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Pape S, Snijders RJALM, Gevers TJG, Chazouilleres O, Dalekos GN, Hirschfield GM, Lenzi M, Trauner M, Manns MP, Vierling JM, Montano-Loza AJ, Lohse AW, Schramm C, Drenth JPH, Heneghan MA, Alvarez F, Andrade R, Arikan C, Assis D, Bardou-Jacquet E, Biewenga M, Cancado E, Cazzagon N, Chazouillères O, Colloredo G, Cuarterolo M, Dalekos G, Debray D, Robles-Díaz M, Drenth J, Dyson J, Efe C, Engel B, Ferri S, Fontana R, Gatselis N, Gerussi A, Halilbasic E, Halliday N, Heneghan M, Hirschfield G, van Hoek B, Hørby Jørgensen M, Indolfini G, Iorio R, Jeong S, Jones D, Kelly D, Kerkar N, Lacaille F, Lammert C, Leggett B, Lenzi M, Levy C, Liberal R, Lleo A, Lohse A, Ines Lopez S, de Martin E, McLin V, Mieli-Vergani G, Milkiewicz P, Mohan N, Muratori L, Nebbia G, van Nieuwkerk C, Oo Y, Ortega A, Páres A, Pop T, Pratt D, Purnak T, Ranucci G, Rushbrook S, Schramm C, Stättermayer A, Swain M, Tanaka A, Taubert R, Terrabuio D, Terziroli B, Trauner M, Valentino P, van den Brand F, Villamil A, Wahlin S, Ytting H, Zachou K, Zeniya M. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group. J Hepatol 2022; 76:841-849. [PMID: 35066089 DOI: 10.1016/j.jhep.2021.12.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [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: 04/09/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) has been well characterised and codified through the development of diagnostic criteria. These criteria have been adapted and simplified and are widely used in clinical practice. However, there is a need to update and precisely define the criteria for both treatment response and treatment. METHODS A systematic review was performed and a modified Delphi consensus process was used to identify and redefine the response criteria in autoimmune hepatitis. RESULTS The consensus process initiated by the International Autoimmune Hepatitis Group proposes that the term 'complete biochemical response' defined as 'normalization of serum transaminases and IgG below the upper limit of normal' be adopted to include a time point at 6 months after initiation of treatment. An insufficient response by 6 months was a failure to meet the above definition. Non-response was defined as '<50% decrease of serum transaminases within 4 weeks after initiation of treatment'. Remission is defined as liver histology with a Hepatitis Activity Index <4/18. Intolerance to treatment was agreed to stand for 'any adverse event possibly related to treatment leading to potential drug discontinuation'. CONCLUSIONS These definitions provide a simple and reproducible framework to define treatment response and non-response, irrespective of the therapeutic intervention. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable inter-study comparisons. Future prospective database studies are needed to validate these endpoints. LAY SUMMARY Consensus among international experts on response criteria and endpoints in autoimmune hepatitis is lacking. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable the comparison of results between clinical trials. Therefore, the International Autoimmune Hepatitis Group (IAIHG) herein presents a statement on 5 agreed response criteria and endpoints: complete biochemical response, insufficient response, non-response, remission, and intolerance to treatment, which can be used to guide future reporting.
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Affiliation(s)
- Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Romée J A L M Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6229HX, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Oliver Chazouilleres
- Hepatology Department, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital Assistance Publique-Hôpitaux de Paris, Paris, France; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa, Greece
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Marco Lenzi
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - John M Vierling
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Canada
| | - Ansgar W Lohse
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Christoph Schramm
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
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Nepogodiev D, Howard R, Pathmakanthan S, Iqbal T, Singh B, Oo Y, Mathers J, McMullan C, Sahamai S, Gath J, Magill L, Handley K, Deeks J, Bemelman W, Morton D, Pinkney T. The ACCURE-UK trial: The effect of appendectomy on the clinical course of ulcerative colitis – A feasibility study. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.031] [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: 11/17/2022]
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3
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Kelly C, Swadling L, Capone S, Brown A, Richardson R, Halliday J, von Delft A, Oo Y, Mutimer D, Kurioka A, Hartnell F, Collier J, Ammendola V, Sorbo MD, Grazioli F, Esposito ML, Marco SD, Siani L, Traboni C, Hill AV, Colloca S, Nicosia A, Cortese R, Folgori A, Klenerman P, Barnes E. Chronic hepatitis C viral infection subverts vaccine-induced T-cell immunity in humans. Hepatology 2016; 63:1455-70. [PMID: 26474390 PMCID: PMC4842008 DOI: 10.1002/hep.28294] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 01/05/2023]
Abstract
UNLABELLED Adenoviral vectors encoding hepatitis C virus (HCV) nonstructural (NS) proteins induce multispecific, high-magnitude, durable CD4(+) and CD8(+) T-cell responses in healthy volunteers. We assessed the capacity of these vaccines to induce functional HCV-specific immune responses and determine T-cell cross-reactivity to endogenous virus in patients with chronic HCV infection. HCV genotype 1-infected patients were vaccinated using heterologous adenoviral vectors (ChAd3-NSmut and Ad6-NSmut) encoding HCV NS proteins in a dose escalation, prime-boost regimen, with and without concomitant pegylated interferon-α/ribavirin therapy. Analysis of immune responses ex vivo used human leukocyte antigen class I pentamers, intracellular cytokine staining, and fine mapping in interferon-γ enzyme-linked immunospot assays. Cross-reactivity of T cells with population and endogenous viral variants was determined following viral sequence analysis. Compared to healthy volunteers, the magnitude of HCV-specific T-cell responses following vaccination was markedly reduced. CD8(+) HCV-specific T-cell responses were detected in 15/24 patients at the highest dose, whereas CD4(+) T-cell responses were rarely detectable. Analysis of the host circulating viral sequence showed that T-cell responses were rarely elicited when there was sequence homology between vaccine immunogen and endogenous virus. In contrast, T cells were induced in the context of genetic mismatch between vaccine immunogen and endogenous virus; however, these commonly failed to recognize circulating epitope variants and had a distinct partially functional phenotype. Vaccination was well tolerated but had no significant effect on HCV viral load. CONCLUSION Vaccination with potent HCV adenoviral vectored vaccines fails to restore T-cell immunity except where there is genetic mismatch between vaccine immunogen and endogenous virus; this highlights the major challenge of overcoming T-cell exhaustion in the context of persistent antigen exposure with implications for cancer and other persistent infections.
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Affiliation(s)
- Christabel Kelly
- Nuffield Department of MedicineUniversity of OxfordOxfordUK,Oxford NIHR BRC and Translational Gastroenterology UnitOxfordUK
| | - Leo Swadling
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Stefania Capone
- ReiThera Srl (formerly Okairos Srl)Viale Città d'EuropaRomeItaly
| | - Anthony Brown
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | | | - John Halliday
- Nuffield Department of MedicineUniversity of OxfordOxfordUK,Oxford NIHR BRC and Translational Gastroenterology UnitOxfordUK
| | | | - Ye Oo
- Department of HepatologyQueen Elizabeth HospitalBirminghamUK
| | - David Mutimer
- Department of HepatologyQueen Elizabeth HospitalBirminghamUK
| | - Ayako Kurioka
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | | | - Jane Collier
- Oxford NIHR BRC and Translational Gastroenterology UnitOxfordUK
| | | | | | - Fabiana Grazioli
- ReiThera Srl (formerly Okairos Srl)Viale Città d'EuropaRomeItaly
| | | | | | - Loredana Siani
- ReiThera Srl (formerly Okairos Srl)Viale Città d'EuropaRomeItaly
| | - Cinzia Traboni
- ReiThera Srl (formerly Okairos Srl)Viale Città d'EuropaRomeItaly
| | - Adrian V.S. Hill
- Nuffield Department of MedicineUniversity of OxfordOxfordUK,The Jenner InstituteUniversity of OxfordOxfordUK
| | - Stefano Colloca
- ReiThera Srl (formerly Okairos Srl)Viale Città d'EuropaRomeItaly
| | - Alfredo Nicosia
- Oxford NIHR BRC and Translational Gastroenterology UnitOxfordUK,ReiThera Srl (formerly Okairos Srl)Viale Città d'EuropaRomeItaly,CEINGENaplesItaly,Department of Molecular Medicine and Medical BiotechnologyUniversity of Naples Federico IINaplesItaly
| | | | | | - Paul Klenerman
- Nuffield Department of MedicineUniversity of OxfordOxfordUK,Oxford NIHR BRC and Translational Gastroenterology UnitOxfordUK,The Jenner InstituteUniversity of OxfordOxfordUK
| | - Eleanor Barnes
- Nuffield Department of MedicineUniversity of OxfordOxfordUK,Oxford NIHR BRC and Translational Gastroenterology UnitOxfordUK,The Jenner InstituteUniversity of OxfordOxfordUK
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Li KK, Trivedi PJ, Von Heimendahl S, Bruns T, Ward ST, Oo Y, Mutimer D. Hepatocellular carcinoma surveillance in hepatitis B virus-infected individuals: Who and how? Hepatology 2016; 63:1394-5. [PMID: 26044282 DOI: 10.1002/hep.27924] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Ka-Kit Li
- NIHR Biomedical Research Unit and Center for Liver Research, University of Birmingham, Birmingham, United Kingdom.,Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Palak J Trivedi
- NIHR Biomedical Research Unit and Center for Liver Research, University of Birmingham, Birmingham, United Kingdom.,Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Tony Bruns
- NIHR Biomedical Research Unit and Center for Liver Research, University of Birmingham, Birmingham, United Kingdom
| | - Steve T Ward
- NIHR Biomedical Research Unit and Center for Liver Research, University of Birmingham, Birmingham, United Kingdom
| | - Ye Oo
- NIHR Biomedical Research Unit and Center for Liver Research, University of Birmingham, Birmingham, United Kingdom.,Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - David Mutimer
- NIHR Biomedical Research Unit and Center for Liver Research, University of Birmingham, Birmingham, United Kingdom.,Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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5
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Arends P, Sonneveld MJ, Zoutendijk R, Carey I, Brown A, Fasano M, Mutimer D, Deterding K, Reijnders JGP, Oo Y, Petersen J, van Bömmel F, de Knegt RJ, Santantonio T, Berg T, Welzel TM, Wedemeyer H, Buti M, Pradat P, Zoulim F, Hansen B, Janssen HLA. Entecavir treatment does not eliminate the risk of hepatocellular carcinoma in chronic hepatitis B: limited role for risk scores in Caucasians. Gut 2015; 64:1289-95. [PMID: 25011935 DOI: 10.1136/gutjnl-2014-307023] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [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: 02/13/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) risk-scores may predict HCC in Asian entecavir (ETV)-treated patients. We aimed to study risk factors and performance of risk scores during ETV treatment in an ethnically diverse Western population. METHODS We studied all HBV monoinfected patients treated with ETV from 11 European referral centres within the VIRGIL Network. RESULTS A total of 744 patients were included; 42% Caucasian, 29% Asian, 19% other, 10% unknown. At baseline, 164 patients (22%) had cirrhosis. During a median follow-up of 167 (IQR 82-212) weeks, 14 patients developed HCC of whom nine (64%) had cirrhosis at baseline. The 5-year cumulative incidence rate of HCC was 2.1% for non-cirrhotic and 10.9% for cirrhotic patients (p<0.001). HCC incidence was higher in older patients (p<0.001) and patients with lower baseline platelet counts (p=0.02). Twelve patients who developed HCC achieved virologic response (HBV DNA <80 IU/mL) before HCC. At baseline, higher CU-HCC and GAG-HCC, but not REACH-B scores were associated with development of HCC. Discriminatory performance of HCC risk scores was low, with sensitivity ranging from 18% to 73%, and c-statistics from 0.71 to 0.85. Performance was further reduced in Caucasians with c-statistics from 0.54 to 0.74. Predicted risk of HCC based on risk-scores declined during ETV therapy (all p<0.001), but predictive performances after 1 year were comparable to those at baseline. CONCLUSIONS Cumulative incidence of HCC is low in patients treated with ETV, but ETV does not eliminate the risk of HCC. Discriminatory performance of HCC risk scores was limited, particularly in Caucasians, at baseline and during therapy.
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Affiliation(s)
- Pauline Arends
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roeland Zoutendijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ivana Carey
- Department of Hepatology and Gastroenterology, Kings College London, London, UK
| | - Ashley Brown
- Department of Hepatology and Gastroenterology, Imperial College London, London, UK
| | - Massimo Fasano
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - David Mutimer
- NIHR Biomedical Research Unit, Centre for Liver Research, Queen Elizabeth Hospital, Birmingham, UK
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Jurriën G P Reijnders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ye Oo
- NIHR Biomedical Research Unit, Centre for Liver Research, Queen Elizabeth Hospital, Birmingham, UK
| | - Jörg Petersen
- Ifi Institute, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Florian van Bömmel
- Department of Gastroenterology and Rheumatology, Hepatology Section, University Clinic Leipzig, Leipzig, Germany
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Teresa Santantonio
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, Hepatology Section, University Clinic Leipzig, Leipzig, Germany
| | - Tania M Welzel
- Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Maria Buti
- Department of Hepatology, Hospital Vall de Hebron and Ciberehd del Instituto Carlos III, Barcelona, Spain
| | - Pierre Pradat
- Department of Hepatology, Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France
| | - Fabien Zoulim
- Department of Hepatology, Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France
| | - Bettina Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, Ontario, Canada
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Oo Y, Packham D, Yau W, Munckhof WJ. Ertapenem-associated psychosis and encephalopathy. Intern Med J 2014; 44:817-9. [DOI: 10.1111/imj.12504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 05/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Y. Oo
- Infectious Diseases Department; Institute for Clinical Pathology and Medical Research; Sydney New South Wales Australia
- Department of General Medicine; Calvary Mater Newcastle Hospital; Newcastle New South Wales Australia
| | - D. Packham
- Infectious Diseases Department; Institute for Clinical Pathology and Medical Research; Sydney New South Wales Australia
| | - W. Yau
- Infectious Diseases Department; Institute for Clinical Pathology and Medical Research; Sydney New South Wales Australia
| | - W. J. Munckhof
- Infection Management Service; Princess Alexandra Hospital; Brisbane Queensland Australia
- Ipswich Hospital; Ipswich Queensland Australia
- Pathology Queensland; Brisbane Queensland Australia
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
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7
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Afford SC, Humphreys EH, Reid DT, Russell CL, Banz VM, Oo Y, Vo T, Jenne C, Adams DH, Eksteen B. Vascular cell adhesion molecule 1 expression by biliary epithelium promotes persistence of inflammation by inhibiting effector T-cell apoptosis. Hepatology 2014; 59:1932-43. [PMID: 24338559 DOI: 10.1002/hep.26965] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/04/2013] [Indexed: 12/20/2022]
Abstract
UNLABELLED Chronic hepatitis occurs when effector lymphocytes are recruited to the liver from blood and retained in tissue to interact with target cells, such as hepatocytes or bile ducts (BDs). Vascular cell adhesion molecule 1 (VCAM-1; CD106), a member of the immunoglobulin superfamily, supports leukocyte adhesion by binding α4β1 integrins and is critical for the recruitment of monocytes and lymphocytes during inflammation. We detected VCAM-1 on cholangiocytes in chronic liver disease (CLD) and hypothesized that biliary expression of VCAM-1 contributes to the persistence of liver inflammation. Hence, in this study, we examined whether cholangiocyte expression of VCAM-1 promotes the survival of intrahepatic α4β1 expressing effector T cells. We examined interactions between primary human cholangiocytes and isolated intrahepatic T cells ex vivo and in vivo using the Ova-bil antigen-driven murine model of biliary inflammation. VCAM-1 was detected on BDs in CLDs (primary biliary cirrhosis, primary sclerosing cholangitis, alcoholic liver disease, and chronic hepatitis C), and human cholangiocytes expressed VCAM-1 in response to tumor necrosis factor alpha alone or in combination with CD40L or interleukin-17. Liver-derived T cells adhered to cholangiocytes in vitro by α4β1, which resulted in signaling through nuclear factor kappa B p65, protein kinase B1, and p38 mitogen-activated protein kinase phosphorylation. This led to increased mitochondrial B-cell lymphoma 2 accumulation and decreased activation of caspase 3, causing increased cell survival. We confirmed our findings in a murine model of hepatobiliary inflammation where inhibition of VCAM-1 decreased liver inflammation by reducing lymphocyte recruitment and increasing CD8 and T helper 17 CD4 T-cell survival. CONCLUSIONS VCAM-1 expression by cholangiocytes contributes to persistent inflammation by conferring a survival signal to α4β1 expressing proinflammatory T lymphocytes in CLD.
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Affiliation(s)
- Simon C Afford
- National Institute for Health Research Biomedical Research Unit and Center for Liver Research, Medical Research Council Center for Immune Regulation, University of Birmingham, Birmingham, UK
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8
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Abstract
Pheochromocytomas are catecholamine producing neuroendocrine tumors that can be adrenal or extra-adrenal in origin. The classic symptoms of pheochromocytoma are headache, palpitation, anxiety and diaphoresis and the tumor can occur at any age with equal gender distribution. In patients with an established mutation or hereditary syndrome the condition may manifest at a younger age than in those with sporadic disease. Pheochromocytoma can be associated with certain genetic syndromes such as multiple endocrine neoplasia type 2 (MEN 2), neurofibromatosis (NF) and von Hippel-Lindau (VHL) syndrome. Pheochromocytoma is diagnosed with biochemical confirmation of hormonal excess followed by anatomical localization (CT or MRI). The mainstay of definitive therapy is surgical resection. In this review, we discuss in detail about the symptomatology, diagnosis, genetic aspects and management of pheochromocytoma.
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Affiliation(s)
- A Tsirlin
- Department of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Y Oo
- Department of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - R Sharma
- Department of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States.
| | - A Kansara
- Department of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - A Gliwa
- Department of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
| | - M A Banerji
- Department of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
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9
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Barnes E, Folgori A, Capone S, Swadling L, Aston S, Kurioka A, Meyer J, Huddart R, Smith K, Townsend R, Brown A, Antrobus R, Ammendola V, Naddeo M, O'Hara G, Willberg C, Harrison A, Grazioli F, Esposito ML, Siani L, Traboni C, Oo Y, Adams D, Hill A, Colloca S, Nicosia A, Cortese R, Klenerman P. Novel adenovirus-based vaccines induce broad and sustained T cell responses to HCV in man. Sci Transl Med 2012. [PMID: 22218690 DOI: 10.1126/scitranslmed.300315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Currently, no vaccine exists for hepatitis C virus (HCV), a major pathogen thought to infect 170 million people globally. Many studies suggest that host T cell responses are critical for spontaneous resolution of disease, and preclinical studies have indicated a requirement for T cells in protection against challenge. We aimed to elicit HCV-specific T cells with the potential for protection using a recombinant adenoviral vector strategy in a phase 1 study of healthy human volunteers. Two adenoviral vectors expressing NS proteins from HCV genotype 1B were constructed based on rare serotypes [human adenovirus 6 (Ad6) and chimpanzee adenovirus 3 (ChAd3)]. Both vectors primed T cell responses against HCV proteins; these T cell responses targeted multiple proteins and were capable of recognizing heterologous strains (genotypes 1A and 3A). HCV-specific T cells consisted of both CD4+ and CD8+ T cell subsets; secreted interleukin-2, interferon-γ, and tumor necrosis factor-α; and could be sustained for at least a year after boosting with the heterologous adenoviral vector. Studies using major histocompatibility complex peptide tetramers revealed long-lived central and effector memory pools that retained polyfunctionality and proliferative capacity. These data indicate that an adenoviral vector strategy can induce sustained T cell responses of a magnitude and quality associated with protective immunity and open the way for studies of prophylactic and therapeutic vaccines for HCV.
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Affiliation(s)
- Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK
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10
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Barnes E, Folgori A, Capone S, Swadling L, Aston S, Kurioka A, Meyer J, Huddart R, Smith K, Townsend R, Brown A, Antrobus R, Ammendola V, Naddeo M, O’Hara G, Willberg C, Harrison A, Grazioli F, Esposito ML, Siani L, Traboni C, Oo Y, Adams D, Hill A, Colloca S, Nicosia A, Cortese R, Klenerman P. Novel adenovirus-based vaccines induce broad and sustained T cell responses to HCV in man. Sci Transl Med 2012; 4:115ra1. [PMID: 22218690 PMCID: PMC3627207 DOI: 10.1126/scitranslmed.3003155] [Citation(s) in RCA: 317] [Impact Index Per Article: 26.4] [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: 12/12/2022]
Abstract
Currently, no vaccine exists for hepatitis C virus (HCV), a major pathogen thought to infect 170 million people globally. Many studies suggest that host T cell responses are critical for spontaneous resolution of disease, and preclinical studies have indicated a requirement for T cells in protection against challenge. We aimed to elicit HCV-specific T cells with the potential for protection using a recombinant adenoviral vector strategy in a phase 1 study of healthy human volunteers. Two adenoviral vectors expressing NS proteins from HCV genotype 1B were constructed based on rare serotypes [human adenovirus 6 (Ad6) and chimpanzee adenovirus 3 (ChAd3)]. Both vectors primed T cell responses against HCV proteins; these T cell responses targeted multiple proteins and were capable of recognizing heterologous strains (genotypes 1A and 3A). HCV-specific T cells consisted of both CD4+ and CD8+ T cell subsets; secreted interleukin-2, interferon-γ, and tumor necrosis factor-α; and could be sustained for at least a year after boosting with the heterologous adenoviral vector. Studies using major histocompatibility complex peptide tetramers revealed long-lived central and effector memory pools that retained polyfunctionality and proliferative capacity. These data indicate that an adenoviral vector strategy can induce sustained T cell responses of a magnitude and quality associated with protective immunity and open the way for studies of prophylactic and therapeutic vaccines for HCV.
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Affiliation(s)
- Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford UK
| | | | - Stefania Capone
- Okairos, via dei Castelli Romani 22, 00040, Pomezia, Rome, Italy
| | - Leo Swadling
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Stephen Aston
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ayako Kurioka
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joel Meyer
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rachel Huddart
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kira Smith
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rachel Townsend
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Anthony Brown
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Antrobus
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Geraldine O’Hara
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chris Willberg
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Abby Harrison
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Loredana Siani
- Okairos, via dei Castelli Romani 22, 00040, Pomezia, Rome, Italy
| | - Cinzia Traboni
- Okairos, via dei Castelli Romani 22, 00040, Pomezia, Rome, Italy
| | - Ye Oo
- NIHR Liver BRU, University of Birmingham, Birmingham, UK
| | - David Adams
- NIHR Liver BRU, University of Birmingham, Birmingham, UK
| | - Adrian Hill
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford UK
| | - Stefano Colloca
- Okairos, via dei Castelli Romani 22, 00040, Pomezia, Rome, Italy
| | - Alfredo Nicosia
- Okairos, via dei Castelli Romani 22, 00040, Pomezia, Rome, Italy
| | - Riccardo Cortese
- Okairos, via dei Castelli Romani 22, 00040, Pomezia, Rome, Italy
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford UK
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11
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Zoutendijk R, Reijnders JGP, Brown A, Zoulim F, Mutimer D, Deterding K, Petersen J, Hofmann WP, Buti M, Santantonio T, van Bömmel F, Pradat P, Oo Y, Luetgehetmann M, Berg T, Hansen BE, Wedemeyer H, Janssen HLA. Entecavir treatment for chronic hepatitis B: adaptation is not needed for the majority of naïve patients with a partial virological response. Hepatology 2011; 54:443-51. [PMID: 21563196 DOI: 10.1002/hep.24406] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [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: 12/12/2022]
Abstract
UNLABELLED Entecavir (ETV) is a potent inhibitor of viral replication in nucleos(t)ide analogue (NA)-naïve chronic hepatitis B (CHB) patients. The aim of this study was to investigate the long term efficacy and safety of ETV in NA-naïve CHB patients, particularly in those with detectable hepatitis B virus (HBV) DNA after 48 weeks, in whom treatment adaptation is suggested by current guidelines. In a multicenter cohort study, we investigated 333 CHB patients treated with entecavir monotherapy. The NA-naïve population consisted of 243 patients, whereas 90 were NA-experienced. Virological response (VR) (HBV DNA<80 IU/mL) was achieved in 48%, 76%, and 90% of hepatitis B e antigen (HBeAg)-positive and in 89%, 98%, and 99% of HBeAg-negative NA-naïve patients at weeks 48, 96, and 144, respectively. Thirty-six of 175 (21%) NA-naïve patients with at least 48 weeks of follow-up had a detectable load at week 48 (partial virological response [PVR]). Twenty-nine (81%) patients with PVR reached VR during prolonged ETV monotherapy, and none of them developed ETV-resistance. Among 22 patients with HBV DNA<1,000 IU/mL at week 48, VR was achieved in 21 (95%) patients, compared with eight of 14 (57%) patients with HBV DNA≥1,000 IU/mL. Continuous HBV DNA decline was observed in most patients without VR during follow-up, and in three patients adherence was suboptimal according to the treating physician. ETV was safe and did not affect renal function or cause lactic acidosis. CONCLUSION ETV monotherapy can be continued in NA-naïve patients with detectable HBV DNA at week 48, particularly in those with a low viral load because long-term ETV leads to a virological response in the vast majority of patients.
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Affiliation(s)
- Roeland Zoutendijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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