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Vidal-Cevallos P, Flores-García N, Chávez-Tapia NC, Chalasani NP. Occult liver disease: A multinational perspective. Ann Hepatol 2024; 29:101480. [PMID: 38354950 DOI: 10.1016/j.aohep.2024.101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Occult liver disease refers to the presence of unrecognized chronic liver disease and cirrhosis. Liver disease is currently the eleventh cause of death globally, representing 4% of all deaths in the world. Alcohol consumption is the leading cause of cirrhosis globally, accounting for approximately 60% of cases. The estimated global prevalence of non-alcoholic fatty liver disease (NAFLD) is 32.4% and has been steadily increasing over the last years. Viral hepatitis B and C accounted for 1.3 million deaths in 2020. Several studies in populations at high risk of chronic liver disease (elevated liver enzymes, type 2 diabetes, excessive alcohol consumption) have found an elevated prevalence of occult liver disease. Attempts should be made to assess the prevalence of occult liver disease in Latin America, a region with one of the highest rates of metabolic diseases and excessive alcohol consumption. Screening for NAFLD in high-risk subjects and screening for excessive drinking and alcohol use disorders at every level of medical care is relevant. Efforts should also focus on the early treatment of occult liver disease to try to reduce liver disease burden and, in the case of occult viral hepatitis infection, prevent further spreading.
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Affiliation(s)
- Paulina Vidal-Cevallos
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico
| | - Nayelli Flores-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Norberto C Chávez-Tapia
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico.
| | - Naga P Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States.
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Vidal-Cevallos P, Sorroza-Martínez AP, Chávez-Tapia NC, Uribe M, Montalvo-Javé EE, Nuño-Lámbarri N. The Relationship between Pathogenesis and Possible Treatments for the MASLD-Cirrhosis Spectrum. Int J Mol Sci 2024; 25:4397. [PMID: 38673981 PMCID: PMC11050641 DOI: 10.3390/ijms25084397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a term that entails a broad spectrum of conditions that vary in severity. Its development is influenced by multiple factors such as environment, microbiome, comorbidities, and genetic factors. MASLD is closely related to metabolic syndrome as it is caused by an alteration in the metabolism of fatty acids due to the accumulation of lipids because of an imbalance between its absorption and elimination in the liver. Its progression to fibrosis is due to a constant flow of fatty acids through the mitochondria and the inability of the liver to slow down this metabolic load, which generates oxidative stress and lipid peroxidation, triggering cell death. The development and progression of MASLD are closely related to unhealthy lifestyle habits, and nutritional epigenetic and genetic mechanisms have also been implicated. Currently, lifestyle modification is the first-line treatment for MASLD and nonalcoholic steatohepatitis; weight loss of ≥10% produces resolution of steatohepatitis and fibrosis regression. In many patients, body weight reduction cannot be achieved; therefore, pharmacological treatment should be offered in particular populations.
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Affiliation(s)
- Paulina Vidal-Cevallos
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico; (P.V.-C.); (N.C.C.-T.); (M.U.); (E.E.M.-J.)
| | | | - Norberto C. Chávez-Tapia
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico; (P.V.-C.); (N.C.C.-T.); (M.U.); (E.E.M.-J.)
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico;
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico; (P.V.-C.); (N.C.C.-T.); (M.U.); (E.E.M.-J.)
| | - Eduardo E. Montalvo-Javé
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico; (P.V.-C.); (N.C.C.-T.); (M.U.); (E.E.M.-J.)
- Department of Surgery, Faculty of Medicine, Universidad Nacional Autónoma de Mexico, Mexico City 04360, Mexico
- Hepatopancreatobiliary Clinic, Department of Surgery, Hospital General de Mexico “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
| | - Natalia Nuño-Lámbarri
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico;
- Department of Surgery, Faculty of Medicine, Universidad Nacional Autónoma de Mexico, Mexico City 04360, Mexico
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3
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Morales-Olvera CG, Lanz-Zubiría L, Aguilar-Zamora E, Camorlinga-Ponce M, Aparicio-Ozores G, Aguilar-Zapata D, Chávez-Tapia NC, Uribe M, Barbero-Becerra VJ, Juárez-Hernández E. Clostridioides Difficile in Latin America: An Epidemiological Overview. Curr Microbiol 2023; 80:357. [PMID: 37768473 DOI: 10.1007/s00284-023-03475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/18/2023] [Indexed: 09/29/2023]
Abstract
Clostridioides difficile infection is one of the most significant causes of nosocomial diarrhea associated with antibiotic use worldwide. In recent years, the incidence of Clostridioides difficile infection in Latin American countries has increased due to the emergence and spread of epidemic Clostridioides difficile strains, such as RT027/NAP1/ST1, RT078/ST11, and RT017/ST37; additionally, endemic multi-drug-resistant strains have recently appeared due to the lack of heterogeneous diagnostic algorithms and guidelines for antibiotic use in each country. The aim of this review is to present the latest information regarding Clostridioides difficile and emphasize the importance of epidemiological surveillance of this pathogen in Latin American countries.
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Affiliation(s)
- Claudia G Morales-Olvera
- Translational Research Unit. Medica Sur Clinic & Foundation, Mexico City, Mexico
- Geriatric Service, PEMEX North Central Hospital and Postgraduate Studies Division, School of Medicine, UNAM, Mexico City, Mexico
| | - Lorena Lanz-Zubiría
- Infectious Diseases and Hospital Epidemiology Department, Médica Sur Clinic & Foundation. Medicine School Universidad Anáhuac, Mexico City, Mexico
| | - Emmanuel Aguilar-Zamora
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Margarita Camorlinga-Ponce
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gerardo Aparicio-Ozores
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Daniel Aguilar-Zapata
- Infectious Diseases and Hospital Epidemiology Department, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - M Uribe
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - Eva Juárez-Hernández
- Translational Research Unit. Medica Sur Clinic & Foundation, Mexico City, Mexico.
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4
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Vidal-Cevallos P, Murúa-Beltrán Gall S, Uribe M, Chávez-Tapia NC. Understanding the Relationship between Nonalcoholic Fatty Liver Disease and Thyroid Disease. Int J Mol Sci 2023; 24:14605. [PMID: 37834051 PMCID: PMC10572395 DOI: 10.3390/ijms241914605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/15/2023] Open
Abstract
The prevalence of hypothyroidism in patients with nonalcoholic fatty liver disease (NAFLD) is high (22.4%). Thyroid hormones (THs) regulate many metabolic activities in the liver by promoting the export and oxidation of lipids, as well as de novo lipogenesis. They also control hepatic insulin sensitivity and suppress hepatic gluconeogenesis. Because of its importance in lipid and carbohydrate metabolism, the involvement of thyroid dysfunction in the pathogenesis of NAFLD seems plausible. The mechanisms implicated in this relationship include high thyroid-stimulating hormone (TSH) levels, low TH levels, and chronic inflammation. The activity of the TH receptor (THR)-β in response to THs is essential in the pathogenesis of hypothyroidism-induced NAFLD. Therefore, an orally active selective liver THR-β agonist, Resmetirom (MGL-3196), was developed, and has been shown to reduce liver fat content, and as a secondary end point, to improve nonalcoholic steatohepatitis. The treatment of NAFLD with THR-β agonists seems quite promising, and other agonists are currently under development and investigation. This review aims to shine a light on the pathophysiological and epidemiological evidence regarding this relationship and the effect that treatment with THs and selective liver THR-β agonists have on hepatic lipid metabolism.
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Affiliation(s)
| | | | | | - Norberto C. Chávez-Tapia
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Av. Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City 14050, Mexico
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Higuera-de-la-Tijera F, Velarde-Ruiz Velasco JA, Raña-Garibay RH, Castro-Narro GE, Abdo-Francis JM, Moreno-Alcántar R, Pérez-Hernández JL, Torre A, Contreras-Omaña R, Cano-Contreras A, Castillo-Barradas M, Pérez-Escobar J, Aldana-Ledesma JM, Cerda-Reyes E, Fernández-Pérez NJ, Meza-Cardona J, Flores-García NC, Reyes-Bastidas M, Lira-Vera JE, García-Jiménez ES, Santana-Vargas D, Páez-Zayas VM, Chávez-Tapia NC, Márquez-Guillén E. Current vision on diagnosis and comprehensive care in hepatic encephalopathy. Rev Gastroenterol Mex (Engl Ed) 2023; 88:155-174. [PMID: 37127462 DOI: 10.1016/j.rgmxen.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/08/2023] [Indexed: 05/03/2023]
Abstract
The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.
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Affiliation(s)
- F Higuera-de-la-Tijera
- Departamento de Gastroenterología y Hepatología, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico.
| | - J A Velarde-Ruiz Velasco
- Departamento de Gastroenterología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico
| | | | - G E Castro-Narro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - R Moreno-Alcántar
- Departamento de Gastroenterología, Hospital de Especialidades Bernardo Sepúlveda del Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - J L Pérez-Hernández
- Departamento de Gastroenterología y Hepatología, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - A Torre
- Centro Médico ABC, Mexico City, Mexico
| | - R Contreras-Omaña
- Centro de Educación e Investigación en Enfermedades Hepáticas y Toxicológicas (CEIHET), Pachuca, Hidalgo, Mexico
| | - A Cano-Contreras
- Centro de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | - M Castillo-Barradas
- Departamento de Gastroenterología, Hospital de Especialidades del Centro Médico Nacional "La Raza", IMSS, Mexico City, Mexico
| | - J Pérez-Escobar
- Instituto Nacional de Enfermedades Respiratorias (INER) "Ismael Cosío Villegas", Mexico City, Mexico
| | - J M Aldana-Ledesma
- Departamento de Gastroenterología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico
| | - E Cerda-Reyes
- Departamento de Gastroenterología, Hospital Central Militar, Mexico City, Mexico
| | | | | | - N C Flores-García
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - J E Lira-Vera
- Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, Mexico
| | - E S García-Jiménez
- Departamento de Gastroenterología, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico
| | - D Santana-Vargas
- Clínica de Trastornos del Sueño, Departamento de Medicina Experimental, Facultad de Medicina, UNAM, Mexico City, Mexico
| | - V M Páez-Zayas
- Departamento de Gastroenterología y Hepatología, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | | | - E Márquez-Guillén
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
Hepatic encephalopathy (HE) is a brain dysfunction caused by liver insufficiency and/or portosystemic shunts. Between 30%-40% of patients with cirrhosis will present overt HE during their lifetime. While the pathophysiology of HE is not entirely understood, three critical factors have been identified: hyperammonaemia, systemic inflammation and oxidative stress by glutaminase gene alterations. Minimal HE is defined by the presence of signs of cognitive abnormalities in a patient without asterixis or disorientation; it can only be diagnosed with neuropsychological or psychometric tests. The diagnosis of overt HE is based on clinical examination with clinical scales. Currently, only overt HE should be routinely treated. The aims of treatment in an acute episode should be to improve the mental status, identify and treat the precipitating factor, reduce duration and limit consequences. Treatment strategies are targeted at reducing ammonia production and/or increasing its elimination. Even though minimal HE has negative effects on the patient's quality of life and effects on prognosis, indications for treatment are still controversial. There are still many unanswered questions regarding the pathophysiology and management of HE. We should also endeavor to develop more accurate and objective diagnostic methods for overt HE that would permit early detection and help improve outcomes on quality of life and economic burden.
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Affiliation(s)
- Paulina Vidal-Cevallos
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, col. Toriello Guerra, C.P. 14050, Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, col. Toriello Guerra, C.P. 14050, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, col. Toriello Guerra, C.P. 14050, Mexico City, Mexico.
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López-Sánchez GN, Montalvo-Javé E, Domínguez-Perez M, Antuna-Puente B, Beltrán-Anaya FO, Hidalgo-Miranda A, Chávez-Tapia NC, Uribe M, Nuño-Lámbarri N. Hepatic mir-122-3p, mir-140-5p and mir-148b-5p expressions are correlated with cytokeratin-18 serum levels in MAFLD. Ann Hepatol 2022; 27:100756. [PMID: 36096296 DOI: 10.1016/j.aohep.2022.100756] [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: 07/04/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Metabolic-associated fatty liver disease (MAFLD) is defined by steatosis in more than 5% of hepatocytes without other liver diseases. Patients with this disease can progress to multiple stages like liver fibrosis, cirrhosis, and hepatocellular carcinoma. miRNAs are single-stranded molecules that regulate metabolic homeostasis; their differential expression postulates them as potential circulating biomarkers for MAFLD. Previous research reported that hsa-miR-140-5p, hsa-miR-148-5p, and hsa-miR-122-3p have a differential expression in patients with MAFLD. This study aimed to investigate the correlation between liver hsa-miR-140-5p, hsa-miR-148-5p, and hsa-miR-122-3p and serum biomarkers CK-18, APOB, IL-6, IL-32, and TNF-α in patients with MAFLD compared with control patients. MATERIALS AND METHODS A cross-sectional study was carried out with 16 patients of both sexes, aged between 18-60 years, to determine the association between the levels of hsa-miR-140-5p, hsa-miR-148-5p, and hsa-miR-122-3p with MAFLD in liver biopsies of patients who underwent laparoscopic cholecystectomy. RESULTS Twelve patients presented MAFLD, four without hepatic steatosis. Circulating levels of CK-18 showed a significant difference in patients with MAFLD, and a strong correlation was found between hsa-miR-122-3p, hsa-miR-140-5p, and hsa-miR-148b-5p versus the CAP value. CONCLUSION There is a correlation between elevated tissue expression of hsa-miR-122-3p, hsa-miR-140-5p, and hsa-miR-148b-3p with plasma levels of CK-18 in patients with simple steatosis compared with patients without the disease.
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Affiliation(s)
| | - Eduardo Montalvo-Javé
- Department of Surgery, Faculty of Medicine, The National Autonomous University of Mexico (UNAM), Mexico City, Mexico; Hepato Pancreato and Biliary Clinic, Department of General Surgery, "Hospital General de Mexico", Dr. Eduardo Liceaga. Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Mayra Domínguez-Perez
- Genomics of Cardiovascular Diseases Laboratory, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Barbara Antuna-Puente
- Infection Disease Division, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Fredy O Beltrán-Anaya
- Virology Laboratory, Faculty of Chemical Biological Sciences, UAGro. Lázaro Cárdenas
| | - Alfredo Hidalgo-Miranda
- Genomics of Cancer Diseases Laboratory, National Institute of Genomic Medicine. Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico.
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Rodríguez-Antonio I, López-Sánchez GN, Reyes-Gómez VA, Contreras-Flores EH, Farías-García F, Espejel-Deloiza M, Durán-Padilla MA, Chablé-Montero F, Uribe M, Chávez-Tapia NC, Montalvo-Javé EE, Nuño-Lámbarri N. Laparoscopic cholecystectomy: Histopathological analysis of metabolic associated fatty liver disease and fibrosis. Ann Hepatol 2022; 27:100651. [PMID: 34896638 DOI: 10.1016/j.aohep.2021.100651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Metabolic (dysfunction) associated fatty liver disease (MAFLD) and cholelithiasis are highly prevalent and are associated with common risk factors such as obesity, hypertriglyceridemia, and fasting glucose levels; however, it is not clear whether cholelithiasis is associated with MAFLD or fibrosis. OBJECTIVE To determine MAFLD severity and associated risk factors in patients diagnosed with cholelithiasis. MATERIALS AND METHODS Observational, cross-sectional and prolective study (from October 2018 to March 2020) of patients undergoing elective laparoscopic cholecystectomy with liver biopsy, excluding other causes of hepatic disease or significant alcohol consumption. MAFLD detection was based on histology using the Kleiner score and one of the following criteria: overweight/obesity, T2DM, or evidence of metabolic dysregulation. The AST to Platelet Ratio Index, the NAFLD Fibrosis Score, the fibrosis-4 index and the hepatic steatosis index were performed to assess the relationship of non-invasive hepatic scores with histopathology. RESULTS 80 patients median age (interquartile range) was 42 (18) years, with a BMI of 27.9 (6.11) Kg/m2. Of all patients, 58.8% had MAFLD, 78.7% were women, and 13.8% had the severe form (formerly named NASH). No substantial correlation between biochemical parameters and histopathological analysis of MAFLD and fibrosis was observed. CONCLUSION Because cholelithiasis and MAFLD are highly prevalent diseases, it is essential to conduct studies on the relationship between both pathologies. Currently, liver biopsy is the best diagnostic method since the predictive biochemical models did not show a substantial correlation to classify MAFLD. Its early detection is relevant since a considerable percentage of advanced fibrosis (8.7%) was found.
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Affiliation(s)
- Itzayana Rodríguez-Antonio
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico
| | - Guillermo N López-Sánchez
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico
| | - Víctor A Reyes-Gómez
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Ericka H Contreras-Flores
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Fernanda Farías-García
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Mariana Espejel-Deloiza
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Marco A Durán-Padilla
- Surgical Pathology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050 Mexico City, Mexico for Dr. Eduardo E. Montolvo-Javé
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050 Mexico City, Mexico for Dr. Eduardo E. Montolvo-Javé
| | - Eduardo E Montalvo-Javé
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico.
| | - Natalia Nuño-Lámbarri
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico.
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Pérez-Monter C, Álvarez-Arce A, Nuño-Lambarri N, Escalona-Nández I, Juárez-Hernández E, Chávez-Tapia NC, Uribe M, Barbero-Becerra VJ. Inulin Improves Diet-Induced Hepatic Steatosis and Increases Intestinal Akkermansia Genus Level. Int J Mol Sci 2022; 23:ijms23020991. [PMID: 35055177 PMCID: PMC8782000 DOI: 10.3390/ijms23020991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 02/01/2023] Open
Abstract
Hepatic steatosis is characterized by triglyceride accumulation within hepatocytes in response to a high calorie intake, and it may be related to intestinal microbiota disturbances. The prebiotic inulin is a naturally occurring polysaccharide with a high dietary fiber content. Here, we evaluate the effect of inulin on the intestinal microbiota in a non-alcoholic fatty liver disease model. Mice exposed to a standard rodent diet or a fat-enriched diet, were supplemented or not, with inulin. Liver histology was evaluated with oil red O and H&E staining and the intestinal microbiota was determined in mice fecal samples by 16S rRNA sequencing. Inulin treatment effectively prevents liver steatosis in the fat-enriched diet group. We also observed that inulin re-shaped the intestinal microbiota at the phylum level, were Verrucomicrobia genus significantly increased in the fat-diet group; specifically, we observed that Akkermansia muciniphila increased by 5-fold with inulin supplementation. The family Prevotellaceae was also significantly increased in the fat-diet group. Overall, we propose that inulin supplementation in liver steatosis-affected animals, promotes a remodeling in the intestinal microbiota composition, which might regulate lipid metabolism, thus contributing to tackling liver steatosis.
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Affiliation(s)
- Carlos Pérez-Monter
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
- Correspondence: (C.P.-M.); (V.J.B.-B.)
| | - Alejandro Álvarez-Arce
- Departamento de Neuropatología Molecular, División de Neurociencias, Instituto de Fisiología Celular, UNAM, Mexico City 04510, Mexico;
| | - Natalia Nuño-Lambarri
- Unidad de Investigación Traslacional, Fundación Clínica Médica Sur, Mexico City 14050, Mexico; (N.N.-L.); (E.J.-H.); (N.C.C.-T.); (M.U.)
| | - Ivonne Escalona-Nández
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Eva Juárez-Hernández
- Unidad de Investigación Traslacional, Fundación Clínica Médica Sur, Mexico City 14050, Mexico; (N.N.-L.); (E.J.-H.); (N.C.C.-T.); (M.U.)
| | - Norberto C. Chávez-Tapia
- Unidad de Investigación Traslacional, Fundación Clínica Médica Sur, Mexico City 14050, Mexico; (N.N.-L.); (E.J.-H.); (N.C.C.-T.); (M.U.)
| | - Misael Uribe
- Unidad de Investigación Traslacional, Fundación Clínica Médica Sur, Mexico City 14050, Mexico; (N.N.-L.); (E.J.-H.); (N.C.C.-T.); (M.U.)
| | - Varenka J. Barbero-Becerra
- Unidad de Investigación Traslacional, Fundación Clínica Médica Sur, Mexico City 14050, Mexico; (N.N.-L.); (E.J.-H.); (N.C.C.-T.); (M.U.)
- Correspondence: (C.P.-M.); (V.J.B.-B.)
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10
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Carnalla M, Vidaña-Pérez D, Alpuche-Aranda C, Chávez-Tapia NC, Romero-Martínez M, Shamah-Levy T, Barrientos-Gutiérrez T. Hepatitis B infection in Mexican adults: Results of a nationally representative survey. Ann Hepatol 2022; 27 Suppl 1:100583. [PMID: 34808394 DOI: 10.1016/j.aohep.2021.100583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis B virus (HBV) infection can lead to cirrhosis, hepatocellular carcinoma, and death if untreated. In Mexico, HBV vaccination for all children and adolescents was implemented in 1999. In 2000 the estimated HBV was 0.21% in the population aged 20 years and older. We estimated the national prevalence for hepatitis B surface antigen (HBsAg) and its association with sociodemographic characteristics, including sexual behavior information for those aged 20 to 49 years. MATERIALS AND METHODS From the 2018 National Health and Nutrition Survey, blood samples were collected from a subsample of 2,280 adults to determine HBsAg. We estimated the national prevalence for HBsAg and evaluated its association with sociodemographic characteristics, adding sexual behavior information for those aged 20 to 49 years. We performed a multiple logistic regression to estimate the association of HBsAg and relevant variables. RESULTS The 2018 estimated prevalence of HBsAg in the Mexican adult population was 0.51% (95%CI 0.19, 2.33), which represents 411,000 cases. This prevalence was higher than previously estimated and it was higher in women than in men (0.54% versus 0.46%, respectively). We did not find an association between HBsAg and sociodemographic characteristics or sexual behaviors. CONCLUSIONS Vaccination and screening strategies towards the elimination of viral hepatitis should be reinforced to further reduce the prevalence over the next years.
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Affiliation(s)
- Martha Carnalla
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Dèsirée Vidaña-Pérez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Celia Alpuche-Aranda
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | | | - Martín Romero-Martínez
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
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11
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Rodríguez-Antonio I, López-Sánchez GN, Uribe M, Chávez-Tapia NC, Nuño-Lámbarri N. Role of the inflammasome, gasdermin D, and pyroptosis in non-alcoholic fatty liver disease. J Gastroenterol Hepatol 2021; 36:2720-2727. [PMID: 34050551 DOI: 10.1111/jgh.15561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 12/25/2022]
Abstract
Pyroptosis is a type of programmed cell death mediated by a multiprotein complex called the inflammasome through the pro-inflammatory activity of gasdermin D. This study aimed to recognize the final biological product that leads to pore formation in the cell membrane, lysis, pro-inflammatory cytokines release, and the establishment of an immune response. An exhaustive search engine investigation of an elevated immune response can induce a sustained inflammation that directly links this mechanism to non-alcoholic fatty liver disease and its progression to non-alcoholic steatohepatitis. Clinical studies and systematic reviews suggest that gasdermin D is a critical molecule between the immune response and the disease manifestation, which could be considered a therapeutic target for highly prevalent diseases characterized by presenting perpetuated inflammatory processes. Both basic and clinical research show evidence on the expression and regulation of the inflammasome-gasdermin D-pyroptosis trinomial for the progression of non-alcoholic fatty liver disease to non-alcoholic steatohepatitis.
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Affiliation(s)
| | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Médica Sur Clinic Foundation, Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Médica Sur Clinic Foundation, Mexico City, Mexico.,Obesity and Digestive Diseases Unit, Médica Sur Clinic Foundation, Mexico City, Mexico
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12
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López-Bautista F, Barbero-Becerra VJ, Ríos MY, Ramírez-Cisneros MÁ, Sánchez-Pérez CA, Ramos-Ostos MH, Uribe M, Chávez-Tapia NC, Juárez-Hernández E. Dietary consumption and serum pattern of bioactive fatty acids in NAFLD patients. Ann Hepatol 2021; 19:482-488. [PMID: 32717363 DOI: 10.1016/j.aohep.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome. Some dietary fatty acids have showed different bioactive functions in metabolic syndrome. The aim of this study is to determine the dietary consumption patterns and serum percentage of bioactive fatty acids in NAFLD patients. PATIENTS AND METHODS Cross-sectional study with NAFLD patients and non-NAFLD patients. Dietary consumption of bioactive fatty acids was assessed by a food frequency questionnaire. NAFLD and liver fibrosis were diagnosed by transient elastography. The identification of serum bioactive fatty acids was achieved by gas chromatography-mass spectrometry (%). Bioactive fatty acids consumption was correlated with NAFLD clinical characteristics with the Spearman correlation analysis. RESULTS A total of 299 patients were included, whose mean of age and body mass index were 44.2±9.9 years and 25.9±3.8kg/m2, respectively. The consumption of bioactive fatty acids was no different regarding the presence of NAFLD; however, the consumption of stearic and linoleic fatty acids was higher in relation with NAFLD severity (p≤0.05). The consumption of myristic acid was higher in patients with fibrosis (p=0.02). Serum percentage and dietary consumption did not show correlations. CONCLUSION Dietary consumption of bioactive fatty acids is different according to NAFLD severity. Individualized diets according to NAFLD severity could be successful in order to prevent liver injury-related outcomes.
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Affiliation(s)
- Fabiola López-Bautista
- Molecular Biology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | | | | | - Martha H Ramos-Ostos
- Integral Diagnosis and Treatment Center, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Misael Uribe
- Gastroenterology and Obesity Department, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | | | - Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico.
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13
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Barbero-Becerra V, Juárez-Hernández E, Chávez-Tapia NC, Uribe M. Inulin as a Clinical Therapeutic Intervention in Metabolic Associated Fatty Liver Disease. Food Reviews International 2021. [DOI: 10.1080/87559129.2020.1867997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - Misael Uribe
- Gastroenterology and Obesity Unit., Medica Sur Clinic & Foundation, Mexico City, Mexico
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14
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Mendez-Sanchez N, Arrese M, Gadano A, Oliveira CP, Fassio E, Arab JP, Chávez-Tapia NC, Dirchwolf M, Torre A, Ridruejo E, Pinchemel-Cotrim H, Castellanos Fernández MI, Uribe M, Girala M, Diaz-Ferrer J, Restrepo JC, Padilla-Machaca M, Dagher L, Gatica M, Olaechea B, Pessôa MG, Silva M. The Latin American Association for the Study of the Liver (ALEH) position statement on the redefinition of fatty liver disease. Lancet Gastroenterol Hepatol 2021; 6:65-72. [PMID: 33181118 DOI: 10.1016/s2468-1253(20)30340-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
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15
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Vidal-Cevallos P, Higuera-De-La-Tijera F, Chávez-Tapia NC, Sanchez-Giron F, Cerda-Reyes E, Rosales-Salyano VH, Servin-Caamaño A, Vázquez-Medina MU, Méndez-Sánchez N. Lactate-dehydrogenase associated with mortality in hospitalized patients with COVID-19 in Mexico: a multi-centre retrospective cohort study. Ann Hepatol 2021; 24:100338. [PMID: 33647501 PMCID: PMC7908830 DOI: 10.1016/j.aohep.2021.100338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/29/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES As of January 2021, over 88 million people have been infected with COVID-19. Almost two million people have died of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A high SOFA score and a D-Dimer >1 µg/mL identifies patients with high risk of mortality. High lactate dehydrogenase (LDH) levels on admission are associated with severity and mortality. Different degrees of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) abnormalities have been reported in these patients, its association with a mortality risk remains controversial. The aim of this study was to explore the correlation between LDH and in-hospital mortality in Mexican patients admitted with COVID-19. MATERIALS & METHODS We performed a retrospective multi-centre cohort study with 377 hospitalized patients with confirmed SARS-CoV-2 in three centres in Mexico City, Mexico, who were ≥18 years old and died or were discharged between April 1 and May 31, 2020. RESULTS A total of 377 patients were evaluated, 298 (79.1%) patients were discharged, and 79 (20.9%) patients died during hospitalization. Non-survivors were older, with a median age of 46.7 ± 25.7 years old, most patients were male. An ALT > 61 U/l (OR 3.45, 95% CI 1.27-9.37; p = 0.015), C-reactive protein (CRP) > 231 mg/l (OR 4.71, 95% CI 2.35-9.46; p = 0.000), LDH > 561 U/l (OR 3.03, 95% CI 1.40-6.55; p = 0.005) were associated with higher odds for in-hospital death. CONCLUSIONS Our results indicate that higher levels of LDH, CRP, and ALT are associated with higher in-hospital mortality risk in Mexican patients admitted with COVID-19.
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Affiliation(s)
- Paulina Vidal-Cevallos
- Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine. National Autonomous University of Mexico, Mexico City, Mexico,National Autonomous University of Mexico. Mexico City, Mexico, 14050, Mexico
| | - Fatima Higuera-De-La-Tijera
- Gastroenterology and Hepatology Department, Mexico’s General Hospital “Dr. Eduardo Liceaga”. Dr. Balmis 148, col. Doctores, C.P. 06720, Mexico City, Mexico
| | - Norberto C. Chávez-Tapia
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation. Puente de Piedra 150, col. Toriello Guerra, C.P. 14050, Mexico City, Mexico
| | - Francisco Sanchez-Giron
- Director of the Clinical Pathology Laboratory, Medica Sur Clinic and Foundation. Puente de Piedra 150, col. Toriello Guerra, C.P. 14050, Mexico City, Mexico
| | - Eira Cerda-Reyes
- Academic Coordinator, Central Military Hospital, Periférico Blvrd Manuel Ávila Camacho s/n, col. Militar, C.P. 11200, Mexico City, Mexico
| | - Victor Hugo Rosales-Salyano
- Internal Medicine Department, Mexico’s General Hospital “Dr. Eduardo Liceaga”. Dr. Balmis 148, col. Doctores, C.P. 06720, Mexico City, Mexico
| | - Alfredo Servin-Caamaño
- Internal Medicine Department, Mexico’s General Hospital “Dr. Eduardo Liceaga”. Dr. Balmis 148, col. Doctores, C.P. 06720, Mexico City, Mexico
| | - Martín Uriel Vázquez-Medina
- Superior School of Medicine, National Polytechnic Institute Salvador Díaz Mirón S/N, Miguel Hidalgo, Casco de Santo Tomas, C.P. 11340, Mexico City, Mexico
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine. National Autonomous University of Mexico, Mexico City, Mexico; National Autonomous University of Mexico. Mexico City, Mexico, 14050, Mexico.
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16
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Rodríguez-Antonio I, López-Sánchez GN, Garrido-Camacho VY, Uribe M, Chávez-Tapia NC, Nuño-Lámbarri N. Cholecystectomy as a risk factor for non-alcoholic fatty liver disease development. HPB (Oxford) 2020; 22:1513-1520. [PMID: 32773176 DOI: 10.1016/j.hpb.2020.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/12/2019] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic steatosis and gallstone disease are highly prevalent in the general population; the shared risk factors are age, ethnicity, obesity, insulin resistance, metabolic syndrome, atherosclerosis, risk of cardiovascular disease, and mortality. The presence of insulin resistance is the critical element in this association because it represents a crucial link between metabolic syndrome and non-alcoholic fatty liver disease, as well as a higher susceptibility to gallstone formation. METHODS An exhaustive search engine investigation of gallstone disease, cholecystectomy, and liver steatosis latest literature was made. RESULTS Clinical studies and systematic reviews suggest an association between gallstone disease, cholecystectomy, and hepatic steatosis. CONCLUSION The bidirectional relationship between liver steatosis and gallstone disease and cholecystectomy is summarized in the role of insulin resistance, lipid metabolism, bile acids signaling pathways regulated by transcription factors expression, and to the gallbladder physiological role; however, more epidemiological and experimental studies should be complemented.
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Affiliation(s)
- Itzayana Rodríguez-Antonio
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico; School of Medicine, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Los Volcanes, Z.C. 72420, Puebla, Mexico
| | - Guillermo N López-Sánchez
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Victor Y Garrido-Camacho
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Natalia Nuño-Lámbarri
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico.
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17
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Valencia-Rodríguez A, Vera-Barajas A, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. Looking into a new era for the approach of metabolic (dysfunction) associated fatty liver disease. Ann Hepatol 2020; 19:227-229. [PMID: 32359519 DOI: 10.1016/j.aohep.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 02/04/2023]
Affiliation(s)
| | | | | | - Misael Uribe
- Liver Research Unit, Medica Sur Clinical Foundation, Mexico City, Mexico
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinical Foundation, Mexico City, Mexico; Faculty of Medicine. National Autonomous University of Mexico, Mexico City, Mexico.
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18
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Barbero-Becerra VJ, López-Méndez I, Romo-Araiza A, Visag-Castillo V, Chávez-Tapia NC, Uribe M, Juárez-Hernandez E. Sarcopenia in chronic liver diseases: a translational overview. Expert Rev Gastroenterol Hepatol 2020; 14:355-366. [PMID: 32299261 DOI: 10.1080/17474124.2020.1757427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sarcopenia refers to a progressive and generalized muscle mass and strength loss. In liver diseases, it has been related to worse outcomes and high risk of decompensations. AREAS COVERED Sarcopenia is caused by a set of cellular processes in the muscle such as denervation, mitochondrial dysfunction, endotoxemia and inflammation; which are manifested through the alteration of several proteolytic pathways such as lysosomal, proteasomal and caspase systems. In autophagy, myostatin and oxidative stress; such as hyperammonemia, contributes importantly to liver sarcopenia through loss of muscle mass already demonstrated in in vitro and in vivo models. In addition, hormones and the regulation of the intestinal microbiota, influence in a not less important magnitude. In the clinical setting, early identification of sarcopenia has been established as a mandatory item to prevent progression of muscle mass loss; however, diagnostic methods have extreme variation according to methodology, population, etiology and severity of liver disease. Reversing sarcopenia should be an integral therapeutic strategy. EXPERT OPINION Clinical and nutritional interventions should be adapted to liver injury etiology and stage of disease, each of them shares a similar sarcopenia development pathway. There are specific biomarkers that condition or exacerbate loss of skeletal muscle.
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Affiliation(s)
| | - Iván López-Méndez
- Transplants and Hepatology Unit, Medica Sur Clinic & Foundation , Mexico City, Mexico
| | | | - Víctor Visag-Castillo
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation , Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Translational Research Unit, Medica Sur Clinic & Foundation , Mexico City, Mexico.,Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation , Mexico City, Mexico
| | - Misael Uribe
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation , Mexico City, Mexico
| | - Eva Juárez-Hernandez
- Translational Research Unit, Medica Sur Clinic & Foundation , Mexico City, Mexico.,Facultad de Ciencias de la Salud, Universidad Anáhuac México , Mexico City, Mexico
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19
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Salva-Pastor N, Chávez-Tapia NC, Uribe M, Nuño-Lámbarri N. Understanding the association of polycystic ovary syndrome and non-alcoholic fatty liver disease. J Steroid Biochem Mol Biol 2019; 194:105445. [PMID: 31381969 DOI: 10.1016/j.jsbmb.2019.105445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 02/07/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-age women. Patients with non-alcoholic fatty liver disease (NAFLD) often suffer from metabolic syndrome, atherosclerosis, ischemic heart disease, and extrahepatic tumors, conferring a lower survival than the general population; therefore it is crucial to study the association between NAFLD and PCOS since it remains poorly understood. Insulin resistance (IR) plays a central role in the pathogenesis of NAFLD and PCOS; also, hyperandrogenism enhances IR in these patients. IR, present in the NAFLD-PCOS association could decrease the hepatic production of sex hormone-binding globulin through a possible regulation mediated by hepatocyte nuclear factor 4 alpha. On the other hand, apoptotic processes initiated by androgens actively contribute to the progression of NAFLD. Considering the association between the two conditions, the screening of women with PCOS for the presence of NAFLD appears reasonable. The pathophysiological mechanisms of PCOS-NAFLD association and the initial approach will be reviewed here.
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Affiliation(s)
- Nicolás Salva-Pastor
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico; School of Medicine, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Los Volcanes, Z.C. 72420, Puebla, Mexico.
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico.
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico.
| | - Natalia Nuño-Lámbarri
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico.
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20
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Affiliation(s)
- Arturo Panduro
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, "Fray Antonio Alcalde" and Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Claudio Tiribelli
- Fondazione Italiana Fegato, AREA Science Park Basovizza, Trieste, Italy
| | - Norberto C Chávez-Tapia
- Translational Research Unit, Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation , Mexico City , Mexico
| | - Misael Uribe
- Medica Sur Clinic & Foundation. Mexico City, Mexico
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21
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Salva-Pastor N, Chávez-Tapia NC, Uribe M, Nuño-Lámbarri N. The diagnostic and initial approach of the patient with non-alcoholic fatty liver disease: role of the primary care provider. Gastroenterol Hepatol Bed Bench 2019; 12:267-277. [PMID: 31749914 PMCID: PMC6820831] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/18/2019] [Indexed: 12/03/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) represents a broad spectrum of liver damage, ranging from simple steatosis to steatohepatitis and fibrosis; as well, there is a close association between NAFLD, obesity, metabolic syndrome and type 2 diabetes mellitus. There is a certain degree of uncertainty regarding the natural history and prognosis of NAFLD; however, several methods are currently used for its diagnostic approach. In the first instance, non-invasive tests could be used to identify patients at low risk of developing fibrosis and to establish more easily the need for a liver biopsy, whose accuracy in the evaluation of fibrosis has been questioned, mainly due to errors of intra and interobserver sampling, technical problems and cost, which limits its use. Therefore, it is essential to determine the diagnostic strategy for patients with NAFLD.
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Affiliation(s)
- Nicolás Salva-Pastor
- Traslational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
- School of Medicine, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, Mexico
| | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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22
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Bazerbachi F, Haffar S, Wang Z, Cabezas J, Arias-Loste MT, Crespo J, Darwish-Murad S, Ikram MA, Olynyk JK, Gan E, Petta S, Berzuini A, Prati D, de Lédinghen V, Wong VW, Del Poggio P, Chávez-Tapia NC, Chen YP, Cheng PN, Yuen MF, Das K, Chowdhury A, Caballeria L, Fabrellas N, Ginès P, Kumar M, Sarin SK, Conti F, Andreone P, Sirli R, Cortez-Pinto H, Carvalhana S, Sugihara T, Kim SU, Parikh P, Chayama K, Corpechot C, Kim KM, Papatheodoridis G, Alsebaey A, Kamath PS, Murad MH, Watt KD. Range of Normal Liver Stiffness and Factors Associated With Increased Stiffness Measurements in Apparently Healthy Individuals. Clin Gastroenterol Hepatol 2019; 17:54-64.e1. [PMID: 30196155 DOI: 10.1016/j.cgh.2018.08.069] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis. METHODS We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m2 were examined with the medium probe and those with a body mass index ≥30 kg/m2 were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses. RESULTS We established LSM ranges for healthy individuals measured with both probes-these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm3 and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis. CONCLUSIONS In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes.
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Affiliation(s)
- Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Samir Haffar
- Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic
| | - Zhen Wang
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Joaquín Cabezas
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Javier Crespo
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | - Sarwa Darwish-Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - John K Olynyk
- School of Health and Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Eng Gan
- School of Health and Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Salvatore Petta
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Alessandra Berzuini
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Victor de Lédinghen
- Centre d'Investigation de la Fibrose Hépatique, Hopital Haut-Leveque, Centre Hospitalier Universitaire Bordeaux, Pessac, France
| | - Vincent W Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Paolo Del Poggio
- Unità di Epatologia, Policlinico S. Marco, Zingonia, Bergamo, Italy
| | - Norberto C Chávez-Tapia
- Department of Gastroenterology, Clinic of Digestive Diseases and Obesity, Liver Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Yong-Peng Chen
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kausik Das
- Department of Hepatology, School of Digestive and liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Abhijit Chowdhury
- Department of Hepatology, School of Digestive and liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Llorenç Caballeria
- Centro d'Investigaciones Biomedicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Nord, Institut d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Núria Fabrellas
- School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, Ciber de Enfermedades Hepáticas y Digestivas, School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Fabio Conti
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Pietro Andreone
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, Bologna, Italy
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Helena Cortez-Pinto
- Departamento de Gastrenterologia, CHLN, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Sofia Carvalhana
- Departamento de Gastrenterologia, CHLN, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Takaaki Sugihara
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Pathik Parikh
- Department of Gastroenterology, Zydus Hospitals, Ahmedabad, Gujarat, India
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Christophe Corpechot
- Hepatology Department, Reference Center for Chronic Inflammatory Biliary Diseases, French Network for Pediatric and Adult Rare Liver Diseases, INSERM UMR_S938, Saint-Antoine Hospital (Assistance Publique-Hôpitaux de Paris), Faculty of Medicine Pierre et Marie Curie, Paris 6 University, Paris, France
| | - Kang Mo Kim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ayman Alsebaey
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Altamirano-Barrera A, Uribe M, Chávez-Tapia NC, Nuño-Lámbarri N. The role of the gut microbiota in the pathology and prevention of liver disease. J Nutr Biochem 2018; 60:1-8. [DOI: 10.1016/j.jnutbio.2018.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/01/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023]
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Panduro A, Tiribelli C, Chávez-Tapia NC, Arrese M, Uribe M. Renovation of Annals of Hepatology's Scientific Scope: Towards Preventing Rather Than Treating End-Stage Liver Disease. Ann Hepatol 2018; 17:539-540. [PMID: 29894288 DOI: 10.5604/01.3001.0012.0913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Indexed: 02/04/2023]
Affiliation(s)
- Arturo Panduro
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, "Fray Antonio Alcalde" and Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Claudio Tiribelli
- Foundazione Italiana Fregato, AREA Science Park Basovizza, Trieste, Italy
| | - Norberto C Chávez-Tapia
- Translational Research Unit, Obesity and Digestive Disease Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine Pontifical Catholic University of Chile, Santiago, Chile
| | - Misael Uribe
- Medica Sur Clinic & Foundation, Mexico City, Mexico
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25
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Juárez-Hernández E, C Chávez-Tapia N, C Brizuela-Alcántara D, Uribe M, H Ramos-Ostos M, Nuño-Lámbarri N. Association Between Serum Hemoglobin Levels and Non Alcoholic Fatty Liver Disease in a Mexican Population. Ann Hepatol 2018; 17:577-584. [PMID: 29893698 DOI: 10.5604/01.3001.0012.0920] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Nonalcoholic fatty liver disease (NAFLD) is closely associated with overweight and obesity, becoming one of the most prevalent hepatic diseases nowadays. Circulating hemoglobin (Hb) concentration is significantly higher in people with NAFLD, compared to healthy patients. While liver biopsy remains the gold standard for NAFLD diagnosis, it is not the best technique due to adverse events that may occur. Therefore it is important to find less invasive and more sensitive markers. This study aimed to determine the association of serum Hb levels in patients with steatosis and fibrosis as a noninvasive marker. MATERIAL AND METHODS A 1,186 patient cross-sectional study nested in a randomized clinical trial (NCT01874249) was conducted. Patients were diagnosed by ultrasound for hepatic steatosis and fibroscan for fibrosis; blood test and anthropometric measurements were also assessed. RESULTS Serum Hb increased proportionally related to the steatosis level, being significantly higher in patients with severe steatosis than in patients with moderate and mild steatosis. CONCLUSION Patients with non-alcoholic fatty liver disease showed elevated levels of circulating Hb, evidence that suggests that Hb exerts a protective role, as it may act as an antioxidant and may counteract the adverse effects of this disease.
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Affiliation(s)
| | - Norberto C Chávez-Tapia
- Translational Research Unit, Medica Sur Clinic & Foundation. Mexico City, Mexico. Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation. Mexico City, Mexico
| | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation. Mexico City, Mexico
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26
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Sánchez-Jiménez BA, Brizuela-Alcántara D, Ramos-Ostos MH, Alva-López LF, Uribe-Esquivel M, Chávez-Tapia NC. Both alcoholic and non-alcoholic steatohepatitis association with cardiovascular risk and liver fibrosis. Alcohol 2018; 69:63-67. [PMID: 29660603 DOI: 10.1016/j.alcohol.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. Mortality in NAFLD is mainly related to cardiovascular disease (CVD) and cancer. NAFLD and its association with both CVD and liver disease risk have been well evaluated, but the association of NAFLD with alcohol, known as "both alcoholic and non-alcoholic steatohepatitis" (BASH), remains uncertain. The objective of this study was to assess the influence of alcohol and obesity in the development of liver and cardiovascular disease risk. METHODS This was a case-control study that included patients from a regular check-up. Alcohol consumption was evaluated with MAST, AUDIT, and CAGE. Cardiovascular risk was evaluated using the Framingham score, and liver fibrosis was evaluated with APRI and NAFLD score. Patients were classified in five groups: healthy patients, steatosis with obesity, steatosis with alcoholism, BASH, and idiopathic steatosis. RESULTS A total of 414 patients were included. The BASH group represented 16% of patients, and showed a greater proportion of patients with high cardiovascular risk with 17% (p = 0.001), and liver fibrosis with 9%, according to the APRI score (p = 0.10). A multivariate logistic regression showed that alcohol consumption >140 g/week (OR 2.546, 95% CI 1.11-5.81, p = 0.003) and BMI >25 kg/m2 (OR 12.64, 95% CI 1.66 96.20, p = 0.001) were related to high cardiovascular risk. Liver fibrosis according to APRI was only related to alcohol consumption >140 g/week (OR 2.74, 95% CI 1-7.48, p = 0.03). CONCLUSIONS BASH remains an area not well explored, and of great implication given the increasing number of patients affected. We observed an additive effect of both etiologies in the development of high cardiovascular and liver disease risk.
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Romero-Flores JL, Fernandez-Rivero JA, Marroquín-Fabian E, Téllez-Ávila FI, Sánchez-Jiménez BA, Juárez-Hernández E, Uribe M, Chávez-Tapia NC. Diagnostic accuracy of nodular gastritis for H. pylori infection. Ther Clin Risk Manag 2016; 13:9-14. [PMID: 28031716 PMCID: PMC5179200 DOI: 10.2147/tcrm.s121735] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The term nodular is not included in the Sydney classification and there is no widely accepted histopathological definition. It has been proposed that the presence of antral nodularity could predict Helicobacter pylori (H. pylori) infection. The aim of this study was to determine the diagnostic accuracy of nodular gastritis (NG) for H. pylori infection after a rigorous standardization process, and to describe the associated histopathological characteristics. Materials and methods Endoscopic images of patients submitted to endoscopy with biopsy sampling were included. Endoscopic images were distributed among six endoscopists. The analysis was performed sequentially in three rounds: the first round assessed the interobserver variability, the second evaluated the intraobserver variability, and the third calculated the interobserver variability after training. A correlation analysis between endoscopic and histopathological findings was performed. Results A total of 917 studies were included. In the first analysis of interobserver variability, a poor kappa value (0.078) was obtained. The second evaluation yielded good intraobserver variability, with kappa values of 0.62–0.86. The evaluation of interobserver variability after training revealed an improvement in the kappa value of 0.42. A correlation was found between endoscopic images and histopathological reports. Conclusion There was a strong correlation between NG and H. pylori, but only after rigorous evaluation. The use of the term NG requires extensive standardization before it can be used clinically.
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Affiliation(s)
| | | | | | - Félix I Téllez-Ávila
- Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | - Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation
| | - Norberto C Chávez-Tapia
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation; Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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28
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Motola-Kuba M, Escobedo-Arzate A, Tellez-Avila F, Altamirano J, Aguilar-Olivos N, González-Angulo A, Zamarripa-Dorsey F, Uribe M, Chávez-Tapia NC. Validation of prognostic scores for clinical outcomes in cirrhotic patients with acute variceal bleeding. Ann Hepatol 2016; 15:895-901. [PMID: 27740523 DOI: 10.5604/16652681.1222107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Background. The Rockall, Glasgow-Blatchford, and AIMS65 are useful and validated scoring systems for predicting the outcomes of patients with nonvariceal gastrointestinal bleeding. However, there are no validated evidence for using them to predict outcomes on variceal bleeding. The aim of this study was to evaluate and compare the prognostic accuracy of different nonvariceal bleeding scores with other liver-specific scoring systems in cirrhotic patients. MATERIAL AND METHODS A retrospective multicenter study that included 160 cirrhotic patients with acute variceal bleeding. The AUROC's to predict in-hospital mortality, and rebleeding, were analyzed for each scoring system. RESULTS Overall in-hospital mortality occurred in 13% and in-hospital rebleeding in 12% of patients. The systems with the best AUROC value for predicting mortality were MELD (0.828; 95% CI 0.748-0.909), and AIMS65 (0.817; 95% CI 0.724-0.909). The best score systems for predicting rebleeding were Glasgow-Blatchford (0.756; 95% CI 0.640- 0.827), and Rockall (0.691; 95% CI 0.580-0.802). CONCLUSIONS In addition to liver-specific scores, the AIMS65 score is accurate for predicting in-hospital mortality in cirrhotic patients with acute variceal bleeding. Other scoring systems might be useful for predicting significant clinical outcomes in these patients.
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Affiliation(s)
- Miguel Motola-Kuba
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - Félix Tellez-Avila
- Endoscopy Department Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Altamirano
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS) Hospital Clínic, University of Barcelona. Vall d'Hebron Institut de Recerca, Liver Unit- Internal Medicine Department. Hospital Vall d'Hebron, Barcelona, Spain
| | - Nancy Aguilar-Olivos
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Nuño-Lámbarri N, Barbero-Becerra VJ, Uribe M, Chávez-Tapia NC. Elevated cholesterol levels have a poor prognosis in a cholestasis scenario. J Biochem Mol Toxicol 2016; 31:1-6. [PMID: 27517733 DOI: 10.1002/jbt.21831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 01/15/2023]
Abstract
Cholestasis results from defective bile flow through the biliary ducts leading to the accumulation of bile acids (BAs) in hepatocytes and serum. It has been seen that cholestasis is associated with hypercholesterolemia, which is a prerequisite for gallstone formation and primary biliary cirrhosis, being some of the most common gastrointestinal disorders in Western societies. Cytotoxic BAs induce proinflammatory mediators, oxidative stress, and apoptosis in hepatocytes, whereas cytoprotective BAs prevent them; they can also modify the plasmatic membrane structure of cells or mitochondrial outer membrane properties as well as the distribution of cholesterol, altering various proteins involved in BAs homeostasis.
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Affiliation(s)
- Natalia Nuño-Lámbarri
- Traslational Research Unit, Médica Sur Clinic & Foundation, Toriello guerra tlalpan, C.P. 14050, Mexico City, Mexico
| | - Varenka J Barbero-Becerra
- Traslational Research Unit, Médica Sur Clinic & Foundation, Toriello guerra tlalpan, C.P. 14050, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Médica Sur Clinic & Foundation, Toriello guerra tlalpan, C.P. 14050, Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Médica Sur Clinic & Foundation, Toriello guerra tlalpan, C.P. 14050, Mexico City, Mexico.,Obesity and Digestive Diseases Unit, Médica Sur Clinic & Foundation, Toriello guerra tlalpan, C.P. 14050, Mexico City, Mexico
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Gómez-Gutiérrez C, Chávez-Tapia NC, Ponciano-Rodríguez G, Uribe M, Méndez-Sánchez N. Prevalence of hepatitis C virus infection among patients undergoing haemodialysis in Latin America. Ann Hepatol 2016; 14:807-14. [PMID: 26436352 DOI: 10.5604/16652681.1171751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 02/06/2023]
Abstract
Hepatitis C infection is a worldwide problem. The global prevalence of the hepatitis C virus (HCV) averages 3%. Moreover, its prevalence among patients undergoing haemodialysis (HD) varies worldwide, ranging from as low as 1% to up to 70%. There are few data on its prevalence in developing countries, and even less information is available on HD patients. A literature review revealed that the prevalence of HCV infection among patients undergoing HD in Latin America ranges from 4.2 to 83.9%, with most data stemming from Argentina, Brazil, Mexico, Peru, Chile, Venezuela and Cuba. The most common genotype was genotype 1, and subtype 1b was the most frequent. The risk factors associated with this condition were the duration of the HD treatment and blood transfusion before hepatitis C screening. In addition, HCV RNA detection by polymerase chain reaction is crucial for the diagnosis of HCV infection in HD patients. Trials using combinations of new oral antiviral drugs, such as sofosbuvir and combo (ombitasvir, paritaprevir, ritonavir and dasabuvir), should be the next step in the improvement of care among HD patients with HCV, because these therapeutic agents apparently do not require dose adjustment according to renal function. Finally, information on this subgroup of patients remains unavailable in some countries; therefore, additional studies are needed to determine the prevalence trend of HCV infection in these populations.
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Affiliation(s)
| | | | | | - Misael Uribe
- Liver Research Unit. Medica Sur Clinic & Foundation, Mexico City, Mexico
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Nuño-Lámbarri N, Barbero-Becerra VJ, Uribe M, Chávez-Tapia NC. Mitochondrial Molecular Pathophysiology of Nonalcoholic Fatty Liver Disease: A Proteomics Approach. Int J Mol Sci 2016; 17:281. [PMID: 26999105 PMCID: PMC4813145 DOI: 10.3390/ijms17030281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 12/14/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a chronic liver condition that can progress to nonalcoholic steatohepatitis, cirrhosis and cancer. It is considered an emerging health problem due to malnourishment or a high-fat diet (HFD) intake, which is observed worldwide. It is well known that the hepatocytes’ apoptosis phenomenon is one of the most important features of NAFLD. Thus, this review focuses on revealing, through a proteomics approach, the complex network of protein interactions that promote fibrosis, liver cell stress, and apoptosis. According to different types of in vitro and murine models, it has been found that oxidative/nitrative protein stress leads to mitochondrial dysfunction, which plays a major role in stimulating NAFLD damage. Human studies have revealed the importance of novel biomarkers, such as retinol-binding protein 4, lumican, transgelin 2 and hemoglobin, which have a significant role in the disease. The post-genome era has brought proteomics technology, which allows the determination of molecular pathogenesis in NAFLD. This has led to the search for biomarkers which improve early diagnosis and optimal treatment and which may effectively prevent fatal consequences such as cirrhosis or cancer.
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Affiliation(s)
- Natalia Nuño-Lámbarri
- Traslational Research Unit, Médica Sur Clinic & Foundation, Mexico City 14050, Mexico.
| | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Médica Sur Clinic & Foundation, Mexico City 14050, Mexico.
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Médica Sur Clinic & Foundation, Mexico City 14050, Mexico.
- Obesity and Digestive Diseases Unit, Médica Sur Clinic & Foundation, Mexico City 14050, Mexico.
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Aguilar-Olivos NE, Carrillo-Córdova D, Oria-Hernández J, Sánchez-Valle V, Ponciano-Rodríguez G, Ramírez-Jaramillo M, Chablé-Montero F, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. The nuclear receptor FXR, but not LXR, up-regulates bile acid transporter expression in non-alcoholic fatty liver disease. Ann Hepatol 2016; 14:487-93. [PMID: 26019035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. Patients with non-alcoholic steatohepatitis (NASH) have increased plasmatic and hepatic concentrations of bile acids (BA), suggesting that they can be associated with the progression of the disease. Hepatic nuclear receptors are known to modulate genes controlling BA metabolism; thus, in this work we aimed to compare the expression of liver nuclear receptors -farnesoid X (FXR), small heterodimer partner (SHP) and liver X alpha (LXRα) receptors- and BA transporters -sodium+/taurocholate cotransporting polypeptide (NTCP) and bile salt export pump (BSEP)- in liver biopsy samples of patients with simple steatosis (SS) and NASH. MATERIAL AND METHODS Forty patients with biopsy-proven NALFD were enrolled between 2009 and 2012; liver biopsies were classified as SS (N = 20) or NASH (N = 20) according to the NAFLD activity score. Gene expression of nuclear FXR, LXRα, SHP, NTCP and BSEP was analyzed by real-time reverse transcription polymerase chain reaction and protein level was quantified by western blot. RESULTS Gene expression of FXR, SHP, NTCP and BSEP was significantly up-regulated in the NASH group in comparison with SS patients (P < 0.05). In contrast, protein level for FXR, SHP and NTCP was decreased in the NASH patients vs. the SS group (P < 0.05). Gene and protein profile of LXRα did not show differences between groups. CONCLUSIONS The results suggest that liver nuclear receptors (FXR and SHP) and BA transporters (NTCP and BSEP) are associated with the progression of NAFLD.
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Affiliation(s)
| | | | - Jesús Oria-Hernández
- Biochemistry and Genetics Lab, National Institute of Pediatrics, Ministry of Health, Mexico City, Mexico
| | | | | | | | | | | | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Chávez-Tapia NC, González-Rodríguez L, Jeong M, López-Ramírez Y, Barbero-Becerra V, Juárez-Hernández E, Romero-Flores JL, Arrese M, Méndez-Sánchez N, Uribe M. Current evidence on the use of probiotics in liver diseases. J Funct Foods 2015. [DOI: 10.1016/j.jff.2015.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Barbero-Becerra VJ, Giraudi PJ, Chávez-Tapia NC, Uribe M, Tiribelli C, Rosso N. The interplay between hepatic stellate cells and hepatocytes in an in vitro model of NASH. Toxicol In Vitro 2015; 29:1753-8. [PMID: 26187275 DOI: 10.1016/j.tiv.2015.07.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/10/2015] [Accepted: 07/13/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIM A complex interplay exists between hepatocytes and hepatic stellate cells (HSC) in hepatic fibrogenesis. The activation of HSCs after liver injury leads to production of extracellular matrix (ECM). Co-culture models could be useful to mimic the liver microenvironment. This study evaluates the effect of free fatty acids (FFA) on HSC cells and the interplay with hepatocytes via both soluble-mediator and cell-cell contact. METHODS The human hepatocyte cell line (HuH7) and HSC cells (LX2) were exposed to FFA for 24 h in 3 different experimental set-ups: (A) monoculture of HSC; (B) Transwell® system (effect of soluble mediators); and (C) Simultaneous Co-Culture (SCC) (cell-to-cell connections). Intracellular FFA accumulation was assessed qualitatively (microscopy) and quantitatively (flow cytometry); the activation of HSC (alpha smooth muscle actin, α-SMA) expression of ECM components were quantified by RT-PCR. RESULTS FFA exposure induces intracellular fat accumulation in all the experimental set-up but the expression of α-SMA was significantly increased only in SCC. On the contrary, the expression of ECM was substantially decreased in the transwell® system. CONCLUSIONS The HSC activation is independent of FFA accumulation but requires cell-to-cell interaction with hepatocyte. On the contrary, the gene regulation of ECM components seems to occur through paracrine mediators.
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Affiliation(s)
- Varenka J Barbero-Becerra
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Puente de Piedra 150, Col. Toriello Guerra, Tlalpan, C.P. 14050 Mexico City, Mexico; Centro Studi Fegato (CSF) - Liver Research Center, Fondazione Italiana Fegato, Bldg Q AREA Science Park, Basovizza Campus SS 14 km 163.5, 34149 Trieste, Italy.
| | - Pablo J Giraudi
- Centro Studi Fegato (CSF) - Liver Research Center, Fondazione Italiana Fegato, Bldg Q AREA Science Park, Basovizza Campus SS 14 km 163.5, 34149 Trieste, Italy.
| | - Norberto C Chávez-Tapia
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Puente de Piedra 150, Col. Toriello Guerra, Tlalpan, C.P. 14050 Mexico City, Mexico.
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Puente de Piedra 150, Col. Toriello Guerra, Tlalpan, C.P. 14050 Mexico City, Mexico.
| | - Claudio Tiribelli
- Centro Studi Fegato (CSF) - Liver Research Center, Fondazione Italiana Fegato, Bldg Q AREA Science Park, Basovizza Campus SS 14 km 163.5, 34149 Trieste, Italy; Department of Medical Sciences, University of Trieste, 34100 Trieste, Italy.
| | - Natalia Rosso
- Centro Studi Fegato (CSF) - Liver Research Center, Fondazione Italiana Fegato, Bldg Q AREA Science Park, Basovizza Campus SS 14 km 163.5, 34149 Trieste, Italy.
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Aguilar-Olivos N, Motola-Kuba M, Candia R, Arrese M, Méndez-Sánchez N, Uribe M, Chávez-Tapia NC. Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis. Ann Hepatol 2015; 13:420-8. [PMID: 24927613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Carvedilol appears to be more effective than propranolol in the treatment of portal hypertension in cirrhotic patients. Aim. To compare the effects of carvedilol vs. propranolol on systemic and splanchnic haemodynamics and to evaluate the adverse events associated with these treatments. MATERIAL AND METHODS We performed a systematic review following the Cochrane and PRISMA recommendations. Randomised controlled trials comparing carvedilol versus propranolol, in the treatment of portal hypertension in cirrhotic patients with oesophageal varices, with or without bleeding history were included. The primary outcome measure was the haemodynamic response to treatment. RESULTS Four randomised trials and 153 patients were included; 79 patients received carvedilol (6.25-50 mg/d) and 74 patients received propranolol (10-320 mg/d). The hepatic vein pressure gradient (HVPG) decreased more with carvedilol than with propranolol (MD -2.21; 95% CI: -2.83 to -1.60, I(2) = 0%, P < 0.00001). Carvedilol was superior to propranolol for reducing HVPG by ≥ 20% from the baseline value or to ≤ 12 mmHg (OR: 2.93; 95% CI: 1.50 to 5.74, I(2) = 22%, P = 0.002). Overall adverse events did not differ between. In conclusion, there is limited evidence suggesting that carvedilol is more effective than propranolol for improving the haemodynamic response in cirrhotic patients with portal hypertension. Long-term randomized controlled trials are needed to confirm this information.
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Affiliation(s)
| | | | - Roberto Candia
- Departamento de Gastroenterología, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Arrese
- Departamento de Gastroenterología, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Misael Uribe
- Medica Sur Clinic & Foundation, Mexico City, Mexico
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Manzano-Robleda MDC, Ornelas-Arroyo V, Barrientos-Gutiérrez T, Méndez-Sánchez N, Uribe M, Chávez-Tapia NC. Boceprevir and telaprevir for chronic genotype 1 hepatitis C virus infection. A systematic review and meta-analysis. Ann Hepatol 2015. [PMID: 25536641 DOI: 10.1016/s1665-2681(19)30800-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment of hepatitis C virus (HCV) infection with newer direct-acting antivirals is unrealistic in some countries because of the lack of availability. AIM Assess benefits and harms of boceprevir (BOC) and telaprevir (TLV) in treatment of genotype 1 HCV infection, and identifying subgroups with most benefit. MATERIAL AND METHODS Search from 2009-2013 in PubMed, EMBASE, and "gray literature" of published and unpublished randomized trials reporting sustained viral response (SVR) or adverse events (AE) with BOC or TLV + pegylated interferon and ribavirin (PR) in HCV-infected patients; cohorts or case reports for comparison protease inhibitors (PI), evaluation of predictors of SVR, and resistant variants. Cochrane guidelines were applied. Comparisons between PI + PR vs. PR were performed. Main outcomes were expressed as risk-ratios with 95% CIs. Meta-regression and trial sequential analysis were performed. RESULTS 33 studies (10,525 patients) were analyzed. SVR was higher for PI + PR (RR, 2.05; 95% CI 1.70-2.48). In meta-regression, previously treated patients exhibited greater benefit from PI + PR (RR, 3.47; 95% CI, 2.78-4.33). AE were higher with PI + PR (RR, 1.01; 95% CI, 1-1.03; NNH 77.59), also the discontinuation rate (RR, 1.69; 95% CI, 1.36-2.10, NNH, 18). Predictors of SVR were IL-28 TT, nonblack race, low viral load, age, no cirrhosis, statin use, undetectable viral load at the first anemia episode and at week 2 of treatment, and low IL-6 levels. In conclusion SVR was higher in patients treated with PIs, patients previously exposed to PR showed superior response rates. Specific predictors will determine the best candidates for treatments that will offer real-life therapeutic alternatives.
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Affiliation(s)
| | | | | | | | - Misael Uribe
- Liver Research Unit. Medica Sur Clinic & Foundation. Mexico City, Mexico
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37
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Ruiz-Morales JM, Dorantes-Heredia R, Arrieta O, Chávez-Tapia NC, Motola-Kuba D. Neutrophil gelatinase-associated lipocalin (NGAL) and matrix metalloproteinase-9 (MMP-9) prognostic value in lung adenocarcinoma. Tumour Biol 2014; 36:3601-10. [DOI: 10.1007/s13277-014-2997-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 12/17/2014] [Indexed: 12/24/2022] Open
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López-Velázquez JA, Silva-Vidal KV, Ponciano-Rodríguez G, Chávez-Tapia NC, Arrese M, Uribe M, Méndez-Sánchez N. The prevalence of nonalcoholic fatty liver disease in the Americas. Ann Hepatol 2014; 13:166-78. [PMID: 24552858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is an alarming public health problem. The disease is one of the main causes of chronic liver disease worldwide and is directly linked to the increased prevalence of obesity and type 2 diabetes mellitus (T2DM) in the general population. The worldwide prevalence of NAFLD has been estimated at 20-30%, but the prevalence is unknown in the Americas because of a lack of epidemiological studies. However, given the trends in the prevalence of diabetes and obesity, the prevalence of NAFLD and its consequences are expected to increase in the near future. The aim of the present study is to present the current data on the prevalence of NAFLD in the Americas. We performed an electronic search of the main databases from January 2000 to September 2013 and identified 356 reports that were reviewed. We focused on the epidemiology and prevalence of known NAFLD risk factors including obesity, T2DM, and the metabolic syndrome (MS). The prevalence of the MS was highest in the United States, Mexico, Costa Rica, Puerto Rico, Chile, and Venezuela. In addition, Puerto Rico, Guyana, and Mexico have the highest prevalence of T2DM in the Americas, while USA has the most people with T2DM. In conclusion, the prevalence rates of NAFLD and obesity were highest in the United States, Belize, Barbados, and Mexico.
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Affiliation(s)
| | | | | | | | - Marco Arrese
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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López-Martínez C, Tovar-Rivera E, Becerra-Laparra IK, Chávez-Tapia NC. Clinical impact of indirect markers of renal function in elderly patients with hip fracture. Geriatr Orthop Surg Rehabil 2014; 5:131-7. [PMID: 25360344 DOI: 10.1177/2151458514542336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There are risk factors associated with mortality in patients older than 70 years with hip fracture, including kidney function. However, indirect formulas to calculate glomerular filtration rate are not validated in patients older than 70 years. We analyzed whether the formula hematocrit, urea, and gender (HUGE) can be used as a prognostic factor. MATERIAL AND METHODS A retrospective cohort study of 88 patients older than 70 years with a diagnosis of hip fracture. At admission, clinical and biochemical parameters were measured and glomerular filtration rate by Cockcroft-Gault, Modification Of Diet In Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and HUGE value. Accuracy to assess long-term mortality was analyzed with receiver-operating curve analysis. Cox regression analysis was performed to identify risk factor for mortality. RESULTS Sample included 88 patients; overall mortality was 13.63%, 17.85%, 28.57%, and 75.85% at 6 months, 1, 2, and 3 years, respectively. There was no significant difference in glomerular filtration rate by different formulas, contrary to HUGE, with higher values in the mortality group (1.83 ± 6.38 vs -2.61 ± 2.70, P = .0001). Survival was lower in patients with higher HUGE values (22.7 months, 95% confidence interval [CI] 16.1-29.5 vs 32.9 months, 95% CI 30.2-35.7; P ≤ .001). In the Cox regression analysis, a negative HUGE value is associated with lower mortality (hazards ratio = 0.238; 95% CI 0.568-0.099). CONCLUSION The HUGE formula is an independent risk factor for mortality in elderly patients with hip fracture, but not the glomerular filtration rate determined by Cockcroft-Gault, MDRD, and CKD-EPI.
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40
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Gutiérrez-Grobe Y, Gavilanes-Espinar JG, Masso-Rojas FA, Sánchez-Valle V, Páez-Arenas A, Ponciano-Rodríguez G, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. Metabolic syndrome and nonalcoholic fatty liver disease. The role of endothelial progenitor cells. Ann Hepatol 2014; 12:908-14. [PMID: 24114821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endothelial dysfunction has been previously described in metabolic syndrome patients. The levels of circulating endothelial progenitor cells (EPCs) inversely correlates with the incidence of cardiovascular disease. The aim of this study was to investigate the association between NAFLD, metabolic syndrome and EPC levels. MATERIAL AND METHODS A cross-sectional pilot study was performed at a university hospital in Mexico. Two groups of patients without previously known chronic diseases were studied and classified according to the presence of NAFLD. Anthropometric, dietary, and biochemical variables, and circulating EPC number were measured and compared between the groups. RESULTS Forty subjects were included and classified into two groups: patients with NAFLD (n = 20) and a control group (n = 20). The overall prevalence of insulin resistance and metabolic syndrome was 25% and 17.5%, respectively. EPC levels were found to be higher in the NAFLD group (p < 0.05) as in the patients with insulin resistance (p < 0.01) and metabolic syndrome (p < 0.01). These levels showed correlation with the severity of steatosis. CONCLUSIONS Patients with NAFLD have increased levels of EPC, such levels are associated with the severity of NAFLD. These findings may suggest that these cells may play a role in the early natural history of NAFLD. EPC might be increased in an attempt to repair the endothelial damage resulting from metabolic alterations accompanying NAFLD. Further studies are needed to establish the dynamics of these cells in NAFLD.
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Méndez-Sánchez N, Paraná R, Cheinquer H, Alves de Mattos A, Gadano A, Silva M, Pessôa MG, Gomes-Ferraz ML, Soza A, Mendes-Correa MC, Chávez-Tapia NC, Dagher L, Padilla M, Hernandez N, Sánchez-Avila JF, Contreras F, Moraes-Coelho HS, Parise ER, Bessone F, Uribe M. Latin American Association for the Study of the Liver recommendations on treatment of hepatitis C. Ann Hepatol 2014; 13 Suppl 2:s4-66. [PMID: 25185535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Raymundo Paraná
- School of Medicine, Federal University of Bahia, Gastro-Hepatologist Unit, University Bahia University Hospital, Bahia, Brazil
| | - Hugo Cheinquer
- Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Fundação Universidade Federal de Ciências da Saude de Porto Alegre, Brazil
| | | | - Adrian Gadano
- Liver Unit, Hospital Italiano, Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit Austral University Hospital Buenos Aires, Argentina
| | - Mario G Pessôa
- Department of Gastroenterology. University of São Paulo School of Medicine. São Paulo, Brazil
| | | | - Alejandro Soza
- Department of Gastroenterology, Centro de Investigación Clínica UC (CICUC), School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - M Cassia Mendes-Correa
- São Paulo University Medical School, Department of Infectious and Parasitic Diseases, Brazil
| | | | | | - Martín Padilla
- Liver Transplant Service, Guillermo Almenara National Hospital, Lima, Peru
| | | | - Juan F Sánchez-Avila
- Hepatology and Liver Transplantation Department, National Institute of Nutrition and Medical Sciences "Salvador Zubiran", Mexico City, Mexico
| | | | | | - Edison R Parise
- School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Bessone
- Gastroenterology, University of Rosario School of Medicine, Rosario, Argentina
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Méndez-Sánchez N, Ridruejo E, Alves de Mattos A, Chávez-Tapia NC, Zapata R, Paraná R, Mastai R, Strauss E, Guevara-Casallas LG, Daruich J, Gadano A, Parise ER, Uribe M, Aguilar-Olivos NE, Dagher L, Ferraz-Neto BH, Valdés-Sánchez M, Sánchez-Avila JF. Latin American Association for the Study of the Liver (LAASL) clinical practice guidelines: management of hepatocellular carcinoma. Ann Hepatol 2014. [PMID: 24998696 DOI: 10.1016/s1665-2681(19)30919-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer death, and accounts for 5.6% of all cancers. Nearly 82% of the approximately 550,000 liver cancer deaths each year occur in Asia. In some regions, cancer-related death from HCC is second only to lung cancer. The incidence and mortality of HCC are increasing in America countries as a result of an ageing cohort infected with chronic hepatitis C, and are expected to continue to rise as a consequence of the obesity epidemic. Clinical care and survival for patients with HCC has advanced considerably during the last two decades, thanks to improvements in patient stratification, an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and the introduction of novel therapies and strategies in prevention. Nevertheless, HCC remains the third most common cause of cancer-related deaths worldwide. These LAASL recommendations on treatment of hepatocellular carcinoma are intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decision-making process by describing the optimal management of patients with liver cancer.
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Affiliation(s)
| | - Ezequiel Ridruejo
- Hepatology Section, Department of Medicine. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC". Ciudad Autónoma de Buenos Aires, Argentina; Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Pilar, Argentina
| | | | | | - Rodrigo Zapata
- Hepatology and Liver Transplantation Unit. University of Chile School of Medicine, German Clinic. Santiago, Chile
| | - Raymundo Paraná
- Associate Professor of School of Medicine - Federal University of Bahia Head of the Gastro-Hepatologist Unit of the University Bahia University Hospital
| | - Ricardo Mastai
- Transplantation Unit. German Hospital.Buenos Aires, Argentina
| | - Edna Strauss
- Clinical hepatologist of Hospital do Coraçao - São Paulo - Brazil. Professor of the Post Graduate Course in the Department of Pathology at the School of Medicine, University of São Paulo
| | | | - Jorge Daruich
- Hepatology Department, Clinical Hospital San Martín. University of Buenos Aires Buenos Aires, Argentina
| | - Adrian Gadano
- Section of Hepatology, Italian Hospital of Buenos Aires. Buenos Aires, Argentina
| | - Edison Roberto Parise
- Professor Associado da Disciplina de Gastroenterologia da Universidade Federal de São Paulo, Presidente Eleito da Sociedade Brasileira de Hepatologia
| | - Misael Uribe
- Digestive Diseases and Obesity Clinic, Medica Sur Clinic Foundation. México City, Mexico
| | - Nancy E Aguilar-Olivos
- Digestive Diseases and Obesity Clinic, Medica Sur Clinic Foundation. México City, Mexico
| | - Lucy Dagher
- Consultant Hepatologist. Metropolitan Policlinic- Caracas- Venezuela
| | - Ben-Hur Ferraz-Neto
- Director of Liver Institute - Beneficencia Portuguesa de São Paulo. Chief of Liver Transplantation Team
| | - Martha Valdés-Sánchez
- Department of Pediatric Oncology National Medical Center "Siglo XXI". Mexico City, Mexico
| | - Juan F Sánchez-Avila
- Hepatology and Liver Transplantation Department National Institute of Nutrition and Medical Sciences "Salvador Zubirán" Mexico City, Mexico
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Abstract
There is no universally accepted definition of acute-on-chronic liver failure; however, it is recognized as an entity characterized by decompensation from an underlying chronic liver disease associated with organ failure that conveys high short-term mortality, with alcoholism and infection being the most frequent precipitating events. The pathophysiology involves inflammatory processes associated with a trigger factor in susceptible individuals (related to altered immunity in the cirrhotic population). This review addresses the different definitions developed by leading research groups, epidemiological and pathophysiological aspects, and the latest treatments for this entity.
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Affiliation(s)
- Luis Eduardo Zamora Nava
- Department of Endoscopy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Jonathan Aguirre Valadez
- Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Aldo Torre
- Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Chávez-Tapia NC, Balderas-Garces BV, Meza-Meneses P, Herrera-Gomar M, García-López S, Gónzalez-Chon O, Uribe M. Hypoxic hepatitis in cardiac intensive care unit: a study of cardiovascular risk factors, clinical course, and outcomes. Ther Clin Risk Manag 2014; 10:139-45. [PMID: 24600229 PMCID: PMC3942220 DOI: 10.2147/tcrm.s59312] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction Hypoxic hepatitis (HH) is observed frequently in intensive care units. Information in the cardiac intensive care unit (CICU) is limited. The aim of this study was to analyze the clinical course and outcomes of HH in the specific setting of the CICU. Methods We analyzed records of patients with HH admitted to the CICU (Group 1). Data were collected and compared with those of an intermediate group of patients with altered liver test results that did not meet the HH criteria who had a serum aminotransferase level of five to ≤20 times the upper-normal limit (Group 2), and with a control group who had an aminotransferase level less than five times the upper-normal limit (Group 3). Results Patients with HH exhibited a worse hemodynamic profile and more of these patients were in shock: 17 (94.4%) in Group 1, 14 (77.8%) in Group 2, and seven (38.9%) in Group 3 (P=0.001). Cardiogenic shock was the most frequent event: 12 (66.7%) in Group 1, 13 (72.2%) in Group 2, and six (33.3%) in Group 3 (P=0.006). The mortality rate was 55.6%. Mechanical ventilation was an independent factor associated with death (odds ratio 12.25, 95% confidence interval 1.26–118.36). Conclusion The mortality rate of patients with HH in CICU is high and is associated with ventilatory disturbances.
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Affiliation(s)
| | | | - Patricia Meza-Meneses
- Obesity and Digestive Diseases Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | | | | | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
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Pérez-Gutiérrez OZ, Hernández-Rocha C, Candia-Balboa RA, Arrese MA, Benítez C, Brizuela-Alcántara DC, Méndez-Sánchez N, Uribe M, Chávez-Tapia NC. Validation study of systems for noninvasive diagnosis of fibrosis in nonalcoholic fatty liver disease in Latin population. Ann Hepatol 2013; 12:416-24. [PMID: 23619258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. The incidence of liver cirrhosis is significantly high in Latin population. The high prevalence of nonalcoholic fatty liver disease NAFLD is likely partially responsible for these figures. Liver biopsy is not a practical diagnostic option in this scenario. The validation of noninvasive markers of fibrosis is important in populations with a high prevalence of NAFLD. Aim. To compare the diagnostic value of noninvasive assessment systems to detect fibrosis in a cohort of Latin patients with biopsy-proven NAFLD. Material and methods. Patients with biopsy-proven NAFLD were included. Noninvasive evaluations included calculations of NAFLD fibrosis, FIB-4, BARD scores, APRI, and AST/ALT ratio. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver-operating characteristic curve (AUROC) were calculated. Results. A total of 228 patients (mean age, 48.6 ± 12.7 years) were included. Fifty-one percent were women; 48% were overweight and 23% were obese. The severity of fibrosis was classified as G0, 56.6%; G1, 25%; G2, 6.6%; G3, 7%; and G4, 4.8%. The AUROC values for advanced fibrosis were 0.72 for the NAFLD fibrosis score, 0.74 for FIB-4 score, 0.67 for AST/ALT ratio, 0.66 for APRI score, and 0.65 for BARD score. In 54% of patients with undetermined FIB-4 score and in 60% of patients with undetermined NAFLD fibrosis score, fibrosis was observed in the liver biopsy. Conclusions. The NAFLD fibrosis, FIB-4, and APRI scores can be used for the noninvasive diagnosis of fibrosis. However, 25% of patients evaluated by these methods have an indeterminate degree of fibrosis.
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Sánchez-Valle V, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. Role of oxidative stress and molecular changes in liver fibrosis: a review. Curr Med Chem 2013; 19:4850-60. [PMID: 22709007 DOI: 10.2174/092986712803341520] [Citation(s) in RCA: 353] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/19/2012] [Accepted: 05/19/2012] [Indexed: 02/06/2023]
Abstract
Liver fibrosis represents a health problem with significant morbidity and mortality that affects 100 million people worldwide. It is a final pathway to several chronic liver diseases and is characterized by excess collagen and accumulation of extracellular matrix in response to chronic hepatocellular damage. Clinical and experimental data suggest that oxidative stress (OS) mediates the progression of fibrosis, and that OS-related molecules may act as mediators of molecular and cellular events implicated in liver fibrosis. The generation of reactive oxygen species (ROS) plays an important role in producing liver damage and initiating hepatic fibrogenesis. OS disrupts lipids, proteins and DNA, induces necrosis and apoptosis of hepatocytes and amplifies the inflammatory response. ROS also stimulate the production of profibrogenic mediators from Kupffer cells and circulating inflammatory cells and directly activate hepatic stellate cells, resulting in the initiation of fibrosis. Advances in understanding the mechanisms involved in fibrosis have identified new molecular targets with therapeutic potential for more targeted and personalized control of this disease. This review will highlight recent concepts in OS, antioxidants and the molecular pathways involved in hepatic fibrosis.
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Affiliation(s)
- V Sánchez-Valle
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Chávez-Tapia NC, Ridruejo E, Alves de Mattos A, Bessone F, Daruich J, Sánchez-Ávila JF, Cheinquer H, Zapata R, Uribe M, Bosques-Padilla F, Gadano A, Sosa A, Dávalos-Moscol M, Marroni C, Muñoz-Espinoza L, Castro-Narro G, Paraná R, Méndez-Sánchez N. An update on the management of hepatitis C: guidelines for protease inhibitor-based triple therapy from the Latin American Association for the Study of the Liver. Ann Hepatol 2013; 12 Suppl 2:s3-35. [PMID: 23559487] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatitis C is a common cause of end-stage liver disease, and the main indication for liver transplantation in Latin America. Treatment of hepatitis C infected patients improves important long-term outcomes as mortality. Sustained viral response is reached in near 50% of patients with the previous management based in pegylated interferon and ribavirin. Recently new drugs were available increasing sustained viral response significantly, changing the standard of care to triple therapy. This guidelines provides a framework for practitioner in Latin America, to the management of patients with hepatitis C chronic infection.
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Téllez-Ávila FI, Chávez-Tapia NC, Franco-Guzmán AM, Uribe M, Vargas-Vorackova F. Rapid diagnosis of spontaneous bacterial peritonitis using leukocyte esterase reagent strips in emergency department: uri-quick clini-10SG® vs. Multistix 10SG®. Ann Hepatol 2013; 11:696-9. [PMID: 22947532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Bacterial peritonitis (SBP) is the most frequent infection in patients with cirrhosis causing significant mortality. Delay in SBP diagnosis is a serious problem. The aim of this study was to evaluate the diagnostic yield of Uri-Quick Clini-10SG® vs. Multistix 10SG® reagent strips in an Emergency Department. MATERIAL AND METHODS A prospective study of consecutive patients with ascites and paracentesis attending to Emergency Department from March 2005 to February 2007 was made. SBP was defined by ≥ 250 neutrophiles /mm³. The ascites obtained at bedside was immediately tested in a dry test tube with both the Uri-Quick Clini 10SG® and MultistixSG10®. The Uri-Quick Clini 10SG® and Multistix SG10®. Strips were considered positive at grade ≥ 3 (≥ 125 leukocytes/mL). RESULTS A total of 223 ascitic fluid samples were obtained. There were 49 episodes of SBP. Median age was 54 (range 18-87 year) years; 62.3% were female. The sensitivity, specificity, PPV, NPV, and 95% CI for Uri-Quick Clini 10SG® were 79.6 (64-87), 98.2 (94-99), 90.5 (78-96) and 93.9 (89-96), respectively. For MultistixSG10® the values were 77.5 (64-88), 97.7 (93-98), 90 (77.9-96.2), and 94 (89.4-96.6), respectively. CONCLUSION The use of reagent strip is useful for SBP diagnosis in an emergency setting. The high PPV allow start antibiotic treatment. In areas without the resources to perform conventional ascites fluid analyses, these strips could be presently used.
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Affiliation(s)
- Félix I Téllez-Ávila
- Department of Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City.
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Chávez-Tapia NC, Rosso N, Uribe M, Bojalil R, Tiribelli C. Kinetics of the inflammatory response induced by free fatty acid accumulation in hepatocytes. Ann Hepatol 2013; 13:113-20. [PMID: 24378274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND. The information available on time and dose effects of the exposure of hepatocytes to free fatty acids (FFA) in vitro is controversial, and very few studies have assessed the hepatocyte inflammatory response in an in vitro model. AIM. To analyze the effect of treatment with FFA on cell viability and on the kinetics of cytokine expression using hepatic cell lines. MATERIAL AND METHODS. Hepatic cell lines, IHH and HuH7, were cultured for 3 h, 6 h, 12 h and 24 h in an enriched medium with palmitic and oleic acids. The cytotoxicity of the FFA was assessed by the MTT test and the intracellular fat content determined cytofluorimetrically and by fluorescence microscopy using Nile Red staining. The expression of mRNA for interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α was assessed by real time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS. Treatment with 600 μM FFA did not affect the viability of either cell line despite a significant increase in the intracellular content of lipid droplets already evident after 3 h of treatment. A time- and dose-dependent upregulation of the expression of IL-6 and IL-8 mRNA was observed during the treatment at 3 and 24 h. In contrast, TNF-α mRNA expression was highly upregulated at 3 h after FFA exposure but returned to control values at 24 h. In conclusion, hepatocytes exposed in vitro for a short time to low FFA concentrations showed a significant upregulation of IL-6 and IL-8 to,and a rapid but transitory elevation of TNF-α.
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Affiliation(s)
- Norberto C Chávez-Tapia
- Centro Studi Fegato, Fondazione Italiana Fegato, Trieste, Italy; Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana. Mexico City, Mexico; Medica Sur Clinic & Foundation. Mexico City, Mexico
| | - Natalia Rosso
- Centro Studi Fegato, Fondazione Italiana Fegato, Trieste, Italy
| | - Misael Uribe
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana. Mexico City, Mexico
| | - Rafel Bojalil
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco. Mexico City, Mexico; Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez; Mexico City, Mexico
| | - Claudio Tiribelli
- Centro Studi Fegato, Fondazione Italiana Fegato, Trieste, Italy; Department of Medical Sciences, University of Trieste, Italy
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López-Velázquez JA, Chávez-Tapia NC, Ponciano-Rodríguez G, Sánchez-Valle V, Caldwell SH, Uribe M, Méndez-Sánchez N. Bilirubin alone as a biomarker for short-term mortality in acute-on-chronic liver failure: an important prognostic indicator. Ann Hepatol 2013; 13:98-104. [PMID: 24378272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS. Acute-on-chronic liver failure has been recognized as a sudden deterioration of cirrhosis, with a high short-term mortality. Prognostic scores are used to assess liver dysfunction. However, there is not enough information on a score to predict short term mortality in those patients. We aimed to investigate the prognostic value of bilirubin concentration in predicting the 1-week outcome of patients with acute-on-chronic liver failure. MATERIAL AND METHODS. We performed a retrospective analysis with a cohort of 65 patients (33 women/32 men), age average of 64 years, diagnosed with acute-on-chronic liver failure with at least 1 week follow-up. Demographics, clinical and biochemical variables were analyzed. Most patients died (59 %) within 1 week of follow-up. RESULTS. In univariate logistic regression analysis, admission to the intensive care unit, use of vasoactive drugs, need for parenteral nutrition, and levels of conjugated, unconjugated, and total bilirubin at the time of hospital admission were significantly associated with 1-week mortality; in a multivariate logistic regression, conjugated (p = 0.01), unconjugated (p =0.01), and total bilirubin (p = 0.009) were independently associated with 1-week mortality. In ROC curve analysis, conjugated (0.751, p < 0.05) and total bilirubin (0.746, p < 0.05) levels were significantly the best short-term mortality predictors. CONCLUSIONS. High levels of bilirubin are able to predict short-term mortality in these patients. Also, we suggest that bilirubin can be used as a biochemical marker to improve triage of patients with acute-on-chronic liver failure especially with emerging interventions such as extracorporeal liver assist devices and possibly improved early phase pharmacological therapies.
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Affiliation(s)
- Jorge A López-Velázquez
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, Mexico
| | | | - Vicente Sánchez-Valle
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA, USA
| | - Misael Uribe
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, Mexico
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, Mexico
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