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Yang YY, Hou MC, Lin MW, Chen PH, Liao WC, Chu CJ, Lin HC. Combined platelet count with sCD163 and genetic variants optimizes esophageal varices prediction in cirrhotic patients. J Gastroenterol Hepatol 2013; 28:112-21. [PMID: 22849380 DOI: 10.1111/j.1440-1746.2012.07245.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic screening for esophageal varices (EVs) is expensive and invasive. Besides traditional noninvasive markers, we explore additional candidate markers including portal hypertension serum marker-soluble CD136 (sCD163) and genetic variants of splanchnic vasodilatation and revascularization pathways for prediction of EVs in cirrhotic patients. METHODS A total of 951 cirrhotic patients without history of variceal bleeding and an independent validation cirrhotic cohort were enrolled to evaluate the association between the presence of EVs and patients' clinical and genetic characteristics. RESULTS Cirrhotic patients with EVs had higher serum sCD163 and heme oxygenase-1 (HO-1) level, which was positively correlated with the number of risk alleles of HO-1 (S, A), vascular endothelial growth factor (VEGF [G, T]) and VEGF receptor-2 (VEGFR2 [Ile]) genes, than those without EVs. Multivariate analysis showed that EVs in cirrhotic patients was predicted by low platelet count, high sCD163 level, splenomegaly, HO-1 AS and the VEGF GT risk haplotypes. Additive effects in relation to predict EVs were observed in the simultaneous presence of HO-1 AS and VEGF GT risk haplotypes. Combining low platelet count with high sCD163/risk haplotypes significantly increased the predictability of EVs. Furthermore, cirrhotic patients carrying both HO-1 AS and VEGF GT risk haplotypes had lower probability of being free of EVs bleeding compared to patients without above risk haplotypes. CONCLUSIONS This study suggested that high sCD163 levels and genetic risk variants are additional markers that can be combined with low platelet count to optimize assessment of EVs and bleeding in cirrhotic patients.
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Affiliation(s)
- Ying-Ying Yang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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2
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Chan CC, Tsai SC, Cheng LY, Lee FY, Lin HC. Hemodynamic assessment of the development of portal-systemic collaterals in portal hypertensive rats. Dig Dis Sci 2011; 56:417-24. [PMID: 20635149 DOI: 10.1007/s10620-010-1302-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 06/14/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND Portal hypertension induced the formation of portal-systemic collaterals. Revealing the developmental change of portal-systemic collaterals is important for future therapy. METHODS We observed the evolution of an accessible shunting vessel, the spleno-renal shunt (SRS), in rats after induction of portal hypertension by partial portal vein ligation (PVL). The hemodynamic and histological assessments of SRS were performed by transit time ultrasound and immunohistochemical studies. RESULTS The portal pressure of PVL rats surged to 16.5 ± 1.1 mmHg on day 1 after ligation surgery and was maintained at a significantly higher level (13.0 ± 0.4 mmHg) to day 14 when compared to sham rats (p < 0.05). The size or flow of SRS in PVL rats did not change immediately after portal pressure surge. Instead, they increased rapidly on day 4, peaked on day 7, and stabilized thereafter. The size and flow were greater and the resistance of SRS was lower in PVL rats after day 7 (p < 0.05). The anti-Ki67 immunohistochemical study demonstrated positive staining of endothelium in SRS and negative in portal vein or aorta of PVL rats. In addition, the endothelial cells of SRS were stained positive for CD31 and KLF5. CONCLUSIONS We concluded that the pressure-induced opening of pre-existing vessels was not the primary underlying mechanism in the formation of SRS. Endothelial proliferating and vascular remodeling process participated actively during the development of SRS. These observations can be used for studying the pathogenesis and developing more effective anti-portal hypertensive therapy in the future.
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Affiliation(s)
- Che-Chang Chan
- Division of Gastroenterology, Taipei Veterans General Hospital, Beitou District, Taipei city, Taiwan, Republic of China.
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Fizanne L, Régenet N, Wang J, Oberti F, Moal F, Roux J, Gallois Y, Michalak S, Calès P. Hemodynamic effects of the early and long-term administration of propranolol in rats with intrahepatic portal hypertension. Hepatol Int 2008; 2:457-64. [PMID: 19669320 DOI: 10.1007/s12072-008-9070-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 02/15/2008] [Indexed: 12/20/2022]
Abstract
Background and aims The aims of this study were to evaluate a preventive effect on collateral venous circulation of long-term administration of propranolol in intrahepatic portal hypertensive rats. Methods Eighty-six Sprague-Dawley rats were allocated to two models of hepatic fibrosis, bile duct-ligated (BDL) induced and carbon tetrachloride (CCl(4)) induced. Each model was divided into two groups: one receiving placebo and the other propranolol (75 mg kg(-1) d(-1)). Mean arterial pressure (MAP), heart rate (HR), portal pressure (PP), cardiac index (CI), vascular systemic resistance, and splenorenal shunt blood flow (SRS-BF) were measured in anesthetized rats. Results In the BDL model, no significant hemodynamic changes were observed in the propranolol group compared with the placebo group. In CCl(4)-induced rats, HR (390 +/- 50 vs. 329 +/- 51 beats/min, P = .001), CI (44 +/- 11 vs. 34 +/- 10 ml/min, P = .004), PP (15.4 +/- 3.0 vs. 13.4 +/- 1.9 mmHg, P = .045), and SRS-BF (1.4 +/- 1.1 vs. 1.0 +/- 1.0 ml/min, P = .047) were significantly lower in the propranolol group. Conclusions This study showed that propranolol has a significant hemodynamic effect only in the CCl(4) model and suggested a model-dependent effect of propranolol.
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Affiliation(s)
- Lionel Fizanne
- Laboratoire HIFIH, UPRES EA 3859, UFR de Médecine, Université d'Angers, Angers, France
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Chiu B, Melin-Aldana H, Pillai S, Hernandez JM, Superina RA. Extrahepatic portal vein obstruction results in hepatocyte proliferation but a decrease in protein-C synthesis. J Pediatr Surg 2007; 42:796-9. [PMID: 17502186 DOI: 10.1016/j.jpedsurg.2006.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Extrahepatic portal vein obstruction (EHPVO) results in decreased levels of liver-dependent coagulation factors in children. We developed a rat model to test the hypothesis that lower factor levels associated with EHPVO were from diminished synthesis rather than increased consumption. METHODS A total of 8 rats (experimental group) underwent narrowing of portal vein (PV) and 8 underwent sham operations. Liver and spleen mass, serum alanine aminotransferase, bilirubin, ammonia, prothrombin time, factor VII, and protein-C were measured before and 3 months after PV narrowing. Hepatocyte proliferation and apoptosis were quantified using Ki-67 and TUNEL assays. RESULTS Portal vein diameter was 71% +/- 13% narrower in experimental animals. Liver mass was unchanged, but proportional spleen mass was higher in the experimental group at 3 months (0.31% +/- 0.05% vs 0.26% +/- 0.04%; P < .05). Percent apoptotic cells at 3 months was similar in both groups (0.14% +/- 0.08% vs 0.13% +/- 0.07%), but percent proliferating cells was higher in the experimental group (0.63% +/- 0.17% vs 0.34% +/- 0.11%; P < .05). Three-month protein-C levels decreased significantly only in the experimental group compared with preoperative values (12.8% +/- 4.4% vs 7.6% +/- 5.1%; P < .05). Changes in other parameters were not significant. CONCLUSIONS Our EHPVO model consistently produced PV narrowing. The increase in hepatocyte proliferation seen after EHPVO suggests a liver repair response that is insufficient to maintain normal protein-C synthesis and serum levels.
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Affiliation(s)
- Bill Chiu
- Department of Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA
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5
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Abstract
Animal models have allowed detailed study of hemodynamic alterations typical of portal hypertension and the molecular mechanisms involved in abnormalities in splanchnic and systemic circulation associated with this syndrome. Models of prehepatic portal hypertension can be used to study alterations in the splanchnic circulation and the pathophysiology of the hyperdynamic circulation. Models of cirrhosis allow study of the alterations in intrahepatic microcirculation that lead to increased resistance to portal flow. This review summarizes the currently available literature on animal models of portal hypertension and analyzes their relative utility. The criteria for choosing a particular model, depending on the specific objectives of the study, are also discussed.
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Affiliation(s)
- Juan-G Abraldes
- Liver Unit, Hospital Clinic, Villarroel 170, University of Barcelona 08036, Spain.
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6
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Abstract
Animal models have allowed detailed study of hemodynamic alterations typical of portal hypertension and the molecular mechanisms involved in abnormalities in splanchnic and systemic circulation associated with this syndrome. Models of prehepatic portal hypertension can be used to study alterations in the splanchnic circulation and the pathophysiology of the hyperdynamic circulation. Models of cirrhosis allow study of the alterations in intrahepatic microcirculation that lead to increased resistance to portal flow. This review summarizes the currently available literature on animal models of portal hypertension and analyzes their relative utility. The criteria for choosing a particular model, depending on the specific objectives of the study, are also discussed.
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Affiliation(s)
- Juan-G Abraldes
- Liver Unit, Hospital Clinic, Villarroel 170, University of Barcelona 08036, Spain.
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Abraldes JG, García-Pagán JC. Modelos animales en el estudio de la hipertensión portal. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:51-9. [PMID: 16393631 DOI: 10.1157/13083254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Animal models allow detailed study of the hemodynamic alterations in portal hypertension syndrome and of the molecular mechanisms involved in the abnormalities in splenic and systemic circulation associated with this syndrome. Models of prehepatic portal hypertension can be used to study alterations in the splenic circulation and the physiopathology of hyperdynamic circulation. Moreover, models of cirrhosis allow the alterations in intrahepatic microcirculation that lead to increased resistance to portal flow to be studied. The present review summarizes currently available animal models of portal hypertension and analyzes their relative utility in investigating the distinct disorders associated with this entity. The criteria for the choice of a particular model, depending on the specific objectives of the study, are also discussed.
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Affiliation(s)
- J G Abraldes
- Servicio de Hepatología, ICMDiM, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
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Zanlungo S, Rigotti A, Nervi F. Hepatic cholesterol transport from plasma into bile: implications for gallstone disease. Curr Opin Lipidol 2004; 15:279-86. [PMID: 15166783 DOI: 10.1097/00041433-200406000-00007] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The transhepatic traffic of cholesterol from plasma lipoproteins into the bile is critical for overall cholesterol homeostasis and its alterations may lead to cholesterol gallstone formation. This review summarizes recent progress in understanding the key hepatic cholesterol metabolism-related proteins and pathways that influence biliary secretion of cholesterol. RECENT FINDINGS In cholesterol-fed apolipoprotein E knockout mice, the availability of dietary cholesterol for biliary disposal is decreased and diet-induced gallstone formation is impaired. Scavenger receptor class B type I is relevant for cholesterol transport from plasma HDL into the bile in chow-fed mice, however its expression is not critical for biliary cholesterol secretion and gallstone formation in lithogenic diet-fed mice. Intrahepatic cholesterol transport proteins (e.g. sterol carrier protein-2, Niemann Pick type C-1 protein) also determine liver cholesterol available for biliary secretion in mice. Genetic manipulation of canalicular ATP-binding cassette transporter G5 and G8 expression in mice has established their essential role for biliary cholesterol secretion. SUMMARY Recent studies have underscored that different proteins involved in hepatic cholesterol transport regulate the availability of cholesterol for biliary secretion. These advances may provide new avenues for prevention and treatment of various disease conditions linked to abnormal cholesterol metabolism.
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Affiliation(s)
- Silvana Zanlungo
- Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Marcoleta 367, Santiago, Chile
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Croquet V, Moal F, Veal N, Wang J, Oberti F, Roux J, Vuillemin E, Gallois Y, Douay O, Chappard D, Calès P. Hemodynamic and antifibrotic effects of losartan in rats with liver fibrosis and/or portal hypertension. J Hepatol 2002; 37:773-80. [PMID: 12445418 DOI: 10.1016/s0168-8278(02)00307-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS To assess the effects of the early and chronic administration of losartan--a specific angiotensin II receptor antagonist--in the prevention of hepatic fibrosis and portal hypertension. METHODS/RESULTS (1) In CCl(4) rats, losartan at 5 and 10 mg/kg per day significantly decreased portal pressure (-11, -18%, respectively), splenorenal shunt blood flow (-60, -80%) and liver fibrosis (liver hydroxyproline and area of fibrosis) without significant changes in mortality and mean arterial pressure (MAP). (2) In bile duct ligated (BDL) rats, losartan at 5 mg/kg per day significantly decreased portal pressure (-14%), splenorenal shunt blood flow (-70%) and liver fibrosis. Losartan at 10 mg/kg per day significantly worsened liver and renal functions, mortality and liver fibrosis, without significant changes in portal pressure and splenorenal shunt blood flow. Losartan at 5 and 10 mg/kg per day significantly decreased MAP (-24, -30%). (3) In portal vein ligated (PVL) rats, losartan significantly decreased MAP (-12%) but did not change portal pressure or splenorenal shunt blood flow. CONCLUSIONS In BDL and CCl(4) rats, losartan has beneficial effects on splanchnic hemodynamics and liver fibrosis. Losartan might decrease hepatic resistances in fibrotic liver. Losartan decreased MAP except in CCl(4) rats. Higher dosage of losartan had deleterious effects in BDL rats.
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Affiliation(s)
- Vincent Croquet
- Laboratoire HIFIH, UPRES EA 2170, Université d'Angers, 49033 Angers Cedex 01, France
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Abstract
Intestinal reabsorption of bile salts plays a crucial role in human health and disease. This process is primarily localized to the terminal ileum and is mediated by a 48-kd sodium-dependent bile acid cotransporter (SLC10A2 = ASBT). ASBT is also expressed in renal tubule cells, cholangiocytes, and the gallbladder. Exon skipping leads to a truncated version of ASBT, which sorts to the basolateral surface and mediates efflux of bile salts. Inherited mutation of ASBT leads to congenital diarrhea secondary to bile acid malabsorption. Partial inhibition of ASBT may be useful in the treatment of hypercholesterolemia and intrahepatic cholestasis. During normal development in the rat ileum, ASBT undergoes a biphasic pattern of expression with a prenatal onset, postnatal repression, and reinduction at the time of weaning. The bile acid responsiveness of the ASBT gene is not clear and may be dependent on both the experimental model used and the species being investigated. Future studies of the transcriptional and posttranscriptional regulation of the ASBT gene and analysis of ASBT knockout mice will provide further insight into the biology, physiology, and pathophysiology of intestinal bile acid transport.
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Affiliation(s)
- B L Shneider
- Mount Sinai Medical Center, New York, NY 10029, USA
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Van de Casteele M, Sägesser H, Zimmermann H, Reichen J. Characterisation of portal hypertension models by microspheres in anaesthetised rats: a comparison of liver flow. Pharmacol Ther 2001; 90:35-43. [PMID: 11448724 DOI: 10.1016/s0163-7258(01)00123-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several portal hypertensive animal models are available and frequently used for haemodynamic studies. The portal venous inflows, measured with microspheres in pentobarbital anaesthetised rats, are compared here. The partial portal vein ligation model is characterised by a high portal venous inflow, together with extensive portal systemic shunting, at the cost of portal sinusoidal flow. In carbon tetrachloride-induced micronodular cirrhosis, portal sinusoidal flow, which reaches liver parenchyma, is high, and this is more pronounced in the presence of ascites. In bile duct ligation and excision-induced cirrhosis, an increase in liver weight was not equally followed by an increase in portal sinusoidal flow, pointing to a relatively underperfused liver.
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Affiliation(s)
- M Van de Casteele
- Institute of Clinical Pharmacology, University of Berne, Murtenstrasse 35, CH-3010 Berne, Switzerland.
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