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Fiorucci S, Urbani G, Di Giorgio C, Biagioli M, Distrutti E. Bile Acids-Based Therapies for Primary Sclerosing Cholangitis: Current Landscape and Future Developments. Cells 2024; 13:1650. [PMID: 39404413 PMCID: PMC11475195 DOI: 10.3390/cells13191650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 09/30/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024] Open
Abstract
Primary sclerosing cholangitis (PSC) is a rare, chronic liver disease with no approved therapies. The ursodeoxycholic acid (UDCA) has been widely used, although there is no evidence that the use of UDCA delays the time to liver transplant or increases survival. Several candidate drugs are currently being developed. The largest group of these new agents is represented by FXR agonists, including obeticholic acid, cilofexor, and tropifexor. Other agents that target bile acid metabolism are ASTB/IBAP inhibitors and fibroblasts growth factor (FGF)19 analogues. Cholangiocytes, the epithelial bile duct cells, play a role in PSC development. Recent studies have revealed that these cells undergo a downregulation of GPBAR1 (TGR5), a bile acid receptor involved in bicarbonate secretion and immune regulation. Additional agents under evaluation are PPARs (elafibranor and seladelpar), anti-itching agents such as MAS-related G-protein-coupled receptors antagonists, and anti-fibrotic and immunosuppressive agents. Drugs targeting gut bacteria and bile acid pathways are also under investigation, given the strong link between PSC and gut microbiota.
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Affiliation(s)
- Stefano Fiorucci
- Dipartimento di Medicina e Chirurgia, Università di Perugia, 06123 Perugia, Italy; (G.U.); (C.D.G.); (M.B.)
| | - Ginevra Urbani
- Dipartimento di Medicina e Chirurgia, Università di Perugia, 06123 Perugia, Italy; (G.U.); (C.D.G.); (M.B.)
| | - Cristina Di Giorgio
- Dipartimento di Medicina e Chirurgia, Università di Perugia, 06123 Perugia, Italy; (G.U.); (C.D.G.); (M.B.)
| | - Michele Biagioli
- Dipartimento di Medicina e Chirurgia, Università di Perugia, 06123 Perugia, Italy; (G.U.); (C.D.G.); (M.B.)
| | - Eleonora Distrutti
- SC di Gastroenterologia ed Epatologia, Azienda Ospedaliera di Perugia, 06123 Perugia, Italy;
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Pinnuck B, Lynch KD. Navigating the pharmacotherapeutic management of comorbid inflammatory bowel disease and primary sclerosing cholangitis. Expert Opin Pharmacother 2024; 25:1835-1849. [PMID: 39316754 DOI: 10.1080/14656566.2024.2407022] [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] [Received: 06/21/2024] [Revised: 09/04/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Primary sclerosing cholangitis (PSC) is the most specific hepatobiliary extraintestinal manifestation in inflammatory bowel disease (IBD). PSC ultimately has a poor prognosis, with disease progression resulting in liver cirrhosis and subsequent liver failure. While there is current data for the medical management of IBD, the optimal approach for concurrent PSC-IBD is unclear. AREAS COVERED This review focuses on the current literature of pharmacotherapy in the PSC-IBD population including anti-tumor necrosis factor agents, vedolizumab, JAK inhibitors, IL-12/23 inhibitors, and thiopurines. Regarding PSC-IBD, it focuses on effectiveness of IBD therapies on liver biochemistry and IBD activity as well as the advent of clinically relevant liver outcomes and safety. The authors also address the need for further advances in research. EXPERT OPINION The longer-term data for pharmacological management for IBD is well established. In the concomitant PSC-IBD population there is no drug to date that has effectively reduced disease related morbidity and mortality outcomes. There are limitations in the current, mostly retrospective data on IBD drugs in PSC-IBD with respect to samples sizes, heterogenous outcomes, and lack of a high-quality surrogate endpoint in PSC. However, current data for adalimumab offers encouraging results which require further exploration with larger prospective studies.
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Affiliation(s)
- Brigid Pinnuck
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Kate D Lynch
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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van Vorstenbosch R, van Munster K, Stavropoulos G, Pachen D, van Schooten FJ, Ponsioen C, Smolinska A. The potential of volatile organic compounds to diagnose primary sclerosing cholangitis. JHEP Rep 2024; 6:101103. [PMID: 39131082 PMCID: PMC11315128 DOI: 10.1016/j.jhepr.2024.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/13/2024] Open
Abstract
Background & Aims Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive inflammation and fibrosis of the bile ducts. PSC is a complex disease of largely unknown aetiology that is strongly associated with inflammatory bowel disease (IBD). Diagnosis, especially at an early stage, is difficult and to date there is no diagnostic biomarker. The present study aimed to assess the diagnostic potential of volatile organic compounds (VOCs) in exhaled breath to detect (early) PSC in an IBD population. Methods Breath samples were obtained from 16 patients with PSC alone, 47 with PSC and IBD, and 53 with IBD alone during outpatient clinic visits. Breath sampling was performed using the ReCIVA breath sampler and subsequently analysed by gas chromatography mass spectrometry. Random forest modelling was performed to find discriminatory VOCs and create a predictive model that was tested using an independent test set. Results The final model to discriminate patients with PSC, with or without IBD, from patients with IBD alone included twenty VOCs and achieved a sensitivity, specificity, and area under the receiver-operating curve on the test set of 77%, 83%, and 0.84 respectively. Three VOCs (isoprene, 2-octanone and undecane) together correlated significantly with the Amsterdam-Oxford score for PSC disease prognosis. A sensitivity analysis showed stable results across early-stage PSC, including in those with normal alkaline phosphatase levels, as well as further progressed PSC. Conclusion The present study demonstrates that exhaled breath can distinguish PSC cases from IBD and has potential as a non-invasive clinical breath test for (early) PSC. Impact and implications Primary sclerosing cholangitis is a complex chronic liver disease, which ultimately results in cirrhosis, liver failure, and death. Detection, especially in early disease stages, can be challenging, and therefore therapy typically starts when there is already some irreversible damage. The current study shows that metabolites in exhaled breath, so called volatile organic compounds, hold promise to non-invasively detect primary sclerosing cholangitis, including at early disease stages.
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Affiliation(s)
- Robert van Vorstenbosch
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands
| | - Kim van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Academic Medical Center, Amsterdam, The Netherlands
| | - Georgios Stavropoulos
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands
| | - Daniëlle Pachen
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands
| | - Frederik-Jan van Schooten
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands
| | - Cyriel Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Academic Medical Center, Amsterdam, The Netherlands
| | - Agnieszka Smolinska
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands
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Fiorucci S, Marchianò S, Urbani G, Di Giorgio C, Distrutti E, Zampella A, Biagioli M. Immunology of bile acids regulated receptors. Prog Lipid Res 2024; 95:101291. [PMID: 39122016 DOI: 10.1016/j.plipres.2024.101291] [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] [Received: 06/12/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Bile acids are steroids formed at the interface of host metabolism and intestinal microbiota. While primary bile acids are generated in the liver from cholesterol metabolism, secondary bile acids represent the products of microbial enzymes. Close to 100 different enzymatic modifications of bile acids structures occur in the human intestine and clinically guided metagenomic and metabolomic analyses have led to the identification of an extraordinary number of novel metabolites. These chemical mediators make an essential contribution to the composition and function of the postbiota, participating to the bidirectional communications of the intestinal microbiota with the host and contributing to the architecture of intestinal-liver and -brain and -endocrine axes. Bile acids exert their function by binding to a group of cell membrane and nuclear receptors collectively known as bile acid-regulated receptors (BARRs), expressed in monocytes, tissue-resident macrophages, CD4+ T effector cells, including Th17, T regulatory cells, dendritic cells and type 3 of intestinal lymphoid cells and NKT cells, highlighting their role in immune regulation. In this review we report on how bile acids and their metabolitesmodulate the immune system in inflammations and cancers and could be exploiting for developing novel therapeutic approaches in these disorders.
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Affiliation(s)
- Stefano Fiorucci
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy.
| | - Silvia Marchianò
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Ginevra Urbani
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | | | - Eleonora Distrutti
- SC di Gastroenterologia ed Epatologia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Angela Zampella
- Department of Pharmacy, University of Napoli Federico II, Napoli, Italy
| | - Michele Biagioli
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
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Zhang W, Lang R. Genetic link between primary sclerosing cholangitis and thyroid dysfunction: a bidirectional two-sample Mendelian randomization study. Front Immunol 2023; 14:1276459. [PMID: 37928559 PMCID: PMC10622799 DOI: 10.3389/fimmu.2023.1276459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background Observational studies have demonstrated an association between primary sclerosing cholangitis (PSC) and thyroid dysfunction (TD). However, the causal relationship between PSC and TD remains uncertain. The purpose of this study is to investigate the causal associations and specific direction between these two conditions. Gaining insight into the potential causal relationship between PSC and TD is valuable for elucidating the pathogenesis of PSC and for devising innovative approaches for the prevention and treatment of PSC and its associated complications. Methods We conducted a bidirectional two-sample Mendelian randomization (MR) analysis to investigate the causal association between PSC and TD, such as autoimmune thyroid disease (AITD), thyroid cancer (TC), thyroid stimulating hormone (TSH), thyrotropin-releasing hormone (TRH), among others. PSC was the exposure variable, while TD was the outcome variable. To identify suitable instrumental variables (IVs), we utilized genome-wide association study (GWAS) datasets to select potential candidate single-nucleotide polymorphisms (SNPs). The primary statistical approach employed was the inverse-variance weighted (IVW) method, which was complemented by a series of sensitivity analyses to assess the robustness of the results by estimating heterogeneity and pleiotropy. Results We found that the causal associations between genetically predicted PSC and Graves' disease (GD), hyperthyroidism (IVW OR=1.230, 95%CI: 1.089-1.389, P=0.001; IVW OR=1.001, 95%CI: 1.000-1.002, P=0.000) were statistically significant. The reverse MR analysis indicated that genetic susceptibility to hyperthyroidism (P=0.000) and hypothyroidism (p=0.028) might be the risk of PSC. There was no statistically significant causal association observed between PSC and other TD (IVW P>0.05), with the exception of GD, hyperthyroidism, and hypothyroidism as determined through bidirectional two-sample analysis. To ensure the reliability of our findings, additional sensitivity analyses were conducted, including the leave-one-out (LOO) test, heterogeneity test, and pleiotropic test. Conclusion In this study, we conducted an investigation into the causal association between PSC and TD. Our findings indicate that PSC significantly elevates the susceptibility to GD and hyperthyroidism from a statistical perspective. These results shed light on the etiology of PSC and have implications for the management of patients with PSC.
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Affiliation(s)
| | - Ren Lang
- Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, China
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Freitas LTDS, Hyppolito EB, Barreto VL, Júnior LHJC, Jorge BCDM, Háteras FCTDSB, Marzola MB, Lima CA, Celedonio RM, Coelho GR, Garcia JHP. Liver transplant in patients with primary sclerosing cholangitis: A retrospective cohort from Northeastern Brazil. World J Hepatol 2023; 15:1033-1042. [PMID: 37900212 PMCID: PMC10600696 DOI: 10.4254/wjh.v15.i9.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/07/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) manifests within a broad ethnic and racial spectrum, reflecting different levels of access to health care. AIM To evaluate the clinical profile, complications and survival rates of patients with PSC undergoing liver transplantation (LTx) at a Brazilian reference center. METHODS All patients diagnosed with PSC before or after LTx were included. The medical records were reviewed for demographic and clinical variables, including outcomes and survival. The level of statistical significance was set at P < 0.05. RESULTS Our cohort represented 1.6% (n = 34) of the 2113 patients receiving liver grafts at our service over the past two decades. Most were male (n = 19; 56%). The average age (40 ± 14 years) was similar for men and women (P = 0.347). The mean follow-up time from diagnosis to LTx was 68 mo. Most patients had the classic form of PSC. Three women had PSC/autoimmune hepatitis overlap syndrome, and one patient had small-duct PSC. Alkaline phosphatase levels at diagnosis and pre-LTx model for end-stage liver disease. scores were significantly higher in males. Inflammatory bowel research (IBD) was investigated by colonoscopy in 26/34 (76%) and was present in most cases (18/26; 69%). IBD was less common in women than in men (44.4% vs. 55.6%) (P = 0.692). Cholangiocarcinoma (CCA) was diagnosed in 2/34 (5.9%) patients by histopathology of the explant (survival: 3 years 6 mo, and 4 years 11 mo). Two patients had complications requiring a second LTx (one after 7 d due to hepatic artery thrombosis and one after 17 d due to primary graft dysfunction). Five patients (14.7%) developed biliary stricture. The overall median post-LTx survival was 66 mo. Most deaths occurred in the first year (infection n = 2, primary liver graft dysfunction n = 3, unknown cause n = 1). The 1-year and 5-year survival rates of this cohort were 82.3% and 70.6%, respectively, matching the mean overall survival rates of LTx patients at our center (87.1% and 69.43%, respectively) (P = 0.83). CONCLUSION Survival after 1 and 5 years was similar to that of other LTx indications. The observed CCA survival rate suggests CCA may be an indication for LTx in selected cases.
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Affiliation(s)
| | - Elodie Bomfim Hyppolito
- Liver Transplant Department, Walter Cantídio Teaching Hospital, Fortaleza 60430270, Ceará, Brazil
- School of Medicine, University of Fortaleza, Fortaleza 60811905, Ceará, Brazil
- Hospital São José, Ceará State Health Department, Fortaleza 60455610, Ceará, Brazil
| | | | | | | | | | | | - Clébia Azevedo Lima
- Liver Transplant Department, Walter Cantídio Teaching Hospital, Fortaleza 60430270, Ceará, Brazil
| | - Raquel Mendes Celedonio
- Liver Transplant Department, Walter Cantídio Teaching Hospital, Fortaleza 60430270, Ceará, Brazil
| | - Gustavo Rêgo Coelho
- Liver Transplant Department, Walter Cantídio Teaching Hospital, Fortaleza 60430270, Ceará, Brazil
- Department of Surgery, Federal University of Ceará, Fortaleza 60430140, Ceará, Brazil
- Surgery Department, São Carlos Hospital, Fortaleza 60130241, Ceará, Brazil
| | - Jose Huygens Parente Garcia
- Liver Transplant Department, Walter Cantídio Teaching Hospital, Fortaleza 60430270, Ceará, Brazil
- Department of Surgery, Federal University of Ceará, Fortaleza 60430140, Ceará, Brazil
- Surgery Department, São Carlos Hospital, Fortaleza 60130241, Ceará, Brazil
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Biron A, Beaugerie L, Chazouillères O, Kirchgesner J. Impact of thiopurines and tumour necrosis factor antagonists on primary sclerosing cholangitis outcomes in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2022; 56:857-868. [PMID: 35789494 DOI: 10.1111/apt.17123] [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: 04/01/2022] [Revised: 04/26/2022] [Accepted: 06/23/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) are at risk of biliary tract cancer and liver damage (possibly leading to liver transplantation), and are often treated for IBD with thiopurines and/or tumour necrosis factor antagonists (anti-TNF) on a long-term basis. AIMS To assess the risk of biliary tract cancer and liver transplantation in patients exposed to thiopurines and/or anti TNF agents in a French nationwide cohort. METHODS We performed a population-based study of patients aged 18 years or older with PSC and IBD in the French national health insurance database. Patients were followed from 1 January 2009 to 31 December 2018. The risks of biliary tract cancer and liver transplantation associated with thiopurines and anti-TNF exposure were assessed with marginal structural Cox proportional hazard models, adjusting for baseline demographics and comorbidities, and time-varying medications and PSC activity. RESULTS Among the 1929 patients with PSC and IBD included, 37 biliary tract cancers and 83 liver transplantations occurred. Compared with patients not exposed to thiopurines or anti-TNF agents, patients exposed to thiopurines (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.39-2.82) or anti-TNF agents (HR, 0.59; 95% CI, 0.13-2.80) had no excess risk of biliary tract cancer. Similarly, patients exposed to thiopurines (HR, 0.67; 95% CI, 0.30-1.48) or anti-TNF agents (HR, 0.68; CI, 0.22-2.09) had no excess risk of liver transplantation. CONCLUSIONS Patients with PSC and IBD who are exposed to thiopurines or anti-TNF agents are not at excess risk of biliary tract cancer or liver transplantation.
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Affiliation(s)
- Amélie Biron
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France.,Department of Gastroenterology, Reims University Hospital, Hôpital Robert Debre, Reims, France
| | - Laurent Beaugerie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - Olivier Chazouillères
- Department of Hepatology, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, INSERM Saint-Antoine Research Center, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, French Network for Rare Liver Diseases (FILFOIE), European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Sorbonne University, Paris, France
| | - Julien Kirchgesner
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
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Carey EJ, Eaton J, Clayton M, Gossard A, Iqbal S, Ullah H, Zhang N, Butterfield R, Lindor KD. A pilot study of vidofludimus calcium for treatment of primary sclerosing cholangitis. Hepatol Commun 2022; 6:1589-1597. [PMID: 35238498 PMCID: PMC9234677 DOI: 10.1002/hep4.1926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
The purpose of this pilot study was to explore the efficacy, safety, and tolerability of vidofludimus calcium (VC) in the treatment of primary sclerosing cholangitis (PSC). This was a single-arm open-label pilot study with a cohort of 18 patients with PSC. Study patients received VC for a period of 6 months. The study was undertaken at two sites, Mayo Clinic, Rochester, MN, and Mayo Clinic, Phoenix, AZ. The primary endpoint of the study was improvement of serum alkaline phosphatase (ALP) at the end of the study. Secondary endpoints included assessment of other liver biomarkers (bilirubin, alanine aminotransferase, and aspartate aminotransferase). Of 18 patients enrolled, 11 completed the 6 months of study treatment. Patients who completed treatment versus those who did not were similar other than a significantly higher direct bilirubin at baseline in the group that completed treatment (mean ± SD, 0.4 ± 0.3 versus 0.1 ± 0.1, p = 0.04). By intent to treat analysis, the primary outcome was met in 16.7% (3/18) of patients. By per-protocol analysis, including only patients who completed treatment, normalization of ALP occurred in 27.7% (3/11) at week 24 (95% confidence interval, 6.0% to 61.0%). VC was well tolerated with no drug-related serious adverse events. Conclusion: This proof of concept study provides support for further exploration of VC in patients with PSC.
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Affiliation(s)
- Elizabeth J Carey
- Division of Gastroenterology and HepatologyMayo ClinicPhoenixArizonaUSA
| | - John Eaton
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Mitchell Clayton
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Andrea Gossard
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Sara Iqbal
- GastroenterologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Hamid Ullah
- GastroenterologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Nan Zhang
- Department of Quantitative Health ResearchMayo ClinicPhoenixArizonaUSA
| | | | - Keith D Lindor
- Division of Gastroenterology and HepatologyMayo ClinicPhoenixArizonaUSA
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Cadamuro M, Strazzabosco M. Inflammatory pathways and cholangiocarcinoma risk mechanisms and prevention. Adv Cancer Res 2022; 156:39-73. [PMID: 35961707 PMCID: PMC10916841 DOI: 10.1016/bs.acr.2022.02.001] [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] [Indexed: 11/19/2022]
Abstract
Cholangiocarcinoma (CCA), a neoplasm burdened by a poor prognosis and currently lacking adequate therapeutic treatments, can originate at different levels of the biliary tree, in the intrahepatic, hilar, or extrahepatic area. The main risk factors for the development of CCA are the presence of chronic cholangiopathies of various etiology. To date, the most studied prodromal diseases of CCA are primary sclerosing cholangitis, Caroli's disease and fluke infestations, but other conditions, such as metabolic syndrome, nonalcoholic fatty liver disease and obesity, are emerging as associated with an increased risk of CCA development. In this review, we focused on the analysis of the pro-inflammatory mechanisms that induce the development of CCA and on the role of cells of the immune response in cholangiocarcinogenesis. In very recent times, these cellular mechanisms have been the subject of emerging studies aimed at verifying how the modulation of the inflammatory and immunological responses can have a therapeutic significance and how these can be used as therapeutic targets.
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Affiliation(s)
| | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University, New Haven, CT, United States.
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Neyazi M, Bharadwaj SS, Bullers S, Varenyiova Z, Travis S, Arancibia-Cárcamo CV, Powrie F, Geremia A. Overexpression of Cancer-Associated Stem Cell Gene OLFM4 in the Colonic Epithelium of Patients With Primary Sclerosing Cholangitis. Inflamm Bowel Dis 2021; 27:1316-1327. [PMID: 33570127 PMCID: PMC8314119 DOI: 10.1093/ibd/izab025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To examine immune-epithelial interactions and their impact on epithelial transformation in primary sclerosing cholangitis-associated ulcerative colitis (PSC-UC) using patient-derived colonic epithelial organoid cultures (EpOCs). METHODS The EpOCs were originated from colonic biopsies from patients with PSC-UC (n = 12), patients with UC (n = 14), and control patients (n = 10) and stimulated with cytokines previously associated with intestinal inflammation (interferon (IFN) γ and interleukin (IL)-22). Markers of cytokine downstream pathways, stemness, and pluripotency were analyzed by real-time quantitative polymerase chain reaction and immunofluorescence. The OLFM4 expression in situ was assessed by RNAscope and immunohistochemistry. RESULTS A distinct expression of stem cell-associated genes was observed in EpOCs derived from patients with PSC-UC, with lower expression of the classical stem-cell marker LGR5 and overexpression of OLFM4, previously associated with pluripotency and early stages of neoplastic transformation in the gastrointestinal and biliary tracts. High levels of OLFM4 were also found ex vivo in colonic biopsies from patients with PSC-UC. In addition, IFNγ stimulation resulted in the downregulation of LGR5 in EpOCs, whereas higher expression of OLFM4 was observed after IL-22 stimulation. Interestingly, expression of the IL-22 receptor, IL22RA1, was induced by IFNγ, suggesting that a complex interplay between these cytokines may contribute to carcinogenesis in PSC-UC. CONCLUSIONS Higher expression of OLFM4, a cancer stemness gene induced by IL-22, is present in PSC-UC, suggesting that IL-22 responses may result in alterations of the intestinal stem-cell niche in these patients.
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Affiliation(s)
- Mastura Neyazi
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Sraddha S Bharadwaj
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Samuel Bullers
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Zofia Varenyiova
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Oxford IBD Cohort Study Investigators
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Carolina V Arancibia-Cárcamo
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Fiona Powrie
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Alessandra Geremia
- Translational Gastroenterology Unit, Nuffield Department of Clinical Medicine, Experimental Medicine Division, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Services Foundation Trust, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Wiecek S, Wojtyniak A, Pindur B, Machnikowska-Sokołowska M, Gruszczyńska K, Grzybowska-Chlebowczyk U. Analysis of the Clinical Course of Primary Sclerosing Cholangitis in Paediatric Population-Single Center Study. ACTA ACUST UNITED AC 2021; 57:medicina57070663. [PMID: 34199130 PMCID: PMC8304821 DOI: 10.3390/medicina57070663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives: Primary sclerosing cholangitis (PSC) is a rare cholestatic disease of the liver of unknown etiology, severe course and poor prognosis. PSC most often co-occurs with inflammatory bowel diseases (IBD), especially with ulcerative colitis (UC). The aim of the study was the analysis of the clinical course of primary sclerosing cholangitis in children, hospitalized in the Gastroenterology Unit in Katowice. Materials and Methods: The analysis included 30 patients, aged from 7 to 18 years, 21/30 boys (70%) and 9/30 girls (30%), diagnosed with PSC in the years 2009–2019. The analysis included the age at diagnosis, clinical symptoms, course of the disease, coexisting diseases, laboratory and imaging results, and complications. Results: The average age at diagnosis was 13 years. 22/30 (73.3%) patients suffered from UC, 4/30 (13.3%) were diagnosed with Crohn’s disease (CD), 2/30 (6.66%) with Eosinophilic Colitis (EC). 2/30 patients (6.66%) had no clinical evidence of coexistent IBD to date. In addition, 7/30 (23.3%) had an overlap syndrome of primary sclerosing cholangitis/autoimmune hepatitis. When PSC was detected before IBD (6/30–20%), patients had complications more often compared to those diagnosed with IBD first or PSC and IBD at the same time. At the moment of diagnosis 6/30 (20%) patients presented with abdominal pain, which was the most common symptom, 3/30 (10%) jaundice, while 17/30 (56.6%) were asymptomatic but had abnormal results of the laboratory tests. Conclusions: Monitoring liver markers in IBD patients is important since most PSC cases are asymptomatic and their elevation might be the first sign of the disease. Patients diagnosed with PSC before IBD diagnosis are more likely to have a more aggressive course of the disease.
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Affiliation(s)
- Sabina Wiecek
- Department of Paediatrics, Faculty of Medical Sciences, Medical University of Silesia, 16 Medykow Street, 40-752 Katowice, Poland
| | - Alicja Wojtyniak
- Student Scientific Club, Department of Paediatrics, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Barbara Pindur
- Student Scientific Club, Department of Paediatrics, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | | | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Urszula Grzybowska-Chlebowczyk
- Department of Paediatrics, Faculty of Medical Sciences, Medical University of Silesia, 16 Medykow Street, 40-752 Katowice, Poland
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Sirica AE, Strazzabosco M, Cadamuro M. Intrahepatic cholangiocarcinoma: Morpho-molecular pathology, tumor reactive microenvironment, and malignant progression. Adv Cancer Res 2020; 149:321-387. [PMID: 33579427 PMCID: PMC8800451 DOI: 10.1016/bs.acr.2020.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a relatively rare, but highly lethal and biologically complex primary biliary epithelial cancer arising within liver. After hepatocellular carcinoma, iCCA is the second most common primary liver cancer, accounting for approximately 10-20% of all primary hepatic malignancies. Over the last 10-20 years, iCCA has become the focus of increasing concern largely due to its rising incidence and high mortality rates in various parts of the world, including the United States. The challenges posed by iCCA are daunting and despite recent progress in the standard of care and management options for iCCA, the prognosis for this cancer continues to be dismal. In an effort to provide a framework for advancing our understanding of iCCA malignant aggressiveness and therapy resistance, this review will highlight key etiological, biological, molecular, and microenvironmental factors hindering more effective management of this hepatobiliary cancer. Particular focus will be on critically reviewing the cell origins and morpho-molecular heterogeneity of iCCAs, providing mechanistic insights into high risk fibroinflammatory cholangiopathies associated with iCCA development, and notably discussing the deleterious role played by the tumor reactive desmoplastic stroma in regulating iCCA malignant progression, lymphangiogenesis, and tumor immunobiology.
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Affiliation(s)
- Alphonse E Sirica
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States.
| | - Mario Strazzabosco
- Liver Center and Section of Digestive Diseases, Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, United States
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13
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Edwards K, Allison M, Ghuman S. Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection. BMJ Case Rep 2020; 13:13/11/e237984. [PMID: 33168538 PMCID: PMC7654135 DOI: 10.1136/bcr-2020-237984] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A previously well 59-year-old man required a prolonged intensive care unit stay due to severe COVID-19 symptoms. During the admission, he developed a cytokine storm, also known as secondary haemophagocytic lymphohistocytosis, and multiorgan failure. Despite recovering from his other organ failures, his liver function continued to deteriorate. Magnetic resonance cholangiopancreatography and subsequent endoscopic retrograde cholangiopancreatography revealed extensive intrahepatic duct dilatation with ‘beading’ but common bile duct sparing. Given the patient had no primary liver disease prior to admission, we considered secondary causes of cholestatic liver injury; this led us to an unusual diagnosis of secondary sclerosing cholangitis in critically ill patients. This case demonstrates a rare disease that has developed specifically in the context of SARS-CoV-2 infection. A review of current literature and the underlying pathophysiology for this rare disease are discussed, particularly in relation to COVID-19.
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Affiliation(s)
- Kate Edwards
- Gastroenterology, Nevill Hall Hospital, Abergavenny, UK
| | - Miles Allison
- Gastroenterology, Nevill Hall Hospital, Abergavenny, UK
| | - Sekina Ghuman
- Gastroenterology, Nevill Hall Hospital, Abergavenny, UK
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14
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Manganis CD, Chapman RW, Culver EL. Review of primary sclerosing cholangitis with increased IgG4 levels. World J Gastroenterol 2020; 26:3126-3144. [PMID: 32684731 PMCID: PMC7336326 DOI: 10.3748/wjg.v26.i23.3126] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/07/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
Primary sclerosing cholangitis (PSC) is a chronic progressive liver disease. Sub-types of PSC have been described, most recently PSC with elevated serum and/or tissue IgG4 subclass. We aim to summarise the clinical phenotype, disease associations, differential diagnosis, response to therapy and pathogenic mechanisms underlying PSC-high IgG4 subtype. We reviewed PubMed, MEDLINE and Embase with the search terms "primary sclerosing cholangitis", "IgG4", and "IgG4-related sclerosing cholangitis (IgG4-SC)". Elevated serum IgG4 are found in up-to one-quarter, and abundant IgG4-plasma cell infiltrates in the liver and bile ducts are found in up-to one-fifth of PSC patients. This group have a distinct clinical phenotype, with some studies reporting a more aggressive course of liver and associated inflammatory bowel disease, compared to PSC-normal IgG4 and the disease mimic IgG4-SC. Distinguishing PSC-high IgG4 from IgG4-SC remains challenging, requiring careful assessment of clinical features, organ involvement and tissue morphology. Calculation of serum IgG4:IgG1 ratios and use of a novel IgG4:IgG RNA ratio have been reported to have excellent specificity to distinguish IgG4-SC and PSC-high IgG4 but require validation in larger cohorts. A role for corticosteroid therapy in PSC-high IgG4 remains unanswered, with concerns of increased toxicity and lack of outcome data. The immunological drivers underlying prominent IgG4 antibodies in PSC are incompletely defined. An association with PSC-high IgG4 and HLA class-II haplotypes (B*07, DRB1*15), T-helper2 and T-regulatory cytokines (IL4, IL10, IL13) and chemokines (CCL1, CCR8) have been described. PSC-high IgG4 have a distinct clinical phenotype and need careful discrimination from IgG4-SC, although response to immunosuppressive treatments and long-term outcome remains unresolved. The presence of IgG4 likely represents chronic activation to persistent antigenic exposure in genetically predisposed individuals.
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Affiliation(s)
- Charis D Manganis
- Translational Gastroenterology Unit and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Roger W Chapman
- Translational Gastroenterology Unit and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Emma L Culver
- Translational Gastroenterology Unit and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
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15
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Patient and clinician opinions of patient reported outcome measures (PROMs) in the management of patients with rare diseases: a qualitative study. Health Qual Life Outcomes 2020; 18:177. [PMID: 32522194 PMCID: PMC7288678 DOI: 10.1186/s12955-020-01438-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background Rare diseases may be life-threatening or chronically debilitating conditions. Patient care needs are often complex and challenging to coordinate and deliver effectively. Rare diseases and their clinical management may therefore substantially impact on patients’ health-related quality of life (HRQOL). The use of patient-reported outcome measures (PROMs) may complement clinical assessments by elucidating patients’ perspectives on their health status and care priorities. This study explored the opinions of patients and clinicians on the use of PROMs in the management of patients with rare diseases in routine clinical practice. Methods A total of 15 semi-structured one-to-one interviews were conducted with four patients with primary sclerosing cholangitis (PSC); five renal transplant recipients; and six PSC doctors from University Hospitals Birmingham (UHB) NHS Foundation Trust. A focus group session was also conducted with 10 clinical staff members (doctors, nurses and other allied health professionals from UHB). The suitability and acceptability of the Chronic Liver Disease Questionnaire (CLDQ) and the Short Form 12 (SF12) were assessed by patients with PSC and their doctors while the Paediatric quality of life inventory Transplant Module (PedsQL-TM) and the EuroQoL-5 dimensions (EQ. 5D) were evaluated by the renal transplant recipients and their doctors. The discussions were audio recorded and transcribed verbatim. Coding of the transcripts was done using the Nvivo 11 Plus software. Thematic analysis was conducted to identify the main themes and subthemes. Results Four themes were identified, namely: (i) potential benefits of PROMs in the management of rare diseases; (ii) views on selected questionnaires; (iii) practical considerations for implementation; and (iv) potential facilitators and barriers of implementation. Patients and clinicians suggested that the use of ePROMs may facilitate patient-centred care by promoting patient-clinician communication, highlighting aspects of HRQOL that are important to patients and encouraging patient involvement in their care. They also felt that the disease-specific CLDQ and PedsQL-TM were more relevant than the generic SF12 and EQ-5D. Conclusions Patients with rare diseases often experience impaired HRQOL. The use of an ePROM system may enhance the routine management of patients with rare diseases.
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An update on primary sclerosing cholangitis epidemiology, outcomes and quantification of alkaline phosphatase variability in a population-based cohort. J Gastroenterol 2020; 55:523-532. [PMID: 31932891 PMCID: PMC8157157 DOI: 10.1007/s00535-020-01663-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Contemporary primary sclerosing cholangitis (PSC) population-based cohorts describing the epidemiology, natural history, and long-term fluctuations in serum alkaline phosphatase (SAP) and their prognostic relevance are lacking. Therefore, we investigated the incidence and natural history of PSC and quantified SAP fluctuations among those with PSC in Olmsted County, Minnesota over the last 41 years. METHODS The Rochester Epidemiology Project was used to identify 56 subjects diagnosed with PSC between 1976 and 2017 in Olmsted County. The primary endpoint (n = 19) included liver transplantation, hepatic decompensation, and cholangiocarcinoma. RESULTS The age- and sex-adjusted incidence of PSC (per 100,000 person years) nearly doubled from 2001 to 2017 compared to 1976-2000 (1.47; 95% CI 0.99-1.96 versus 0.79; 95% CI 0.42-1.16, p = 0.02). This increase paralleled a rise in patients with markers of a milder phenotype at the time of diagnosis: normal SAP (26.32% versus 0%, p < 0.01) and lower Mayo PSC risk score [0.36 (- 0.57 to 1.55) versus - 0.50 (- 1.25 to 0.35), p = 0.03]. Intra-individual SAP fluctuates with a median coefficient of variation of 36.20%. SAP normalization and dropping below 1.5 × upper limit of normal (ULN) occurs at a rate of 5% and 10% per year, respectively. SAP less than 1.5 × ULN was associated with a lower risk of PSC-related complications (hazard ratio 0.11; 95% CI 0.03-0.42). CONCLUSIONS The patients with PSC are increasingly being diagnosed with a milder phenotype. While a lower SAP is associated with improved outcomes, the high intra-individual variation of SAP levels calls into question the practice of using a single SAP value as a surrogate endpoint in clinical trials.
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17
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Martins P, Verdelho Machado M. Secondary Sclerosing Cholangitis in Critically Ill Patients: An Underdiagnosed Entity. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:103-114. [PMID: 32266307 PMCID: PMC7113589 DOI: 10.1159/000501405] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/07/2019] [Indexed: 12/12/2022]
Abstract
Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a recently identified cholestatic liver disease occurring in patients without prior history of hepatobiliary disease, after receiving treatment in the intensive care unit (ICU) in different settings, including cardiothoracic surgery, infection, trauma, and burns. It is a rare entity, being estimated to occur in 1/2,000 patients in an ICU; however, it is a dismal condition, with up to half of the patients dying during the ICU stay and with rapid progression to liver cirrhosis over weeks to months. SSC-CIP should be considered in the differential diagnosis of cholestasis in the ICU, particularly when cholestasis persists after recovery from the critical event. Diagnosis is established with magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography showing dilations and stenoses of the intrahepatic bile ducts as well as biliary casts. No available treatment has been shown to slow the rapid progression of the disease, and liver transplant referral should be considered early after the diagnosis of SSC-CIP. Increased awareness and timely diagnosis are crucial in order to improve the current appalling outcome.
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Affiliation(s)
- Pedro Martins
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mariana Verdelho Machado
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Serviço de Gastrenterologia, Hospital de Santa Maria, CHULN, Lisbon, Portugal
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18
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Hernández-Woodbine MJ, Del Castillo-Rix DS, Baquero-Mejía IC. Reporte de una nueva mutación en Colombia: un paciente con síndrome de Kabuki. IATREIA 2019. [DOI: 10.17533/udea.iatreia.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introducción: el síndrome de Kabuki es un desorden pediátrico congénito de origen genético. Los pacientes presentan anormalidades morfológicas como paladar hendido, globos oculares prominentes, eversión del tercio externo del párpado inferior, persistencia de cojinetes dactilares y anormalidades vertebrales. La mayoría cursan con dificultad del aprendizaje.Objetivo: reportar un caso pediátrico de síndrome de Kabuki y fomentar el reconocimiento del fenotipo asociado para facilitar su diagnóstico oportuno.Caso clínico: paciente masculino de 9 años con características clínicas y diagnóstico genético probable para síndrome de Kabuki. Presenta fisuras palpebrales largas, paladar en ojival, baja implantación auricular, persistencia de almohadillas en pulpejos de dedos, talla baja y colangitis esclerosante primaria.Conclusión: el síndrome de Kabuki tipo 1, se caracteriza por alteraciones faciales que inducen una sospecha diagnóstica. El paciente reportado presentaba múltiples hallazgos descritos. En el estudio genético realizado se considera la variante identificada en el gen KMT2D, probablemente patogénica.
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19
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Freeman E, Majeed A, Kemp W, Roberts SK. Long-term outcomes of primary sclerosing cholangitis: an Australian non-transplant tertiary hospital perspective. Intern Med J 2019; 49:323-327. [PMID: 30043518 DOI: 10.1111/imj.14041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are limited Australian epidemiological and outcome data on primary sclerosing cholangitis (PSC), with the only published study involving a state liver transplantation service. AIM The aim of this retrospective study was to evaluate the natural history, and morbidity and mortality of PSC in an Australian population managed in a large metropolitan non-transplant teaching hospital. METHODS We identified all PSC patients managed at The Alfred Hospital over a 10-year period and analysed their clinical and demographic data. Primary outcomes were liver transplantation and death. Secondary outcomes included cholangiocarcinoma, development of cirrhosis, liver decompensation, cholangitis requiring hospital admission and the development of dominant strictures requiring dilatation. RESULTS We identified 39 PSC patients (69% male) with a median follow-up time of 63 months (range 5-289). Median age at diagnosis was 45 years (range 10-81) and 29 (74%) patients had concurrent inflammatory bowel disease. Five patients had cirrhosis at diagnosis and 10 (26%) developed cirrhosis after a median follow up of 54 months. Three (8%) patients developed cholangiocarcinoma and one with overlap syndrome required liver transplantation. The 10- and 20-year survival rates for the entire cohort were 77.4% (95% confidence interval 55.6-89.4) and 68.8% (95% confidence interval 42.1-85) respectively. Survival in patients with small-duct disease was not different from those without. CONCLUSION Although the PSC population in this Australian cohort appears typical of the disease, rates of liver decompensation are relatively low and the overall transplant-free survival may be better than that reported in overseas cohorts or from cohorts derived from liver transplantation centres.
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Affiliation(s)
- Elliot Freeman
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Linear IgA Bullous Dermatosis Preceding the Diagnosis of Primary Sclerosing Cholangitis and Ulcerative Colitis: A Case Report. Am J Dermatopathol 2019; 41:498-501. [PMID: 30461424 DOI: 10.1097/dad.0000000000001313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disorder seen in the pediatric and adult populations that is often linked to a medication, infection, or underlying gastrointestinal, hepatobiliary, or autoimmune disease. In this study, we describe the case of a 23-year-old white man whose presentation and diagnosis of LABD ultimately led to the discovery of underlying primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). His dermatitis resolved with topical steroids and dapsone, and he is undergoing systemic treatment for his UC and PSC. This exceptional case further validates the association between LABD with UC, strengthens that with PSC, and underscores the importance of alerting clinicians to consider conducting a systemic workup in addition to thorough medication history on making the diagnosis of LABD.
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Abstract
Chronic liver disease (CLD) is a global health problem with chronic viral hepatitis, alcohol-related liver disease, and nonalcoholic fatty liver disease being important causes of mortality. Besides its clinical burden, patients with CLD also suffer from impairment of their health-related quality of life and other patient-reported outcomes (PRO). In this context, a combination of both clinical and PROs will allow assessment of the comprehensive burden of liver disease on patients. PROs cannot be observed directly and must be assessed by validated questionnaires or tools. Various tools have been developed to accurately measure PROs in patients with CLD, including generic and disease-specific questionnaires such as Short Form-36, Chronic Liver Disease Questionnaire and its subtypes. It is important to note that PRO instruments can be used to appreciate the impact of the natural history of CLD or of treatment on patients' experiences. This review summarizes PRO assessment in different types of liver disease and different tools useful to investigators and clinicians who are interested in this aspect of patients' experience.
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Investigating Pathogenic and Hepatocarcinogenic Mechanisms from Normal Liver to HCC by Constructing Genetic and Epigenetic Networks via Big Genetic and Epigenetic Data Mining and Genome-Wide NGS Data Identification. DISEASE MARKERS 2018; 2018:8635329. [PMID: 30344796 PMCID: PMC6174771 DOI: 10.1155/2018/8635329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
The prevalence of hepatocellular carcinoma (HCC) is still high worldwide because liver diseases could develop into HCC. Recent reports indicate nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NAFLD&NASH) and primary biliary cirrhosis and primary sclerosing cholangitis (PBC&PSC) are significant of HCC. Therefore, understanding the cellular mechanisms of the pathogenesis and hepatocarcinogenesis from normal liver cells to HCC through NAFLD&NASH or PBC&PSC is a priority to prevent the progression of liver damage and reduce the risk of further complications. By the genetic and epigenetic data mining and the system identification through next-generation sequencing data and its corresponding DNA methylation profiles of liver cells in normal, NAFLD&NASH, PBC&PSC, and HCC patients, we identified the genome-wide real genetic and epigenetic networks (GENs) of normal, NAFLD&NASH, PBC&PSC, and HCC patients. In order to get valuable insight into these identified genome-wide GENs, we then applied a principal network projection method to extract the corresponding core GENs for normal liver cells, NAFLD&NASH, PBC&PSC, and HCC. By comparing the signal transduction pathways involved in the identified core GENs, we found that the hepatocarcinogenesis through NAFLD&NASH was induced through DNA methylation of HIST2H2BE, HSPB1, RPL30, and ALDOB and the regulation of miR-21 and miR-122, and the hepatocarcinogenesis through PBC&PSC was induced through DNA methylation of RPL23A, HIST2H2BE, TIMP1, IGF2, RPL30, and ALDOB and the regulation of miR-29a, miR-21, and miR-122. The genetic and epigenetic changes in the pathogenesis and hepatocarcinogenesis potentially serve as potential diagnostic biomarkers and/or therapeutic targets.
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Hoffmanová I, Sánchez D, Tučková L, Tlaskalová-Hogenová H. Celiac Disease and Liver Disorders: From Putative Pathogenesis to Clinical Implications. Nutrients 2018; 10:nu10070892. [PMID: 30002342 PMCID: PMC6073476 DOI: 10.3390/nu10070892] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Abstract
Immunologically mediated liver diseases belong to the common extraintestinal manifestations of celiac disease. We have reviewed the current literature that addresses the association between celiac disease and liver disorders. We searched relevant articles on MEDLINE/PubMed up to 15 June 2018. The objective of the article is to provide a comprehensive and up-to-date review on the latest hypotheses explaining the pathogenetic relationship between celiac disease and liver injury. Besides the involvement of gut–liver axis, tissue transglutaminase antibodies, and impairment of intestinal barrier, we integrate the latest achievements made in elucidation of the role of gut microbiota in celiac disease and liver disorders, that has not yet been sufficiently discussed in the literature in this context. The further objective is to provide a complete clinical overview on the types of liver diseases frequently found in celiac disease. In conclusion, the review highlights the clinical implication, recommend a rational approach for managing elevated transaminases in celiac patients, and underscore the importance of screening for celiac disease in patients with associated liver disease.
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Affiliation(s)
- Iva Hoffmanová
- Centre for Research on Nutrition, Metabolism and Diabetes, Third Faculty of Medicine, Charles University, Ruska 87, 100 00 Prague, Czech Republic.
- Second Department of Internal Medicine, Third Faculty of Medicine, Charles University, Ruska 87, 100 00 Prague, Czech Republic.
| | - Daniel Sánchez
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Videnska 1083, 142 20 Prague, Czech Republic.
| | - Ludmila Tučková
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Videnska 1083, 142 20 Prague, Czech Republic.
| | - Helena Tlaskalová-Hogenová
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Videnska 1083, 142 20 Prague, Czech Republic.
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Isa F, Turner GM, Kaur G, Kyte D, Slade A, Pankhurst T, Kerecuk L, Keeley T, Ferguson J, Calvert M. Patient-reported outcome measures used in patients with primary sclerosing cholangitis: a systematic review. Health Qual Life Outcomes 2018; 16:133. [PMID: 29976215 PMCID: PMC6034220 DOI: 10.1186/s12955-018-0951-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary Sclerosing Cholangitis (PSC) is a rare chronic, cholestatic liver condition in which patients can experience a range of debilitating symptoms. Patient reported outcome measures (PROMs) could provide a valuable insight into the impact of PSC on patient quality of life and symptoms. A previous review has been conducted on the quality of life instruments used in liver transplant recipients. However, there has been no comprehensive review evaluating PROM use or measurement properties in PSC patients' to-date. The aim of the systematic review was to: (a) To identify and categorise which PROMs are currently being used in research involving the PSC population (b) To investigate the measurement properties of PROMs used in PSC. METHODS A systematic review of Medline, EMBASE and CINAHL, from inception to February 2018, was undertaken. The methodological quality of included studies was assessed using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) checklist. RESULTS Thirty-seven studies were identified, which included 36 different PROMs. Seven PROMs were generic, 10 disease-specific, 17 symptom-specific measures and 2 measures on dietary intake. The most common PROMs were the Short form-36 (SF-36) (n = 15) and Chronic liver disease questionnaire (CLDQ) (n = 6). Only three studies evaluated measurement properties, two studies evaluated the National Institute of Diabetes Digestive and Kidney Diseases Liver Transplant (NIDDK-QA) and one study evaluated the PSC PRO; however, according to the COSMIN guidelines, methodological quality was poor for the NIDDK-QA studies and fair for the PSC PRO study. CONCLUSION A wide variety of PROMs have been used to assess health-related quality of life and symptom burden in patients with PSC; however only two measures (NIDDK-QA and PSC PRO) have been formally validated in this population. The newly developed PSC PRO requires further validation in PSC patients with diverse demographics, comorbidities and at different stages of disease; however this is a promising new measure with which to assess the impact of PSC on patient quality of life and symptoms.
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Affiliation(s)
- Fatima Isa
- Public Health England, 5 St Philips Place, Birmingham, B3 2PW UK
| | - Grace M. Turner
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Geetinder Kaur
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
| | | | | | - Thomas Keeley
- PAREXEL International, Evergreen House North, 160 Euston Road, London, NW1 2DX UK
| | - James Ferguson
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
- University Hospital Birmingham, Birmingham, B15 2TH UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
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Symptoms Do Not Correlate With Findings From Colonoscopy in Children With Inflammatory Bowel Disease and Primary Sclerosing Cholangitis. Clin Gastroenterol Hepatol 2018; 16:1098-1105.e1. [PMID: 29378308 DOI: 10.1016/j.cgh.2018.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Approximately 75% of children with primary sclerosing cholangitis (PSC) also have inflammatory bowel disease (IBD). IBD in patients with PSC (PSC-IBD) often has a unique phenotype, including a mild clinical course, yet it is associated with an increased risk of colorectal cancer compared with colonic IBD without PSC. We investigated whether subclinical endoscopic and histologic inflammation could account for the increased risk of colorectal cancer in patients with PSC-IBD, and whether these patients have increased fecal levels of calprotectin, a marker of inflammation. METHODS We performed a prospective study of children (age, <18 y) with colonic IBD with and without PSC who underwent colonoscopy from February 1, 2016, through March 31, 2017, at the Hospital for Sick Children in Toronto, Canada. We collected pediatric ulcerative colitis activity index (PUCAI) scores (to measure symptoms) and fecal levels of calprotectin from 37 children with PSC-IBD and 50 children with only IBD (controls; UC or IBD-unclassified). Colonoscopies were scored using the Mayo endoscopic subscore and the UC Endoscopic Index of Severity (UCEIS) scores, and histologic activity was graded. Among patients in clinical remission, endoscopic scores and the odds of active endoscopic disease (based on a UCEIS score ≥1) were compared between patients with and without PSC in univariate and multivariable analyses. Correlations between activity markers were compared between groups. The ability of fecal calprotectin to identify mucosal healing in patients with PSC-IBD was assessed using receiver operating characteristic curve analyses. Analogous analyses were performed for histologic activity. RESULTS Patients with PSC-IBD in clinical remission had higher endoscopic scores and greater odds of active endoscopic disease than controls (odds ratio, 5.9; 95% CI, 1.6-21.5). There was a higher degree of correlation between PUCAI and UCEIS scores in controls (r = 0.82) than in patients with PSC-IBD (r = 0.51; P = .01). Fecal levels of calprotectin correlated with UCEIS in patients with PSC-IBD (r = 0.84) and controls (r = 0.82; P = .80). Fecal levels of calprotectin identified mucosal healing in patients with PSC-IBD with an area under the receiver operating characteristic curve of 0.94 (optimal cut-point, 93 μg/g; 100% sensitivity and 92% specificity). Histologic activity scores and the odds of active histologic disease were also greater in patients in clinical remission with PSC-IBD than controls. CONCLUSIONS Children with PSC-IBD in clinical remission, based on PUCAI scores, have a significantly higher risk of active endoscopic and histologic disease than children with colitis without PSC. Fecal levels of calprotectin correlate with endoscopic findings in pediatric patients with PSC-IBD; levels below 93 μg/g are associated with mucosal healing.
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IgG4 Status in Explanted Livers Does Not Affect the Outcome of Primary Sclerosing Cholangitis (PSC) After Liver Transplant. HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.66037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Salla M, Aguayo-Ortiz R, Danmaliki GI, Zare A, Said A, Moore J, Pandya V, Manaloor R, Fong S, Blankstein AR, Gibson SB, Garcia LR, Meier P, Bhullar KS, Hubbard BP, Fiteh Y, Vliagoftis H, Goping IS, Brocks D, Hwang P, Velázquez-Martínez CA, Baksh S. Identification and Characterization of Novel Receptor-Interacting Serine/Threonine-Protein Kinase 2 Inhibitors Using Structural Similarity Analysis. J Pharmacol Exp Ther 2018; 365:354-367. [PMID: 29555876 DOI: 10.1124/jpet.117.247163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/26/2018] [Indexed: 12/16/2022] Open
Abstract
Receptor-interacting protein kinase 2 (RIP2 or RICK, herein referred to as RIPK2) is linked to the pathogen pathway that activates nuclear factor κ-light-chain-enhancer of activated B cells (NFκB) and autophagic activation. Using molecular modeling (docking) and chemoinformatics analyses, we used the RIPK2/ponatinib crystal structure and searched in chemical databases for small molecules exerting binding interactions similar to those exerted by ponatinib. The identified RIPK2 inhibitors potently inhibited the proliferation of cancer cells by > 70% and also inhibited NFκB activity. More importantly, in vivo inhibition of intestinal and lung inflammation rodent models suggests effectiveness to resolve inflammation with low toxicity to the animals. Thus, our identified RIPK2 inhibitor may offer possible therapeutic control of inflammation in diseases such as inflammatory bowel disease, asthma, cystic fibrosis, primary sclerosing cholangitis, and pancreatitis.
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Affiliation(s)
- Mohamed Salla
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Rodrigo Aguayo-Ortiz
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Gaddafi I Danmaliki
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Alaa Zare
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Ahmed Said
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Jack Moore
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Vrajeshkumar Pandya
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Robin Manaloor
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Sunny Fong
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Anna R Blankstein
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Spencer B Gibson
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Laura Ramos Garcia
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Pascal Meier
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Khushwant S Bhullar
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Basil P Hubbard
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Yahya Fiteh
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Harissios Vliagoftis
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Ing Swie Goping
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Dion Brocks
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Peter Hwang
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Carlos A Velázquez-Martínez
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
| | - Shairaz Baksh
- Departments of Biochemistry (M.S., G.I.D., A.S., J.M., V.P., I.S.G., P.H., S.B.), Pediatrics (A.Z., R.M., S.F., S.B.), Pharmacology (K.S.B., B.P.H.), Oncology (S.B.) Medicine (Y.F., H.V., P.H.), and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.-O., D.B., C.A.-V.M.), University of Alberta, Edmonton, Alberta, Canada; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, Mexico City, Mexico (R.A.-O.); Departments of Biochemistry and Medical Genetics and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada (A.R.B., S.B.G.); Breakthrough Breast Cancer Research Center Chester Beatty Laboratories, London, United Kingdom (L.R.G., P.M.); Cancer Research Institute of Northern Alberta, Edmonton, Alberta, Canada (S.B.); and Women and Children's Health Research Institute, Edmonton, Alberta, Canada (S.B.)
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de Vries EMG, Färkkilä M, Milkiewicz P, Hov JR, Eksteen B, Thorburn D, Chazouillères O, Pares A, Nygård S, Gilja OH, Wunsch E, Invernizzi P, Carbone M, Bernuzzi F, Boberg KM, Røsjø H, Rosenberg W, Beuers UH, Ponsioen CY, Karlsen TH, Vesterhus M. Enhanced liver fibrosis test predicts transplant-free survival in primary sclerosing cholangitis, a multi-centre study. Liver Int 2017; 37:1554-1561. [PMID: 28267887 DOI: 10.1111/liv.13402] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/21/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Biomarkers reflecting disease activity and prognosis in primary sclerosing cholangitis (PSC) have not been firmly established. Enhanced liver fibrosis (ELF) test was previously reported to predict outcome in PSC. We aimed to validate the prognostic utility of ELF test in an independent, multi-centre, retrospective PSC study population. METHODS We collected serum samples from PSC patients from seven countries. We estimated rates of transplant-free survival by the Kaplan-Meier method, used Cox proportional hazards regression to explore the association between ELF test and clinical outcome and determined prognostic performance of ELF test by computing the area under the receiver operating characteristic (AUC-ROC) curve. RESULTS The final analysis included 534 PSC patients (61% males). Features of autoimmune hepatitis or concomitant inflammatory bowel disease affected 44 (8%) and 379 (71%) patients respectively. ELF test levels were higher in patients reaching the combined endpoint liver transplantation or death (median 10.9 [Interquartile range (IQR): 9.8-12.1]; n=24 deaths, 79 liver transplantations) compared to those censored (8.8 [IQR: 8.0-9.8]); P<.001. ELF test expressed as mild, moderate and severe fibrosis was significantly associated with the risk of reaching the endpoint (P<.001). ELF test independently predicted clinical outcome (Hazard ratio 1.31; 95% confidence interval [1.05-1.65]; P=.018), and enabled good discrimination between PSC patients with and without endpoint (AUC-ROC: 0.79). CONCLUSION Our retrospective data validates the predictive utility of ELF test for clinical outcomes in PSC. The clinical utility of biomarkers for fibrosis in patients with PSC should be assessed in prospective patient cohorts.
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Affiliation(s)
- Elisabeth M G de Vries
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Martti Färkkilä
- Clinic of Gastroenterology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
| | - Johannes R Hov
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Bertus Eksteen
- Snyder Institute of Chronic Diseases, Department of Medicine, University of Calgary, Calgary, Canada
| | - Douglas Thorburn
- UCL Institute for Liver and Digestive Health, Division of Medicine, University College London & Royal Free London, NHS Foundation Trust, London, UK
| | | | - Albert Pares
- Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ståle Nygård
- Bioinformatics Core Facility, Institute for Medical Informatics, Oslo University Hospital, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Odd H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ewa Wunsch
- Department of Translational Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Pietro Invernizzi
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Marco Carbone
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Francesca Bernuzzi
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Kirsten M Boberg
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Helge Røsjø
- Center for Heart Failure Research, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - William Rosenberg
- UCL Institute for Liver and Digestive Health, Division of Medicine, University College London & Royal Free London, NHS Foundation Trust, London, UK
| | - Ulrich H Beuers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Tom H Karlsen
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Mette Vesterhus
- Norwegian PSC Research Center, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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30
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Chapman RW. Update on primary sclerosing cholangitis. Clin Liver Dis (Hoboken) 2017; 9:107-110. [PMID: 30992971 PMCID: PMC6467155 DOI: 10.1002/cld.633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/06/2017] [Accepted: 03/16/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Roger W. Chapman
- Nuffield Department of MedicineOxford UniversityOxfordUnited Kingdom
- Translational Gastroenterology UnitJohn Radcliffe HospitalOxfordUnited Kingdom
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31
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Chapman RW, Williamson KD. Are Dominant Strictures in Primary Sclerosing Cholangitis a Risk Factor for Cholangiocarcinoma? ACTA ACUST UNITED AC 2017; 16:124-129. [PMID: 28706774 PMCID: PMC5486581 DOI: 10.1007/s11901-017-0341-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cholangiocarcinoma is a devastating, unpredictable complication of large duct primary sclerosing cholangitis (PSC), which occurs in 5-15% of patients. The aim of this review is to discuss whether dominant strictures (DS) occurring in the larger bile ducts in PSC are a risk factor for the development of cholangiocarcinoma. RECENT FINDINGS The development of DS is related to specific genetic polymorphisms affecting the innate immune system and the microbiome. In a recent study, the mean survival of PSC patients with DS was much worse (13.7 years) than for those without a DS (23 years). Survival difference was related to a 26% risk of cholangiocarcinoma, which developed only in those with DS. Half of the patients with cholangiocarcinoma presented within 4 months of the diagnosis of PSC. In another study, the risk of developing cholangiocarcinoma was directly related to the presence of underlying IBD, although this remains controversial. Efforts are being made towards surveying for cholangiocarcinoma including magnetic resonance imaging, endoscopic surveillance and serum tumour markers, but so far, an effective surveillance strategy has not been identified. DS should be treated endoscopically in the setting of symptoms, and there is limited evidence to suggest this may impact protectively on progression to cholangiocarcinoma. SUMMARY It is established that the presence of symptomatic DS occurring in the larger bile ducts in PSC can be the first presentation of cholangiocarcinoma. There is an increasing body of evidence that even when proven to be benign, dominant biliary strictures predispose to the future development of cholangiocarcinoma. Regular surveillance should be targeted at this selected high-risk group of PSC patients.
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Affiliation(s)
- Roger W Chapman
- Nuffield Department of Medicine, Oxford University, Oxford, UK.,Translational Gastroenterology Unit, Oxford University Hospital, Oxford, UK.,Translational Gastroenterology Unit, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU UK
| | - Kate D Williamson
- Nuffield Department of Medicine, Oxford University, Oxford, UK.,Translational Gastroenterology Unit, Oxford University Hospital, Oxford, UK
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32
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Crosstalk between the gut and the liver via susceptibility loci: Novel advances in inflammatory bowel disease and autoimmune liver disease. Clin Immunol 2017; 175:115-123. [DOI: 10.1016/j.clim.2016.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/08/2016] [Accepted: 10/18/2016] [Indexed: 02/07/2023]
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Fernandes MA, Braun HJ, Evason K, Rhee S, Perito ER. De novo inflammatory bowel disease after pediatric kidney or liver transplant. Pediatr Transplant 2017; 21:10.1111/petr.12835. [PMID: 27862714 PMCID: PMC5272825 DOI: 10.1111/petr.12835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 12/26/2022]
Abstract
A subset of children who receive a liver and/or kidney transplant develop de novo inflammatory bowel disease-like chronic intestinal inflammation, not explained by infection or medications, following transplant. We have conducted a single-center, retrospective case series describing the unique clinical and histologic features of this IBD-like chronic intestinal inflammation following solid organ transplant. At our center, nine of 327 kidney or liver recipients developed de novo IBD following transplant (six liver, two kidney, one liver-kidney). Most children presented with prolonged hematochezia and diarrhea and were treated with aminosalicylates. At time of diagnosis, five were not currently using mycophenolate mofetil for transplant immunosuppression. Histologic and endoscopic findings at IBD diagnosis included inflammation, ulcerations, granulomas, and chronic colitis. Since diagnosis, no patients have required surgical intervention, or escalation to biologic therapy, nor developed stricturing or perianal disease. In this case series, de novo post-transplant IBD developed in 4% of pediatric liver and/or kidney recipients; however, it often does not fit the classic patterns of Crohn's disease or ulcerative colitis.
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Affiliation(s)
- Melissa A. Fernandes
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Benioff Children’s Hospital San Francisco, University of California San Francisco
| | | | - Kim Evason
- Department of Pathology, University of California San Francisco
| | - Sue Rhee
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Benioff Children’s Hospital San Francisco, University of California San Francisco
| | - Emily R. Perito
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Benioff Children’s Hospital San Francisco, University of California San Francisco
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Lee HJ, Park JM, Han YM, Gil HK, Kim J, Chang JY, Jeong M, Go EJ, Hahm KB. The role of chronic inflammation in the development of gastrointestinal cancers: reviewing cancer prevention with natural anti-inflammatory intervention. Expert Rev Gastroenterol Hepatol 2016; 10:129-39. [PMID: 26524133 DOI: 10.1586/17474124.2016.1103179] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inflammatory mediators alter the local environment of tumors, known as the tumor microenvironment. Mechanistically, chronic inflammation induces DNA damage, but understanding this hazard may help in the search for new chemopreventive agents for gastrointestinal (GI) cancer which attenuate inflammation. In the clinic, GI cancer still remains a major cause of cancer-associated mortality, chemoprevention with anti-inflammatory agents is thought to be a realistic approach to reduce GI cancer. Proton pump inhibitors, monoclonal antibodies targeting tumor necrosis factor-alpha, anti-sense targeted smad7 and non-steroidal anti-inflammatory agents have been investigated for their potential to prevent inflammation-based GI cancer. Besides these, a wide variety of natural products have also shown potential for the prevention of GI cancer. In this review, the authors will provide insights to explain the mechanistic connection between inflammation and GI cancer, as well as describe a feasible cancer prevention strategy based on anti-inflammatory treatments.
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Affiliation(s)
- Ho-Jae Lee
- a Laboratory of Chemoprevention, Lee Gil Ya Cancer and Diabetes Institute , Gachon University , Incheon , Korea
| | - Jong-Min Park
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Young Min Han
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Hong Kwon Gil
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Jinhyung Kim
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Ji Young Chang
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Migyeong Jeong
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Eun-Jin Go
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea
| | - Ki Baik Hahm
- b CHA Cancer Prevention Research Center , CHA Cancer Institute, CHA University , Seongnam , Korea.,c Digestive Disease Center , CHA University Bundang Medical Center , Seongnam , Korea
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Marzorati S, Invernizzi P, Lleo A. Making Sense of Autoantibodies in Cholestatic Liver Diseases. Clin Liver Dis 2016; 20:33-46. [PMID: 26593289 DOI: 10.1016/j.cld.2015.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are the most common chronic cholestatic liver diseases (CLD) in adults and are associated with immune mechanisms. PBC is considered a model autoimmune disease, and more than 90% of patients present very specific autoantibodies against mitochondrial antigens. Whether PSC should be considered an autoimmune or merely immune-mediated disease is still under debate. This review addresses the clinical relevance of autoantibodies in CLD and their pathogenic mechanisms and illustrates the technology available for appropriate autoantibody detection.
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Affiliation(s)
- Simona Marzorati
- Liver Unit and Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Via A. Manzoni 113, Rozzano, Milan 20089, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, via Ponzio 34/5, Milan 20133, Italy
| | - Pietro Invernizzi
- Liver Unit and Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Via A. Manzoni 113, Rozzano, Milan 20089, Italy; Division of Rheumatology, Allergy, and Clinical Immunology, University of California Davis, GBSF, 451 Health Science Drive, Davis, CA 95616, USA
| | - Ana Lleo
- Liver Unit and Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Via A. Manzoni 113, Rozzano, Milan 20089, Italy.
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36
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Esparza-Baquer A, Labiano I, Bujanda L, Perugorria MJ, Banales JM. MicroRNAs in cholangiopathies: Potential diagnostic and therapeutic tools. Clin Res Hepatol Gastroenterol 2016; 40:15-27. [PMID: 26774196 DOI: 10.1016/j.clinre.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/23/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023]
Abstract
Cholangiopathies are the group of diseases targeting the bile duct epithelial cells (i.e. cholangiocytes). These disorders arise from different etiologies and represent a current diagnostic, prognostic and therapeutic challenge. Different molecular mechanisms participate in the development and progression of each type of biliary disease. However, microRNA deregulation is a common central event occurring in all of them that plays a key role in their pathogenesis. MicroRNAs are highly stable small non-coding RNAs present in cells, extracellular microvesicles and biofluids, representing valuable diagnostic tools and potential targets for therapy. In the following sections, the most novel and significant discoveries in this field are summarized and their potential clinical value is highlighted.
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Affiliation(s)
- Aitor Esparza-Baquer
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Ibone Labiano
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Luis Bujanda
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastián, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain
| | - María J Perugorria
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastián, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain; IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Jesús M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastián, Spain; National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain; IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
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