University , 1051, Nádor utca 7, Budapest, Hungary
| | - Armanda Szücs
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Szofia Hajósi-Kalcakosz
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
| | - Zoltán Pávai
- e 5 Department of Anatomy and Embryology, University of Medicine and Pharmacy Targu Mures , 540139, Gh. Marinescu 38, Targu Mures, Romania
| | - Dénes Görög
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - László Kóbori
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Imre Fehérvári
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Balázs Nemes
- b 2 Department of Transplantation and Surgery, Semmelweis University , 1085, Baross utca 23, Budapest, Hungary
| | - Péter Nagy
- a 1 First Department of Pathology and Experimental Cancer Research, Semmelweis University , 1085, Üllői út 26, Budapest, Hungary
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Nielsen MJ, Lehmann J, Leeming DJ, Schierwagen R, Klein S, Jansen C, Strassburg CP, Bendtsen F, Møller S, Sauerbruch T, Karsdal MA, Krag A, Trebicka J. Circulating Elastin Fragments Are Not Affected by Hepatic, Renal and Hemodynamic Changes, But Reflect Survival in Cirrhosis with TIPS. Dig Dis Sci 2015; 60:3456-64. [PMID: 26138655 DOI: 10.1007/s10620-015-3783-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Progressive fibrosis increases hepatic resistance and causes portal hypertension with complications. During progressive fibrosis remodeling and deposition of collagens and elastin occur. Elastin remodeling is crucially involved in fibrosis progression in animal models and human data. This study investigated the association of circulating elastin with the clinical outcome in cirrhotic patients with severe portal hypertension receiving transjugular intrahepatic porto-systemic shunt (TIPS). METHODS We analyzed portal and hepatic venous samples of 110 cirrhotic patients obtained at TIPS insertion and 2 weeks later. The circulating levels of elastin fragments (ELM) were determined using specific monoclonal ELISA. The relationship of ELM with clinical short-time follow-up and long-term outcome was investigated. RESULTS Circulating levels of ELM showed a gradient across the liver before TIPS with higher levels in the hepatic vein. Interestingly, the circulating ELM levels remained unchanged after TIPS. The circulating levels of ELM in portal and hepatic veins correlated with platelet counts and inversely with serum sodium. Hepatic venous levels of ELM were higher in CHILD C compared to CHILD A and B and were associated with the presence of ascites. Patients with high levels of ELM in the hepatic veins before TIPS showed poorer survival. In multivariate analysis ELM levels in the hepatic veins and MELD were independent predictors of mortality in these patients. CONCLUSION This study demonstrated that circulating levels of ELM are not associated with hemodynamic changes, but might reflect fibrosis remodeling and predict survival in patients with severe portal hypertension receiving TIPS independently of MELD.
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Affiliation(s)
- M J Nielsen
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark.,Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark
| | - J Lehmann
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D J Leeming
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
| | - R Schierwagen
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - S Klein
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C Jansen
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Bendtsen
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - S Møller
- Department of Clinical Physiology and Nuclear Medicine, 239 Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Sauerbruch
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M A Karsdal
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
| | - A Krag
- Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark
| | - J Trebicka
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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Abstract
Patients with cirrhosis and portal hypertension are at an increased risk of the development of circulatory dysfunction that may potentially result in multiple organ failure. Apart from the liver, this may involve the heart, lungs, kidneys, the immune system, the adrenal glands, and other organ systems. As the disease progresses, the circulation becomes hyperdynamic, and signs of cardiac, pulmonary, and renal dysfunction are observed, in addition to reduced survival. Infections and an altered cardiac function known as cirrhotic cardiomyopathy may be precipitators for the development of other complications such as hepatorenal syndrome. In patients with chronic organ dysfunction, various precipitating events may induce an acute-on-chronic renal failure and acute-on-chronic liver failure that negatively affect the prognosis. Future research on the pathophysiologic mechanisms of the complications and the precipitating factors is essential to understand the basics of the treatment of these challenging conditions. The aim of the present review is to focus on the development and precipitating factors of various organ failures in patients with decompensated cirrhosis.
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Nag HH, Arora A, Tyagi I, Ramaswamy D, Patil N, Sakhuja P, Saha R, Agarwal AK. Correlations of portal pressure in post-cholecystectomy benign biliary stricture. Hepatol Res 2015; 45:E73-81. [PMID: 25537420 DOI: 10.1111/hepr.12463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 02/08/2023]
Abstract
AIM Presence of portal hypertension (PH) adversely affects perioperative and long-term outcome in patients with post-cholecystectomy benign biliary stricture (PCBBS). Identification of factors related to the development of PH will help to prevent this complication. METHODS From September 2010 to December 2012, 30 patients with PCBBS were studied prospectively for correlation of portal pressure (PP) with injury repair interval (IRI), biliary pressure (BP), severity of hepatic fibrosis (FS), severity of hepatic inflammation (IS) and obstructive biliary pathology score (OBPS). Appropriate statistical methods employed and P ≤ 0.05 (two-sided) was considered statistically significant. RESULTS Mean PP, mean BP and median IRI were 19.4 ± 4.74 mmHg, 20.1 ± 3.99 mmHg and 145 days, respectively. Spearman's rank correlation coefficients (P-value) of PP with IRI, FS, IS and OBPS were 0.564 (0.001), 0.502 (0.004), 0.752 (0.0001) and 0.242 (0.19), respectively. Pearson correlation of PP with BP was r = 0.383 (r(2) = 0.146, P = 0.03). Spearman's rank correlation coefficients (P-value) of FS with IS and OBPS were 0.561 (0.003) and 0.371 (0.04), respectively. Spearman's rank correlation coefficient of serum bilirubin with OBPS was 0.550 (P = 0.001). Incidence of PH was 33.3% and mean fall of PP following biliary repair was 6.2 ± 1.98 mmHg (P < 0.0001). CONCLUSION PP in patients with PCBBS has a good correlation with IS, and a fair correlation with both FS and IRI whereas PP was not directly related to BP and OBPS; further prospective trials are mandatory to confirm this correlation, and to evaluate mechanism of fall in PP following biliary decompression.
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Affiliation(s)
- Hirdaya H Nag
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Asit Arora
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Ila Tyagi
- Department of Pathology, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Dinesh Ramaswamy
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Nilesh Patil
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Puja Sakhuja
- Department of Pathology, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Renuka Saha
- Department of Statistics, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
| | - Anil K Agarwal
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and M A M College, Delhi University, New Delhi, India
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Goossens N, Nakagawa S, Hoshida Y. Molecular prognostic prediction in liver cirrhosis. World J Gastroenterol 2015; 21:10262-10273. [PMID: 26420954 PMCID: PMC4579874 DOI: 10.3748/wjg.v21.i36.10262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
The natural history of cirrhosis varies and therefore prognostic prediction is critical given the sizable patient population. A variety of clinical prognostic indicators have been developed and enable patient risk stratification although their performance is somewhat limited especially within relatively earlier stage of disease. Molecular prognostic indicators are expected to refine the prediction, and potentially link a subset of patients with molecular targeted interventions that counteract poor prognosis. Here we overview clinical and molecular prognostic indicators in the literature, and discuss critical issues to successfully define, evaluate, and deploy prognostic indicators as clinical scores or tests. The use of liver biopsy has been diminishing due to sampling variability on fibrosis assessment and emergence of imaging- or lab test-based fibrosis assessment methods. However, recent rapid developments of genomics technologies and selective molecular targeted agents has highlighted the need for biopsy tissue specimen to explore and establish molecular information-guided personalized/stratified clinical care, and eventually achieve “precision medicine”.
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Torok N, Dranoff JA, Schuppan D, Friedman SL. Strategies and endpoints of antifibrotic drug trials: Summary and recommendations from the AASLD Emerging Trends Conference, Chicago, June 2014. Hepatology 2015; 62:627-34. [PMID: 25626988 PMCID: PMC4515973 DOI: 10.1002/hep.27720] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/21/2015] [Indexed: 12/21/2022]
Abstract
There is an urgent need to develop antifibrotic therapies for chronic liver disease, and clarify which endpoints in antifibrotic trials will be acceptable to regulatory agencies. The American Association for the Study of Liver Diseases sponsored an endpoints conference to help accelerate the efficient testing of antifibrotic agents and develop recommendations on clinical trial design for liver fibrosis. In this review, we summarize the salient and novel elements of this conference and provide directions for future clinical trial design. The article follows the structure of the conference and is organized into five areas: (1) antifibrotic trial design; (2) preclinical proof-of-concept studies; (3) pharmacological targets, including rationale and lessons to learn; (4) rational drug design and development; and (5) consensus and recommendations on design of clinical trials in liver fibrosis. Expert overviews and collaborative discussions helped to summarize the key unmet needs and directions for the future, including: (1) greater clarification of at-risk populations and study groups; (2) standardization of all elements of drug discovery and testing; (3) standardization of clinical trial approaches; (4) accelerated development of improved noninvasive markers; and (5) need for exploration of potential off-target toxicities of future antifibrotic drugs.
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Affiliation(s)
- Natalie Torok
- Department of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA and VA Northern California Healthcare System, Mather CA
| | - Jonathan A. Dranoff
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR and Research Service, Central Arkansas VA Healthcare System, Little Rock AR
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center, Mainz, Germany, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Scott L. Friedman
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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Leeming DJ, Veidal SS, Karsdal MA, Nielsen MJ, Trebicka J, Busk T, Bendtsen F, Krag A, Møller S. Pro-C5, a marker of true type V collagen formation and fibrillation, correlates with portal hypertension in patients with alcoholic cirrhosis. Scand J Gastroenterol 2015; 50:584-92. [PMID: 25639675 DOI: 10.3109/00365521.2014.996590] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The hepatic venous pressure gradient (HVPG) is an important but invasive diagnostic and prognostic marker in cirrhotic patients. The aim of the study was to evaluate a novel biochemical plasma marker of true type V collagen formation (Pro-C5) for describing HVPG. METHODS Ninety-four patients mainly with alcoholic cirrhosis and fourteen liver-healthy controls were included in a retrospective study. Relevant clinical and routine laboratory data and hemodynamics were determined. Plasma Pro-C5 was correlated to HVPG and liver function parameters. Furthermore, Pro-C5 was combined in a linear regression model. RESULTS Plasma Pro-C5 correlated to HVPG, indocyanine green clearance, sustained vascular resistance and mean arterial pressure (r = -0.68-0.33, p < 0.0001). A multiple regression analysis including Pro-C5, alanine aminotransferase, bilirubin and model for end-stage liver disease (MELD) improved the correlation to HVPG (r = 0.74, p < 0.0001). Plasma Pro-C5 was positively or negatively correlated to a number of routine liver function markers and MELD score (r = 0.27-0.68; p < 0.05-0.0001). Furthermore, plasma Pro-C5 could clearly separate patients with a HVPG <10 mmHg or HVPG ≥10 mmHg (p < 0.001, area under the curve (AUC) = 0.73), HVPG 10-<16 mmHg or HVPG ≥16 mmHg (p < 0.001, AUC = 0.68) and controls from diseased patients (p < 0.0001, AUC = 0.88). Finally, there was a clear relation to increasing Child score A-C and plasma Pro-C5 (ANOVA p < 0.001). CONCLUSION Plasma Pro-C5 reflects liver hemodynamics, liver function, disease stage and clinically significant portal hypertension (PH). A multimarker model in combination with clinical scores predicted HVPG and separated clinical relevant HVPG thresholds. Plasma Pro-C5 may be suitable for the noninvasive evaluation of PH in patients with cirrhosis.
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Affiliation(s)
- Diana J Leeming
- Nordic Bioscience, Fibrosis Biology and Biomarkers , Herlev , Denmark
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Mura VL, Nicolini A, Tosetti G, Primignani M. Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement. World J Hepatol 2015; 7:688-695. [PMID: 25866605 PMCID: PMC4388996 DOI: 10.4254/wjh.v7.i4.688] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/11/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice.
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Yegin EG, Yegin K, Karatay E, Kombak EF, Tuney D, Ataizi-Celikel C, Ozdogan OC. Quantitative assessment of liver fibrosis by digital image analysis: Relationship to Ishak staging and elasticity by shear-wave elastography. J Dig Dis 2015; 16:217-27. [PMID: 25620218 DOI: 10.1111/1751-2980.12231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze the relationship between fibrosis staged by Ishak stage and quantified by digital image analysis (DIA), and to reveal the optimum performance of shear-wave elastography (SWE) using quantitative DIA measurements as a comparative histological standard. METHODS The proportionate area (PA) of fibrosis was measured by DIA from images of the PA of trichrome-stain (TPA) of 168 chronic hepatitis patients. SWE was performed in 105 patients. The accuracy of SWE for predicting the fibrosis defined by quantitative PA thresholds (≥ 2.5%, ≥ 5%, ≥ 10% and ≥ 20%, respectively) and by Ishak stages was measured using the area under the receiver operating characteristic curve (AUROC). RESULTS DIA was proven to be highly reproducible (interclass correlation coefficient 0.926). The TPA range corresponding to each Ishak stage was large, widened as stages progressed, and reached its greatest extent in cirrhosis. TPA magnified at ×50 ranges 11.9-56% for Ishak stage F5-6. A good correlation between TPA and elasticity was presented for more advanced fibrosis (TPA ≥10%, rs = 0.732, P = 0.000) than milder fibrosis (TPA <10%, rs = 0.308, P = 0.006). With the advance of fibrosis either by stages or PA thresholds the discriminative accuracy of SWE gradually increased, but was less satisfactory for milder fibrosis. CONCLUSIONS DIA may serve as a reproducible and reliable quantitative standard for surrogate tests for liver fibrosis. The performance and correlation of SWE with the fibrotic extent were better for advanced fibrosis, but less satisfactory for milder fibrosis.
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50
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Møller S, Henriksen JH, Bendtsen F. Extrahepatic complications to cirrhosis and portal hypertension: Haemodynamic and homeostatic aspects. World J Gastroenterol 2014; 20:15499-15517. [PMID: 25400435 PMCID: PMC4229516 DOI: 10.3748/wjg.v20.i42.15499] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/06/2014] [Accepted: 06/23/2014] [Indexed: 02/07/2023] Open
Abstract
In addition to complications relating to the liver, patients with cirrhosis and portal hypertension develop extrahepatic functional disturbances of multiple organ systems. This can be considered a multiple organ failure that involves the heart, lungs, kidneys, the immune systems, and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation. This affects both the haemodynamic and functional homeostasis of many organs and largely determines the course of the disease. With the progression of the disease, the circulation becomes hyperdynamic with cardiac, pulmonary as well as renal consequences for dysfunction and reduced survival. Infections and a changed cardiac function known as cirrhotic cardiomyopathy may be involved in further aggravation of other complications such as renal failure precipitating the hepatorenal syndrome. Patients with end-stage liver disease and related complications as for example the hepatopulmonary syndrome can only radically be treated by liver transplantation. As a bridge to this treatment, knowledge on the mechanisms of the pathophysiology of complications is essential for the choice of vasoactive drugs, antibiotics, drugs with specific effects on fibrogenesis and inflammation, and drugs that target specific receptors.
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