High plasma interleukin-6 level, but not IL-6 gene variants, as a predictive marker for the development of hepatocellular carcinoma in a Moroccan population

Chronic inflammation triggered by hepatitis B (HBV) and hepatitis C (HCV) viruses elevates interleukin 6 (IL-6) levels, activating pathways that cause liver damage and contribute to hepatocellular carcinoma (HCC) development. In this study, we assessed IL-6 levels and explored the correlation between the rs1800795 and rs1800797 variants of the IL-6 gene and the risk of developing HCC. We conducted a case-control study involving 314 participants. Among them, 157 were HCC patients (94 anti-HCV, 22 HBsAg and 41 metabolic dysfunction-associated steatotic liver disease [MASLD]) and 157 controls. Genotyping for IL-6 rs1800795 and rs1800797 polymorphisms was performed using real-time polymerase chain reaction (PCR). Additionally, plasma IL-6 levels were determined using enzyme-linked immunosorbent assay. The IL-6 levels were notably higher in patients compared to controls (p < .0001). Among HCC patients, those with MASLD exhibited higher plasma IL-6 levels than those with HCV and HBV (p = .003). In male HCC patients, IL-6 levels were significantly elevated compared to controls (p < .0001). Similarly, female patients showed significantly higher IL-6 levels compared to female controls, though still lower than in male HCC patients (p = .023). However, no significant difference was observed in IL-6 levels between male and female HCC patients (p = .129). Contrastingly, the genotype and allele distributions of the rs1800795 and rs1800797 polymorphisms in the IL-6 gene displayed no association with HCC development (all p > .005). In Moroccan HCC patients, chronic liver inflammation is characterized by elevated levels of IL-6, potentially playing a role in the progression of liver disease and tumourigenesis.

Association of Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1 Alpha Coding Variants with Hepatocellular Carcinoma Risk in the Moroccan Population: A Case-Control Study

BACKGROUND

Hepatocellular carcinoma (HCC) is the most common primary malignancy. Peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PPARGC1A) plays a crucial role in regulating the biogenesis of mitochondria. We aimed to assess the association between PPARGC1A polymorphisms and HCC risk in a Moroccan population.

METHODS

In this case-control study, 147 patients with HCC and 147 controls without pre-existing liver disease were matched for ethnicity. TaqMan SNP allelic discrimination assays were used for genotyping of PPARGC1A rs8192678 and rs12640088 polymorphisms.

RESULTS

The result revealed that individuals with the GA/AA genotypes for rs8192678 had a significantly higher risk of HCC compared to those with the GG genotype (OR=6.68; P<0.0001, and OR=9.78; P<0.0001, respectively). In particular, the A allele of rs8192678 was over-represented in HCC patients compared to controls (40% versus 12%, P<0.0001, respectively). With respect to PPARGC1A rs12640088 variant, two genetic models (codominant and dominant) were tested to explore any potential variations in the distribution of SNP A>C among HCC cases and control subjects group. Overall, no significant association between rs12640088 and HCC was found (P>0.05). Interestingly, a significantly higher level of aspartate aminotransferase was observed in HCC patients with GG-GA genotypes (280 IU/L) compared to those with GG genotype (164 IU/L) at rs8192678 (P=0.0019).

CONCLUSION

Our results suggest that the PPARGC1A rs8192678 polymorphism is associated with an increased risk of HCC in Moroccan population and may serve as a prognostic marker for liver cancer.

The peroxisome proliferator-activated receptor γ coactivator-1 alpha rs8192678 (Gly482Ser) variant and hepatitis B virus clearance

BACKGROUND

Chronic hepatitis B virus (CHB) infection is still incurable a major public health problem. It is yet unclear how host genetic factors influence the development of HBV infection. The peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1A) has been shown to regulate hepatitis B virus (HBV). Several reports found that PPARGC1A variants are involved in a number of distinct liver diseases. Here we investigate whether the PPARGC1A rs8192678 (Gly482Ser) variant is involved in the spontaneous clearance of acute HBV infection and if it participates in chronic disease progression in Moroccan patients.

METHODS

Our study included 292 chronic hepatitis B (CHB) patients and 181 individuals who spontaneously cleared-HBV infection. We genotyped the rs8192678 SNP using a TaqMan allelic discrimination assay and then explored its association with spontaneous HBV clearance and CHB progression.

RESULTS

Our data showed that individuals carrying CT and TT genotypes were more likely to achieve spontaneous clearance (OR = 0.48, 95% CI (0.32-0.73), p = 0.00047; OR = 0.28, 95% CI (0.15-0.53), p = 0.00005, respectively). Subjects carrying the mutant allele T were more likely to achieve spontaneous clearance (OR = 0.51, 95% CI (0.38-0.67), P = 2.68E-06). However, when we investigated the impact of rs8192678 on the progression of liver diseases, we neither observe any influence (p > 0.05) nor found any significant association between ALT, AST, HBV viral loads, and the PPARGC1A rs8192678 genotypes in patients with CHB (p > 0.05).

CONCLUSION

Our result suggests that PPARGC1A rs8192678 may modulate acute HBV infection, and could therefore represent a potential predictive marker in the Moroccan population.

Association between TLR2, TLR4, and TLR5 genetic variants and the risk of hepatocellular carcinoma in Moroccan population

Hepatocellular carcinoma (HCC) is the fifth most common human malignancy and the fourth most frequent cause of cancer-related deaths worldwide. Toll-like receptors (TLRs), are known to play a key role in hepatocarcinogenesis through induction of inflammation. We aimed to investigate the association between TLR2 rs3804099, TLR4 rs4986790, rs4986791, and rs11536889 and TLR5 rs5744174 and HCC risk in a total of 306 Moroccan subjects, including 152 HCC patient and 154 controls using a TaqMan allelic discrimination assay. Our result showed that the frequency of TLR4 rs11536889 C allele was higher in control group than in HCC patients (OR = 0.52, 95% CI = 0.30-0.88, p = 0.01). Moreover, under the dominant model, we observed that CG/CC genotypes were protective factors against HCC risk (OR = 0.51, 95% CI = 0.28-0.91, p = 0.02). However, no significant differences were found in the allele and genotype frequencies of TLR4 rs4986790 and rs4986791, between HCC patients and controls. Similarly, genotypic frequencies of TLR2 and TLR5 polymorphisms did not differ significantly between HCC patients and controls. However, TLR4 haplotype analysis revealed that ACC haplotype may be protective of HCC risk in patients with HCC (OR = 0.53, 95% CI = 0.31-0.92, p = 0.02). In conclusion, our result suggest that TLR4 rs11536889 polymorphism and ACC haplotype may decrease risk of hepatocellular carcinoma in Moroccan population.

CXCL-8 as a signature of severe Helicobacter pylori infection and a stimulator of stomach region-dependent immune response

Helicobacter pylori infection is involved in development of diverse gastro-pathologies. Our aim is to investigate potential signature of cytokines-chemokine levels (IL-17A, IL-1β, and CXCL-8) in H. pylori-infected patients and their impact on immune response in both corpus and antrum. Multivariate level analysis with machine learning model were carried out using cytokines/chemokine levels of infected Moroccan patients. In addition, Geo dataset was used to run enrichment analysis following CXCL-8 upregulation. Our analysis showed that combination of cytokines-chemokine levels allowed prediction of positive H. pylori density score with <5% of miss-classification error, with fundus CXCL-8 being the most important variable for this discrimination. Furthermore, CXCL-8 dependent expression profile was mainly associated to IL6/JAK/STAT3 signaling in the antrum, interferons alpha and gamma responses in the corpus and commonly induced transcriptional /proliferative activities. To conclude, CXCL-8 level might be a signature of Moroccan H. pylori-infected patients and an inducer of regional-dependent immune response at the gastric level. Larger trials must be carried out to validate the relevance of these results for diverse populations.

IL-1 Polymorphism and Helicobacter pylori Infection Features: Highlighting VNTR's Potential in Predicting the Susceptibility to Infection-Associated Disease Development

Genetic polymorphisms at the IL-1 cluster are associated with increased Helicobacter pylori (H. pylori)-associated disease risk in an ethnically dependent manner. Due to the corroborated role of IL-1β in H. pylori infection progression, our aim is to depict the impact of IL1B rs1143627 and rs16944 as well as the IL1RN variable number of identical tandem repeats (VNTR) on the clinical and biological features of Moroccan H. pylori-infected patients. A total of 58 patients with epigastralgic pain were referred to the gastroenterology department for histopathological and clinical analysis. DNA extraction from antrum and fundus biopsies and PCR-RFLP were performed to detect polymorphisms. As a result, VNTR was significantly associated with IL-1β antrum levels (p-value = 0.029), where the *1/*4 genotype showed a positive association with upregulated cytokine levels in the antrum and was clustered with H. pylori-infected patients' features and higher levels of IL-1β in the antrum and fundus. Likewise, *1/*1 genotype carriers clustered with severe gastritis activity and H. pylori density scores along with low levels of IL-1β in the antrum and fundus, while the *1/*2 genotype was clustered with non-infected-patient features and normal IL-1β levels. In conclusion, VNTR might be an interesting predictor to identify patients at risk of developing H. pylori-associated pathologies.

[Gastrointestinal bleeding due to the expulsion of cyanoacrylate glue after endoscopic embolization of gastric varices: a case report]

Embolization of gastric varices with cyanoacrylate glue is the treatment of choice for digestive bleeding due to rupture of gastric varices. Gastrointestinal bleeding due to the expulsion of cyanoacrylate glue after gluing of gastric varices is a rare complication. We here report the case of a 65-year-old female patient on cirrhosis and decompensation treatment, undergoing cyanoacrylate glue of gastric varices 3 months before her admission for upper gastrointestinal bleeding; oesogastroduodenal fibroscopy objectified oesophageal varices grade 2 with ulcerated gastric varices and active bleeding due to the expulsion of cyanoacrylate glue. The patient received blood transfusion and sandostatin as well as cyanoacrylate gluing of GOV2 with no complications. Gastrointestinal bleeding after expulsion of cyanoacrylate glue is a serious complication of gluing. Few cases have been described in the literature that required, most often, endoscopic hemostasis.

[Common variable immune deficiency complicated by amyloidosis: a case report]

Common variable immune deficiency (CVID) is the most common symptomatic immunodeficiency in adults, but it remains rare. It is characterized by its extremely heterogeneous phenotypic spectrum. We here report the case of a 39-year-old patient presenting with chronic diarrhoea with anal fistula. Laboratory tests showed inflammatory syndrome and malabsorption syndrome, hypogammaglobulinemia on serum protein electrophoresis, global hypogammaglobulinemia in weight-based assignments for immunoglobulin and a low level of lymphocytes in the analysis of lymphocyte subpopulations, thus confirming the diagnosis of common variable immune deficiency (CVID) complicated by systemic AA amyloidosis identified by amyloid deposits in the biopsies. This study highlights the importance of paying attention to common gastrointestinal symptoms of immune deficiency and to suspect it in patients with treatment-resistant symptoms.

Comparative Study of Helicobacter Pylori Resistance to Clarithromycin and Metronidazole and Its Association with Epidemiological Factors in A Moroccan Population

OBJECTIVE

Knowledge of local antibiotic resistance is crucial to the adaption of the effective empirical first-line treatment for Helicobacter Pylori (H. pylori) infection. This study aimed to evaluate the prevalence of H. pylori resistance to clarithromycin and compare it with that of metronidazole, and highlight the impact of epidemiological factors and gastric lesions severity on H. pylori resistance.

METHODS

The susceptibility to clarithromycin of 96 isolates was determined by PCR-RFLP and the susceptibility to metronidazole of 185 isolates was determined by classic PCR.

RESULT

Our results showed that the prevalence of H. pylori resistance to clarithromycin (‎14.6%) was low compared to that recorded with metronidazole (‎62.7%). Moreover, we remarked that 7.3% of isolates were co-resistant to both antibiotics. The assessment of epidemiological factors' impact on the resistance to studied antibiotics has revealed no association. Besides, our results had demonstrated that the metronidazole and clarithromycin resistance was not related to the severity of gastric lesions.

CONCLUSION

In our population, clarithromycin seems to be an effective antibiotic as long as the resistance rate of H. pylori is low. In contrast to metronidazole, it appears that this antibiotic will lose its efficacy, due to the high rate of resistance among our population. Therefore, each population must conduct their epidemiologic studies separately to survey the resistance profile of strains and choose the appropriate antibiotic, in order to avoid the failure of H. pylori eradication and the development of severe gastric diseases.

Multisystemic Sarcoidosis Revealed by Hepatosplenomegaly: A Case Report

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the presence of non-caseating granulomas. Gastrointestinal involvement in sarcoidosis is extremely rare. However, hepatic sarcoidosis occurs in 70% of cases. This is a case report of multisystemic sarcoidosis revealed by hepatosplenomegaly. The patient presented initially with asthenia, anorexia, and weight loss. An abdominal computed tomography scan revealed hepatosplenomegaly and lumbo-aortic adenopathy. During hospitalization, the patient presented an extended erythematous cutaneous lesion in the peri-auricular area. The diagnosis of sarcoidosis was confirmed by salivary, cutaneous, and bronchoscopic biopsy, which revealed the presence of epithelioid granuloma without necrosis. Consequently, the patient was treated with oral corticosteroids with good improvement. 

Association of Helicobacter pylori vacA polymorphisms with the risk of gastric precancerous lesions in a Moroccan population

INTRODUCTION

Helicobacter pylori infection is the major risk factor of atrophic gastritis and intestinal metaplasia. The vacA gene is one of the most virulence factors of H. pylori and genetic diversity in its s, m, i, and d regions is associated with gastric lesions severity. This study aimed to investigate the association of vacA s, m, i, and d regions with the risk of atrophic gastritis and intestinal metaplasia in a Casablanca population.

METHODOLOGY

A total of 210 patients suffering from gastric lesions (chronic gastritis, atrophic gastritis, and intestinal metaplasia) were enrolled. The type of lesion was diagnosed by histological examination. Detection of H. pylori infection and genotyping of vacA regions were carried out by PCR.

RESULTS

The prevalence of H. pylori was 95%. The most common vacA genotypes were s2 (51.5%), m2 (77%), i2 (60.5%), and d2 (58.5%). VacA s1, m1, and i1 genotypes were associated with a high risk of intestinal metaplasia, while the vacA d1 genotype increases the risk of atrophic gastritis and intestinal metaplasia. The most common vacA combination was s2/m2/i2/d2 (52%), and it was more detected in chronic gastritis. The moderate virulent vacA combination (s1/m2/i1/d1) increases the risk of atrophic gastritis, while the most virulent vacA combination (s1/m1/i1/d1) increases the risk of intestinal metaplasia.

CONCLUSIONS

Genotyping of vacA d region might be a reliable marker for the identification of vacA virulent strains that represent a high risk of developing precancerous lesions (atrophic gastritis and intestinal metaplasia).

Retention of an endoscopic videocapsule on inflammatory polyposis of the small bowel

The Video Capsule Diagnostic Imaging is a technique for exploring the digestive tract, particularly the small bowel. It is indicated for any unexplained digestive bleeding or as a means of monitoring intestinal polyposis or inflammatory diseases. This videocapsule is not digestible, and the risk of its retention, symptomatic or not, is not negligible following an inflammatory, anastomatous or tumoral stenosis. This retention or blockage is defined by the presence of the Video Capsule in the digestive tract at least two weeks after ingestion. Surgical approach is considered effective to retrieve the retained capsule, treat the pathology responsible and prevent acute complications.

We report the case of retention of a video capsule in a young patient with severe anaemia due to inflammatory polyposis of the small bowl, whose removal required surgery to extract the capsule and resect the segment of the small intestine stenosis by the polyps.

•

The video Capsule Endoscopy is the most sensitive examination for the detection of inflammatory lesions of the small bowel.

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It does not currently allow a biopsy but it is indicated for unexplained or occult digestive bleeding.

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Its main limitation is the risk of blockage in a stenosis with or without occlusion.

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Surgical approach is considered effective to retrieve the retained capsule, and treat the pathology responsible.

IFNL4 rs12979860 polymorphism influences HBV DNA viral loads but not the outcome of HBV infection in Moroccan patients

OBJECTIVES

The interferon (IFN) is known to bridge innate and adaptive immune responses, and to play a critical role particularly against hepatitis B virus (HBV) infection. Defects in IFN signals may result, therefore, in attenuated responses against HBV. Accordingly, polymorphisms in genes coding for immune response effectors may affect the clinical outcome of HBV infection. We analyzed the putative association between IFNL4 rs12979860 polymorphism and the outcome of HBV infection in Moroccan patients.

METHODS

In this study, 237 chronic HBV (CHB) patients and 129 spontaneously resolved HBV (SRB) individuals were enrolled and genotyped using a predesigned Taqman allelic discrimination assay.

RESULTS

Our data show a significant increase of HBV DNA loads in patients with IFNL4 rs12979860 CC genotype compared to patients with CT and TT genotypes (p = 0.0008). However, there was no consistent association between IFNL4 rs12979860 polymorphism and the outcome of HBV infection.

CONCLUSIONS

Although IFNL4 rs12979860 polymorphism seems to modulate circulating HBV DNA levels, it is disconnected from chronic disease progression. This observation suggests that the role of rs12979860 in liver disease is restricted to viral control and inactive in the deleterious immune pathology that affects liver tissue. Taken together, our data suggest that rs12979860 CC genotypes could be useful as a predictor of success or failure of IFN-based therapy in chronic HBV-infected patients.

[Autoimmune hepatitis following acute severe Epstein-Barr virus hepatitis]

Non-alphabetical hepatitis (Epstein Barr virus -EBV-, cytomegalovirus -CMV-, Herpes simplex virus -HSV-, varicella zoster virus -VZV-etc.) may be a mode of revelation of several underlying chronic liver diseases including autoimmune hepatitis (HAI). We report a peculiar case of acute EBV hepatitis, revealing type I autoimmune hepatitis confirmed by liver biopsy through puncture in a female patient on breast cancer treatment. The study involved a 29-year-old female patient on breast cancer treatment scheduled to receive radiotherapy and chemotherapy, hospitalized for acute severe hepatitis (fever with jaundice, hypertransaminasemia (normal AST level 47 and normal ALT level 23 and prothrombin activity 25%). The test for viral hepatitis A, B, C, and E was negative and subhepatic veins were free on doppler. Non-alphabetical hepatitis was suspected based on fever with jaundice. Patient's assessment showed recent EBV infection diagnosed on the basis of the presence of anti-VAC IgM/G and anti-EBNA Ab IgG. The patient received acyclovir for 10 days. Progression was marked by ascites. The diagnosis of autoimmune hepatitis was retained based on laboratory tests (gamma peak on serum protein electrophoresis and positive anti-nuclear antibodies) and histological examination. Clinical-biological remission was obtained with corticosteroid therapy. EBV infections should be investigated in immunocompromised patients with fever in the clinical course of acute hepatitis. Practitioners should also suspect it in patients with persistent cytolysis following an infectious episode in order to prevent the occurrence of autoimmune hepatitis, in particular in female patients, in a context of self-immunity and negative serological tests for alphabetical viral hepatitis.

Associations of the -238(G/A) and -308(G/A) TNF-α Promoter Polymorphisms and TNF-α Serum Levels with the Susceptibility to Gastric Precancerous Lesions and Gastric Cancer Related to Helicobacter pylori Infection in a Moroccan Population

Objective:

Helicobacter pylori (H. pylori) induces the production of tumor necrosis factor-alpha (TNF-α), which is closely related to a gastric epithelial injury. TNF-α gene polymorphism and TNF-α serum levels are associated with various malignant conditions. Identification of the ideal marker for gastric cancer (GC) is still the leading aim of several trials. Physio-pathological considerations of GC led us to investigate the association of two TNF-α promoter polymorphisms (-308G>A and -238G>A), and TNF-α serum levels with the susceptibility to gastric precancerous (PL) and GC.

Methods:

Patients suffering from gastric lesions (65 chronic gastritis, 50 PL, 40 GC) related to H. pylori ‎infection , and 63 healthy controls (HC) were involved in this study. Individuals are genotyped by TNF-α gene promoter sequencing and TNF-α serum levels are measured by ELISA quantitative method.

Results:

Regarding TNF-α-308 G/A locus, we noticed higher risk for GC (OR=4.3, CI 1.5-11.9, p-value=0.005) and PL (OR=3.4, CI 1.2-9.2, p-value=0.01) for individuals with AA/GA genotypes compared to GG genotype. Concerning TNF-α-238 G/A locus, we noticed higher risk for GC (OR=5.9, CI 1.2-27.5, p-value=0.01) and PL (OR=4.8, CI 1.3-18, p-value=0.01) for individuals with GG genotype compared to AA/GA genotypes. We noticed that TNF-α serum levels have been increased together with gastric lesions severity. Moreover, TNF-α-308 and TNF-α-238 A alleles seemed to, respectively, upregulate and downregulate TNF-α serum levels.

Conclusion:

The TNF-α -308 A allele has a promotive effect for GC progression, whereas the TNF-α -238 A allele has a protective function against GC progression. High levels of TNF-α seemed to be associated with the aggressiveness of gastric lesions. TNF-α gene polymorphisms and TNF-α serum levels might be helpful to select those patients who are at high risk for GC.

Effect of Peroxisome Proliferator-Activated Receptor-γ Coactivator-1 Alpha Variants on Spontaneous Clearance and Fibrosis Progression during Hepatitis C Virus Infection in Moroccan Patients

Hepatitis C virus (HCV) is still one of the main causes of liver disease worldwide. Metabolic disorders, including non-alcoholic fatty liver disease (NAFLD), induced by HCV have been shown to accelerate the progression of fibrosis to cirrhosis and to increase the risk of hepatocellular carcinoma. An optimal peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1A) activity is crucial to prevent NAFLD installation. The present study aims to investigate the associations between two common PPARGC1A polymorphisms (rs8192678 and rs12640088) and the outcomes of HCV infection in a North African context. A series of 592 consecutive Moroccan subjects, including 292 patients with chronic hepatitis C (CHC), 100 resolvers and 200 healthy controls were genotyped using a TaqMan allelic discrimination assay. PPARGC1A variations at rs8192678 and rs12640088 were not associated with spontaneous clearance of HCV infection (adjusted ORs = 0.76 and 0.79 respectively, P > 0.05, for both). Furthermore, multivariable logistic regression analysis showed that both SNPs were not associated with fibrosis progression (OR = 0.71; 95% CI 0.20-2.49; P = 0.739; OR = 1.28; 95% CI 0.25-6.54; P = 0.512, respectively). We conclude that, in the genetic context of South Mediterranean patients, rs8192678 and rs12640088 polymorphisms of PPARGC1A are neither associated with spontaneous clearance nor with disease progression in individuals infected with HCV.

Gastric IL-1β, IL-8, and IL-17A expression in Moroccan patients infected with Helicobacter pylori may be a predictive signature of severe pathological stages

INTRODUCTION

Helicobacter pylori induces acute gastritis that can progress to serious diseases such as gastric cancer. H. pylori interacts with host cells within the gastric mucosa, resulting in activation of multiple innate immune signalling pathways, leading to pro-inflammatory cytokines production and immune cells recruitment. Various studies have shown that there are ethnic- and population-related differences in the expression of these cytokines. Although the H. pylori infection is a major public health problem in Morocco, to our knowledge, no study has been carried out in gastric cytokine expression from H. pylori-infected Moroccan patients. Thus we aimed to (i) determine the IL-1β, IL-8 and IL-17A gene expression in gastric biopsies from Moroccan patients infected with H. pylori, and (ii) to determine the cytokine signature of each pathological stages associated with this infection.

MATERIAL AND METHODS

71 patients with epigastralgic pain were included in this study. The H. pylori detection on gastric biopsies was performed by histopathological and PCR analysis. The IL-1β, IL-8 and IL-17A mRNA expression in the antrun and fundus biopsies was performed by RT-qPCR.

RESULTS

The histopathological and PCR analyses revealed that 87.32% of the patients were infected with H. pylori. IL-1β mRNA expression was significantly lower in the antral mucosa of H. pylori-infected patients (p = 0.0038) than in the uninfected while there was no significant difference in the expression of IL-8 and IL-17A mRNA. The expression of the three cytokines was higher in the fundic mucosa of H. pylori-infected patients than in the uninfected patients, but only IL-8 and IL-17A expression reached statistical significance (p = 0.042 and p = 0.0179 respectively). Furthermore, the multivariate predictive analysis highlighted a cytokine signature that may predict metaplasia during the infection progression that involves a specific down-regulation of IL17A and an up-regulation of IL1β in antral and fundic metaplasia respectively.

[Krukenberg tumour: about 5 cases]

Les tumeurs de Krukenberg sont des tumeurs malignes rares de l'ovaire, souvent bilatérales et secondaires à un cancer volontiers gastrique, muco-sécrétant dans 90% des cas. Nous avions colligé sur une période de 17ans, entre janvier 2002 et janvier 2019, 5 cas de tumeurs de Krukenberg pris en charge dans le Service d'Hépato-Gastro-Entérologie d'IBN ROCHD de Casablanca. L'objectif de cette étude rétrospective et descriptive était de mettre le point sur ce type de néoplasie au pronostic sombre afin d'améliorer les performances diagnostiques et thérapeutiques. L'âge moyen de nos patientes était de 42ans avec des extrêmes entre 25ans et 61ans. L'ascite était la présentation dominante, rapportée dans 80% des cas. Le bilan radiologique avait mis en évidence la tumeur ovarienne de taille d'écho-structure variables, qui était unilatérale dans 60% des cas. La fibroscopie oeso-gastroduodénale avait retrouvé un processus gastrique chez 4 patientes. L'exploration chirurgicale et l'étude immuno-histochimique des prélèvements biopsiques avaient redressé le diagnostic vers un cancer du colon transverse avec une extension locorégionale massive et infiltration gastrique dans un des 4 cas. Et la laparotomie exploratrice du cinquième cas avait retrouvé une néoplasie colique métastatique. La chirurgie radicale n'était possible que chez 2 patientes, dans les 2 autres cas, l'état local avancé n'avait permis que la réalisation des biopsies. Et chez une patiente, l'état général profondément altéré et le haut risque anesthésique ont rendu tout geste chirurgical inutile. Uniquement deux patientes avaient reçu une chimiothérapie postopératoire. L'évolution était fatale dans 100% des cas. Ce travail reconfirme le pronostic catastrophique de la tumeur de Krukenberg vue son évolution souvent insidieuse amenant à un diagnostic tardif et l'incompréhension claire de son étiopathogénie. Ainsi déduisons-nous que l'amélioration des chances de survie repose sur l'exploration systématique des ovaires devant toute néoplasie digestive. Certains auteurs proposent même une ovariectomie prophylactique chez les femmes âgées de plus de 40 ans qui ont été opérées pour une tumeur digestive.

Consumption of meat, traditional and modern processed meat and colorectal cancer risk among the Moroccan population: A large-scale case-control study

The current study aimed to investigate the relationship between red and white meat subtypes, processed meat (divided into traditional "Khlii, Kaddid" and industrially processed meat) and colorectal cancer (CRC) risk, considering CRC subsites, in Moroccan adults. A case-control study was conducted including 2,906 matched case-control pairs recruited from the five largest university hospitals in Morocco. Dietary data were collected through a validated Food Frequency Questionnaire (FFQ). Multivariable odds ratios (OR) and 95% confidence intervals (CI), for the association of CRC risk with meat consumption (high vs. low intake), were estimated using conditional logistic regression models, adjusted for relevant confounding variables. Overall, consumption of red meat was positively associated with colon cancer and CRC risk (OR = 1.23, 95% CI = 1.05-1.44; OR = 1.14, 95% CI = 1.02-1.27), respectively. In contrast, no significant association was observed between the consumption of red meat and rectal cancer risk (OR = 1.05, 95% = 0.90-1.23). Interestingly, while processed meat from industrial processes was positively associated with colon cancer, rectal cancer and CRC (OR = 1.61, 95% CI = 1.27-2.04; OR = 1.73, 95% CI = 1.34-2.23; OR = 1.67, 95% CI = 1.41-1.98), processed meat prepared using traditional methods was inversely associated with colon cancer and CRC risk (OR = 0.74, 95% CI = 0.57-0.98; OR = 0.77, 95% CI = 0.64-0.93), respectively. Furthermore, positive associations were observed between poultry intake and colon cancer risk among men (OR = 1.27, 95% CI = 1.01-1.59). Our study showed similar associations between the consumption of red meat and CRC risk in Morocco as in developed countries, while inverse associations were found for traditionally processed meat products. This is the first study to investigate the differential effects of traditional vs. westernized processed meat products in a developing country. Other studies are needed to confirm these findings and to understand the physiological pathways underlying these associations.

[An ileo-caecal foreign body mimicking a Crohn disease: case report]

L'ingestion du corps étranger est une situation fréquente en gastro-entérologie, cependant la localisation iléo-caecale reste très rare. L'objectif de ce travail était de rapporter le cas exceptionnel d'un corps étranger iléo-caecal révélé par des syndromes sub-occlusifs. Il s'agit d'un patient âgé de 22 ans sans antécédents pathologiques notables, qui s'est présenté avec un syndrome de Koening évoluant dans un contexte d'altération de l'état général. Le diagnostic d'un épaississement iléo-caecal inflammatoire réactionnel à un corps étranger est posé grâce à l'étude anatomo-pathologique d'une pièce opératoire de résection iléo-caecale après que l'endoscopie, l'histologie des biopsies et l'imagerie scannographique étaient non contributives. En l'absence d'orientation anamnestique, la localisation iléo-caecale d'un corps étranger pose un réel problème de diagnostic différentiel avec les pathologies inflammatoires, infectieuses et tumorales du carrefour iléo-caecal. Elle peut être révélée par des complications à type d'occlusion ou de perforation où l'imagerie tient une place primordiale. L'endoscopie joue toujours un rôle diagnostique et thérapeutique essentiel dans la prise en charge des corps étrangers ingérés limitant ainsi la morbidité chirurgicale quoique celle-ci demeure parfois incontournable et l'étude anatomo-pathologique met en évidence un granulome à corps étranger constitué. Le corps étranger iléo-caecal est une situation rarement rapportée et doit dorénavant être considéré devant toute symptomatologie du carrefour iléo-caecal afin d'éviter au patient les effets secondaires et les complications des traitements lourds.

Toll-like receptor 9 polymorphisms and Hepatitis B virus clearance in Moroccan chronic carriers

OBJECTIVES

Toll-like receptor 9 (TLR9) plays a crucial role in the innate immune response against viral infections. The failure of this system may result, in an attenuated immune response against HBV. Recent research has focused on the possibility of targeting the defects in TLR9 pathway as a novel approach for anti-HBV treatment. Our study aimed to assess the impact of both TLR9 rs5743836 and rs187084 polymorphisms on spontaneous HBV clearance in Moroccan chronic HBV carriers.

METHODS

In this study, 239 individuals chronically infected with HBV (CHB) and 133 subjects who spontaneously resolved the infection (SRB) were genotyped using a Taqman allelic discrimination assay.

RESULTS/CONCLUSION

Remarkably, we observed a dosage effect of both SNPs on viral loads; with a significant increase of circulating HBV DNA within AA, AG to GG rs5743836 genotypes, whereas the inverse phenomenon was noticed within rs187084 genotypes. There were no consistent association between TLR9 polymorphisms and spontaneous clearance of HBV, however, a significant association was observed between rs187084 AA genotype and HBV progression to advanced liver disease. Further studies on larger populations might be necessary to understand the modulating effect of TLR9 polymorphisms on HBV loads that remain a viral factor of paramount importance to predict HCC development.

The PTPN22 C1858T (R620W) functional polymorphism in inflammatory bowel disease

Objective

In view of the discrepant data regarding the association between the protein tyrosine phosphatase non-receptor 22 (PTPN22) rs2476601 (R620W, 1858C→T) polymorphism and susceptibility to autoimmune diseases including inflammatory bowel diseases (IBD), we investigated whether this functional single-nucleotide polymorphism influences IBD risk in a group of Moroccan patients.

Results

This is the first report on the prevalence of PTPN22 (R620W) variant in a Moroccan cohort. No evidence of statistically significant differences was observed when the PTPN22 (R620W) allele and genotype distribution among IBD, Crohn’s disease (CD), ulcerative colitis (UC) patients and healthy controls were compared. The frequency of the variant allele in healthy subjects was 1.77% compared to 2.56% in the IBD patients and 1.85% in CD patients. Furthermore, the frequency of this allele was increased in UC patients compared to controls (4.17% vs. 1.77%, OR = 2.42, 95% CI 0.82–7.08; P = 0.09), but the difference was not statistically significant. Our data suggest a lack of association between PTPN22 R620W variant and IBD susceptibility in Moroccan patients.

Is There Any Association Between Processed Meat Consumption and Colorectal Cancer Risk in Morocco?

Background: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related deaths worldwide. A large body of epidemiologic research show that countries where people eat more red meat and processed meat are also countries where the risk of CRC is high. The processed meat intake was described as a convincing risk factor for CRC according to the recent report of the World Cancer Research Fund published in 2017. In Morocco the incidence of CRC is increased significantly during the last years according to the Cancer Registry of the Greater Casablanca region. In addition to the imported of modern processed meat; this country is characterized also by the presence of their traditional processed meat as: quaddid (obtained by salting and sun-drying of meat) and khlii (obtained from salted-dried meat, which is cooked and conditioned in fat). In contrast, no studies have been conducted previously to evaluate the association between processed meat and CRC risk. Aim: This study aimed to evaluate the association between processed meat intake and CRC risk in Morocco. Methods: A case-control study was conducted in 5 major public health hospitals in Morocco. Each case was matched with a control by age (±5 years), sex and center. Dietary data were collected by a validated Food Frequency Questionnaire including traditional processed meat (quaddid and khlii) and modern processed meat (delicatessen meat). Conditional logistic regression was done to predict the association between processed meat consumption and CRC risk. Results: Among 500 cases and 500 controls matched by age; sex and center, 50.9% were male and 49.1% were female. The mean age was 55.53 ± 14.53 years. Among the cases, 44.5% was diagnosed with colon cancer, and 55.5% with rectum cancer. Most participants live in the urban area; never attend school and are poor. The bivariate analysis was used to evaluate the association between processed meat intake and CRC. We found no statistical significant between the occurrence of CRC and consumption of traditional processed meat (OR = 1.04; 95% CI, 0.74-1.48; P = 0.43). While, this study found strong significant association between modern processed meat and CRC risk (OR = 9.23; 95% CI, 3.91-21.77; P = 0.00). Conclusion: This study support that high consumption of modern processed meat such delicatessen meat increased the risk of CRC. In contrast, this study did not provide evidence that traditional processed meat is related to CRC risk in Morocco. We could explain this association by the low consumption of traditional processed meat in this study sample. In addition, the increases in the urbanization could also reduce the consumption of these types of traditional processed meat. Further studies are needed to evaluate the association between meat consumption and CRC risk in the context Moroccan.

Genetic variations in toll-like receptors 7 and 8 modulate natural hepatitis C outcomes and liver disease progression

BACKGROUND & AIMS

The natural outcomes of hepatitis C virus (HCV) as well as the progression of the liver disease are highly variable and depend primarily on an efficient immune response. As toll-like receptors seven (TLR7) and eight (TLR8) are important effectors of the innate immunity, this study aims to evaluate the association between TLR7 and TLR8 polymorphisms and the HCV infection outcomes in Moroccan subjects.

METHODS

In this case-control study, 643 subjects including 293 mild chronic hepatitis patients, 119 with advanced liver disease (AdLD), 93 with HCV spontaneous clearance and 138 healthy controls were genotyped using TaqMan SNPs assays.

RESULTS

Patients carrying TLR7 rs179008-A allele were more likely to clear the virus spontaneously (P = .0001 for women, and P < .001 for men). Besides, carriage of TLR7 rs179009-A allele was associated with a twofold increase in spontaneous viral clearance in female patients (P = .0002), but not in men. In addition, we observed that TLR7 rs179008-T and rs179009-G alleles increased the risk of disease progression in both sexes (P < .05). TLR8 rs3764880-G allele was associated with spontaneous HCV clearance in both sexes (P < .0001) albeit with an apparently stronger association in males (OR = 6.02 for men vs 2.2 for women). In males, TLR8 rs3764879-C and TLR8 rs3764880-A alleles were significantly associated with AdLD status (P < .05).

CONCLUSIONS

Our results suggest that variations in TLR7 and TLR8 genes modulate the clearance and progression of HCV infection with different magnitudes between sexes. Our results refine, therefore, our understanding of the sex-specific differences observed regarding the susceptibility to chronic hepatitis.

Polymorphisms in oxidative pathway related genes and susceptibility to inflammatory bowel disease

AIM

To investigate whether common variants in the oxidative pathway genes influence inflammatory bowel disease (IBD) risk among Moroccan patients.

METHODS

The distribution of (TAAA)n_rs12720460 and (CCTTT)n _rs3833912 NOS2A microsatellite repeats, HIF-1A_rs11549467 and NFKB1-94ins/delATTG_rs28362491 was analyzed in 507 subjects grouped in 199 IBD and 308 healthy controls. Genotyping was performed with polymerase chain reaction-fluorescent method and the TaqMan^® allelic discrimination technology.

RESULTS

The allele and genotype frequencies of HIF1A_ rs11549467, NFKB1_rs28362491 and NOS2A_ (TAAA)n did not differ significantly between patients and controls. Analysis of NOS2A_ (CCTTT)n markers evidenced differences between patients and healthy controls. A preferential presence of the (CCTTT)8 (P = 0.02; OR = 1.71, 95%CI: 1.07-2.74), (CCTTT)14 (P = 0.02; OR = 1.71, 95%CI: 1.06-2.76) alleles in IBD, (CCTTT)8 (P = 0.008; OR = 1.95, 95%CI: 1.17-3.23) in CD and (CCTTT)7 (P = 0.009; OR = 7.61, 95%CI: 1.25-46.08), (CCTTT)11 (P = 0.05; OR = 0.51, 95%CI: 0.25-1.01), (CCTTT)14 (P = 0.02; OR = 2.05, 95%CI: 1.07-3.94), (CCTTT)15 (P = 0.01; OR = 2.25, 95%CI: 1.16-4.35) repeats in UC patients indicated its possible association with higher disease risk which need to be confirmed in a larger sample size.

CONCLUSION

Our results suggest that the NOS2A_ (CCTTT)n gene variations may influence IBD susceptibility in the Moroccan population.

Peroxiredoxin-2 up-regulation in inflammatory bowel disease: Friend or foe?

BACKGROUND

Inflammatory bowel diseases (IBD) are chronic multi-factorial inflammatory disorders. Accumulating investigations have provided compelling evidence that describe the interplay of a complex genetic landscape and inappropriate inflammatory response to intestinal microbes in disease etiopathogenesis but still pose challenges in diagnostic practices.

METHOD

In this study, comparative proteomic analysis was conducted to identify disease specific proteins underlying IBD pathogenetic mechanisms. Total blood proteins of the IBD patients and healthy subjects were analyzed with one-dimensional electrophoresis; differentially expressed bands were excised and subjected to matrix-assisted laser desorption ionization-time of flight mass spectrometry along with nanoflow liquid chromatography electrospray ionization-tandem mass spectrometry analysis. Presence of glycosylation, hydroxylation, and phosphorylation post-translational modifications was further investigated by immunoprecipitation.

RESULTS

Peroxiredoxin-2 (PRDX2) and hemoglobin-subunits proteins, which are closely involved in the response to oxidative stress, were identified. PRDX2 was selected for further validation using western blot and reverse transcription-polymerase chain reaction. PRDX2 overexpression was restricted to the protein level within the membrane fraction. Immunoprecipitation identified PRDX2 to be post-translationally glycosylated and phosphorylated.

CONCLUSION

Our findings demonstrate the implication of PRDX2 in IBD. Future studies are required to establish its functional role and to determine the clinical utility.

[Gastric trichobezoar: about a case]

Le trichobézoard est une affection rare, le plus souvent asymptomatique, mais de diagnostic facile par la fibroscopie œsogastroduodénale. Le traitement est le plus souvent chirurgical. On rapporte une observation d’un trichobézoard gastrique chez une fillette de 16 ans, qui a été extrait par gastrotomie, sans complications. Une prise en charge psychiatrique a été faite.

Le déficit immunitaire commun variable à révélation tardive par des manifestations digestives: à propos d’un cas

Le déficit immunitaire commun variable (DICV) est une pathologie rare, il s’agit d’un déficit constitutionnel de l'immunité humorale caractérisé par des infections bactériennes à répétition, et par une fréquence accrue de tumeurs, de maladies auto-immunes ou granulomateuses. Les manifestations gastro-intestinales sont très variables et parfois révélatrices d’un déficit immunitaire commun variable. Nous rapportons le cas d’un patient âgé de 31 ans, ayant comme antécédent des infections respiratoires à répétition depuis le bas âge, compliquées d’une dilatation des bronches, qui présente depuis 3 ans une diarrhée glaireuse récurrente, chez qui l’ensemble du bilan étiologique est en faveur d’un DICV avec une manifestation auto-immune (vitiligo). Le traitement a consisté en une perfusion mensuelle d’immunoglobulines (Ig) avec une bonne évolution. Le recul actuel est de deux ans.

[Primitive anorectal melanoma]

Nous proposons une étude rétrospective réalisée au sein du département de gastro-entérologie et d'Oncologie du CHU Casablanca colligeant tous les cas des mélanomes ano-rectaux primitifs, sur une période de 15 ans (du 1997 au 2012). Notre série comportait 14 patients, 8 hommes et 6 femmes avec une moyenne d’âge de 60,5 ans. Les signes cliniques étaient dominés par les rectorragies et le syndrome rectal (plus de 80% des malades). L'aspect tumoral noirâtre à été noté chez la moitié des malades. L'examen endoscopique a révélé une prédominance des lésions ulcéro-bourgeonnantes. Dans 5 cas la tumeur était plus haut située entre 5 à 8 cm de la marge anale. Le bilan d'extension avait décelé des métastases ganglionnaires, osseuses ou viscérales chez 7 malades. Un traitement chirurgical a été pratiqué chez 50% des malades (7 cas). Il a consisté en une exérèse locale isolée (2 cas) ou associée à une radiothérapie (2 cas) et une amputation abdomino-périnéale dans 3 cas. Quatre malades ont reçu une chimiothérapie et/ou radiothérapie palliative et dans deux cas on s'est contenté d'un traitement symptomatique. L’évolution a été marquée par une récidive chez les 2 patients traités par exérèse locale, dont un a été bénéficié d'une amputation abdomino-pelvienne de rattrapage et un des trois patients traités par chirurgie radicale. Deux patients sont en rémission complète après 36 mois de recul.

NOD2/CARD15 gene influences disease behaviour but not IBD susceptibility in a Moroccan population

BACKGROUND/AIMS

IBD (Crohn's disease and Ulcerative Colitis) is chronic and multifactorial disease of the gastrointestinal tract. Till now, his pathogenesis remains unclear. It involves innate immunity, environmental component and genetic predisposition. Polymorphisms in NOD2/CARD15 have been implicated in Crohn's disease in several ethnic groups. The purpose of our study was to assess the frequency of the three major variants of this gene (Leu1007fsinsC, R702W, and G908R) in Moroccan IBD patients and to determine a possible effect of these variants on Disease's phenotype and clinical course.

MATERIALS AND METHODS

A total of 96 Moroccan unrelated IBD patients and 114 healthy controls were genotyped (PCR-RFLP method) for the three main polymorphisms.

RESULTS

In this study, no correlation was found between NOD2/CARD15 polymorphisms and ulcerative colitis or Crohn's disease in our population. Nevertheless, 3020insC (Leu1007fsinsC) variant was associated to a structuring behaviour on CD patients.

CONCLUSION

These findings suggest that NOD2/CARD15 influences disease behaviour but not susceptibility to crohn's disease in Moroccan IBD patients.

Hepatic primary neuroendocrine carcinoma: about a new case

We report a new case of Primary hepatic neuroendocrine carcinoma admitted in our hospital and revealed in 53 years man by epigastric pain and flush syndrome. A liver biopsy with immunohistochemical study confirmed the original location of a neuroendocrine carcinoma. After 12 cures of Chemotherapy and a follow up of 12 months, the patient is still in complete remission.

Toll-like receptor 4 Asp299Gly and Thr399Ile polymorphisms: New data and a meta-analysis

Background

The pathogenesis of inflammatory bowel disease (IBD) involves interactions between the host genetic susceptibility, intestinal microflora and mucosal immune responses through the pattern recognition receptor. Polymorphisms in toll-like receptor 4 (TLR4) induce an aberrant immune response to indigenous intestinal flora, which might favor IBD development. In this study, we aimed to determine whether TLR4 gene was associated with Crohn’s disease (CD) and ulcerative colitis (UC) among Moroccan patients, and evaluated its correlation with clinical manifestation of the disease.

Methods

The study population comprised 117 patients with IBD and 112 healthy unrelated blood donors. TLR4 polymorphisms: Asp299Gly and Thr399Ile were genotyped by polymerase chain reaction-restriction fragment length polymorphism. PCR products were cleaved with Nco I for the Asp299Gly polymorphism and Hinf I for the Thr399Ile polymorphism. Meta-analysis was performed to test the association of 299Gly and 399Ileu carriage with CD, UC and the overall IBD risk.

Results

Our study revealed that the frequency of Asp299Gly and Thr399Ile did not differ significantly between patients and controls in the Moroccan population. However, meta-analysis demonstrated significantly higher frequencies of both Asp299Gly and Thr399Ile SNPs in IBD and CD and for 399Ileu carriage in UC patients.

Conclusion

The meta-analysis provides evidence that TLR4 polymorphisms confer a significant increased risk for the overall IBD development.

IL23R and ATG16L1 variants in Moroccan patients with inflammatory bowel disease

BACKGROUND

Inflammatory bowel diseases (IBD) are chronic diseases of the gastrointestinal tract. Although their pathogenesis is unclear, the combination of genetic predisposition and environmental components are believed to be the main cause of these diseases. Recently, many variants in interleukin 23 receptor (IL23R) and autophagy-related 16-like 1 (ATG16L1) genes have been associated with the disease. Our objective was to assess the frequency of ATG16L1 (T300A) and IL23R (L310P) variants in Moroccan IBD (Crohn's disease and Ulcerative Colitis) patients and to evaluate a possible effect of these variants on disease's phenotype and clinical course.

METHODS

96 Moroccan IBD patients and 114 unrelated volunteers were genotyped for ATG16L1 (T300A) and IL23R (L310P) variants by PCR-restriction fragment length polymorphism.

RESULTS

This is the first report on the prevalence of ATG16L1 (T300A) and IL23R (L310P) variants in a Moroccan group. We found that IL23R (L310P) variant conferred a protective effect for crohn's disease (CD) but not ulcerative colitis (UC) patients. The presence of ATG16L1 (T300A) mutated alleles was associated with CD type but not with disease onset. In addition, the carriage of T300A variant alleles conferred a protective effect in UC.

CONCLUSION

Our results showed that the prevalence of ATG16L1 and IL23R variants was not significantly different between patients and controls. However a possible role of ATG16L1 (T300A) on CD phenotype was suggested.

Chronic permanent hypoxemia predisposes to mild elevation of liver stiffness

AIM: To evaluate the impact of long term permanent hypoxemia noticed in patients with non operated congenital cyanogenic cyanotic cardiopathy on liver stiffness.

METHODS: We included ten adult patients with non operated inoperate cyanotic cardiopathy and ten matched patients for age and gender admitted to the gastroenterology department for proctologic diseases; Clinical and laboratory data were collected [age, gender, body mass index, oxygen saturation, glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), glycemia and cholesterol]. Measurement of hepatic stiffness by transient elastography was carried out in all patients using the Fibroscan device. All patients underwent an echocardiography to eliminate congestive heart failure.

RESULTS: Among the patients with cyanotic cardiopathy, median liver stiffness 5.9 ± 1.3 kPa was greater than control group (4.7 ± 0.4 kPa) (P = 0.008). Median levels of GOT, GPT, gamma-glutamyltransferase, glycemia and cholesterol were comparable in cardiopathy and control group. In regression analysis including age, gender, body mass index, oxygen saturation, GOT, GPT, glycemia, cholesterol showed that only oxygen saturation was related to liver stiffness (r = -0.63 P = 0.002).

CONCLUSION: Chronic permanent hypoxemia can induce mild increase of liver stiffness, but further studies are needed to explore the histological aspects of liver injury induced by chronic permanent hypoxemia.

Occult HBV infection in Morocco: from chronic hepatitis to hepatocellular carcinoma

BACKGROUND & AIMS

Morocco is one of low to intermediate endemic areas for hepatitis B virus (HBV) infection, but no reports have been published on Occult HBV infection (OBI). To determine the prevalence of OBI and its clinical impact among patients with cryptogenic and HCV-related chronic liver disease in Morocco.

METHODS

A total of 152 HBsAg-negative patients (60 patients with cryptogenic hepatitis and 92 HCV carriers) were enrolled in this study. Sera collected from all patients were tested for anti-HBc and anti-HBs antibodies. OBI was assessed in serum and liver tissue samples using highly sensitive PCR assays targeting Surface, X and core regions of the HBV genome and confirmed by Southern blot hybridization.

RESULTS

A high rate of anti-HBc positivity was found among patients with HCV infection (57/92, 61.95%) compared to those with cryptogenic hepatitis (24/60, 40%) (P = 0.034). A high prevalence of OBI was found among patients with HCV infection (42/92, 45.65%) compared to those with cryptogenic hepatitis (17/60, 28.3%) (P = 0.013). In both groups, the prevalence of OBI increased in parallel with advancing stage of liver disease (χ2 = 6.73; P = 0.0095). The highest proportion of OBI was reached among HCV-related HCC cases (62.5%). Multivariate Cox regression analysis revealed that older age (≥56 years), positivity for anti-HBc and presence of OBI were independent risk factors for the development of HCC in HCV-infected patients.

CONCLUSION

This study helps to understand the current status of OBI and its impact on the severity of liver disease in Moroccan patients.

Clinical and molecular characterization of colorectal cancer in young Moroccan patients

BACKGROUND/AIMS

Early-onset colorectal cancers are relatively rare. About 20% of colorectal cancers are familial or hereditary. Two autosomal dominantly inherited cancer syndromes are more studied: Lynch syndrome accounts for 2-5% of colorectal cancers and familial adenomatous polyposis represents 1% of total colorectal cancers. Unlike the familial adenomatous polyposis syndrome, there are no clinical features that help in easily recognizing Lynch syndrome. The young age of cancer occurrence could be a criterion that should raise a suspicion of Lynch syndrome. In Morocco, the average age at diagnosis of colorectal cancers according to the register of cancers of Casablanca is 56 years, which is 10 years earlier than in European countries. Our study aimed to assess the frequency and molecular characteristics of the Lynch syndrome in Moroccan early-onset colorectal cancers patients.

MATERIALS AND METHODS

The population analyzed included 70 patients. The criteria for inclusion of patients in this study were a colorectal cancers before age 50 and the exclusion of familial adenomatous polyposis. We started by searching for microsatellite instability, first by immunohistochemistry of 3 mismatch repair proteins (MLH1, MSH2 and MSH6) and with second confirmation using 4 monomorphic markers (BAT25, BAT26, NR21, and CAT25).

RESULTS

We found instability in 10/70 (15%) of the cases. The loss of expression affects more often the MLH1 protein, with 8 cases, versus 2 cases of altered MSH2. None of the 70 patients of the series fulfilled the Amsterdam II criteria, indicative of Lynch syndrome.

CONCLUSIONS

Further work needs to be done to discriminate hereditary cases from sporadic ones, but testing for microsatellite instability as a first step is important.

Risk factors for liver fibrosis among human immunodeficiency virus monoinfected patients using the FIB4 index in Morocco

AIM: To study the prevalence and risk factors of significant hepatic fibrosis in Moroccan human immunodeficiency virus (HIV) monoinfected patients.

METHODS: We conducted a cross-sectional study among HIV monoinfected patients (negative for hepatitis B surface antigen and hepatitis C antibody). Clinical and laboratory data were collected from the data base of the Infectious Diseases Unit in Ibn Rochd Hospital Center [age, gender, duration of HIV infection, CD4 T lymphocyte count, HIV viral load, glycemia and current or prior use of antiretroviral and antiretroviral therapy (ART) duration]. The primary outcome was a FIB4 score > 1.45. Multivariable logistic regression identified independent risk factors for FIB4 > 1.45.

RESULTS: A FIB4 score > 1.45 was identified in 96 among 619 (15.5%). HIV monoinfected patients followed up between September 1990 and September 2012. Multivariate analysis showed that only a viral load > 75 (OR = 2.23, 95%CI: 1.36-3.67), CD4 > 200 cells/mm³ (OR = 0.39, 95%CI: 0.21-0.72) and age at FIB4 index calculation (OR = 1.10, 95%CI: 1.07-1.13) were independently associated with the occurrence of FIB4 index (> 1.45). Gender, duration of HIV infection, glycemia, use of antiretroviral therapy and ART duration were not associated with significant fibrosis by FIB4.

CONCLUSION: FIB4 score > 1.45 was found in 15.5% of Moroccan HIV monoinfected patients. Age, HIV viremia > 75 copies/mL and CD4 count > 200 cells/mm³ are associated with liver fibrosis. Further studies are needed to explore mechanisms for fibrosis in HIV monoinfected patients.

Methylenetetrahydrofolate reductase C677T variant in Moroccan patients with inflammatory bowel disease

BACKGROUND

The association of genetic polymorphisms related to metabolism of homocysteine and folate with inflammatory bowel disease has been evidenced. Several studies have identified genetic variants of MTHFR as significant susceptibility loci for Crohn's disease (CD) and ulcerative colitis (UC). The C677T genetic polymorphism in the MTHFR gene is found to be associated with a thermolabile variant enzyme that shows a reduced activity. Therefore, we investigated whether the C677T variant confers genetic susceptibility to CD or UC and evaluated the genotype-phenotype associations in the Moroccan population.

METHODS

The present study included 96 inflammatory bowel disease patients (68 patients with CD and 28 with UC) and 182 healthy controls. DNA samples were genotyped for the MTHFR (C677T) mutation by the PCR-RFLP method. Statistical analyzes were performed using MedCalc software, Chi square test and Fisher test.

RESULTS

The respective odds ratio for CD, UC and control group were, 1.55 (CI 95%: 0.53-4.53, P=0.52); 0.50 (CI 95%: 0.06-4.15, P=0.52) and 0.50 (CI 95%: 0.06-4.15, P=0.52). Thus, no statistically significant association with the disease was observed in frequency of the TT variant in comparison to healthy controls. Stratification of IBD patients on the basis of CD or UC showed that individuals carrying at least one T allele are not protected against Crohn's disease. Furthermore, clinical features of the disease did not show any significant association.

CONCLUSION

In conclusion, the present study indicates that the genetic risk for IBD is not modulated by MTHFR C677T polymorphism in Moroccan population.