1
|
Bertino G, Ardiri AM, Calvagno GS, Bertino N, Ruggeri MI, Malaguarnera M, Malaguarnera G, Toro A, Di Carlo I. Telbivudine on-treatment HBsAg loss in naive HBeAg negative chronic hepatitis B: a case report and brief review of the literature. Clin Ter 2012; 163:e429-e434. [PMID: 23306758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The authors describe the clinical case of a naive patient with chronic hepatitis HBV-related (CHB) HBeAg negative, treated with Telbivudine (LdT) 600mg/day. After six months of treatment, as well as it determines rapid, profound and sustained suppression of HBV replication, LdT induced a progressive decline of HBsAg serum level and HBsAg loss, probably through an immune modulator effect. Recent studies have indicated the possible action of LdT on the immune system and specifically it would be able to stimulate Th1 lymphocyte subpopulation by increasing their cytokines production, thus playing a major role in cleaning the HBV infection. This aspect appears to be of much interest in clinical practice, because on-treatment HBsAg rapid decline >1 log10 IU/mL during the first year of treatment is highly predictive for future HBsAg clearance and CHB resolution.
Collapse
Affiliation(s)
- G Bertino
- Hepatology Unit, Department of Medical and Pediatric Science, Cannizzaro Hospital, University of Catania, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Bertino G, Neri S, Bruno CM, Ardiri AM, Calvagno GS, Malaguarnera M, Toro A, Malaguarnera M, Clementi S, Bertino N, Di Carlo I. Diagnostic and prognostic value of alpha-fetoprotein, des-γ-carboxy prothrombin and squamous cell carcinoma antigen immunoglobulin M complexes in hepatocellular carcinoma. Minerva Med 2011; 102:363-371. [PMID: 22193346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The hepatocellular carcinoma (HCC) is one of the most common malignant tumors. It carries a poor survival rate and has an increasing incidence worldwide. In most cases, HCC is diagnosed at a late stage. Therefore, the prognosis of patients with HCC is generally poor and has a less than 5% 5-year survival rate. The aim of this study was compare the accuracy of α-fetoprotein (AFP), des-γ- carboxy prothrombin (DCP), squamous cell carcinoma antigen-immunoglobulin M complexes (SCCA-IgM Cs) in the early diagnosis and in the prognosis of HCC. A literature search identified the markers for hepatocellular carcinoma. A search of the literature was made using cancer literature and the PubMed database for the following keywords: "markers and HCC", "α-fetoprotein (AFP) and HCC", "Des-γ-carboxy prothrombin"(DCP) and HCC, "squamous cell carcinoma antigen-immunoglobulin M complexes" (SCCA-IgM Cs). Despite the large number of studies devoted to the immunohistochemistry of HCC, at the present time, the absolute positive and negative markers for HCC are still lacking, and even those characterized by very high sensitivity and specificity do not have an universal diagnostic usefulness. In conclusion none of the three biomarkers (AFP, DCP, SCCA-IgM Cs) is optimal. According to recent reviews, these biomarkers should be measured simultaneously and in combination with imaging techniques to increase the sensitivity, specificity, diagnostic accuracy and to make a reliable prognosis. Currently the recommended screening strategy for patients with cirrhosis includes the determination of serum AFP levels and an abdominal ultrasound every six months to detect HCC at an earlier stage.
Collapse
Affiliation(s)
- G Bertino
- Department of Internal Medicine and Systemic Diseases, Catania University, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Bertino G, Ardiri AM, Santonocito MM, Boemi PM. Some patients with HCC haven't abnornormal des-gamma-carboxy prothrombin and alpha-fetoprotein levels. Panminerva Med 2009; 51:133-134. [PMID: 19776714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
4
|
Bertino G, Ardiri AM, Boemi PM, Ierna D, Interlandi D, Caruso L, Minona E, Trovato MA, Vicari S, Li Destri G, Puleo S. A study about mechanisms of des-gamma-carboxy prothrombin's production in hepatocellular carcinoma. Panminerva Med 2008; 50:221-226. [PMID: 18927526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM Des-gamma-carboxy prothrombin (DCP) is an abnormal prothrombin, increased in serum of patients with hepatocellular carcinoma (HCC) as result of an acquired defect of post-translational carboxylation of prothrombin's precursor. It is unclear if the reduced activity of gamma-carboxylase is secondary to vitamin K deficiency or to an altered gene encoding this enzyme. The aim of this study was to evaluate the effect of vitamin K administration on DCP and alpha-fetoprotein (AFP) levels, to identify a relationship between vitamin K and DCP serum levels and to investigate mechanisms of serum elevation of DCP levels. METHODS The authors determined DCP and AFP serum levels and vitamin K concentration in 64 cirrhotics with HCC and in 60 cirrhotic subjects without HCC. In HCC subjects DCP and AFP levels were measured before and after vitamin K administration. A t-test for unpaired data was applied (P values <0.05 statistically significant). RESULTS Only HCC patients had detectable levels of DCP and significant AFP levels. Administration of vitamin K reduced DCP but not AFP levels in HCC patients. No correlation was observed between vitamin K concentration and DCP levels: vitamin K concentration was similar both in HCC patients and in control group without HCC; HCC patients had the same vitamin K concentration regardless of elevated o reduced DCP levels after vitamin K administration. CONCLUSION DCP detectable serum levels are the result not only of vitamin K deficiency or selective defects of carboxylase, because probably alterations of membrane receptors or cytoplasmatic transfers, that are necessary for the function of vitamin K, are involved.
Collapse
Affiliation(s)
- G Bertino
- Department of Internal Medicine and Systemic Diseases, Santa Marta Hospital, University of Catania, Catania, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Bertino G, Ardiri AM, Boemi P, Bruno CM, Valenti M, Mazzarino MC, Consolo M, Calvagno GS, Pulvirenti D, Neri S. Meaning of elevated CA 19-9 serum levels in chronic hepatitis and HCV-related cirrhosis. MINERVA GASTROENTERO 2007; 53:305-309. [PMID: 18043548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM Carbohydrate 19-9 antigen (CA 19-9) has been used in the diagnosis and follow-up of gastrointestinal tumors. However, a remarkable reduction of specificity has been described in subjects with chronic diseases. Elevated CA 19-9 serum levels have been described in non neoplastic liver diseases, such as hepatic cirrhosis, where they correlate with the fibrosis grade and the disease severity. The aim of the study is to evaluate CA 19-9 levels in chronic hepatitis patients (CH) and hepatic cirrhosis patients, Hepatitis C Virus (HCV)-correlated. Our goal was to establish whether elevated CA 19-9 levels can be considered a non casual event in chronic liver disease and whether a correlation can be found between CA 19-9 levels and the severity of the disease. METHODS 116 patients have been recruited (76 m, 40 f, average 54 years); 56 patients were affected by CH and 60 by hepatic cirrhosis (Child A). All patients were HCV+, genotype 1b. Patients positive to CA 19-9 high levels were subjected to abdominal echography, EGDS, colonscopy, abdominal CT. RESULTS Fifty two percent presented high levels of CA 19-9. None was affected by intestinal or pancreatic neoplasia, or colestatic icterus. CA 19-9 levels were elevated in 46% of patients with chronic hepatitis, and in 54% in patients with hepatic cirrhosis. Furthermore, CA 19-9 levels in hepatic cirrhosis compared to CA 19-9 levels in chronic hepatitis was statistically significant (P>0.007). CONCLUSION Increased serum levels of CA 19-9 are frequent in chronic viral hepatitis; this often does not indicate a contemporary neoplastic disease and correlates in a statistically significant way (P>0.007) with the severity of the disease.
Collapse
Affiliation(s)
- G Bertino
- Department of Internal Medicine and Systemic Diseases,St. Marta Hospital, University of Catania, Catania, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Bertino G, Ardiri AM, Boemi PM, Ierna D, Sciuto M, Cilio D, Pulvirenti D, Neri S. [Hepatic iron, iron depletion and response to therapy with peg-Interferon and Ribavirin in chronic hepatitis C. Pilot study]. Clin Ter 2007; 158:391-395. [PMID: 18062344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM To estimate whether pretreatment serum iron levels, the HIC (hepatic iron concentration) and the distribution of hepatic iron identify the long-term "responders" and "non-responders" to therapy with peg-IFN and RBV, and whether the addition of phlebotomy could increase the likelihood of therapeutic response. PATIENTS AND METHODS 45 subjects with chronic hepatitis C were taking peg-IFN alpha-2a 180 microg once a week and RBV 1000 mg/die. The "responders" continued therapy with peg-IFN plus RBV, while, the "non-responders" were subjected to phlebotomy. After two weeks and subsequently every month the patients were subjected to blood test and clinical appraisal. RESULTS Hepatic iron storage meaningfully conditions the outcome of therapy with peg-IFN and RBV, its reduction by phlebotomy favourably correlates with response to treatment and, at last, the semiquantitative histological appraisal would have to be included in the pre-treatment work-up of patients with chronic hepatitis C. CONCLUSIONS The study results, even though obtained on a small size of cases, allow to conclude that serum corporeal iron evaluation underestimates the real hepatic iron concentration; the hepatic iron concentration, in turn, negatively conditions the response to therapy with peg-IFN and RBV (by reducing the percentage of the fast virological response). Lastly, iron removal by phlebotomy favourably correlates with the response to treatment.
Collapse
Affiliation(s)
- G Bertino
- Dipartimento di Medicina Interna e Patologie Sistemiche, Ospedale Santa Marta, Università degli Studi di Catania, Italia.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Bertino G, Ardiri AM, Boemi PM, Ierna D, Pulvirenti D, Neri S. [A case of overlap syndrome: autoimmune idiopathic hepatitis/pulmonary idiopathic hypertension]. Clin Ter 2007; 158:313-315. [PMID: 17953282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In medical practice we frequently encounter autoimmune syndromes, called "overlap-syndromes," which are of difficult nosographic classification because of the presence of sero-immunologic and clinical features common to various diseases having an autoimmune pathogenesis. Some of these syndromes have already been extensively described in scientific literature such as, for example, the presence of clinical and biohumoral alterations with hepatic and extrahepatic involvement, in the course of viral and autoimmune chronic hepatitis. The described clinical case can be classified as a new "overlap syndrome": Type 1 autoimmune hepatitis (AIH)/Primary pulmonary hypertension (PPH). Although the presence of pulmonary hypertension has been extensively described in the course of various connective tissue diseases (S.L.E., Mixed Connective Tissue Disease, Scleroderma, Hashimoto's Thyroiditis, Sjögren's Syndrome), in recent scientific literature, the association is quite rare. The interest in the described clinical case lies both in the possibility to classify it in the context of a more complex "overlap syndrome" AIH/PPH and in the correlated diagnostic and therapeutic implications. Therefore, in cases of primary pulmonary hypertension, a thorough immunological and hepatic functionality study is always recommended in order to ensure an early diagnosis and a prompt AIH treatment, thus warding off the risk of a rapid progression in cirrhosis.
Collapse
Affiliation(s)
- G Bertino
- Dipartimento di Medicina Interna e Patologie Sistemiche Ospedale Santa Marta, Universittà degli Studi di Catania, Italia.
| | | | | | | | | | | |
Collapse
|
8
|
Bertino G, Ardiri AM, Bruno MC, Valenti M, Lerna D, Boemi PM, Interlandi D, Urso G, Fisichella A, Pulvirenti D, Neri S. [HAV infection in patients with chronic hepatitis C]. Clin Ter 2007; 158:223-5. [PMID: 17612281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM In most cases, hepatitis A virus (HAV) infection causes a self-limiting benign acute hepatitis which confers permanent acquired immunity. However, in patients with pre-existing chronic hepatitis, HAV superinfection can cause acute hepatitis with severe progression leading to a fulminant form or linked to the risk of a rapid deterioration of hepatic function. For such a reason, some Authors recommend anti-HAV vaccination for subjects with HCV-correlated chronic hepatitis before the initiation of peg-Interferon and Ribavirin treatment. Subsequently, the real prevalence of IgG anti-HAV antibodies in patients with HC HCV-related and in healthy subjects from Eastern Sicily has been verified. PATIENTS AND METHODS In 254 subjects affected by HC HCV-related it has been carried out the research of antibodies IgG and IgM anti HAV. The control group was formed by 685 non hepatopathic subjects, subdivided in range of ages. RESULTS 97.64% out of the patients affected by HC HCV related exhibit antibodies IgG anti HAV, while only 2.36% of them was negative. The prevalence of infection in the control group has been stratified in relation to different ranges of age of the people taken into consideration. CONCLUSIONS The results obtained in this study performed in our geographical area, let us to suggest that it is not necessary the anti HAV vaccination during the phase of pre-treatment for HC HCV-related.
Collapse
Affiliation(s)
- G Bertino
- Dipartimento di Medicina Interna e Patologie Sistemrniche, Ospedale Santa Marta, Università degli Studi di Catania, Italia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Bertino G, Ardiri AM, Alì FT, Boemi PM, Cilio D, Di Prima P, Fisichella A, Ierna D, Neri S, Pulvirenti D, Urso G, Mauceri B, Valenti M, Bruno CM. Obesity and related diseases: an epidemiologic study in eastern Sicily. MINERVA GASTROENTERO 2006; 52:379-85. [PMID: 17108868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM The aim of this study was to investigate the prevalence of obesity in a non selected cohort of adult subjects living in eastern Sicily. METHODS Out of 2 296 examined subjects, 834 (36.3%) were affected by obesity. Of these, only 160 (19.1%) were affected by obesity alone while 674 (80.9%) showed other associated pathologies. RESULTS The prevalence of arterial hypertension, diabetes mellitus, hepatic steatosis, hyperdyslipidemia and renal failure was significantly higher (P = 0.000) than in a control group of non-obese subjects comparable for sex and age. CONCLUSIONS In a large part of obese patients, the presence of insulin resistance was observed suggesting that this alteration can play a pivotal role in the development of some important metabolic and cardiovascular complications related to obesity.
Collapse
Affiliation(s)
- G Bertino
- Department of Internal Medicine and Systemic Diseases University of Catania, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|