Abnormal liver enzymes: A review for clinicians

A study on the factors influencing mortality risk in sepsis-induced acute kidney injury based on analysis of the MIMIC database

Sepsis-induced acute kidney injury (SA-AKI) significantly increases mortality and healthcare burdens. Identifying key mortality risk factors is crucial for improving patient outcomes. This study aims to identify the primary factors affecting mortality in SA-AKI patients using the MIMIC-III database. A retrospective analysis was conducted on 4868 SA-AKI patients from the MIMIC-III database. Clinical data from the first 24 h of ICU admission were analyzed using logistic regression to identify mortality predictors. Key mortality predictors included advanced age (OR = 1.015, 95% CI: 1.006-1.024), severe AKI stages (OR = 1.470, 95% CI: 1.285-1.676), low serum albumin (OR = 0.606, 95% CI: 0.506-0.722), delayed antibiotics (OR = 1.001, 95% CI: 1.000-1.002), high AST (OR = 1.035, 95% CI: 1.027-1.083), and bilirubin (OR = 1.055, 95% CI: 1.037-1.083). The area under the curve (AUC) of the combined predictors for mortality risk was 0.796, indicating high predictive accuracy. Conclusions: Early intervention and monitoring of identified risk factors such as age, AKI stage, albumin levels, and antibiotic timeliness can enhance survival rates in SA-AKI patients.

Effect of methoxychlor on liver function, lipid peroxidation, and antioxidants in experimental rats

Background

Methoxychlor (MXC), a widely used pesticide, poses significant toxicological risks to various biological systems. It is an environmental contaminant and the only organochlorine pesticide still using instead of DDT. Endocrine disruption of MXC is also under investigation.This study aimed to investigate the effects of MXC on antioxidant status, lipid peroxidation, and liver metabolism in experimental rats.

Methods

Male Wistar rats were divided into control and treatment groups, with the latter receiving 150 mg/kg and 250 mg/kg body weight (BW) of MXC via oral administration for 30 days. Liver function was assessed by measuring circulating biomarkers, including Alanine Transaminase (ALT), Aspartate Transaminase (AST), and Alkaline Phosphatase (ALP). Oxidative damage was evaluated by determining Thiobarbituric Acid Reactive Substances (TBARS), hydroperoxide (HYP), and other lipid peroxidation markers. Key enzymes involved in antioxidant defense mechanisms were also analyzed in the liver of experimental animals.

Results

Our results demonstrated a significant increase in ALT, AST, and ALP levels in the serum of rats exposed to MXC, indicating impaired liver function. This was accompanied by elevated lipid peroxidation, further emphasizing oxidative stress. Moreover, the activities of antioxidant enzymes such as SOD, GPx, and CAT were markedly reduced in the MXC-exposed groups compared to the controls, suggesting a compromised antioxidant defense system.

Conclusion

These findings suggest that methoxychlor exposure disrupts liver function and induces oxidative stress by enhancing lipid peroxidation, thereby depleting natural antioxidant defenses. This study highlights the potential hepatotoxic effects of methoxychlor and underscores the role of oxidative stress in mediating its toxicity.

Influence of Montelukast Combined With Methylprednisolone on Liver Function, Platelet Count, Eosinophil Count, and Myocardial Enzymes in Bronchopneumonia Children With Wheezing

Aims/Background Bronchopneumonia is a common infectious disease in pediatrics, which can lead to myocardial and hepatic impairments. Children with bronchopneumonia accompanied by wheezing are vulnerable to hypoxia, which may damage other systems. Therefore, this study explored the influence of montelukast combined with methylprednisolone on liver function, platelet count, eosinophil count, and myocardial enzymes in children with bronchopneumonia accompanied by wheezing. Methods The clinical data of this retrospective study included 82 pediatric cases diagnosed with bronchopneumonia and wheezing between April 2022 and April 2024. Based on treatment methods, patients were divided into the methylprednisolone group (40 cases) as well as the montelukast and methylprednisolone group (42 cases). Therapeutic efficacy, resolution time of clinical symptoms, and adverse effects were recorded. Furthermore, liver function indicators, platelet count, eosinophil count, and myocardial enzyme levels were comparatively assessed using biochemical analyzer, hematology analyzer and biological kits in both groups. Results The total efficacy rate of the montelukast and methylprednisolone group was 95.2% (40/42), higher than the 77.5% of the methylprednisolone group (p = 0.018). Patients in the montelukast and methylprednisolone group had shorter hospitalization and clinical symptom disappearance times than the methylprednisolone group (both p < 0.05). In addition, there was no significant difference in total incidence of adverse reactions (p = 0.700). Methylprednisolone monotherapy or in combination with montelukast, substantially reduced liver function indicators, platelet count, eosinophil count, and myocardial enzyme levels (p < 0.05). Moreover, the platelet count, eosinophil count, and myocardial enzymes [aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB)] were reduced in the montelukast and methylprednisolone group compared to the methylprednisolone group after treatment (p < 0.05). Compared to the methylprednisolone group, alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL) levels were significantly diminished in the montelukast and methylprednisolone group following treatment (p < 0.05). Conclusion Montelukast and methylprednisolone combination therapy reduces platelet and eosinophil counts, alleviates myocardial and liver function damage, and demonstrates good therapeutic efficacy in children with bronchopneumonia accompanied by wheezing.

A 3D Co-Culture System Inspired by Fracture Healing Cell Interactions for Bone Tissue Engineering

Peri-bone fibroblasts play a crucial role in regulating bone regeneration during early fracture healing. Inspired by the synergy between osteoblasts and fibroblasts at fracture sites, a biomimetic three-dimensional (3D) indirect co-culture system is developed, comprising a 3D scaffold and co-cultured cells. To mimic cellular interactions in the fracture healing zone, the scaffold features an inner-outer ring structure with communication channels that support indirect cell co-culture. This setup provides fibroblasts and osteoblasts with a 3D culture environment resembling the in vivo extracellular matrix, enhancing intercellular signaling while minimizing risks of direct contact. Mechanically tunable bioinks are formulated by incorporating hyaluronic acid methacrylate (HAMA) hydrogel into gelatin methacryloyl (GelMA) hydrogel to construct the scaffold. The optimal co-culture ratio is established in vitro, where fibroblasts are found to regulate the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) via zinc ion transport mechanisms. In vivo validations are conducted, including ectopic bone formation in nude mice and bone regeneration in rat cranial defect and tooth extraction socket models. This 3D indirect co-culture system enhances osteogenesis by promoting functional fibroblast-osteoblast interactions, offering a novel platform for co-culture studies and a promising strategy for clinical bone regeneration applications.

Beyond obesity: lean metabolic dysfunction-associated steatohepatitis from unveiling molecular pathogenesis to therapeutic advancement

Nonalcoholic fatty liver disease (NAFLD), now known by the name of metabolic dysfunction-associated fatty liver disease (MAFLD), with increased global incidence, has been recognized as a significant metabolic disorder. NAFLD includes a spectrum liver disease from hepatocellular fat accumulation (isolated steatosis) to an advanced form of liver injury known as nonalcoholic steatohepatitis (NASH), which refers to distinct histologic features, including hepatocellular steatosis and injury, necroinflammation, and eventually fibrosis. Nonobese or lean individuals associated with metabolic dysregulation usually demonstrated diverse risk factors compared to obese MAFLD. The presence of normal range body mass index (BMI) and excess visceral adiposity with increased cardiometabolic and renal comorbidities, along with sarcopenia, has been evidenced to be associated with lean MASH. Genetic predispositions accompanying lifestyle and environmental factors contribute to disease initiation and progression. The genetic influence in pathophysiology indicated the significant contributions of the following genes: PNPLA3, TM6SF2, APOB, LIPA, MBOAT7, and HSD17B13, and the impact of their disease-specific variants in the development of obesity-independent MASH. The epigenetic modifications exhibited differential DNA methylation patterns in the genes involved in lipid metabolism, particularly hypomethylation of PEMT. Diet-induced and genetic animal models of lean MASH, including Slc: Wistar/ST rats, PPAR-α, PTEN, and MAT1A knockout mice models, are indicated to be pivotal in the exploration of disease progression and observing the effect of therapeutic interventions. This comprehensive review comprises the molecular and genetic pathophysiology, molecular diagnostics, and therapeutic aspects of lean MASH to enunciate a diagnostic approach that combines detailed clinical phenotyping regarding genomic analysis.

Alkaline Phosphatase-Targeted, Gadolinium-Labeled Nanoparticles for Enhanced Multimodal Imaging of Liver Cancer

Liver cancer remains one of the most lethal malignancies worldwide, primarily due to limited diagnostic and therapeutic strategies. Biological imaging agents capable of selective accumulation in cancerous liver tissue offer a promising route for earlier detection and improved patient outcomes. In this work, we synthesized and characterized alkaline phosphatase (ALP)-targeted, gadolinium-labeled gold nanoparticles (AuNPs) designed for simultaneous detection using magnetic resonance imaging (MRI), computed tomography (CT), and fluorescence (Fl) microscopy. The synthesized AuNPs feature 13 nm gold cores functionalized with ALP-binding ligands and Gd(III)-macrocycles. Characterization by ultraviolet-visible (UV-vis) spectroscopy, dynamic light scattering (DLS), transmission electron microscopy (TEM), and energy dispersive X-ray spectroscopy (EDX) confirmed successful functionalization. During the functionalization process, variations in Gd(III) loading, surface packing density, and r1 relaxivity were observed; however, high reproducibility was achieved when including methanol during the AuNP labeling protocol. In vitro studies with HepG2 liver cancer and HEK293 kidney cells demonstrated selective cellular uptake in relation to cellular ALP expression levels. Optimized uptake conditions demonstrated 10-fold increase in Gd(III) internalization into HepG2 versus HEK293 cells. Further imaging by scanning electron microscopy (SEM) and TEM on thinly sliced cell samples verified the intracellular localization of these nanoparticles. Collectively, these findings underscore the potential of ALP-targeted, gadolinium-labeled AuNPs as a versatile multimodal imaging platform for the early detection of liver cancer.

Comparative Effectiveness and Safety of Moderate-Intensity Pravastatin Versus Atorvastatin in Patients with Dyslipidemia: A Retrospective Cohort Study Using a Common Data Model of Multicenter Electronic Health Records in South Korea

AIM

To compare the effectiveness and safety of moderate-intensity pravastatin 40 mg/day and atorvastatin 10 mg/day in patients with dyslipidemia.

METHODS

We conducted a retrospective cohort study using electronic health records of 19 million patients across 14 secondary/tertiary hospitals, standardized to a Common Data Model. New users of pravastatin (40 mg/day) and atorvastatin (10 mg/day) were identified. Six distinct cohorts were used to assess the comparative effectiveness in preventing major adverse cardiovascular events (MACE) and the risks of new-onset diabetes mellitus (NODM), myalgia or rhabdomyolysis, and hepatotoxicity (measured by aspartate aminotransferase [AST]/alanine aminotransferase [ALT]). Propensity score matching (PSM) was applied to each cohort for effectiveness and safety analyses, followed by a meta-analysis of hospital-specific results.

RESULTS

After PSM, patients were equally assigned to the pravastatin and atorvastatin groups for primary (n = 2,688/group) and secondary MACE prevention (n = 1,258/group) and to assess the risk of NODM (n = 2,391/group), new-onset myalgia or rhabdomyolysis (n = 11,799/group), and hepatotoxicity (AST, n = 4,034/group; ALT, n = 3,655/group). No significant differences were observed in the hazard ratios (HRs) for primary (HR = 0.84; 95% CI, 0.59-1.20) and secondary MACE prevention (HR = 0.89; 95% CI, 0.68-1.16). Similarly, no significant difference was observed in the risk of NODM (HR, 0.99; 95% CI, 0.79-1.23). The risk of new-onset myalgia/rhabdomyolysis (HR = 0.82, 95% CI, 0.69-0.96) and the incidence of abnormal elevations in AST levels (2.35% vs. 3.37%, p＜0.05) were significantly lower in the pravastatin group.

CONCLUSION

Moderate-intensity pravastatin (40 mg/day) showed comparable effectiveness to moderate-intensity atorvastatin (10 mg/day) in preventing MACE with a more favorable safety profile.

Characterization of non-alcoholic fatty liver disease-related hepatocellular carcinoma on contrast-enhanced ultrasound with Sonazoid

PURPOSE

This study aimed to evaluate the contrast-enhanced ultrasound with Sonazoid (Sonazoid-CEUS) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

In this retrospective study, patients who underwent surgical resection and were histopathologically diagnosed with NAFLD or cirrhosis-related HCC were included. All patients received Sonazoid-CEUS examinations within 1 week prior to hepatic surgery. The enhancement patterns of HCC lesions were evaluated and compared between the two groups according to the current World Federation for Ultrasound in Medicine and Biology guidelines. Multivariate logistic regression analysis was used to assess the correlations between Sonazoid-CEUS enhancement patterns and clinicopathologic characteristics.

RESULTS

From March 2022 to April 2023, a total of 151 patients with HCC were included, comprising 72 with NAFLD-related HCC and 79 with hepatitis B virus (HBV) cirrhosis-related HCC. On Sonazoid-CEUS, more than half of the NAFLD-related HCCs exhibited relatively early and mild washout within 60 seconds (54.2%, 39/72), whereas most HBV cirrhosis-related HCCs displayed washout between 60 and 120 seconds (46.8%, 37/79) or after 120 seconds (39.2%, 31/79) (P<0.001). In the patients with NAFLD-related HCC, multivariate analysis revealed that international normalized ratio (odds ratio [OR], 0.002; 95% confidence interval [CI], 0.000 to 0.899; P=0.046) and poor tumor differentiation (OR, 21.930; 95% CI, 1.960 to 245.319; P=0.012) were significantly associated with washout occurring within 60 seconds.

CONCLUSION

Characteristic Sonazoid-CEUS features are useful for diagnosing HCC in patients with NAFLD.

A Comparative Study of N-Acetyl Cysteine, Rosuvastatin, and Vitamin E in the Management of Patients with Non-Alcoholic Steatohepatitis: A Randomized Controlled Trial

Background: Non-alcoholic steatohepatitis (NASH) is characterized by increased production of proinflammatory cytokines, fibrosis, and hepatocyte apoptosis. This study aimed to assess the efficacy of N-acetyl cysteine (NAC), rosuvastatin (RSV), and vitamin E (VE) in patients with NASH. Methods: A double-blinded, parallel, randomized, controlled study was conducted and registered on clinicaltrials.gov (Identifier: NCT06105060), involving 135 NASH participants, who were divided into three groups: the control group (group 1), consisting of patients receiving standard therapy VE at a dosage of 400 IU twice daily. In the treated group (group 2), patients were administered NAC at a dosage of 1200 mg twice daily, while treatment (group 3) received RSV at a dosage of 20 mg once daily. FibroScan® examination of liver tissue and fibrosis scores, along with tests for liver aminotransferases, lipid profile, glycemic parameters, and renal and hepatic functions, were assessed before and after six months of treatment. Results: The analyzed groups demonstrated a significant reduction in steatosis and lipid peroxidation (p < 0.05). The NAC group demonstrated greater anti-inflammatory and anti-apoptotic effects compared to the RSV group, although this difference was not significant in the control group. NAC is conceded as the only significant antifibrotic agent in liver stiffness measurement (LSM), biological marker findings, and non-invasive liver fibrosis scores (p < 0.05), in addition to its improvement of several metabolic parameters and health-related quality of life. Conclusions: Patients receiving NAC demonstrated safety and efficacy in enhancing steatosis, fibrosis, and metabolic parameters, representing a novel strategy in the management of NASH.

Mediating factors associated with alcohol intake and periodontal condition

Background

Alcohol consumption has been reported to increase the risk of periodontal disease and various health abnormalities such as obesity, hyperglycemia, and liver abnormalities. While the link between these health abnormalities and periodontal disease has been established, their potential mediating role in the association between alcohol consumption and periodontal disease remains unclear. Therefore, this study aims to investigate the multiple mediating roles of obesity, hyperglycemia, and liver abnormalities in this association.

Methods

A cross-sectional study was conducted on 6,529 individuals aged 35-64 years who underwent workplace health check-ups in 2003 (mean age: 45.7 ± 8.7 years). The periodontal condition was evaluated using the mean pocket depth (PD), and participants were classified into no, light/moderate (alcohol consumption 0.1-29.9 g/day), and heavy (≥30 g/day) drinking groups. Causal mediation analysis was performed.

Results

Heavy drinking had a direct effect on the mean PD. Light/moderate drinking had a indirect effect on the mean PD through the body mass index (BMI), glucose level, alanine aminotransferase level (ALT), with proportion mediated of 25.1%, 8.9%, and 18.9%, respectively. The mediating role of glucose level was found in the association between heavy drinking and the mean PD with proportion mediated of 32.7%.

Conclusion

This study confirmed that alcohol consumption was associated with worse periodontal condition among Japanese adults who received workplace health check-ups. This association was partially contributed by several factors such as BMI, glucose level, and ALT.

Determination of reference intervals for common liver function tests among healthy adults

Reference intervals (RIs) are significant means for health evaluation, prognosis, diagnosis, and monitoring of adverse events. The RIs are affected by ethnicity, age, gender, geographic area, diet, socioeconomic, and physical situation. This study aimed to determine RIs of commonly used liver function tests (LFT) for healthy adults in Ibb City, middle of Yemen. A total of 390 participants aged between 18 and 70 were selected and administered a questionnaire. Blood specimens were assembled after an overnight fast, and the sera were separated for analysis of common LFT (DBIL, TBIL, ALB, TP, ALP, AST, and ALT) using Mindray BS-240 Automatic Clinical Chemistry Analyzer. The data were computed by GraphPad Prism 8.0.1. This study revealed that RIs for males and females of DBIL, TBIL, ALB, ALP, and ALT were significantly higher in males than females. Although RIs for TP and AST were higher in males than females, the difference was non-significance. Notably, most of the RIs in our study were different than those from other countries, either higher or lower. In conclusion, this study has established a panel of locally relevant RIs for commonly used LFT in adults, Ibb City, which may help interpret laboratory results for healthy adults and patients.

Effect of high-altitude hypoxia on function and cytoarchitecture of rats' liver

The liver is central to metabolic, detoxification, and homeostatic functions. Exposure to hypobaric hypoxia at high altitudes causes detrimental effects on the liver, leading to injury. This study evaluated the effect of hypoxia-induced at high altitudes on liver function, oxidative stress, and histopathological changes in rats. This study used 24 male Wistar rats (aged 8-10 weeks). The hypoxia (hypobaric hypoxia) was inducted at a high altitude of 2,100 m above sea level. Normoxia is defined as 40 m above the sea level. The rats were randomly divided into two groups: a control group maintained at low altitudes and an experimental group exposed to high altitudes for eight weeks. Blood samples were collected from all rats through a cardiac puncture, and liver samples were taken through an abdominal approach. All samples were processed through standard methods and evaluated for liver function tests and histopathological assessment. Serum aspartate aminotransferase and alanine transaminase levels significantly increased by 25% and 30%, respectively, in the high-altitude group compared to controls (p < 0.01), indicating mild hepatocellular damage. Oxidative stress assessment indicated a significant elevation in malondialdehyde by 42% in the liver homogenates of high-altitude rats compared to controls (p < 0.001). Moreover, Superoxide dismutase activity and glutathione content decreased by 18% and 22% in the high-altitude group (p < 0.01), confirming the increased oxidative stress. Histologically, minimal inflammatory infiltration was observed in the rat livers at high altitudes, with no signs of necrosis or severe structural changes. Subclinical liver dysfunction, as evidenced by altered serum enzyme levels and increased oxidative stress with mild histological changes, is induced by high-altitude hypoxia in rats. This study's results support that a hypobaric hypoxic environment physiologically stresses the liver. Further research into the long-term implications of hypobaric hypoxia and the adaptive responses of the liver is warranted.

Development and validation of the albumin-bilirubin gamma-glutamyl transferase score for enhanced prognostic accuracy after hepatocellular carcinoma resection

BACKGROUND

The albumin-bilirubin (ALBI) score, used for predicting outcomes after hepatocellular carcinoma (HCC) resection, does not directly capture liver cell damage or biliary obstruction. Gamma-glutamyl transferase (GGT), which reflects hepatic oxidative stress and inflammation, may complement the ALBI score. We sought to develop the ALBI-GGT score, a composite prognostic tool, and evaluate its performance to predict long-term outcomes among patients undergoing HCC resection.

METHODS

Patients undergoing curative-intent HCC resection (2000-2023) were identified from an international, multi-institutional database. The cohort was divided into training (65%) and testing cohorts (35%). Multivariable Cox analysis examined the association of ALBI-GGT score with overall survival (OS).

RESULTS

Among 759 patients, the median ALBI score was -2.78 (-3.02 to -2.48), and the median GGT was 55.0 U/L (31.0-93.0). On multivariable analysis, ALBI score (hazard ratio [HR], 1.473 [1.112-1.950]; P =.007) and GGT (HR, 1.007 [1.004-1.010]; P <.001) were predictors of overall mortality, alongside tumor burden score (HR, 1.051 [1.015-1.090]; P =.006) and American Society of Anesthesiologists class >2 (HR, 1.473 [1.005-2.161]; P =.047). There was a near-linear correlation between increasing ALBI scores and GGT and higher hazards of death. The ALBI-GGT score demonstrated the highest predictive accuracy in the testing set (concordance index, 0.68 [0.58-0.72]), outperforming the ALBI score (0.62 [0.56-0.69]) and GGT (0.65 [0.58-0.72]). The ALBI-GGT achieved the lowest Akaike and Bayesian information criteria. Time-dependent area under the curve (AUC) analysis demonstrated consistent superiority over 0 to 60 months. At 1-, 3-, and 5-years, the ALBI-GGT score had AUCs of 0.782, 0.725, and 0.688, respectively, outperforming ALBI score and GGT. The ALBI-GGT score was able to stratify patients into distinct prognostic groups (5-year OS, low ALBI-GGT [85.0%] vs intermediate ALBI-GGT [65.8%] vs high ALBI-GGT [56.8%]; P <.001).

CONCLUSION

ALBI score alone may be insufficient to prognostically stratify patients with HCC. Combining ALBI score with GGT was a superior tool to stratify patients relative to long-term survival.

Subphenotypes and the De Ritis ratio for mortality risk stratification in sepsis-associated acute liver injury: a retrospective cohort study

Background

Sepsis-associated liver injury (SALI) is associated with poor outcomes and increased mortality. However, effectively stratifying SALI patients according to prognosis remains challenging. This study evaluates laboratory-based clustering filters for stratifying SALI patients by 30-day mortality risk, utilizing data mining techniques for novel pattern discovery.

Methods

This retrospective cohort study analyzed SALI patients from two ICU databases: Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 73,181, study period: 2008 to 2019) and Amsterdam UMC (n = 16,194, study period: 2003 to 2016). Patients were identified using Sepsis-3 criteria and liver injury markers. Risk stratification employed three laboratory-based approaches: (I) De Ritis ratio (aspartate aminotransferase/alanine aminotransferase), (II) R-factor (alanine aminotransferase and alkaline phosphatase relative to their upper limits of normal), and (III) alanine aminotransferase elevation. Kaplan-Meier analysis and multivariable Cox regression assessed the association between stratification methods and 30-day mortality risk.

Findings

SALI patients had almost a 2-fold higher risk of 30-day mortality than those without SALI (hazard ratio: 1.73; 95%-CI: 1.58-1.90, p < 0.0001). Each stratification method (I-III) successfully classified patients into statistically distinct risk strata. The De Ritis ratio emerged as the strongest prognostic differentiation method: a ratio ≤1 indicated no significant increase in mortality risk (hazard ratio: 0.86; 95%-CI: 0.68-1.09, p = 0.21), whereas ratios of 1-2 and ≥2 were significantly associated with higher mortality (hazard ratio: 1.56; 95%-CI: 1.37-1.78, p < 0.0001 and hazard ratio: 2.46; 95%-CI: 2.18-2.77, p < 0.0001, respectively). All findings were confirmed in the validation cohort.

Interpretation

The De Ritis ratio serves as a valuable prognostic tool for 30-day mortality in SALI patients. Our findings indicate that patients with a ratio ≥1 face significantly worse outcomes, highlighting the need for targeted interventions. These results refine risk stratification in SALI subphenotypes, enhancing our understanding of its prognostic implications.

Funding

This study received no external funding and was solely financed through the departmental resources of the authors.

Activatable Photoacoustic Probe for Imaging Infection: Gold Nanorod Dissociation In Vivo Reports Bacterial Protease Activity

We present a strategy for constructing activatable photoacoustic imaging (PAI) probes for in vivo enzyme activity measurements, based on a dissociation strategy previously applied to in vitro sensing. Unlike conventional nanoparticle aggregation strategies, dissociation minimizes false positives and functions effectively in complex biological environments. Overcoming the challenge of dissociating nanostructure aggregates, which arises from the strong van der Waals forces at short distances, we demonstrate the controlled assembly and dissociation of citrate-capped gold nanorods (AuNRs-citrate) using a diarginine peptide additive and a thiolated polyethylene glycol (HS-PEG-OMe), respectively. This assembly dissociation mechanism enables precise control of the optical and photoacoustic (PA) properties of AuNRs in both in vitro and in vivo settings. Building on these findings, we engineered an enzyme-sensitive PAI probe (AuNRs@RgpB) composed of AuNR assemblies and a PEG-peptide conjugate with a protease-specific cleavage sequence. The probe detects Arg-specific gingipain (RgpB), a protease expressed by Porphyromonas gingivalis associated with periodontal disease and Alzheimer's disease. Proteolytic cleavage of the peptide sequence triggers AuNR dissociation, resulting in enhanced PA signal output. The probe was designed to be injected intrathecally for preclinical trials to image gingipains and investigate the value of gingipain inhibitors developed for Alzheimer's disease. The probe's performance was characterized in vitro using UV-vis spectroscopy and PAI, achieving detection limits of 5 and 20 nM, respectively. In vivo studies involved intracranial injection of AuNRs@RgpB into RgpB-containing murine models, with PA monitoring over time. RgpB activity produced a four-fold PA signal increase within 2 h, while P. gingivalis-infected mice showed similar signal enhancement. Specificity was confirmed by negligible responses to Fusobacterium nucleatum, a non-RgpB-producing bacterium. Additionally, the system demonstrated utility in drug development by successfully monitoring the inhibition of RgpB activity using RgpB inhibitors (leupeptin and KYT-1) in vivo models. Beyond its immediate application to RgpB detection, this modular approach to plasmonic-based sensing holds significant potential for detecting other proteases, advancing both nanotechnology and protease-targeted diagnostics.

Development of a nomogram to predict in-ICU mortality of elderly patients with sepsis-associated liver injury: an analysis of the MIMIC-IV database

Background

Sepsis-associated liver injury (SALI) is a frequent and lethal complication among critically ill patients in the intensive care unit (ICU). Despite its significance, there has been a notable lack of specialized tools for evaluating the in-ICU mortality risk in these patients. This study seeks to address this gap by developing a practical nomogram to predict risk factors associated with in-ICU mortality in patients suffering from SALI.

Methods

Data were extracted from the MIMIC-IV database, a Critical Care Public Medical Information Mart. The diagnostic criteria for sepsis adhered to the Sepsis 3.0 guidelines, requiring a SOFA score of ≥ 2. SALI was defined as total bilirubin (TBIL) levels > 2 mg/dL in patients with sepsis and an International Normalized Ratio (INR) > 1.5. Lasso regression analyses were conducted on the training set (n = 653) to develop a predictive nomogram model. Receiver Operating Characteristic (ROC) curves were generated to evaluate model discrimination. Model calibration was assessed through calibration curves and Hosmer-Lemeshow goodness-of-fit tests. Clinical decision curves were plotted to analyze the net benefit of the model and evaluate its clinical applicability.

Results

A total of 934 elderly patients with SALI were included in the study. Random seeds were allocated in a 7:3 ratio, resulting in training and validation sets comprising 653 and 281 patients, respectively. Variables were selected using lasso regression, culminating in the inclusion of six final variables within the model. The nomogram was evaluated against standard ICU scoring systems, specifically SAPS II and SOFA scores, yielding AUROC values of 0.814, 0.798, and 0.634 for the training set, respectively. Conversely, the validation set demonstrated AUROC values of 0.809, 0.791, and 0.596. The nomogram exhibited strong predictive performance for in-ICU outcomes. P-values from the Hosmer-Lemeshow goodness-of-fit test for both training and validation sets were recorded at 0.627 and 0.486, respectively, indicating good fit quality. Decision curve analysis revealed that the nomogram consistently provides greater net benefits compared to SAPS II and SOFA scores.

Conclusion

A prediction model of in-ICU mortality in SALI elderly patients was established by screening variables through lasso regression. Nomgram was the best predictor of in-ICU mortality in SALI patients, which has a high reference value and clinical application.

Effects of adenosine triphosphate, thiamine pyrophosphate, melatonin, and liv-52 on subacute pyrazinamide proliferation hepatotoxicity in rats

BACKGROUND

Hepatotoxicity of pyrazinamide, an antituberculosis drug, limits its therapeutic use and oxidative stress has been implicated in this toxicity. This study investigated the protective effects of adenosine triphosphate (ATP), thiamine pyrophosphate (TPP), melatonin, and Liv-52, which have previously been shown antioxidant activities, on pyrazinamide-induced hepatotoxicity.

METHODS

36 albino Wistar male rats were divided into randomized six groups; healthy (HG), pyrazinamide (PZG), ATP + pyrazinamide (APZG), TPP + pyrazinamide (TPZG), melatonin + pyrazinamide (MPZG) and Liv-52 + pyrazinamide (LPZG) groups. ATP 4 mg/kg and TPP 25 mg/kg were administered intraperitoneally (IP). Melatonin 10 mg/kg and Liv-52 20 mg/kg were given orally. One hour after administration of ATP, TPP, melatonin, and Liv-52, 250 mg/kg pyrazinamide was applied orally to all rats except HG group. The treatment was repeated (1 × 1) for 4 weeks. Then, blood samples were taken for determination of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities. Immediately after, the rats were euthanized with thiopental sodium (50 mg/kg, IP), and the livers were removed. The tissues were analyzed for malondialdehyde (MDA), total glutathione (tGSH), superoxide dismutase (SOD), and catalase (CAT) also hydropic degeneration, necrosis, and apoptosis (caspase 3) were examined.One-Way ANOVA was used in biochemical analyses and Tukey test was used as post-hoc. For histopathological and immunohistochemical analysis, the Kruskal-Wallis test was used and Dunn's test as a post-hoc.

RESULTS

Pyrazinamide increased MDA land decreased tGSH, SOD, and CAT levels in liver tissues (p < 0.001). It also increased serum ALT and AST activities and caused severe hydropic degeneration and necrosis in liver tissue (p < 0.001). ATP, TPP, melatonin, and Liv-52 significantly prevented the biochemical and histopathological changes induced by pyrazinamide (p < 0.05). On the other hand, Liv-52 was more successful than other potential protectors in protecting liver tissue from pyrazinamide damage (p < 0.05).

CONCLUSIONS

ATP, TPP, melatonin, and Liv-52 can be used to protect liver tissue from pyrazinamide-induced hepatotoxicity in rats.

Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases

Aminotransferases, particularly alanine aminotransferase (ALT), are commonly used in the detection, diagnosis, and management of chronic liver diseases. ALT, a sensitive and cost-effective marker of liver injury, remains pivotal in predicting clinical outcomes and guiding interventions in several chronic liver diseases including metabolic dysfunction-associated steatotic liver disease, and chronic viral hepatitis. This study aims to explore the evolving role of ALT as a biomarker. A comprehensive review of evidence was conducted, focusing on studies evaluating ALT thresholds, diagnostic accuracy, and integration with non-invasive liver assessment tools. Special emphasis was given to novel approaches, including artificial intelligence-driven algorithms. Expert opinions from hepatology care perspectives were considered to assess the practical implications of refining ALT-based diagnostic strategies. ALT levels are influenced by diverse factors such as age, gender, and metabolic risks, challenging the use of specific thresholds as biomarker of disease and prognosis. Emerging evidence suggests redefining ALT ranges to enhance sensitivity and accuracy in detecting liver abnormalities. The integration of ALT with advanced non-invasive diagnostic tools, artificial intelligence, and comprehensive patient assessments can optimize early detection of liver disease, thus reducing underdiagnosis, particularly in asymptomatic or vulnerable populations. This work highlights the urgency to tailor the diagnostic approaches in primary and specialised care, ensuring timely and targeted intervention to effectively address the global burden of liver diseases.

The efficacy of sodium-glucose transporter 2 inhibitors in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis

The efficacy of sodium-glucose transporter 2 (SGLT-2) inhibitors for nonalcoholic fatty liver disease (NAFLD) is unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate SGLT-2 inhibitors efficacy for NAFLD treatment. We systematically searched major electronic databases (PubMed, Cochrane Library, Web of Science, Embase) from inception until 11/2023, identifying randomized controlled trials (RCTs) of SGLT-2 inhibitors treatment for patients with NAFLD. The mean differences (MD or SMD) and 95 % confidence intervals (CIs) were calculated via random-effects models. Eleven articles (n = 805 patients with NAFLD) were included in this study. Of these, 408 participants received SGLT-2 inhibitors, while 397 participants were in the control group. SGLT-2 inhibitors significantly reduced liver enzyme levels, including aspartate alanine aminotransferase (ALT) (MD [95 % CI]; -9.31 U/L [-13.41, -5.21], p < 0.00001), aspartate aminotransferase (AST) (MD [95 % CI]; -6.06 U/L [-10.98, -1.15], p = 0.02), and gamma-glutamyltransferase (GGT) (MD [95 % CI]; -11.72 U/L [-15.65, -7.80], p < 0.00001). SGLT-2 inhibitors intervention was also associated with significant reductions in body weight (MD [95 % CI]; -2.72 kg [-3.49, -1.95], p < 0.00001) and BMI (MD [95 % CI]; -1.11 kg/m2 [-1.39, -0.82], p < 0.00001) and improvements in glycaemic indices, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). However, no significant changes in total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) were observed. The meta-analysis revealed a beneficial effect of SGLT-2 inhibitors on liver functions and body weight, BMI, TG, HDL-C, and glucose homeostasis in patients with NAFLD, indicating that SGLT-2 inhibitors might be a clinical therapeutic strategy for these patients, especially individuals with concurrent type 2 diabetes mellitus (T2DM).

Hepatitis Associated with Catha edulis Consumption-A Single-Center Study

Background/Objectives:Catha edulis, also known as Khat, is a stimulant with hepatotoxic properties. Studies reporting laboratory patterns are scarce. The aim was to assess the patterns associated with hepatic dysfunction due to Khat usage. Methods: Patients with liver injury and self-reported Khat consumption presenting to the gastroenterology department at the King Fahad Central Hospital in Jazan between January 2017-May 2024 were retrospectively included in the study. Patients with any signs of cirrhosis or viral hepatitis were excluded to have a more homogenous inclusion. Normal distribution was not assumed; data were presented as the median (IQR or %). Results: Sixty-three patients (of which 62 (98.4%) were male) aged 35 (29-41) years were included in the study. An IgG > 20 g/L was present in 41 (61.5%) patients, and the majority (n = 48, 76.2%) had a hepatocellular injury pattern based on an R-factor > 5. Over half of the patients had at least one positive autoantibody(ANA 47.6%; SMA 55.6% and AMA 4.8%), while 57 (90.5%) patients received immunosuppressive therapy. Conclusions: Khat-induced liver injury seems to be predominantly AIH-like in nature, given the IgG elevation, hepatocellular injury pattern, and relatively high rate of autoantibody positivity.

Illness perception, coping and psychological distress among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) in China

OBJECTIVES

The study examined the effects of illness perception on mental health among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and the moderating role of coping style in this effect.

METHODS

The current study has collected the data of MAFLD patients at baseline and 8 months after. In both baseline and follow-up surveys, structural questionnaires were adopted to assess participants' illness perception (BIPQ), coping strategies (Brief COPE) and psychological distress (GHQ-12). A cross-lagged panel model was constructed to examine the associations between illness perception and psychological distress over 8 months. The moderating role of coping in the relationship between illness perception and psychological distress was addressed.

RESULTS

A total of 155 participants diagnosed with MAFLD were enrolled in the baseline survey, of which 71 patients engaged in the 8-month follow-up. The results showed that severe illness perceptions (perceiving MAFLD with more negative consequence, more negative emotions, lower coherence, and less treatment control) were associated with increased psychological distress 8 months later (β = 0.171, p < 0.05). Though approach coping showed an overall positive effect (β = 0.169, p < 0.05), people using it as a dominant strategy tend to be more subjected to the impacts of negative illness perceptions.

CONCLUSION

Threatening perceptions about MAFLD were associated with more psychological distress over time, and coping style has moderated the effects of illness perceptions. Healthcare providers should be aware of the impacts of negative illness perceptions, particularly when developing coping skill training programs to promote well-being and recovery.

Useful biomarkers for predicting poor prognosis of patients with drug-induced liver injury: A retrospective cohort study

BACKGROUND

Drug-induced liver injury (DILI) plays an important role in liver failure and causes mortality. Patients with DILI compatible with Hy's law are associated with poorer outcomes. However, the predictive accuracy of Hy's law is not good enough in clinical practice. This study aimed to investigate the optimal values of biomarkers associated with the prognosis of DILI.

METHODS

From June 1, 2014-May 30, 2022, patients with reported DILI were included. Patients' characteristics, drugs, DILI type, liver enzymes, and comorbidities were assessed. The associations with DILI-related comorbidities and survival were analyzed.

RESULTS

Ninety-five DILI patients were enrolled, 5 patients died of liver failure, and 23 patients died within 56 weeks after DILI. This study found that 15 mg/dL of total bilirubin, 1000 U/L of ALT, and 2 of PT-INR were optimal cut-off values in predicting DILI-related mortality. For the overall survival, patients with sepsis (HR:5.053, 95% CI:1.594-16.018, p = 0.006), malignancy (HR:4.371, 95% CI:1.573-12.147, p = 0.005), or end-stage renal disease (HR:7.409, 95% CI:1.404-39.103, p = 0.018) were independent poor prognostic factors in multivariate Cox regression analysis.

CONCLUSIONS

Total bilirubin >15 mg/dL, ALT >1000 U/L, and PT-INR >2 are useful biomarkers in predicting DILI-related mortality. DILI patients with sepsis, malignancy, or end-stage renal disease are associated with worse overall survival.

Impact of Helicobacter pylori Eradication on Clinical and Laboratory Parameters in Non-alcoholic Fatty Liver Disease Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

Helicobacter pylori (HP) infection is associated with non-alcoholic fatty liver disease (NAFLD) and insulin resistance; however, the correlation between HP eradication and NAFLD remains controversial. This systematic review and meta-analysis examined the effect of HP treatment on clinical and laboratory parameters in NAFLD patients.

METHODS

We conducted a literature search of the PubMed, Embase, Scopus, and Web of Science databases through September 2023 for randomized controlled trials (RCTs) examining the effect of HP treatment on NAFLD patients versus lifestyle changes alone. The primary outcome was the change in steatosis parameters. The secondary endpoints were changes in anthropometric parameters, inflammatory markers (TNF-α), and metabolic parameters (fasting blood glucose, homeostasis model assessment of insulin resistance, AST/ALT, and lipid profile). The random effects model was used to calculate the standardized mean difference (SMD) with associated 95% confidence intervals (CIs) for our desired outcome.

RESULTS

Four RCTs met our inclusion criteria. A total of 453 patients were included (mean age 42.8 years, 58.5% males), 228 (50.3%) of whom were in the HP eradication group and 225 (49.7%) of whom were in the lifestyle modification group. Compared with lifestyle modification alone, HP eradication had a significant effect on reducing liver steatosis and TNF-α levels (SMD: - 0.9; 95% CI - 14.67, - 3.82, I2 = 0% and SMD: - 6.3; 95% CI - 9.04, - 3.56, I2 = 0%, respectively). No significant effect on other metabolic parameters was found.

CONCLUSIONS

HP eradication significantly reduced liver steatosis and TNF-α levels in NAFLD patients. However, HP eradication did not significantly affect other metabolic indices compared to lifestyle changes alone.

The link between the ANPEP gene and type 2 diabetes mellitus may be mediated by the disruption of glutathione metabolism and redox homeostasis

Aminopeptidase N (ANPEP), a membrane-associated ectoenzyme, has been identified as a susceptibility gene for type 2 diabetes (T2D) by genome-wide association and transcriptome studies; however, the mechanisms by which this gene contributes to disease pathogenesis remain unclear. The aim of this study was to determine the comprehensive contribution of ANPEP polymorphisms to T2D risk and annotate the underlying mechanisms. A total of 3206 unrelated individuals including 1579 T2D patients and 1627 controls were recruited for the study. Twenty-three common functional single nucleotide polymorphisms (SNP) of ANPEP were genotyped by the MassArray-4 system. Six polymorphisms, rs11073891, rs12898828, rs12148357, rs9920421, rs7111, and rs25653, were found to be associated with type 2 diabetes (Pperm ≤ 0.05). Common haplotype rs9920421G-rs4932143G-rs7111T was strongly associated with increased risk of T2D (Pperm = 5.9 × 10-12), whereas two rare haplotypes such as rs9920421G-rs4932143C-rs7111T (Pperm = 6.5 × 10-40) and rs12442778A-rs12898828A-rs6496608T-rs11073891C (Pperm = 1.0 × 10-7) possessed strong protection against disease. We identified 38 and 109 diplotypes associated with T2D risk in males and females, respectively (FDR ≤ 0.05). ANPEP polymorphisms showed associations with plasma levels of fasting blood glucose, aspartate aminotransferase, total protein and glutathione (P < 0.05), and several haplotypes were strongly associated with the levels of reactive oxygen species and uric acid (P < 0.0001). A deep literature analysis has facilitated the formulation of a hypothesis proposing that increased plasma levels of ANPEP as well as liver enzymes such as aspartate aminotransferase, alanine aminotransferase and gammaglutamyltransferase serve as an adaptive response directed towards the restoration of glutathione deficiency in diabetics by stimulating the production of amino acid precursors for glutathione biosynthesis.

Hidden Partner of Immunity: Microbiome as an Innovative Companion in Immunotherapy

Recent studies have highlighted that the microbiome is the essential factor that can modulate the clinical activity of immunotherapy. However, the role of the microbiome varies significantly across different immunotherapies, suggesting that it is critical to understand the precise function of the microbiome in each type of immunotherapy. While many previous studies primarily focus on summarizing the role of the microbiome in immune checkpoint inhibitors, we seek to explore a novel aspect of the microbiome in other immunotherapies such as mesenchymal stem cell therapy, chimeric antigen receptor T cell therapy, and antibodies-based therapy (e.g., adalimumab, infliximab, bevacizumab, denosumab, etc.) which are rarely summarized in previous reviews. Moreover, we highlight innovative strategies for utilizing microbiome and microbial metabolites to enhance the clinical response of immunotherapy. Collectively, we believe that our manuscript will provide novel insights and innovative approaches to the researchers, which could drive the development of the next generation of personalized therapeutic interventions using microbiomes.

Two Clinically Implementable Digital PCR Assessments of DNA Methylation for Diagnosing Heavy Alcohol Consumption

BACKGROUND

Heavy alcohol consumption (HAC) has a profound adverse effect on human health. Unfortunately, there is a relative lack of tools that are easily implementable in clinical settings and that can be used to supplement self-reporting in the diagnosis and management of HAC. In part, this paucity is due to limitations of currently available biological measures and a mismatch between available biological measures and the needs of clinicians managing HAC.

OBJECTIVES

We first review the pros and cons of existing biological measures. Next, we review the underlying theory and the performance characteristics of two recently developed methylation-sensitive digital PCR (MSdPCR) assays, referred to as the Alcohol T Score (ATS) and ZSCAN25, for the assessment of chronic and recent HAC, respectively. Finally, we outline a paradigm for improving the clinical diagnosis and management of alcohol use disorders by utilizing these new markers of alcohol consumption.

CONCLUSIONS

We conclude that further studies to understand the test performance characteristics of each of these epigenetic tools in larger, diverse populations are in order.

Rosmarinic acid protects against cyclophosphamide-induced hepatotoxicity via inhibition of oxidative stress, inflammation, and apoptosis and upregulation of Nrf2 in mice

Cyclophosphamide (CP) is widely used in chemotherapy to treat various types of cancer. However, it is toxic to the liver and other organs. Rosmarinic acid (RA) possesses anti-inflammatory, antioxidant, and cytoprotective properties. This study investigated the protective effects of RA against CP-induced liver injury in mice. Mice were treated with RA (25, 50, and 100 mg/kg) for 15 days and followed by a single injection of CP on day 16th. CP injection resulted in an elevation in serum AST, ALT, and ALP, along with multiple histopathological alterations in the liver. CP also induced increased levels of MDA and NO, associated with declined GSH, SOD and CAT. RA pretreatment prevented liver injury, alleviated the enhanced levels of MDA and NO, and restored antioxidants defenses, hence avoiding the oxidative injury in the liver. Moreover, RA pretreatment attenuated NF-κB p65 and proinflammatory cytokines levels. Liver of CP-injected mice also showed a decrease in Bcl2, accompanied with elevated BAX and caspase-3 expression, an effect that RA pretreatment alleviated. In addition, pretreatment of CP-administrated mice with RA restored the Nrf2 expression in the liver. Taken together, this study suggests a potential application value of RA in preventing CP hepatotoxicity and sheds light on the possible mechanism.

Exploring the therapeutic potential of triterpenoid saponins from Gymnema sylvestre: Mechanistic insights into hepatoprotection, immunomodulation, anticancer activities, molecular docking, and pharmacokinetics

The study comprehensively investigated the therapeutic potential of Gymnema sylvestre triterpenoid saponin extract (GST), encompassing its hepatoprotective, immunomodulatory, and anticancer activities. The study employed a Prednisolone (PRD)-induced immunosuppressed rat model to assess the hepatoprotective and immunomodulatory effects of GST. Using this model, GST was found to modulate haematopoiesis, improving RBC, platelet, and WBC counts, underscoring its potential in hematopoietic homeostasis. Organ atrophy, a hallmark of immunosuppression in spleen, thymus, liver, and kidneys, was reversed with GST treatment, reinforcing its hepatotrophic and organotropic capabilities. Elevated hepatic biomarkers, including alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and lipid peroxidase (LPO), indicative of hepatocellular injury and oxidative stress, were reduced with GST, underscoring its hepatoprotective and antioxidative effects. Additionally, GST restored depleted antioxidants glutathione (GSH) and superoxide dismutase (SOD), highlighting its strong antioxidative capabilities. Molecular insights revealed a downregulation of interleukin-2 (IL-2) and interleukin-4 (IL-4) mRNA in the spleen of immunosuppressed rats, while GST treatment significantly upregulated IL-2 and IL-4 mRNA expression, showcasing its immunomodulatory potential. Increased levels of tumor necrosis factor-α (TNF-α) associated with immune dysregulation were effectively decreased by GST, underscoring its role in modulating inflammatory responses and restoring immune balance. Molecular docking studies indicated strong inhibition of TNF-α by GST compounds. In terms of anticancer activity, GST demonstrated significant cytotoxicity against MCF-7, and MDA-MB-231 (breast cancer cell lines). Notably, GST demonstrated biocompatibility with normal CHO (Chinese hamster ovary cell line) and HUVEC (Human umbilical vein endothelial cells) cell lines. Molecular docking studies indicated strong inhibition of breast cancer proteins HER1 and HER2 (human epidermal growth factor receptors) by GST compounds. Additionally, pharmacokinetics, bioavailability, drug-likeness, and toxicity risk predictions suggest that GST compounds are pharmacologically favourable with no adverse effects.

Echinocystic acid inhibits sepsis-associated renal inflammation and apoptosis by targeting protein tyrosine phosphatase 1B

Thefruits of Gleditsia sinensis Lam. have been utilized to treat inflammatory diseases in China. Echinocystic acid (EA), one pentacyclic triterpenoid isolated from thefruits of G. sinensis, exhibits an anti-inflammatory effect. However, its anti-sepsis activity and mechanism of action, especially the protective effect against sepsis-associated acute kidney injury (SA-AKI), are not investigated yet. This study is to explore the efficacy and potential mechanism of EA on SA-AKI. EA elevated the function of multiple organs and effectively reduced the increased inflammation and apoptosis of kidney tissue and HK-2 cells. DARTS, CETSA, and molecular docking experiments revealed that EA could directly bind to protein tyrosine phosphatase 1B (PTP1B), a widespread prototype non-receptor tyrosine phosphatase. Collectively, EA can alleviate murine SA-AKI though restraining inflammation and apoptosis and may be a potential natural drug for remedying SA-AKI.

Comparison of serum alkaline phosphatase levels between two measurement methods in chronic hemodialysis patients in Japan: involvement of ABO blood group system and relationship with mortality risk

BACKGROUND

Elevated serum alkaline phosphatase (ALP) levels are a risk factor for all-cause mortality in hemodialysis patients. Traditionally in Japan, ALP measurements were conducted using the JSCC method, which yields higher ALP measurement values than the IFCC method, mainly due to its increased sensitivity to intestinal ALP.

METHODS

Serum total ALP levels before and after switching the assay method from JSCC to IFCC were compared among different blood types in 521 hemodialysis patients (Study 1). The association between ALP levels measured by the JSCC method and 7-year mortality was analyzed, including blood types and liver function parameters as covariates, in 510 hemodialysis patients (Study 2).

RESULTS

ALP levels measured by the JSCC method were approximately three times higher than those measured by the IFCC method, with significant elevation in patients with blood types B and O compared to those with blood types A and AB. Similarly, ALP levels measured by the IFCC method were significantly higher in patients with blood types B and O compared to those with blood types A and AB (Study 1). The highest tertile of ALP levels showed a significantly increased risk of all-cause mortality, even after adjusting for patient background. However, this significance disappeared when serum liver function-related or inflammatory markers were included as covariates (Study 2).

CONCLUSION

ALP levels measured by the JSCC method are associated with life prognosis, but caution should be exercised due to their elevation in patients with blood types B and O and in those with hepatic dysfunction or inflammation.

Embryonic exposure to flubendiamide induces hepatotoxicity in domestic chicks by altering drug-metabolizing enzymes, antioxidant status, and liver function

Pesticides have increased crop yield but severely impacted ecosystems and non-target organisms. Flubendiamide, a new generation pesticide, targets insect larvae but also affects non-target organisms. This study examines the effects of lowest observed effect concentration of technical grade flubendiamide (0.5 µg/µL) flubendiamide on chick liver, focusing on cytochrome P450 (CYP) enzyme expression, oxidative stress, and liver damage. Chick embryos treated with flubendiamide showed significant alterations in CYP mRNA and protein levels, indicating increased toxicant accumulation. Elevated CYP3A4, CYP1A1, CYP1A2, and CYP2C19 levels were noted, suggesting enhanced biotransformation and detoxification processes. However, increased oxidative byproducts led to oxidative stress, as evidenced by decreased glutathione (GSH) levels and elevated superoxide dismutase (SOD) and catalase activities. DCFDA staining confirmed increased hydrogen peroxide (H2O2) levels, indicating heightened reactive oxygen species (ROS). Liver function tests revealed significant increases in serum ALP, ALT, and AST levels, indicating acute liver damage. Histopathological analysis showed structural liver damage, including expanded sinusoidal spaces, impaired portal veins, and compromised hepatocyte architecture. These findings underscore flubendiamide's potential hepatotoxicity in non-target organisms, emphasizing the need for cautious pesticide use to minimize environmental impacts.

A new nano approach to prevent tumor growth in the local treatment of glioblastoma: Temozolomide and rutin-loaded hybrid layered composite nanofiber

Total resection of glioblastoma (GB) tumors is nearly impossible, and systemic administration of temozolomide (TMZ) is often inadequate. This study presents a hybrid layered composite nanofiber mesh (LHN) designed for localized treatment in GB tumor bed. The LHN, consisting of polyvinyl alcohol and core-shell polylactic acid layers, was loaded with TMZ and rutin. In vitro analysis revealed that LHNTMZ and LHNrutin decelerated epithelial-mesenchymal transition and growth of stem-like cells, while the combination, LHNTMZ +rutin, significantly reduced sphere size compared to untreated and LHNTMZ-treated cells (P < 0.0001). In an orthotopic C6-induced GB rat model, LHNTMZ +rutin therapy demonstrated a more pronounced tumor-reducing effect than LHNTMZ alone. Tumor volume, assessed by magnetic resonance imaging, was significantly reduced in LHNTMZ +rutin-treated rats compared to untreated controls. Structural changes in tumor mitochondria, reduced membrane potential, and decreased PARP expression indicated the activation of apoptotic pathways in tumor cells, which was further confirmed by a reduction in PHH3, indicating decreased mitotic activity of tumor cells. Additionally, the local application of LHNs in the GB model mitigated aggressive tumor features without causing local tissue inflammation or adverse systemic effects. This was evidenced by a decrease in the angiogenesis marker CD31, the absence of inflammation or necrosis in H&E staining of the cerebellum, increased production of IFN-γ, decreased levels of interleukin-4 in splenic T cells, and lower serum AST levels. Our findings collectively indicate that LHNTMZ +rutin is a promising biocompatible model for the local treatment of GB.

Chitosan-encapsulated selenium nanoparticles alleviate CCl4 induced hepatotoxicity through synergistically modulating NF-κB and Nrf2 signaling pathways and regulating Bcl-2 and Caspase-3 expression: A comprehensive study with multiple regression analysis

BACKGROUND

The delivery of selenium in a nano-form (Se-NPs) is a promising modality of treatment for various oxidative stress-induced diseases.

OBJECTIVE

This study aims to investigate the conceivable effects of selenium nanoparticles either alone (Se-NPs) or encapsulated with chitosan (Se-CS-NPs) on toxicity induced by CCl4 in rats.

METHODS

Eighty albino rats were divided equally into eight groups. The first group was the placebo. The second group was a positive control, while the third and the fourth groups got orally (Se-NPs 5 mg/Kg) and (Se-CS-NPs 225 mg/Kg) respectively. The fifth and sixth groups were protective groups in which Se-NPs or Se-CS-NPs were given simultaneously. The seventh and eighth groups were therapeutic as they received either Se-NPs or Se-CS-NPs after stopping the CCl4 injection for 4 weeks more.

RESULTS

Our results showed that the protective and therapeutic groups showed an increase in caspase-3 gene expression with a decline in the expression of Bcl-2, Nrf2, and AFP genes. Histopathological and immunohistochemical investigations showed the role of selenium nanoparticles either alone or coated with chitosan in decreasing fibrotic marker collagen I positive reaction CONCLUSION: Selenium nanoparticles showed an excellent effect in counteracting the toxic effect of carbon tetrachloride on liver functions, inflammation reactions, and apoptosis process. Moreover, using selenium nanoparticles has a strong role in preserving the liver architecture with its normal constituents. No additional benefit was observed when the selenium nanoparticles were encapsulated with chitosan.

Using a blend of oilseed meals in the diets of Nile tilapia (Oreochromis niloticus): effects on the growth performance, feed utilization, intestinal health, growth, and metabolic-related genes

In this study, Nile tilapia were fed a blend of oilseed meals (BOM) that includes cottonseed meal (CSM), linseed meal (LSM), sesame meal (SSM), and sunflower meal (SFM) at a ratio of 1 CSM: 1 LSM: 1 SSM: 1 SFM. Six diets were formulated where the first diet included FM and SBM as protein sources and considered the positive control diet (FM). Another five FM-free diets were formulated, where SBM was substituted with BOM and included at 0, 100, 200, 300, and 400 g/kg diet. After 90 days, the FBW, WG, and PER were markedly increased while FCR decreased by FM-based diet and BOM at 0, 100, or 200 g/kg compared to fish-fed BOM at 300, and 400 g/kg (P < 0.05). The groups treated with BOM at 100-200 g/kg demonstrated considerable impairments, followed by those treated with BOM at 300 g/kg. Furthermore, fish given BOM at 400 g/kg had significantly less intestinal histological characteristics than the other groups. The relative expression of the IGF-1, GHR1, FABP, and CCK genes were downregulated in tilapia-fed BOM at 200, 300, and 400 g/kg compared to fish-fed FM-based diet (P < 0.05). The relative cost of feed per kg fish gain showed 4.42, 7.11, 8.14, 10.32, and 8.10% reduction rates in fish-fed SBM, or BOM at 100, 200, 300, and 400 g/kg. In conclusion, dietary BOM can be incorporated in Nile tilapia diets at up to 200 g/kg without affecting growth performance or feed utilisation. High inclusion levels (300 and 400 g/kg) may impair growth performance and feed utilisation by disrupting intestinal histological characteristics and reducing expression of growth and metabolic genes (GHR1, IGF-1, FABP, and CCK) in the liver.

Liver-related aspects of valoctocogene roxaparvovec gene therapy for hemophilia A: expert guidance for clinical practice

Adeno-associated virus-based gene therapy (valoctocogene roxaparvovec) is an attractive treatment for hemophilia A. Careful clinical management is required to minimize the risk of hepatotoxicity, including assessment of baseline liver condition to determine treatment eligibility and monitoring liver function after gene therapy. This article describes recommendations (developed by a group of hemophilia experts) on hepatic function monitoring before and after gene therapy. To prevent harmful liver-related effects, gene therapy is contraindicated in patients with uncontrolled liver infections, autoimmune hepatitis, liver stiffness ≥8 kPa, or cirrhosis. Before using gene therapy in patients with liver steatosis or other liver disorders, the risk of liver damage should be considered using a highly individualized approach. Treatment is not recommended in patients with abnormal liver enzymes, including alanine aminotransferase (ALT) at any level above the upper limit of normal (ULN). Therefore, pretreatment assessment of liver health should include laboratory tests, abdominal ultrasound, and liver stiffness measurements by transient elastography (TE). In the first year after therapy, ALT levels should be monitored 1 to 2 times per week to detect elevations ≥1.5× ULN, which may require immunosuppressant therapy. Patients with ALT elevation should receive prednisone 60 mg/d for 2 weeks, followed by stepwise tapering when ALT returns to baseline. ALT monitoring should continue long term (every 3-6 months), along with abdominal ultrasound (every 6 months) and TE (yearly) evaluations. When patients with good liver health are selected for treatment and closely monitored thereafter, ALT elevations can be promptly treated and are expected to resolve without long-term hepatic sequelae.

Effect of Hibiscus sabdariffa L. leaf flavonoid-rich extract on Nrf-2 and HO-1 pathways in liver damage of streptozotocin-induced diabetic rats

This study investigated the effects of flavonoid-rich extract from Hibiscus sabdariffa L. (Malvaceae) leaves on liver damage in streptozotocin-induced diabetic rats by evaluating various biochemical parameters, including the molecular gene expressions of Nrf-2 and HO-1 as well as histological parameters. The extract was found to significantly reduce liver damage, as evidenced by lower levels of fragmented DNA and protein carbonyl concentrations. Oxidative stress markers, including malondialdehyde (MDA) level, were also significantly (p < 0.05) decreased, while antioxidant biomarkers, like reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione-S-transferase (GST) were enhanced. Additionally, the extract improved the activities of key liver enzymes, including phosphatases and transaminases, and increased albumin levels. Importantly, the study demonstrated that H. sabdariffa extract effectively regulated the expression of Nrf-2 and HO-1, suggesting a significant role in mitigating liver damage. These findings highlight its potential as a therapeutic agent for liver protection in diabetic conditions.

Use of N-Acetylcysteine in the Management of Isoniazid-Induced Liver Injury in a Tuberculosis Patient: A Case Report

Drug-induced liver injury (DILI) is a rare but significant cause of acute liver failure, often challenging to diagnose due to its clinical similarity to other liver conditions. Since most drugs are metabolized by liver enzymes, the liver is at risk for hepatotoxicity. Although DILI has a low incidence in clinical practice, it remains a critical consideration for patients on potentially hepatotoxic medications. Acetaminophen is the most commonly implicated drug in DILI cases and is prioritized in toxicology screenings. Effective management of DILI requires the prompt discontinuation of the offending drug and supportive care. This case report discusses a 65-year-old male patient who developed elevated liver enzymes three weeks after starting tuberculosis treatment, raising suspicion of DILI. This report explores the diagnostic process, management strategies, and therapeutic role of N-acetylcysteine (NAC), emphasizing its mechanism of action, current clinical applications, and potential future uses in treating DILI.

The primary cause of markedly elevated aminotransferases in hospitalized patients with cirrhosis in ischemic hepatitis

BACKGROUND

Marked elevation in aminotransferases (≥1000 IU/l) is typically associated with acute liver injury. Here, we hypothesized that the cause of elevation in aminotransferases ≥1000 in patients with cirrhosis is likely due to a limited number of disorders and may be associated with poor outcomes.

AIM

We aimed to investigate the most common etiologies of acute elevations in aminotransferases in patients with cirrhosis, and to examine their associated outcomes.

METHODS

From May 2012 to December 2022, all hospitalized patients with cirrhosis and an aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/l were identified through Medical University of South Carolina's Clinical Data Warehouse. Complete clinical data were abstracted for each patient, and in-hospital mortality was examined.

RESULTS

The cohort was made up of 152 patients, who were 57 ± 12 years old, with 51 (34%) women. Underlying liver disease included mainly hepatitis C cirrhosis, alcohol-related cirrhosis, metabolic dysfunction-associated steatohepatitis cirrhosis, autoimmune cirrhosis, primary sclerosing cholangitis cirrhosis, and cryptogenic cirrhosis. The most common cause of marked elevation in aminotransferases in cirrhotic patients was ischemic hepatitis (71%), followed by chemoembolization (7%), autoimmune hepatitis (6%), drug-induced liver injury (3%), post-transjugular intrahepatic portosystemic shunt placement (3%), rhabdomyolysis (3%), and hepatitis C (2%). During hospitalization and over a 1-month follow-up period, the mortality rate in patients with ischemic hepatitis was 73% (79/108), while that for other causes of liver injury was 20% (9/44).

CONCLUSION

Ischemic hepatitis is the leading cause of marked elevation of aminotransferases in patients with cirrhosis, with distinctive clinical characteristics than other etiologies, and significantly poorer outcomes.

A prediction nomogram for mortality in patients following wasp stings: a retrospective study

Numerous studies have shown that wasp stings can lead to serious, sometimes fatal, health outcomes. Predicting deaths associated with wasp stings remains challenging yet is of critical importance. This study was conducted to identify predictors and develop a visual model for predicting mortality following wasp stings. Clinical data from 486 patients were analyzed, dividing them into two groups: survival group (N = 435) and death group (N = 51). Various statistical methods were used to create a prognostic model, including one-way analysis, the least absolute shrinkage and selection operator (LASSO) regression, and binary logistic regression. The model's accuracy was evaluated through ROC curves, calibration plots, and decision curve analysis (DCA). The study identified four key predictors of mortality: receiving more than 50 stings, having serum lactate dehydrogenase (LDH) levels of ≥ 2200 U/L, activated partial thromboplastin time (APTT) of ≥ 90 s, and the requirement for invasive mechanical ventilation within 24 h. These factors contributed to a model with an area under the ROC curve of 0.980 (95% CI: [0.968-0.992]), indicating high calibration and applicability. The decision curve analysis confirmed the model's substantial net clinical benefit. Thus, the number of stings, serum LDH, APTT, and the need for early invasive mechanical ventilation are reliable, independent predictors of death among patients experiencing wasp stings. The developed predictive model exhibits high levels of accuracy, sensitivity, consistency, and practical use.

Copaiba Oleoresin Improves Weight Gain and IL-10 Concentration, with No Impact on Hepatic Histology, in Liver Cirrhosis

Copaifera sp. is a native tree in the Amazon region. Copaiba oleoresin has components such as sesquiterpenes, which have anti-inflammatory and antioxidant potential. Liver cirrhosis is the end stage of liver disease with limited therapeutic options. We aimed to evaluate the effect of copaiba oleoresin supplementation on the liver of animals with thioacetamide (TAA)-induced cirrhosis. For the induction of liver cirrhosis, 100 mg/kg of TAA was administered intraperitoneally twice a week for 8 weeks. A total of 200 mg/kg/day of copaiba oleoresin was administered via gavage for the same period. Copaiba oleoresin supplementation improved cirrhosis-associated cachexia by increasing weight gain and body fat. In addition, copaiba oleoresin attenuated systemic inflammation, as shown by the decrease in the circulating C-reactive protein. In the liver, the copaiba oleoresin decreased carbonyl proteins and increased IL-10 compared with TAA-treated rats. TAA groups demonstrated increased SOD, catalase, GST, and GSH activity in the liver. In conclusion, the supplementation of copaiba oleoresin demonstrated a beneficial systemic effect in alleviating cirrhotic cachexia and antioxidant and anti-inflammatory action in the liver. However, it failed to improve the serological and histological markers of liver damage, which could be associated with the advanced stage of the disease.

Key Insights and Clinical Pearls in the Identification and Management of Cirrhosis and Its Complications

Cirrhosis is a prevalent, chronic condition with an asymptomatic compensated phase, in which patients may feel well, and a decompensated phase that begins with the onset of complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding). Because patients with cirrhosis may appear healthy with normal liver enzymes, alkaline phosphatase, and serum bilirubin levels, awareness of clinical signals is important. For example, patients with thrombocytopenia should be evaluated for chronic liver disease and cirrhosis. Early recognition and management of cirrhosis-related complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding) are important, given their association with hospitalization and poor prognosis (eg increased odds of short-term mortality). Hepatic encephalopathy can be the most subtle cirrhosis-related complication and associated cognitive impairment may be misdiagnosed. Because hepatic encephalopathy can be associated with hospital readmissions, reducing readmission rates after hepatic encephalopathy-related hospitalizations is critical. This includes incorporating ongoing therapy (eg rifaximin plus lactulose) in postdischarge management plans to reduce the risk of hepatic encephalopathy recurrence. Strategies that mitigate cirrhosis progression and prevent the development of cirrhosis-related complications are key to improving patient outcomes.

Virus Load Kinetics in Lassa Fever Patients Treated With Ribavirin: A Retrospective Cohort Study From Southern Nigeria

Background

The standard of care for Lassa fever is the use of ribavirin with supportive therapy. There is little information on the course of viremia and its relationship with clinical outcomes in patients treated with ribavirin.

Methods

We conducted a retrospective analysis of virologic and clinical parameters of 152 reverse transcription polymerase chain reaction-confirmed Lassa fever cases admitted and treated with ribavirin therapy. We describe the Lassa virus RNA kinetics in blood in relation to the clinical course of the patients.

Results

The overall mortality was 9%. The median duration (interquartile range [IQR]) of illness before admission was 8 (5-12) days. Median (IQR) Ct values on admission (t0 ) were lower among patients who died (21 [20-27]) than in those who survived (34 [30-37]; P < .01). The receiver operating characteristics curve of the association between outcome and Ct value at t0 had a high classification performance, with an AUC of 0.92 (95% CI, 0.86-0.98). The median time to viral clearance (IQR) was 10 (5-15) days. The viral load decreased steadily with the duration of treatment, and all survivors achieved viral clearance within 25 days of hospitalization.

Conclusions

Our study demonstrates that the Ct value on admission has prognostic value and Lassa fever patients treated with ribavirin typically clear the virus within 3-4 weeks of hospitalization. This kinetics has implications for the design of clinical case management and future clinical trial protocols.

Gamma-glutamyl transferase to aspartate aminotransferase ratio (GSR) predicts prognoses in patients with colorectal cancer with liver metastasis after microwave ablation

BACKGROUND

Microwave ablation (MWA) is widely used to eliminate colorectal liver metastases (CRLM). However, the risk of tumor recurrence is difficult to predict due to lack of reliable clinical and biological markers. Elevation of gamma-glutamyl transferase (GGT) and aspartate transaminase (AST) provides signals for liver inflammation and cancer progression. The present study evaluated the association between pre-ablation GGT to AST ratio index (GSR) and hepatic recurrence in patients with CRLM after MWA.

METHODS

A retrospectively analyzed 192 CRLM patients who underwent MWA from January 2013 to December 2017. Pre-ablation GSR was classified into high (≤ 2.34) or low (> 2.34) using the upper quartile value. The prognostic value of GSR and other risk factors for liver progression-free survival (LPFS) and cancer-specific survival (CSS) were evaluated by univariate and multivariate analyses.

RESULTS

High GSR was significantly associated with males (P = 0.041), the presence of cholelithiasis (P = 0.012), but not pre-ablation chemotherapy (P = 0.355), which caused significantly increased levels of GGT (P = 0.015) and AST (P = 0.008). GSR showed a significant association with LPFS and CSS through univariate analysis (P = 0.002 and 0.006) and multivariate analysis (P = 0.043 and 0.037). The subgroup analysis demonstrated no interaction between GSR and all variables except for distribution in the sub-analysis of LPFS.

CONCLUSIONS

Our findings suggest that the pre-ablation GSR can be considered as a promising prognostic indicator for poor prognosis of patients with CRLM underwent MWA.

TRIAL REGISTRATION

Not applicable.

Department of Pharmacology, Mahatma Gandhi Vidyamandirs Pharmacy College, Mumbai Agra Road, Panchavati, Nashik – 422 003, Maharashtra, India, M. M, Aswale MP, Department of Pharmacology, Mahatma Gandhi Vidyamandirs Pharmacy College, Mumbai Agra Road, Panchavati, Nashik – 422 003, Maharashtra, India, Kulkarni AN, Department of Rasashastra, A.S.S. Ayurved Mahavidyalaya, Nashik – 422 003, Maharashtra, India, Pande SP, Department of Rasashastra, A.S.S. Ayurved Mahavidyalaya, Nashik – 422 003, Maharashtra, India, Kulkarni RA, Department of Rasashastra, A.S.S. Ayurved Mahavidyalaya, Nashik – 422 003, Maharashtra, India. ASSESSMENT OF SUBCHRONIC ORAL TOXICITY AND SAFETY PROFILE OF SUVARNAPARPATI IN WISTAR RATS

Suvarnaparpati is an ayurvedic metallic formulation used in gastrointestinal and respiratory disorders and as an antipyretic. The inclusion of heavy metals like mercury, sulfur and calcinated gold in Suvarnaparpati raises concerns and may lead to safety issues. Consequently, this research explores the sub-chronic oral toxicity of Suvarnaparpati in Wistar rats, adhering to OECD guideline 408, to analyse its safety profile. 24 Wistar rats were segmented into four groups. Animals received suvarnaparpati treatment continuously for 90 days at specified doses of 20.59 mg kg-1 (therapeutic dose-TD), 83.12 mg kg-1. (TD × 4) and 205.3 mg kg-1 (TD × 10). The effect of this formulation was examined on the water intake, food intake, urine analysis, hematology, serum biochemistry, organ-to-body weight ratio and histopathology of various organs, after 90 days of oral administration. Suvarnaparpati does not exhibit dose-related toxicity in Wistar rats of either sex across the said doses and may therefore be considered safe for human consumption.

Investigation of the effects of Theranekron and Sorafenib treatments on carcinogenesis, apoptosis and biochemical profile in hepatocellular carcinoma in rats

This study aimed to investigate the effects of Tarantula cubensis alcohol extract (TCAE, Theranekron) and Sorafenib (S) treatments on carcinogenesis, apoptosis and biochemical profile of rats with experimentally induced hepatocellular carcinoma (HCC). In the presented study, 58 male rats were divided into 7 groups; Negative Control (NC, n = 6), NC + TCAE (NCT, n = 6), NC + Sorafenib (NCS, n = 6), Positive Control (PC, n = 10), Positive Control + TCAE (PCT, n = 10), Positive Control + Sorafenib (PCS, n = 10), Positive Control + TCAE + Sorafenib (PCTS, n = 10). The active ingredients Diethylnitrosamine (DEN, 120 mg/kg, single dose) and Nitrosomorpholine (NMOR, 50 ppm, 21 weeks orally) were used to induce HCC in rats. At the end of the experiment, the animals were euthanized under appropriate conditions and samples were collected for biochemical and pathological investigations. In the PC group, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) levels were higher (p < 0.001) and urea levels were lower (p < 0.001) compared to all other groups. Treatment groups reorganized the relevant markers (ALT, AST, GGT, and urea). A significant increase was detected in Caspase-10, Caspase-3 and Granzyme-B (GrzB) (p < 0.001) in blood and Caspase-10 and GrzB (p < 0.05) in liver tissue in PCT, PCS and PCTS groups compared to the PC group. Histopathological examination revealed that the PC group showed cancer morphology, and the treatment groups caused a decrease in tumor incidence and size. Our current findings suggest that the mechanism of action of TCAE in HCC is through the NKs/CTLs-GrzB-Casp10-Casp3 signaling pathway and can be used in combination with chemotherapy drugs for the development of future drug designs.

The protective effects of Lactobacillus SNK-6 on growth, organ health, and intestinal function in geese exposed to low concentration Aflatoxin B1

Aflatoxin B1 (AFB1) is a prevalent mycotoxin present in feed ingredients. In this study, we investigated the effects of Lactobacillus salivarius (L. salivarius) on the Landes geese exposed to AFB1. The 300 one-day-old Landes geese were randomly divided into five groups: The control group received a basic diet, while the other groups were fed a basic diet supplemented with 10 μg/kg AFB1, 10 μg/kg AFB1+ 4*108 cfu/g L. salivarius, 50 μg/kg AFB1, and 50 μg/kg AFB1 + 4*108 cfu/g L. salivarius for 63 d. Results showed that high level AFB1 exposure significantly decreased final BW and ADG, increased feed/gain ratio (F/G) and liver index (P < 0.05). L. salivarius improved levels of IL-1, IL-6, and IL-12 under low level of AFB1 exposure (P < 0.05), along with similar trends observed in serum IgA, IgG, IgM, T3, T4, TNF-ɑ, and EDT (P < 0.05). AFB1 exposure reduced jejunum villus high and villus high/crypt depth ratio, and suppressed expression of ZO-1, Occludin, and Claudin-1 mRNA, and significant improved with L. salivarius supplementation under low level AFB1 exposure (P < 0.05). AFB1 significantly increased expression levels of TLR3 and NF-kB1, with supplementation of L. salivarius showing significant improvement under low AFB1 exposure (P < 0.05). Cecal microbiota sequencing revealed that under low level AFB1 exposure, supplementation with L. salivarius increased the abundance of Bacteroidetes and Lactococcus. In summary, supplementation with 4*108 cfu/g L. salivarius under 10 μg/kg AFB1 exposure improved growth performance and immune capacity, enhanced jejunum morphology, reduced liver inflammation, altered the cecal microbial structure, and positively affected the growth and development of geese.

New compatible pair of TCM: Paeoniae Radix Alba effectively alleviate Psoraleae Fructus-induced liver injury by suppressing NLRP3 inflammasome activation

Objective

Drug-induced liver injury (DILI), a type of acute inflammation, has sparked significant concern owing to its unpredictability and severity. Psoraleae Fructus (PF), an edible Chinese herb widely used in traditional Chinese medicine (TCM), causes liver injury. Therefore, the elucidation of the mechanism underlying PF-induced liver injury and the search for more effective means of detoxification using herbal compatibility has become an urgent issue. This study evaluated the hepatoprotective effects of Paeoniae Radix Alba (PRA), a hepatoprotective Chinese medicine, on PF-induced liver injury and explored the underlying mechanisms.

Methods

A rat model of lipopolysaccharide (LPS)-induced immune stress was established to evaluate the hepatotoxicity of PF and the detoxifying effect of PRA. Subsequently, inflammatory pathways were identified using network pharmacology. Finally, the molecular mechanism by which PRA alleviates PF-induced liver injury was validated using an inflammasome activation model in bone marrow-derived macrophages (BMDMs).

Results

In vivo, hepatocytes in rats treated with LPS + PF exhibited massive inflammatory infiltration and apoptosis, and the expression of liver injury indicators and inflammatory factors was significantly upregulated, which was reversed by PRA pretreatment. Network pharmacology showed that PRA alleviated PF-induced liver injury and was associated with the NOD-like receptor signaling pathway. Moreover, PF directly induced inflammasome activation in LPS-primed BMDMs which in turn induced caspase-1 activation and the secretion of downstream effector cytokines such as IL-1β. PRA pretreatment inhibited PF-induced activation of the NLRP3 inflammasome by mitigating the accumulation of mitochondrial reactive oxygen species (mtROS).

Conclusions

The present study demonstrates that PRA alleviated PF induced-liver injury by inhibiting NLRP3 inflammasome activation. The results of this study are expected to inform the prevention and control of PF-induced hepatotoxicity in clinical practice.

Potential relationships between apelin and metabolic-associated indices in transition dairy cows

Metabolic disorders pose significant challenges in transition dairy cows. Numerous parameters have been investigated in this context, and apelin has recently emerged as a potential metabolic indicator. Accordingly, this study aimed to assess the associations between this hormone and other metabolic parameters. Twenty-two adult Holstein-Friesian dairy cows, 21 days before their expected calving date, were selected for blood sampling and serum separation at four time points: 21 and 10 days before calving and 10 and 21 days after parturition. Serum concentrations of apelin, leptin, insulin, cortisol, T3, T4, non-esterified fatty acids, glucose, total protein, albumin, globulin, aspartate aminotransferase, alanine transaminase, triglycerides, cholesterol, high, low and very low-density lipoproteins, total, direct and indirect bilirubin were measured in these samples. Surrogate indices for insulin resistance, body condition score, and milk production were also evaluated. Throughout the transition period, a significant increase in apelin levels was observed. Various models were employed to identify associations between apelin and the studied metabolic parameters. Notably, significant correlations between apelin and Leptin, Insulin, Cortisol, T3, T4, NEFA, Cholesterol, LDL, VLDL, Total Protein, Albumin, Globulin, Total Bilirubin, Direct Bilirubin and Indirect Bilirubin were observed, with some being immediate while others developed over time. These findings indicate a mutual influence between apelin and specific metabolic indices. Changes in any component of the metabolic profile at one stage can lead to alterations in apelin levels in subsequent stages. The correlations uncovered between apelin and other components of the metabolic profile in transitioning dairy cows offer valuable insights, contributing to a better understanding of the potential effects of apelin on the studied indicators and vice versa.

Differences in the Ability of Lactic Acid Bacteria To Prevent Acute Alcohol-Induced Liver Injury via the Gut Microbiota-Bile Acid-Liver Axis

Probiotics can regulate gut microbiota and protect against acute alcohol-induced liver injury through the gut-liver axis. However, efficacy is strain-dependent, and their mechanism remains unclear. This study investigated the effect of lactic acid bacteria (LAB), including Lacticaseibacillus paracasei E10 (E10), Lactiplantibacillus plantarum M (M), Lacticaseibacillus rhamnosus LGG (LGG), Lacticaseibacillus paracasei JN-1 (JN-1), and Lacticaseibacillus paracasei JN-8 (JN-8), on the prevention of acute alcoholic liver injury in mice. We found that LAB pretreatment reduced serum alanine transaminase (ALT) and aspartate transaminase (AST) and reduced hepatic total cholesterol (TC) and triglyceride (TG). JN-8 pretreatment exhibited superior efficacy in improving hepatic antioxidation. LGG and JN-8 pretreatment significantly attenuated hepatic and colonic inflammation by decreasing the expression of interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) and increasing the expression of interleukin 10 (IL-10). JN-1 and JN-8 pretreatments have better preventive effects than other LAB pretreatment on intestinal barrier dysfunction. In addition, the LAB pretreatment improved gut microbial dysbiosis and bile acid (BA) metabolic abnormality. All of the strains were confirmed to have bile salt deconjugation capacities in vitro, where M and JN-8 displayed higher activities. This study provides new insights into the prevention and mechanism of LAB strains in preventing acute alcoholic liver injury.