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Maiwall R, Kulkarni AV, Arab JP, Piano S. Acute liver failure. Lancet 2024:S0140-6736(24)00693-7. [PMID: 39098320 DOI: 10.1016/s0140-6736(24)00693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 08/06/2024]
Abstract
Acute liver failure (ALF) is a life-threatening disorder characterised by rapid deterioration of liver function, coagulopathy, and hepatic encephalopathy in the absence of pre-existing liver disease. The cause of ALF varies across the world. Common causes of ALF in adults include drug toxicity, hepatotropic and non-hepatotropic viruses, herbal and dietary supplements, antituberculosis drugs, and autoimmune hepatitis. The cause of liver failure affects the management and prognosis, and therefore extensive investigation for cause is strongly suggested. Sepsis with multiorgan failure and cerebral oedema remain the leading causes of death in patients with ALF and early identification and appropriate management can alter the course of ALF. Liver transplantation is the best current therapy, although the role of artificial liver support systems, particularly therapeutic plasma exchange, can be useful for patients with ALF, especially in non-transplant centres. In this Seminar, we discuss the cause, prognostic models, and management of ALF.
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Affiliation(s)
- Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Juan Pablo Arab
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University and Hospital of Padova, Padova, Italy
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2
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Liu M, Zhang R, Huang H, Liu P, Zhao X, Wu H, He Y, Xu R, Qin X, Cheng Z, Liu H, Ergonul O, Can F, Ouyang D, Wang Z, Pang Z, Liu F. Erythrocyte-Leveraged Oncolytic Virotherapy (ELeOVt): Oncolytic Virus Assembly on Erythrocyte Surface to Combat Pulmonary Metastasis and Alleviate Side Effects. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2303907. [PMID: 37997186 PMCID: PMC10837356 DOI: 10.1002/advs.202303907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/24/2023] [Indexed: 11/25/2023]
Abstract
Despite being a new promising tool for cancer therapy, intravenous delivery of oncolytic viruses (OVs) is greatly limited by poor tumor targeting, rapid clearance in the blood, severe organ toxicity, and cytokine release syndrome. Herein, a simple and efficient strategy of erythrocyte-leveraged oncolytic virotherapy (ELeOVt) is reported, which for the first time assembled OVs on the surface of erythrocytes with up to near 100% efficiency and allowed targeted delivery of OVs to the lung after intravenous injection to achieve excellent treatment of pulmonary metastases while greatly improving the biocompatibility of OVs as a drug. Polyethyleneimine (PEI) as a bridge to assemble OVs on erythrocytes also played an important role in promoting the transfection of OVs. It is found that ELeOVt approach significantly prolonged the circulation time of OVs and increased the OVs distribution in the lung by more than tenfold, thereby significantly improving the treatment of lung metastases while reducing organ and systemic toxicity. Taken together, these findings suggest that the ELeOVt provides a biocompatible, efficient, and widely available approach to empower OVs to combat lung metastasis.
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Affiliation(s)
- Mingyang Liu
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Ruizhe Zhang
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Hanwei Huang
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Pengfei Liu
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Xu Zhao
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Hu Wu
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Ying He
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
| | - Ruizhe Xu
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
| | - Xifeng Qin
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
| | - Zhenguo Cheng
- Sino‐British Research Centre for Molecular OncologyNational Centre for International Research in Cell and Gene TherapySchool of Basic Medical SciencesAcademy of Medical SciencesZhengzhou UniversityZhengzhou450052China
| | - Hongyu Liu
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Onder Ergonul
- Koç University Iş Bank Center for Infectious Diseases (KUISCID)Koç University School of Medicine and American HospitalIstanbul34010Turkey
| | - Füsun Can
- Koç University Iş Bank Center for Infectious Diseases (KUISCID)Koç University School of Medicine and American HospitalIstanbul34010Turkey
| | - Defang Ouyang
- State Key Laboratory of Quality Research in Chinese MedicineInstitute of Chinese Medical Sciences (ICMS)University of MacauMacau999078China
| | - Zhenning Wang
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
| | - Zhiqing Pang
- Department of PharmaceuticsSchool of PharmacyFudan University and Key Laboratory of Smart Drug DeliveryMinistry of EducationShanghai201203China
| | - Funan Liu
- Department of Surgical Oncology and General SurgeryThe First Hospital of China Medical University155 North Nanjing Street, Heping DistrictShenyang110001China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal TumorsChina Medical UniversityMinistry of Education155 North Nanjing Street, Heping DistrictShenyang110001China
- Phase I Clinical Trials CenterThe First HospitalChina Medical University518 North Chuangxin Road, Baita Street, Hunnan DistrictShenyangLiaoning110102China
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Singh S, Nirala SK, Bhadauria M. Comparative role of acetaminophen, carbon tetrachloride and thioacetamide in development of fibrosis in rats. Toxicol Res (Camb) 2024; 13:tfad114. [PMID: 38179004 PMCID: PMC10762665 DOI: 10.1093/toxres/tfad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
Background Several hepatotoxicants such as acetaminophen, carbon tetrachloride, and thioacetamide are repeatedly used to develop hepatic fibrosis to mimic the histological and hemodynamic characteristics of human illness. It may be a good idea to establish a better model among these hepatotoxicants to develop hepatic fibrosis. Aim The present study evaluated comparative toxic effects of three model hepatotoxicants for experimental progression of fibrosis or cirrhosis. Materials and methods Acetaminophen (200 mg/kg), carbon tetrachloride (200 µl/kg) and thioacetamide (200 mg/kg) were administered orally, thrice in a week for 8 weeks in different groups. After 8 weeks of exposure, animals were euthanized, blood and tissues were collected for various hematological, serological, tissue biochemical analysis and histological observations for comparative assessment of toxic consequences. Results Significant deviation was noted in liver function tests, lipid peroxidation, glutathione, activities of superoxide dismutase, catalase, and GSH cycle enzymes; aniline hydroxylase, amidopyrine-N-demethylase, DNA fragmentation and level of hydroxyproline when compared with control group. Histology also depicted damage in liver histoarchitecture with exposure to acetaminophen, carbon tetrachloride and thioacetamide. Tukey's HSD post hoc test confirmed that thioacetamide produced severe toxic effects in comparison to carbon tetrachloride and acetaminophen. Conclusion In conclusion, toxic effects were noted in ascending order as acetaminophen.
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Affiliation(s)
- Shubham Singh
- Toxicology and Pharmacology Laboratory, Department of Zoology, Guru Ghasidas University, Koni-Bilaspur, Chhattisgarh 495009, India
| | - Satendra Kumar Nirala
- Laboratory of Natural Products, Department of Rural Technology and Social Development, Guru Ghasidas University, Koni-Bilaspur, Chhattisgarh 495009, India
| | - Monika Bhadauria
- Toxicology and Pharmacology Laboratory, Department of Zoology, Guru Ghasidas University, Koni-Bilaspur, Chhattisgarh 495009, India
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Dulek DE. Update on Epidemiology and Outcomes of Infection in Pediatric Organ Transplant Recipients. Infect Dis Clin North Am 2023; 37:561-575. [PMID: 37532391 DOI: 10.1016/j.idc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pediatric solid organ transplant (SOT) recipients are at risk for infection following transplantation. Data from adult SOT recipients are often used to guide prevention and treatment of infections associated with organ transplantation in children. This article highlights key recent pediatric SOT-specific publications for an array of infectious complications of organ transplantation. Attention is given to areas of need for future study.
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Affiliation(s)
- Daniel E Dulek
- Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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Peters AL, Kim S, Mourya R, Asai A, Taylor A, Rogers M, Campbell K, Fei L, Miethke A, Balistreri WF, Bezerra JA. Recent Increase in Incidence of Severe Acute Hepatitis of Unknown Etiology in Children is Associated with Infection with Adenovirus and Other Nonhepatotropic Viruses. J Pediatr 2023; 259:113439. [PMID: 37088181 PMCID: PMC10524234 DOI: 10.1016/j.jpeds.2023.113439] [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: 12/20/2022] [Revised: 02/13/2023] [Accepted: 03/19/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To evaluate whether the nature and severity of non-A-E severe acute hepatitis in children noted by the World Health Organization from late 2021 through early 2022 was indeed increased in 2021-2022 compared with prior years. STUDY DESIGN We performed a single-center, retrospective study to track the etiology and outcomes of children with non-A-E severe acute hepatitis in 2021-2022 compared with the prior 3-year periods (2018-2019, 2019-2020, and 2020-2021). We queried electronic medical records of children ≤16 years of age with alanine or aspartate aminotransferase levels of >500 IU. Data were analyzed for the periods of October 1, 2021, to May 1, 2022, and compared with the same time periods in 2018-2021. RESULTS Of 107 children meeting entry criteria, 82 cases occurred from October to May of 2018-2022. The average annual case number was 16.3 in 2018-2021 compared with a 2-fold increase (to 33) in 2021-2022 (P = .0054). Analyses of etiologies showed that this increase was associated with a higher number of children who tested positive for viruses (n = 16) when compared with the average of 3.7 for 2018-2021 (P = .018). Adenovirus (26.1%) and severe acute respiratory syndrome coronavirus-2 (10.3%) were the most frequently detected viruses in 2021-2022. Despite evidence of acute liver failure in 37.8% of children in the entire cohort and in 47% of those with viral infection, the overall survival rate was high at 91.4% and 88.9%, respectively. CONCLUSIONS The number of children with severe acute hepatitis in our center increased from 2021 to May 2022, with a greater frequency of cases associated with adenovirus, yet transplant-free survival remains high.
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Affiliation(s)
- Anna L Peters
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Seung Kim
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Reena Mourya
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Akihiro Asai
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amy Taylor
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Rogers
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kathleen Campbell
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lin Fei
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alexander Miethke
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
| | - William F Balistreri
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics of the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jorge A Bezerra
- Children's Medical Center at Dallas and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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Mandato C, Colucci A, Vajro P. Emerging, re-emerging and/or atypically behaving infectious diseases. Acta Paediatr 2023; 112:1145-1147. [PMID: 36944185 DOI: 10.1111/apa.16744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Claudia Mandato
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Section of Pediatrics, Baronissi, Italy
| | - Angelo Colucci
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Section of Pediatrics, Baronissi, Italy
| | - Pietro Vajro
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Section of Pediatrics, Baronissi, Italy
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