Liver morphology in acute viral hepatitis related to the hepatitis B antigen

Insight into microRNAs-Mediated Communication between Liver and Brain: A Possible Approach for Understanding Acute Liver Failure?

Acute liver failure (ALF) is a life-threatening consequence of hepatic function rapid loss without preexisting liver disease. ALF may result in a spectrum of neuropsychiatric symptoms that encompasses cognitive impairment, coma, and often death, collectively defined as acute hepatic encephalopathy. Micro RNAs are small non-coding RNAs that modulate gene expression and are extensively verified as biomarker candidates in various diseases. Our systematic literature review based on the last decade's reports involving a total of 852 ALF patients, determined 205 altered circulating miRNAs, of which 25 miRNAs were altered in the blood, regardless of study design and methodology. Selected 25 miRNAs, emerging predominantly from the analyses of samples obtained from acetaminophen overdosed patients, represent the most promising biomarker candidates for a diagnostic panel for symptomatic ALF. We discussed the role of selected miRNAs in the context of tissue-specific origin and its possible regulatory role for molecular pathways involved in blood-brain barrier function. The defined several common pathways for 15 differently altered miRNAs were relevant to cellular community processes, indicating loss of intercellular, structural, and functional components, which may result in blood-brain barrier impairment and brain dysfunction. However, a causational relationship between circulating miRNAs differential expression, and particular clinical features of ALF, has to be demonstrated in a further study.

Cholestatic features in hepatitis A

The clinical, biochemical and histological characteristics of 13 cases of acute hepatitis A were evaluated. In 10 biopsies moderate to severe cholestasis was seen consisting of bile thrombi, cholestatic liver cell rosettes and ductular transformation of hepatocytes as shown on keratin- and S-100 immunostaining. The periportal spotty necrosis may play a role in the pathogenesis of cholestasis in hepatitis A by creating an interruption in continuity of bile flow. In 6 cases, abnormal ductular epithelium was seen resembling the ductular lesion in septicemia. Such ductular lesion may be related to the accumulation of leucotrienes as a result of cholestasis.

The pathology of hepatitis A in man

Liver biopsies from 17 patients with serologically established hepatitis A were examined by light microscopy. Biopsies were taken from 2 to 27 weeks after onset of symptoms. All showed acute hepatitis, usually with centrilobular lesions but also commonly with a striking portal and periportal inflammatory reaction, resembling that seen in chronic active hepatitis. The infiltrate was rich in plasma cells. Centrilobular cholestasis was common and occasionally severe. Neither cholestasis nor the periportal lesion appeared to be related to patient age or to the timing of liver biopsy. All patients made a full recovery and none developed chronic liver disease. The histological changes differed from those reported in children and in chimpanzees in the presence of centrilobular lesions, but resembled them in that the latter two groups also had periportal lesions. These lesions may lead to a false impression of impending chronicity if the aetiology of the hepatitis is not known at the time of liver biopsy.

Correlations between anti-albumin antibodies and HBsAG in hepatic patients

A new category of autoantibodies--antipolymerized albumin antibodies (AAA)--was discovered in 1974. Studies performed from 1974 to 1976 showed their diagnosis and prognostic values in hepatic diseases; the AAA tests [immunodiffusion (ID) and hemagglutination (HS)] made possible a good estimation of the total liver cell function. Without being specific for a viral hepatitis B infection, highly significant linear correlations were found for AAA precipitin and agglutinin positivities with presence of HBsAg. High titre of AAA agglutinins unaccompanied by a positive ID test, characterise the "healthy carrier" of the HBsAg, while the isolated AAA positivity in ID is met in more severe, long-standing hepatic diseases.

The long-term outcome of hepatitis B

Among 466 hospitalized patients with serologically verified acute hepatitis B, 440 individuals (94.4%) could be followed up until normalization of liver function had occured, or for at least one year. In 90.2% of the patients followed-up liver function including galactose tolerance) returned to normal within four months after onset of illness. Chronic persistent hepatitis B surface antigen (HB Ag) for at least one year in 14 patients (50%). Liver biopsy was performed in consistent with CPH in all cases. Histological signs of chronic aggressive hepatitis developed in 15 patients (3.4%) and persistence of HB Ag was observed in 11 of these patients (73%). No histological follow-up was performed in patients with normal liver function within four months after onset of illness. Cprticosteroid treatment in 56 patients with prolonged symptoms did not seem to predispose to persistence of HbsaG in the serum.

Clinical pathologic correlation in viral hepatitis. The effect of the virus on the liver

In clinical pathologic correlations, including the potential effect of the virus on the liver, the morphologic features of the various stages of viral hepatitis are the firm information available today. With acute hepatitis being an inflammatory reaction to cell injury and necrosis, and chronic hepatitis being sustained inflammation, correlation with clinical features and functional defects is good in acute hepatitis and less so in the chronic stages. The pathogenesis of the diseases-including cell necrosis, inflammation, fibrosis, and cirrhosis formation-is reasonably well understood, and this knowledge assists both in prognosis and in monitoring of therapy. The localization of the components of the hepatitis B antigen and their effects, including the nature of the immune response, is the most exciting aspect of the clinical pathologic problem. Today's interpretations offer, at best, a working hypothesis promising further understanding of the evolution of the disease.

Acute viral hepatitis: a comparative study of clinical, biochemical, morphological and immunological features in patients with and without Australia Antigen

500 consecutive patients with acute viral hepatitis verified by biopsy were divided into groups of 202 patients with detectable Australia (Au) antigen and 298 patients without antigenaemia at the time of admission to hospital. Comparison was made of the initially recorded clinical, biochemical, histological and serological variables in the two groups. Judged by both histological and biochemical criteria, the acute disease was more severe in the 202 patients with Au antigen than in the 298 patients without Au antigen. Evidence is presented that this difference is possibly due more to qualitative aetiological differences between the two groups than to the duration of antigenaemia or the time of hospitalization. Thus, the demonstration of Au antigenaemia provides not only epidemiological but also relevant clinical information.