Study of liver function in healthy elderly subjects using the 13C-methacetin breath test

Cardio-Hepatic Interaction in Cardiac Amyloidosis

Background: Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Methods: Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and 13C-methacetin breath test. Results: In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31) were analysed. ATTR-CA patients showed decreased microsomal liver function expressed by maximal percentage of dose rate (PDRpeak) related to hepatic congestion. Reduced PDRpeak in AL-CA could result from altered pharmacokinetics due to changed hepatic blood flow. Liver stiffness as a combined surrogate of chronic liver damage and congestion was identified as a predictor of all-cause mortality. Statistical modelling of the cardio-hepatic interaction revealed septum thickness, NT-proBNP and PDRpeak as predictors of liver stiffness in both CA subtypes; dilatation of liver veins and the fibrosis score FIB-4 were only significant for ATTR-CA. Conclusions: Non-invasive methods allow us to characterise CA-associated hepatic pathophysiology. Liver stiffness might be promising for risk stratification in CA.

13C Methacetin Breath Test for Assessment of Microsomal Liver Function: Methodology and Clinical Application

Assessment of the liver function, and the need of constant monitoring of the organ's capacity, concerns not only patients with primary liver diseases, but also those at risk of hepatopathies secondary to other chronic diseases. Most commonly, the diagnostics is based on measurements of static biochemical parameters, which allow us to draw conclusions only indirectly about the function and the degree of damage of the organ. On the other hand, liver biopsy is an invasive procedure and therefore it is associated with a considerable risk of complications. Dynamic tests enable us to assess quantitatively the organ's functional reserve by analyzing the kinetics of the metabolization of the substrate by the liver. In practice applied are breath tests using substances such as aminopyrine, caffeine, methacetin, erythromycin (for assessment of the microsomal function); phenylalanine, galactose (for assessment of the cytosolic function); methionine, octanoate, ketoisocaproic acid (for assessment of the mitochondrial function). The test with ¹³C methacetin belongs to the best described and most widely applied methods in noninvasive liver function assessment. Due to the rising availability of this method, knowledge concerning its limitations and controversies regarding the methodology, as well as its usefulness in chosen groups of patients, seems to be vital.

Dynamic carbon 13 breath tests for the study of liver function and gastric emptying

In gastroenterological practice, breath tests (BTs) are diagnostic tools used for indirect, non-invasive assessment of several pathophysiological metabolic processes, by monitoring the appearance in breath of a metabolite of a specific substrate. Labelled substrates originally employed radioactive carbon 14 (¹⁴C) and, more recently, the stable carbon 13 isotope (¹³C) has been introduced to label specific substrates. The ingested ¹³C-substrate is metabolized, and exhaled ¹³CO₂ is measured by mass spectrometry or infrared spectroscopy. Some ¹³C-BTs evaluate specific (microsomal, cytosolic, and mitochondrial) hepatic metabolic pathways and can be employed in liver diseases (i.e. simple liver steatosis, non-alcoholic steato-hepatitis, liver fibrosis, cirrhosis, hepatocellular carcinoma, drug and alcohol effects).

Another field of clinical application for ¹³C-BTs is the assessment of gastric emptying kinetics in response to liquids (¹³C-acetate) or solids (¹³C-octanoic acid in egg yolk or in a pre-packed muffin or the ¹³C-Spirulina platensis given with a meal or a biscuit). Studies have shown that ¹³C-BTs, used for gastric emptying studies, yield results that are comparable to scintigraphy and can be useful in detecting either delayed- (gastroparesis) or accelerated gastric emptying or changes of gastric kinetics due to pharmacological effects. Thus, ¹³C-BTs represent an indirect, cost-effective and easy method of evaluating dynamic liver function and gastric kinetics in health and disease, and several other potential applications are being studied.

Critical appraisal of 13C breath tests for microsomal liver function: aminopyrine revisited

As liver diseases are a major health problem and especially the incidence of metabolic liver diseases like non-alcoholic fatty liver disease (NAFLD) is rising, the demand for non-invasive tests is growing to replace liver biopsy. Non-invasive tests such as carbon-labelled breath tests can provide a valuable contribution to the evaluation of metabolic liver function. This review aims to critically appraise the value of the (13) C-labelled microsomal breath tests for the evaluation of metabolic liver function, and to discuss the role of cytochrome P450 enzymes in the metabolism of the different probe drugs, especially of aminopyrine. Although a number of different probe drugs have been used in breath tests, the perfect drug to assess the functional metabolic capacity of the liver has not been found. Data suggest that both the (13) C(2) -aminopyrine and the (13) C-methacetin breath test can play a role in assessing the capacity of the microsomal liver function and may be useful in the follow-up of patients with chronic liver diseases. Furthermore, CYP2C19 seems to be an important enzyme in the N-demethylation of aminopyrine, and polymorphisms in this gene may influence breath test values, which should be kept in mind when performing the (13) C(2) -aminopyrine breath test in clinical practice.

Impact of combined oral contraceptives containing ethinylestradiol on the liver microsomal metabolism

OBJECTIVES

To check whether currently used combined oral contraceptives (COCs) containing ethinylestradiol (EE) affect the liver microsomal metabolism.

METHODS

(13)C-methacetin breath test ((13)C-MBT) - a sensitive non-invasive probe of cytochrome P-450 1A2 activity - was performed in 15 women on day 14, 15, 16, 17 or 18 of intake of their COC (containing EE), and between day 1 and 5 during the withdrawal bleeding, as well as in nine women not using hormonal contraception during the luteal phase of their cycle (between the 17th and the 23rd day), and between day 1 and 5 during menstruation.

RESULTS

The maximum breath (13)C elimination was significantly lower during the phase of intake of contraceptive pills than during withdrawal bleeding: 31.5 ± 2.2 %/h vs. 38.2 ± 1.9 %/h (p = 0.0045), whereas the time to reach it was similar on the two study days: 21.2 ± 1.2 min vs. 21.0 ± 1.1 min. Between the 27th and the 180th min of observation the cumulative breath (13)C elimination was statistically significantly lower during intake of the pill than during withdrawal bleeding. No significant menstrual cycle phase-dependent fluctuations in the results of the (13)C- methacetin breath test were observed in the control group.

CONCLUSION

COCs containing EE markedly inhibit hepatic microsomal function. This phenomenon must be taken into consideration when interpreting results of (13)C-MBT.

Liver involvement in hereditary hemorrhagic telangiectasia: can breath test unmask impaired hepatic first-pass effect?

Hepatic arteriovenous malformations (HAVMs) in hereditary hemorrhagic telangiectasia (HHT) have long been considered to have scarce clinical significance in most cases. Nevertheless, data are lacking regarding the influence of HAVMs on the liver first-pass effect on drugs in HHT patients. To gain insight into the effect of HAVMs on hepatic drug clearance by means of two specific (13)C-labeled probes, namely the (13)C-methacetin and (13)C-aminopyrine, 46 HHT patients and 44-matched healthy controls were enrolled. The liver first-pass effect was studied by the (13)C-based breath test using methacetin and aminopyrine. The methacetin breath test showed statistically significant reduced metabolism rates (p < 0.0001) in HHT when compared with controls, both in patients with and without CT-detectable HAVMs, and when expressed both as cumulative (13)C-percentage dose per hour and as (13)C-percentage peak after 15 min. In contrast, no significant difference was found between HHT and controls regarding aminopyrin metabolism rates. In HHT, (13)C%-methacetin breath test values are significantly lower than those found in normal subjects, probably due to the effect of hepatic shunts. A reduced perfusion and an impaired hepatic metabolism might affect hepatic drug clearance in HHT. Therefore, an appropriate dosage adjustments should be considered when high-hepatic-metabolism drugs are administered to HHT patients.

Comparison of two dosage regimens of the substrate for the [13C]methacetin breath test

The [(13)C]methacetin breath test ([(13)C]MBT)--a valuable non-invasive tool dedicated to the assessment of the liver metabolic capacity--still needs standardisation. The aim of this study was to check whether currently used dosage regimens of [(13)C]methacetin provide concordant [(13)C]MBT results in subjects with an atypical body constitution. Healthy volunteers: low body mass<55 kg (eight women), and high body mass>95 kg (eight large body frame men) were recruited. They underwent [(13)C]MBT on separate days, taking in random order [(13)C]methacetin: a fixed 75 mg dose (FX75), or a 1 mg kg(-1) body mass-adjusted dose (BMAD). Samples of expiratory air for (13)CO(2) measurement were collected over 3 h. The maximum momentary (13)C elimination in breath air occurred earlier and was higher following BMAD than with FX75 in the low body mass females (T (max) 14.6 ± 1.0 min vs. 22.1 ± 2.4 min, p = 0.019; D (max) 41.9 ± 2.9 % dose h(-1) vs. 36.6 ± 3.6 % dose h(-1), p = 0.071). In the high body mass men, T (max) remained unchanged, whereas D (max) was slightly higher with BMAD compared to FX75 (21.5 ± 3.2 min vs. 23.0 ± 3.0 min; 38.5 ± 2.9 % dose h(-1) vs. 32.3 ± 2.5 % dose h(-1)). It is concluded that in subjects with a body constitution outside the general population average, the dosage of the substrate may affect some results of the [(13)C]MBT. The dosage-related differences appear, however, to be insignificant if the result of the [(13)C]MBT is reported as a cumulative (13)C recovery in breath air.

13C-methacetin breath test reproducibility study reveals persistent CYP1A2 stimulation on repeat examinations

AIM: To find the most reproducible quantitative parameter of a standard ¹³C-methacetin breath test (¹³C-MBT).

METHODS: Twenty healthy volunteers (10 female, 10 male) underwent the ¹³C-MBT after intake of 75 mg ¹³C-methacetin p.o. on three occasions. Short- and medium-term reproducibility was assessed with paired examinations taken at an interval of 2 and 18 d (medians), respectively.

RESULTS: The reproducibility of the 1-h cumulative ¹³C recovery (AUC_0-60), characterized by a coefficient of variation of 10%, appeared to be considerably better than the reproducibility of the maximum momentary ¹³C recovery or the time of reaching it. Remarkably, as opposed to the short gap between consecutive examinations, the capacity of the liver to handle ¹³C-methacetin increased slightly but statistically significantly when a repeat dose was administered after two to three weeks. Regarding the AUC_0-60, the magnitude of this fixed bias amounted to 7.5%. Neither the time gap between the repeat examinations nor the gender of the subjects affected the ¹³C-MBT reproducibility.

CONCLUSION: ¹³C-MBT is most reproducibly quantified by the cumulative ¹³C recovery, but the exactitude thereof may be modestly affected by persistent stimulation of CYP1A2 on repeat examinations.

Interference of acute cigarette smoking with [¹³C]methacetin breath test

It is essential to establish whether and how environmental factors affect the reliability of [(13)C]methacetin breath test ((13)C-MBT). In 12 healthy volunteers (smokers), a standard (13)C-MBT with 75 mg [(13)C]methacetin was performed twice in random order: on a control day without smoking and on another day with smoking two cigarettes antecedently. A considerable flattening of the curve of the momentary (13)C recovery within the expiratory air was observed when the (13)C-MBT was performed after smoking. The maximum of the momentary (13)C recovery, D(max), decreased from 37.20±2.58 to 25.39±2.29% dose/h (p=0.00052). Moreover, the time to reach D(max) was prolonged after cigarette smoking (26.5±3.1 vs. 16.5±1.9 min, p=0.0199). The curve of the cumulative (13)C recovery on the cigarette smoking day appeared to be shifted downwards, and statistically significant differences relative to the control situation were found between the 24th and 75th minute following [(13)C]methacetin administration. Smoking cigarettes immediately prior to the (13)C-MBT diminishes the ability of the liver to handle methacetin, and hence a possibility of such an interaction should be excluded in order to interpret the results of the test correctly.

Clinical research on liver reserve function by 13C-phenylalanine breath test in aged patients with chronic liver diseases

Background

The objective of this study was to investigate whether the ¹³C-phenylalanine breath test could be useful for the evaluation of hepatic function in elderly volunteers and patients with chronic hepatitis B and liver cirrhosis.

Methods

L-[1-¹³C] phenylalanine was administered orally at a dose of 100 mg to 55 elderly patients with liver cirrhosis, 30 patients with chronic hepatitis B and 38 elderly healthy subjects. The breath test was performed at 8 different time points (0, 10, 20, 30, 45, 60, 90, 120 min) to obtain the values of Delta over baseline, percentage ¹³CO₂ exhalation rate and cumulative excretion (Cum). The relationships of the cumulative excretion with the ¹³C-%dose/h and blood biochemical parameters were investigated.

Results

The ¹³C-%dose/h at 20 min and 30 min combined with the cumulative excretion at 60 min and 120 min correlated with hepatic function tests, serum albumin, hemoglobin, platelet and Child-Pugh score. Prothrombin time, total and direct bilirubin were significantly increased, while serum albumin, hemoglobin and platelet, the cumulative excretion at 60 min and 120 min values decreased by degrees of intensity of the disease in Child-Pugh A, B, and C patients (P < 0.01).

Conclusions

The ¹³C-phenylalanine breath test can be used as a non-invasive assay to evaluate hepatic function in elderly patients with liver cirrhosis. The ¹³C-%dose/h at 20 min, at 30 min and cumulative excretion at 60 min may be the key value for determination at a single time-point. ¹³C-phenylalanine breath test is safe and helpful in distinguishing different stages of hepatic dysfunction for elderly cirrhosis patients.

Exact profiles of (13)CO(2) recovery in breath air after per oral administration of [(13)C]methacetin in two groups of different ages

The aim of this study is to determine if age is a factor influencing the results of a [(13)C]methacetin breath test ((13)C-MBT). Two groups of healthy volunteers, each comprising six men and six women, but differing in average age (Y=young, 25.1+/-0.6 years, MA=middle-aged;, 46.0+/-2.1 years) orally took 75 mg [(13)C]methacetin. Samples of expiratory air for (13)CO(2) measurement were collected up to 48 h after intake of the substrate. A maximum momentary (13)CO(2) breath exhalation of 37.0+/-2.6%dose/h was observed at 18 min (median, range: 9-30 min) in the young subjects and of 38.4+/-2.5%dose/h at 18 min (median, range: 12-30 min) in the middle-age volunteers. The cumulative (13)C elimination in expiratory air was statistically significantly higher in the MA compared with the Y group as from 75 min up to 180 min, indicating a greater microsomal metabolic efficiency of the liver in the middle-aged healthy subjects. Gender, use of hormonal contraception, cigarette smoking, or body mass index did not modify the age-related effect on the cumulative (13)C elimination in breath air. The study results imply a necessity of composing control groups well matched with regard to the age structure for a proper interpretation of clinical (13)C-MBT results.

Effect of alcohol consumption on the liver detoxication capacity as measured by [13C]methacetin- and [methyl-13C]methionine-breath tests

The aim of this study was to investigate the hepatic microsomal and mitochondrial functions by using the 13CO2-breath test in healthy subjects either before or after the consumption of red wine. Fourteen adults received [13C]methacetin and [methyl-13C]methionine together with a standardised dinner. Expired air samples were taken over 6 h. After a wash-out period, the subjects consumed 0.4 ml ethanol/kg/day together with dinner over a 10-day period. Thereafter, 13C-tracer administration was repeated under identical conditions. The 13CO2-enrichments were measured by isotope ratio mass spectrometry. The mean cumulative percentage 13C-dose recovery (CPDR) after administration of [13C]methacetin and [methyl-13C]methionine either without or with red wine consumption amounted to 38.2+/-6.3 vs. 36.3+/-6.7% (p=0.363) and 9.5+/-3.3 vs. 8.8+/-2.5% (p=0.47), respectively. Moderate alcohol consumption does not induce significant short-term changes of the microsomal and the mitochondrial functions of the human liver in healthy subjects.

Review article: the assessment of liver function using breath tests

BACKGROUND

Hepatologists have long sought to develop a test for assessing liver function, but this aim has been stalled by the complexity of the liver and its diverse functions. Results of metabolic tests, including breath tests, correlate with clinical and histological parameters of patients with liver disorders; however, these tests tend to be cumbersome and impractical for everyday use. The recent development of a real-time, point-of-care liver function breath test has made it straightforward to assess the metabolic function of the liver.

AIM

To review the available data on the use of breath tests for assessing liver reserve in various conditions and their application in various clinical hepatology settings.

RESULTS

The (13)C-methacetin breath test enables accurate follow-up of patients with acute or chronic liver damage, where overall hepatic function is significantly suppressed by known causes of liver disorders, including acute, sub-acute or chronic conditions. The metabolic breath test can detect both gradual and spontaneous improvements in liver function and the effects of treatment.

CONCLUSIONS

Breath testing that provides continuous quantification of methacetin metabolism may be a sensitive tool for the diagnosis and follow-up of patients with liver disorders.

13C-breath tests: current state of the art and future directions

13C-breath tests provide a non-invasive diagnostic method with high patient acceptance. In vivo, human and also bacterial enzyme activities, organ functions and transport processes can be assessed semiquantitatively using breath tests. As the samples can directly be analysed using non-dispersive isotope selective infrared spectrometers or sent to analytical centres by normal mail breath tests can be easily performed also in primary care settings. The 13C-urea breath test which detects a Helicobacter pylori infection of the stomach is the most prominent application of stable isotopes. Determination of gastric emptying using test meals labelled with 13C-octanoic or 13C-acetic acid provide reliable results compared to scintigraphy. The clinical use of 13C-breath tests for the diagnosis of exocrine pancreatic insufficiency is still limited due to expensive substrates and long test periods with many samples. However, the quantification of liver function using hepatically metabolised 13C-substrates is clinically helpful in special indications. The stable isotope technique presents an elegant, non-invasive diagnostic tool promising further options of clinical applications. This review is aimed at providing an overview on the relevant clinical applications of 13C-breath tests.

13C-methacetin breath test shortened: 2-point-measurements after 15 minutes reliably indicate the presence of liver cirrhosis

BACKGROUND AND GOALS

The 13C-methacetin breath test (MBT) measures the activity of the cytochrome P450 dependent enzyme system and has been developed to assess the functional hepatic mass. We evaluated simple modifications of the 13C-MBT to further increase its practicability and therefore clinical acceptance.

STUDY

One hundred and four patients with different chronic liver diseases (including 35 patients with histologically proven cirrhosis) and 65 healthy controls underwent the 13C-MBT. Breath test results of 2-point measurements were compared with conventional breath test results (cumulative recovery after 30 min) and liver histology.

RESULTS

The 2-point-measurement at 0 and 15 minutes (with a cut-off <14.6 per thousand delta over baseline) had 92.6% sensitivity and 94.1% specificity in identifying the presence of cirrhosis compared with liver histology. The 2-point-measurements at 5 and 10 minutes also provided good discrimination between cirrhotic and noncirrhotic patients.

CONCLUSIONS

The 13C-MBT using 2-point-measurement of breath samples at baseline and after 15 minutes reliably indicates decreased liver function in liver cirrhosis. This simplification of the 13C-MBT will increase practicability and cost efficiency, thus facilitating its clinical acceptability.

Comparison of clinical value of IRIS 13C-methacetin breath test and ICG test in assessment of liver function in cirrhosis

AIM: To compare the clinical value of ¹³C-methacetin breath test and ICG test in the assessment of liver function in patients with cirrhosis.

METHODS: Fifty-nine patients with liver cirrhosis received ¹³C-methacetin breath test after an overnight fast. Breath samples were taken before and at different time within 120 min after administration. ¹³CO₂ enrichment was measured by infrared isotope spectrometry (IRIS). The ¹³CO₂ maximum excretive rate before 40 min (mv_max40), ¹³CO₂ cumulative excretion at 40 min (cum₄₀) and ¹³CO₂ cumulative excretion at 120 min (cum₁₂₀) were determined. Plasma retention rate of indocyanine green at 15 min (R_{15 ICG}) was also measured.

RESULTS: ¹³C mv_max40, cum₄₀ and cum₁₂₀ were significantly different between the cirrhosis patients with different Child-Pugh grades (A, B, C). (mv_max40 A-B, B-C and A-C: 2.80, 4.82 and 10.38; cum₄₀ A-B, B-C and A-C: 3.85, 3.39 and 8.64; cum₁₂₀ A-B, B-C and A-C: 4.52, 3.75 and 12.36, P<0.01). The differences of R_{15 ICG} of patients with different Child-Pugh grades were also significant (A-B and B-C: -4.72,-1.27, P<0.01) except between Child-Pugh B and C group (A-C: -5.85, P>0.05).¹³C mv_max40, cum₄₀, cum₁₂₀ and R_{15 ICG} significantly correlated with Child-Pugh classification score (r = -0.562, -0.614, -0.716 and 0.555, P<0.001). For the evaluation of liver function in patients with cirrhosis, the consistence of 13C-methacetin breath test with Child-Pugh classification (Kappa: 0.69, P<0.05) was better than that of ICG test (Kappa: 0.47, P<0.05).

CONCLUSION: ICG test is a good quantitative method for the evaluation of the liver function in cirrhosis. ¹³C-methacetin breath test can be used to measure immediate hepatocyte injure and liver functional reserve. It is more sensitive than ICG test in the evaluation of liver function in cirrhosis, especially in uncompensated patients.

13C-methacetin breath test as liver function test in patients with chronic hepatitis C virus infection

BACKGROUND

The 13C-methacetin breath test enables the quantitative evaluation of the cytochrome P450-dependent liver function.

AIM

To find out whether this breath test is sensitive in noncirrhotic patients also with chronic hepatitis C in early stages of fibrosis.

METHODS

Sixty-one healthy controls and 81 patients with chronic hepatitis C underwent a 13C-methacetin breath test. In all patients, a liver biopsy was performed. The liver histology was classified according to the histology activity index-Knodell score.

RESULTS

Delta over baseline values of the patients at 15 min significantly differed from controls (19.2 +/- 9.2 per thousand vs. 24.1 +/- 5.7 per thousand; P < 0.003). The cumulative recovery after 30 min in patients was 11.4 +/- 4.8% and in healthy controls 13.8 +/- 2.8% (P < 0.002). However, patients with early fibrosis (histology activity index IVB) did not differ in delta over baseline values of the patients at 15 min (23.2 +/- 7.9 per thousand vs. 22.6 +/- 7.2 per thousand; P = 0.61) or cumulative recovery (13.6 +/- 3.7% vs. 13.2 +/- 3.8%; P = 0.45) from patients with more advanced fibrosis (histology activity index IVC). Patients with clinically nonsymptomatic cirrhosis (histology activity index IVD; Child A) metabolized 13C-methacetin to a significantly lesser extent (delta over baseline values of the patients at 15 min: 8.3 +/- 4.9 per thousand; P < 0.005 and cumulative recovery after 30 min: 5.6 +/- 3.2%; P < 0.003). The 13C-methacetin breath test identified cirrhotic patients with 95.0% sensitivity and 96.7% specificity.

CONCLUSION

The non-invasive 13C-methacetin breath test reliably distinguishes between early cirrhotic (Child A) and noncirrhotic patients, but fails to detect early stages of fibrosis in patients with chronic hepatitis C.

13C- mithacetin breath test for assessment of liver functional capacity

AIM: To investigate the clinical significance of ¹³C-mithacetin breath tests for assessment and the classification of liver functional capacity.

METHODS: Twelve healthy volunteers served as a control group. Patients (test group) with different kinds of liver diseases were divided into 4 sub-groups: compensatory period (n = 4), Child-Pugh classification A, B, C (n = 12, 12, 16, respectively). Patients in both groups were examined for liver function by a biochemical test after orally taking ¹³C-mithacetin (75 mg). Gas breathed out was collected at 9 different time within 120 min. The samples were analyzed with mass spectrograph to obtain DOB, MV and CUM curves and CUM120 value.

RESULTS: Biochemical index such as ALB and pre-albumin (PA) in patients of test group (Child-Pugh A, B and C) were significantly decreased as compared with those in patients of control group (ALB: 33.1 ± 3.1, 29.3 ± 6.5, 27.9 ± 5.0 vs 36.6 ± 4.7; PA: 119.7 ± 51.0, 104.3 ± 21.1, 77.4 ± 32.9 vs 176.4 ± 68.2; P < 0.05). The classifications of liver capacity significantly related to the values of ALB and PA (P < 0.05). Peak values of DOB and MV curves negatively related to the peak time in the test group (DOB: r = -0.48, P < 0.01; MV: r = -0.57, P < 0.01). Peak values of DOB, MV and CUM decreased with the development of liver dysfunction. Significant difference existed between the test group (Child-Pugh A, B, and C respectively) and control group (DOB: 10.4 ± 3.39, 6.71 ± 3.58, 4.00 ± 1.40 vs 20.93 ± 7.56; MV: 13.12 ± 9.51, 11.61 ± 8.02, 10.20 ± 4.99 vs 29.53; CUM: 18.09 ± 18.09, 16.60 ± 16.60, 15.82 ± 15.82 vs 30.67 ± 2.85; P < 0.05 repectively). CUM120 values in patients of the test group (Child-Pugh A, B, and C) significantly decreased as compared with those in patients of control group (63.61 ± 36.67, 59.32 ± 24.73, 52.62 ± 23.92 vs 109.45 ± 10.26; P < 0.05), but no significant decrease appeared among sub-groups.

CONCLUSION: ¹³C-mithacetin breath test is a safe, effective method in assessment and classification of liver capacity. Mean peak values of DOB, MV and CUM curves and CUM120 value decrease with the development of liver dysfunctions. Peak values are more clinically significant than peak time.

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Cirrhosis Progression as a Model of Accelerated Senescence: Affecting the Biological Aging Clock by a Breakthrough Biophysical Methodology

To test new treatment modalities, a pilot study with a novel noninvasive biophysical methodology (Delta-S DVD) that can artificially exert a "decrease of entropy" through the patented electromagnetic-driven delivery of "energy clusters" was designed. This process has been modulated and integrated by the body as a "self" source to support the energy-dependent functional stores, thus modifying reparative into regenerative mechanisms of liver parenchyma. Seven long-standing hepatitis C virus-positive (Child A-B) cirrhosis patients with overt symptoms and portal hypertension and failure or side effects of antiviral drug treatment underwent 40-min sessions of Delta-S DVD daily for six months and were followed up monthly. At the end of the first month, rapid improvement of symptoms and a decrease of portal hypertension were noted. At the end of treatment, all patients showed either a complete (80%) or a partial (20%) regression of fatigue (FISK score), peripheral edema, pruritus, and palmar erythema. As observed, despite having stopped beta-blockers, F1 esophageal varices disappeared (60%), whereas F2 decreased to F1. The Doppler ultrasound aspect of partial (40%) or total (20%) atrophy was either reduced (60%) or reverted to normal (20%), and the respiratory dynamics of the portal vein improved (80%) or normalized (20%), whereas gross scarring nodules disappeared in 40% of cases. These promising data pave the way for an innovative physiopathological approach with extensive clinical applications.