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Bowman CA, Bichoupan K, Posner S, Schonfeld E, Pappas A, Woodward M, Schiano T, Branch AD. A Prospective Open-Label Dose-Response Study to Correct Vitamin D Deficiency in Cirrhosis. Dig Dis Sci 2024; 69:1015-1024. [PMID: 38217683 DOI: 10.1007/s10620-023-08224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/29/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Patients with advanced liver disease often have vitamin D deficiency, but the daily dosages of vitamin D3 needed to raise their serum 25-hydrodroxyvitamin D [25(OH)D] concentrations are unknown. OBJECTIVE We aimed to establish the dose-response relationship between vitamin D3 and 25(OH)D in patients with liver cirrhosis. DESIGN An open-label study of orally-administered vitamin D3 (gelcaps) was conducted in patients with liver cirrhosis using a tiered-dosing regimen: 4,000 IU/d for baseline 25(OH)D ≤ 15 ng/mL and 2,000 IU/d for baseline 25(OH)D > 15 to ≤ 25 ng/mL (NCT01575717). Supplementation continued for 6 months, or until liver transplantation. Changes in 25(OH)D were measured after ≥ 3 months. Dose-response data on 48 patients (21 receiving 4000 IU/d and 27 receiving 2,000 IU/d) reporting ≥ 80% adherence were analyzed using generalized estimating equations (GEE). RESULTS Among the 48 patients, 39 (81%) had 25(OH)D > 20 ng/mL while on supplements, and none experienced hypercalcemia. The magnitude of the increase in 25(OH)D was approximately twofold greater in patients receiving the higher dose. The mean incremental increase was 5.1 ng/ml ± 3.9 of 25(OH)D per 1000 IU/d of vitamin D3. Multivariable models demonstrated a significant positive relationship between baseline 25(OH)D and serum albumin (p < 0.01) and hemoglobin (p = 0.01), and a negative relationship with the MELD score (p < 0.01) and total bilirubin (p < 0.01). CONCLUSIONS A two-tiered dosing regimen of daily oral vitamin D3 supplementation safely raised 25(OH)D concentrations in the majority of adults with liver cirrhosis who were adherent to supplement use.
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Affiliation(s)
- Chip A Bowman
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University New York Presbyterian, New York, NY, USA
| | - Kian Bichoupan
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029, USA
| | - Shai Posner
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029, USA
| | - Emily Schonfeld
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029, USA
| | - Alexis Pappas
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029, USA
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Thomas Schiano
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029, USA
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029, USA.
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Doyle EH, Aloman C, El-Shamy A, Eng FJ, Kim-Schulze S, Rahman A, Schiano T, Heeger P, Branch AD. Imprinted immune abnormalities in liver transplant patients cured of hepatitis C with antiviral drugs. Liver Transpl 2024:01445473-990000000-00325. [PMID: 38315053 DOI: 10.1097/lvt.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024]
Abstract
Chronic HCV infection induces interferon and dysregulates immune responses through inflammation and chronic antigenic stimulation. Antiviral drugs can cure HCV, providing a unique opportunity to examine the immunological restoration that does and does not occur when a chronic viral infection is eradicated. We quantified blood cytokines levels and used mass cytometry to immunophenotype peripheral blood mononuclear cells before and after HCV cure in 2 groups of patients and controls. At baseline, serum interferon α and soluble CD163 (a macrophage product) were elevated in both liver transplant and nonliver transplant patients compared to controls; the frequencies of several peripheral blood mononuclear cell populations differed from controls; and programmed death protein 1-positivity was increased in nearly all T cell subsets. Many abnormalities persisted after HCV cure, including elevated programmed death protein 1 expression on CD4 naïve and central memory T cells, elevated soluble CD163, and expansion of the plasmablast/plasma cell compartment. Several myeloid-lineage subsets, including Ag-presenting dendritic cells, remained dysregulated. In mechanistic studies, interferon α treatment increased programmed death protein 1 on human T cells and increased T cell receptor signaling. The data identify immunological abnormalities that persist after curative HCV treatment. Before cure, high levels of interferon α may stimulate programmed death protein 1 expression on human T cells, causing persistent functional changes.
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Affiliation(s)
- Erin H Doyle
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Costica Aloman
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Ahmed El-Shamy
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- College of Graduate Studies, Master of Pharmaceutical Sciences Program
| | - Francis J Eng
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Seunghee Kim-Schulze
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adeeb Rahman
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Heeger
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Shaltiel T, Sarpel U, Branch AD. The adverse characteristics of hepatocellular carcinoma in the non-cirrhotic liver disproportionately disadvantage Black patients. Cancer Med 2024; 13:e6654. [PMID: 38230878 PMCID: PMC10905547 DOI: 10.1002/cam4.6654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/24/2023] [Accepted: 10/12/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Black patients have higher hepatocellular carcinoma (HCC)-related mortality than White patients and more often develop HCC in non-cirrhotic liver. HCC surveillance is primarily directed toward cirrhotic patients. We aimed to characterize HCC in non-cirrhotic patients and to identify factors associated with HCC beyond Milan criteria. METHODS Demographic, imaging, laboratory, and pathology data of HCC patients at our institution, 2003-2018, were reviewed, retrospectively. Race/ethnicity were self-reported. Cirrhosis was defined as a Fibrosis-4 score ≥3.25. RESULTS Compared to 1146 cirrhotic patients, 411 non-cirrhotic patients had larger tumors (median 4.7 cm vs. 3.1 cm, p < 0.01) and were less likely to be within Milan criteria (42.6% vs. 57.7%, p < 0.01). Among non-cirrhotic patients, Black patients had larger tumors (4.9 cm vs. 4.3 cm, p < 0.01) and a higher percentage of poorly differentiated tumors (39.4% vs. 23.1%, p = 0.02). Among cirrhotic patients, Black patients had larger tumors (3.3 cm vs. 3.0 cm, p = 0.03) and were less likely to be within Milan criteria (52.3% vs. 83.2%, p < 0.01). In multivariable analysis, lack of commercial insurance (OR 1.45 [CI 95% 1.19-1.83], p < 0.01), male sex (OR 1.34 [CI 95% 1.05-1.70], p < 0.01), absence of cirrhosis (OR 1.58 [CI 95% 1.27-1.98], p < 0.01) and Black race/ethnicity (OR 1.34 [CI 95% 1.09-1.66], p = 0.01) were associated with HCC beyond Milan criteria. Black patients had lower survival rates than other patients (p < 0.01). CONCLUSIONS Non-cirrhotic patients had more advanced HCC than cirrhotic patients. Black patients (with or without cirrhosis) had more advanced HCC than comparable non-Black patients and higher mortality rates. Improved access to healthcare (commercial insurance) may increase early diagnosis (within Milan criteria) and reduce disparities.
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Affiliation(s)
- Tali Shaltiel
- Division of Surgical Oncology, Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrea D. Branch
- Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Rutledge SM, Soper ER, Ma N, Pejaver V, Friedman SL, Branch AD, Kenny EE, Belbin GM, Abul-Husn NS. Association of HSD17B13 and PNPLA3 With Liver Enzymes and Fibrosis in Hispanic/Latino Individuals of Diverse Genetic Ancestries. Clin Gastroenterol Hepatol 2023; 21:2578-2587.e11. [PMID: 36610497 DOI: 10.1016/j.cgh.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND & AIMS Genetic variants affecting liver disease risk vary among racial and ethnic groups. Hispanics/Latinos in the United States have a high prevalence of PNPLA3 I148M, which increases liver disease risk, and a low prevalence of HSD17B13 predicted loss-of-function (pLoF) variants, which reduce risk. Less is known about the prevalence of liver disease-associated variants among Hispanic/Latino subpopulations defined by country of origin and genetic ancestry. We evaluated the prevalence of HSD17B13 pLoF variants and PNPLA3 I148M, and their associations with quantitative liver phenotypes in Hispanic/Latino participants from an electronic health record-linked biobank in New York City. METHODS This study included 8739 adult Hispanic/Latino participants of the BioMe biobank with genotyping and exome sequencing data. We estimated the prevalence of Hispanic/Latino individuals harboring HSD17B13 and PNPLA3 variants, stratified by genetic ancestry, and performed association analyses between variants and liver enzymes and Fibrosis-4 (FIB-4) scores. RESULTS Individuals with ancestry from Ecuador and Mexico had the lowest frequency of HSD17B13 pLoF variants (10%/7%) and the highest frequency of PNPLA3 I148M (54%/65%). These ancestry groups had the highest outpatient alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and the largest proportion of individuals with a FIB-4 score greater than 2.67. HSD17B13 pLoF variants were associated with reduced ALT level (P = .002), AST level (P < .001), and FIB-4 score (P = .045). PNPLA3 I148M was associated with increased ALT level, AST level, and FIB-4 score (P < .001 for all). HSD17B13 pLoF variants mitigated the increase in ALT conferred by PNPLA3 I148M (P = .006). CONCLUSIONS Variation in HSD17B13 and PNPLA3 variants across genetic ancestry groups may contribute to differential risk for liver fibrosis among Hispanic/Latino individuals.
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Affiliation(s)
- Stephanie M Rutledge
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emily R Soper
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ning Ma
- Division of Liver Medicine, Icahn School of Medicine Mount Sinai, New York, New York
| | - Vikas Pejaver
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott L Friedman
- Division of Liver Medicine, Icahn School of Medicine Mount Sinai, New York, New York
| | - Andrea D Branch
- Division of Liver Medicine, Icahn School of Medicine Mount Sinai, New York, New York
| | - Eimear E Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gillian M Belbin
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
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Rocha C, Doyle EH, Bowman CA, Fiel M, Stueck AE, Goossens N, Bichoupan K, Patel N, Crismale JF, Makkar J, Lewis S, Perumalswami PV, Schiano TD, Hoshida Y, Schwartz M, Branch AD. Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis. Cancer Med 2023; 12:10175-10186. [PMID: 37078924 PMCID: PMC10225173 DOI: 10.1002/cam4.5711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Successful treatment of hepatitis C reduces liver inflammation and fibrosis; however, patients remain at risk of developing hepatocellular carcinoma (HCC). AIMS To identify risk factors for new-onset HCC in patients cured of hepatitis C. METHODS Imaging, histological, and clinical data on patients whose first HCC was diagnosed >12 months of post-SVR were analyzed. Histology of 20 nontumor tissues was analyzed in a blinded manner using the Knodel/Ishak/HAI system for necroinflammation and fibrosis/cirrhosis stage and the Brunt system for steatosis/steatohepatitis. Factors associated with post-SVR HCC were identified by comparison with HALT-C participants who did not develop post-SVR HCC. RESULTS Hepatocellular carcinoma was diagnosed in 54 patients (45 M/9F), a median of 6 years of post-SVR [interquartile range (IQR) =1.4-10y] at a median age of 61 years (IQR, 59-67). Approximately one-third lacked cirrhosis, and only 11% had steatosis on imaging. The majority (60%) had no steatosis/steatohepatitis in histopathology. The median HAI score was 3 (1.25-4), indicating mild necroinflammation. In a multivariable logistic regression model, post-SVR HCC was positively associated with non-Caucasian race (p = 0.03), smoking (p = 0.03), age > 60 years at HCC diagnosis (p = 0.03), albumin<3.5 g/dL (p = 0.02), AST/ALT>1 (p = 0.05), and platelets <100 × 103 cells/μL (p < 0.001). Alpha fetoprotein ≥4.75 ng/mL had 90% specificity and 71% sensitivity for HCC occurrence. Noncirrhotic patients had larger tumors (p = 0.002) and a higher prevalence of vascular invasion (p = 0.016) than cirrhotic patients. CONCLUSIONS One-third of patients with post-SVR HCC did not have liver cirrhosis; most had no steatosis/steatohepatitis. Hepatocellular carcinomas were more advanced in noncirrhotic patients. Results support AFP as a promising marker of post-SVR HCC risk.
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Affiliation(s)
- Chiara Rocha
- Department of Surgery—Transplant DivisionIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erin H. Doyle
- Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount Sinai SchoolNew YorkNew YorkUSA
| | - Chip A. Bowman
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - M‐Isabel Fiel
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Ashley E. Stueck
- Department of PathologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Nicolas Goossens
- Division of Liver Diseases, Department of MedicineTisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kian Bichoupan
- Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Neal Patel
- Division of GastroenterologyDepartment of Medicine, Nuvance Health Danbury HospitalDanburyCTUSA
| | - James F. Crismale
- Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jasnit Makkar
- Department of RadiologyColumbia UniversityNew YorkNew YorkUSA
| | - Sara Lewis
- Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Thomas D. Schiano
- Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Yujin Hoshida
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Myron Schwartz
- Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrea D. Branch
- Division of Liver Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Ma N, Yip R, Lewis S, Dinani A, Wyatt C, Crane M, Jirapatnakul A, Li L, Aloman C, Bansal MB, Dieterich D, Wyatt B, Yankelevitz D, Henschke C, Branch AD. Environmental exposures are important risk factors for advanced liver fibrosis in African American adults. JHEP Rep 2023; 5:100696. [PMID: 36937989 PMCID: PMC10017423 DOI: 10.1016/j.jhepr.2023.100696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 03/21/2023] Open
Abstract
Background & Aims The prevalence and aetiology of liver fibrosis vary over time and impact racial/ethnic groups unevenly. This study measured time trends and identified factors associated with advanced liver fibrosis in the United States. Methods Standardised methods were used to analyse data on 47,422 participants (≥20 years old) in the National Health and Nutrition Examination Survey (1999-2018). Advanced liver fibrosis was defined as Fibrosis-4 ≥2.67 and/or Forns index ≥6.9 and elevated alanine aminotransferase. Results The estimated number of people with advanced liver fibrosis increased from 1.3 million (95% CI 0.8-1.9) to 3.5 million (95% CI 2.8-4.2), a nearly threefold increase. Prevalence was higher in non-Hispanic Black and Mexican American persons than in non-Hispanic White persons. In multivariable logistic regression analysis, cadmium was an independent risk factor in all racial/ethnic groups. Smoking and current excessive alcohol use were risk factors in most. Importantly, compared with non-Hispanic White persons, non-Hispanic Black persons had a distinctive set of risk factors that included poverty (odds ratio [OR] 2.09; 95% CI 1.44-3.03) and susceptibility to lead exposure (OR 3.25; 95% CI 1.95-5.43) but did not include diabetes (OR 0.88; 95% CI 0.61-1.27; p =0.52). Non-Hispanic Black persons were more likely to have high exposure to lead, cadmium, polychlorinated biphenyls, and poverty than non-Hispanic White persons. Conclusions The number of people with advanced liver fibrosis has increased, creating a need to expand the liver care workforce. The risk factors for advanced fibrosis vary by race/ethnicity. These differences provide useful information for designing screening programmes. Poverty and toxic exposures were associated with the high prevalence of advanced liver fibrosis in non-Hispanic Black persons and need to be addressed. Impact and Implications Because liver disease often produces few warning signs, simple and inexpensive screening tests that can be performed by non-specialists are needed to allow timely diagnosis and linkage to care. This study shows that non-Hispanic Black persons have a distinctive set of risk factors that need to be taken into account when designing liver disease screening programs. Exposure to exogenous toxins may be especially important risk factors for advanced liver fibrosis in non-Hispanic Black persons.
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Key Words
- ALD, alcohol-associated liver disease
- ALT, alanine aminotransferase
- APC, annual percent change
- Aetiology
- BMI, body mass index
- CI, confidence interval
- Environmental toxins
- FIB-4, Fibrosis-4
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HR, hazard ratio
- KI, kidney insufficiency
- LF, liver fibrosis
- MA, Mexican American
- NAFLD, non-alcoholic fatty liver disease
- NEI, no exposure identified
- NHANES, National Health and Nutrition Evaluation Survey
- NHB, non-Hispanic Black
- NHW, non-Hispanic White
- Non-invasive scores
- O, other race
- PCB, polychlorinated biphenyl
- Q1–Q4, quartiles 1–4
- Racial disparities
- Screening
- ULN, upper limit of normal
- USFLI, US Fatty Liver Index
- VH, viral hepatitis
- WC, waist circumference
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Affiliation(s)
- Ning Ma
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Artit Jirapatnakul
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Li
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Costica Aloman
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Meena B. Bansal
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Brooke Wyatt
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - David Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
- Corresponding author. Address: Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1123, New York, NY 10029, USA. Tel.: +1-212-659-8371; Fax: +1-212-849-2574.
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Park J, Zhao Y, Zhang F, Zhang S, Kwong AC, Zhang Y, Hoffmann HH, Bushweller L, Wu X, Ashbrook AW, Stefanovic B, Chen S, Branch AD, Mason CE, Jung JU, Rice CM, Wu X. IL-6/STAT3 axis dictates the PNPLA3-mediated susceptibility to non-alcoholic fatty liver disease. J Hepatol 2023; 78:45-56. [PMID: 36049612 PMCID: PMC9772150 DOI: 10.1016/j.jhep.2022.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS A number of genetic polymorphisms have been associated with susceptibility to or protection against non-alcoholic fatty liver disease (NAFLD), but the underlying mechanisms remain unknown. Here, we focused on the rs738409 C>G single nucleotide polymorphism (SNP), which produces the I148M variant of patatin-like phospholipase domain-containing protein 3 (PNPLA3) and is strongly associated with NAFLD. METHODS To enable mechanistic dissection, we developed a human pluripotent stem cell (hPSC)-derived multicellular liver culture by incorporating hPSC-derived hepatocytes, hepatic stellate cells, and macrophages. We first applied this liver culture to model NAFLD by utilising a lipotoxic milieu reflecting the circulating levels of disease risk factors in affected individuals. We then created an isogenic pair of liver cultures differing only at rs738049 and compared NAFLD phenotype development. RESULTS Our hPSC-derived liver culture recapitulated many key characteristics of NAFLD development and progression including lipid accumulation and oxidative stress, inflammatory response, and stellate cell activation. Under the lipotoxic conditions, the I148M variant caused the enhanced development of NAFLD phenotypes. These differences were associated with elevated IL-6/signal transducer and activator of transcription 3 (STAT3) activity in liver cultures, consistent with transcriptomic data of liver biopsies from individuals carrying the rs738409 SNP. Dampening IL-6/STAT3 activity alleviated the I148M-mediated susceptibility to NAFLD, whereas boosting it in wild-type liver cultures enhanced NAFLD development. Finally, we attributed this elevated IL-6/STAT3 activity in liver cultures carrying the rs738409 SNP to increased NF-κB activity. CONCLUSIONS Our study thus reveals a potential causal link between elevated IL-6/STAT3 activity and 148M-mediated susceptibility to NAFLD. IMPACT AND IMPLICATIONS An increasing number of genetic variants manifest in non-alcoholic fatty liver disease (NAFLD) development and progression; however, the underlying mechanisms remain elusive. To study these variants in human-relevant systems, we developed an induced pluripotent stem cell-derived multicellular liver culture and focused on a common genetic variant (i.e. rs738409 in PNPLA3). Our findings not only provide mechanistic insight, but also a potential therapeutic strategy for NAFLD driven by this genetic variant in PNPLA3. Our liver culture is therefore a useful platform for exploring genetic variants in NAFLD development.
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Affiliation(s)
- Jiwoon Park
- Laboratory of Virology and Infectious Disease, Rockefeller University, New York, NY, USA; Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, NY, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Yuanyuan Zhao
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Fan Zhang
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shaoyan Zhang
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew C Kwong
- Laboratory of Virology and Infectious Disease, Rockefeller University, New York, NY, USA; The Biological and Biomedical Sciences Program, Harvard Medical School, Boston, MA, USA
| | - Yujie Zhang
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Hans-Heinrich Hoffmann
- Laboratory of Virology and Infectious Disease, Rockefeller University, New York, NY, USA
| | - Leila Bushweller
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Xin Wu
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alison W Ashbrook
- Laboratory of Virology and Infectious Disease, Rockefeller University, New York, NY, USA
| | - Branko Stefanovic
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Shuyang Chen
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrea D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher E Mason
- Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, NY, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Jae U Jung
- Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Charles M Rice
- Laboratory of Virology and Infectious Disease, Rockefeller University, New York, NY, USA.
| | - Xianfang Wu
- Laboratory of Virology and Infectious Disease, Rockefeller University, New York, NY, USA; Infection Biology Program and Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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8
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Hershman M, Torbjornsen K, Pang D, Wyatt B, Dieterich DT, Perumalswami PV, Branch AD, Dinani AM. Modification of the Diabetes Prevention Program for the Treatment of Nonalcoholic Fatty Liver Disease: A Pilot Study. Obes Sci Pract 2022. [DOI: 10.1002/osp4.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Melissa Hershman
- Division of Gastroenterology Oregon Health & Science University Portland OR97329 United States of America
- Department of Gastroenterology and Hepatology Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
| | - Karen Torbjornsen
- Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
| | - Daniel Pang
- Department of Medicine Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
| | - Brooke Wyatt
- Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
| | - Douglas T Dieterich
- Division of Liver Diseases Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
| | - Ponni V Perumalswami
- Division of Liver Diseases Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
- Division of Gastroenterology and Liver Diseases University of Michigan Ann Arbor MI48109 United States of America
| | - Andrea D Branch
- Division of Liver Diseases Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
| | - Amreen M Dinani
- Division of Liver Diseases Icahn School of Medicine at Mount Sinai New York NY10029 United States of America
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9
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Perumalswami PV, Wyatt B, Bowman CA, Patel K, Mageras A, Lewis SC, Branch AD. Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C. Cancer Med 2022; 11:1995-2005. [PMID: 35261196 PMCID: PMC9089228 DOI: 10.1002/cam4.4508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) incidence and mortality vary by race/ethnicity and both are higher in Black patients than in Whites. For HCC surveillance, all cirrhotic patients are advised to undergo lifelong twice‐annual abdominal imaging. We investigated factors associated with surveillance and HCC incidence in a diverse HCC risk group, cirrhotic patients recently cured of hepatitis C virus (HCV) infection. Methods In this observational cohort study, all participants (n = 357) had advanced fibrosis/cirrhosis and were cured of HCV with antiviral treatment. None had Liver Imaging Reporting and Data System (LI‐RADS) 2–5 lesions prior to HCV cure. Ultrasound, computed tomography, and/or magnetic resonance imaging were used for surveillance. Results At a median follow‐up of 40 months [interquartile range (IQR) = 28–48], the median percentage of time up‐to‐date with surveillance was 49% (IQR) = 30%–71%. The likelihood of receiving a first surveillance examination was not significantly associated with race/ethnicity, but was higher for patients with more advanced cirrhosis, for example, bilirubin [odds ratio (OR) = 3.8/mg/dL, p = 0.002], private insurance (OR = 3.4, p = 0.006), and women (OR = 2.3, p = 0.008). The likelihood of receiving two or three examinations was significantly lower for non‐Hispanic Blacks and Hispanics versus non‐Hispanic Whites (OR = 0.39, and OR = 0.40, respectively, p < 0.005 for both) and for patients with higher platelet counts (OR = 0.99/10,000 cells/µl, p = 0.01), but higher for patients with private insurance (OR = 2.8, p < 0.001). Incident HCC was associated with higher bilirubin (OR = 1.7, p = 0.02) and lower lymphocyte counts (OR = 0.16, p = 0.01). Conclusions Contrary to best practices, HCC surveillance was associated with sociodemographic factors (insurance status and race/ethnicity) among patients cured of HCV. Guideline‐concordant surveillance is needed to address healthcare disparities.
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Affiliation(s)
- Ponni V Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brooke Wyatt
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chip A Bowman
- Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krupa Patel
- Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna Mageras
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara C Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Wyatt B, Perumalswami PV, Mageras A, Miller M, Harty A, Ma N, Bowman CA, Collado F, Jeon J, Paulino L, Dinani A, Dieterich D, Li L, Vandromme M, Branch AD. A Digital Case-Finding Algorithm for Diagnosed but Untreated Hepatitis C: A Tool for Increasing Linkage to Treatment and Cure. Hepatology 2021; 74:2974-2987. [PMID: 34333777 PMCID: PMC9299620 DOI: 10.1002/hep.32086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/29/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Although chronic HCV infection increases mortality, thousands of patients remain diagnosed-but-untreated (DBU). We aimed to (1) develop a DBU phenotyping algorithm, (2) use it to facilitate case finding and linkage to care, and (3) identify barriers to successful treatment. APPROACH AND RESULTS We developed a phenotyping algorithm using Java and SQL and applied it to ~2.5 million EPIC electronic medical records (EMRs; data entered January 2003 to December 2017). Approximately 72,000 EMRs contained an HCV International Classification of Diseases code and/or diagnostic test. The algorithm classified 10,614 cases as DBU (HCV-RNA positive and alive). Its positive and negative predictive values were 88% and 97%, respectively, as determined by manual review of 500 EMRs randomly selected from the ~72,000. Navigators reviewed the charts of 6,187 algorithm-defined DBUs and they attempted to contact potential treatment candidates by phone. By June 2020, 30% (n = 1,862) had completed an HCV-related appointment. Outcomes analysis revealed that DBU patients enrolled in our care coordination program were more likely to complete treatment (72% [n = 219] vs. 54% [n = 256]; P < 0.001) and to have a verified sustained virological response (67% vs. 46%; P < 0.001) than other patients. Forty-eight percent (n = 2,992) of DBU patients could not be reached by phone, which was a major barrier to engagement. Nearly half of these patients had Fibrosis-4 scores ≥ 2.67, indicating significant fibrosis. Multivariable logistic regression showed that DBUs who could not be contacted were less likely to have private insurance than those who could (18% vs. 50%; P < 0.001). CONCLUSIONS The digital DBU case-finding algorithm efficiently identified potential HCV treatment candidates, freeing resources for navigation and coordination. The algorithm is portable and accelerated HCV elimination when incorporated in our comprehensive program.
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Affiliation(s)
- Brooke Wyatt
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Ponni V. Perumalswami
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY,Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI,Gastroenterology SectionVeterans AffairsAnn Arbor Healthcare SystemAnn ArborMI
| | - Anna Mageras
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Mark Miller
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Alyson Harty
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Ning Ma
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Chip A. Bowman
- Department of MedicineIcahn School of Medicine Mount SinaiNew YorkNY
| | - Francina Collado
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Jihae Jeon
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Lismeiry Paulino
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Amreen Dinani
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Douglas Dieterich
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Li Li
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Maxence Vandromme
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine Mount SinaiNew YorkNY
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11
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Jirapatnakul A, Yip R, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI. Dose-response relationship between World Trade Center dust exposure and hepatic steatosis. Am J Ind Med 2021; 64:837-844. [PMID: 34328231 DOI: 10.1002/ajim.23269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The World Trade Center (WTC) attack exposed thousands of workers to toxic chemicals that have been linked to liver diseases and cancers. This study examined the relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis in the WTC General Responders Cohort (GRC). METHODS All low-dose computed tomography (CT) scans of the chest performed on the WTC GRC between September 11, 2001 and December 31, 2018, collected as part of the World Trade Center Health Program, were reviewed. WTC dust exposure was categorized into five groups based on WTC arrival time. CT liver density was estimated using an automated algorithm, statistics-based liver density estimation from imaging. The relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis was examined using univariate and multivariable regression analyses. RESULTS Of the 1788 WTC responders, 258 (14.4%) had liver attenuation less than 40 Hounsfield units (HU < 40) on their earliest CT. Median time after September 11, 2001 and the earliest available CT was 11.3 years (interquartile range: 8.0-14.9 years). Prevalence of liver attenuation less than 40 HU was 17.0% for arrivals on September 11, 2001, 16.0% for arrivals on (September 12, 2001 or September 13, 2001), 10.9% for arrivals on September 14-30, 2001, and 9.0% for arrivals on January 10, 2001 or later (p = 0.0015). A statistically significant trend of increasing liver steatosis was observed with earlier arrival times (p < 0.0001). WTC arrival time remained a significant independent factor for decreased liver attenuation after controlling for other covariates. CONCLUSIONS Early arrival at the WTC site was significantly associated with increasing hepatic steatosis.
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Affiliation(s)
- Artit Jirapatnakul
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rowena Yip
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Andrea D. Branch
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Sara Lewis
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health Icahn School of Medicine at Mount Sinai New York New York USA
| | - David F. Yankelevitz
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Claudia I. Henschke
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
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12
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Winters AC, Shaltiel T, Sarpel U, Branch AD. Liver Cancer Has a Distinctive Profile in Black Patients: Current Screening Guidelines May Be Inadequate. Hepatol Commun 2021; 6:8-11. [PMID: 34558225 PMCID: PMC8710783 DOI: 10.1002/hep4.1771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Adam C Winters
- Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Tali Shaltiel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Kim D, Adeniji N, Latt N, Kumar S, Bloom PP, Aby ES, Perumalswami P, Roytman M, Li M, Vogel AS, Catana AM, Wegermann K, Carr RM, Aloman C, Chen VL, Rabiee A, Sadowski B, Nguyen V, Dunn W, Chavin KD, Zhou K, Lizaola-Mayo B, Moghe A, Debes J, Lee TH, Branch AD, Viveiros K, Chan W, Chascsa DM, Kwo P, Dhanasekaran R. Predictors of Outcomes of COVID-19 in Patients With Chronic Liver Disease: US Multi-center Study. Clin Gastroenterol Hepatol 2021; 19:1469-1479.e19. [PMID: 32950749 PMCID: PMC7497795 DOI: 10.1016/j.cgh.2020.09.027] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19). METHODS We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD. RESULTS Of the 978 patients in our cohort, 867 patients (mean age 56.9 ± 14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29-4.55), decompensated cirrhosis (HR 2.91 [1.70-5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53-7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47-3.70]) and decompensated cirrhosis (OR 2.50 [1.20-5.21]) were independently associated with risk for severe COVID-19. CONCLUSIONS The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19. Clinicaltrials.gov number NCT04439084.
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Affiliation(s)
| | | | - Nyann Latt
- Ochsner Medical Center, New Orleans, Louisiana
| | | | | | - Elizabeth S. Aby
- Hennepin County Medical Center, Minneapolis, Minnesota,University of Minnesota, Minneapolis, Minnesota
| | | | - Marina Roytman
- University of California San Francisco, Fresno, California
| | - Michael Li
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | - Winston Dunn
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - Kali Zhou
- University of Southern California, Los Angeles, California
| | | | - Akshata Moghe
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - José Debes
- Hennepin County Medical Center, Minneapolis, Minnesota,University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Walter Chan
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Paul Kwo
- Stanford University, Stanford, California
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14
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Patel AA, Bui A, Prohl E, Bhattacharya D, Wang S, Branch AD, Perumalswami PV. Innovations in Hepatitis C Screening and Treatment. Hepatol Commun 2021; 5:371-386. [PMID: 33681673 PMCID: PMC7917266 DOI: 10.1002/hep4.1646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.
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Affiliation(s)
- Arpan A. Patel
- Division of Digestive DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
| | - Aileen Bui
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Eian Prohl
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Debika Bhattacharya
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
- Division of Infectious DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Su Wang
- Saint Barnabas Medical CenterLivingstonNJUSA
- World Hepatitis AllianceLondonUnited Kingdom
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Ponni V. Perumalswami
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
- Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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15
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Shaltiel T, Zheng S, Siderides C, Gleeson EM, Carr J, Pletcher ER, Cohen NA, Golas BJ, Magge DR, Labow DM, Branch AD, Sarpel U. Hepatitis C-positive Black patients develop hepatocellular carcinoma at earlier stages of liver disease and present with a more aggressive phenotype. Cancer 2021; 127:1395-1406. [PMID: 33629759 DOI: 10.1002/cncr.33377] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States, mortality after a diagnosis of hepatocellular carcinoma (HCC) is higher in patients who are Black than in patients of other racial groups. The objective of this study was to clarify factors contributing to this disparity by analyzing liver and tumor characteristics in patients with HCC who have a history of hepatitis C virus (HCV) infection. METHODS Records of patients with HCV and HCC at the authors' institution from 2003 to 2018 were retrospectively reviewed. Race and ethnicity were self-identified. Imaging, laboratory, and pathologic features were compared between Black and non-Black cohorts. RESULTS Among 1195 individuals with HCC, 390 identified as Black. At the time of HCC diagnosis, Black patients had better liver function, as measured by Child-Pugh score, Model of End-Stage Liver Disease score, histology of nontumor tissue, and fibrosis-4 (FIB-4) score (all P < .05). FIB-4 scores were <3.25 in 31% of Black patients. In addition, Black patients had less early stage HCC (20.2% vs 32.3%; P < .05), larger tumors (median [interquartile range]: 3.5 cm [2.2-6.2 cm] vs 3.1 cm [2.1-5.1 cm]; P < .01), more multiple tumors (median, [interquartile range]: 1 tumor [1-3 tumors] vs 1 tumor [1-2 tumors]; P = .03), more poorly differentiated tumors (30.3% vs 20.5%; P < .05), and more microvascular invasion (67.2% vs 56.5%; P < .05). CONCLUSIONS Black patients with HCV exposure develop HCC at earlier stages of liver disease than members of other racial groups. Nearly one-third would not qualify for HCC screening using the common FIB-4 cirrhosis threshold. Practice guidelines that stress HCC surveillance for cirrhotic patients with HCV may need to be revised to be more inclusive for Black patients. In addition, tumors in Black patients carry worse prognostic features, and molecular studies are needed to characterize their biologic properties.
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Affiliation(s)
- Tali Shaltiel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serena Zheng
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cleo Siderides
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth M Gleeson
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacquelyn Carr
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric R Pletcher
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Noah A Cohen
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin J Golas
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deepa R Magge
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Doyle EH, Aloman C, El-Shamy A, Eng F, Rahman A, Klepper AL, Haydel B, Florman SS, Fiel MI, Schiano T, Branch AD. A subset of liver resident natural killer cells is expanded in hepatitis C-infected patients with better liver function. Sci Rep 2021; 11:1551. [PMID: 33452360 PMCID: PMC7810844 DOI: 10.1038/s41598-020-80819-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
Viral hepatitis leads to immune-mediated liver injury. The rate of disease progression varies between individuals. We aimed to phenotype immune cells associated with preservation of normal liver function during hepatitis C virus (HCV) infection. Clinical data and specimens were obtained from 19 HCV-infected patients undergoing liver transplantation. Liver and peripheral blood mononuclear cells were isolated and eight subsets of innate immune cells were delineated by multiparameter flow cytometry. Cytokine assays and microarrays were performed. Intrahepatic CD56Bright/CD16- natural killer (NK) cells comprised the only subset correlating with better liver function, i.e., lower bilirubin (p = 0.0002) and lower model for end stage of liver disease scores (p = 0.03). The signature of liver NK cells from HCV-infected patients included genes expressed by NK cells in normal liver and by decidual NK cells. Portal vein blood had a higher concentration of interleukin (IL)-10 than peripheral blood (p = 0.03). LMCs were less responsive to toll-like receptor (TLR) stimulation than PBMCs, with fewer pro-inflammatory gene-expression pathways up-regulated after in vitro exposure to lipopolysaccharide and a TLR-7/8 agonist. Hepatic CD56Bright/CD16- NK cells may be critical for maintaining liver homeostasis. Portal vein IL-10 may prime inhibitory pathways, attenuating TLR signaling and reducing responsiveness to pro-inflammatory stimuli.
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Affiliation(s)
- Erin H Doyle
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai School, 1425 Madison Ave., Icahn 11-23, New York, NY, 10029, USA
| | | | - Ahmed El-Shamy
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai School, 1425 Madison Ave., Icahn 11-23, New York, NY, 10029, USA
| | - Francis Eng
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai School, 1425 Madison Ave., Icahn 11-23, New York, NY, 10029, USA
| | - Adeeb Rahman
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arielle L Klepper
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai School, 1425 Madison Ave., Icahn 11-23, New York, NY, 10029, USA
| | - Brandy Haydel
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Sander S Florman
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - M Isabel Fiel
- Department of Pathology, The Mount Sinai Hospital, New York, NY, USA
| | - Thomas Schiano
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Andrea D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai School, 1425 Madison Ave., Icahn 11-23, New York, NY, 10029, USA.
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17
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Abstract
Coronavirus disease 2019 (COVID-19) has created an emergency of epic proportions. While a vaccine may be forthcoming, this is not guaranteed, as discussed herein. The potential problems and ominous signs include (1) lung injury that developed in animals given an experimental vaccine for the severe acute respiratory syndrome coronavirus (SARS-CoV)-1; (2) a perversion of adaptive immune responses called antibody-dependent enhancement of infection that occurs in SARS-CoV-1 and that may occur in people vaccinated for COVID-19; (3) the frequent and recurrent infections that are caused by respiratory coronaviruses; and (4) the appearance of mutations in SARS-CoV-2 proteins, which raise the specter of vaccine escape mutants. Because success is uncertain, alternatives to vaccines need to be vigorously pursued during this critical moment in the pandemic. Alternatives include (1) engineered monoclonal antibodies that do not cause antibody-dependent enhancement; (2) cocktails of antiviral drugs and inhibitors of the cellular proteins required for SARS-CoV-2 replication; (3) interferons; and (4) anticoagulants, antioxidants, and immune modulators. To organize and coordinate the systematic investigation of existing therapies and new therapies (as they emerge), a Covid-19 clinical trials network is needed to provide (1) robust funding (on a par with vaccine funding) and administration; (2) an adaptive trial design committee to prioritize interventions and review results in real time; (3) a computer interface to facilitate patient enrollment, make data available to investigators, and present findings; (4) a practice guidelines study group; and (5) a mobile corps of COVID-19 experts available for rapid deployment, to assist local health care providers and enroll patients in trials as outbreaks occur. To combat the COVID-19 pandemic and future mass contagions, the network would be a cornerstone of a comprehensive infectious diseases research program.
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Affiliation(s)
- Andrea D. Branch
- Division of Liver DiseasesDepartment of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
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18
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Sung JC, Wyatt BE, Perumalswami PV, Branch AD. Response to 'hepatitis C cure improved patient-reported outcomes in patients with and without liver fibrosis in a prospective study at a large urban medical center'. J Viral Hepat 2020; 27:1502-1503. [PMID: 32841428 DOI: 10.1111/jvh.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/10/2020] [Indexed: 12/09/2022]
Abstract
Patient-reported outcomes (PROs) are important measures of quality of life. Direct-acting antiviral (DAA) drugs for hepatitis C virus (HCV) improved PROs in clinical trials. We prospectively evaluated the impact of DAA-based HCV cure on PROs and liver-related outcomes in real-world patients at a large urban medical centre. The Short Form (SF)-36 and three additional validated instruments were used. F3-4 fibrosis was defined as >9.6 kPa by transient elastography (TE); S2-3 steatosis was defined as >270 dB/m by TE-controlled attenuation parameter (CAP). Data were analysed by paired and unpaired t tests. Patients (n = 16) who did not achieve a sustained virologic response at 12 weeks (SVR12) were excluded. The study achieved its primary endpoint and showed a significant 30% improvement in the SF-36 vitality score, measured baseline to SVR12: 63 vs 82, P < .001 (n = 111). Scores in 24 of 25 PRO domains improved at SVR12 (P < .05). Nearly all gains exceeded 5%, indicating their clinical significance. Transaminase values and liver stiffness improved (decreased) significantly, baseline to SVR12 (p<0.005), but steatosis was unchanged (p=0.58). Patients with baseline F0-2 fibrosis and those with F3-F4 fibrosis both improved in 22 domains. Patients with baseline S0-S1 steatosis improved in more domains (23) than patients with S2-S3 steatosis (19). At baseline, patients with F3-F4 fibrosis and patients with S2-3 steatosis had worse scores in certain PRO domains than patients with F0-2 fibrosis or S0-S1 steatosis, but this difference resolved by SVR12. HCV cure led to meaningful gains in PROs, and these findings may encourage patients to seek treatment.
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Affiliation(s)
- Julie C Sung
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brooke E Wyatt
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Andrea D Branch
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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19
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Dinani AM, Lewis S, Branch AD, Perumalswami P. Working Up an Incidental Finding of Hepatic Steatosis on Imaging. Clin Liver Dis (Hoboken) 2020; 16:58-62. [PMID: 32922751 PMCID: PMC7474143 DOI: 10.1002/cld.926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/08/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Amreen M. Dinani
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Sara Lewis
- Department of RadiologyIcahn School of MedicineNew YorkNY
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Ponni Perumalswami
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
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20
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Li H, Marks KM, Talal AH, van Seggelen WO, Akil B, Radix A, Huprikar S, Branch AD, Wang S, Shaw GM, Fierer DS. Assessing routes of hepatitis C transmission in HIV-infected men who have sex with men using single genome sequencing. PLoS One 2020; 15:e0235237. [PMID: 32667919 PMCID: PMC7363067 DOI: 10.1371/journal.pone.0235237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023] Open
Abstract
The epidemic of hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) is in its second decade, but the routes of transmission remain poorly understood. We hypothesized that by pairing single genome sequencing (SGS), to enumerate infecting HCV genomes (viruses), with detailed sexual and drug histories, we could gain insight into the routes of transmission among MSM. We used SGS to analyze blood specimens from eight HIV-infected MSM who had 10 episodes of acute (seronegative) or early HCV infections. Seven of eight men reported condomless receptive anal intercourse (CRAI), six with rectal exposure to semen, and all eight denied rectal trauma or bleeding. Of the 10 HCV infections, eight resulted from transmission of a single virus; one infection resulted from transmission of either one or a few (three or four) closely-related viruses; and one infection resulted from transmission of >10 distinct viruses. The participant infected by >10 viruses reported sharing injection equipment for methamphetamine during sex. Two other participants also injected methamphetamine during sex but they did not share injection equipment and were infected by a single virus. Conclusions: Most HCV infections of HIV-infected MSM without a history of either rectal trauma or bleeding or shared injection equipment were caused by a single virus. Intra-rectal exposure to semen during CRAI is therefore likely sufficient for HCV transmission among MSM. Conversely, rectal trauma or bleeding or shared injection equipment are not necessary for HCV transmission among MSM. These results help clarify routes of HCV transmission among MSM and can therefore help guide the design of much-needed behavioral and other interventions to prevent HCV transmission among MSM.
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Affiliation(s)
- Hui Li
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kristen M. Marks
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Andrew H. Talal
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Wouter O. van Seggelen
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Bisher Akil
- Chelsea Village Medical, New York, New York, United States of America
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, United States of America
| | - Shirish Huprikar
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Shuyi Wang
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - George M. Shaw
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Daniel S. Fierer
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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21
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Dharmapuri S, Özbek U, Lin JY, Sung M, Schwartz M, Branch AD, Ang C. Predictive value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in advanced hepatocellular carcinoma patients treated with anti-PD-1 therapy. Cancer Med 2020; 9:4962-4970. [PMID: 32419290 PMCID: PMC7367631 DOI: 10.1002/cam4.3135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background Currently, there are no recognized or validated biomarkers to identify hepatocellular carcinoma patients (HCC) likely to benefit from anti–PD‐1 therapy. We evaluated the relationship between neutrophil‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR) and survival outcomes, pretreatment and after three doses (posttreatment) of nivolumab in HCC patients. Methods Medical records of HCC patients treated with nivolumab between June 2016 and July 2018 were reviewed. Kaplan‐Meier analysis and the log‐rank test were used to calculate and compare overall survival between NLR < 5 Vs ≥ 5 and among PLR tertiles. Results A total of 103 patients were identified. Median age was 66 (29‐89) years. Median treatment duration was 26 (2‐149) weeks. Sixty‐four (62%) patients had Child‐Pugh class A (CP‐A) liver function. Barcelona Clinic Liver Cancer stage was B in 20 (19%) and C in 83 (81%) patients. CP‐A patients who achieved a partial or complete response had significantly lower posttreatment NLR and PLR (P < .001 for both) compared to patients who had stable disease or progression of disease. No relationship was observed between response and pretreatment NLR and PLR. NLR < 5 was associated with improved OS compared to NLR ≥ 5 both pretreatment (23 Vs10 months, P = .004) and posttreatment (35 Vs 9 months, P < .0001). Survival also differed significantly among PLR tertiles both pre‐ (P = .05) and posttreatment (P = .013). In a multivariable model, posttreatment NLR (HR = 1.10, P < .001) and PLR (HR = 1.002, P < .001) were strongly associated with survival. In a composite model of posttreatment NLR and PLR, a combination of high NLR and PLR was associated with an eightfold increased risk of death (HR = 8.3, P < .001). Conclusions This study suggests a strong predictive role of these inflammatory cell ratios in the posttreatment setting in HCC patients treated with anti anti–PD‐1 therapy and should be evaluated in a larger cohort.
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Affiliation(s)
- Sirish Dharmapuri
- Department of Medicine, Division of Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Umut Özbek
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jung-Yi Lin
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Max Sung
- Department of Medicine, Division of Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Myron Schwartz
- Department of Surgery, Recanati/Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea D Branch
- Department of Medicine, Division of Liver Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celina Ang
- Department of Medicine, Division of Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Sung JC, Bosh C, Wyatt B, Miller M, Harty A, Del Bello D, Knight S, Dieterich DT, Perumalswami PV, Branch AD. Hepatitis C cure improved patient-reported outcomes in patients with and without liver fibrosis in a prospective study at a large urban medical center. J Viral Hepat 2020; 27:350-359. [PMID: 31742821 DOI: 10.1111/jvh.13234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022]
Abstract
Patient-reported outcomes (PROs) are important measures of quality of life. Direct-acting antiviral (DAA) drugs for hepatitis C virus (HCV) improved PROs in clinical trials. We prospectively evaluated the impact of DAA-based HCV cure on PROs and liver-related outcomes in real-world patients at a large urban medical center. The short form (SF)-36 and three additional validated instruments were used. F3-4 fibrosis was defined as > 9.6 kPa by transient elastography (TE); S2-3 steatosis was defined as > 270 dB/m by TE-controlled attenuation parameter (CAP). Data were analysed by paired and unpaired t tests. Patients (n = 16) who did not achieve a sustained virologic response at 12 weeks (SVR12) were excluded. The study achieved its primary endpoint and showed a significant 30% improvement in the SF-36 vitality score, measured baseline to SVR12: 63 versus 82, P < .001 (n = 111). Scores in 24 of 25 PRO domains improved at SVR12 (P < .05). Nearly all gains exceeded 5%, indicating their clinical significance. Transaminase values and liver stiffness improved (decreased) significantly, baseline to SVR12 (P < .005), but steatosis was unchanged (P = .58). Patients with baseline F0-2 fibrosis and those with F3-F4 fibrosis both improved in 22 domains. Patients with baseline S0-S1 steatosis improved in more domains (23) than patients with S2-S3 steatosis (19). At baseline, patients with F3-F4 fibrosis and patients with S2-3 steatosis had worse scores in certain PRO domains than patients with F0-2 fibrosis or S0-S1 steatosis, but this difference resolved by SVR12. HCV cure led to meaningful gains in PROs, and these findings may encourage patients to seek treatment.
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Affiliation(s)
- Julie C Sung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Ciara Bosh
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Brooke Wyatt
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Mark Miller
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Alyson Harty
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - David Del Bello
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Sterling Knight
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Douglas T Dieterich
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Ponni V Perumalswami
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Andrea D Branch
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
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23
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Branch AD. Escape from planned obsolescence: Hepatitis C, the cirrhotic liver, and clonal expansions. J Exp Med 2020; 217:133817. [PMID: 33002101 PMCID: PMC7062522 DOI: 10.1084/jem.20191070] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 11/04/2022] Open
Abstract
Eliminating the burden of disease caused by hepatitis C virus infection is proving difficult, despite the availability of curative drug treatments. Progress will require innovations in healthcare delivery and a deeper understanding of how the liver and other vital organs survive damage caused by chronic injury.
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24
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Chen X, Ma T, Yip R, Perumalswami PV, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI. Elevated prevalence of moderate-to-severe hepatic steatosis in World Trade Center General Responder Cohort in a program of CT lung screening. Clin Imaging 2019; 60:237-243. [PMID: 31945662 DOI: 10.1016/j.clinimag.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS To determine the prevalence of moderate-to-severe hepatic steatosis (HS) and associated risk factors in members of the World Trade Center (WTC) General Responder Cohort (GRC) who qualify for low-dose non-contrast computed tomography for lung cancer screening and compare them to non-WTC participants in the same screening program. METHODS All participants gave written informed consent before participating in this IRB-approved study. Clinical variables and laboratory values were recorded. Hepatic attenuation measurement (Hounsfield unit; HU) was measured on low-dose computed tomography (LDCT) and a threshold attenuation value <40HU indicated moderate-to-severe HS. Bivariate and multivariable linear and logistic regression analyses were performed. Propensity scores (PS) were calculated and inverse probability weighting (IPW) was used to adjust for potential confounders when comparing the WTC with non-WTC participants. RESULTS The prevalence of moderate-to-severe HS was 16.2% among 154 WTC participants compared to 5.3% among 170 non-WTC participants. In WTC members, moderate-to-severe HS was associated with higher BMI, higher laboratory liver function tests, and former smoking status. Using PS analysis and IPW to account for potential confounders, the odds ratio for moderate-to-severe HS was 3.4-fold higher (95% confidence interval: 1.7-6.7) in the WTC participants compared with non-WTC participants. Moderate-to-severe HS was also associated with higher BMI and former smoker status. CONCLUSION Prevalence of moderate-to-severe HS was >3-fold higher in the WTC-GRC group than in other participants.
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Affiliation(s)
- Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Radiology, Jiangmen Central Hospital, Jiangmen 529030, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, Tong Ren Hospital, Capital Medical University, Beijing 100730, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Michael Crane
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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25
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Singal AG, Rich NE, Mehta N, Branch AD, Pillai A, Hoteit M, Volk M, Odewole M, Scaglione S, Guy J, Said A, Feld JJ, John BV, Frenette C, Mantry P, Rangnekar AS, Oloruntoba O, Leise M, Jou JH, Bhamidimarri KR, Kulik L, Ioannou GN, Huang A, Tran T, Samant H, Dhanasekaran R, Duarte-Rojo A, Salgia R, Eswaran S, Jalal P, Flores A, Satapathy SK, Kagan S, Gopal P, Wong R, Parikh ND, Murphy CC. Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma. Gastroenterology 2019; 157:1253-1263.e2. [PMID: 31374215 PMCID: PMC6815711 DOI: 10.1053/j.gastro.2019.07.040] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/24/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is controversy regarding the benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs and patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy. METHODS We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting. RESULTS Of 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16-0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33-0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18-0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55-2.33). CONCLUSIONS In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.
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Affiliation(s)
- Amit G. Singal
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Nicole E. Rich
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Neil Mehta
- Division of Gastroenterology, University of California San Francisco
| | | | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago
| | - Maarouf Hoteit
- Division of Gastroenterology and Hepatology, University of Pennsylvania
| | - Michael Volk
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health
| | - Mobolaji Odewole
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Steven Scaglione
- Division of Hepatology, Loyola University Medical Center and Edward Hines Veterans Affairs
| | - Jennifer Guy
- Department of Transplantation, California Pacific Medical Center
| | - Adnan Said
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine
| | - Jordan J. Feld
- Toronto Center for Liver Disease, Toronto General Hospital
| | - Binu V. John
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center
| | | | | | | | | | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - Janice H. Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Science University
| | | | - Laura Kulik
- Division of Hepatology, Northwestern University
| | - George N. Ioannou
- Division of Gastroenterology and Research and Development, Veterans Affairs Puget Sound Healthcare System and University of Washington
| | - Annsa Huang
- Division of Gastroenterology, University of California San Francisco
| | - Tram Tran
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center
| | - Hrishikesh Samant
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center
| | | | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Hospital
| | | | - Prasun Jalal
- Division of Abdominal Transplantation, Baylor College of Medicine
| | - Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine
| | - Sanjaya K. Satapathy
- Division of Hepatology, Donald and Barbara Zucker School of Medicine, Northshore University Hospital, Northwell Health, Manhasset, New York
| | - Sofia Kagan
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Purva Gopal
- Department of Pathology, UT Southwestern Medical Center
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Alameda Health System
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26
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Jirapatnakul A, Reeves AP, Lewis S, Chen X, Ma T, Yip R, Chin X, Liu S, Perumalswami PV, Yankelevitz DF, Crane M, Branch AD, Henschke CI. Automated measurement of liver attenuation to identify moderate-to-severe hepatic steatosis from chest CT scans. Eur J Radiol 2019; 122:108723. [PMID: 31778964 DOI: 10.1016/j.ejrad.2019.108723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Develop and validate an automated method for measuring liver attenuation in non-contrast low-dose chest CT (LDCT) scans and compare it to the standard manual method for identifying moderate-to-severe hepatic steatosis (HS). METHOD The automated method identifies a region below the right lung within the liver and uses statistical sampling techniques to exclude non-liver parenchyma. The method was used to assess moderate-to-severe HS on two IRB-approved cohorts: 1) 24 patients with liver disease examined between 1/2013-1/2017 with non-contrast chest CT and abdominal MRI scans obtained within three months of liver biopsy, and 2) 319 lung screening participants with baseline LDCT performed between 8/2011-1/2017. Agreement between the manual and automated CT methods, the manual MRI method, and pathology for determining moderate-to-severe HS was assessed using Cohen's Kappa by applying a 40 HU threshold to the CT method and 17.4% fat fraction to MRI. Agreement between the manual and automated CT methods was assessed using the intraclass correlation coefficient (ICC). Variability was assessed using Bland-Altman limits of agreement (LoA). RESULTS In the first cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.97, κ = 1.00) with LoA of -7.6 to 4.7 HU. Both manual and automated CT methods had almost perfect agreement with MRI (κ = 0.90) and substantial agreement with pathology (κ = 0.77). In the second cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.94, κ = 0.87). LoA were -10.6 to 5.2 HU. CONCLUSION Automated measurements of liver attenuation from LDCT scans can be used to identify moderate-to-severe HS on LDCT.
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Affiliation(s)
- Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Anthony P Reeves
- School of Electrical and Computer Engineering, Cornell University, 392 Rhodes Hall, Ithaca, NY 14853, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Huangpu West Ave No. 613, Guangzhou, Guangdong, China; Department of Radiology, Jiangmen Central Hospital, No. 18 Zicha Road, Jiangmen, Guangdong, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States; Department of Radiology, Jiangmen Central Hospital, No. 18 Zicha Road, Jiangmen, Guangdong, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Xing Chin
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Shuang Liu
- School of Electrical and Computer Engineering, Cornell University, 392 Rhodes Hall, Ithaca, NY 14853, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1123, New York, NY 10029, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Michael Crane
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1123, New York, NY 10029, United States
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States.
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Nickolas TL, Yin MT, Hong T, Mugwanya KK, Branch AD, Heffron R, Ramalho J, Nandakumar R, Dworakowski E, Wanga V, Mugo NR, Ronald A, Celum C, Donnell D, Baeten JM, Wyatt CM. Impact of Tenofovir-Based Pre-exposure Prophylaxis on Biomarkers of Bone Formation, Bone Resorption, and Bone Mineral Metabolism in HIV-Negative Adults. Open Forum Infect Dis 2019; 6:ofz338. [PMID: 31660332 PMCID: PMC6778426 DOI: 10.1093/ofid/ofz338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) reduces the risk of HIV seroconversion but may promote bone mineral density (BMD) decline. The mechanisms of BMD decline with FTC/TDF remain unclear, and studies in HIV-positive individuals have been confounded by the effects of HIV and concomitant antiretroviral medications. We evaluated the impact of FTC/TDF on biomarkers of bone remodeling and bone mineral metabolism in HIV-negative men and women enrolled in the Partners PrEP Study. METHODS In a random sample of HIV-negative participants randomized to FTC/TDF PrEP (n = 50) or placebo (n = 50), serum parathyroid hormone (PTH), bone biomarkers (C-telopeptide, procollagen 1 intact N-terminal propeptide, and sclerostin), and plasma fibroblast growth factor 23 were measured at baseline and month 24, and the percentage change was compared between groups. In a complementary analysis, we compared the change in biomarkers between participants with and without a 25% decline in glomerular filtration rate (GFR) on FTC/TDF. RESULTS Baseline characteristics were similar between the groups (median age, 38 years; 40% women). Vitamin D insufficiency was common, but baseline GFR and PTH were in the normal range. We observed a significantly greater percent increase in serum C-telopeptide in participants randomized to FTC/TDF vs placebo (P = .03), suggesting an increase in bone remodeling. We observed no differences in the other biomarkers, or in a separate analysis comparing participants with and without a decline in GFR. CONCLUSIONS Increased bone remodeling may mediate the BMD decline observed with tenofovir-containing PrEP and antiretroviral therapy, independent of a TDF-mediated decrease in kidney function.
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Affiliation(s)
- Thomas L Nickolas
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Michael T Yin
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Ting Hong
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Kenneth K Mugwanya
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Andrea D Branch
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Renee Heffron
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Janaina Ramalho
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Renu Nandakumar
- Department of Medicine, Columbia University Medical Center, New York, New York
| | | | - Valentine Wanga
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Nelly R Mugo
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Allan Ronald
- Departments of Medicine and Medical Microbiology, University of Manitoba, Manitoba, Canada
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Deborah Donnell
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | - Christina M Wyatt
- Department of Medical Center, Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina
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Doyle EH, Rahman A, Aloman C, Klepper AL, El-Shamy A, Eng F, Rocha C, Kim S, Haydel B, Florman SS, Fiel MI, Schiano T, Branch AD. Individual liver plasmacytoid dendritic cells are capable of producing IFNα and multiple additional cytokines during chronic HCV infection. PLoS Pathog 2019; 15:e1007935. [PMID: 31356648 PMCID: PMC6687199 DOI: 10.1371/journal.ppat.1007935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/08/2019] [Accepted: 06/20/2019] [Indexed: 01/17/2023] Open
Abstract
Plasmacytoid dendritic cells (pDCs) are "natural" interferon α (IFNα)-producing cells. Despite their importance to antiviral defense, autoimmunity, and ischemic liver graft injury, because DC subsets are rare and heterogeneous, basic questions about liver pDC function and capacity to make cytokines remain unanswered. Previous investigations failed to consistently detect IFNα mRNA in HCV-infected livers, suggesting that pDCs may be incapable of producing IFNα. We used a combination of molecular, biochemical, cytometric, and high-dimensional techniques to analyze DC frequencies/functions in liver and peripheral blood mononuclear cells (PBMCs) of hepatitis C virus (HCV)-infected patients, to examine correlations between DC function and gene expression of matched whole liver tissue and liver mononuclear cells (LMCs), and to determine if pDCs can produce multiple cytokines. T cells often produce multiple cytokines/chemokines but until recently technical limitations have precluded tests of polyfunctionality in individual pDCs. Mass cytometry (CyTOF) revealed that liver pDCs are the only LMC that produces detectable amounts of IFNα in response TLR-7/8 stimulation. Liver pDCs secreted large quantities of IFNα (~2 million molecules of IFNα/cell/hour) and produced more IFNα than PBMCs after stimulation, p = 0.0001. LMCs secreted >14-fold more IFNα than IFNλ in 4 hours. Liver pDC frequency positively correlated with whole liver expression of "IFNα-response" pathway (R2 = 0.58, p = 0.007) and "monocyte surface" signature (R2 = 0.54, p = 0.01). Mass cytometry revealed that IFNα-producing pDCs were highly polyfunctional; >90% also made 2-4 additional cytokines/chemokines of our test set of 10. Liver BDCA1 DCs, but not BDCA3 DCs, were similarly polyfunctional. pDCs from a healthy liver were also polyfunctional. Our data show that liver pDCs retain the ability to make abundant IFNα during chronic HCV infection and produce many other immune modulators. Polyfunctional liver pDCs are likely to be key drivers of inflammation and immune activation during chronic HCV infection.
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Affiliation(s)
- Erin Heather Doyle
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Adeeb Rahman
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Costica Aloman
- Rush University Medical Center, Chicago, Illinois, United States of America
| | - Arielle L. Klepper
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ahmed El-Shamy
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Francis Eng
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chiara Rocha
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, United States of America
| | - Sang Kim
- Department of Anesthesiology, The Mount Sinai Hospital, New York, New York, United States of America
| | - Brandy Haydel
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, United States of America
| | - Sander S. Florman
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, United States of America
| | - M. Isabel Fiel
- Department of Pathology, The Mount Sinai Hospital, New York, New York, United States of America
| | - Thomas Schiano
- Recanati Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, United States of America
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
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29
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Zhang L, Mosoian A, Schwartz ME, Florman SS, Gunasekaran G, Schiano T, Fiel MI, Jiang W, Shen Q, Branch AD, Bansal MB. HIV infection modulates IL-1β response to LPS stimulation through a TLR4-NLRP3 pathway in human liver macrophages. J Leukoc Biol 2019; 105:783-795. [PMID: 30776150 DOI: 10.1002/jlb.4a1018-381r] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 12/11/2022] Open
Abstract
IL-1β is an important mediator of innate inflammatory responses and has been shown to contribute to liver injury in a number of etiologies. HIV patients have increased necroinflammation and more rapid fibrosis progression in chronic liver injury compared to non-HIV-infected patients. As the resident liver macrophage is critical to the IL-1β response to microbial translocation in chronic liver disease, we aim to examine the impact of HIV-1 and LPS stimulation on the IL-1β response of the resident hepatic macrophages. We isolated primary human liver macrophages from liver resection specimens, treated them with HIV-1BaL and/or LPS ex vivo, examined the IL-1β response, and then studied underlying mechanisms. Furthermore, we examined IL-1β expression in liver tissues derived from HIV-1 patients compared to those with no underlying liver disease. HIV-1 up-regulated TLR4 and CD14 expression on isolated primary CD68+ human liver macrophages and contributed to the IL-1β response to LPS stimulation as evidenced by TLR4 blocking. Nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) was shown to be involved in the IL-1β response of liver macrophages to HIV-1 infection and NLRP3 blocking experiments in primary CD68+ liver macrophages confirmed the contribution of the NLRP3-caspase 1 inflammatory signaling pathway in the IL-1β response. High in situ IL-1β expression was found in CD68+ cells in human liver tissues from HIV-1-infected patients, suggesting a critical role of IL-1β responses in patients infected by HIV. HIV infection sensitizes the IL-1β response of liver macrophages to LPS through up-regulation of CD14 and TLR4 expression and downstream activation of the NLRP3-caspase 1 pathway. These findings have implications for enhanced immune activation in HIV+ patients and mechanisms for rapid fibrosis progression in patients with chronic liver injury.
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Affiliation(s)
- Lumin Zhang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arevik Mosoian
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Myron E Schwartz
- Recanti-Miler Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sander S Florman
- Recanti-Miler Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ganesh Gunasekaran
- Recanti-Miler Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Recanti-Miler Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Wei Jiang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Qi Shen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea D Branch
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meena B Bansal
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Winters AC, Sung JC, Wyatt B, Berera D, Schiano TD, Schwartz ME, Perumalswami PV, Branch AD. At diagnosis of hepatocellular carcinoma, African Americans with hepatitis C have better liver function than other patients. Clin Liver Dis (Hoboken) 2018; 12:109-112. [PMID: 30416720 PMCID: PMC6220896 DOI: 10.1002/cld.745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Adam C. Winters
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Julie C. Sung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Brooke Wyatt
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Deeva Berera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Thomas D. Schiano
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Myron E. Schwartz
- Department of Surgery, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Ponni V. Perumalswami
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Andrea D. Branch
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
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31
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Azad A, Chang P, Devuni D, Bichoupan K, Kesar V, Branch AD, Oh WK, Galsky MD, Ahmad J, Odin JA. Real World Experience of Drug Induced Liver Injury in Patients Undergoing Chemotherapy. ACTA ACUST UNITED AC 2018; 2. [PMID: 30637414 DOI: 10.21767/2575-7733.1000047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background & Aim To better understand the clinical significance of drug induced liver injury (DILI) during chemotherapy, we examined the epidemiology, incidence, and treatment effects of DILI in patients undergoing chemotherapy for genitourinary malignancies over a two-year period. Methods We conducted a retrospective review of 284 patients who underwent chemotherapy for prostate, bladder, testicular and renal cell carcinomas over a two year period. Those with abnormal or absent liver test (LT) results prior to chemotherapy initiation were excluded. Post chemotherapy LT results were defined as DILI if ALT>3× ULN and/or total bilirubin (TB)>2× ULN, in the absence of other more likely causes of elevated LT. Results The cumulative incidence of DILI in the total study population was 6.1% (17/284), and in the population who had appropriate LT performed it increased to 18.9% (17/90). Chemotherapeutic agents were determined to be the cause of DILI in 82% (14/17) of patients, and the treatment plans were changed in 59% (10/17) of patients. Conclusion In this real world study, the cumulative incidence of DILI was higher than commonly reported in clinical trials, and the majority of affected patients had to have their cancer treatment altered or interrupted.
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Affiliation(s)
- Adiba Azad
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Paul Chang
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Deepika Devuni
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Kian Bichoupan
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | | | | | - William K Oh
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | | | - Jawad Ahmad
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Joseph A Odin
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
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32
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El-Shamy A, Branch AD, Schiano TD, Gorevic PD. The Complement System and C1q in Chronic Hepatitis C Virus Infection and Mixed Cryoglobulinemia. Front Immunol 2018; 9:1001. [PMID: 29910796 PMCID: PMC5992393 DOI: 10.3389/fimmu.2018.01001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022] Open
Abstract
The complement system bridges innate and adaptive immunity against microbial infections, with viral infection being a major trigger. Activation of the classical, alternative, and lectin pathways have been reported in chronic hepatitis C virus (HCV) infection and/or cryoglobulinemia. HCV infection leads to dysregulation of complement-mediated immune responses. Clinical and experimental evidence support involvement of complement in intra- and extrahepatic manifestations of HCV infection, such as liver fibrosis and type II cryoglobulinemia. In this review, we summarize studies that have investigated the interplay between HCV and the complement system to establish chronic infection and autoimmunity, as well as the association between HCV pathogenesis and abnormal complement profiles. Several unanswered questions are highlighted which suggest additional informative lines of investigation.
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Affiliation(s)
- Ahmed El-Shamy
- Division of Liver Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Pharmaceutical and Biological Sciences, California Northstate University, Elk Grove, CA, United States
| | - Andrea D Branch
- Division of Liver Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas D Schiano
- Division of Liver Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter D Gorevic
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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33
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Eng FJ, El-Shamy A, Doyle EH, Klepper A, Muerhoff AS, Branch AD. Newly discovered hepatitis C virus minicores circulate in human blood. Hepatol Commun 2017; 2:21-28. [PMID: 29404509 PMCID: PMC5776872 DOI: 10.1002/hep4.1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 12/18/2022] Open
Abstract
Hepatitis C virus (HCV) is one of the most prevalent causes of chronic blood‐borne infections worldwide. Despite developments of highly effective treatments, most infected individuals are unaware of their infection. Approximately 75% of infections are in low‐ and middle‐income countries; therefore, continuing research in HCV molecular virology and the development of vaccines and affordable diagnostics is required to reduce the global burden. Various intracellular forms of the HCV nucleocapsid (core) protein are produced in cell culture; these comprise the conventional p21 core and the newly discovered shorter isoforms (minicores). Minicores lack the N‐terminus of p21 core. This study was conducted to determine if minicores are secreted in cell culture and more importantly if they circulate in the blood of individuals infected with HCV. We also developed a new monoclonal antibody that detects minicores targeting a C‐terminal region common to p21 core and minicores. Direct evidence of minicores requires western blot analysis to distinguish the detection of p21 core from minicores. However, the sensitivity for western blot detection of HCV proteins from blood is nil without their prior purification/enrichment from blood. Therefore, we developed a purification method based on a heparin/Mn+2 precipitation of apolipoprotein B‐containing lipoproteins because HCV is thought to circulate as a hybrid lipoviral particle. Minicores are secreted in culture when cells are grown in the presence of human serum. The heparin/Mn+2 precipitate from HCV‐infected cell culture supernatants and from the blood of 4 patients with high‐titer genotype‐1 HCV contained minicores. Conclusion: Minicores are major newly discovered HCV proteins that are secreted and circulate in blood during natural infections. Minicore proteins have translational potential as targets in diagnostic assays and in vaccine development. (Hepatology Communications 2018;2:21–28)
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Affiliation(s)
- Francis J Eng
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
| | - Ahmed El-Shamy
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
| | - Erin H Doyle
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
| | - Arielle Klepper
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
| | - A Scott Muerhoff
- Abbott Diagnostics, Biologics Discovery and Design Abbott Laboratories Abbott Park IL
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
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34
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Bichoupan K, Tandon N, Crismale JF, Hartman J, Del Bello D, Patel N, Chekuri S, Harty A, Ng M, Sigel KM, Bansal MB, Grewal P, Chang CY, Leong J, Im GY, Liu LU, Odin JA, Bach N, Friedman SL, Schiano TD, Perumalswami PV, Dieterich DT, Branch AD. Real-world cure rates for hepatitis C virus treatments that include simeprevir and/or sofosbuvir are comparable to clinical trial results. World J Virol 2017; 6:59-72. [PMID: 29147645 PMCID: PMC5680347 DOI: 10.5501/wjv.v6.i4.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/03/2017] [Accepted: 09/17/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To assess the real-world effectiveness and cost of simeprevir (SMV), and/or sofosbuvir (SOF)-based therapy for chronic hepatitis C virus (HCV) infection.
METHODS The real-world performance of patients treated with SMV/SOF ± ribavirin (RBV), SOF/RBV, and SOF/RBV with pegylated-interferon (PEG) were analyzed in a consecutive series of 508 patients with chronic HCV infection treated at a single academic medical center. Patients with genotypes 1 through 4 were included. Rates of sustained virological response - the absence of a detectable serum HCV RNA 12 wk after the end of treatment [sustained virological response (SVR) 12] - were calculated on an intention-to-treat basis. Costs were calculated from the payer’s perspective using Medicare/Medicaid fees and Redbook Wholesale Acquisition Costs. Patient-related factors associated with SVR12 were identified using multivariable logistic regression.
RESULTS SVR12 rates were as follows: 86% (95%CI: 80%-91%) among 178 patients on SMV/SOF ± RBV; 62% (95%CI: 55%-68%) among 234 patients on SOF/RBV; and 78% (95%CI: 68%-86%) among 96 patients on SOF/PEG/RBV. Mean costs-per-SVR12 were $174442 (standard deviation: ± $18588) for SMV/SOF ± RBV; $223003 (± $77946) for SOF/RBV; and $126496 (± $31052) for SOF/PEG/RBV. Among patients on SMV/SOF ± RBV, SVR12 was less likely in patients previously treated with a protease inhibitor [odds ratio (OR): 0.20, 95%CI: 0.06-0.56]. Higher bilirubin (OR: 0.47, 95%CI: 0.30-0.69) reduced the likelihood of SVR12 among patients on SOF/RBV, while FIB-4 score ≥ 3.25 reduced the likelihood of SVR12 (OR: 0.18, 95%CI: 0.05-0.59) among those on SOF/PEG/RBV.
CONCLUSION SVR12 rates for SMV and/or SOF-based regimens in a diverse real-world population are comparable to those in clinical trials. Treatment failure accounts for 27% of costs.
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Affiliation(s)
- Kian Bichoupan
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Neeta Tandon
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, United States
| | - James F Crismale
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Joshua Hartman
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - David Del Bello
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Neal Patel
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Sweta Chekuri
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Alyson Harty
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Michel Ng
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Keith M Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Meena B Bansal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Priya Grewal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Charissa Y Chang
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Jennifer Leong
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Gene Y Im
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Lawrence U Liu
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Joseph A Odin
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Nancy Bach
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Scott L Friedman
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Thomas D Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Douglas T Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Shankar H, Blanas D, Bichoupan K, Ndiaye D, Carmody E, Martel-Laferriere V, Culpepper-Morgan J, Dieterich DT, Branch AD, Bekele M, Nichols K, Perumalswami PV. A Novel Collaborative Community-Based Hepatitis B Screening and Linkage to Care Program for African Immigrants. Clin Infect Dis 2017; 62 Suppl 4:S289-97. [PMID: 27190318 DOI: 10.1093/cid/ciw090] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sub-Saharan African nations have among the highest rates of chronic hepatitis B virus (HBV) infection worldwide, but little is known about HBV infection in African-born persons in the United States. METHODS From October 2011 to July 2013, community-based HBV screenings were conducted targeting persons originating from Africa in New York City. Persons were identified as currently HBV infected (HBsAg positive) or exposed (HBcAb positive). RESULTS Overall, 955 persons were screened for HBV; the median age was 45 years (interquartile range, 35-54 years) and 75.5% were men. Of these, 919 persons had no history of liver disease, of whom 9.6% (n = 88) had current HBV infection and 73.9% (n = 679) had exposure. In logistic regression, older age (odds ratio [OR], 0.97; 95% confidence interval [CI], .94-.99; P < .01) and female sex (OR, 0.35; 95% CI, .14-.75; P < .01) were less likely to be associated with HBV infection, whereas having a mother with hepatitis was associated with infection (OR, 18.8; 95% CI, 2.72-164.65; P < .01). HBV exposure was associated with older age (OR, 1.03; 95% CI, 1.01-1.04; P < .01), whereas female sex (OR, 0.46; 95% CI, .33-.66; P < .01) and history of blood transfusion (OR, 0.43; 95% CI, .22-.83; P = .01) were negatively associated. A patient navigator linked 97% of infected persons to care. Eleven persons were recommended for treatment, of whom 9 (82%) started therapy. Three persons were diagnosed with hepatocellular carcinoma on the first screening ultrasound. CONCLUSIONS The high burden of HBV infection among African immigrants in the United States underscores a need for continued screening and linkage to care in this at-risk population.
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Affiliation(s)
- Hari Shankar
- Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine
| | - Demetri Blanas
- Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine
| | - Kian Bichoupan
- Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine
| | | | - Ellie Carmody
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine
| | | | - Joan Culpepper-Morgan
- Division of Gastroenterology, Department of Medicine, Harlem Hospital Center, New York, New York
| | - Dougles T Dieterich
- Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine
| | | | | | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine
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Klepper A, Eng FJ, Doyle EH, El‐Shamy A, Rahman AH, Fiel MI, Avino GC, Lee M, Ye F, Roayaie S, Bansal MB, MacDonald MR, Schiano TD, Branch AD. Hepatitis C virus double-stranded RNA is the predominant form in human liver and in interferon-treated cells. Hepatology 2017; 66:357-370. [PMID: 27642141 PMCID: PMC5573989 DOI: 10.1002/hep.28846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/25/2016] [Accepted: 08/27/2016] [Indexed: 12/25/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) is unique among RNA viruses in its ability to establish chronic infection in the majority of exposed adults. HCV persists in the liver despite interferon (IFN)-stimulated gene (ISG) induction; robust induction actually predicts treatment failure and viral persistence. It is unclear which forms of HCV RNA are associated with ISG induction and IFN resistance during natural infections. To thoroughly delineate HCV RNA populations, we developed conditions that fully separate the strands of long double-stranded RNA (dsRNA) and allow the released RNAs to be quantified in reverse transcription/polymerase chain reaction assays. These methods revealed that dsRNA, a pathogen-associated molecular pattern (PAMP), comprised 52% (standard deviation, 28%) of the HCV RNA in the livers of patients with chronic infection. HCV dsRNA was proportionally higher in patients with the unfavorable IL28B TT (rs12979860) genotype. Higher ratios of HCV double-stranded to single-stranded RNA (ssRNA) correlated positively with ISG induction. In Huh-7.5 cells, IFN treatment increased the total amount of HCV dsRNA through a process that required de novo viral RNA synthesis and shifted the ratio of viral dsRNA/ssRNA in favor of dsRNA. This shift was blocked by ribavirin (RBV), an antiviral drug that reduces relapse in HCV patients. Northern blotting established that HCV dsRNA contained genome-length minus strands. CONCLUSION HCV dsRNA is the predominant form in the HCV-infected liver and has features of both a PAMP and a genomic reservoir. Interferon treatment increased rather than decreased HCV dsRNA. This unexpected finding suggests that HCV produces dsRNA in response to IFN, potentially to antagonize antiviral defenses. (Hepatology 2017;66:357-370).
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Affiliation(s)
| | | | | | | | | | | | | | - Moonju Lee
- Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Fei Ye
- Icahn School of Medicine at Mount SinaiNew YorkNY
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Chen X, Li K, Yip R, Perumalswami P, Branch AD, Lewis S, Del Bello D, Becker BJ, Yankelevitz DF, Henschke CI. Hepatic steatosis in participants in a program of low-dose CT screening for lung cancer. Eur J Radiol 2017; 94:174-179. [PMID: 28712697 DOI: 10.1016/j.ejrad.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Determine the frequency of moderate-to-severe hepatic steatosis (HS) in asymptomatic participants in a low-dose CT (LDCT) screening program for lung cancer, to identify risk factors, and develop recommendations. METHODS Baseline LDCT scans of the chest of 170 participants in an IRB-approved study between August 2011 and April 2016 were reviewed. Demographic variables, comorbidities, and liver function tests were documented. Hepatic and splenic attenuation values hounsfield unit (HU) were measured. Regression analyses were performed. RESULTS Average liver attenuation was 57.6HU (standard deviation (SD) 9.3) and average liver/spleen (L/S) ratio was 1.3 (SD 0.3). Liver attenuation was <40HU for 9 (5.3%), liver/spleen (L/S) ratio <0.8 for 6 (3.5%), and either <40HU or L/S ratio <0.8 for 9 (5.3%). Male sex (p=0.004), diabetes (p=0.0005), emphysema (p=0.03), and high BMI (p=0.0006) were significant predictors of HS. Aspartate aminotransferase (p=0.0018) and alanine aminotransferase (p=0.012) were negatively correlated with liver attenuation. Reduced serum levels of alpha-1-antitrypsin may be a common factor of emphysema and HS. CONCLUSION LDCT can detect HS in asymptomatic participants with frequencies similar to previous reports. If liver attenuation is below 40HU and/or L/S ratio below 0.8, further evaluation of HS to the primary care physician or liver specialist is recommended.
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Affiliation(s)
- Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Department of Radiology, Jiangmen Central Hospital, Jiangmen, 529030, China.
| | - Kunwei Li
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, China.
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Ponni Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - David Del Bello
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Betsy J Becker
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, FL, 32306, United States.
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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Bichoupan K, Tandon N, Martel-Laferriere V, Patel NM, Sachs D, Ng M, Schonfeld EA, Pappas A, Crismale J, Stivala A, Khaitova V, Gardenier D, Linderman M, Olson W, Perumalswami PV, Schiano TD, Odin JA, Liu LU, Dieterich DT, Branch AD. Factors associated with success of telaprevir- and boceprevir-based triple therapy for hepatitis C virus infection. World J Hepatol 2017; 9:551-561. [PMID: 28469811 PMCID: PMC5395804 DOI: 10.4254/wjh.v9.i11.551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate new therapies for hepatitis C virus (HCV), data about real-world outcomes are needed.
METHODS Outcomes of 223 patients with genotype 1 HCV who started telaprevir- or boceprevir-based triple therapy (May 2011-March 2012) at the Mount Sinai Medical Center were analyzed. Human immunodeficiency virus-positive patients and patients who received a liver transplant were excluded. Factors associated with sustained virological response (SVR24) and relapse were analyzed by univariable and multivariable logistic regression as well as classification and regression trees. Fast virological response (FVR) was defined as undetectable HCV RNA at week-4 (telaprevir) or week-8 (boceprevir).
RESULTS The median age was 57 years, 18% were black, 44% had advanced fibrosis/cirrhosis (FIB-4 ≥ 3.25). Only 42% (94/223) of patients achieved SVR24 on an intention-to-treat basis. In a model that included platelets, SVR24 was associated with white race [odds ratio (OR) = 5.92, 95% confidence interval (CI): 2.34-14.96], HCV sub-genotype 1b (OR = 2.81, 95%CI: 1.45-5.44), platelet count (OR = 1.10, per x 104 cells/μL, 95%CI: 1.05-1.16), and IL28B CC genotype (OR = 3.54, 95%CI: 1.19-10.53). Platelet counts > 135 x 103/μL were the strongest predictor of SVR by classification and regression tree. Relapse occurred in 25% (27/104) of patients with an end-of-treatment response and was associated with non-FVR (OR = 4.77, 95%CI: 1.68-13.56), HCV sub-genotype 1a (OR = 5.20; 95%CI: 1.40-18.97), and FIB-4 ≥ 3.25 (OR = 2.77; 95%CI: 1.07-7.22).
CONCLUSION The SVR rate was 42% with telaprevir- or boceprevir-based triple therapy in real-world practice. Low platelets and advanced fibrosis were associated with treatment failure and relapse.
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Perumalswami PV, Patel N, Bichoupan K, Ku L, Yalamanchili R, Harty A, Motamed D, Khaitova V, Chang C, Grewal P, Liu L, Schiano TD, Woodward M, Dieterich DT, Branch AD. High baseline bilirubin and low albumin predict liver decompensation and serious adverse events in HCV-infected patients treated with sofosbuvir-containing regimens. J Viral Hepat 2016; 23:667-76. [PMID: 26989855 DOI: 10.1111/jvh.12530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/11/2016] [Indexed: 01/05/2023]
Abstract
To conduct surveillance and determine the safety profile of new hepatitis C virus treatments in real-world clinical practice. Hepatic decompensation and other serious adverse events were investigated in an observational cohort study of 511 patients treated with regimens containing sofosbuvir, December 2013-June 2014. Among 499 previously stable patients (no history of hepatic decompensation during the previous 12 months), a nested case-control study was performed to identify predictors of decompensation/serious adverse event. Cases and controls were matched 1:5 based on treatment regimen and duration. Matched conditional logistic regression was used for analysis. Providers scored the likelihood that events were treatment-related (scale = 0-4). The cumulative incidence of decompensation/events was 6.4% for the total cohort. Among 499 previously stable patients, the incidence of decompensation/events was 4.5%; the mortality rate was 0.6%. Sixteen of the 499 experienced one or more serious complications considered to be at least potentially treatment-related, and the sustained virological response rate was 7/16 (44%). Two cases, both on sofosbuvir/simeprevir (without interferon or ribavirin), had complications consistent with autoimmune events (score 3, 'likely treatment-related'), and one experienced a flare of autoimmune hepatitis. Compared to controls, cases had higher baseline median model for end-stage liver disease scores (14 vs 8, P < 0.01). Decompensation/events was independently associated with lower baseline albumin (OR = 0.12/g/dL, P = 0.01) and higher total bilirubin (OR = 4.31/mg/dL, P = 0.01). Reduced hepatic function at baseline increased the risk of liver decompensation/events.
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Affiliation(s)
- P V Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Patel
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K Bichoupan
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Ku
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Yalamanchili
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Harty
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - D Motamed
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - V Khaitova
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Chang
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P Grewal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Liu
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Woodward
- Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - D T Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Chekuri S, Nickerson J, Bichoupan K, Sefcik R, Doobay K, Chang S, DelBello D, Harty A, Dieterich DT, Perumalswami PV, Branch AD. Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus. PLoS One 2016; 11:e0159413. [PMID: 27442255 PMCID: PMC4956253 DOI: 10.1371/journal.pone.0159413] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/02/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIM To investigate the impact of a sustained virological response (SVR) to hepatitis C virus (HCV) treatment on liver stiffness (LS). METHODS LS, measured by transient elastography (FibroScan), demographic and laboratory data of patients treated with interferon (IFN)-containing or IFN-free regimens who had an SVR24 (undetectable HCV viral load 24 weeks after the end of treatment) were analyzed using two-tailed paired t-tests, Mann-Whitney Wilcoxon Signed-rank tests and linear regression. Two time intervals were investigated: pre-treatment to SVR24 and SVR24 to the end of follow-up. LS scores ≥ 12.5 kPa indicated LS-defined cirrhosis. A p-value below 0.05 was considered statistically significant. RESULTS The median age of the patients (n = 100) was 60 years [IQR (interquartile range) 54-64); 72% were male; 60% were Caucasian; and 42% had cirrhosis pre-treatment according to the FibroScan measurement. The median LS score dropped from 10.40 kPa (IQR: 7.25-18.60) pre-treatment to 7.60 kPa (IQR: 5.60-12.38) at SVR24, p <0.01. Among the 42 patients with LS-defined cirrhosis pre-treatment, 25 (60%) of patients still had LS scores ≥ 12.5 kPa at SVR24, indicating the persistence of cirrhosis. The median change in LS was similar in patients receiving IFN-containing and IFN-free regimens: -1.95 kPa (IQR: -5.75 --0.38) versus -2.40 kPa (IQR: -7.70 --0.23), p = 0.74. Among 56 patients with a post-SVR24 LS measurement, the LS score changed by an additional -0.90 kPa (IQR: -2.98-0.5) during a median follow-up time of 1.17 (IQR: 0.88-1.63) years, which was not a statistically significant decrease (p = 0.99). CONCLUSIONS LS decreased from pre-treatment to SVR24, but did not decrease significantly during additional follow-up. Earlier treatment may be needed to reduce the burden of liver disease.
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Affiliation(s)
- Sweta Chekuri
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jillian Nickerson
- Department of Medical Education, Icahn School of Medicine at the Mount Sinai Medical Center, New York, NY, United States of America
| | - Kian Bichoupan
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Roberta Sefcik
- Department of Medical Education, Icahn School of Medicine at the Mount Sinai Medical Center, New York, NY, United States of America
| | - Kamini Doobay
- Department of Medical Education, Icahn School of Medicine at the Mount Sinai Medical Center, New York, NY, United States of America
| | - Sanders Chang
- Department of Medical Education, Icahn School of Medicine at the Mount Sinai Medical Center, New York, NY, United States of America
| | - David DelBello
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Alyson Harty
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Douglas T. Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ponni V. Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Del Bello D, Cha A, Sorbera M, Bichoupan K, Levine C, Doyle E, Harty A, Patel N, Ng M, Gardenier D, Odin J, Schiano TD, Fierer DS, Berkowitz L, Perumalswami PV, Dieterich DT, Branch AD. Real-World Sustained Virologic Response Rates of Sofosbuvir-Containing Regimens in Patients Coinfected With Hepatitis C and HIV. Clin Infect Dis 2016; 62:1497-1504. [PMID: 26936665 DOI: 10.1093/cid/ciw119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/24/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with hepatitis C virus (HCV) with or without human immunodeficiency virus (HIV) achieve high sustained virological response (SVR) rates on sofosbuvir (SOF)-containing regimens in clinical trials. Real world data on patients coinfected with HCV and HIV treated with SOF-based regimens are lacking. METHODS This observational cohort study included HIV/HCV-coinfected adults with genotype 1 HCV who initiated treatment with a SOF-containing regimen between December 2013 and December 2014 (n = 89) at the Mount Sinai Hospital or the Brooklyn Hospital Center. The primary outcome was SVR at 12 weeks after the end of treatment. The secondary outcomes were risk factors for treatment failure, serious adverse events, and side effects. A post hoc per protocol analysis of SVR was performed on patients who completed treatment and follow-up. RESULTS In an intention-to-treat analysis, SVR rates were 76% (31/41) for simeprevir (SMV)/SOF, 94% (16/17) for SMV/SOF/ribavirin (RBV), and 52% (16/31) for SOF/RBV. The SVR rates of SMV/SOF/RBV and SMV/SOF did not differ significantly in this small study (P = .15). However the SVR rate of SMV/SOF/RBV was higher than that of SOF/RBV (P < .01). In a per protocol analysis, SMV/SOF/RBV had a higher SVR rate than SOF/RBV: 100% (16/16) vs 57% (16/28) (P < .01). The most commonly reported adverse effects were rash, pruritus, fatigue, and insomnia. One patient who had decompensated cirrhosis prior to treatment initiation died after receiving SMV/SOF. CONCLUSIONS SMV/SOF ± RBV is an effective option with minimal adverse effects for most HIV-positive patients with genotype 1 HCV. SMV should be used with caution in patients with decompensated cirrhosis.
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Affiliation(s)
- David Del Bello
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai
| | - Agnes Cha
- Department of Pharmacotherapy, Brooklyn Hospital Center
| | - Maria Sorbera
- Department of Pharmacotherapy, Brooklyn Hospital Center
| | | | - Calley Levine
- Department of Medicine, Icahn School of Medicine at Mount Sinai
| | | | - Alyson Harty
- Faculty Practice Associates, Mount Sinai Hospital
| | | | - Michel Ng
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai
| | | | | | | | - Daniel S Fierer
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai
| | | | | | - Douglas T Dieterich
- Division of Liver Diseases, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York
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Hartman J, Bichoupan K, Patel N, Chekuri S, Harty A, Dieterich D, Perumalswami P, Branch AD. Re-re-treatment of hepatitis C virus: Eight patients who relapsed twice after direct-acting-antiviral drugs. World J Gastroenterol 2015; 21:12430-12438. [PMID: 26604650 PMCID: PMC4649126 DOI: 10.3748/wjg.v21.i43.12430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/02/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine risk factors associated with hepatitis C virus (HCV) treatment failure after direct acting antivirals in patients with complex treatment histories.
METHODS: All HCV mono-infected patients who received treatment at our institution were queried. Analysis was restricted to patients who previously failed treatment with boceprevir (BOC) or telaprevir (TVR) and started simeprevir (SMV) and sofosbuvir (SOF) ± ribavirin (RBV) between December 2013 and June 2014. Patients with human immunodeficiency virus (HIV)/HCV co-infection or patients who received a liver transplant in the past were excluded. Viral loads were recorded while on treatment and after treatment. Data collection continued until December, 31st 2014 when data analysis was initiated. Patients missing virologic outcomes data were not included in the analysis. Analysis of 35 patients who had virologic outcome data available resulted in eight patients who were viral load negative at the end of treatment with SMF/SOF but later relapsed. Data related to patient demographics, HCV infection, and treatment history was collected in order to identify risk factors shared among patients who failed treatment with SMF/SOF.
RESULTS: Eight patients who were treated with the first generation HCV protease inhibitors BOC or TVR in combination with pegylated-interferon (PEG) and RBV who failed this triple therapy were subsequently re-treated with an off-label all-oral regimen of SMV and SOF for 12 wk, with RBV in seven cases. Treatment was initiated before the Food and Drug Administration approved a 24-wk SMV/SOF regimen for patients with liver cirrhosis. All eight patients had an end of treatment response, but later relapsed. Eight (100%) patients were male. Mean age was 56 (range, 49-64). Eight (100%) patients had previously failed PEG/RBV dual therapy at least once in addition to prior failure with triple therapy. Total number of times treated ranged from 3-6 (mean 3.8). Eight (100%) patients were male had liver cirrhosis as determined by Fibroscan or MRI. Seven (87.5%) patients had genotype 1a HCV. Seven (87.5%) patients had over 1 million IU/mL HCV RNA at the time of re-treatment.
CONCLUSION: This study identifies factors associated with SMV/SOF treatment failure and provides evidence that twleve weeks of SMV/SOF/RBV is insufficient in cirrhotics with high-titer genotype 1a HCV.
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Barsa JE, Branch AD, Schiano TD. A pleasant dilemma to have: to treat the HCV patient on the waiting list or to treat post-liver transplantation? Clin Transplant 2015; 29:859-65. [DOI: 10.1111/ctr.12596] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 12/13/2022]
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Hearn B, Chasan R, Bichoupan K, Suprun M, Bagiella E, Dieterich DT, Perumalswami P, Branch AD, Huprikar S. Low adherence of HIV providers to practice guidelines for hepatocellular carcinoma screening in HIV/hepatitis B coinfection. Clin Infect Dis 2015; 61:1742-8. [PMID: 26240206 DOI: 10.1093/cid/civ654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/27/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In the era of combination therapy for human immunodeficiency virus (HIV), liver disease, and hepatocellular carcinoma (HCC) are major causes of death for patients coinfected with HIV and hepatitis B virus (HBV). This study compared HIV provider and hepatologist awareness of and adherence to the American Association for the Study of Liver Diseases (AASLD) practice guidelines for chronic HBV management. The primary endpoint of HIV provider adherence to HCC screening recommendations was compared to that of hepatologists at a large metropolitan academic medical center. METHODS Medical record database searches by ICD-9 codes were used to identify HIV/HBV coinfected (n = 144) and HBV monoinfected (n = 225) patients who were seen at least twice over a 2-year period in outpatient clinics. Adherence to AASLD guidelines was assessed by chart review. Provider awareness was evaluated through a voluntary anonymous survey with knowledge-based questions. RESULTS Over a 2-year period, only 36.0% of HIV/HBV coinfected patients seen in HIV practices completed HCC screening compared to 81.8% of HBV monoinfected patients in hepatology practices (P < .00001). Similarly, HIV providers less frequently monitored HBV viral load (P < .0001), HBeAg/anti-HBe (P < .00001), HBsAg/anti-HBs (P < .00001) than hepatologists but screened more often for hepatitis A immunity (P = .028). Self-reported adherence and knowledge scores were similar among 19 HIV providers and 16 hepatologists. CONCLUSIONS HIV providers ordered significantly fewer HCC screening and HBV monitoring tests than hepatologists within a single academic medical center. In the setting of increased reliance on quality indicators for care, both patients and providers will benefit from greater adherence to established guidelines.
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Affiliation(s)
- Bevin Hearn
- Department of Medicine, Division of Infectious Diseases, Carolinas HealthCare System, Charlotte, North Carolina
| | - Rachel Chasan
- Department of Medicine, Division of Infectious Diseases
| | | | - Maria Suprun
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emilia Bagiella
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Martel-Laferrière V, Michel A, Schaefer S, Bindal S, Bichoupan K, Branch AD, Huprikar S, Schiano TD, Perumalswami PV. Clinical characteristics of human immunodeficiency virus patients being referred for liver transplant evaluation: a descriptive cohort study. Transpl Infect Dis 2015; 17:527-35. [PMID: 25929731 DOI: 10.1111/tid.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/05/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a treatment option for select human immunodeficiency virus (HIV)-infected patients with advanced liver disease. The aim of this study was to describe LT evaluation outcomes in HIV-infected patients. METHODS All HIV-infected patients referred for their first LT evaluation at the Mount Sinai Medical Center were included in this retrospective, descriptive cohort study. Multivariable logistic regression was used to identify factors independently associated with listing. RESULTS Between February 2000 and April 2012, 366 patients were evaluated for LT, with 66 (18.0%) listed for LT and 300 (82.0%) not listed. Fifty-one patients (13.9%) died before completing evaluation and 85 (23.2%) were too early for listing. Reasons patients were declined for listing were psychosocial (15.8%), HIV-related (10.4%), loss to follow-up (9.6%), surgical/medical (6.0%), liver-related (4.4%), patient choice (3.4%), and financial (1.6%). Listed patients were more likely to have hepatocellular carcinoma (HCC) (43.1% vs. 17.1%; P < 0.0001) and less likely to have hepatitis B (6.2% vs. 15.7%; P = 0.04) or a psychiatric history (19.7% vs. 35.2%; P = 0.02) than those not listed. In multivariable analysis, HCC (odds ratio [OR] 5.79; 95% confidence interval [95% CI]: 2.97-11.28), model for end-stage liver disease (MELD) score at referral (OR 1.06; 95% CI 1.01-1.11), and hepatitis B (OR 0.26; 95% CI 0.08-0.79) were associated with listing. CONCLUSION MELD score and HCC were positive predictors of listing in HIV-infected patients referred for LT evaluation and, therefore, timely referrals are vital in these patients. As MELD is a predictor for death while undergoing evaluation, rapid evaluation should be performed in HIV-infected patients with a higher MELD score.
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Affiliation(s)
- V Martel-Laferrière
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - A Michel
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Schaefer
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Bindal
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - K Bichoupan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - A D Branch
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Huprikar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - T D Schiano
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - P V Perumalswami
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Klepper A, Branch AD. Macrophages and the Viral Dissemination Super Highway. EC Microbiol 2015; 2:328-336. [PMID: 26949751 PMCID: PMC4774560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Monocytes and macrophages are key components of the innate immune system yet they are often the victims of attack by infectious agents. This review examines the significance of viral infection of macrophages. The central hypothesis is that macrophage tropism enhances viral dissemination and persistence, but these changes may come at the cost of reduced replication in cells other than macrophages.
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Affiliation(s)
- Arielle Klepper
- Division of Liver Diseases, Department of Medicine, Mount Sinai Medical Center, USA
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Mount Sinai Medical Center, USA
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47
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Sefcik RK, Bichoupan K, Martel-Laferrière V, Odin JA, Liu LU, Perumalswami P, Bansal M, Dieterich DT, Ahmad J, Schiano TD, Branch AD. Telaprevir activity in treatment-naive patients infected with hepatitis C virus genotype 4. J Infect Dis 2014; 210:1855-6. [PMID: 24970848 DOI: 10.1093/infdis/jiu360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Roberta K Sefcik
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Kian Bichoupan
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | | | - Joseph A Odin
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Lawrence U Liu
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Ponni Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Meena Bansal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Douglas T Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Jawad Ahmad
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Thomas D Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Andrea D Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York
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48
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Bichoupan K, Martel-Laferriere V, Sachs D, Ng M, Schonfeld EA, Pappas A, Crismale J, Stivala A, Khaitova V, Gardenier D, Linderman M, Perumalswami PV, Schiano TD, Odin JA, Liu L, Moskowitz AJ, Dieterich DT, Branch AD. Costs of telaprevir-based triple therapy for hepatitis C: $189,000 per sustained virological response. Hepatology 2014; 60:1187-95. [PMID: 25065814 PMCID: PMC4190678 DOI: 10.1002/hep.27340] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/11/2014] [Accepted: 07/24/2014] [Indexed: 12/15/2022]
Abstract
UNLABELLED In registration trials, triple therapy with telaprevir (TVR), pegylated interferon (Peg-IFN), and ribavirin (RBV) achieved sustained virological response (SVR) rates between 64% and 75%, but the clinical effectiveness and economic burdens of this treatment in real-world practice remain to be determined. Records of 147 patients who initiated TVR-based triple therapy at the Mount Sinai Medical Center (May-December 2011) were reviewed. Direct medical costs for pretreatment, on-treatment, and posttreatment care were calculated using data from Medicare reimbursement databases, RED Book, and the Healthcare Cost and Utilization Project database. Costs are presented in 2012 U.S. dollars. SVR (undetectable hepatitis C virus [HCV] RNA 24 weeks after the end of treatment) was determined on an intention-to-treat basis. Cost per SVR was calculated by dividing the median cost by the SVR rate. Median age of the 147 patients was 56 years (interquartile range [IQR] = 51-61), 68% were male, 19% were black, 11% had human immunodeficiency virus/HCV coinfection, 36% had advanced fibrosis/cirrhosis (FIB-4 scores ≥3.25), and 44% achieved an SVR. The total cost of care was $11.56 million. Median cost of care was $83,721 per patient (IQR = $66,652-$98,102). The median cost per SVR was $189,338 (IQR = $150,735-$221,860). Total costs were TVR (61%), IFN (24%), RBV (4%), adverse event management (8%), professional fees (2%), and laboratory tests (1%). CONCLUSIONS TVR and Peg-IFN accounted for 85% of costs. Pharmaceutical prices and the low (44%) SVR rate, in this real-world study, were major contributors to the high cost per SVR.
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Affiliation(s)
- Kian Bichoupan
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - David Sachs
- Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michel Ng
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Alexis Pappas
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James Crismale
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alicia Stivala
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Viktoriya Khaitova
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Donald Gardenier
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Linderman
- Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Thomas D. Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph A. Odin
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lawrence Liu
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan J. Moskowitz
- Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Douglas T. Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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Crismale JF, Martel-Laferrière V, Bichoupan K, Schonfeld E, Pappas A, Wyatt C, Odin JA, Liu LU, Schiano TD, Perumalswami PV, Bansal M, Dieterich DT, Branch AD. Diabetes mellitus and advanced liver fibrosis are risk factors for severe anaemia during telaprevir-based triple therapy. Liver Int 2014; 34:1018-24. [PMID: 24118693 PMCID: PMC3972374 DOI: 10.1111/liv.12342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/22/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Adding telaprevir to pegylated-interferon and ribavirin increased both response rates and side effects of hepatitis C virus (HCV) treatment. We identified variables associated with severe anaemia during telaprevir-based triple therapy. METHODS An observational study was performed on 142 HCV-infected patients between June 2011 and March 2012. All subjects completed 12 weeks of telaprevir-based triple therapy or discontinued early because of anaemia. Severe anaemia was defined by a haemoglobin≤8.9 g/dl; advanced fibrosis was determined by Fib-4≥3.25. RESULTS The 47 (33%) patients who developed severe anaemia were similar to those who did not in sex, race, and prior response to dual therapy, but they were more likely to have diabetes (23.4% vs. 6.3%, P<0.01), advanced fibrosis (46.8% vs. 29.5%, P=0.04) and a history of anaemia during previous dual therapy (29.7% vs. 11.4%, P=0.02). Patients developing severe anaemia were older (59 vs. 56 years, P=0.02), had lower baseline platelet counts (134 vs. 163×10(9) /L, P=0.04), haemoglobin (14.0 vs. 15.0 g/dl, P<0.01), estimated glomerular filtration rate (79 vs. 90 ml/min/1.73 m2, P=0.03) and a higher median ribavirin/weight ratio (14.9 vs. 13.2 mg/kg, P<0.01). In multivariable logistic regression, presence of diabetes (OR=5.61, 95% CI: 1.59-19.72), Fib-4≥3.25 (OR=3.09, 95% CI: 1.28-7.46), higher ribavirin/weight ratio (OR=1.31 per mg/kg, 95% CI: 1.13-1.52) and lower baseline haemoglobin (OR=0.57 per g/dl, 95% CI, 0.41-0.80) were independently associated with developing severe anaemia. CONCLUSIONS Severe anaemia occurred in one-third of patients receiving telaprevir-based triple therapy. Risk was greater in patients with diabetes, advanced liver fibrosis, higher ribavirin/weight ratio and lower baseline haemoglobin.
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Affiliation(s)
- James F. Crismale
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Kian Bichoupan
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily Schonfeld
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexis Pappas
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christina Wyatt
- Division of Renal Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph A. Odin
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lawrence U. Liu
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas D. Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Meena Bansal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Douglas T. Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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50
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Ge X, Antoine DJ, Lu Y, Arriazu E, Leung TM, Klepper AL, Branch AD, Fiel MI, Nieto N. High mobility group box-1 (HMGB1) participates in the pathogenesis of alcoholic liver disease (ALD). J Biol Chem 2014; 289:22672-22691. [PMID: 24928512 PMCID: PMC4132775 DOI: 10.1074/jbc.m114.552141] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Growing clinical and experimental evidence suggests that sterile inflammation contributes to alcoholic liver disease (ALD). High mobility group box-1 (HMGB1) is highly induced during liver injury; however, a link between this alarmin and ALD has not been established. Thus, the aim of this work was to determine whether HMGB1 contributes to the pathogenesis of ALD. Liver biopsies from patients with ALD showed a robust increase in HMGB1 expression and translocation, which correlated with disease stage, compared with healthy explants. Similar findings were observed in chronic ethanol-fed wild-type (WT) mice. Using primary cell culture, we validated the ability of hepatocytes from ethanol-fed mice to secrete a large amount of HMGB1. Secretion was time- and dose-dependent and responsive to prooxidants and antioxidants. Selective ablation of Hmgb1 in hepatocytes protected mice from alcohol-induced liver injury due to increased carnitine palmitoyltransferase-1, phosphorylated 5′AMP-activated protein kinase-α, and phosphorylated peroxisome proliferator-activated receptor-α expression along with elevated LDL plus VLDL export. Native and post-translationally modified HMGB1 were detected in humans and mice with ALD. In liver and serum from control mice and in serum from healthy volunteers, the lysine residues within the peptides containing nuclear localization signals (NLSs) 1 and 2 were non-acetylated, and all cysteine residues were reduced. However, in livers from ethanol-fed mice, in addition to all thiol/non-acetylated isoforms of HMGB1, we observed acetylated NLS1 and NLS2, a unique phosphorylation site in serine 35, and an increase in oxidation of HMGB1 to the disulfide isoform. In serum from ethanol-fed mice and from patients with ALD, there was disulfide-bonded hyperacetylated HMGB1, disulfide-bonded non-acetylated HMGB1, and HMGB1 phosphorylated in serine 35. Hepatocytes appeared to be a major source of these HMGB1 isoforms. Thus, hepatocyte HMGB1 participates in the pathogenesis of ALD and undergoes post-translational modifications (PTMs) that could condition its toxic effects.
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Affiliation(s)
- Xiaodong Ge
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Daniel J Antoine
- Medical Research Council Centre for Drug Safety Science, Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Buildings, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - Yongke Lu
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Elena Arriazu
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Tung-Ming Leung
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Arielle L Klepper
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Maria Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York 10029 and
| | - Natalia Nieto
- Division of Liver Diseases, Department of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York 10029.
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