Future Perspectives in the Diagnosis and Treatment of Liver Disease Associated with Alpha-1 Antitrypsin Deficiency

Alpha-1 antitrypsin deficiency (AATD) is one of the most common genetic diseases and is caused by mutations in the SERPINA1 gene. The homozygous Pi*Z variant is responsible for the majority of the classic severe form of alpha-1 antitrypsin deficiency, which is characterized by markedly decreased levels of serum alpha-1 antitrypsin (AAT) with a strong predisposition to lung and liver disease. The diagnosis and early treatment of AATD-associated liver disease are challenges in clinical practice. In this review, the authors aim to summarize the current evidence of the non-invasive methods in the assessment of liver fibrosis, as well as to elucidate the main therapeutic strategies under investigation that may emerge in the near future.

Infectious proctitis: what every gastroenterologist needs to know

The incidence of sexually transmitted infections (STI) is rising, especially in high-risk groups, namely people living with human immunodeficiency virus (HIV), men who have sex with men, and people with multiple sexual partners. Additionally, the growing availability and use of pre-exposure prophylaxis to prevent HIV infection appears to be associated with an increased risk of infection by venereal agents. The correct recognition of these infections is crucial, not only for individual patients, but also in terms of public health. Furthermore, a diligent diagnostic assessment is key for an efficient therapeutic approach. Infectious proctitis (IP) predominantly occurs in individuals with a history of receptive anal exposure, being a frequent cause for referral to a gastroenterology specialist. The most frequently identified agents are Neisseria gonorrhoeae, Chlamydia trachomatis, Herpes simplex virus, and Treponema pallidum. This paper aims to provide a practice-oriented and up-to-date review regarding the diagnostic and therapeutic approaches to patients with suspected IP. The authors reviewed the most important issues in terms of clinical history, physical examination, and specific diagnostic and therapeutic methods. It is also highlighted the most important topics regarding vaccination, screening for other STIs and differential diagnosis with inflammatory bowel disease. Identification of high-risk groups, screening of potential STIs, and notification of diagnosed anorectal diseases are extremely important and essential to prevent transmission and other complications.

Hepatobiliary phenotypes of adults with alpha-1 antitrypsin deficiency

OBJECTIVE

Alpha-1 antitrypsin deficiency (AATD) is a common, potentially lethal inborn disorder caused by mutations in alpha-1 antitrypsin (AAT). Homozygosity for the 'Pi*Z' variant of AAT (Pi*ZZ genotype) causes lung and liver disease, whereas heterozygous 'Pi*Z' carriage (Pi*MZ genotype) predisposes to gallstones and liver fibrosis. The clinical significance of the more common 'Pi*S' variant remains largely undefined and no robust data exist on the prevalence of liver tumours in AATD.

DESIGN

Baseline phenotypes of AATD individuals and non-carriers were analysed in 482 380 participants in the UK Biobank. 1104 participants of a multinational cohort (586 Pi*ZZ, 239 Pi*SZ, 279 non-carriers) underwent a comprehensive clinical assessment. Associations were adjusted for age, sex, body mass index, diabetes and alcohol consumption.

RESULTS

Among UK Biobank participants, Pi*ZZ individuals displayed the highest liver enzyme values, the highest occurrence of liver fibrosis/cirrhosis (adjusted OR (aOR)=21.7 (8.8-53.7)) and primary liver cancer (aOR=44.5 (10.8-183.6)). Subjects with Pi*MZ genotype had slightly elevated liver enzymes and moderately increased odds for liver fibrosis/cirrhosis (aOR=1.7 (1.2-2.2)) and cholelithiasis (aOR=1.3 (1.2-1.4)). Individuals with homozygous Pi*S mutation (Pi*SS genotype) harboured minimally elevated alanine aminotransferase values, but no other hepatobiliary abnormalities. Pi*SZ participants displayed higher liver enzymes, more frequent liver fibrosis/cirrhosis (aOR=3.1 (1.1-8.2)) and primary liver cancer (aOR=6.6 (1.6-26.9)). The higher fibrosis burden was confirmed in a multinational cohort. Male sex, age ≥50 years, obesity and the presence of diabetes were associated with significant liver fibrosis.

CONCLUSION

Our study defines the hepatobiliary phenotype of individuals with the most relevant AATD genotypes including their predisposition to liver tumours, thereby allowing evidence-based advice and individualised hepatological surveillance.

[Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting]

BACKGROUND/AIM

Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI.

RESULTS

One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi.

CONCLUSIONS

The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer.

The helminth fauna of the barbary partridgeAlectoris barbarain Tenerife, Canary Islands

The helminth fauna of the barbary partridge (Alectoris barbara) in Tenerife Island (Canary Archipelago) was studied from 2001 to 2002, as there were no records of helminths from this host in the Canary Islands. Seven helminth species were identified: two cestodesChoanotaenia infundibulumandLyruterina nigropunctata, and five nematodesAonchotheca caudinflata,Baruscapillaria obsignata,Eucoleus annulatus,Ascaridia galliandHeterakis gallinarum.Lyruterina nigropunctata,A. galli and E. annulatusare recorded for first time inA. barbara. An analysis of available data onAlectorisspp. reveals the importance of intermediate hosts such as arthropods and earthworms in the diet of partridges. Terrestrial helminths are dominant species, with monoxenous and heteroxenous species being present in similar numbers in differentAlectorisspecies along their geographical distribution. Helminth species found in Tenerife fromA. barbaraare poor indicators of the host colonization from North Africa because these helminths are species that are commonly found in fowl with a cosmopolitan distribution.

Parasites of Columba livia (Aves: Columbiformes) in Tenerife (Canary Islands) and their role in the conservation biology of the laurel pigeons

The prevalence and intensity of the parasites from 50 wild doves (Columba livia) from the city of Santa Cruz de Tenerife, in the island of Tenerife (Canary Archipelago), were studied. The following ectoparasites were found in apparently healthy pigeons (prevalences are shown in percentage (%) and mean intensities with their standard deviations): the acari Dermanyssus gallinae (De Geer, 1778) (6, 241.0 +/- 138.9) and Tinaminyssus melloi Fain, 1962 (10%, 218.3 +/- 117.3); the louses, Columbicola columbae Linnaeus, 1758 (100%, 111.4 +/- 76.8) and Campanulotes bidentatus Scopoli, 1763 (94%, 48.4 +/- 26.6); and the pigeon fly, Pseudolynchia canariensis Macquart, 1839 (36%, 6.2 +/- 1.6). The endoparasites we found were: a haemoprotozoan species, Haemoproteus columbae Kruze, 1890 (82%, 14.8 +/- 10.3 per 1000); coccidian oocysts, Eimeria sp. (50%, 0.2 x 10(3) +/- 1.7 x 10(3) per gr); a cestode species Raillietina micracantha (Fuhrmann, 1909) López Neyra, 1947 (44%, 12.3 +/- 9.4); and four nematode species, Tetrameres (Tetrameres) fissispina (Diesing, 1861) Travassos, 1915 (4%, 99.5 +/- 34.1), Synhimantus (Dispharynx) spiralis (Molin, 1858) (8%, 46.8 +/- 11.6), Ascaridia columbae (Gmelin, 1790) Travassos, 1913 (40%, 8.4 +/- 8.8) and Aonchotheca sp. (18%, 6.0 +/- 3.1). Several species detected in our study can be pathogens for C. bollii and C. junoniae, which are endemic pigeons of the Canary Islands, considered endangered species. Parasites (ectoparasites, protozoa and helminths) of C. livia found in Tenerife and others from wild and farm birds in the island were considered as healthy controls.

Parasitic helminths of the wild rabbit, Oryctolagus cuniculus, in different bioclimatic zones in Tenerife, Canary Islands

Faunistic and ecological analyses of the wild rabbit helminth fauna were undertaken in Tenerife island (Canary Islands). Rabbits were collected between 1998 and 2000 in seven bioclimatic zones in Tenerife selected by orientation and altitude. Five parasite species were identified, three cestodes (Taenia pisiformis (larvae), Andrya cuniculi and Mosgovoyia ctenoides) and two nematodes (Trichostrongylus retortaeformis and Passalurus ambiguus). Taenia pisiformis presented an irregular distribution with significant differences in prevalences between the zones. Andrya cuniculi was only found in two zones and there were no significant differences in prevalence values. Mosgovoyia ctenoides presented a wide distribution with significant prevalences, which were higher in northern compared to southern zones. Trichostrongylus retortaeformis was absent in the low southern zones of the island. Passalurus ambiguus was found in all zones with no significant difference in the prevalence of infection. The differences in prevalences are likely to be explained by abiotic factors in the case of T. retortaeformis, and by the absence of definitive and intermediate hosts in the case of T. pisiformis and A. cuniculi, respectively. All parasite species in Tenerife are common helminths in the Iberian Peninsula, from which their rabbit hosts originated. No significant differences were recorded in the mean intensities of infection of any of the parasite species identified.

Mucosal immunogenicity of the hepatitis B core antigen

The hepatitis B virus (HBV) core antigen (HBcAg) is a potent immunogen in animal models and humans and has been used as a carrier for several antigens, however, the mucosal immunogenicity of HBcAg or chimeric HBcAg proteins has been poorly studied and only using the truncated variant of the HBcAg. In this study we explored the mucosal immunogenicity in mice of the recombinant complete nucleocapside of HBcAg. The antigen was administered by different mucosal and parenteral routes. The antibody response in sera was evaluated after each immunization and mucosal lavages were tested with the final extraction. To characterize the immune response, the serum IgG antibody response was tested during six months and also the ratio IgG2a to IgG1 was determined. The results obtained evidenced that the mucosal immunogenicity of HBcAg depended on the administration route, being the intranasal (i.n.) route the one that generated the higher IgG responses in sera, similar in intensity and duration to parenteral administrations. The IgA response in mucosal washes was superior for nasally immunized mice compared to the rest of mucosal and parenteral groups. The nasal route also induced the higher IgG2a to IgG1 ratio, evidencing a Th1-like Ab subclass pattern. In addition to the high Ab responses, preliminary results of the cellular response induced by nasal administration evidenced the induction of strong lymphoproliferative responses in spleen cells.