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Du K, Jun JH, Dutta RK, Diehl AM. Plasticity, heterogeneity, and multifunctionality of hepatic stellate cells in liver pathophysiology. Hepatol Commun 2024; 8:e0411. [PMID: 38619452 PMCID: PMC11019831 DOI: 10.1097/hc9.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/26/2024] [Indexed: 04/16/2024] Open
Abstract
HSCs, the resident pericytes of the liver, have consistently been at the forefront of liver research due to their crucial roles in various hepatic pathological processes. Prior literature often depicted HSCs in a binary framework, categorizing them as either quiescent or activated. However, recent advances in HSC research, particularly the advent of single-cell RNA-sequencing, have revolutionized our understanding of these cells. This sophisticated technique offers an unparalleled, high-resolution insight into HSC populations, uncovering a spectrum of diversity and functional heterogeneity across various physiological states of the liver, ranging from liver development to the liver aging process. The single-cell RNA-sequencing revelations have also highlighted the intrinsic plasticity of HSCs and underscored their complex roles in a myriad of pathophysiological processes, including liver injury, repair, and carcinogenesis. This review aims to integrate and clarify these recent discoveries, focusing on how the inherent plasticity of HSCs is central to their dynamic roles both in maintaining liver homeostasis and orchestrating responses to liver injury. Future research will clarify whether findings from rodent models can be translated to human livers and guide how these insights are harnessed to develop targeted therapeutic interventions.
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Pereira TA, Espósito BP. Can iron chelators ameliorate viral infections? Biometals 2024; 37:289-304. [PMID: 38019378 DOI: 10.1007/s10534-023-00558-x] [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] [Received: 08/29/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023]
Abstract
The redox reactivity of iron is a double-edged sword for cell functions, being either essential or harmful depending on metal concentration and location. Deregulation of iron homeostasis is associated with several clinical conditions, including viral infections. Clinical studies as well as in silico, in vitro and in vivo models show direct effects of several viruses on iron levels. There is support for the strategy of iron chelation as an alternative therapy to inhibit infection and/or viral replication, on the rationale that iron is required for the synthesis of some viral proteins and genes. In addition, abnormal iron levels can affect signaling immune response. However, other studies report different effects of viral infections on iron homeostasis, depending on the class and genotype of the virus, therefore making it difficult to predict whether iron chelation would have any benefit. This review brings general aspects of the relationship between iron homeostasis and the nonspecific immune response to viral infections, along with its relevance to the progress or inhibition of the inflammatory process, in order to elucidate situations in which the use of iron chelators could be efficient as antivirals.
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Gallo P, Silletta M, Prinzi FL, Farolfi T, Coppola A. Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease: A Modern Context for an Ancient Disease. J Clin Med 2023; 12:4605. [PMID: 37510720 PMCID: PMC10380839 DOI: 10.3390/jcm12144605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related deaths worldwide [...].
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Affiliation(s)
- Paolo Gallo
- Operative Research Unit of Clinical Medicine and Hepatology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Marianna Silletta
- Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Federica Lo Prinzi
- Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Tommaso Farolfi
- General Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Alessandro Coppola
- Dipartimento di Chirurgia, Sapienza University of Rome, Viale Regina Elena 291, 00161 Rome, Italy
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Etiologic fractions in patients of hepatocellular carcinoma in India with and without a background of cirrhosis: a multi-centric study. Hepatol Int 2023; 17:745-752. [PMID: 36940070 DOI: 10.1007/s12072-023-10498-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/04/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Hepatocellular cancer (HCC) typically arises in the background of cirrhosis. The epidemiology of HCC has changed in recent years due to availability of newer antivirals, changing life-styles and greater possibility for early detection. We undertook a multicentric national sentinel surveillance for liver cirrhosis and HCC to assess the attributable risk factors for the development of HCC, both with and without a background of cirrhosis. METHODS Data from January 2017 till August 2022 from hospital-based records of eleven participating centers were included. Diagnosed cases of cirrhosis [radiological (multiphase and/or histopathological] and HCC [as per AASLD 2018] were included. History of significant alcohol intake was elicited by AUDIT-C questionnaire. RESULTS Altogether 5798 enrolled patients were assessed, of which 2664 patients had HCC. The mean age was 58.2 ± 11.7 years and 84.3% (n = 2247) were males. Diabetes was found in over a third of those with HCC (n = 1032;39.5%). The most common etiology of HCC was NAFLD (n = 927;35.5%) followed by viral hepatitis B and C and harmful levels of alcohol. Among those with HCC, 27.9% (n = 744) had no cirrhosis. Higher proportion of cirrhotic HCC patients had alcohol as an etiological factor as compared to non-cirrhotic (17.5 vs. 4.7%, p ≤ 0.001). NAFLD was an etiological factor for a higher proportion of non-cirrhotic HCC patients as compared to cirrhotic HCC (48.2 vs. 30.6%, p ≤0.001). Diabetics more commonly had non-cirrhotic HCC (50.5 vs. 35.2%). The following factors were associated with an occurrence of cirrhotic HCC: male gender (OR 1.372 and 95% CI 1.070-1.759), age above 60 years (OR 1.409 and 95% CI 1.176-1.689), HBV (OR 1.164 and 95% CI 0.928-1.460), HCV (OR 1.228 and 95 CI 0.964-1.565) and harmful consumption of alcohol (OR 3.472 and 95% CI 2.388-5.047). The adjusted odds of non-cirrhotic patients having NAFLD was 1.553 (95% CI 1.290-1.869). CONCLUSION This large multi-centric study demonstrates that NAFLD is the most important risk factor for development of both cirrhotic and non-cirrhotic HCC in India and has overtaken viral hepatitis. Awareness campaigns and large-scale screening are required to reduce the high burden of NAFLD-related HCC in India.
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Shin J, Yu JH, Jin YJ, Lee JW. Incidence and Clinical Features of Hepatitis C Virus-associated Hepatocellular Carcinoma Patients without Liver Cirrhosis in Hepatitis B Virus-endemic Area. JOURNAL OF LIVER CANCER 2021; 21:34-44. [PMID: 37384274 PMCID: PMC10035726 DOI: 10.17998/jlc.21.1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 06/30/2023]
Abstract
Background/objective Hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) is rarely observed in patients without liver cirrhosis (LC). We evaluated the incidence and clinical feature of HCV-associated HCC patients with or without LC. Methods The medical records of 1,516 patients diagnosed as having primary HCC at our hospital between January 2005 and December 2017 were retrospectively reviewed. Of these, 154 (10.2%) HCV-associated HCC patients were analyzed. LC was diagnosed histologically or clinically. Results Seventeen (11.0%) of the 154 patients had non-cirrhotic HCC, and all were of Child-Turcotte-Pugh (CTP) class A, Among the 17 patients, 88.2% were male, all had nodular type HCC, and only 2 (11.8%) were under HCC surveillance. Median overall survival (OS) of HCV-associated HCC patients with and without LC was 15 months and 37 months, respectively. Cumulative OS rates were not different between non-cirrhotic patients and cirrhotic patients with CTP class A (P=0.229). Cumulative OS rates were significantly higher in non-cirrhotic patients than in cirrhotic patients of CTP class B (P<0.001) or C (P<0.001). Multivariate analyses showed serum AST (hazard ratio [HR] 1.01, P=0.003) and AFP levels (HR 1.01, P=0.016), antiviral therapy (HR 0.25, P=0.022), and LC of CTP class B (HR, 5.24, P=0.006) or C (HR 21.79, P<0.001) were significantly associated with prognosis in HCV-associated HCC patients. Conclusions HCC in a non-cirrhotic liver was found in 11% of HCV-associated HCC patients. OSs of HCV-associated HCC patients were better in those of CTP A, regardless of LC than in those with LC of CTP class B or C.
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Affiliation(s)
- Jongbeom Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jung Hwan Yu
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young-Joo Jin
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jin-Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Shin J, Yu JH, Jin YJ, Chae MH, Yoon CH, Lee JW. Comparison of survival outcomes of alcohol-related hepatocellular carcinoma with or without liver cirrhosis; a ten-year experience. Medicine (Baltimore) 2019; 98:e18020. [PMID: 31764818 PMCID: PMC6882638 DOI: 10.1097/md.0000000000018020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We evaluated overall survivals (OSs) of alcohol-related hepatocellular carcinoma (HCC) patients without LC compared to those with LC.Between 2005 and 2015, 1343 patients were initially diagnosed as having HCC in our hospital. Of these, 186 alcohol-related HCC patients were enrolled in this study, and their medical records were retrospectively analyzed. Significant alcohol intake was defined as more than 210 grams/week for men and more than 140 grams/week for women.Non-cirrhotic HCC was observed in 37.1% of the 186 patients. Cumulative OS rates were significantly higher in non-cirrhotic patients (P = .006). For the 117 cirrhotic patients, cumulative OS rate was significantly higher in the CTP class A patients than in the CTP class B (P < .001) or CTP class C (P < .001) patients, respectively. In the 69 non-cirrhotic patients, cumulative OS rate was significantly higher in the CTP class A patients than in the CTP class C patients (P < .001), but, not than in the CTP class B patients (P = .157). Multivariate analyses revealed that CTP class B (P < .001), CTP class C (P < .001), and tumor size (P = .006) were significant predictors for OS in cirrhotic patients, and that CTP class C (P = .002) and tumor size (P = .023) were significant predictors for OS in non-cirrhotic patients.OS was found to be better for non-cirrhotic than cirrhotic patients with alcohol-related HCC. Survivals of alcohol-related HCC patients without cirrhosis were comparable between patients with CTP class A and B.
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Desai A, Sandhu S, Lai JP, Sandhu DS. Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol 2019; 11:1-18. [PMID: 30705715 PMCID: PMC6354117 DOI: 10.4254/wjh.v11.i1.1] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/22/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research.
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Affiliation(s)
- Aakash Desai
- Department of Internal Medicine, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, United States
| | - Sonia Sandhu
- Department of Hematology and Oncology, Cleveland Clinic/Akron General Medical Center, Akron, OH 44307, United States
| | - Jin-Ping Lai
- Department of Pathology, University of Florida, Gainsville, FL 32611, United States
| | - Dalbir Singh Sandhu
- Division of Gastroenterology and Hepatology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, the United States
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Davidson M, Aioub M, Gutierrez M, Song K, Hagopian E, Karpeh M. Operable synchronous ampullary carcinoma and hepatocellular carcinoma: a case report and review of the literature. J Surg Case Rep 2017; 2017:rjx182. [PMID: 28959430 PMCID: PMC5610581 DOI: 10.1093/jscr/rjx182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 01/02/2023] Open
Abstract
We report a rare case of synchronous double primary malignancies of the liver and ampulla. A 70-year-old white female was diagnosed with ampullary and hepatocellular carcinoma. The management and outcome of this rare case of synchronous double primary hepatic and periampullary malignancies, amenable to surgical resection is discussed.
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Affiliation(s)
- Marson Davidson
- Department of Surgery, Hackensack University Medical Center,Hackensack, NJ 07601, USA
| | - Miriam Aioub
- Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Martin Gutierrez
- Department Medical Oncology, John Theurer Cancer Center, Hackensack, NJ 07601, USA
| | - Kunchang Song
- Department of Pathology, Hackensack University Medical Center, Hackensack, NJ 07601, USA
| | - Ellen Hagopian
- Department of Surgery, Hackensack University Medical Center,Hackensack, NJ 07601, USA
| | - Martin Karpeh
- Department of Surgery, Hackensack University Medical Center,Hackensack, NJ 07601, USA
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Kabbage L, El Kouhen M, Taghy A, Znati K, Kabbaj N. A rare presentation of hepatocellular carcinoma in non-cirrhotic liver. Pan Afr Med J 2017; 28:69. [PMID: 29255539 PMCID: PMC5724728 DOI: 10.11604/pamj.2017.28.69.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/12/2017] [Indexed: 01/26/2023] Open
Abstract
Hepatocellular carcinoma is the most frequent type of liver malignancy. Most cases of hepatocellular carcinoma are secondary to either viral hepatitis (hepatitis B, C) or alcoholic cirrhosis. Liver cirrhosis due to any other causes is considered as a risk factor for development of hepatocellular carcinoma; however, hepatocellular carcinoma in non cirrhotic livers remains a rare condition. The present case report describes a 59-year-old woman patient admitted to explore right hypochondriac and epigastric pain, with no evidence of pre-existing liver disease and with a good general condition. The computed tomography was very suggestive of a gastro-intestinal stromal tumor. But, at laparotomy, a huge hepatic tumor was discovered. Histopathological study confirmed the presence of primary hepatocellular carcinoma. Hepatocellular carcinoma occurs more frequently on a cirrhotic liver. However, it can occur on a non cirrhotic liver and remains and extremely rare case.
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Affiliation(s)
- Lamia Kabbage
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- EFD-hepatogastroenterology Unit, ibn sina hospital, Rabat,Morocco
| | - Meryem El Kouhen
- EFD-hepatogastroenterology Unit, ibn sina hospital, Rabat,Morocco
| | - Ahmed Taghy
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- Clinique chirurgicale B, ibn sina hospital, Rabat, Morocco
| | - Kaoutar Znati
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- Pathology departement, ibn sina hospital, Rabat, Morocco
| | - Nawal Kabbaj
- Faculty of medicine, mohammed V Souissi University Rabat Morocco
- EFD-hepatogastroenterology Unit, ibn sina hospital, Rabat,Morocco
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Gonçalves PL, Zago-Gomes MDP, Gonçalves CS, Pereira FEL. Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo. Rev Soc Bras Med Trop 2015; 47:559-63. [PMID: 25467255 DOI: 10.1590/0037-8682-0145-2014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil. METHODS We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging. RESULTS HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases. CONCLUSIONS These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection.
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Affiliation(s)
- Patrícia Lofêgo Gonçalves
- Hospital Universitário Cassiano Antonio de Morais, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Maria da Penha Zago-Gomes
- Hospital Universitário Cassiano Antonio de Morais, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Carlos Sandoval Gonçalves
- Hospital Universitário Cassiano Antonio de Morais, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Fausto Edmundo Lima Pereira
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Abstract
About 80% of hepatocellular carcinoma (HCC) is caused by hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infections especially in the setting of established cirrhosis or advanced fibrosis, making HCC prevention a major goal of antiviral therapy. HCC tumors are highly complex and heterogeneous resulting from the aberrant function of multiple molecular pathways. The roles of HCV or HBV in promoting HCC development are still either directly or indirectly are still speculative, but the evidence for both effects is compelling. In patients with chronic hepatitis viral infection, cirrhosis is not a prerequisite for tumorigenesis.
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Affiliation(s)
- Ziv Ben Ari
- Liver Disease Center, Sheba Medical Center, Derech Sheba No 1, Ramat Gan 52621, Israel; Liver Research Laboratory, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Ella Weitzman
- Liver Disease Center, Sheba Medical Center, Derech Sheba No 1, Ramat Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Michal Safran
- Liver Disease Center, Sheba Medical Center, Derech Sheba No 1, Ramat Gan 52621, Israel; Liver Research Laboratory, Sheba Medical Center, Ramat Gan, Israel
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K-Kutala B, Bedossa P, Guedj J, Asselah T, Martinot-Peignoux M, Duval X, Marcellin P. Patients with chronic hepatitis C without advanced fibrosis and hepatocellular carcinoma: a retrospective clinical-pathological study. Dig Liver Dis 2015; 47:296-302. [PMID: 25596930 DOI: 10.1016/j.dld.2014.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/25/2014] [Accepted: 12/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are very few studies on the incidence and risk factors of hepatitis C virus (HCV)-induced hepatocellular carcinoma (HCC) in the absence of advanced fibrosis. Our objective was to identify the clinical-pathological features of these patients. METHODS We retrospectively reviewed 162 patients admitted to our hospital for HCV-related HCC between 2000 and 2010. Patients with hepatitis of other aetiologies, human immunodeficiency virus co-infection, or treated with interferon were excluded. We compared demographic, laboratory, clinical and outcome parameters of patients with and without advanced fibrosis. RESULTS 137 patients had advanced fibrosis (85%). Median age was higher in the advanced fibrosis vs. the non-advanced fibrosis group (62 vs. 65 years, respectively; p = 0.025). Steatosis was significantly more frequent in patients with advanced fibrosis compared to those without advanced fibrosis (43% vs. 20%, respectively; p = 0.032). Independent predictors associated to the occurrence of HCC in patients without advanced fibrosis were hepatitis B core antigen (odds ratio: 3.86; p = 0.044) and duration of hepatitis C infection (odds ratio: 1.21; p = 0.003). CONCLUSIONS Risk factors such as steatosis or diabetes were not frequent in patients without advanced fibrosis. Further studies are needed to evaluate the role of occult hepatitis B and the duration of hepatitis infection in patients with HCC and chronic hepatitis C without advanced fibrosis.
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Affiliation(s)
- Blaise K-Kutala
- Department of Hepatology, Beaujon Hospital, AP-HP, Clichy, France; INSERM U1137, University Paris 7, UFR of Medicine, France; INSERM U1149/CRI, Beaujon Hospital, AP-HP, Clichy, France.
| | - Pierre Bedossa
- Department of Pathology, Beaujon Hospital, AP-HP, Clichy, France
| | - Jeremie Guedj
- INSERM U1137, University Paris 7, UFR of Medicine, France
| | - Tarik Asselah
- Department of Hepatology, Beaujon Hospital, AP-HP, Clichy, France; INSERM U1149/CRI, Beaujon Hospital, AP-HP, Clichy, France
| | | | - Xavier Duval
- INSERM U1137, University Paris 7, UFR of Medicine, France
| | - Patrick Marcellin
- Department of Hepatology, Beaujon Hospital, AP-HP, Clichy, France; INSERM U1149/CRI, Beaujon Hospital, AP-HP, Clichy, France
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Li H, Song T, Shao Y, Wen H. Cystic echinococcosis accompanied by hepatocellular carcinoma in a female herdsman. Int J Clin Exp Med 2015; 8:2985-2988. [PMID: 25932268 PMCID: PMC4402915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
Human cystic echinococcosis is a zoonosis caused by the larval cestode Echinococcus granulosus. Hepatocellular carcinoma is one of the most common types of cancer in the whole world including China. A few reports about cystic echinococcosis concurrent with hepatocellular carcinoma were noted until now. In addition, the association between these two diseases is still not well defined as the case with cystic echinococcosis with hepatocellular carcinoma is rare. In this case report, we presented a female herdsman living in Xinjiang Uyghur Autonomous region, China, which may raise the possibility that echinococcosis may play a role in the development of hepatocellular carcinoma.
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Affiliation(s)
- Haitao Li
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
- Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Tao Song
- Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
- Department of Ultrasonography, First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Yingmei Shao
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
- Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Hao Wen
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
- Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
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Bouomrani S, Kilani I, Nouma H, Slama A, Beji M. [Non fibrolamellar hepatocellular carcinoma on a healthy liver]. Pan Afr Med J 2014; 18:155. [PMID: 25419293 PMCID: PMC4236843 DOI: 10.11604/pamj.2014.18.155.2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 12/21/2013] [Indexed: 01/10/2023] Open
Abstract
Le carcinome hépatocellulaire (CHC) survient le plus souvent sur foie de cirrhose. Sa survenue sur un foie sain est exceptionnelle et pose un véritable défit diagnostique pour le clinicien. Nous rapportons l'observation d'un patient de 53 ans, sans antécédents pathologiques notables qui fût admis pour exploration d'une douleur de l'hypochondre droit évoluant depuis quelques mois avec une exacerbation récente, associée à un amaigrissement important et une altération de l’état général. L'examen clinique notait une hépatomégalie ferme et douloureuse. L’échographie abdominale montrait une masse hétérogène du secteur latéral droit du foie faisant 10 cm de grand axe. La TDM abdominale montrait une masse tissulaire, hétérogène, à vascularisation artérielle importante, mesurant 10 cm de diamètre et occupant le secteur latéral droit du foie. Cette tumeur comprime la branche portale droite sans signes d'extension. Il n'y avait pas d'adénopathie ni d’épanchement intra abdominal. La ponction biopsique écho-guidée avait conclu à un CHC non fibrolamellaire. Le bilan biologique, en particulier les transaminases, le taux de prothrombine, l’électrophorèse des protéines sanguine et l'alpha foeto-protéine, était sans anomalies. Les sérologies de l'hépatites virales B et C ainsi que la recherche des auto anticorps spécifiques des hépatites auto immunes et le bilan cuprique étaient aussi négatives. Vue l’âge, le stade avancé de la tumeur et l'altération de l’état général la conduite thérapeutique était de s'abstenir.
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Affiliation(s)
- Salem Bouomrani
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
| | - Ichrak Kilani
- Service de Gastroentérologie, Hôpital Militaire de Gabès 6000, Tunisie
| | - Hanène Nouma
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
| | - Alaeddine Slama
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
| | - Maher Beji
- Service de Médecine Interne, Hôpital Militaire de Gabes 6000, Tunisie
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Abstract
Globally, hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection leads to liver fibrosis and cirrhosis, which in turn causes resultant hepatocellular carcinoma (HCC). Frequently, HCC recurs very soon even after a potentially curative treatment such as surgical interference or locoregional ablative therapies. Chronic HBV/HCV infection is often responsible for this recurrence, through secondary carcinogenesis. Antiviral therapy after a curative treatment of HCC plays an important role in preventing or delaying recurrence and improves survival in patients with HBV/HCV infection-related HCC. This article reviews the worldwide epidemiology of HBV/HCV infection, the association of viral infection with HCC, the mechanism of hepatitis virus-related hepatocarcinogenesis, and the paramount importance of antiviral therapy in the management of HCC.
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Hepatocellular carcinoma in chronic hepatitis C in the absence of advanced fibrosis or cirrhosis. AJR Am J Roentgenol 2013; 200:W610-6. [PMID: 23701091 DOI: 10.2214/ajr.12.9151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of our study was to describe the cross-sectional imaging appearance of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) infection in the absence of advanced fibrosis and cirrhosis. MATERIALS AND METHODS This study is a retrospective review of our surgical database to identify patients with chronic HCV infection and HCC who underwent hepatectomy and who had undergone preoperative CT or MRI. Only patients with a Metavir fibrosis score of F0, F1, or F2 on pathology were included. Patients with hepatitis B virus coinfection or other causes of chronic liver disease and patients with histopathologic evidence of advanced fibrosis or cirrhosis (Metavir scores F3 and F4) were excluded. Contrast-enhanced CT or MRI examinations performed within 2 months before surgery were reviewed for the number, size, and location of tumors; tumor enhancement characteristics; and presence of macrovascular invasion. RESULTS Two hundred forty-five resections of HCC in patients with HCV were performed in our institution from 1987 to 2012. Of this group, 26 patients (10.6%) had a Metavir fibrosis score of F0, F1, or F2; of those patients, 19 (18 men and one woman; 18 non-Asian patients and one Asian patient; mean age, 64 years) had imaging studies available for review. Twenty-one HCCs (mean size, 4.5 cm; range, 0.9-14.8 cm) were evaluated at imaging. Typical wash-in and washout characteristics were seen in 16 of 19 viable lesions (84.2%). The remaining two HCCs were completely necrotic after transarterial chemoembolization. Eighteen patients had a solitary tumor. Most tumors (15/21, 71.4%) developed in the right hepatic lobe. CONCLUSION HCC can develop in patients with chronic HCV without advanced fibrosis or cirrhosis, most frequently in older non-Asian men, and usually appears as a large solitary tumor with a typical wash-in-washout enhancement pattern.
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Schwartz ME, Shrager B. Surgical resection for hepatocellular carcinoma in the noncirrhotic: the Western experience. Recent Results Cancer Res 2013; 190:85-100. [PMID: 22941015 DOI: 10.1007/978-3-642-16037-0_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although hepatocellular carcinoma (HCC) is most often a sequela of severe hepatic fibrosis or cirrhosis, a proportion of cases arise in the noncirrhotic patient. The gold standard therapy in such cases is surgical resection. Innovations in operative technique allow for this treatment to be implemented with very low mortality and acceptable morbidity at high-volume hepatobiliary centers. This chapter discusses various etiologies of noncirrhotic HCC and presents a large single-center experience that is compared to other Western series.
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Affiliation(s)
- Myron E Schwartz
- Department of Surgery, Mount Sinai School of Medicine, NewYork, NY 10029-6574, USA.
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Albeldawi M, Soliman M, Lopez R, Zein NN. Hepatitis C virus-associated primary hepatocellular carcinoma in non-cirrhotic patients. Dig Dis Sci 2012; 57:3265-70. [PMID: 22695885 DOI: 10.1007/s10620-012-2260-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/17/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited literature on hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) infection in the absence of cirrhosis. AIMS To investigate the relationship between HCV and HCC in the absence of cirrhosis and to characterize patients with HCV infection presenting with HCC in the absence of cirrhosis. METHODS We identified all adult patients with histological confirmation of HCC between 1994 and 2007 (404 patients). A case-control design (four controls for each case with non-cirrhotic HCC) was chosen to compare characteristics and survival of HCV in HCC patients without (cases) and with (controls) cirrhosis. Conditional logistic regression analysis was used to identify factors independently associated with HCV in non-cirrhotic HCC. RESULTS Eighty-seven patients with non-cirrhotic HCC were identified, six (7 %) had HCV infection in comparison with 107 of 317 (55.7 %) with cirrhotic HCC (P < 0.001). Compared with the HCV-associated HCC cirrhotic group, patients with HCV-associated HCC in the absence of cirrhosis were more likely to present with a single nodule (100 vs. 66.7 %), larger nodule size (>5 cm) (100 vs. 16.7 %), and macrovascular invasion (66.7 vs. 17.4 %) at time of diagnosis. Four of six patients with HCV-associated HCC in the absence of cirrhosis where alive at three years (all had resection), which was better survival than for HCC arising in cirrhotic livers of HCV-infected individuals (66.7 vs. 39.1 %). CONCLUSION We found that HCV is responsible for a small minority of non-cirrhotic HCC cases representing an uncommon and poorly defined subgroup of HCC.
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Affiliation(s)
- Mazen Albeldawi
- Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
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Herzer K, Carbow A, Sydor S, Sowa JP, Biesterfeld S, Hofmann TG, Galle PR, Gerken G, Canbay A. Deficiency of the promyelocytic leukemia protein fosters hepatitis C-associated hepatocarcinogenesis in mice. PLoS One 2012; 7:e44474. [PMID: 22984515 PMCID: PMC3439406 DOI: 10.1371/journal.pone.0044474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 08/08/2012] [Indexed: 12/20/2022] Open
Abstract
Overwhelming lines of epidemiological evidence have indicated that persistent infection with hepatitis C virus (HCV) is a major risk for the development of hepatocellular carcinoma (HCC). We have recently shown that HCV core protein mediates functional inactivation of the promyelocytic leukemia (PML) tumor suppressor pathway. However, the role of PML in HCC development yet remains unclear. To clarify the function of PML in liver carcinogenesis and HCV-associated pathogenesis we crossed PML-deficient mice with HCV transgene (HCV-Tg) expressing mice and treated the resulting animals with DEN/Phenobarbital, an established protocol for liver carcinogenesis. Seven months after treatment, livers were examined macroscopically and histologically. Genetic depletion of the tumor suppressor PML coincided with an increase in hepatocyte proliferation, resulting in development of multiple dysplastic nodules in 100% of the PML-deficient livers and of HCCs in 53%, establishing a tumor suppressive function of PML in the liver. In animals expressing the HCV-transgene in PML-deficient background, HCC development occurred even in 73%, while only 7% of their wildtype littermates developed HCC. The neoplastic nature of the tumors was confirmed by histology and expression of the HCC marker glutamine synthetase. Several pro- and antiapoptotic factors were tested for differential expression and liver carcinogenesis was associated with impaired expression of the proapoptotic molecule TRAIL in PML-deficient mice. In conclusion, this study provides first in vivo evidence that the tumor suppressor PML acts as an important barrier in liver carcinogenesis and HCV-dependent liver pathology.
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Affiliation(s)
- Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital, Essen, Germany.
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Teixeira AC, Mente ED, Cantao CAB, Sankarankutty AK, Souza FF, Motta TC, Monsignore L, Junior JE, Muglia VF, Abud DG, Peria FM, Silva OC, de Lourdes Candolo Martinelli A. Clinical Characteristics of 130 Patients With Hepatocellular Carcinoma Followed at a Tertiary Hospital From Brazil. World J Oncol 2012; 3:165-172. [PMID: 29147300 PMCID: PMC5649839 DOI: 10.4021/wjon549w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 12/21/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that represents a serious public health problem all over the world, corresponding to the third cause of cancer death worldwide. The object was to present the clinical characteristics and follow-up of patients with HCC attended at the University Hospital of the Faculty of Medicine of Ribeirao Preto-USP (HCFMRP-USP), Ribeirao Preto, Sao Paulo, Brazil. Methods Epidemiological and clinical data were revised from medical records. Results A total of 130 patients participated in the study, 81.5% of them being males. Mean (± SD) age at the time of HCC diagnosis was 55.6 ± 11.2 years. Cirrhosis was present in 89.2% of cases, with 53.4% of the patients being Child-Pugh A; chronic hepatitis B or C without cirrhosis was detected in 3.2%, non-alcoholic steatohepatitis (NASH) in 3.8%, and a normal liver in 3.8%. Orthotopic liver transplantation was performed in 26.2% of the subjects, 16.9% of the patients were submitted to surgical resection, and 6.2% to percutaneous ethanol infusion (PEI). Transarterial embolization and transarterial chemoembolization were performed in 9.2% of the patients. Systemic chemotherapy was applied to 4.6% of cases and 24.6% of the patients received symptomatic treatment. Conclusion Thus, in the present series cirrhosis was the main risk factor for HCC, with 53.4% of the patients being Child-Pugh A. Liver transplantation or surgical resection of the tumor, potentially curative techniques, were possible in only 43.1% of cases.
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Affiliation(s)
- Andreza Correa Teixeira
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Enio David Mente
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Cassio Alfred Brattig Cantao
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ajith Kumar Sankarankutty
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernanda Fernandes Souza
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Tatiane Cardoso Motta
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Lucas Monsignore
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Jorge Elias Junior
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Daniel Giansante Abud
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernanda Maris Peria
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Orlando Castro Silva
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Vibert E, Ishizawa T. Hepatocellular carcinoma: Western and Eastern surgeons' points of view. J Visc Surg 2012; 149:e302-6. [PMID: 22694943 DOI: 10.1016/j.jviscsurg.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Developed on a pathological liver in 90% of cases, theoretically liver transplantation (LT) is its best treatment because it cures both malignancy and cause of malignancy, the underlying pathological liver. Cadaveric donors are the main source of liver in Western countries as France and living donors are the rules in Eastern countries as Japan. Because organ shortage could impact choices in HCC treatments, it was interesting to compare a Western and Eastern surgeon's points of view about treatment of HCC to assess if the source of organs has modified therapeutic strategies. Hence, aim of this work was to compare points of view of two hepatobiliary and transplant surgeons specialized in the treatment of HCC in France and Japan concerning five keys points that are decisive to choose one of the two curative treatments in HCC on pathological liver: liver resection or LT. These questions included the definition of an oncological treatment of HCC, the assessment of liver function, the treatment of HCC recurrences, the incidence of pathological information on therapeutic strategy and potential future therapeutics strategies.
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Affiliation(s)
- E Vibert
- Hôpital Paul-Brousse, AP-HP, Centre Hépato-Biliaire, 12, avenue Paul-Vaillant-Couturier, 94804 Villejuif cedex, France.
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Association of IL28B SNP With Progression of Egyptian HCV Genotype 4 Patients to End Stage Liver Disease. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hepatmon.6064] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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El-Awady MK, Mostafa L, Tabll AA, Abdelhafez TH, Bader El Din NG, Zayed N, Shenawy RE, El Abd Y, Hasan RM, Zaghlol H, El Khayat H, Abdel Aziz AO. Association of IL28B SNP With Progression of Egyptian HCV Genotype 4 Patients to End Stage Liver Disease. HEPATITIS MONTHLY 2012; 12:271-7. [PMID: 22690235 PMCID: PMC3360937 DOI: 10.5812/hepatmon.835] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 01/20/2012] [Accepted: 02/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND IL28B single nucleotide polymorphisms (SNPs) play important roles in the management of hepatitis C virus (HCV) infections and are strongly associated with spontaneous and treatment-induced HCV clearance. OBJECTIVES In the present study, the association between IL28B variants and the progression of HCV infection in Egyptian patients infected with type 4a virus will be examined. PATIENTS AND METHODS Frequencies of the protective genotype C/C of SNP, rs12979860 were determined in healthy subjects, spontaneous resolvers, and chronic HCV type 4 patients with low F scores and in patients with end stage liver disease (ESLD). This study included a total of 404 subjects. Patients infected with HCV type 4a (n = 304) were divided into; chronic hepatitis C (CHC) with low F scores (CHC, n = 110), end stage liver disease (n = 110), liver cirrhosis (LC) (n = 35) and hepatocellular carcinoma (HCC) patients (n = 75), spontaneous resolvers of HCV infection (n = 84) were also included. A healthy group representing the Egyptian population (n = 100) was also included in the genotyping of IL28B. The later was typed via a polymerase chain reaction based restriction fragment length polymorphism (PCR-RFLP) assay analysis on purified genomic DNA extracted from all individuals. RESULTS A significant increase (P < 0.0005) was observed in frequencies of IL-28B rs12979860 C/C genotypes in the healthy population, than in the CHC, LC and HCC groups (C/C = 48%, 13%, 0%.and 0% respectively). On the other hand the C/C genotype was significantly higher (P < 0.0005) in spontaneous resolvers than in healthy subjects. A comparable significant increase in the frequency of C/T allele accompanied by mild elevation of T/T allele frequency, were detected along the progression towards ESLD. CONCLUSIONS Genotype C/C is associated with viral clearance during acute infection. The sharp decline in the C/C genotype from healthy to CHC subjects and the total absence of the C/C genotype in ESLD suggests a central role of this genotype against HCV disease progression.
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Affiliation(s)
- Mostafa K. El-Awady
- Department of Microbial Biotechnology, National Research Center, Giza, Egypt
- Corresponding author: Mostafa K. El Awady, Department of Microbial Biotechnology (Biomedical Technology group) National Research Center, El-Behooth Street 12622m Dokki, Giza, Egypt. Tel.: +20-123132640, Fax: +20-23370931, E-mail:
| | | | - Ashraf A. Tabll
- Department of Microbial Biotechnology, National Research Center, Giza, Egypt
| | | | | | - Naglaa Zayed
- Department of Tropical Medicine and Hepatology Kasr El Aini Cairo University, Cairo, Egypt
| | - Reem El Shenawy
- Department of Microbial Biotechnology, National Research Center, Giza, Egypt
| | - Yasmin El Abd
- Department of Microbial Biotechnology, National Research Center, Giza, Egypt
| | - Reham M. Hasan
- Department of Microbial Biotechnology, National Research Center, Giza, Egypt
| | - Hosam Zaghlol
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ashraf O. Abdel Aziz
- Department of Tropical Medicine and Hepatology Kasr El Aini Cairo University, Cairo, Egypt
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Bruno S, Savojardo D, Almasio PL, Mondelli MU. Critical reappraisal of risk factors for occurrence of hepatocellular carcinoma in patients with hepatitis C virus. Hepat Med 2011; 3:21-8. [PMID: 24367218 PMCID: PMC3846922 DOI: 10.2147/hmer.s16991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
More than one and half of current cases of hepatocellular carcinoma in the US, Europe, and Japan are attributable to hepatitis C virus (HCV) infection. HCV is also the primary cause of death in patients with HCV-related cirrhosis, with annual incidences of 0.5%-5% in Europe and 4%-10% in Asia. Screening is based on serum alpha-fetoprotein determination and liver ultrasound scan, but the sensitivity of the former is far less than optimal, and screening intervals are still poorly defined for the latter. Risk factors related to the host or environment, or both, appear to be more relevant than viral factors, such as HCV genotype, in determining disease progression to cirrhosis and cancer, and include age, male gender, severity of liver disease at presentation, coinfection with hepatitis B virus or human immunodeficiency virus, and alcohol abuse. Early liver transplantation in selected cases can be curative, but most patients are not eligible for liver grafting and are treated with locoregional ablative therapies, after which recurrence is common. Recently, orally available inhibitors of the vascular endothelial growth factor receptor have shown a significant, albeit modest, increment of survival in patients with advanced hepatocellular carcinoma, thus paving the way for modern molecular approaches to treatment of this highly malignant tumor.
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Affiliation(s)
- Savino Bruno
- Liver Unit, Department of Medicine, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Daniela Savojardo
- Liver Unit, Department of Medicine, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Piero L Almasio
- Unità Complessa di Gastroenterologia ed Epatologia, University of Palermo, Palermo, Italy
| | - Mario U Mondelli
- Struttura Complessa Laboratori di Infettivologia, Dipartimento di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, Pavia, Italy
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Castello G, Costantini S, Scala S. Targeting the inflammation in HCV-associated hepatocellular carcinoma: a role in the prevention and treatment. J Transl Med 2010; 8:109. [PMID: 21047421 PMCID: PMC2991329 DOI: 10.1186/1479-5876-8-109] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/03/2010] [Indexed: 12/19/2022] Open
Abstract
Epidemiological, preclinical and clinical studies demonstrated that chronic inflammation induced by hepatitis C virus (HCV) is crucial in hepatocellular carcinogenesis. The interaction between hepatocytes and microenvironment regards virus, inflammatory and immunocompetent cells, chemo- and cyto-kines, reactive oxygen species (ROS) and nitric oxide (NO), generating cell transformation. We suggest hepatocarcinoma (HCC) as a model in which the targeting of microenvironment determine neoplastic transformation. The present review focuses on: the role of inflammation in carcinogenesis, the clinical impact of HCC and the inadequacy of the actual therapy, the chemoprevention targeting the microenvironment.
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Affiliation(s)
- Giuseppe Castello
- Oncology Research Centre of Mercogliano (CROM), Mercogliano (AV), Italy.
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