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Loomba R, Neuschwander-Tetri BA, Sanyal A, Chalasani N, Diehl AM, Terrault N, Kowdley K, Dasarathy S, Kleiner D, Behling C, Lavine J, Van Natta M, Middleton M, Tonascia J, Sirlin C, Allende D, Dasarathy S, McCullough AJ, Penumatsa R, Dasarathy J, Lavine JE, Abdelmalek MF, Bashir M, Buie S, Diehl AM, Guy C, Kigongo C, Kopping M, Malik D, Piercy D, Chalasani N, Cummings OW, Gawrieh S, Ragozzino L, Sandrasegaran K, Vuppalanchi R, Brunt EM, Cattoor T, Carpenter D, Freebersyser J, King D, Lai J, Neuschwander‐Tetri BA, Siegner J, Stewart S, Torretta S, Wriston K, Gonzalez MC, Davila J, Jhaveri M, Kowdley KV, Mukhtar N, Ness E, Poitevin M, Quist B, Soo S, Ang B, Behling C, Bhatt A, Loomba R, Middleton MS, Sirlin C, Akhter MF, Bass NM, Brandman D, Gill R, Hameed B, Maher J, Terrault N, Ungermann A, Yeh M, Boyett S, Contos MJ, Kirwin S, Luketic VA, Puri P, Sanyal AJ, Schlosser J, Siddiqui MS, Yost‐Schomer L, Brunt EM, Fowler K, Kleiner DE, Doo EC, Hall S, Hoofnagle JH, Robuck PR, Sherker AH, Torrance R, Belt P, Clark JM, Dodge J, Donithan M, Isaacson M, Lazo M, Meinert J, Miriel L, Sharkey EP, Smith J, Smith M, Sternberg A, Tonascia J, Van Natta ML, Wagoner A, Wilson LA, Yamada G, Yates K, Covarrubias Y, Gamst A, Hamilton G, Henderson W, Hooker J, Lavine JE, Loomba R, Middleton MS, Schlein A, Schwimmer JB, Shen W, Sirlin C, Wolfson T. Multicenter Validation of Association Between Decline in MRI-PDFF and Histologic Response in NASH. Hepatology 2020; 72:1219-1229. [PMID: 31965579 PMCID: PMC8055244 DOI: 10.1002/hep.31121] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/23/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Emerging data from a single-center study suggests that a 30% relative reduction in liver fat content as assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF) from baseline may be associated with histologic improvement in nonalcoholic steatohepatitis (NASH). There are limited multicenter data comparing an active drug versus placebo on the association between the quantity of liver fat reduction assessed by MRI-PDFF and histologic response in NASH. This study aims to examine the association between 30% relative reduction in MRI-PDFF and histologic response in obeticholic acid (OCA) versus placebo-treated patients in the FLINT (farnesoid X receptor ligand obeticholic acid in NASH trial). APPROACH AND RESULTS This is a secondary analysis of the FLINT trial including 78 patients with MRI-PDFF measured before and after treatment along with paired liver histology assessment. Histologic response was defined as a 2-point improvement in nonalcoholic fatty liver disease activity score without worsening of fibrosis. OCA (25 mg orally once daily) was better than placebo in improving MRI-PDFF by an absolute difference of -3.4% (95% confidence interval [CI], -6.5 to -0.2%, P value = 0.04) and relative difference of -17% (95% CI, -34 to 0%, P value = 0.05). The optimal cutoff point for relative decline in MRI-PDFF for histologic response was 30% (using Youden's index). The rate of histologic response in those who achieved less than 30% decline in MRI-PDFF versus those who achieved a 30% or greater decline in MRI-PDFF (MRI-PDFF responders) relative to baseline was 19% versus 50%, respectively. Compared with MRI-PDFF nonresponders, MRI-PDFF responders demonstrated both a statistically and clinically significant higher odds 4.86 (95% CI, 1.4-12.8, P value < 0.009) of histologic response, including significant improvements in both steatosis and ballooning. CONCLUSION OCA was better than placebo in reducing liver fat. This multicenter trial provides data regarding the association between 30% decline in MRI-PDFF relative to baseline and histologic response in NASH.
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Affiliation(s)
- Rohit Loomba
- University of California San Diego, La Jolla, CA, USA
| | | | - Arun Sanyal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Norah Terrault
- University of California San Francisco, San Francisco, CA USA
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Radhakrishna G, collins M, Wilson S, Sebag-Montefiore D, Carey B, Swift S, Franks K, Lilley J, Smith D, Kirwin S, Lindsay R, Summers H, Woolley A, Byrne P, Roberts N, Sykes J, Needham A, Crellin A. 936 poster DOSE ESCALATION STUDY USING 4D CT PLANNING IN LOCALLY ADVANCED PANCREATIC CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Radhakrishna G, Collins M, Sebag-Montefiore D, Carey B, Swift S, Franks K, Liley J, Smith D, Kirwin S, Wilson S, Lindsey R, Summers H, Wooley A, Byrne P, Roberts N, Sykes J, Needham A, Crellin A. Comparison of 4D CT Planning and 3D Conformal Planning in Locally Advanced Pancreatic Cancer. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levine RF, Eldor A, Shoff PK, Kirwin S, Tenza D, Cramer EM. Circulating megakaryocytes: delivery of large numbers of intact, mature megakaryocytes to the lungs. Eur J Haematol Suppl 1993; 51:233-46. [PMID: 8243613 DOI: 10.1111/j.1600-0609.1993.tb00637.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine the locus of platelet production, we sought to determine if sufficient megakaryocytes reach the lungs in a state that could produce platelets. Elutriation was used to isolate megakaryocytes from blood reaching and leaving the lungs of 20 patients undergoing routine cardiac catheterizations. A mean of 5.0 intact megakaryocytes/ml were found in pulmonary artery blood, compared to only 0.5 megakaryocytes/ml, with partial cytoplasmic content, in aortic samples. The megakaryocytes in central venous and aortic samples were all mature. The identity of these cells as megakaryocytes, their maturity and normal morphology were confirmed by standard and immunoelectron microscopy. Cardiac outputs were obtained for each patient at the time of blood sampling, allowing an extrapolation that 40 x 10(6) intact, mature megakaryocytes were being delivered to the lungs every day in the average patient, compared to only 4.0 x 10(6) partially spent megakaryocytes exiting the lungs daily. About 98% of megakaryocyte cytoplasm reaching the lungs did not exit as recognizable megakaryocytes or fragments. The number and state of the megakaryocytes apparently filtered in the lungs is consistent with the hypothesis that megakaryocytes may shed platelets within the pulmonary microvasculature, which may be the primary site of platelet production.
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Affiliation(s)
- R F Levine
- DVA Medical Center, Washington, DC 20422
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