Aging liver and hepatitis

Old age as a risk factor for liver diseases: Modern therapeutic approaches

Recent scientific interest has been directed towards age-related diseases, driven by the significant increase in global life expectancy and the growing population of individuals aged 65 and above. The ageing process encompasses various biological, physiological, environmental, psychological, behavioural, and social changes, leading to an augmented susceptibility to chronic illnesses. Cardiovascular, neurological, musculoskeletal, liver and oncological diseases are prevalent in the elderly. Moreover, ageing individuals demonstrate reduced regenerative capacity and decreased tolerance towards therapeutic interventions, including organ transplantation. Liver diseases, such as non-alcoholic fatty liver disease, alcoholic liver disease, hepatitis, fibrosis, and cirrhosis, have emerged as significant public health concerns. Paradoxically, these conditions remain underestimated despite their substantial global impact. Age-related factors are closely associated with the severity and unfavorable prognosis of various liver diseases, warranting further investigation to enhance clinical management and develop novel therapeutic strategies. This comprehensive review focuses specifically on age-related liver diseases, their treatment strategies, and contemporary practices. It provides a detailed account of the global burden, types, molecular mechanisms, and epigenetic alterations underlying these liver pathologies.

Aging of Liver in Its Different Diseases

The proportion of elderly people in the world population is constantly increasing. With age, the risk of numerous chronic diseases and their complications also rises. Research on the subject of cellular senescence date back to the middle of the last century, and today we know that senescent cells have different morphology, metabolism, phenotypes and many other characteristics. Their main feature is the development of senescence-associated secretory phenotype (SASP), whose pro-inflammatory components affect tissues and organs, and increases the possibility of age-related diseases. The liver is the main metabolic organ of our body, and the results of previous research indicate that its regenerative capacity is greater and that it ages more slowly compared to other organs. With age, liver cells change under the influence of various stressors and the risk of developing chronic liver diseases such as non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), alcoholic steatohepatitis (ASH) and hepatocellular carcinoma (HCC) increases. It has been proven that these diseases progress faster in the elderly population and in some cases lead to end-stage liver disease that requires transplantation. The treatment of elderly people with chronic liver diseases is a challenge and requires an individual approach as well as new research that will reveal other safe and effective therapeutic modalities.

Fenugreek (Trigonella foenum-graecum L.) Seeds Dietary Supplementation Regulates Liver Antioxidant Defense Systems in Aging Mice

Fenugreek seeds are widely used in Asia and other places of the world for their nutritive and medicinal properties. In Asia, fenugreek seeds are also recommended for geriatric populations. Here, we evaluated for the first time the effect of fenugreek seed feed supplementation on the liver antioxidant defense systems in aging mice. The study was conducted on 12-months aged mice which were given fenugreek seed dietary supplement. We evaluated the activities of various antioxidant defense enzymes such as superoxide dismutase (SOD), glutathione reductase (GR), and glutathione peroxidase (GPx), and also estimated the phenolics and free radical scavenging properties in mice liver upon fenugreek supplementation. The estimation of SOD, GPx, and GR activities in aged mice liver revealed a significant (p < 0.01) difference among all the liver enzymes. Overall, this study reveals that fenugreek seed dietary supplementation has a positive effect on the activities of the hepatic antioxidant defense enzymes in the aged mice.

Age-dependent changes of the antioxidant system in rat livers are accompanied by altered MAPK activation and a decline in motor signaling

Aging is characterized by a progressive decrease of cellular functions, because cells gradually lose their capacity to respond to injury. Increased oxidative stress is considered to be one of the major contributors to age-related changes in all organs including the liver. Our study has focused on elucidating whether important antioxidative enzymes, the mTOR pathway, and MAPKs exhibit age-dependent changes in the liver of rats during aging. We found an age-dependent increase of GSH in the cytosol and mitochondria. The aged liver showed an increased SOD enzyme activity, while the CAT enzyme activity decreased. HO-1 and NOS-2 gene expression was lower in adult rats, but up-regulated in aged rats. Western blot analysis revealed that SOD1, SOD2, GPx, GR, γ-GCL, and GSS were age-dependent up-regulated, while CAT remained constant. We also demonstrated that the phosphorylation of Akt, JNK, p38, and TSC2(Ser1254) decreased while ERK1/2 and TSC2(Thr1462) increased age-dependently. Furthermore, our data show that the mTOR pathway seems to be activated in livers of aged rats, and hence stimulating cell proliferation/regeneration, as confirmed by an age-dependent increase of PCNA and p-eIF4E(Ser209) protein expression. Our data may help to explain the fact that liver cells only proliferate in cases of necessity, like injury and damage. In summary, we have demonstrated that, age-dependent changes of the antioxidant system and stress-related signaling pathways occur in the livers of rats, which may help to better understand organ aging.

Prognostic indicators for acute liver failure development and mortality in patients with hepatitis A: consecutive case analysis

PURPOSE

Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.

MATERIALS AND METHODS

A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation.

RESULTS

The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD≥23.5 was significantly more predictive than a SIRS score≥3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score≥23.5, King's College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis.

CONCLUSION

MELD and SIRS scores≥23.5 and ≥3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores≥3 were valuable in predicting mortality of patients with a MELD≥23.5.

Mast cells and the liver aging process

It has now ascertained that the clinical manifestations of liver disease in the elderly population reflect both the cumulative effects of longevity on the liver and the generalized senescence of the organism ability to adjust to metabolic, infectious, and immunologic insults. Although liver tests are not significantly affected by age, the presentation of liver diseases such as viral hepatitis may be subtler in the elderly population than that of younger patients.

Human immunosenescence is a situation in which the immune system, particularly T lymphocyte function, deteriorates with age, while innate immunity is negligibly affected and in some cases almost up-regulated.

We here briefly review the relationships between the liver aging process and mast cells, the key effectors in a more complex range of innate immune responses than originally though.

Liver disease, HIV and aging

The life expectancy of HIV-infected patients has increased due to the efficacy of highly active antiretroviral therapy (HAART) in controlling HIV replication; thus, the population living with HIV infection is steadily aging. Liver-related morbidity and mortality has emerged as a leading problem in HIV-infected patients. Since aging, HIV infection and HAART all affect the liver, understanding the impact of the combination of these factors on liver disease is crucial for optimisation of care in the aging HIV-infected population. This review will focus on the current understanding of liver disease in older (>50 years old) HIV-negative individuals and in HIV-infected individuals. Areas for future research in the area of HIV, liver disease and aging will also be discussed.

[Liver disease in the elderly]

A non-negligible percentage of the morbidity and mortality in older persons is due to liver disease. A discussion of the clinical presentation and proposed treatment of selected liver diseases in the elderly is therefore appropriate. Based on literature we will discuss the clinical course and treatment modalities of viral and autoimmune hepatitis, hepatocellular carcinoma and drug induced liver injury in the elderly.

Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009

BACKGROUND

Transmission of bloodborne pathogens due to breaches in infection control is becoming increasingly recognized as greater emphasis is placed on reducing health care-associated infections. Two women, aged 60 and 77 years, were diagnosed with acute hepatitis B virus (HBV) infection; both received chemotherapy at the same physician's office. Due to suspicion of health care-associated HBV transmission, a multidisciplinary team initiated an investigation of the hematology-oncology office practice.

METHODS

We performed an onsite inspection and environmental assessment, staff interviews, records review, and observation of staff practices. Patients who visited the office practice between January 1, 2006 and March 3, 2009 were advised to seek testing for bloodborne pathogens. Patients and medical providers were interviewed. Specimens from HBV-infected patients were sent to the Centers for Disease Control and Prevention for HBV DNA testing and phylogenic analysis.

RESULTS

Multiple breaches in infection control were identified, including deficient policies and procedures, improper hand hygiene, medication preparation in a blood processing area, common-use saline bags, and reuse of single-dose vials. The office practice was closed, and the physician's license was suspended. Out of 2,700 patients notified, test results were available for 1,394 (51.6%). Twenty-nine outbreak-associated HBV cases were identified. Specimens from 11 case-patients demonstrated 99.9%-100% nucleotide identity on phylogenetic analysis.

CONCLUSION

Systematic breaches in infection control led to ongoing transmission of HBV infection among patients undergoing invasive procedures at the office practice. This investigation underscores the need for improved regulatory oversight of outpatient health care settings, improved infection control and injection safety education for health care providers, and the development of mechanisms for ongoing communication and cooperation among public health agencies.

Gastrointestinal and liver side effects of drugs in elderly patients

It is expected that the percentage of people >60 years of age will be 22% worldwide by the year 2050. Multi-morbidity and poly-pharmacy are common in individuals during old age, while adverse drug reactions are at least twice as common in the elderly compared to younger adults. Publications related to drug side effects are rather rare in this age group since most clinical trials exclude patients >75-80 years of age. Gastrointestinal adverse drug reactions studied in the elderly include non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulant-induced gastrointestinal tract mucosal injuries. Malabsorption, diarrhoea and constipation are common side effects of laxatives, antibiotics, anticholinergics and calcium channel blockers. Drug (amoxycilin/clavulanic acid, isoniazide, nitrofurantoin, diclifenac and methotrexate)-induced hepatotoxicity in the elderly is four times more common than in younger adults and may simulate almost all known liver disorders. Further clinical studies are needed to investigate gastrointestinal and hepatic side effects of drugs in elderly patients.

Liver disorders in the elderly

Although there are no specific age-related liver diseases, it is increasingly recognized that the percentage and the actual number of elderly will increase substantially over the next twenty years. Moreover, the developments of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches have provoked increasing enthusiasm among hepatologists. Some liver diseases are particularly frequent in the elderly, e.g. chronic hepatitis C and hepatocellular carcinoma. The clinical course and management of liver disease in the elderly may differ in several aspects from those of younger adults. The problem of whether to offer antiviral treatment to a wide range of patients with chronic hepatitis C has arisen over the last eight to ten years, since the reduction in the risk of hepatocellular carcinoma was analyzed. Selected patients aged 65 and older have a chance of treatment with pegylated interferon plus ribavirin, despite a higher likelihood of side effects. The diagnosis of autoimmune hepatitis should be suspected in a patient over 65 years of age in case of 'acute' presentation with 10-fold increase in transaminases, jaundice and hyper-gammaglobulinemia, to avoid any delay in starting immunosuppressive therapy. The age of an end stage liver disease will increase over the next years, thus we will expects an increasing number of decompensated liver disease and hepatocellular carcinomas.

The impact of cirrhosis and portal hypertension on mortality following colorectal surgery: a nationwide, population-based study

PURPOSE

Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery.

METHODS

We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates.

RESULTS

Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P < 0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P < 0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis.

CONCLUSIONS

Patients with liver cirrhosis, in particular, those with portal hypertension, have increased in-hospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.

Non-invasive evaluation of liver fibrosis by transient elastography and biochemical markers in elderly inpatients

AIM

The objective of this study was to evaluate liver fibrosis using non-invasive methods in elderly patients.

METHODS

In a prospective two-day study, all consecutive patients of geriatric units were examined using transient elastography (FibroScan) and biochemical markers (Hepascore, Aspartate Transaminase (AST) to platelet ratio index [APRI], Forns score, FibroTest). Three groups of patients were included: elderly patients without liver disease (group A, 85.2+/-7.3 years); healthy younger control subjects without liver fibrosis (group B, 46.4+/-15.2 years); and elderly patients with confirmed liver disease (group C, 82.4+/-2.3 years).

RESULTS

FibroScan) results in the elderly patients correlated well with fibrosis surrogates, but were more difficult to obtain than in the younger subjects. Mean liver stiffness was 6.1 kPa (group A) versus 4.9 kPa (group B) and versus 10.2 kPa (group C) (P<0.0001). FibroTest results were 0.5 in group A versus 0.2 in group B, and versus 0.6 in group C (P<0.0001). In group A, statistical analysis showed that diabetes was associated with advanced liver fibrosis (FibroScan) > or = 9.5 kPa). A body mass index greater than 26kg/m2, age greater than 85 years, comorbidity score and polymedication were not associated with fibrosis.

CONCLUSION

Although liver stiffness may be more difficult to assess in the elderly, FibroScan may nevertheless serve as a new, non-invasive method for detecting liver fibrosis in this population.

Aging and neutrophils: there is still much to do

Human neutrophils are activated by a wide array of compounds through their receptors. This elicits their classical functions, such as chemotaxis, phagocytosis, and the production of reactive oxygen species (ROS). Upon stimulation, neutrophils also produce lipid and immune mediators and can present antigen through the major histocompatibility complex I (MHC-I). The age-related impairment of the classical functions of neutrophils is well described, but experimental evidence showing alterations in the production of mediators and antigen presentation with aging are lacking. This review highlights the role of neutrophils in age-related pathologies such as Alzheimer's disease, atherosclerosis, cancer, and autoimmune diseases. Furthermore, we discuss how aging potentially affects the production and release of mediators by human neutrophils in ways that may contribute to the development of these pathologies.