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Chen T, Chen G, Wang G, Treeprasertsuk S, Lesmana CRA, Lin HC, Al-Mahtab M, Chawla YK, Tan SS, Kao JH, Yuen MF, Lee GH, Alcantara-Payawal D, Nakayama N, Abbas Z, Jafri W, Kim DJ, Choudhury A, Mahiwall R, Hou J, Hamid S, Jia J, Bajaj JS, Wang F, Sarin SK, Ning Q. Expert consensus on the diagnosis and treatment of end-stage liver disease complicated by infections. Hepatol Int 2024:10.1007/s12072-023-10637-3. [PMID: 38460060 DOI: 10.1007/s12072-023-10637-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/22/2023] [Indexed: 03/11/2024]
Abstract
End-stage liver disease (ESLD) is a life-threatening clinical syndrome and when complicated with infection the mortality is markedly increased. In patients with ESLD, bacterial or fungal infection can induce or aggravate the occurrence or progression of liver decompensation. Consequently, infections are among the most common complications of disease deterioration. There is an overwhelming need for standardized protocols for early diagnosis and appropriate management for patients with ESLD complicated by infections. Asia Pacific region has the largest number of ESLD patients, due to hepatitis B and the growing population of alcohol and NAFLD. Concomitant infections not only add to organ failure and high mortality but also to financial and healthcare burdens. This consensus document assembled up-to-date knowledge and experience from colleagues across the Asia-Pacific region, providing data on the principles as well as evidence-based current working protocols and practices for the diagnosis and treatment of patients with ESLD complicated by infections.
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Affiliation(s)
- Tao Chen
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, P.R. China
| | - Guang Chen
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, P.R. China
| | - Guiqiang Wang
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Sombat Treeprasertsuk
- Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, and Thai Red Cross, Bangkok, Thailand
| | - Cosmas Rinaldi Adithya Lesmana
- Internal Medicine, Hepatobiliary Division, Dr. Captor Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, DKI, Indonesia
| | - Han-Chieh Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Yogesh K Chawla
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Soek-Siam Tan
- Department of Hepatology, Hospital Selayang, Selangor Darul Ehsan, Malaysia
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Guan-Huei Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Nobuaki Nakayama
- Department of Gastroenterology & Hepatology, Saitama Medical University, Saitama, Japan
| | - Zaigham Abbas
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Wasim Jafri
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Dong-Joon Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital of Hallym University Medical Center, Chuncheon, Korea
| | - Ashok Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Mahiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Jinlin Hou
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Clinical Research Center for Viral Hepatitis, Key Laboratory of Infectious Diseases Research in South China, Ministry of Education, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Saeed Hamid
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - J S Bajaj
- Department of Medicine, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | - Fusheng Wang
- Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Qin Ning
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, P.R. China.
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Al-Mahtab M, Akbar SMF, Yoshida O, Aguilar JC, Guillen G, Hiasa Y. Antiviral Response across Genotypes after Treatment of Chronic Hepatitis B Patients with the Therapeutic Vaccine NASVAC or Pegylated Interferon. Vaccines (Basel) 2023; 11:vaccines11050962. [PMID: 37243066 DOI: 10.3390/vaccines11050962] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
An open-level, randomized and treatment-controlled clinical trial has shown that a therapeutic vaccine containing hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) (NASVAC) is endowed with antiviral and liver protecting capacity and is safer than pegylated interferon (Peg-IFN) in patients with chronic hepatitis B (CHB). The present study provides information about the role of the hepatitis B virus (HBV) genotype in this phase III clinical trial. From a total of 160 patients enrolled in this trial, the HBV genotypes of 133 patients were characterized, and NASVAC induced a stronger antiviral effect (HBV DNA reduction below 250 copies per mL) than Peg-IFN. The antiviral effects and alanine aminotransferase levels were not significantly different among different HBV genotypes in NASVAC-treated patients. However, a significantly higher proportion of genotype-D patients receiving NASVAC showed better therapeutic effects, compared to genotype-D patients receiving Peg-IFN, with a marked difference of 44%. In conclusion, NASVAC seems to be a better alternative to Peg-IFN, especially in patients with HBV genotype-D patients. This reflects the attractiveness of NASVAC in countries where genotype D is highly prevalent. The mechanisms underlying the effect of HBV genotype are being studied in a new clinical trial.
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Affiliation(s)
- Mamun Al-Mahtab
- Interventional Hepatology Division, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
| | - Sheikh Mohammad Fazle Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | | | - Gerardo Guillen
- Center for Genetic Engineering and Biotechnology, Havana 10400, Cuba
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
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3
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Ozkan H, Al-Mahtab M, Akbar SMF. The Journal Moving to an Adult State. Euroasian J Hepatogastroenterol 2023. [DOI: 10.5005/ejohg-12-2-iv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
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Choudhury A, Vijayaraghavan R, Maiwall R, Kumar M, Duan Z, Yu C, Hamid SS, Jafri W, Butt AS, Devarbhavi H, Ning Q, Ma K, Tan SS, Shukla A, Dhiman R, Duseja A, Taneja S, Eapen CE, Goel A, Treeprasertsuk S, Al-Mahtab M, Ghazinyan H, Kim DJ, Sahu MK, Lee GH, Lesmana LA, Lesmana RC, Shah S, Abbas Z, Sollano JD, Rao PN, Kulkarni A, Shiha G, Shrestha A, Dokmeci AK, Yuen MF, Payawal DA, Kalista KF, Prasad VGM, Lau GK, Karim F, Jain P, Kumar G, Arora V, Pamecha V, Sinha P, Sarin SK. 'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure. Hepatol Int 2021; 15:1376-1388. [PMID: 34608586 DOI: 10.1007/s12072-021-10206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/26/2020] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT). METHODS Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant. RESULTS The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p < 0.01) contributing to 23% of the first week and 55% of all-cause 28-day mortality. In a matched cohort analysis, the actuarial survival with LT (n = 41) and conditional survival in the absence of transplant (n = 191) were comparable, when the condition, i.e., transplant was adjusted. The comparison curve showed differentiation in survival beyond 7 days (p < 0.01). CONCLUSIONS ACLF is a rapidly progressive disease and risk stratification within the first week of hospitalization is needed. 'Emergent LT' should be defined in the first week in the ACLF patients; the transplant window for improving survival in a live donor setting.
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Affiliation(s)
- Ashok Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.,Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajan Vijayaraghavan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.,Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.,Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.,Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Zhongping Duan
- Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China
| | - Chen Yu
- Translational Hepatology Institute Capital Medical University, Beijing You'an Hospital, Beijing, China
| | - Saeed Sadiq Hamid
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Wasim Jafri
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Amna Subhan Butt
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Harshad Devarbhavi
- Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India
| | - Qin Ning
- Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Ma
- Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Soek-Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Akash Shukla
- Department of Hepatology, KEM Hospital and Seth GSMC, Mumbai, India
| | - Radhakrishna Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - C E Eapen
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Ashish Goel
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
| | - Dong Joon Kim
- Centre for Liver and Digestive Diseases, Gangwon-Do, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Manoj K Sahu
- Department of Gastroenterology and Biliary Sciences, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Guan Huei Lee
- Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
| | | | | | - Samir Shah
- Department of Hepatology, Global Hospital, Mumbai, India
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan
| | - Jose D Sollano
- Department of Hepatology, Cardinal Santos Medical Centre, Manila, Philippines
| | - P N Rao
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Gamal Shiha
- Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt
| | | | - AKadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Man Fung Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Kemal Fariz Kalista
- Division of Hepatobiliary Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - George K Lau
- Department of Gastroenterology, Humanity and Health Medical Centre, Hong Kong, China
| | - Fazal Karim
- Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh
| | - Priyanka Jain
- Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vinod Arora
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.,Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Piyush Sinha
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. .,Department of Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.
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5
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Chowdhury FR, McNaughton AL, Amin MR, Barai L, Saha MR, Rahman T, Das BC, Hasan MR, Islam KMS, Faiz MA, Al-Mahtab M, Mokaya J, Kronsteiner B, Jeffery K, Andersson MI, de Cesare M, Ansari MA, Dunachie S, Matthews PC. Endemic HBV among hospital in-patients in Bangladesh, including evidence of occult infection. J Gen Virol 2021; 102. [PMID: 34328828 PMCID: PMC8491891 DOI: 10.1099/jgv.0.001628] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bangladesh is one of the top-ten most heavily burdened countries for viral hepatitis, with hepatitis B (HBV) infections responsible for the majority of cases. Recombinant and occult HBV infections (OBI) have been reported previously in the region. We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of HBV and OBI. A target-enrichment deep sequencing pipeline was applied to samples with HBV DNA >3.0 log10 IU ml−1. HBV infection was present in 16/201 (8 %), among whom 3/16 (19 %) were defined as OBI (HBsAg-negative but detectable HBV DNA). Whole genome deep sequences (WGS) were obtained for four cases, identifying genotypes A, C and D. One OBI case had sufficient DNA for sequencing, revealing multiple polymorphisms in the surface gene that may contribute to the occult phenotype. We identified mutations associated with nucleos(t)ide analogue resistance in 3/4 samples sequenced, although the clinical significance in this cohort is unknown. The high prevalence of HBV in this setting illustrates the importance of opportunistic clinical screening and DNA testing of transfusion products to minimise OBI transmission. WGS can inform understanding of diverse disease phenotypes, supporting progress towards international targets for HBV elimination.
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Affiliation(s)
- Fazle Rabbi Chowdhury
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka 1200, Bangladesh.,Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok 10400, Thailand
| | - Anna L McNaughton
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK
| | | | - Lovely Barai
- Department of Microbiology, BIRDEM General Hospital, Dhaka 1200, Bangladesh
| | - Mili Rani Saha
- Department of Microbiology, BIRDEM General Hospital, Dhaka 1200, Bangladesh
| | - Tanjila Rahman
- Department of Microbiology, BIRDEM General Hospital, Dhaka 1200, Bangladesh
| | - Bikash Chandra Das
- Surveillance and Immunization Unit, World Health Organization Office, Dhaka 1200, Bangladesh
| | - M Rokibul Hasan
- Department of Microbiology, BIRDEM General Hospital, Dhaka 1200, Bangladesh
| | - K M Shahidul Islam
- Department of Microbiology, BIRDEM General Hospital, Dhaka 1200, Bangladesh
| | - M A Faiz
- Dev Care Foundation, Dhaka 1200, Bangladesh
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1200, Bangladesh
| | - Jolynne Mokaya
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK
| | - Barbara Kronsteiner
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK.,Centre for Tropical Medicine and Global Health, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Katie Jeffery
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX1 3SY, UK
| | - Monique I Andersson
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX1 3SY, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Roosevelt Drive, Headington, Oxford, OX3 7BN, UK
| | - M Azim Ansari
- Wellcome Centre for Human Genetics, Roosevelt Drive, Headington, Oxford, OX3 7BN, UK.,Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK
| | - Susanna Dunachie
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX1 3SY, UK.,Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok 10400, Thailand.,Centre for Tropical Medicine and Global Health, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Philippa C Matthews
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX1 3SY, UK.,NIHR Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX1 3SY, UK.,Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Rd, Oxford OX1 3SY, UK
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Singh SP, Anirvan P, Reddy KR, Conjeevaram HS, Marchesini G, Rinella ME, Madan K, Petroni ML, Al-Mahtab M, Caldwell SH, Aithal GP, Hamid SS, Farrell GC, Satapathy SK, Duseja A, Acharya SK, Dassanayake AS, Goh KL. Non-alcoholic fatty liver disease: Not time for an obituary just yet! J Hepatol 2021; 74:972-974. [PMID: 33340575 DOI: 10.1016/j.jhep.2020.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Shivaram Prasad Singh
- Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
| | - Prajna Anirvan
- Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hari S Conjeevaram
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Giulio Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, Sant'Orsola-Malpighi Hospital, "Alma Mater" University, via G. Massarenti 9, 40138 Bologna, Italy
| | - Mary E Rinella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Kaushal Madan
- Department of Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, 110017, India
| | - Maria Letizia Petroni
- Unit of Metabolic Diseases and Clinical Dietetics, Sant'Orsola-Malpighi Hospital, "Alma Mater" University, via G. Massarenti 9, 40138 Bologna, Italy
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Stephen H Caldwell
- Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Guruprasad P Aithal
- National Institute for Health Research (NIHR), Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
| | - Saeed S Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Geoffrey C Farrell
- Department of Hepatic Medicine, ANU College of Health and Medicine, Senior Staff Hepatologist, Canberra Hospital, Australian Capital Territory, Australia
| | - Sanjaya K Satapathy
- Sandra Atlas Bass Center for Liver Diseases & Transplantation, Department of Medicine, North Shore University Hospital/Northwell Health, 400 Community Drive, Manhasset, NY 11030, USA
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subrat Kumar Acharya
- Department of Gastroenterology and Hepatology,KIIT University, Patia, Bhubaneshwar 751024, Odisha, India
| | | | - Khean-Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Al-Mahtab M, Roy PP, Khan MSI, Akbar SM. Nobel Prize for the Discovery of Hepatitis B and C: A Brief History in Time. Euroasian J Hepatogastroenterol 2021; 10:98-100. [PMID: 33511072 PMCID: PMC7801893 DOI: 10.5005/jp-journals-10018-1328] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In 2020, the Noble Prize for Medicine jointly went to three scientists for hepatitis C virus-related discoveries. Earlier in 1976, an American scientist won this award for the discovery of hepatitis B virus. The Noble Prize, constituted as per the will of Alfred Noble, is awarded every year for achievements that benefit human beings in the best possible way. Although humans have known hepatitis as a deadly disease for hundreds of years, it was the discovery of hepatitis B and C viruses that changed the way we knew the hepatitis viruses forever and paved the way for saving millions of lives all over the world, the reason why the Noble Committee has on two different occasions picked up the great minds behind the discovery of these two hepatitis viruses and recognized them by conferring them with the highest recognition that one dreams of. How to cite this article: Al-Mahtab M, Roy PP, Khan MSI, et al. Nobel Prize for the Discovery of Hepatitis B and C: A Brief History in Time. Euroasian J Hepatogastroenterol 2020;10(2):98-100.
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Affiliation(s)
- Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Partho P Roy
- Shaheed Suhrawardi Medical College, Dhaka, Bangladesh
| | - Md Sakirul I Khan
- Department of Anatomy and Embryology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sheikh Mf Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.,Miyakawa Memorial Research Foundation, Tokyo, Japan
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Haque MN, Al-Mahtab M, Das DC, Mohammad NEAS, Mamun AA, Khan MSI, Akbar SM, Rahman S. Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure. Euroasian J Hepatogastroenterol 2021; 10:64-67. [PMID: 33511067 PMCID: PMC7801888 DOI: 10.5005/jp-journals-10018-1330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 12/20/2022] Open
Abstract
Introduction Patients with acute-on-chronic liver failure (ACLF) have low survival without liver transplantation. Granulocyte colony-stimulating factor (G-CSF) improves survival in ACLF and erythropoietin (EPO) promotes hepatic regeneration in animal studies. The aim of this study is to determine whether coadministration of G-CSF and EPO improves the outcome in ACLF. Methods The study was conducted in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Consecutive patients with ACLF were randomly assigned into group A and group B. Group A patients received subcutaneous G-CSF (5 mcg/kg/d) for 6 days and subcutaneous EPO (40 mcg/wk) for 4 weeks and group B patients received only standard medical care (control group). All patients were followed up for 3 months. The primary end point was to see survival at 3 months. Results Patients had comparable baseline characteristics; hepatitis B virus infection was the commonest etiology of ACLF as both acute and chronic events. A higher proportion of patients were male in both groups. The survival was higher in group A than in group B at the end of 3 months (36.4% vs 29.4%; p = 0.457), but this was not statistically significant. Regarding complications, hepatorenal syndrome was higher in group B than in group A (36.7% vs 41.7%). In both the groups, Child-Turcotte-Pugh score and model for end-stage liver disease scores were similar before treatment and improved during follow-up. Conclusion This is one of the early human studies that demonstrate potential hepatic regeneration using EPO in ACLF patients. Further study with a larger cohort will be needed to reproduce the results of the present work. How to cite this article Haque Md N, Al-Mahtab M, Das DC, et al. Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure. Euroasian J Hepato-Gastroenterol 2020;10(2):64-67.
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Affiliation(s)
- Md Nazmul Haque
- Department of Medicine, Pabna Medical College and Hospital, Pabna, Bangladesh
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Dulal C Das
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Ayub A Mamun
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Sakirul I Khan
- Department of Anatomy and Embryology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sheikh Mf Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Salimur Rahman
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Islam MA, Mazumder MA, Akhter N, Huq AKMF, Al-Mahtab M, Khan MSI, Akbar SMF. Extraordinary Survival Benefits of Severe and Critical Patients with COVID-19 by Immune Modulators: The Outcome of a Clinical Trial in Bangladesh. Euroasian J Hepatogastroenterol 2020; 10:68-75. [PMID: 33511068 PMCID: PMC7801887 DOI: 10.5005/jp-journals-10018-1327] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID)-19 has devasted the healthcare delivery system as well as social establishments of almost all countries of the world. However, vaccines for containing new cases of COVID-19 are yet to be realized. Also, presently available antiviral drugs and other standard of care (SOC) management strategies could not satisfactorily control COVID-19-related mortality, which has crossed the one million mark during the last 9 months. These facts present an emergent need for developing new, novel, and evolving therapeutic strategies for the management of COVID-19. AIM AND OBJECTIVE This cohort study represents a clinical trial in real-life situations in Bangladesh where two immune modulators were applied in patients with severe and critical COVID-19 patients. MATERIALS AND METHODS A total of 199 confirmed patients of COVID-19 were enrolled in this study. All of them had severe and critical COVID-19 and they were hospitalized at the intensive care unit (ICU) of the Combined Military Hospital (CMH), Dhaka, Bangladesh. All patients were positive for SARS-CoV-2 by polymerase chain reaction (PCR) of the nasal swab and they were endowed with severe pneumonia, multiple organ dysfunctions, and coagulopathy. The median percentage of lung involvement was 65%. The mean oxygen saturation was 83%. The patients received two immune modulators (tocilizumab and bevacizumab) in different combinations to retrieve broader insights about the safety and efficacy of immune modulators in COVID-19 management. RESULTS Out of the total 199 patients, 122 survived and 77 expired. A single dose of tocilizumab resulted in the survival of 71.5% (73 of 102 COVID-19 patients). On the other hand, a dramatic survival benefit was found in patients receiving bevacizumab (92%). CONCLUSION The study indicates that active treatment should be started as early as possible for COVID-19 patients as moderate COVID-patients may progress to more severe illnesses with grave consequences. The safety of two immune modulators has been recorded in this cohort of severe and critical COVID-19 patients. In order to have a proper use of these immune modulators, there is a need to accomplish controlled, blinded, and large-scale prospective studies with at least two arms. HOW TO CITE THIS ARTICLE Islam MA, Mazumder MA, Akhter N, et al. Extraordinary Survival Benefits of Severe and Critical Patients with COVID-19 by Immune Modulators: The Outcome of a Clinical Trial in Bangladesh. Euroasian J Hepato-Gastroenterol 2020;10(2):68-75.
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Affiliation(s)
- Md Azizul Islam
- Department of Medicine, Combined Military Hospital, Dhaka, Bangladesh
| | - Masudul A Mazumder
- Department of Critical Care Centre, Combined Military Hospital, Dhaka, Bangladesh
| | | | - AKM Faizul Huq
- Department of Medicine, Combined Military Hospital, Dhaka, Bangladesh
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Sakirul I Khan
- Department of Anatomy and Embryology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sheikh MF Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
- Miyakawa Memorial Research Foundation, Tokyo, Japan
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Akbar SMF, Al-Mahtab M. EDITORIAL. Euroasian J Hepatogastroenterol 2019; 9:iv. [PMID: 32117701 PMCID: PMC7047313 DOI: 10.5005/ejohg-9-2-iv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Mijočević H, Karimzadeh H, Seebach J, Usman Z, Al-Mahtab M, Bazinet M, Vaillant A, Roggendorf M. Variants of hepatitis B virus surface antigen observed during therapy with nucleic acid polymer REP 2139-Ca have no influence on treatment outcome and its detection by diagnostic assays. J Viral Hepat 2019; 26:485-495. [PMID: 30450662 DOI: 10.1111/jvh.13044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/15/2018] [Indexed: 12/23/2022]
Abstract
The treatment of patients suffering from HBeAg-positive chronic hepatitis B with REP 2139-Ca resulted in potent reductions in HBsAg and HBV DNA, seroconversion to anti-HBs and the establishment of functional control of infection. In this cohort of 12 patients, we investigated whether differences between HBsAg sequences might explain the lack of response to REP 2139-Ca observed in 3 of 12 patients. We also assessed if the reduction or complete loss of HBsAg in serum observed during therapy were caused by mutations in the "a" determinant preventing the detection of HBsAg by standard diagnostic assays. The complete pre-S/S open reading frame (ORF) was sequenced and pre-S1, pre-S2 and S amino acid sequences were analysed. We found no major differences between pre-S1, pre-S2 and S sequences in responders and nonresponders correlated with low reduction in HBsAg. In addition, we found no mutations in the "a" determinant that would significantly affect the reactivity of HBsAg in diagnostic assays. These results demonstrate that the amino acid sequence of complete pre-S/S ORF has no direct influence on response to REP 2139-Ca therapy.
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Affiliation(s)
- Hrvoje Mijočević
- Institute of Virology, Technische Universität München, Munich, Germany
| | - Hadi Karimzadeh
- Institute of Virology, Technische Universität München, Munich, Germany.,Department of Medicine II, University Hospital Munich-Grosshadern, Munich, Germany
| | - Judith Seebach
- Institute of Virology, Technische Universität München, Munich, Germany
| | - Zainab Usman
- Department of Bioinformatics, Wissenschaftszentrum Weihenstephan, Technische Universität München, Freising, Germany
| | - Mamun Al-Mahtab
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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12
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Shrestha A, Al-Mahtab M, Rahman S, Sarkar J, Lama TK. Its Congenital Hepatic Fibrosis; Not Cirrhosis At All. Nep Med J 2018. [DOI: 10.3126/nmj.v1i2.21624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Congenital hepatic fibrosis is a rare condition characterized by extensive fibrosis of liver but with preserved normal lobular architecture inherited as autosomal recessive trait. We report a 19 year-old-female admitted to Bangabandhu Sheikh Mujib Medical University with the complaints of lump in upper abdomen since last 13 years and episodes of fever and abdominal pain for same duration. She was diagnosed with hepatic TB on hepatic histology. Congenital hepatic fibrosis is a rare cause of portal hypertension that presents during childhood. Prognosis of congenital hepatic fibrosis is good. Life threatening events in these patients are related with variceal bleeding and episodes of cholangitis. Owing to relatively good liver function these patients tolerate portosystemic shunt surgeries quite well.Though rare, congenital hepatic fibrosis should be included in the differential diagnosis of portal hypertension in early life.
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13
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Mf Akbar S, Al-Mahtab M, I Khan S. Nature of Host Immunity during Hepatitis B Virus Infection and designing Immune Therapy. Euroasian J Hepatogastroenterol 2018; 8:42-46. [PMID: 29963460 PMCID: PMC6024052 DOI: 10.5005/jp-journals-10018-1256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/09/2018] [Accepted: 02/14/2018] [Indexed: 12/23/2022] Open
Abstract
Hepatitis B virus (HBV) infections represent one of the major public health problems in global context. More than 2 billion people in the world have been infected with this virus at some point of time in their life and millions are chronically infected, indicating that chronic HBV-infected subjects remain as a living source of HBV transmission. The public health impact of this is tremendous. Considerable numbers of chronic HBV-infected individuals would eventually develop progressive liver diseases and their complications like hepatic failure, liver cirrhosis (LC), and hepatocellular carcinoma (HCC). Epidemiological studies have suggested that about 0.6 to 1.2 million people die annually from HBV-related liver diseases. These figures about death due to HBV and sufferings from HBV-related diseases indicate a notion of medical emergencies about HBV. In addition to these, the impact of HBV on health care delivery system moves beyond these numbers of HBV-related patients and HB-related deaths. This is because significant insights have already been developed about epidemiology, virology, and pathogenesis of HBV. Also, an effective and widely used preventive vaccine is available against HBV. In addition to these, antiviral drugs against HBV have been developed from early 1980s and several such drugs are now available commercially in the open market around the worldwide. Unfortunately, the ongoing therapeutic regimens could not stand the test of time and new insights about HBV pathogenesis are required for the development of new, novel, and evidence-based therapies for chronic HBV infections. How to cite this article: Akbar SMF, Al-Mahtab M, Khan SI. Nature of Host Immunity during Hepatitis B Virus Infection and designing Immune Therapy. Euroasian J Hepato-Gastroenterol 2018;8(1):42-46.
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Affiliation(s)
- Sheikh Mf Akbar
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan and Miyakawa Memorial Research Foundation, Tokyo Japan
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sakirul I Khan
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Ehime, Japan
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14
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Fazle Akbar SM, Ozkan H, Al-Mahtab M. The Journal in the Horizon of Asia and Europe. Euroasian J Hepatogastroenterol 2018; 8:iv. [PMID: 29963477 PMCID: PMC6024050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Hasan Ozkan
- Editor-in-Chief, Euroasian Journal of Hepato-Gastroenterology
| | - Mamun Al-Mahtab
- Co-Editor-in-Chief, Euroasian Journal of Hepato-Gastroenterology
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15
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Ozkan H, Al-Mahtab M. The Journal in the Horizon of Asia and Europe. Euroasian J Hepatogastroenterol 2018. [DOI: 10.5005/jp-ejohg-8-1-iv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Al-Mahtab M. Editorial. Euroasian J Hepatogastroenterol 2017. [DOI: 10.5005/ejohg-7-1-i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Al-Mahtab M, Bazinet M, Vaillant A. Letter to the Editor. Curr Opin Virol 2017; 23:130. [DOI: 10.1016/j.coviro.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Al-Mahtab M, Akbar SMF, Khan MSI, Rahman S. Increased survival of patients with end-stage hepatocellular carcinoma due to intake of ONCOXIN®, a dietary supplement. Indian J Cancer 2016; 52:443-6. [PMID: 26905163 DOI: 10.4103/0019-509x.176699] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIMS Treatment and management of patients with end-stage hepatocellular carcinoma (HCC) represents a formidable challenge to contemporary branches of medical sciences. The study presented here was conducted to assess the utility of nutrient supplement, if any, for management of patients with end-stage HCC. MATERIALS AND METHODS A total of 19 patients with end-stage HCC (Barcelona Clinic Liver Cancer [BCLC] staging D) were provided with ONCOXIN® for 3 months. Another 10 patients with end-stage HCC (BCLC stage D) with similar clinical conditions received conservative management, but they did not give consent for taking ONCOXIN® (non-ONCOXIN® group). All patients of both groups were followed on regular basis until their death. STATISTICAL ANALYSIS The results were expressed as mean and standard deviation. Comparison between groups was performed using Student's t-test or the Mann-Whitney U test. For categorical data, Chi-square or Fisher exact test was applied. RESULTS All patients of the control group (non-ONCOXIN® group) (10 of 10 patients) died within 2 months after study commencement. On the other hand, 10 of 19 patients receiving ONCOXIN® died within 2 months (less than 53% patients) after the start of taking ONCOXIN® (P < 0.05, compared with patients of non-ONCOXIN® group). Five more patients died within 5 months after the start of intake of ONCOXIN®. Four patients receiving ONCOXIN® survived for more than 6 months after study commencement. CONCLUSIONS Although this is a preliminary report, it inspires considerable optimism about safety and efficacy of a food supplement for management of patients with end-stage HCC.
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Affiliation(s)
| | - S M F Akbar
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
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19
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Abstract
The possible use of immunotherapy for hepatitis B has emerged for two major reasons: (1) chronic hepatitis B (CHB) is an immune-mediated pathological condition, and (2) commercially available antiviral drugs are of limited efficacy. Although various immunomodulatory agents have been used to treat patients with CHB during the last three decades, there is currently no consensus among physicians and hepatologists regarding the suitability of immunotherapy for patients with CHB. However, new insights into immunotherapy for CHB have emerged; these may facilitate design of effective and tolerable immunotherapy regimens for these patients. This review provides a comprehensive overview of immunotherapy for CHB.
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Affiliation(s)
| | - Mamun Al-Mahtab
- b Department of Hepatology , Bangabandhu Sheikh Mujib Medical University , Dhaka , Bangladesh
| | - Munira Jahan
- c Department of Virology , Bangabandhu Sheikh Mujib Medical University , Dhaka , Bangladesh
| | - Osamu Yoshida
- d Department of Gastroenterology and Metabology , Ehime University Graduate School of Medicine , Toon , Japan
| | - Yoichi Hiasa
- d Department of Gastroenterology and Metabology , Ehime University Graduate School of Medicine , Toon , Japan
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20
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Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, Lesmana CRA, Sollano J, Kumar M, Jindal A, Sharma BC, Hamid SS, Dokmeci AK, Al-Mahtab M, McCaughan GW, Wasim J, Crawford DHG, Kao JH, Yokosuka O, Lau GKK, Sarin SK. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int 2016; 10:681-701. [PMID: 27229718 PMCID: PMC5003900 DOI: 10.1007/s12072-016-9736-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on "APASL consensus statements and recommendations for management of hepatitis C" in March 2015 to revise the "APASL consensus statements and management algorithms for hepatitis C virus infection" (Hepatol Int 6:409-435, 2012). The working party consisted of expert hepatologists from the Asian-Pacific region gathered at the Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed, and debated during the course of drafting a revision. Participants of the consensus meeting assessed the quality of the cited studies. The finalized recommendations for hepatitis C prevention, epidemiology, and laboratory testing are presented in this review.
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Affiliation(s)
- Masao Omata
- Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan.
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Ming-Lung Yu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wang-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Banha, Egypt
| | | | - Jose Sollano
- University Santo Tomas Hospital, Manila, Philippines
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
| | - Geofferey W McCaughan
- Royal Prince Alfred Hospital, Centenary Institute, University of Sydney, Sydney, Australia
| | - Jafri Wasim
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Darrell H G Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia
| | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - George K K Lau
- The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Abstract
Although several antiviral drugs are now available for treatment of patients with chronic hepatitis B (CHB), sustained off-treatment clinical responses and containment of CHB-related complications are not achieved in majority of CHB patients by antiviral therapy. In addition, use of these drugs is endowed with substantial long term risk of viral resistance and drug toxicity. The infinite treatment regimens of antiviral drugs for CHB patients are also costly and usually unbearable by most patients of developing and resource-constrained countries. Taken together, there is a pressing need to develop new and innovative therapeutic approaches for CHB patients. Immune therapy seems to be an alternate therapeutic approach for CHB patients because impaired or distorted or diminished immune responses have been detected in most of these patients. Also, investigators have shown that restoration or induction of proper types of immune responses may have therapeutic implications in CHB. Various immunomodulatory agents have been used to treat patients with CHB around the world and the outcomes of these clinical trials show that the properties of immune modulators and nature and designing of immune therapeutic regimens seem to be highly relevant in the context of treatment of CHB patients. In this review, the general properties and specific features of immune therapy for CHB have been discussed for developing the guidelines of effective regimens of immune therapy for CHB.
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Affiliation(s)
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Sakilur Islam Khan
- Department of Anatomy and Embryology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Ruksana Raihan
- Department of Virology, AIMST University, Semeling, Bedong, Kedah, Malaysia
| | - Ananta Shrestha
- Department of Hepatology, The Liver Clinic, Liver Foundation, Kathmandu, Nepal
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Jahan M, Islam MA, Akbar SMF, Takahashi K, Tabassum S, Rahman A, Haque MA, Biswas J, Mishiro S, Al-Mahtab M. Anti-HBc Screening of Blood Donors in Bangladesh: Relevance to Containment of HBV Propagation. J Clin Exp Hepatol 2016; 6:115-8. [PMID: 27493459 PMCID: PMC4963325 DOI: 10.1016/j.jceh.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/07/2016] [Accepted: 05/06/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To avoid further transmission of hepatitis B virus (HBV) infection, blood is tested for hepatitis B surface antigen (HBsAg) before transfusion. However, post-transfusion hepatitis B has been detected in clinics after transfusion of HBsAg-negative blood. The study presented here was undertaken to assess if HBsAg-negative blood is free from HBV or not. METHODS Sera were collected from 398 blood donors who were negative for HBsAg. Out of 398 blood samples, antibody to hepatitis B core antigen (ant-HBc) was detected in 82 sera samples. HBV DNA was evaluated in HBsAg-negative, anti-HBc-positive sera. HBsAg, hepatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe), and anti-HBc in the sera were measured by an enzyme-linked immunosorbent assay (ELISA). HBV DNA was quantified by a real time polymerase chain reaction (PCR). RESULTS Out of 82 HBsAg-negative, anti-HBc-positive sera samples, HBV DNA were detected in the sera of 7 voluntary blood donors. Out of these 7 subjects, all were negative for HBeAg. The levels of ALT were more than 30 IU/L in 6 of 7 HBVDNA-positive subjects and it was above upper limit of normal (>42 IU/ml) in one subject. CONCLUSIONS The present recommendation about blood transfusion of HBsAg-negative blood system is not capable of blocking HBV transmission to blood recipients. Although advanced countries have adopted nucleic acid testing (NAT) for preventing HBV transmission, developing countries may apply anti-HBc testing and ALT estimation before blood transmission.
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Key Words
- ALT
- CHB, chronic hepatitis B
- ELISA, enzyme-linked immunosorbent assay
- ETV, entecavir
- HBV DNA
- HBV DNA, hepatitis B virus deoxyribonucleic acid
- HBV, hepatitis B virus
- HBeAg, hepatitis B virus e antigen
- HBsAg, hepatitis B virus surface antigen
- HBsAg-negative donor
- NA, nucleoside analog
- PCR, polymerase chain reaction
- Peg IFN, pegylated interferon
- anti-HBc
- blood transfusion
- hepatitis B
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Affiliation(s)
- Munira Jahan
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Asadul Islam
- Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Kazuaki Takahashi
- Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahina Tabassum
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Atiar Rahman
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Atiqul Haque
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Joly Biswas
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shunji Mishiro
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,Address for correspondence: Mamun Al-Mahtab, Associate Professor, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka 1000, Bangladesh. Tel.: +880 1711567275; fax: +880 28826840.
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23
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Abstract
One of the major successes in the area of vaccinology is the emergence, development and usage of hepatitis B vaccine (a prophylactic vaccine against HBV). Hepatitis B vaccine has protected millions of individuals from acquiring HBV infection and has prevented liver cancer in the majority of vaccinated subjects. Although initially designed as prophylactic vaccines, accumulative evidence has shown that these vaccines may also be used to treat patients with chronic hepatitis B. At present, there are two main areas of discussion in hepatitis B vaccination; development of more effective prophylactic hepatitis B vaccine that can provide protection to all vaccine recipients, and designing hepatitis B-based therapeutic vaccines for treatment of chronic hepatitis B patients.
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Affiliation(s)
- Sheikh MF Akbar
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sakirul I Khan
- Department of Anatomy & Embryology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Ananta Shrestha
- Department of Hepatology, The Liver Clinic, Liver Foundation, Nepal
| | - Shahina Tabassum
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Yoichi Hiasa
- Department of Gastroenterology & Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
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Cox IJ, Aliev AE, Crossey MME, Dawood M, Al-Mahtab M, Akbar SM, Rahman S, Riva A, Williams R, Taylor-Robinson SD. Urinary nuclear magnetic resonance spectroscopy of a Bangladeshi cohort with hepatitis-B hepatocellular carcinoma: A biomarker corroboration study. World J Gastroenterol 2016; 22:4191-4200. [PMID: 27122669 PMCID: PMC4837436 DOI: 10.3748/wjg.v22.i16.4191] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/19/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish if a distinct urinary metabolic profile could be identified in Bangladeshi hepatitis-B hepatocellular carcinoma (HCC) patients compared to cirrhosis patients and controls.
METHODS: Urine samples from 42 Bangladeshi patients with HCC (39 patients with hepatitis-B HCC), 47 with cirrhosis on a background of hepatitis B, 46 with chronic hepatitis B, and seven ethnically-matched healthy controls were analyzed using nuclear magnetic resonance (NMR) spectroscopy. A full dietary and medication history was recorded for each subject. The urinary NMR data were analyzed using principal component analysis (PCA) and orthogonal partial least squared discriminant analysis (OPLS-DA) techniques. Differences in relative signal levels of the most discriminatory metabolites identified by PCA and OPLS-DA were compared between subject groups using an independent samples Kruskal-Wallis one-way analysis of variance (ANOVA) test with all pairwise multiple comparisons. Within the patient subgroups, the Mann-Whitney U test was used to compare metabolite levels depending on hepatitis B e-antigen (HBeAg) status and treatment with anti-viral therapy. A Benjamini-Hochberg adjustment was applied to acquire the level of significance for multiple testing, with a declared level of statistical significance of P < 0.05.
RESULTS: There were significant differences in age (P < 0.001), weight (P < 0.001), and body mass index (P < 0.001) across the four clinical subgroups. Serum alanine aminotransferase (ALT) was significantly higher in the HCC group compared to controls (P < 0.001); serum α-fetoprotein was generally markedly elevated in HCC compared to controls; and serum creatinine levels were significantly reduced in the HCC group compared to the cirrhosis group (P = 0.004). A three-factor PCA scores plot showed clustering of the urinary NMR spectra from the four subgroups. Metabolites that contributed to the discrimination between the subgroups included acetate, creatine, creatinine, dimethyamine (DMA), formate, glycine, hippurate, and trimethylamine-N-oxide (TMAO). A comparison of relative metabolite levels confirmed that carnitine was significantly increased in HCC; and creatinine, hippurate, and TMAO were significantly reduced in HCC compared to the other subgroups. HBeAg negative patients showed a significant increase in creatinine (P = 0.001) compared to HBeAg positive patients in the chronic hepatitis B subgroup, whilst HBeAg negative patients showed a significant decrease in DMA (P = 0.004) in the cirrhosis subgroup compared to HBeAg positive patients. There were no differences in metabolite levels in HCC patients who did or did not receive antiviral treatment.
CONCLUSION: Urinary NMR changes in Bangladeshi HCC were identified, corroborating previous findings from Egypt and West Africa. These findings could form the basis for the development of a cost-effective HCC dipstick screening test.
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Shrestha A, Lama TK, Karki S, Sigdel DR, Rai U, Rauniyar SK, Al-Mahtab M, Takahashi K, Arai M, Akbar SMF, Mishiro S. Hepatitis E epidemic, Biratnagar, Nepal, 2014. Emerg Infect Dis 2015; 21:711-3. [PMID: 25811975 PMCID: PMC4378489 DOI: 10.3201/eid2104.141512] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Karim MF, Al-Mahtab M, Rahman S, Debnath CR. Non-alcoholic Fatty Liver Disease (NAFLD)--A Review. Mymensingh Med J 2015; 24:873-880. [PMID: 26620035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an emerging problem in Hepatology clinics. It is closely related to the increased frequency of overweight or obesity. It has recognised association with metabolic syndrome. Central obesity, diabetes mellitus, dyslipidemia are commonest risk factors. Association with hepatitis C genotype 3 is also recognised. NAFLD is an important cause of cyptogenic cirrhosis of liver. It affects all populations and all age groups. Most patients with NAFLD are asymptomatic or vague upper abdominal pain. Liver function tests are mostly normal or mild elevation of aminotranferases. Histological features almost identical to those of alcohol-induced liver damage and can range from mild steatosis to cirrhosis. Two hit hypothesis is prevailing theory for the development of NAFLD. Diagnosis is usually made by imaging tools like ultrasonogram which reveal a bright liver while liver biopsy is gold standard for diagnosis as well as differentiating simple fatty liver and non-alcoholic steatohepatitis (NASH). Prognosis is variable. Simple hepatic steatosis generally has a benign long-term prognosis. However, one to two third of NASH progress to fibrosis or cirrhosis and may have a similar prognosis as cirrhosis from other liver diseases. Treatment is mostly control of underlying disorders and dietary advice, exercise, insulin sensitizers, antioxidants, or cytoprotective agents. The prevalence of NAFLD is increasing. So it needs more research to address this problem.
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Affiliation(s)
- M F Karim
- Dr Md Fazal Karim, Associate Professor, Department of Hepatology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh; E-mail:
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Al-Mahtab M, Bazinet M, Vaillant A. Effects of nucleic acid polymer therapy alone or in combination with immunotherapy on the establishment of SVR in patients with chronic HBV infection. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Omata M, Kanda T, Yokosuka O, Crawford D, Al-Mahtab M, Wei L, Ibrahim A, Lau GKK, Sharma BC, Hamid SS, Chuang WL, Dokmeci AK. Features of hepatitis C virus infection, current therapies and ongoing clinical trials in ten Asian Pacific countries. Hepatol Int 2015; 9:486-507. [PMID: 25941137 DOI: 10.1007/s12072-015-9630-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 11/17/2014] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
Abstract
Estimated hepatitis C virus (HCV) infection rates in the general populations were 1.3, 0.9, 0.4-1.0, 14.7, 0.1-0.3, 0.9-1.9, 1.0-2.0, 5, 4.4-8.6 and 0.5-1.3 % in Australia, Bangladesh, Mainland China, Egypt, Hong Kong, India, Japan, Pakistan, Taiwan and Turkey, respectively. The main HCV genotypes (Gs) are G1, G3, G1b, G4, G1b, G3, G1b, G3, G1b and G2, and G1 in Australia, Bangladesh, Mainland China, Egypt, Hong Kong, India, Japan, Pakistan, Taiwan and Turkey, respectively. Of IL28B genotypes, favorable alleles are ~50 % in Australia and Turkey, but 60-70 % in most of the other Asian countries. Peginterferon plus ribavirin is available in all ten Asian Pasific countries. In addition, HCV NS3/4A protease inhibitors with peginterferon plus ribavirin are currently available in several countries. Clinical trials of interferon-free regimens for HCV are ongoing in most of the ten Asian Pacific countries.
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Affiliation(s)
- Masao Omata
- Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan. .,University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Darrell Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia.
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh.
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Benha, Egypt.
| | - George K K Lau
- Humanity and Health Medical Centre, Hong Kong SAR China Institute of Translational Hepatology and Centre of Liver Fibrosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
| | - Barjesh C Sharma
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
| | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
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Karim MF, Brunetti E, Rahman S, Budke CM, Ahsan ASMA, Al-Mahtab M, Zaki KMJ, Alam MJ, Akbar SMF, Jalil MA. Abdominal cystic echinococcosis in Bangladesh: a hospital-based study. J Infect Dev Ctries 2015; 9:70-5. [DOI: 10.3855/jidc.4934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/15/2014] [Indexed: 10/31/2022] Open
Abstract
Introduction: Cystic echinococcosis (CE) is reported from nearly all geographic areas of Bangladesh, but little information is available on its epidemiologic and clinical features. The aim of this study was to describe the clinical manifestations of hepatic and abdominal CE cases presenting to tertiary referral hospitals in Dhaka, Bangladesh. Methodology: A retrospective study was conducted via chart reviews of hepatic and abdominal CE patients under care at tertiary referral hospitals in Dhaka, Bangladesh, between 2002 and 2011. Age, sex, education level, occupation, urban versus rural residence, drinking water source, history of dog ownership, cyst type and location, and clinical manifestations were recorded for all patients. Results: Of the 130 patients enrolled, 92 (70.8%) were female and 38 (29.2%) were male. The majority of patients were from rural (76.2%) rather than urban (23.8%) areas. All cases were from the northern part of the country, with no cases reported from the south or southeast. Most patients were between 21 and 40 years of age. A total of 119 patients (91.5%) had cysts only in the liver, with the remaining 8.5% having cysts in both the liver and lungs or in the abdominal cavity. Seventy-six (58.5%) of the hepatic cysts were stage CE1, indicating recent infection. Conclusions: Active transmission of Echinococcus granulosus appears to be occurring in Bangladesh, as indicated by the high number of CE1 hepatic cysts seen at tertiary care hospitals. Community ultrasound screening studies are warranted to better define the distribution of cases and risk factors for parasite transmission.
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Chen S, Akbar SMF, Miyake T, Abe M, Al-Mahtab M, Furukawa S, Bunzo M, Hiasa Y, Onji M. Diminished immune response to vaccinations in obesity: role of myeloid-derived suppressor and other myeloid cells. Obes Res Clin Pract 2015; 9:35-44. [PMID: 25660173 DOI: 10.1016/j.orcp.2013.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 02/05/2023]
Abstract
Obesity is a chronic inflammatory condition associated with an increased production of cytokines and exacerbated immune response. However, obese subjects are susceptible to infections and respond poorly to vaccines. This study evaluated the immune responses of obese mice and the underlying mechanisms by exploring the roles of myeloid cells. Diet-induced obese (DIO) mice were prepared from C57BL/6J mice fed a high-calorie and high-fat diet for 12 weeks. Humoral and cellular immune responses of DIO mice to a hepatitis B vaccine containing the hepatitis B surface antigen (HBsAg) were assessed in sera and via a lymphoproliferative assay, respectively. The effects of CD11b(+)GR1(+) myeloid-derived suppressor cells (MDSC) and CD11b(+)GR1(-) non-MDSC on T cell proliferation and cytokine production were compared via a cell culture system. The production of cytokines, expression of activation and exhaustion markers, and proportions of apoptotic T cells were estimated with flow cytometry. Increased T and B lymphocyte proliferation and higher interferon-γ and tumor necrosis factor-α levels were detected in spleen cells and liver non-parenchymal cell cultures of DIO mice compared to controls (p<0.05). However, antibody to HBsAg (anti-HBs) levels and HBsAg-specific T cell proliferation were significantly lower in DIO mice compared to controls (p<0.05). The addition of MDSC, but not non-MDSC, induced a decrease in HBsAg-specific T cell proliferation, lower cytokine production, decrease in T cell activation, and increase in T cell exhaustion and apoptosis (p<0.05). MDSC play an important role in mediating impaired antigen-specific immunity.
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Affiliation(s)
- Shiyi Chen
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan; Department of Endocrinology and Rheumatology, The Second Affiliated Hospital of Shantou University Medical College, Guangdong, China
| | | | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shinya Furukawa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Matsuura Bunzo
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Morikazu Onji
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
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Raihan R, Tabassum S, Al-Mahtab M, Nessa A, Jahan M, Shamim Kabir CM, Kamal M, Cesar Aguilar J. Hepatitis B Core Antigen in Hepatocytes of Chronic Hepatitis B: Comparison between Indirect Immunofluorescence and Immunoperoxidase Method. Euroasian J Hepatogastroenterol 2015; 5:7-10. [PMID: 29201677 PMCID: PMC5578511 DOI: 10.5005/jp-journals-10018-1120] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/09/2014] [Indexed: 12/03/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection has many faces. Precore and core promoter mutants resemble inactive carrier status. The identification of hepatitis B core antigen (HBcAg) in hepatocytes may have variable clinical significance. The present study was undertaken to detect HBcAg in chronic hepatitis B (CHB) patients and to assess the efficacy of detection system by indirect immunofluorescence (IIF) and indirect immunoperoxidase (IIP). Materials and methods The study was done in 70 chronic HBV-infected patients. Out of 70 patients, eight (11.4%) were hepatitis B e antigen (HBeAg) positive and 62 (88.57%) were HBeAg negative. Hepatitis B core antigen was detected by indirect immunofluorescence (IIF) and indirect immunoperoxidase (IIP) methods in liver tissue. Results All HBeAg positive patients expressed HBcAg by both IIF and IIP methods. Out of 62 patients with HBeAg-negative CHB, HBcAg was detected by IIF in 55 (88.7%) patients and by IIP in 51 (82.26%) patients. A positive relation among viral load and HBcAg detection was also found. This was more evident in the case of HBeAg negative patients and showed a positive relation with HBV DNA levels. Conclusion Hepatitis B core antigen can be detected using the IIF from formalin fixed paraffin block preparation and also by IIP method. This seems to reflect the magnitudes of HBV replication in CHB. How to cite this article Raihan R, Tabassum S, Al-Mahtab M, Nessa A, Jahan M, Kabir CMS, Kamal M, Aguilar JC. Hepatitis B Core Antigen in Hepatocytes of Chronic Hepatitis B: Comparison between Indirect Immunofluorescence and Immunoperoxidase Method. Euroasian J Hepato-Gastroenterol 2015;5(1):7-10.
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Affiliation(s)
- Ruksana Raihan
- Department of Microbiology, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia.,Department of Virology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Shahina Tabassum
- Department of Microbiology, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Afzalun Nessa
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Munira Jahan
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | | | - Mohammad Kamal
- Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Julio Cesar Aguilar
- Department of Biomedical Research, Centre for Genetic Engineering and Biotechnology, Havana City, Cuba
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Stefanska B, Cheishvili D, Suderman M, Arakelian A, Huang J, Hallett M, Han ZG, Al-Mahtab M, Akbar SMF, Khan WA, Raqib R, Tanvir I, Khan HA, Rabbani SA, Szyf M. Genome-wide study of hypomethylated and induced genes in patients with liver cancer unravels novel anticancer targets. Clin Cancer Res 2014; 20:3118-32. [PMID: 24763612 DOI: 10.1158/1078-0432.ccr-13-0283] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We utilized whole-genome mapping of promoters that are activated by DNA hypomethylation in hepatocellular carcinoma (HCC) clinical samples to shortlist novel targets for anticancer therapeutics. We provide a proof of principle of this approach by testing six genes short-listed in our screen for their essential role in cancer growth and invasiveness. EXPERIMENTAL DESIGN We used siRNA- or shRNA-mediated depletion to determine whether inhibition of these genes would reduce human tumor xenograft growth in mice as well as cell viability, anchorage-independent growth, invasive capacities, and state of activity of nodal signaling pathways in liver, breast, and bladder cancer cell lines. RESULTS Depletion of EXOSC4, RNMT, SENP6, WBSCR22, RASAL2, and NENF effectively and specifically inhibits cancer cell growth and cell invasive capacities in different types of cancer, but, remarkably, there is no effect on normal cell growth, suggesting a ubiquitous causal role for these genes in driving cancer growth and metastasis. Depletion of RASAL2 and NENF in vitro reduces their growth as explants in vivo in mice. RASAL2 and NENF depletion interferes with AKT, WNT, and MAPK signaling pathways as well as regulation of epigenetic proteins that were previously demonstrated to drive cancer growth and metastasis. CONCLUSION Our results prove that genes that are hypomethylated and induced in tumors are candidate targets for anticancer therapeutics in multiple cancer cell types. Because these genes are particularly activated in cancer, they constitute a group of targets for specific pharmacologic inhibitors of cancer and cancer metastasis. Clin Cancer Res; 20(12); 3118-32. ©2014 AACR.
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Affiliation(s)
- Barbara Stefanska
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, PakistanAuthors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - David Cheishvili
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Matthew Suderman
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Ani Arakelian
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Jian Huang
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Michael Hallett
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Ze-Guang Han
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Mamun Al-Mahtab
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Sheikh Mohammad Fazle Akbar
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Wasif Ali Khan
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Rubhana Raqib
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Imrana Tanvir
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Haseeb Ahmed Khan
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Shafaat A Rabbani
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
| | - Moshe Szyf
- Authors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, PakistanAuthors' Affiliations: Departments of Pharmacology and Therapeutics and Medicine, McGill University Health Centre, Montreal; McGill Centre for Bioinformatics; and Sackler program for Psychobiology and Epigenetics at McGill University, Montreal, Quebec, Canada; Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh; Department of Medical Sciences, Toshiba General Hospital, Tokyo, Kanto, Japan; and Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore, Pakistan
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Al-Mahtab M, Akbar SMF, Aguilar JC, Uddin MH, Khan MSI, Rahman S. Therapeutic potential of a combined hepatitis B virus surface and core antigen vaccine in patients with chronic hepatitis B. Hepatol Int 2013. [PMID: 26202028 DOI: 10.1007/s12072-013-9486-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The safety and clinical efficacy of a vaccine containing both hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) (HBsAg/HBcAg) were evaluated in patients with chronic hepatitis B (CHB). METHODS Eighteen patients with CHB were administered a vaccine containing 100 μg of HBsAg and 100 μg of HBcAg. The vaccine was administered ten times at 2-weekly intervals, the first five times via the nasal route only and the subsequent five times via both nasal and subcutaneous routes. The safety and efficacy of this therapeutic approach were assessed by periodic assessment of the patients' general condition, viral kinetics, and biochemical parameters during treatment and 24 and 48 weeks after therapy. The production of cytokines by peripheral blood mononuclear cells (PBMC) and antigen-pulsed dendritic cells (DC) was evaluated to assess the immunomodulatory effects of the HBsAg/HBcAg vaccine in CHB patients. RESULTS The HBsAg/HBcAg vaccine was safe in all patients. No flare of HBV DNA or alanine aminotransferase (ALT) was recorded in any patient. Sustained HBV DNA negativity and persistently normalized ALT were detected in 9 (50 %) and 18 (100 %) patients with CHB, respectively. PBMC and HBsAg/HBcAg-pulsed DCs from HBsAg/HBcAg-vaccinated CHB patients produced significantly higher levels of various cytokines [interleukin 1β (IL-1β), IL-6, IL-8, IL-12, and tumor necrosis factor α (TNF-α)] than those from control unvaccinated CHB patients (p < 0.05) after stimulation with HBsAg/HBcAg in vitro. CONCLUSION HBsAg/HBcAg vaccine seems a safe and efficient therapeutic approach for patients with CHB.
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Affiliation(s)
- Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
| | | | | | | | | | - Salimur Rahman
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
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Stefanska B, Bouzelmat A, Huang J, Suderman M, Hallett M, Han ZG, Al-Mahtab M, Akbar SMF, Khan WA, Raqib R, Szyf M. Discovery and validation of DNA hypomethylation biomarkers for liver cancer using HRM-specific probes. PLoS One 2013; 8:e68439. [PMID: 23950870 PMCID: PMC3737236 DOI: 10.1371/journal.pone.0068439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/29/2013] [Indexed: 12/13/2022] Open
Abstract
Poor prognosis of hepatocellular carcinoma (HCC) associated with late diagnosis necessitates the development of early diagnostic biomarkers. We have previously delineated the landscape of DNA methylation in HCC patients unraveling the importance of promoter hypomethylation in activation of cancer- and metastasis-driving genes. The purpose of the present study was to test the feasibility that genes that are hypomethylated in HCC could serve as candidate diagnostic markers. We use high resolution melting analysis (HRM) as a simple translatable PCR-based method to define methylation states in clinical samples. We tested seven regions selected from the shortlist of genes hypomethylated in HCC and showed that HRM analysis of several of them distinguishes methylation states in liver cancer specimens from normal adjacent liver and chronic hepatitis in the Shanghai area. Such regions were identified within promoters of neuronal membrane glycoprotein M6-B (GPM6B) and melanoma antigen family A12 (MAGEA12) genes. Differences in HRM in the immunoglobulin superfamily Fc receptor (FCRL1) separated invasive tumors from less invasive HCC. The identified biomarkers differentiated HCC from chronic hepatitis in another set of samples from Dhaka. Although the main thrust in DNA methylation diagnostics in cancer is on hypermethylated genes, our study for the first time illustrates the potential use of hypomethylated genes as markers for solid tumors. After further validation in a larger cohort, the identified DNA hypomethylated regions can become important candidate biomarkers for liver cancer diagnosis and prognosis, especially in populations with high risk for HCC development.
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Affiliation(s)
- Barbara Stefanska
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Aurelie Bouzelmat
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Jian Huang
- Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, Shanghai, China
| | - Matthew Suderman
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Michael Hallett
- McGill Centre for Bioinformatics, McGill University, Montreal, Quebec, Canada
| | - Ze-Guang Han
- Shanghai-MOST Key Laboratory for Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, Shanghai, China
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka District, Bangladesh
| | | | - Wasif Ali Khan
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh
| | - Rubhana Raqib
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Dhaka District, Bangladesh
| | - Moshe Szyf
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Sackler Program for Psychobiology and Epigenetics at McGill University, McGill University, Montreal, Quebec, Canada
- * E-mail:
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Harun-Or-Rashid M, Akbar SMF, Takahashi K, Al-Mahtab M, Khan MSI, Alim MA, Ekram ARMS, Khan MMR, Arai M, Mishiro S. Epidemiological and molecular analyses of a non-seasonal outbreak of acute icteric hepatitis E in Bangladesh. J Med Virol 2013; 85:1369-76. [PMID: 23703666 DOI: 10.1002/jmv.23601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Kazuaki Takahashi
- Department of Medical Sciences; Toshiba General Hospital; Tokyo Japan
| | - Mamun Al-Mahtab
- Department of Hepatology; Bangabandhu Sheikh Mujib Medical University; Dhaka Bangladesh
| | | | | | | | | | - Masahiro Arai
- Department of Medical Sciences; Toshiba General Hospital; Tokyo Japan
| | - Shunji Mishiro
- Department of Medical Sciences; Toshiba General Hospital; Tokyo Japan
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Akbar SMF, Al-Mahtab M, Khan MSI. Non-antigen-specific and antigen-specific immune therapies for chronic hepatitis B: evidences from laboratory benches and patient's bedsides. Expert Opin Biol Ther 2013; 13:1063-74. [PMID: 23581572 DOI: 10.1517/14712598.2013.789016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Due to unsatisfactory therapeutic efficacy and considerable side effects of antiviral drugs in patients with chronic hepatitis B (CHB), immunotherapy has emerged as an alternative approach. CHB immunotherapy may be categorized into two main types: i) non-antigen-specific immune therapy and ii) hepatitis B virus (HBV) antigen-specific immune therapy. Although different immune modulators have been used in CHB patients for the last two to three decades, the nature and design of ongoing regimens of immunotherapeutic approaches need considerable modifications. AREAS COVERED In this review, the authors have outlined the relevant immunotherapies for CHB patients that have been used for the last two to three decades. The mechanisms underlying the limited therapeutic efficacy of available therapeutic agents for CHB patients have been discussed to aid in the development of an effective therapeutic approach for these patients. EXPERT OPINION Circumstantial evidence indicates that a better regimen of immunotherapy may be developed using different HBV-related antigens or combinations of two or more HBV-related antigens, or combinations of HBV-related antigens and antiviral drugs. However, the capacity of 'inducible immunity' by immune modulators to cure or block progression of liver diseases in CHB patients needs to be addressed.
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Affiliation(s)
- Sheikh Mohammad Fazle Akbar
- Toshiba General Hospital, Department of Medical Sciences, Higashi Oi 6-3-22, Shinagawa, Tokyo 140-8522, Japan.
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Al-Mahtab M, Akbar SMF, Rahman S, Kamal M, Khan MSI. Biochemical, virological, immunological and histopathological features of 702 incidentally detected chronic hepatitis B virus carriers in Bangladesh. Digestion 2013; 86:1-5. [PMID: 22688441 DOI: 10.1159/000337529] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 11/17/2011] [Accepted: 02/28/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Simultaneous assessment of biochemical, virological, and histological parameters of incidentally detected chronic hepatitis B virus (HBV)-infected subjects in Bangladesh were done to develop strategies for containment of HBV and management of liver diseases of these patients. METHODS A total of 702 chronic HBV carriers detected incidentally were enrolled in the study. Levels of HBV DNA and alanine aminotransferase (ALT) in sera were measured. The extent of hepatic inflammation and liver fibrosis was evaluated in all patients by examining liver biopsy specimens. RESULTS Of the 702 patients, 358 (50.7%) exhibited HBV DNA levels >10(5) copies/ml. ALT levels were above the upper limit of normal (ULN; >42 U/l) in more than 50% of the patients. High levels of HBV DNA (>10(5) copies/ml), increased ALT (>1.0 × ULN), moderate hepatic inflammation (HAI-NI ≥7) and severe hepatic fibrosis (HAI-F ≥3) were detected in 60 patients. CONCLUSION As considerable numbers of apparently healthy subjects are unaware of the fact that they are chronically infected by HBV, many of whom have already developed progressive liver damage, emergency strategies would be needed for the containment and management of HBV infection in developing countries.
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Affiliation(s)
- Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Rahman S, Al-Mahtab M, Jamshed Alam M. Association of Fatty Liver and Hypothyroidism. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rahman S, Al-Mahtab M, Fazal Karim M, Al-Mamun A, Mashud G, Jyoti Tarafdar A, Fowaz Hossain M. Serum Creatinine Levels Unrelated to Child-Pugh Status in Uncomplicated Cirrhosis of Liver with Ascites. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rahman S, Al-Mahtab M, Ahmed F, Fazal Karim M, Dalil Uddin M. Ribavirin as a Therapeutic Modality in Patients with Severe Acute Hepatitis E. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Akbar SMF, Chen S, Al-Mahtab M, Abe M, Hiasa Y, Onji M. Strong and multi-antigen specific immunity by hepatitis B core antigen (HBcAg)-based vaccines in a murine model of chronic hepatitis B: HBcAg is a candidate for a therapeutic vaccine against hepatitis B virus. Antiviral Res 2012; 96:59-64. [PMID: 22884884 DOI: 10.1016/j.antiviral.2012.07.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 12/13/2022]
Abstract
Experimental evidence suggests that hepatitis B core antigen (HBcAg)-specific cytotoxic T lymphocytes (CTL) are essential for the control of hepatitis B virus (HBV) replication and prevention of liver damage in patients with chronic hepatitis B (CHB). However, most immune therapeutic approaches in CHB patients have been accomplished with hepatitis B surface antigen (HBsAg)-based prophylactic vaccines with unsatisfactory clinical outcomes. In this study, we prepared HBsAg-pulsed dendritic cells (DC) and HBcAg-pulsed DC by culturing spleen DC from HBV transgenic mice (HBV TM) and evaluated the immunomodulatory capabilities of these antigens, which may serve as a better therapy for CHB. The kinetics of HBsAg, antibody levels against HBsAg (anti-HBs), proliferation of HBsAg- and HBcAg-specific lymphocytes, production of antigen-specific CTL, and activation of endogenous DC were compared between HBV TM vaccinated with either HBsAg- or HBcAg-pulsed DC. Vaccination with HBsAg-pulsed DC induced HBsAg-specific immunity, but failed to induce HBcAg-specific immunity in HBV TM. However, immunization of HBV TM with HBcAg-pulsed DC resulted in: (1) HBsAg negativity, (2) production of anti-HBs, and (3) development of HBsAg- and HBcAg-specific T cells and CTL in the spleen and the liver. Additionally, significantly higher levels of activated endogenous DC were detected in HBV TM immunized with HBcAg-pulsed DC compared to HBsAg-pulsed DC (p<0.05). The capacity of HBcAg to modulate both HBsAg- and HBcAg-specific immunity in HBV TM, and activation of endogenous DC in HBV TM without inducing liver damage suggests that HBcAg should be an integral component of the therapeutic vaccine against CHB.
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Affiliation(s)
- Sheikh Mohammad Fazle Akbar
- Department of Medical Sciences, Toshiba General Hospital, Higashi Oi 6-3-22, Shinagawa, Tokyo 140-8522, Japan.
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Rahman S, Al-Mahtab M, Karim F, Ahmed F. Successful Treatment of Severe Hepatitis E with Ribavirin: A Case Report from Bangladesh. Euroasian J Hepatogastroenterol 2012. [DOI: 10.5005/jp-journals-10018-1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Onji M, Al-Mahtab M, Mohammad Fazle Akbar S, Chen S, Abe M, Yoshida O, Ikeda Y, Hiasa Y. Suppression of Inflammatory Mucosal Milieu by Administration of Regulatory Dendritic Cells in an Animal Model of Primary Biliary Cirrhosis. Euroasian J Hepatogastroenterol 2012. [DOI: 10.5005/jp-journals-10018-1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Al-Mahtab M, Rahman S, Akbar SMF, Kamal M, Khan MSI. Assessment of clinical utility of low and high normal alanine aminotransferase values in patients with chronic hepatitis B virus infection in Bangladesh. Digestion 2011; 83:60-4. [PMID: 20975272 DOI: 10.1159/000319758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 04/13/2010] [Accepted: 07/22/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS There is a lack of consensus about the currently accepted range of normal values for serum alanine aminotransferase (ALT) levels because some investigators have claimed that the true values are significantly lower than those listed by kit manufacturers. METHODS A total of 255 chronic hepatitis-B-virus (HBV)-infected patients with traditional, normal levels of ALT (≤42 U/l) were divided into 2 groups: (1) low normal ALT (men: ≤30 U/l; women: ≤19 U/l) and (2) high normal ALT (men: 31-42 U/l; women: 20-42 U/l). The extent of hepatic inflammation and fibrosis was evaluated in these patients by examining liver biopsy specimens. RESULTS The levels of HBV DNA were >10,000 copies/ml in 58.4, 52.9 and 61.2% of the patients with traditional normal ALT, low normal ALT and high normal ALT values, respectively (p > 0.05). Also, the moderate degrees of hepatic necroinflammation [histological activity index (HAI)-NI score of ≥9] and severe hepatic fibrosis (HAI-F score of ≥3) were similar among the 3 groups of patients (p > 0.05). CONCLUSION The newly defined low normal cutoff values for ALT did not exhibit any added clinical benefit for assessing the extent of liver damage in patients with chronic HBV infection in Bangladesh.
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Affiliation(s)
- Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Al-Mahtab M. Immunotherapy for Chronic Hepatitis B:
Will This Lead to Rome? Euroasian J Hepatogastroenterol 2011. [DOI: 10.5005/jp-journals-10018-1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Al-Mahtab M. Immune Interventional Strategies against
Chronic Infection Diseases and Cancers:
Present Challenges and Road Map
to Solution. Euroasian J Hepatogastroenterol 2010. [DOI: 10.5005/jp-journals-10018-1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Al-Mahtab M, Rahman S, Akbar SM, Khan SI, Uddin H, Karim MF, Ahmed F. Combination therapy of lamivudine and interferon-alpha in pediatric patients with chronic hepatitis B in Bangladesh: a safe and effective therapeutic approach for pediatric CHB patients in developing countries. Int J Immunopathol Pharmacol 2010; 23:659-64. [PMID: 20646364 DOI: 10.1177/039463201002300231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Hepatitis B virus (HBV) is mainly transmitted during birth or perinatal period, however, treatment is not usually recommended for pediatric patients with chronic hepatitis B (CHB). Twelve pediatric patients with CHB in Bangladesh were treated with both lamivudine and interferon. Lamivudine was given at a dose of 3 mg/kg, daily for 12 months. Two months after commencement of lamivudine therapy, all patents were given interferon-alpha (3 million IU/square meter of body surface area) three times weekly, subcutaneously for 10 months. Combination therapy was safe for all pediatric CHB patients. The levels of serum HBV DNA became undetectable (less than 500 copies/ml) in 8 patients and reduced in 4 patients after the end of therapy. Anti-HBe was detected in 10 of 12 patients at this time point. The levels of serum alanine aminotransferase (ALT) were significantly reduced in these patients (p less than 0.05) due to therapy. Neither flare of HBV DNA nor elevation of serum ALT were detected during follow-up. In conclusion, combination therapy with lamivudine and interferon-alpha represents a new and novel therapeutic option for treatment of pediatric CHB patients.
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Chen ZJ, Al-Mahtab M, Rahman S, Tan NC, Luo N, Tai BC. Validity and reliability of the Bengali version of the Hepatitis Quality of Life Questionnaire. Qual Life Res 2010; 19:1343-8. [DOI: 10.1007/s11136-010-9702-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2010] [Indexed: 01/05/2023]
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Al-Mahtab M, Rahman S, Akbar SMF, Kamal M, Khan MSI. Clinical use of liver biopsy for the diagnosis and management of inactive and asymptomatic hepatitis B virus carriers in Bangladesh. J Med Virol 2010; 82:1350-4. [DOI: 10.1002/jmv.21830] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Al-Mahtab M, Rahman S, Fazle Akbar SM, Khan SI, Uddin H, Karim F, Ahmed F. Combination Therapy with Antiviral Drugs and Hepatitis B Vaccine in Incidentally-Detected and Asymptomatic Chronic Hepatitis Virus B Carriers at Bangladesh. Viral Immunol 2010; 23:335-8. [DOI: 10.1089/vim.2009.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Viral Hepatitis Foundation Bangladesh, Dhaka, Bangladesh
| | - Salimur Rahman
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Viral Hepatitis Foundation Bangladesh, Dhaka, Bangladesh
| | | | - Sakirul Islam Khan
- Department of Animal Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
- Viral Hepatitis Foundation Bangladesh, Dhaka, Bangladesh
| | - Helal Uddin
- Viral Hepatitis Foundation Bangladesh, Dhaka, Bangladesh
| | - Fazal Karim
- Department of Hepatology, Dhaka Medical College, Dhaka, Bangladesh
| | - Faroque Ahmed
- Department of Hepatology, Dhaka Medical College, Dhaka, Bangladesh
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