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Chen T, Chen G, Wang G, Treeprasertsuk S, Lesmana CRA, Lin HC, Al-Mahtab M, Chawla YK, Tan SS, Kao JH, Yuen MF, Lee GH, Alcantara-Payawal D, Nakayama N, Abbas Z, Jafri W, Kim DJ, Choudhury A, Mahiwall R, Hou J, Hamid S, Jia J, Bajaj JS, Wang F, Sarin SK, Ning Q. Expert consensus on the diagnosis and treatment of end-stage liver disease complicated by infections. Hepatol Int 2024; 18:817-832. [PMID: 38460060 DOI: 10.1007/s12072-023-10637-3] [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: 08/28/2023] [Accepted: 12/22/2023] [Indexed: 03/11/2024]
Abstract
End-stage liver disease (ESLD) is a life-threatening clinical syndrome and when complicated with infection the mortality is markedly increased. In patients with ESLD, bacterial or fungal infection can induce or aggravate the occurrence or progression of liver decompensation. Consequently, infections are among the most common complications of disease deterioration. There is an overwhelming need for standardized protocols for early diagnosis and appropriate management for patients with ESLD complicated by infections. Asia Pacific region has the largest number of ESLD patients, due to hepatitis B and the growing population of alcohol and NAFLD. Concomitant infections not only add to organ failure and high mortality but also to financial and healthcare burdens. This consensus document assembled up-to-date knowledge and experience from colleagues across the Asia-Pacific region, providing data on the principles as well as evidence-based current working protocols and practices for the diagnosis and treatment of patients with ESLD complicated by infections.
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Affiliation(s)
- Tao Chen
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, P.R. China
| | - Guang Chen
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, P.R. China
| | - Guiqiang Wang
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Sombat Treeprasertsuk
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, and Thai Red Cross, Bangkok, Thailand
| | - Cosmas Rinaldi Adithya Lesmana
- Internal Medicine, Hepatobiliary Division, Dr. Captor Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, DKI, Indonesia
| | - Han-Chieh Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Yogesh K Chawla
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Soek-Siam Tan
- Department of Hepatology, Hospital Selayang, Selangor Darul Ehsan, Malaysia
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Guan-Huei Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Nobuaki Nakayama
- Department of Gastroenterology & Hepatology, Saitama Medical University, Saitama, Japan
| | - Zaigham Abbas
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Wasim Jafri
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Dong-Joon Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital of Hallym University Medical Center, Chuncheon, Korea
| | - Ashok Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Mahiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Jinlin Hou
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Clinical Research Center for Viral Hepatitis, Key Laboratory of Infectious Diseases Research in South China, Ministry of Education, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Saeed Hamid
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - J S Bajaj
- Department of Medicine, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | - Fusheng Wang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Qin Ning
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, P.R. China.
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2
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Lehner T, Gao B, Mackowiak B. Alcohol metabolism in alcohol use disorder: a potential therapeutic target. Alcohol Alcohol 2024; 59:agad077. [PMID: 37950904 PMCID: PMC10783952 DOI: 10.1093/alcalc/agad077] [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: 08/14/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023] Open
Abstract
Ethanol metabolism plays an essential role in how the body perceives and experiences alcohol consumption, and evidence suggests that modulation of ethanol metabolism can alter the risk for alcohol use disorder (AUD). In this review, we explore how ethanol metabolism, mainly via alcohol dehydrogenase and aldehyde dehydrogenase 2 (ALDH2), contributes to drinking behaviors by integrating preclinical and clinical findings. We discuss how alcohol dehydrogenase and ALDH2 polymorphisms change the risk for AUD, and whether we can harness that knowledge to design interventions for AUD that alter ethanol metabolism. We detail the use of disulfiram, RNAi strategies, and kudzu/isoflavones to inhibit ALDH2 and increase acetaldehyde, ideally leading to decreases in drinking behavior. In addition, we cover recent preclinical evidence suggesting that strategies other than increasing acetaldehyde-mediated aversion can decrease ethanol consumption, providing other potential metabolism-centric therapeutic targets. However, modulating ethanol metabolism has inherent risks, and we point out some of the key areas in which more data are needed to mitigate these potential adverse effects. Finally, we present our opinions on the future of treating AUD by the modulation of ethanol metabolism.
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Affiliation(s)
- Taylor Lehner
- Laboratory of Liver Diseases, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Bethesda, MD 20892, United States
| | - Bin Gao
- Laboratory of Liver Diseases, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Bethesda, MD 20892, United States
| | - Bryan Mackowiak
- Laboratory of Liver Diseases, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Bethesda, MD 20892, United States
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3
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Pratim Das P, Medhi S. Role of inflammasomes and cytokines in immune dysfunction of liver cirrhosis. Cytokine 2023; 170:156347. [PMID: 37639845 DOI: 10.1016/j.cyto.2023.156347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Liver cirrhosis develops as a result of persistent inflammation and liver injury. The prolonged inflammation triggers the buildup of fibrous tissue and regenerative nodules within the liver, leading to the distortion of the hepatic vascular structure and impaired liver function. Cirrhosis disrupts the ability of liver function to maintain homeostasis and hepatic immunosurveillance which causes immunological dysfunction in the body. In pathological conditions, the production of cytokines in the liver is carefully regulated by various cells in response to tissue stimulation. Cytokines and inflammasomes are the key regulators and systematically contribute to the development of cirrhosis which involves an inflammatory response. However, the crosstalk role of different cytokines in the cirrhosis progression is poorly understood. Tumour necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interferon-gamma (IFN-γ), among others, are proinflammatory cytokines that contribute to liver cell necrosis, which in turn causes the development of fibrosis. While IL-10 exhibits a potent anti-inflammatory effect on the liver by inhibiting immune cell activation and neutralizing pro-inflammatory cytokine activity. Inflammasomes have also been implicated in the profibrotic processes of liver cirrhosis, as well as the production of chemokines such as CCL2/MCP-1. It is evident that inflammasomes have a role in the proinflammatory response seen in chronic liver illnesses. In conclusion, cirrhosis significantly impacts the immune system, leading to immunological dysfunction and alterations in both innate and acquired immunity. Proinflammatory cytokines like TNF-α, IL-1β, IL-6, and IFNγ are upregulated in cirrhosis, contributing to liver cell necrosis and fibrosis development. Managing cytokine-mediated inflammation and fibrosis is a key therapeutic approach to alleviate portal hypertension and its associated liver complications. This review attempted to focus largely on the role of immune dysfunction mediated by different cytokines and inflammasomes involved in the progression, regulation and development of liver cirrhosis.
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Affiliation(s)
- Partha Pratim Das
- Dept. of Bioengineering & Technology, Gauhati University, Assam 781014, India
| | - Subhash Medhi
- Dept. of Bioengineering & Technology, Gauhati University, Assam 781014, India.
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Mirijello A, Sestito L, Antonelli M, Gasbarrini A, Addolorato G. Identification and management of acute alcohol intoxication. Eur J Intern Med 2023; 108:1-8. [PMID: 35985955 DOI: 10.1016/j.ejim.2022.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/03/2022] [Accepted: 08/11/2022] [Indexed: 02/07/2023]
Abstract
Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.
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Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luisa Sestito
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Mariangela Antonelli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Giovanni Addolorato
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy.
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Murthy P, Shadakshari D, Mahadevan J, Chand PK. Management of Alcohol Use Disorder in Patients With Alcoholic Liver Disease. J Clin Exp Hepatol 2022; 12:1514-1526. [PMID: 36340303 PMCID: PMC9630026 DOI: 10.1016/j.jceh.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/10/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a common condition that develops on the background of heavy alcohol use and is characterised by the loss of control over alcohol use and a compulsion to use alcohol, often despite negative consequences. AUD is a leading cause for the resumption of alcohol use in patients with alcoholic liver disease (ALD) after treatment. Hence it is essential to screen all patients with ALD for the presence of AUD. Screening tools such as alcohol use disorders identification test (AUDIT) and AUDIT-C are used, following which the diagnosis and severity of AUD are determined using DSM-5 criteria. The management of AUD in patients with ALD is best carried out using an integrated approach involving psychiatrists and gastroenterologists/hepatologists. The treatment most often involves a combination of pharmacotherapy and psychosocial interventions which try to achieve and maintain abstinence. Although, there is limited evidence, Baclofen is the first line pharmacological agent for long-term management of AUD in patients with ALD. Intensive psychological interventions such as motivation enhancement therapy and cognitive behavioural therapy are also seen to be beneficial. Treatment retention and follow-up are vital and can positively influence outcomes.
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Key Words
- AA, Alcoholics Anonymous
- ALD, Alcoholic Liver Disease
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- AUD, Alcohol Use Disorder
- AUDIT – C, Alcohol Use Disorder Identification Test – Consumption
- AUDIT, Alcohol Use Disorder Identification Test
- CBT, Cognitive Behavioural Therapy
- CDT, Carbohydrate Deficient Transferrin
- CIWA – Ar, Clinical Institute Withdrawal Assessment for Alcohol Revised
- DALY, Disability Adjusted Life Years
- EtG, Ethyl glucuronide
- EtS, Ethyl Sulphate
- FAEE, Fatty acid ethyl ester
- FDA, Food and Drug Administration
- GABA, Gamma-Aminobutyric acid
- GGT, Gamma glutamyl transferase
- HCV, Hepatitis C Virus
- HE, Hepatic Encephalopathy
- LT, Liver Transplantation
- MCV, Mean corpuscular volume
- MET, Motivation Enhancement Therapy
- MI, Motivational Interviewing
- NMDA, N-Methyl-d-aspartate
- PEth, Phosphatidylethanol
- RCT, Randomised control trial
- SMS, Short Message Service
- alcohol use disorder
- alcoholic liver disease
- diagnosis
- pharmacotherapy
- psychotherapy
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Affiliation(s)
- Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Darshan Shadakshari
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prabhat Kumar Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Rattan P, Shah VH. Review article: current and emerging therapies for acute alcohol-associated hepatitis. Aliment Pharmacol Ther 2022; 56:28-40. [PMID: 35567372 DOI: 10.1111/apt.16969] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/20/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol-associated hepatitis is an acute manifestation of alcohol-associated liver disease (ALD) and is associated with 30%-40% mortality at 28 days. Abstinence and corticosteroids are the mainstays of treatment, but the latter only improves short-term mortality, so new and improved therapies remain an unmet need. AIMS The aim was to review the pathophysiology of alcohol-associated hepatitis and how various targets can be used by current and emerging therapies as treatment. METHODS A thorough literature review was conducted on acute alcohol-associated hepatitis, current therapies and therapies under investigation. RESULTS With the increasing prevalence of alcohol use disorder and ALD, the burden of alcohol-associated hepatitis is also expected to rise. The current understanding of alcohol-associated hepatitis pathophysiology has led to clinical trials of several therapies involving IL-1 antagonism, modification of the gut microbiome and liver regeneration. CONCLUSIONS Corticosteroid therapy for alcohol-associated hepatitis is restricted in its applicability and has limited efficacy. Developing multidisciplinary, patient-centred care models based on digital health technologies, in combination with continued discovery of novel therapies using multiomics data and computational biology techniques will be necessary to tackle the increasing burden of alcohol-associated hepatitis.
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Affiliation(s)
- Puru Rattan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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7
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Getachew B, Csoka AB, Tizabi Y. Dihydromyricetin Protects Against Ethanol-Induced Toxicity in SH-SY5Y Cell Line: Role of GABA A Receptor. Neurotox Res 2022; 40:892-899. [PMID: 35386023 DOI: 10.1007/s12640-022-00503-9] [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: 01/16/2022] [Revised: 03/07/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
Toxicity induced by binge alcohol drinking, particularly in adolescent and young adults, is of major medical and social consequence. Recently, we reported that butyrate, a short chain fatty acid, can protect against ethanol (ETOH)-induced toxicity in an in vitro model. In this study, we sought to evaluate the potential effectiveness of dihydromyricetin (DHM), a natural bioactive flavonoid, alone or in combination with butyrate in the same model. Exposure of SH-SY5Y cells for 24 h to 500 mM ETOH resulted in approximately 40% reduction in cell viability, which was completely prevented by 0.1 μM DHM. Combinations of DHM and butyrate provided synergistic protection against alcohol toxicity. Whereas butyrate effect was shown to be mediated primarily through fatty acid receptor 3 activation, DHM protection appears to be mediated primarily via benzodiazepine receptor site of GABAA receptor. This is based on the finding that DHM's effect could be completely prevented by pretreatment with flumazenil, a selective antagonist at this site, but not by bicuculline, a selective antagonist at the actual GABAA receptor binding site. These findings suggest potential utility of DHM alone or in combination with butyrate against ETOH-induced toxicity.
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Affiliation(s)
- Bruk Getachew
- Department of Pharmacology, Howard University College of Medicine, 520 W Street NW, Washington, DC, USA
| | - Antonei B Csoka
- Department of Anatomy, Howard University College of Medicine, 520 W Street NW, Washington, DC, USA
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, 520 W Street NW, Washington, DC, USA.
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Sun L, Wen S, Li Q, Lai X, Chen R, Zhang Z, Li D, Sun S. L-theanine relieves acute alcoholic liver injury by regulating the TNF-α/NF-κB signaling pathway in C57BL/6J mice. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Suresh Babu K, Paradesi D. Investigation of Related Impurities in Metadoxine by a Reversed Phase High Performance Liquid Chromatography Technique. ANAL SCI 2021; 37:581-584. [PMID: 33041305 DOI: 10.2116/analsci.20p271] [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: 11/23/2022]
Abstract
A new reversed-phase high-performance liquid chromatography (RP-HPLC) method has been developed for the separation and identification of impurities present in metadoxine. Herein, we report that one of the impurities eluted from the metadoxine sample is 4-deoxypyridoxine hydrochloride (4-DPH). In HPLC analysis, the retention time (RT) of 4-DPH was observed to be at 13.5 min in both the reference and metadoxine samples and the relative retention time (RRT) was 1.71. The presence of 4-DPH in a metadoxine sample was also confirmed by a chromatogram obtained by spiking the 4-DPH standard into the sample. Furthermore, the elution and mass of impurity 4-DPH in metadoxine was proven by LC-mass spectroscopy studies. This method highlights the presence of another unknown impurity that has so far not been observed in earlier methods of metadoxine evaluation. Hence, the developed method achieved superior resolution between metadoxine and impurities and thereby facilitates the production of a purer metadoxine drug.
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Affiliation(s)
- Krishnan Suresh Babu
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology
| | - Deivanayagam Paradesi
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology
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10
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Sehrawat TS, Liu M, Shah VH. The knowns and unknowns of treatment for alcoholic hepatitis. Lancet Gastroenterol Hepatol 2020; 5:494-506. [PMID: 32277902 DOI: 10.1016/s2468-1253(19)30326-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023]
Abstract
Alcoholic hepatitis is an acute, inflammatory liver disease associated with high morbidity and mortality both in the short term and long term. Alcoholic hepatitis often arises in patients with a background of chronic liver disease and it is characterised by the rapid onset of jaundice and the development of myriad complications. Medical therapy for severe alcoholic hepatitis relies on corticosteroids, which have modest effectiveness. Abstinence from alcohol is critically important in patients with alcoholic hepatitis, but recidivism is high. Because of the absence of effective medical treatments for alcoholic hepatitis and alcohol dependency, there is a pressing need to develop new and effective therapeutics. Supported by promising preliminary and preclinical studies, many ongoing clinical trials of new therapies for alcoholic hepatitis are currently underway and are discussed further in this Series paper.
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Affiliation(s)
- Tejasav S Sehrawat
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mengfei Liu
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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11
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Li YM, Fan JG. Guidelines of prevention and treatment for alcoholic liver disease (2018, China). J Dig Dis 2019; 20:174-180. [PMID: 30450822 DOI: 10.1111/1751-2980.12687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022]
Affiliation(s)
- You Ming Li
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jian Gao Fan
- Department of Gastroenterology, XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Children's Digestion and Nutrition, Shanghai, China
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12
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Connolly JJ, Ooka K, Lim JK. Future Pharmacotherapy for Non-alcoholic Steatohepatitis (NASH): Review of Phase 2 and 3 Trials. J Clin Transl Hepatol 2018; 6:264-275. [PMID: 30271738 PMCID: PMC6160309 DOI: 10.14218/jcth.2017.00056] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/16/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022] Open
Abstract
Non-alcoholic steatohepatitis (NASH) results from inflammation and hepatocyte injury in the setting of hepatic steatosis. Non-alcoholic steatohepatitis increases the risk of progression to liver fibrosis and cirrhosis, and is the most rapidly growing etiology for liver failure and indication for liver transplantation in the USA. Weight loss and lifestyle modification remain the standard first-line treatment, as no USA Food and Drug Administration-approved pharmacotherapy currently exists. The past decade has seen an explosion of interest in drug development targeting pathologic pathways in non-alcoholic steatohepatitis, with numerous phase 2 and 3 trials currently in progress. Here, we concisely review the major targets and mechanisms of action by class, summarize results from completed pivotal phase 2 studies, and provide a detailed outline of key active studies with trial data for drugs in development, including obeticholic acid, elafibranor, cenicriviroc and selonsertib.
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Affiliation(s)
- James J. Connolly
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kohtaro Ooka
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph K. Lim
- Yale Liver Center, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- *Correspondence to: Joseph K. Lim, Yale Liver Center, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520-8019, USA. Tel: +1-203-737-6063, Fax: +1-203-785-7273, E-mail:
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13
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Testino G, Leone S, Fagoonee S, Pellicano R. Alcoholic liver fibrosis: detection and treatment. Minerva Med 2018; 109:457-471. [PMID: 30221911 DOI: 10.23736/s0026-4806.18.05844-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alcohol consumption is one of the main risks to public health. Alcohol use disorders (AUDs) cause 80% of hepatotoxic deaths, and approximately 50% of cirrhosis is alcohol-related. The acceptable daily intake (ADI) for ethanol is 2.6 g/day, deduced from morbidity and mortality rates due to liver fibrosis. The relative risk of cirrhosis increases significantly for doses above 60 g/day for men and 20 g/day for women over a period of around 10 years. Twenty to 40% of steatosis cases will evolve into steatohepatitis/steatofibrosis, and 8 to 20% will evolve directly into liver cirrhosis. About 20 to 40% of steatohepatitis cases will evolve into cirrhosis, and 4 to 5% into hepatocellular carcinoma. This cascade of events evolves in 5 to 40 years, with the temporal variability caused by the subjects' genetic patterns and associated risk/comorbidity factors. Steatohepatitis should be considered "the rate limiting step:" usually, it can be resolved through abstinence, although for some patients, once this situation develops, it is not substantially modified by abstention and there is a risk of fibrotic evolution. Early detection of fibrosis, obtained by hepatic elastography, is a crucial step in patients with AUDs. Such strategy allows patients to be included in a detoxification program in order to achieve abstention. Drugs such as silybin, metadoxine, and adenosylmethionine can be used. Other drugs, with promising antifibrotic effects, are currently under study. In this review, we discuss clinical and pathogenetic aspects of alcohol-related liver fibrosis and present and future strategies to prevent cirrhosis.
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Affiliation(s)
- Gianni Testino
- Alcohological Regional Center, Ligurian Region, ASL3, San Martino Hospital, Genoa, Italy -
| | - Silvia Leone
- Alcohological Regional Center, Ligurian Region, ASL3, San Martino Hospital, Genoa, Italy
| | - Sharmila Fagoonee
- Institute for Biostructure and Bioimaging (CNR), Molecular Biotechnology Center, Turin, Italy
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14
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Li B, Li D, Wang Y, Meng X, Sun X, Tian J, Shi L, Ma F. Schisantherin A alleviated alcohol-induced liver injury by the regulation of alcohol metabolism and NF-kB pathway. Exp Anim 2018; 67:451-461. [PMID: 29806627 PMCID: PMC6219874 DOI: 10.1538/expanim.18-0021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Schisantherin A (SinA), one of the most abundant active ingredients of Schisandra chinensis, was reported to protect and benefit the liver, however, its effect on alcohol-induced liver injury (ALI) was still not clear. In the present study, an ALI mice model was induced by feeding mice an alcohol-containing liquid diet for four weeks. Then, 100 mg/kg or 200 mg/kg SinA was administered to mice every day by gavage for the last two weeks. Histopathological analysis showed that alcohol-induced liver lipid vacuoles were reduced by SinA. The activities of aspartate aminotransferase (AST, 61.90 ± 14.65 vs. 93.65 ± 20.50, 50.46 ± 13.21 vs. 93.65 ± 20.50) and alanine transaminase (ALT, 41.29 ± 9.20 vs. 64.04 ± 18.13, 36.52 ± 7.71 vs. 64.04 ± 18.13) in the serum of ALI mice were significantly reduced by 100 mg/kg or 200 mg/kg SinA when compared with control mice. Alcohol-induced oxidative stress and the inflammatory response in the liver were suppressed by SinA in a dose-dependent manner. Meanwhile, treatment with SinA decreased alcohol dehydrogenase (ADH) activity and increased acetaldehyde dehydrogenase (ALDH) activity in ALI mice. Alcohol-induced upregulation of CYP2E1 and CYP1A2 in the liver was inhibited by SinA. Further, SinA suppressed activation of the NF-kB pathway in ALI mice. In conclusion, our findings demonstrate that SinA is able to protect against ALI, and this may be, at least in part, caused by regulation of alcohol metabolism and the NF-kB pathway. Our data suggest a therapeutic potential of SinA in the treatment of ALI.
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Affiliation(s)
- Bin Li
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Dongnan Li
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Yuehua Wang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Xianjun Meng
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Xiyun Sun
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Jinlong Tian
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Lin Shi
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
| | - Fengming Ma
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, People's Republic of China
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Tang X, Wei R, Deng A, Lei T. Protective Effects of Ethanolic Extracts from Artichoke, an Edible Herbal Medicine, against Acute Alcohol-Induced Liver Injury in Mice. Nutrients 2017; 9:nu9091000. [PMID: 28891983 PMCID: PMC5622760 DOI: 10.3390/nu9091000] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022] Open
Abstract
Oxidative stress and inflammation are well-documented pathological factors in alcoholic liver disease (ALD). Artichoke (Cynara scolymus L.) is a healthy food and folk medicine with anti-oxidative and anti-inflammatory properties. This study aimed to evaluate the preventive effects of ethanolic extract from artichoke against acute alcohol-induced liver injury in mice. Male Institute of Cancer Research mice were treated with an ethanolic extract of artichoke (0.4, 0.8, and 1.6 g/kg body weight) by gavage once daily. Up to 40% alcohol (12 mL/kg body weight) was administered orally 1 h after artichoke treatment. All mice were fed for 10 consecutive days. Results showed that artichoke extract significantly prevented elevated levels of aspartate aminotransferase, alanine aminotransferase, triglyceride, total cholesterol, and malondialdehyde. Meanwhile, the decreased levels of superoxide dismutase and glutathione were elevated by artichoke administration. Histopathological examination showed that artichoke attenuated degeneration, inflammatory infiltration and necrosis of hepatocytes. Immunohistochemical analysis revealed that expression levels of toll-like receptor (TLR) 4 and nuclear factor-kappa B (NF-κB) in liver tissues were significantly suppressed by artichoke treatment. Results obtained demonstrated that artichoke extract exhibited significant preventive protective effect against acute alcohol-induced liver injury. This finding is mainly attributed to its ability to attenuate oxidative stress and suppress the TLR4/NF-κB inflammatory pathway. To the best of our knowledge, the underlying mechanisms of artichoke on acute ALD have been rarely reported.
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Affiliation(s)
- Xuchong Tang
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
| | - Ruofan Wei
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
| | - Aihua Deng
- College of Life and Environmental Science, Hunan University of Arts and Science, Changde 415000, China.
| | - Tingping Lei
- College of Mechanical Engineering and Automation, Huaqiao University, Xiamen 361021, China.
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Haass-Koffler CL, Akhlaghi F, Swift RM, Leggio L. Altering ethanol pharmacokinetics to treat alcohol use disorder: Can you teach an old dog new tricks? J Psychopharmacol 2017; 31:812-818. [PMID: 28093021 PMCID: PMC5768306 DOI: 10.1177/0269881116684338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Disulfiram was the first pharmacotherapy approved to treat alcohol use disorder in the 1950s. Disulfiram alters ethanol pharmacokinetics and causes uncomfortable reactions (e.g. headache, tachycardia, nausea, flushing and hypotension) when alcohol is consumed. Subsequently, a better understanding of the neurobiological pathways involved in alcohol use disorder led to the development of other medications (e.g. naltrexone and acamprosate). These neurobiological-based medications act on alcohol use disorder-related phenotypes including craving, stress, and/or withdrawal. The original approach to treat alcohol use disorder, by altering ethanol pharmacokinetics has been much less investigated. Recent research on ethanol pharmacokinetics has shed light on the mechanisms of action underlying alcohol use disorder and how some medications that alter ethanol pharmacokinetics may be helpful in treating alcohol use disorder. This review summarizes and discusses the complex pharmacokinetics of ethanol, and proposes that altering ethanol pharmacokinetics via novel pharmacological approaches may be a viable approach to treat alcohol use disorder.
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Affiliation(s)
- Carolina L. Haass-Koffler
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Fatemeh Akhlaghi
- Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI
| | - Robert M. Swift
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI
- Veterans Affairs Medical Center, Providence, RI
| | - Lorenzo Leggio
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
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Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J Hepatol 2016; 65:618-30. [PMID: 27155530 DOI: 10.1016/j.jhep.2016.04.029] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/24/2016] [Accepted: 04/25/2016] [Indexed: 12/18/2022]
Abstract
Alcohol use disorders (AUDs) is one of the leading causes of disease and disability in almost all European countries. Among the alcohol-related diseases, alcoholic liver disease (ALD) is the most common. At present, alcohol is the most frequent cause of liver cirrhosis in the Western world. The cornerstone of treatment for ALD is achieving total alcohol abstinence and preventing relapse; medical and surgical treatments for ALD are limited when drinking continues. This narrative review summarizes current treatments for AUDs with a particular emphasis to the treatment of AUDs in patients with ALD. Medical management, psychosocial and pharmacological interventions are analyzed, underlying limits and options in AUD patients. Finally, this review discusses the most appropriate setting for the management of AUD patients with advanced liver disease as well as the indications for liver transplantation in AUD patients.
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Affiliation(s)
- Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy.
| | - Antonio Mirijello
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy; Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Pablo Barrio
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
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Haass-Koffler CL, Leggio L, Davidson D, Swift RM. Effects of idazoxan on alcohol pharmacokinetics and intoxication: a preliminary human laboratory study. Alcohol Clin Exp Res 2016; 39:594-602. [PMID: 25833022 DOI: 10.1111/acer.12658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preliminary basic and human studies suggest that the α2 -adrenergic antagonist idazoxan may represent a novel medication for alcohol dependence. The goal of this study was to evaluate the safety and tolerability of the co-administration of idazoxan with alcohol and explore whether pharmacokinetics (PK) and biobehavioral mechanisms of idazoxan may alter alcohol's effects. METHODS This was a preliminary double-blind, single-dose, placebo-controlled, crossover, randomized human laboratory study. Ten social drinkers were dosed, in 2 different alcohol challenge studies (ACS), with a single oral dose of idazoxan (40 mg) or placebo, followed by a fixed alcohol dose 60 minutes later. Participants returned after a 1-week washout, and they were crossed over to the opposite medication condition. RESULTS There were no significant differences in adverse events between idazoxan and placebo. Moreover, during the ACS paradigm, 40 mg idazoxan was well tolerated with no significant autonomic effects compared to placebo; idazoxan reduced the peak blood alcohol level (p < 0.01) and time to peak (p < 0.05) compared to placebo. A PK/pharmacodynamic model aligned the biobehavioral effects, demonstrating that the co-administration of 40 mg idazoxan with alcohol decreased alcohol-related stimulation (p < 0.05) and increased alcohol-related sedation (p < 0.05). CONCLUSIONS This study supports the safety and tolerability of 40 mg idazoxan when co-administered with alcohol. Additionally, this study suggests that idazoxan may alter the biphasic effects of alcohol by decreasing stimulation and increasing sedation. These findings have implications for further investigation of using idazoxan as a probe to develop potential novel medications to treat alcoholic patients.
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Affiliation(s)
- Carolina L Haass-Koffler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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Tijera FHDL, Servín-Caamaño AI, Serralde-Zúñiga AE, Cruz-Herrera J, Pérez-Torres E, Abdo-Francis JM, Salas-Gordillo F, Pérez-Hernández JL. Metadoxine improves the three- and six-month survival rates in patients with severe alcoholic hepatitis. World J Gastroenterol 2015; 21:4975-4985. [PMID: 25945012 PMCID: PMC4408471 DOI: 10.3748/wjg.v21.i16.4975] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/16/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the impact of metadoxine (MTD) on the 3- and 6-mo survival of patients with severe alcoholic hepatitis (AH).
METHODS: This study was an open-label clinical trial, performed at the “Hospital General de México, Dr. Eduardo Liceaga”. We randomized 135 patients who met the criteria for severe AH into the following groups: 35 patients received prednisone (PDN) 40 mg/d, 35 patients received PDN+MTD 500 mg three times daily, 33 patients received pentoxifylline (PTX) 400 mg three times daily, and 32 patients received PTX+MTD 500 mg three times daily. The duration of the treatment for all of the groups was 30 d.
RESULTS: In the groups treated with the MTD, the survival rate was higher at 3 mo (PTX+MTD 59.4% vs PTX 33.3%, P = 0.04; PDN+MTD 68.6% vs PDN 20%, P = 0.0001) and at 6 mo (PTX+MTD 50% vs PTX 18.2%, P = 0.01; PDN+MTD 48.6% vs PDN 20%, P = 0.003) than in the groups not treated with MTD. A relapse in alcohol intake was the primary independent factor predicting mortality at 6 mo. The patients receiving MTD maintained greater abstinence than those who did not receive it (74.5% vs 59.4%, P = 0.02).
CONCLUSION: MTD improves the 3- and 6-mo survival rates in patients with severe AH. Alcohol abstinence is a key factor for survival in these patients. The patients who received the combination therapy with MTD were more likely to maintain abstinence than those who received monotherapy with either PDN or PTX.
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Abstract
Alcohol use disorder is a heterogeneous illness with a complex biology that is controlled by many genes and gene-by-environment interactions. Several efficacious, evidence-based treatments currently exist for treating and managing alcohol use disorder, including a number of pharmacotherapies that target specific aspects of biology that initiate and maintain dangerous alcohol misuse. This article reviews the neurobiological and neurobehavioral foundation of alcohol use disorder, the mechanisms of action and evidence for the efficacy of currently approved medications for treatment, and the literature on other emerging pharmacotherapies.
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Affiliation(s)
- Robert M Swift
- From the Department of Psychiatry and Human Behavior, Brown University Alpert School of Medicine (Dr. Swift); Center for Alcohol and Addiction Studies, Brown University School of Public Health (Drs. Swift and Aston); VA Medical Center, Providence, RI (Dr. Swift)
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Vuittonet CL, Halse M, Leggio L, Fricchione SB, Brickley M, Haass-Koffler CL, Tavares T, Swift RM, Kenna GA. Pharmacotherapy for alcoholic patients with alcoholic liver disease. Am J Health Syst Pharm 2014; 71:1265-76. [PMID: 25027533 PMCID: PMC4170837 DOI: 10.2146/ajhp140028] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE An update on pharmacotherapy for achieving and maintaining abstinence and mitigating hepatic damage in patients with alcoholic liver disease (ALD) is presented. SUMMARY Currently there are limited pharmacotherapy options for managing ALD, which encompasses a broad spectrum of disorders ranging from steatosis and alcoholic hepatitis to fibrosis, cirrhosis, and hepatocellular cancer. Individual variation in the severity, presentation, and complex pathologenesis of ALD defines barriers to effective treatment. Scoring of disease severity using validated assessment instruments should guide treatment approaches; abstinence and proper nutrition continue to be the cornerstones of management. A literature search (through December 31, 2013) identified no reports of randomized controlled trials using Food and Drug Administration (FDA)-approved medications for the treatment of alcohol dependence in ALD-spectrum disorders. Disulfiram, acamprosate, and naltrexone (oral and intramuscular), while approved by FDA for treatment of alcohol dependence, are not currently approved for use in patients with ALD. Baclofen (also not FDA-approved for use in ALD) is the only medication available in the United States with demonstrated safety and efficacy in reducing alcoholic behavior that has been formally tested in clinical trials in patients with ALD. Pharmacotherapy of alcoholic hepatitis using glucocorticoids or pentoxifylline has shown promise, but these options are reserved for severe ALD only. CONCLUSION Although various treatments have been investigated for ALD in patients with alcoholism, complete abstinence from alcohol is currently the only recommended form of hepatoprotection for the entire spectrum of ALD diagnoses.
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Affiliation(s)
- Cynthia L Vuittonet
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Michael Halse
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Lorenzo Leggio
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Samuel B Fricchione
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Michael Brickley
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Carolina L Haass-Koffler
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Tonya Tavares
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Robert M Swift
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - George A Kenna
- Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.
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Abenavoli L, Milic N, Rouabhia S, Addolorato G. Pharmacotherapy of acute alcoholic hepatitis in clinical practice. World J Gastroenterol 2014; 20:2159-67. [PMID: 24605014 PMCID: PMC3942820 DOI: 10.3748/wjg.v20.i9.2159] [Citation(s) in RCA: 8] [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: 10/17/2013] [Revised: 01/02/2014] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Severe alcoholic hepatitis (AH) is an acute form of alcohol induced liver disease with a poor prognosis that is seen in the patients who consume large quantities of alcohol. The diagnosis of AH is based on the appropriate alcohol intake history and is supported with clinical and histological features, and several scoring systems. Glucocorticoids are the mainstay for treating severe AH with pentoxifylline used as an alternative to steroids in addition to total alcohol abstinence. Liver transplantation is a possible therapeutic option for severe AH. Among the anti-craving medications able to improve abstinence rate, baclofen seems to be effective and safe in the alcoholic patients affected by severe liver damage.
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Addolorato G, Mirijello A, Leggio L, Ferrulli A, Landolfi R. Management of alcohol dependence in patients with liver disease. CNS Drugs 2013; 27:287-99. [PMID: 23456576 PMCID: PMC4979989 DOI: 10.1007/s40263-013-0043-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alcohol dependence represents a chronic and relapsing disease affecting nearly 10 % of the general population both in the USA and in Europe, with a widespread burden of morbidity and mortality. Alcohol dependence represents the most common cause of liver damage in the Western world. Although alcoholic liver disease is associated primarily with heavy drinking, continued alcohol consumption, even in low doses after the onset of liver disease, increases the risk of severe consequences, including mortality. Consequently, the ideal treatment of patients affected by alcohol dependence and alcoholic liver disease should aim at achieving long-term total alcohol abstinence and preventing relapse. The aim of the present review is to provide an update on the management of alcohol dependence in patients with alcoholic liver disease. Increasing evidence suggests the usefulness of psychosocial interventions and medications combined in order to reduce alcohol intake, promote abstinence and prevent relapse in alcohol-dependent patients. Disulfiram, naltrexone and acamprosate have been approved for this indication; gamma-hydroxybutyric acid (GHB) is approved in Italy and Austria. However, these drugs have not been tested in patients with advanced liver disease. Amongst other emerging pharmacotherapies for alcoholism, topiramate, ondansetron, and baclofen seem the most promising ones. Both topiramate and ondansetron have a safe profile in alcoholic patients; however, none of them has been tested in alcoholic patients with advanced liver disease. To date, baclofen represents the only anti-craving medication formally tested in a randomized clinical trial in alcoholic patients affected by liver cirrhosis, although additional confirmatory studies are warranted.
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Affiliation(s)
- Giovanni Addolorato
- Department of Internal Medicine, Institute of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo Gemelli 8, 00168 Rome, Italy.
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Tang YL, Hao W, Leggio L. Treatments for alcohol-related disorders in China: a developing story. Alcohol Alcohol 2012; 47:563-70. [PMID: 22683652 DOI: 10.1093/alcalc/ags066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Alcohol-related disorders (ARDs) have become an increasing mental health and social challenge in China. Research from China may provide important clinical information for researchers and clinicians around the world. However, most of the Chinese research on ARDs has only been published in Chinese language journals. This article summarizes publications related to treatments for ARDs found in the Chinese literature. METHODS A descriptive study based on literature identified from searches of the China National Knowledge Infrastructure (1979-2012), Pubmed databases and hand-picked references with emphasis on traditional Chinese medicine (TCM). RESULTS More than 1500 Chinese language papers on treatment for ARDs were found and ~110 were selected. Many medications used in the Western countries (e.g. disulfiram and acamprosate) are not available in China, and no drugs have been officially approved for alcohol dependence. TCM approaches (including acupuncture, electroacupunture and herbals) have played a role in treatment for ARDs with some positive results. These unique methods are reviewed and the need for additional controlled studies is noted. CONCLUSION Currently, very limited facilities, medications or programs are available for patients with ARDs in China, thus much improvement is needed in the field, including setting up intervention/treatment programs.
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Affiliation(s)
- Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 2004 Ridgewood Drive, Suite 218, Atlanta, GA 30322, USA.
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Leggio L, Promrat K, Kenna GA. A Call to Action: Alcohol Interventions in HIV-Infected Patients. Front Psychiatry 2012; 3:35. [PMID: 22529825 PMCID: PMC3328083 DOI: 10.3389/fpsyt.2012.00035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 03/28/2012] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorenzo Leggio
- Center for Alcohol and Addiction Studies, Brown University Providence, RI, USA
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