The pathological spectrum of alcoholic liver disease

[Diagnosis and Severity Assessment of Alcohol-Related Liver Disease]

A diagnosis of alcohol-related liver disease (ALD) requires information on the history of excessive alcohol consumption (average intake of 40 g or more in men and 20 g or more in women a day). Furthermore, blood tests, such as GGT, AST, ALT, and mean corpuscular volume, and imaging studies, including abdominal ultrasound or transient elastography, are also useful. A liver biopsy can be useful for confirming the diagnosis and has prognostic value. ALD includes alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis, and in most cases, clinical manifestations can overlap. The prognostic scoring systems of ALD are limited mainly to alcoholic hepatitis, and the early mortality and treatment response can be predicted using various scoring systems. This review summarizes how to diagnose and evaluate the severity of ALD in clinical practice.

Quantification and isotopic analysis of bulk and of exchangeable and ultrafiltrable serum copper in healthy and alcoholic cirrhosis subjects

Information on the Cu speciation in blood serum can be valuable for a better understanding of the metabolism of this essential transition metal, but Cu speciation analysis and, to an even larger extent, compound-specific high-precision Cu isotopic analysis are challenging. In this work, quantification and isotopic analysis of Cu were carried out in bulk serum and in both its exchangeable + ultrafiltrable (EXCH + UF) Cu fraction and its non-exchangeable + non-ultrafiltrable (NEXCH + NUF) fraction using quadrupole and multi-collector ICP-mass spectrometry, respectively. The EXCH + UF serum Cu represents the labile Cu pool, i.e. Cu loosely bound to proteins, such as albumin, alpha-2 macroglobulin and other low molecular weight compounds, while the NEXCH + NUF serum Cu contains the Cu firmly bound to ceruloplasmin (Cp). The method was evaluated using human, goat and fetal bovine serum and applied to serum samples from assumed healthy subjects and from patients with alcoholic liver cirrhosis (AC). The healthy subjects showed an isotopic composition of EXCH + UF serum Cu heavier (by on average + 0.4‰) than that of their total serum Cu. In general, patients with AC showed higher EXCH + UF serum Cu concentrations and significantly lower δ⁶⁵Cu_EXCH+UF and δ⁶⁵Cu_serum values than did healthy subjects. Within the AC population, δ⁶⁵Cu_EXCH+UF values were comparable to or lower than the corresponding δ⁶⁵Cu_serum values, potentially reflecting the extent of labile Cu deregulation. As to be expected, the NEXCH + NUF serum Cu isotopic composition was similar to that of the total serum Cu, as most of the serum Cu is firmly bound to Cp.

Overview: Liver disease and transplantation

Australia has had a proud and enviable record of seminal contributions to hepatology, with many contributors. Thus, any attempt to summarize these contributions ab initio in a brief review article is a significant challenge, primarily because it is so easy to overlook or underestimate particular aspects. In this article, I have confined my comments primarily to the areas where the contributions have had a significant global impact and have clearly been recognized internationally. This means that many worthwhile Australian additions will be omitted if there was less apparent international impact. The first significant interest in liver disease in Australia was from the Melbourne group at the Walter and Eliza Hall Institute (WEHI) and Royal Melbourne Hospital, leading to seminal contributions to the description, diagnosis, aetiopathogenesis and therapy of autoimmune hepatitis and primary biliary cirrhosis. Others from Royal Prince Alfred Hospital in Sydney contributed substantially to the effects of immunosuppression of autoimmune hepatitis and to early descriptions of primary sclerosing cholangitis. Other areas where Australians have contributed significantly include steatohepatitis, iron metabolism (and in particular hemochromatosis), viral hepatitis (both at the molecular and clinical level), portal hypertension, and transplant immunology. The remarkable contribution of Professor Dame Sheila Sherlock to Australian hepatology is also summarized.

The liver sinusoidal cells. Their role in disorders of the liver, lipoprotein metabolism and atherogenesis

A review of the morphological and metabolic interactions between hepatocytes, the various sinusoidal cells and sinusoidal blood is presented. This field of investigation is rapidly expanding, with widespread implications in the regulation of physiological processes and diseases in the liver and other organs. Although most of the review is of already published work, some areas incorporate personal speculations of the probable role of sinusoidal cells in disease processes.