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Khatua CR, Panigrahi MK, Choudhury AK, Nath G, Khandelwal R, Anirvan P, Singh SP. Acute Kidney Injury (AKI) at Admission Predicts Mortality in Patients With Severe Alcoholic Hepatitis (SAH). J Clin Exp Hepatol 2023; 13:225-232. [PMID: 36950492 PMCID: PMC10025676 DOI: 10.1016/j.jceh.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background & aims Severe alcoholic hepatitis (SAH) is a grave condition, and the presence of acute kidney injury (AKI) further jeopardizes patient survival. However, the impact of AKI on survival in SAH has not been assessed from this region of Asia. Materials and methods This study was conducted on consecutive alcohol-associated liver disease (ALD) patients hospitalized in Gastroenterology Department, SCB Medical College, Cuttack, India, between October 2016 and December 2018. On diagnosis of SAH (mDF score ≥32), demographic, clinical, and laboratory parameters were recorded, and survival was compared between patients with and without AKI (AKIN criteria). In addition, survival was compared among SAH patients defined by other criteria and prognostic models in the presence and absence of AKI. Results 309 (70.71%) of ALD patients had SAH, and 201 (65%) of them had AKI. SAH patients with AKI had higher total leucocyte count, total bilirubin, serum creatinine, serum urea, INR, MELD (UNOS), MELD (Na+), CTP score, mDF score, Glasgow score, ABIC score, and increased prevalence of acute on chronic liver failure (ACLF) as per EASL-CLIF Consortium criteria (P < 0.001). Further, they had prolonged hospital stay, and increased death during hospitalization, at 28 days as well as 90 days (P < 0.001). Significant differences in survival were also seen in SAH (as per MELD, ABIC, and GAHS criteria) patients above the marked cut offs in respect to AKI. Conclusions Over two-thirds of ALD patients had SAH, and about two-thirds had AKI. Patients with SAH and AKI had an increased prevalence of ACLF, longer hospital stay, and increased mortality during hospitalization at 28 days and 90 days. Lay summary SAH is a critical condition, and the presence of AKI negatively affects their survival. Hence, early identification of SAH and AKI, as well as early initiation of treatment, is crucial for better survival. Our study from the coastal part of eastern India is the first to demonstrate the prevalence of SAH among patients with ALD along with the prevalence of AKI among SAH patients in this region. This knowledge will be helpful in managing these patients from this region of world.
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Key Words
- ABIC, Age serum, bilirubin, INR, and serum creatinine
- ACLF, Acute on chronic liver failure
- AH, Alcoholic hepatitis
- AKI, Acute kidney injury
- AKIN, Acute kidney injury network
- ALD, Alcohol-associated liver disease
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- CS, Corticosteroids
- CTP, Child–Turcotte–Pugh
- EASL-CLIF Consortium, European Association for the Study of the Liver-Chronic Liver Failure
- GAHS, Glasgow Alcoholic Hepatitis Score
- HE, Hepatic encephalopathy
- INR, International normalized ratio
- MDRI, Multidrug-resistant infection
- MELD, Model for end-stage liver disease
- PT, Prothrombin time
- PTX, Pentoxifylline
- SAH, Severe alcoholic hepatitis
- SCr, Serum creatinine
- SIRS, Systemic inflammatory response syndrome
- alcohol-associated liver disease
- mDF, Modified Maddrey discriminant function
- modified maddrey discriminant function
- severe alcoholic hepatitis
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Affiliation(s)
- Chitta R. Khatua
- MKCG Medical College and Hospital, Berhampur- 760004, Odisha, India
| | | | - Ashok K. Choudhury
- Department of Liver Transplant, Hepatology and Medical Gastroenterology, Narayana Health Super-speciality Hospital, DLF-3 Gurugram, India
| | - Gautam Nath
- Sriram Chandra Bhanja Medical College and Hospital, Cuttack- 753007, Odisha, India
| | - Reshu Khandelwal
- Sriram Chandra Bhanja Medical College and Hospital, Cuttack- 753007, Odisha, India
| | - Prajna Anirvan
- Sriram Chandra Bhanja Medical College and Hospital, Cuttack- 753007, Odisha, India
| | - Shivaram P. Singh
- Sriram Chandra Bhanja Medical College and Hospital, Cuttack- 753007, Odisha, India
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Bashir A, Duseja A, Verma A, De A, Tiwari P. Lysosomal Acid Lipase Activity in Non-alcoholic Fatty Liver Disease as a Novel Diagnostic and Therapeutic Target: A Systematic Literature Review of Current Evidence and Future Directions. J Clin Exp Hepatol 2022; 12:1535-1546. [PMID: 36340307 PMCID: PMC9630019 DOI: 10.1016/j.jceh.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background and aim Non-alcoholic fatty liver disease (NAFLD) presents with the accumulation of excessive intra-hepatic fat without significant alcohol intake. Multifactorial pathogenesis is reported to be involved. Reduced lysosomal acid lipase (LAL) activity is suggested as one of the novel-involved pathogenic mechanisms. This review summarizes the available evidence on the role of LAL activity in NAFLD pathogenesis. Methods Four databases namely, PubMed/Medline, Science direct, Cochrane Library, and Google scholar were searched to identify relevant observational records evaluating the role of LAL activity in the pathogenesis of NAFLD. All studies were assessed for their quality by using Newcastle-Ottawa Scale or The Joanna Briggs Institute Critical Appraisal tools for cohort and cross-sectional studies, respectively. The estimates of LAL activity and other clinical outcomes were expressed as mean (SD) and number (%) as presented in the primary studies. Results A total of nine good quality studies with 1711 patients with NAFLD and 877 controls from different groups (healthy volunteers, alcoholics, cryptogenic cirrhosis, and HCV-positive) were included. From the NAFLD group, 59.55% were males and the overall mean age ranged between the studies from 12.6 ± 8.5 months in pediatrics to 58.90 ± 13.82 years in adults. In the NAFLD group, the LAL activity varied from 0.53 ± 0.08 to 1.3 ± 0.70 (nmol/spot/hr) between the studies which was less than all control groups except cryptogenic cirrhosis patients (0.5 ± 0.15 nmol/spot/hr). Of the other outcomes of interest, ALT, AST, total cholesterol, triglyceride, and LDL cholesterol were found elevated in NAFLD patients than in controls. Conclusion The current evidence suggests a potential correlation of reduced LAL activity with NAFLD pathogenesis according to its severity. Large-scale studies are recommended, more importantly in patients with NAFLD having no metabolic or genetic involvement. Further LAL can act as a new non-invasive diagnostic biomarker to identify that specific NAFLD subgroup.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- CESD, Cholesterol ester storage disease
- HCC, Hepatocellular carcinoma
- JBI, Joanna Briggs Institute
- LAL
- LAL, Lysosomal acid lipase
- MAFLD, Metabolic (dysfunction)-associated fatty liver disease
- NAFLD
- NAFLD, Non-alcoholic fatty liver disease
- NASH
- NASH, Non-alcoholic steatohepatitis
- NOS, Newcastle–Ottawa Scale
- PNPLA3, Patatin-like phospholipase domain containing 3 protein
- WD, Wolman disease
- pathogenesis
- systematic review
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Affiliation(s)
- Aamir Bashir
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, S.A.S. Nagar Mohali, Punjab, 160062, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Verma
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, S.A.S. Nagar Mohali, Punjab, 160062, India
| | - Arka De
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, S.A.S. Nagar Mohali, Punjab, 160062, India
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Ikewaki N, Levy GA, Kurosawa G, Iwasaki M, Dedeepiya VD, Vaddi S, Senthilkumar R, Preethy S, Abraham SJ. Hepatoprotective Effects of Aureobasidium pullulans Derived β 1,3-1,6 Glucans in a Murine Model of Non-alcoholic Steatohepatitis. J Clin Exp Hepatol 2022; 12:1428-1437. [PMID: 36340302 PMCID: PMC9630018 DOI: 10.1016/j.jceh.2022.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/08/2022] [Accepted: 06/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are highly prevalent conditions characterized by inflammation and fibrosis of the liver, which can progress to cirrhosis and hepatocellular carcinoma if left untreated. Conventional modalities are mainly symptomatic, with no definite solution. Beta-glucan-based biological response modifiers are a potential strategy in lieu of their beneficial metabolic effects. Aureobasidium pullulans strains AFO-202 and N-163 beta-glucans were evaluated for anti-fibrotic and anti-inflammatory hepatoprotective potentials in a NASH animal model in this study. Methods In the STAM™ murine model of NASH, five groups were studied for 8 weeks: (1) vehicle (RO water), (2) AFO-202 beta-glucan; (3) N-163 beta-glucan, (4) AFO-202+N-163 beta-glucan, and (5) telmisartan (standard pharmacological intervention). Evaluation of biochemical parameters in plasma and hepatic histology including Sirius red staining and F4/80 immunostaining were performed. Results AFO-202 beta-glucan significantly decreased inflammation-associated hepatic cell ballooning and steatosis. N-163 beta-glucan decreased fibrosis and inflammation significantly (P value < 0.05). The combination of AFO-202 with N-163 significantly decreased the NAFLD Activity Score (NAS) compared with other groups. Conclusion This preclinical study supports the potential of N-163 and AFO-202 beta-glucans alone or in combination as potential preventive and therapeutic agent(s), for NASH.
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Key Words
- ALT, Alanine aminotransferase
- ARRIVE, Animal Research: Reporting of In Vivo Experiments
- IL, Interleukin
- MCP-1, Monocyte chemoattractant protein-1
- NAFLD, Non-alcoholic fatty liver disease
- NAS, NAFLD Activity Score
- NASH, Non-alcoholic steatohepatitis
- PPAR, Peroxisome proliferator-activated receptor
- STAM, Stelic Animal Model
- TGF-β, Transforming growth factor beta
- TIMPs, Tissue inhibitors of matrix metalloproteinases
- TNF-α, Tumor necrosis factor alpha
- anti-fibrotic
- anti-inflammatory
- beta-glucans
- hepatoprotective
- non-alcoholic fatty liver disease (NAFLD)
- non-alcoholic steatohepatitis (NASH)
- telmisartan
- αSMA, Smooth muscle alpha-actin
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Affiliation(s)
- Nobunao Ikewaki
- Department of Medical Life Science, Kyushu University of Health and Welfare, Japan
- Institute of Immunology, Junsei Educational Institute, Nobeoka, Miyazaki, Japan
| | - Gary A. Levy
- Medicine and Immunology, University of Toronto, Ontario, Canada
| | - Gene Kurosawa
- Department of Academic Research Support Promotion Facility, Center for Research Promotion and Support, Fujita Health University, Aichi, Japan
- MabGenesis KK, Nagoya, Japan
| | - Masaru Iwasaki
- Centre for Advancing Clinical Research (CACR), University of Yamanashi - School of Medicine, Chuo, Japan
| | - Vidyasagar D. Dedeepiya
- Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India
| | | | - Rajappa Senthilkumar
- Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India
| | - Senthilkumar Preethy
- Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India
| | - Samuel J.K. Abraham
- Centre for Advancing Clinical Research (CACR), University of Yamanashi - School of Medicine, Chuo, Japan
- Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), Chennai, India
- Antony- Xavier Interdisciplinary Scholastics (AXIS), GN Corporation Co. Ltd., Kofu, Japan
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Bhadauria DS, Kumar P, Tiwari P, Kaul A, Negi TS, Rai P, Shanmugam S, Veeranki V, Prasad N, Goel A. Liver Stiffness is Reduced to Normal After Successful Renal Transplantation: A Prospective Cohort Study. J Clin Exp Hepatol 2022; 12:1445-1450. [PMID: 36340304 PMCID: PMC9630024 DOI: 10.1016/j.jceh.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background Liver stiffness (LS) may be falsely elevated in patients on maintenance hemodialysis (MHD) due to fluid overload. We measured LS change by transient elastography (TE) in MHD patients before and after successful renal transplantation. Method Adults on ≥2 years of MHD, without additional risk factors for liver fibrosis or fluid overload, and planned for renal transplantation were prospectively recruited. LS was measured on two occasions, i.e., within two weeks before transplantation (pre-Tx LS) and after ≥ 3 months after successful transplantation (post-Tx LS). The participants with pre-Tx LS ≤ 7.0 KPa and >7.0 KPa were classified as "Group I" and "Group II," respectively. Categorical and numerical data are expressed as ratio/proportions and mean (SD), respectively. Results Paired data from 43 participants (males 42 [97.7%]; age 32 [11] years) were analyzed. The pre-Tx and post-Tx LS of the entire cohort, measured at 307 (198) days of interval, were 8.5 (7.3) KPa and 6.7 (3.1) KPa, respectively. Before transplantation, 21 (49%) participants belonged to Group II and 22 (51%) to Group I. Among the Group II participants, 12 (57%) showed LS normalization after 312 (182) days of transplantation. Of the 22 participants in Group I, three (13.6%) showed LS elevation to >7.0 KPa after 303 (217) days of transplantation. The mean LS changes among the overall cohort, Group II, and Group I were -1.8 KPa, -4.1 KPa, and +0.2 KPa, respectively. Conclusion LS in people on MHD may be falsely elevated, which is likely to normalize after successful renal transplantation.
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Affiliation(s)
- Dharmendra S. Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Pankaj Kumar
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prachi Tiwari
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Tajwar S. Negi
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Praveer Rai
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sabrinath Shanmugam
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vamsidhar Veeranki
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Goel
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Setyawati AN, Tjahjono DK K, Chionardes MA, Arkhaesi N. Acute acalculous cholecystitis in a pediatric dengue hemorrhagic fever patient: A case report, lesson learned from limited resource setting. Ann Med Surg (Lond) 2022; 81:104437. [PMID: 36147073 PMCID: PMC9486663 DOI: 10.1016/j.amsu.2022.104437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Dengue fever (DF) is endemic in numerous regions of Indonesia with primary clinical features such as high fever as well as pullout of intravascular fluid and albumin leakage, which provokes pleural effusion, hypoproteinemia, and blood hemoconcentration. However, the incidence of abdominal pain as a clinical manifestation of DF, which refers to acalculous cholecystitis, is rare. CASE PRESENTATION An 11-year-old female was admitted to the to hospital with fever, headache, and myalgia. Blood examination resulted in low platelet coua nt and positive IgM Dengue antibody test. On the third day, the patient felt sharp abdominal pain. Abdominal ultrasound showed cholecystitis, cholestasis, pleural effusion, ascites, and laboratory finding showed increased C-reactive protein. The management was conservative and discharged at the 7th day. DISCUSSION The acalculous cholecystitis in Dengue Fever/Dengue Hemorrhagic fever (DF/DHF) is challenging in diagnose due to atypical presentations. Several proposed mechanisms are critical illness, including direct invasion of the gallbladder epithelial cells, vasculitis, stasis of biliary flow, obstruction of the biliary tree, ischemia, and sequestration. The actual mechanism of the dengue virus has been proposed that direct viral incursion of the gallbladder may yield edema and exudation. Abdominal ultrasonography is considered to diagnose acute acalculous cholecystitis (AAC) in children. CONCLUSION Understanding pathophysiology of the acalculous cholecystitis in DF/DHF patients and atypical presentation of sharp abdominal pain help physicians for early diagnosis and management both in monitoring and patient care management. Abdominal ultrasonography can help physicians to diagnose AAC.
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Affiliation(s)
- Amallia Nuggetsiana Setyawati
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
- Department of Pediatrics, National Diponegoro Hospital, Semarang, Indonesia
- Division of Pediatrics, Williambooth General Hospital, Semarang, Indonesia
- Corresponding author. Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia.
| | - Kusmiyati Tjahjono DK
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Melissa Angela Chionardes
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Nahwa Arkhaesi
- Department of Pediatrics, National Diponegoro Hospital, Semarang, Indonesia
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Yang M, Tao L, Kang XR, Li LF, Zhao CC, Wang ZL, Sheng J, Tian Y. Recent developments in Moringa oleifera Lam. polysaccharides: A review of the relationship between extraction methods, structural characteristics and functional activities. Food Chem X 2022; 14:100322. [PMID: 35571331 PMCID: PMC9092490 DOI: 10.1016/j.fochx.2022.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 02/07/2023] Open
Abstract
Moringa oleifera Lam. (M. oleifera Lam) is a perennial tropical deciduous tree that belongs to the Moringaceae family. Polysaccharides are one of the major bioactive compounds in M. oleifera Lam and show immunomodulatory, anticancer, antioxidant, intestinal health protection and antidiabetic activities. At present, the structure and functional activities of M. oleifera Lam polysaccharides (MOPs) have been widespread, but the research data are relatively scattered. Moreover, the relationship between the structure and biological activities of MOPs has not been summarized. In this review, the current research on the extraction, purification, structural characteristics and biological activities of polysaccharides from different sources of M. oleifera Lam were summarized, and the structural characteristics of purified polysaccharides were focused on this review. Meanwhile, the biological activities of MOPs were introduced, and some molecular mechanisms were listed. In addition, the relationship between the structure and biological activities of MOPs was discussed. Furthermore, new perspectives and some future research of M. oleifera Lam polysaccharides were proposed in this review.
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Key Words
- ABTS, 2,2′-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid)
- AKP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- AST, Asparate aminotransferase
- Ara, Arabinose
- BUN, Blood urea nitrogen
- Bax, Bcl2-associated X protein
- Bcl-2, B-cell lymphoma
- Biological activities
- CCl4, Carbon tetrachloride
- COX-2, Cyclooxygenase-2
- Caspase-3, Cysteinyl aspartate specific proteinase 3
- Caspase-9, Cysteinyl aspartate specific proteinase 9
- DPPH, 2.2-diphenyl-picryl-hydrazyl radical
- EAE, Enzyme-assisted extraction
- FRAP, Ferric ion reducing antioxidant power
- FTIR, Fourier transform infrared spectroscopy
- Future trends
- GC, Gas chromatography
- GC–MS, Gas chromatography-mass spectrometry
- GSH-Px, Glutathione peroxidase
- Gal, Galactose
- Glc, Glucose
- HDL, High-density Lipoprotein
- HPGPC, High-performance gel permeation chromatography
- HPLC, High performance liquid chromatography
- HepG2, Human hepatocellular carcinoma cell line
- IL-10, Interleukin-10
- IL-1β, Interleukin 1β
- IL-2, Interleukin-2
- IL-6, Interleukin-6
- LDL, Low-density Lipoprotein
- LPS, Lipopolysaccharide
- M. oleifera Lam, Moringa oleifera Lam.
- MAE, Microwave-assisted extraction
- MDA, Malondialdehyde
- MOPs, Moringa oleifera Lam polysaccharides
- MS, Mass spectrometry
- MTT, 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl tetrazolium bromide
- MW, Molecular weight
- Man, Mannose
- Moringa oleifera Lam
- NF-κB, Nuclear factor kappa-B
- NK, Natural killer cell
- NMR, Nuclear magnetic resonance
- NO, Nitric oxide
- PLE, Pressurized liquid extraction
- Polysaccharides
- ROS, Reactive oxygen species
- Rha, Rhamnose
- SCFAs, Short-chain fatty acids
- SOD, Superoxide dismutase
- Structure characteristics
- Structure-biological relationship
- TC, Total Cholesterol
- TG, Triglycerides
- TNF-α, Tumour necrosis factor-α
- TOF, Time of flight
- UAE, Ultrasound-assisted extraction
- V/C, Ileum crypt and villus length
- WAE, Water-assisted extraction
- Xyl, Xylose
- iNOS, Inducible nitric oxide synthase
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Affiliation(s)
- Min Yang
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, China.,National Research and Development Professional Center for Moringa Processing Technology, Yunnan Agricultural University, Kunming, China.,Engineering Research Center of Development and Utilization of Food and Drug Homologous Resources, Ministry of Education, Yunnan Agricultural University, Kunming, China
| | - Liang Tao
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, China.,National Research and Development Professional Center for Moringa Processing Technology, Yunnan Agricultural University, Kunming, China.,Engineering Research Center of Development and Utilization of Food and Drug Homologous Resources, Ministry of Education, Yunnan Agricultural University, Kunming, China
| | - Xin-Rui Kang
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, China.,Yunnan Provincial Engineering Research Center for Edible and Medicinal Homologous Functional Food, Yunnan Agricultural University, Kunming, China
| | - Ling-Fei Li
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, China.,Yunnan Provincial Engineering Research Center for Edible and Medicinal Homologous Functional Food, Yunnan Agricultural University, Kunming, China
| | - Cun-Chao Zhao
- Engineering Research Center of Development and Utilization of Food and Drug Homologous Resources, Ministry of Education, Yunnan Agricultural University, Kunming, China.,Yunnan Provincial Engineering Research Center for Edible and Medicinal Homologous Functional Food, Yunnan Agricultural University, Kunming, China
| | - Zi-Lin Wang
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, China.,National Research and Development Professional Center for Moringa Processing Technology, Yunnan Agricultural University, Kunming, China
| | - Jun Sheng
- National Research and Development Professional Center for Moringa Processing Technology, Yunnan Agricultural University, Kunming, China.,Key Laboratory of Pu-er Tea Science, Ministry of Education, Yunnan Agricultural University, Kunming, China
| | - Yang Tian
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, China.,National Research and Development Professional Center for Moringa Processing Technology, Yunnan Agricultural University, Kunming, China.,Engineering Research Center of Development and Utilization of Food and Drug Homologous Resources, Ministry of Education, Yunnan Agricultural University, Kunming, China.,Yunnan Provincial Engineering Research Center for Edible and Medicinal Homologous Functional Food, Yunnan Agricultural University, Kunming, China
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Salihu M, Batiha GES, Kasozi KI, Zouganelis GD, Sharkawi SM, Ahmed EI, Usman IM, Nalugo H, Ochieng JJ, Ssengendo I, Okeniran OS, Pius T, Kimanje KR, Kegoye ES, Kenganzi R, Ssempijja F. Crinum jagus (J. Thomps. Dandy): Antioxidant and protective properties as a medicinal plant on toluene-induced oxidative stress damages in liver and kidney of rats. Toxicol Rep 2022; 9:699-712. [PMID: 35433275 PMCID: PMC9011043 DOI: 10.1016/j.toxrep.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/22/2022] [Accepted: 03/25/2022] [Indexed: 12/18/2022] Open
Abstract
Crinum jagus (C. jagus; J. Thomps.) Dandy (Liliaceae) is a pantropical plant known for its medicinal values and pharmacological properties. The study assessed the protective effects and changes in oxidative stress indices due to C. jagus leaf extracts on the toluene-induced liver and kidney injuries in rats. The study was conducted on 8-week-old male Wistar rats (n = 80), weighing 243.3 ± 1.42 g. Group I, 1 ml/kg distilled water for 7 days; Group II, 4.5 ml/kg toluene once, 1 ml/kg distilled water for 7 days; Group III, 4.5 ml/kg toluene once, 500 mg/kg methanolic extract for 7 days; Group IV, 4.5 ml/kg toluene once, 500 mg/kg aqueous extract for 7 days; Group V, 500 mg/kg methanolic extract for 7 days; Group VI, 500 mg/kg aqueous extract for 7 days; Group VII, 500 mg/kg of vitamin C for 7 days; Group, VIII, 4.5 ml/kg toluene once, 500 mg/kg vitamin C for 7 days, all administrations were given by oral gavage. The phytochemical contents, absolute and relative organ weights of liver and kidneys, liver and kidney function tests, antioxidant status, as well as histological tests were analyzed using standard protocols. The tannins, flavonoids, and polyphenols were in highest concentration in both extracts, content in methanol extract (57.04 ± 1.51 mgg-1, 35.43 ± 1.03 mgg-1, 28.2 ± 0.34 mgg-1 respectively) > aqueous extract (18.74 ± 1.01 mgg-1, 13.43 ± 0.47 mgg-1, 19.65 ± 0.21 mgg-1 respectively). In the negative control group (II), bodyweights significantly (P < 0.05) reduced by 22%, liver weight and kidney weight significantly (P < 0.05) increased by 42% and 83% respectively, liver-to-bodyweight and kidney-to-bodyweight ratios increased significantly (P < 0.05); serum liver function tests (LFTs) i.e., bilirubin, alkaline phosphatase (ALP), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Gamma-glutamyl transferase (GGT), and serum kidney function tests (creatinine and urea) were significantly (P < 0.05) elevated; oxidant status (tissue malondialdehyde; MDA) was significantly (P < 0.05) elevated, antioxidant status i.e., tissue superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels was significantly (P < 0.05) reduced; with markedly visible renal and hepatic histopathological findings, compared to the normal control group. In C. jagus extract test groups (III and IV), the parameters were significantly (P < 0.05) alleviated and reversed to normal/near normal compared to the negative control. The LFTs, kidney function tests, and antioxidant status were significantly (P < 0.05) more improved with the methanol extract test and standard control groups compared to the aqueous extract test group; Also, the methanol extract test group showed better histological features than the aqueous extract test and standard control groups. The methanolic extract shows better antioxidant potential due to the availability of more nonenzymatic antioxidants (tannins, flavonoids, and polyphenols). The findings showed that toluene is a very aggressive xenobiotic due to the promotion of oxidative stress and peroxidation of cellular lipids, but C. jagus leaves provide significant protection through the reducing power of nonenzymatic antioxidants and their ability to induce endogenous antioxidant enzymes (SOD, CAT, and glutathione reductase or GR) causing reduced cellular lipid peroxidation and tissue damages, quickened tissue repair, and improved cell biology of liver and kidneys during toluene toxicity. The methanol leaf extract provides better protection and should be advanced for more experimental and clinical studies to confirm its efficacy in alleviating oxidative stress tissue injuries, specifically due to toluene.
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Key Words
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- AST, Aspartate Aminotransferase
- Anti-lipid peroxidation
- Antioxidants
- Catalase Crinum jagus
- GGT, Gamma-glutamyl transferase
- GR, glutathione reductase
- GSH, Glutathione
- Glutathione superoxide dismutase
- Histoprotective
- LFTs, Liver function tests
- MDA, malondialdehyde
- Malondialdehyde
- SOD, Superoxide dismutase
- TOL, Toluene
- Toluene toxicity
- VC, Vitamin C
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Affiliation(s)
- Mariama Salihu
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, Egypt
| | | | - George D. Zouganelis
- Human Science Research Centre, University of Derby, Kedleston Road, DE22 1GB, Derby, United Kingdom
| | - Souty M.Z. Sharkawi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Nahda University, Beni-Suef, Egypt
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Eman Ibrahim Ahmed
- Pharmacology and Therapeutics Department, College of Medicine, Jouf University, Sakaka 72346, Saudi Arabia
- Pharmacology Department, Faculty of Medicine, Fayoum University, Fayoum 63511, Egypt
| | - Ibe Michael Usman
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Halima Nalugo
- Department of Anatomy, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Juma J. Ochieng
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Ibrahim Ssengendo
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Olatayo Segun Okeniran
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Theophilus Pius
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, Kampala International University Teaching Hospital, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Kyobe Ronald Kimanje
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Eric Simidi Kegoye
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Ritah Kenganzi
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, Kampala International University Teaching Hospital, P.O Box 71, Ishaka, Bushenyi, Uganda
| | - Fred Ssempijja
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O Box 71, Ishaka, Bushenyi, Uganda
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El-Sawah SG, Rashwan HM, Althobaiti F, Aldhahrani A, Fayad E, Shabana ES, El-Hallous EI, Amen RM. AD-MSCs and BM-MSCs Ameliorating Effects on The Metabolic and Hepato-renal Abnormalities in Type 1 Diabetic Rats. Saudi J Biol Sci 2022; 29:1053-60. [PMID: 35197774 DOI: 10.1016/j.sjbs.2021.09.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/14/2021] [Accepted: 09/25/2021] [Indexed: 01/31/2023] Open
Abstract
Diabetes mellitus (DM) is one of the most serious threats in the 21th century throughout the human population that needs to be addressed cautiously. Nowadays, stem cell injection is considered among the most promising protocols for DM therapy; owing to its marked tissues and organs repair capability. Therefore, our 4 weeks study was undertaken to elucidate the probable beneficial effects of two types of adult mesenchymal stem cells (MSCs) on metabolism disturbance and some tissue function defects in diabetic rats. Animals were classified into 4 groups; the control group, the diabetic group, the diabetic group received a single dose of adipose tissue-derived MSCs and the diabetic group received a single dose of bone marrow-derived MSCs. Herein, both MSCs treated groups markedly reduced hyperglycemia resulting from diabetes induction via lowering serum glucose and rising insulin and C-peptide levels, compared to the diabetic group. Moreover, the increased lipid fractions levels were reverted back to near normal values as a consequence to MSCs injection compared to the diabetic untreated rats. Furthermore, both MSCs types were found to have hepato-renal protective effects indicated through the decreased serum levels of both liver and kidney functions markers in the treated diabetic rats. Taken together, our results highlighted the therapeutic benefits of both MSCs types in alleviating metabolic anomalies and hepato-renal diabetic complications.
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Key Words
- AD-MSCs, Adipose-derived mesenchymal stem cells
- AGEs, Advanced glycation end products
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BM-MSCs, Bone marrow-derived mesenchymal stem cells
- BUN, Blood urea nitrogen
- CD, Cluster of differentiation
- D, Diabetic
- DM, Diabetes mellitus
- DMEM, Dulbecco's modified Eagle's medium
- DN, Diabetic nephropathy
- Diabetes
- Diabetic nephropathy
- FBG, Fasting blood glucose
- FBS, Fetal bovine serum
- HDL-C, High-density lipoprotein cholesterol
- HO-1, Heme-oxygenase 1
- HbA1c, Glycosylated hemoglobin
- Hyperlipidemia
- IPCs, Insulin producing cells
- ISCT, International Society for Cellular Therapy
- LDL-C, Low-density lipoprotein cholesterol
- LPO, Lipid peroxidation
- MSCs
- MSCs, Mesenchymal stem cells
- PBS, Phosphate-buffered saline
- ROS, Reactive oxygen species
- SEM, Standard error of mean
- SPSS, Statistical Package for Social Scientists
- STZ, Streptozotocin
- T1DM, Type 1 diabetes mellitus
- TC, Total cholesterol
- TG, Triglycerides
- TL, Total lipids
- γ-GT, gamma glutamyl transferase
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Shankar S, Pande A, Geetha TS, Raichurkar K, Sakpal M, Lochan R, Asthana S. A New Variant of an Old Itch: Novel Missense Variant in ABCB4 Presenting with Intractable Pruritus. J Clin Exp Hepatol 2022; 12:701-704. [PMID: 35535055 PMCID: PMC9077154 DOI: 10.1016/j.jceh.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
We report a novel homozygous missense variant in ABCB4 gene in a Yemeni child born to consanguineous parents, with a significant family history of liver disease-related deaths, resulting in a progressive familial intrahepatic cholestasis (PFIC) type 3 phenotype requiring liver transplantation for intractable pruritus.
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Key Words
- ABCB11, ATP binding cassette subfamily B member 11
- ABCB4 mutation
- ABCB4, ATP-binding cassette subfamily B member 4
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- ATP8B1, ATPase phospholipid transporting 8B1
- BSEP, bile salt export pump
- FXR, farnesoid X receptor
- GGT, Gamma Glutamyl- Transpeptidase
- ICP, Intrahepatic cholestasis of pregnancy
- MDR3, multidrug resistance p-glycoprotein 3
- MYO5B, Myosin 5B
- PFIC
- PFIC, Progressive familial intrahepatic cholestasis
- TJP2, Tight junction protein 2
- congenital liver disease
- liver transplantation
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Affiliation(s)
- Sahana Shankar
- Division of Pediatric Gastroenterology, Department of Pediatrics, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Apurva Pande
- Aster Integrated Liver Care, Aster CMI Hospital, Bangalore, India
| | - Thenral S. Geetha
- Medgenome Labs Pvt Ltd, 3rd Floor, Narayana Netralaya Building, # 258/A, Bommasandra, Hosur Road, Narayana Health City, Bangalore, 560 099, India
| | | | | | - Rajiv Lochan
- Aster Integrated Liver Care, Aster CMI Hospital, Bangalore, India
| | - Sonal Asthana
- Aster Integrated Liver Care, Aster CMI Hospital, Bangalore, India,Address for correspondence: Dr. Sonal Asthana, Aster Integrated Liver Care, Aster CMI Hospital, New Airport Road, Hebbal, Bangalore, 560092, India.
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10
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Anand A, Singh AA, Elhence A, Vaishnav M, Biswas S, Gunjan D, Gamanagatti SR, Nayak B, Kumar R, Shalimar. Prevalence and Predictors of Nonalcoholic Fatty Liver Disease in Family Members of Patients With Nonalcoholic Fatty Liver Disease. J Clin Exp Hepatol 2022; 12:362-371. [PMID: 35535086 PMCID: PMC9077183 DOI: 10.1016/j.jceh.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aims Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide. Despite the high prevalence, no screening recommendations yet exist. We designed a prospective observational study to estimate the prevalence of NAFLD in the family of patients with NAFLD and develop a predictive model for identifying it. Methodology The prevalence of NAFLD in patients' family members was estimated using ultrasonography, and univariate and multivariate odds were calculated for its predictors. A model was created using the significant parameters on multivariate odds, and its performance was tested using the area under the receiver operating characteristic (AUROC). Results Among 447 family members of 191 patients with NAFLD, the prevalence of NAFLD was 55.9%. Family members with NAFLD were younger and had lower serum levels of aspartate aminotransferase, alanine aminotransferase (ALT), triglycerides. The liver stiffness measurement and controlled attenuation parameter values were also lesser in family members compared to the index cases. Age, body mass index (BMI), and ALT were independent predictors of NAFLD in the family members. A model combining age and BMI had an AUROC of 0.838 [95% confidence interval (CI) 0.800-0.876, P < 0.001]. Age ≥30 years and BMI ≥25 kg/m2 had an odds ratio of 33.5 (95% CI 17.0-66.0, P < 0.001) for prediction of NAFLD, in comparison to BMI <25 kg/m2 and age <30 years. Conclusion Family members of patients with NAFLD are at increased risk of NAFLD. Screening strategies using BMI and age ensure early identification and could be beneficial in clinical practice.
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Key Words
- ALT, Alanine aminotransferase
- APRI, AST to platelet ratio index
- AST, Aspartate aminotransferase
- AUROC, Area under ROC
- BMI
- BMI, Body mass index
- CAP, Controlled attenuation parameter
- CI, Confidence interval
- EASL, European Association for the Study of the Liver
- FAST, FibroScan-AST
- FDRs, First-degree relatives
- FIB-4, Fibrosis-4
- HDL-C, High-density lipoprotein-cholesterol
- HbA1C, Glycosylated hemoglobin
- LSM, Liver stiffness measure
- MetS, Metabolic syndrome
- NAFLD, Non-alcoholic fatty liver disease
- NASH, Non-alcoholic steatohepatitis
- NCEP-ATP, National Cholesterol Education Program- Adult Treatment Panel
- NFS, NAFLD fibrosis score
- OR, Odds ratio
- ROC, Receiver operating curve
- family members
- nonalcoholic fatty liver disease
- predictors
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Affiliation(s)
- Abhinav Anand
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Amit A. Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Vaishnav
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sagnik Biswas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | | | - Baibaswata Nayak
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr Shalimar, Additional Professor, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India. Tel.: +91 9968405815; Fax: +91 11 26588663, +91 11 26588641.
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Patidar Y, Chandel K, Condati NK, Srinivasan SV, Mukund A, Sarin SK. Transarterial Chemoembolization (TACE) Combined With Sorafenib versus TACE in Patients With BCLC Stage C Hepatocellular Carcinoma - A Retrospective Study. J Clin Exp Hepatol 2022; 12:745-754. [PMID: 35677519 PMCID: PMC9168730 DOI: 10.1016/j.jceh.2021.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Advanced-stage hepatocellular carcinoma is a heterogeneous group with limited treatment options. TACE has been advocated recently by various study groups. The purpose of this study was to evaluate if TACE in combination with sorafenib, as well as TACE alone, was safe and efficacious in treating BCLC stage C HCC. METHODS A retrospective evaluation of the clinical data of 78 patients with BCLC stage C HCC who received either TACE-sorafenib (TS) combination therapy or TACE monotherapy as their first treatment was done. The two groups were compared in terms of radiological tumor response 1 month after the intervention. The two groups were also compared in terms of time to progression (TTP), overall survival (OS), and adverse events. RESULTS The disease control rate (44.9% and 25.8%, respectively, P = 0.09) was higher in the TS combination group than in the TACE monotherapy group after 1 month of treatment. The TS combination group had significantly superior TTP and OS than the TACE group (TTP was 4.6 and 3.1 months, respectively, P = 0.001), and OS was 10.1 and 7.8 months, respectively, P < 0.001). The TACE-S group had a greater cumulative survival time at 6 months, 9 months, and 1 year than the TACE group (97.9%, 51.1%, 25.7% vs. 90.4%, 51.6%, and 0%, respectively). CONCLUSION TS combination therapy in advanced-stage (BCLC-C) HCC significantly improved disease control rate, TTP, and OS compared with TACE alone, without any significant increase in adverse reactions.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCLC, Barcelona-Clinic Liver Cancer
- CT, Computed tomography
- CTCAE, Common terminology criteria for adverse events
- CTP, Child–Turcotte–Pugh
- ECOG, Eastern Cooperative Group
- EHS, Extrahepatic spread
- HCC, Hepatocellular carcinoma
- MRI, Magnetic resonance imaging
- MVI, Macrovascular invasion
- OS, Overall survival
- PS, Performance status
- SPSS, Statistical Package for Social Sciences
- TACE
- TACE, Transarterial chemoembolisation
- TS, TACE-sorafenib
- TTP, Time to tumor progression
- hepatocellular carcinoma (HCC)
- m-RECIST, Modified Response Evaluation Criteria in Solid Tumors
- overall survival
- sorafenib
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India,Address for correspondence. Yashwant Patidar, Department of Interventional Radiology, Institute of Liver and Biliary Sciences, Pocket D-1, Vasant Kunj, New Delhi, 110070, India. Tel.: +9540950980.
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Naveen K. Condati
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shyam V. Srinivasan
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Chhavi N, Ojha S, Awasthi A, Shalimar, Goel A. Serum Level of Alanine- and Aspartate-Aminotransferase Levels in Newborns in India. J Clin Exp Hepatol 2022; 12:306-11. [PMID: 35535103 DOI: 10.1016/j.jceh.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤40 IU/L is normal. This cutoff, although determined in adults, is widely used for newborns. We studied the reference ranges for ALT and AST in newborns in India. Methods We prospectively included babies with gestational age (GA) between 34 and 41weeks and birth weight (BW) ≥ 1500 g. We excluded the babies who either themselves or their mother had risk factors, which could cause elevation of serum levels of liver enzymes. Serum ALT and AST were measured in venous cord blood. The estimated percentile curves for ALT and AST, for BW and GA covariates, were drawn with General Additive Model for Location Scale and Shape (GAMLSS) with Box-Cox Power Exponential (BCPE). Results Five-hundred thirty-seven babies (Boys 53.3%; GA 34-36 wks 19.7%; appropriate for GA 74.9%; BW < 2500 g 20.5%) were included. Overall, mean [SD] serum ALT and AST were 4412 IU/L and 5218 IU/L, respectively. The serum AST was significantly higher than the ALT level, regardless of gender, BW, GA, or fetal growth categories. The percentile curve against GA remained flat for ALT, although it showed a slight rise for AST. Serum levels of ALT and AST plotted against BW were also similar and showed an increase up to 2000 g and then remained stationary after that. Conclusion The serum levels of ALT and AST up to 44 IU/L and 52 IU/L, respectively, can be taken as normal in newborns with BW ≥ 2000 g or GA ≥34 weeks.
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Key Words
- AFD, Appropriate for date
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCPE, Box–Cox Power Exponential
- BW, Birth weight
- GA, Gestational age
- GAMLSS, General Additive Model for Location Scale and Shape
- LFD, Large for date
- SFD, Small for date
- ULN, Upper limit of normal
- alanine aminotransferase
- aspartate aminotransferase
- liver enzymes
- liver injury
- newborns
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13
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Yadav S, Goel A, Lingaiah R, Pradhan M, Katiyar H, Aggarwal R. Serum Bile Acid Levels in Women With Intrahepatic Cholestasis of Pregnancy in India. J Clin Exp Hepatol 2022; 12:379-383. [PMID: 35535067 PMCID: PMC9077159 DOI: 10.1016/j.jceh.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Intrahepatic cholestasis of pregnancy (ICP) manifests as unexplained intense pruritus in the third trimester of pregnancy and is often diagnosed based on elevated serum bile acid measurement. There are no data from India on serum bile acid levels in pregnant women with ICP. Methods Pregnant women with significant pruritus during the third trimester of gestation and with elevated serum alanine aminotransferase and/or aspartate aminotransferase (normal: <40 IU/L) were taken as having ICP. Serum BA levels were measured in them and in nonpregnant women and healthy pregnant women without itching. Results Of the 3735 pregnant women screened, 105 (2.8%) had ICP (age 28 [26-32] years; gestational age 32 [30-36] weeks; primigravida 32.3%, and 95.3% normal fetal growth). Median (interquartile range) serum bile acid levels in nonpregnant women (n = 61; 28 [25-31] years) and pregnant women without ICP (n = 59; 28 [25-31] years) were similar (3.7 [1.6-5.1] μmol/L and 3.7 [2.2-5.8] μmol/L, respectively). By comparison, serum bile acid level in women with ICP (n = 105; 28 [26-32] years) was significantly higher (20.2 [12.7-39.5] μmol/L; P < 0.05 each), being above 10 μmol/L in 88 (83.8%). The optimum cut-off for the diagnosis of ICP in our population was ≥8.6 μmol/L, with sensitivity of 87.6%, specificity of 93.3% and area under the receiver-operator characteristics curve of 0.937 (95% CI: 0.904-0.970). Conclusion Serum BA levels in healthy Indian nonpregnant and pregnant women are similar to those in other populations and can be used to diagnose ICP with an optimal cut-off being 8.6 μmol/L.
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Affiliation(s)
- Sangeeta Yadav
- Department of Maternal & Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Raghavendra Lingaiah
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mandakini Pradhan
- Department of Maternal & Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Harshita Katiyar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India,Address for correspondence. Rakesh Aggarwal, Director, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
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Khedr MA, Adawy NM, Salim TA, Salem ME, Ghazy RM, Elharoun AS, Sultan MM, Ehsan NA. Kupffer Cell Hyaline Globules in Children With Autoimmune Hepatitis. J Clin Exp Hepatol 2022; 12:20-28. [PMID: 35068781 PMCID: PMC8766698 DOI: 10.1016/j.jceh.2021.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hyaline globules (HGs) in the cytoplasm of Kupffer cells (KCs) have been appraised for being a typical feature of autoimmune hepatitis (AIH). This study aimed to determine how useful Kupffer cell hyaline globules (KCHGs) are in diagnosing AIH vs. other causes of pediatric chronic liver diseases (PCLDs). MATERIALS AND METHODS This retrospective study recruited 124 children; 58 with AIH, 50 with chronic hepatitis C virus (HCV) infection, and 16 with Wilson's disease (WD). Two pathologists retrieved paraffin blocks of liver biopsies and prepared new cut sections for Periodic acid-Schiff-Diastase (PAS-D) stain. They independently examined liver biopsies before starting treatment. Two pediatricians reviewed medical records for demographic, clinical, laboratory, and serological findings. RESULTS Females represented 48.6% of the studied children with a median age of 5.8 (4.9) years. Pathologists identified KCHGs in 67.24%, 12.5%, and 6.0% of AIH, WD, and HCV affected children respectively, P < 0.001. A significantly higher proportion of seropositive than seronegative AIH patients had KCHGs (77.5% vs. 50.0%), (P < 0.05). In multivariate analysis, KCHGs and prolonged prothrombin time were the only significant predictors that differentiate between AIH and the other studied PCLDs. The odds ratio of having AIH increased 68 times if KCHGs were seen. Among children with AIH, the presence of KCHGs was associated with higher median levels of direct bilirubin 2.2 (1.3) vs. 1.2 (2.2), and immunoglobulin G 3.2 (1.9) vs. 2.0 (1.7), (P < 0.05), but not to histopathological findings or hepatic fibrosis and activity. CONCLUSIONS KCHGs are key indicators that can differentiate between AIH and other PCLDs, and between seropositive and seronegative AIH.
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Key Words
- AIH, Autoimmune hepatitis
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- AMA, Antimitochondrial antibody
- ANA, Antinuclear antibody
- AST, Aspartate aminotransferase
- GGT, Gamma-glutamyl transpeptidase
- H&E, Hematoxylin and eosin
- HCV, Hepatitis C virus
- IAIHG, International Autoimmune Hepatitis Group
- KCHGs, Kupffer cell hyaline globules
- KCs, Kupffer cells
- Kupffer cells
- LKMA, Liver-kidney microsome 1 antibody
- PAS, Periodic Acid Schiff
- PAS-D, Periodic acid–Schiff–Diastase
- PCLD, Pediatric chronic liver disease
- SMA, Smooth muscle antibody
- WBCs, White blood cell count
- WD, Wilson’s disease
- Wilson’s disease
- antiLC1, Antiliver cytosol type 1 antibody
- autoimmune hepatitis
- hepatitis C virus infection
- hyaline globules
- liver histopathology
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Affiliation(s)
- Mohammed A. Khedr
- Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Egypt
| | - Nermin M. Adawy
- Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Egypt
| | - Tahany A. Salim
- Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Egypt
| | - Menan E. Salem
- Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University, Egypt
| | - Ramy M. Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Egypt
| | - Ahmed S. Elharoun
- Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Egypt
| | - Mervat M. Sultan
- Department of Pathology, National Liver Institute, Menoufia University, Egypt
| | - Nermine A. Ehsan
- Department of Pathology, National Liver Institute, Menoufia University, Egypt
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15
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Chhabra S, Singh SP, Singh A, Mehta V, Kaur A, Bansal N, Sood A. Diabetes Mellitus Increases the Risk of Significant Hepatic Fibrosis in Patients With Non-alcoholic Fatty Liver Disease. J Clin Exp Hepatol 2022; 12:409-416. [PMID: 35535092 PMCID: PMC9077176 DOI: 10.1016/j.jceh.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus is associated with an increased risk of development of non-alcoholic fatty liver disease (NAFLD). However, the risk posed by diabetes mellitus in progression of liver disease is uncertain. This study compared the severity of hepatic fibrosis in patients with NAFLD with and without diabetes mellitus. Methods Consecutive adult patients with NAFLD undergoing transient elastography [FibroScan Touch 502 (Echosens, Paris, France)] at a tertiary care center in north India were analyzed for severity of hepatic fibrosis. The aspartate aminotransferase (AST) to platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and NAFLD Fibrosis Score (NFS) were calculated. The degree of hepatic fibrosis as determined by FibroScan and non-invasive serum fibrosis models in patients with and without diabetes mellitus were compared. Results A total of two hundred patients [118 (59%) males, mean age 50.30 ± 11.13 years] were enrolled. Significant hepatic fibrosis was present in 86 (43%) patients [mean age 50.66 ± 10.96 years, 56 (65.11%) males]. The mean FibroScan, APRI, FIB-4, and NFS scores were 9.86 ± 2.97, 0.75 ± 0.47, 2.41 ± 1.41 and -0.24 ± 1.43 in patients with diabetes compared to 5.31 ± 1.09, 0.49 ± 0.27, 1.55 ± 0.85, and -2.12 ± 1.88 in patients without diabetes, respectively (P=<0.0001). There was a fair correlation between FibroScan and non-invasive serum fibrosis models (P=<0.0001). Conclusion Presence of diabetes increases the risk of significant hepatic fibrosis in patients with NAFLD. FIB-4 correlates fairly with FibroScan in patients with diabetes and can be used as a screening tool to detect significant hepatic fibrosis.
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Key Words
- ALT, Alanine aminotransferase
- APRI, Aspartate aminotransferase to platelet ratio index
- AST, Aspartate aminotransferase
- DM, Diabetes Mellitus
- FIB-4, Fibrosis index based on 4 factors
- HDL, High-density lipoprotein
- HbA1C, Glycosylated hemoglobin
- IFG, Impaired fasting glucose
- LDL, Low-density lipoprotein
- NAFLD, Non-alcoholic fatty liver disease
- NASH, Non-alcoholic steatohepatitis
- NFS, NAFLD Fibrosis Score
- TE, Transient Elastography
- diabetes mellitus
- fibrosis
- liver cirrhosis
- non-alcoholic fatty liver disease
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Affiliation(s)
- Sandeep Chhabra
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Sukhraj P. Singh
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India,Address for correspondence. Varun Mehta, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
| | - Amninder Kaur
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Namita Bansal
- Department of Research and Development, Dayanand Medical College and Hospital, Ludhiana, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
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16
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Erken R, Loukachov VV, de Niet A, Jansen L, Stelma F, Helder JT, Peters MW, Zaaijer HL, Kootstra NA, Willemse SB, Reesink HW. A Prospective Five-Year Follow-up After peg-Interferon Plus Nucleotide Analogue Treatment or no Treatment in HBeAg Negative Chronic Hepatitis B Patients. J Clin Exp Hepatol 2022; 12:735-44. [PMID: 35677522 DOI: 10.1016/j.jceh.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Currently available treatment options for chronic hepatitis B (CHB) are not recommended for HBeAg-negative patients with a low viral load. These patients may however benefit from treatment by achieving a functional cure, defined by HBsAg-loss and undetectable HBV DNA. This study evaluated the long-term effect of combination treatment with peg-interferon-alpha-2a (peg-IFN) and adefovir or tenofovir compared to no treatment in these patients. METHODS HBeAg-negative CHB patients with HBV-DNA levels < 20,000 IU/mL (n = 151) were previously randomised 1:1:1 for peg-IFN 180 μg/week plus either adefovir 10 mg/day or tenofovir 245 mg/day, or no treatment and treated for 48 weeks in an open-label study. In this prospective long-term follow-up study, patients were monitored yearly up to five years after end of treatment (week 308). The primary outcome was sustained HBsAg-loss and secondary outcome the dynamics of HBsAg and HBV-DNA levels over time. RESULTS Of the 131 followed patients, the HBsAg-status was known for 118 patients after five-year follow-up. HBsAg-loss occurred similarly (P = 0.703) in all arms: 8/43 (18.6%) peg-IFN + adefovir, 4/34 (11.7%) peg-IFN + tenofovir, and 6/41 (14.6%) among the untreated patients. The time to HBsAg-loss did not differ between groups (P = 0.641). Low baseline HBsAg levels and genotype A were independently associated with HBsAg-loss irrespective of allocation. HBsAg and HBV-DNA levels declined similarly during follow-up in all patient groups. CONCLUSIONS This prospective randomised controlled study showed that HBsAg-loss overtime was not influenced by treatment with a combination of nucleotide analogue and Peg-IFN. Low baseline HBsAg levels can predict HBsAg-loss irrespective of treatment allocation.
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Key Words
- ADV, Adefovir dipivoxil
- ALT, Alanine aminotransferase
- CHB, Chronic hepatitis B
- EOT, End of treatment
- GZ, Grey zone
- HBeAg, Hepatitis B e antigen
- HBsAg, Hepatitis B surface antigen
- HCC, Hepatocellular Carcinoma
- HNCH, HBeAg-negative chronic infection
- NA, Nucleot(s)ide analogue
- ROC, Receiver operating characteristic
- TAF, Tenofovir alafenamide fumarateor
- TDF, Tenofovir disoproxil fumarate
- ULN, Upper limit of normal
- UMC, University Medical Centers
- combination therapy
- functional cure
- hepatitis B virus
- inactive carrier
- low viral load
- peg-IFN, Pegylated-interferon
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17
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Shalimar, Elhence A, Bansal B, Gupta H, Anand A, Singh TP, Goel A. Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis. J Clin Exp Hepatol 2022; 12:818-829. [PMID: 35677499 PMCID: PMC9168741 DOI: 10.1016/j.jceh.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) contributes to a large proportion of liver disease burden in the world. Several groups have studied the prevalence of NAFLD in the Indian population. AIM A systematic review of the published literature and meta-analysis was carried out to estimate the prevalence of NAFLD in the Indian population. METHODS English language literature published until April 2021 was searched from electronic databases. Original data published in any form which had reported NAFLD prevalence in the Indian population were included. The subgroup analysis of prevalence was done based on the age (adults or children) and risk category, i.e., average-risk group (community population, participants of control arm, unselected participants, hypothyroidic individuals, athletes, aviation crew, and army personnel) and high-risk group (obesity or overweight, diabetes mellitus, coronary artery disease, etc.). The prevalence estimates were pooled using the random-effects model. Heterogeneity was assessed with I2. RESULTS Sixty-two datasets (children 8 and adults 54) from 50 studies were included. The pooled prevalence of NAFLD was estimated from 2903 children and 23,581 adult participants. Among adults, the estimated pooled prevalence was 38.6% (95% CI 32-45.5). The NAFLD prevalence in average-risk and high-risk subgroups was estimated to be 28.1% (95% CI 20.8-36) and 52.8% (95% CI 46.5-59.1), respectively. The estimated NAFLD prevalence was higher in hospital-based data (40.8% [95% CI 32.6-49.3%]) than community-based data (28.2% [95% CI 16.9-41%]). Among children, the estimated pooled prevalence was 35.4% (95% CI 18.2-54.7). The prevalence among non-obese and obese children was 12.4 (95% CI 4.4-23.5) and 63.4 (95% CI 59.4-67.3), respectively. CONCLUSION Available data suggest that approximately one in three adults or children have NAFLD in India.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BMI, Body mass index
- CAD, Coronary artery disease
- CI, Confidence interval
- DM, Diabetes mellitus
- GBD, Global burden of disease
- GDM, Gestational diabetes mellitus
- GDP, Gross domestic product
- HC, Healthy control
- IGT, Impaired glucose tolerance
- NAFLD, Non-alcoholic fatty liver disease
- NASH, Non-alcoholic steatohepatitis
- NPCDCS, National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
- OSA, Obstructive sleep apnea
- PCOS, Polycystic ovarian syndrome
- UT, Union Territories
- diabetes mellitus
- fatty liver
- metabolic syndrome
- obesity
- steatohepatitis
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Affiliation(s)
- Shalimar
- All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Bhavik Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - Hardik Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Anand
- All India Institute of Medical Sciences, New Delhi, India
| | - Thakur P. Singh
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amit Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India,Address for correspondence: Amit Goel, Additional Professor, Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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18
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Hijazi G, Paschall A, Young SP, Smith B, Case LE, Boggs T, Amarasekara S, Austin SL, Pendyal S, El-Gharbawy A, Deak KL, Muir AJ, Kishnani PS. A retrospective longitudinal study and comprehensive review of adult patients with glycogen storage disease type III. Mol Genet Metab Rep 2021; 29:100821. [PMID: 34820282 PMCID: PMC8600151 DOI: 10.1016/j.ymgmr.2021.100821] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction A deficiency of glycogen debrancher enzyme in patients with glycogen storage disease type III (GSD III) manifests with hepatic, cardiac, and muscle involvement in the most common subtype (type a), or with only hepatic involvement in patients with GSD IIIb. Objective and methods To describe longitudinal biochemical, radiological, muscle strength and ambulation, liver histopathological findings, and clinical outcomes in adults (≥18 years) with glycogen storage disease type III, by a retrospective review of medical records. Results Twenty-one adults with GSD IIIa (14 F & 7 M) and four with GSD IIIb (1 F & 3 M) were included in this natural history study. At the most recent visit, the median (range) age and follow-up time were 36 (19–68) and 16 years (0–41), respectively. For the entire cohort: 40% had documented hypoglycemic episodes in adulthood; hepatomegaly and cirrhosis were the most common radiological findings; and 28% developed decompensated liver disease and portal hypertension, the latter being more prevalent in older patients. In the GSD IIIa group, muscle weakness was a major feature, noted in 89% of the GSD IIIa cohort, a third of whom depended on a wheelchair or an assistive walking device. Older individuals tended to show more severe muscle weakness and mobility limitations, compared with younger adults. Asymptomatic left ventricular hypertrophy (LVH) was the most common cardiac manifestation, present in 43%. Symptomatic cardiomyopathy and reduced ejection fraction was evident in 10%. Finally, a urinary biomarker of glycogen storage (Glc4) was significantly associated with AST, ALT and CK. Conclusion GSD III is a multisystem disorder in which a multidisciplinary approach with regular clinical, biochemical, radiological and functional (physical therapy assessment) follow-up is required. Despite dietary modification, hepatic and myopathic disease progression is evident in adults, with muscle weakness as the major cause of morbidity. Consequently, definitive therapies that address the underlying cause of the disease to correct both liver and muscle are needed.
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Key Words
- AFP, Alpha-fetoprotein
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BG, Blood glucose
- BMI, Body mass index
- CEA, Carcinoembryonic antigen
- CPK, Creatine phosphokinase
- CT scan, Computerized tomography scan
- Cardiomyopathy
- Cirrhosis
- DM, Diabetes mellitus
- GDE, Glycogen debrancher enzyme
- GGT, Gamma glutamyl transferase
- GSD, Glycogen storage disease
- Glc4, Glucose tetrasaccharide
- Glycogen storage disease type III (GSD III)
- HDL, High density lipoprotein
- Hypoglycemia
- LDL, Low density lipoproteins
- LT, liver transplantation.
- Left ventricular hypertrophy (LVH)
- MRI, Magnetic resonance imaging
- TGs, Triglycerides
- US, Ultrasound
- and myopathy
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Affiliation(s)
- Ghada Hijazi
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Anna Paschall
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Sarah P Young
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Brian Smith
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Laura E Case
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tracy Boggs
- Duke University Health System, Department of Physical Therapy and Occupational Therapy, USA
| | | | - Stephanie L Austin
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Surekha Pendyal
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Areeg El-Gharbawy
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Kristen L Deak
- Department of Pathology, Duke University, Durham, NC, USA
| | - Andrew J Muir
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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Zheng H, Jin S, Li T, Ying W, Ying B, Chen D, Ning J, Zheng C, Li Y, Li C, Chen C, Li X, Gao H. Metabolomics reveals sex-specific metabolic shifts and predicts the duration from positive to negative in non-severe COVID-19 patients during recovery process. Comput Struct Biotechnol J 2021; 19:1863-1873. [PMID: 33841749 PMCID: PMC8021501 DOI: 10.1016/j.csbj.2021.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Metabolic profiling in COVID-19 patients has been associated with disease severity, but there is no report on sex-specific metabolic changes in discharged survivors. Herein we used an integrated approach of LC-MS-and GC-MS-based untargeted metabolomics to analyze plasma metabolic characteristics in men and women with non-severe COVID-19 at both acute period and 30 days after discharge. The results demonstrate that metabolic alterations in plasma of COVID-19 patients during the recovery and rehabilitation process were presented in a sex specific manner. Overall, the levels of most metabolites were increased in COVID-19 patients after the cure relative to acute period. The major plasma metabolic changes were identified including fatty acids in men and glycerophosphocholines and carbohydrates in women. In addition, we found that women had shorter length of hospitalization than men and metabolic characteristics may contribute to predict the duration from positive to negative in non-severe COVID-19 patients. Collectively, this study shed light on sex-specific metabolic shifts in non-severe COVID-19 patients during the recovery process, suggesting a sex bias in prognostic and therapeutic evaluations based on metabolic profiling.
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Key Words
- ALT, Alanine aminotransferase
- AP, Acute period (AP)
- APTT, Activated partial thromboplastin time
- BCAAs, Branched‐chain amino acids
- BP, Blood platelet
- CA, Carbamide
- COVID-19
- COVID-19, Novel coronavirus disease 2019
- CRP, C-reactive protein
- DAA, Dehydroascorbic acid
- DD, D-dimer
- DP, Diastolic pressure
- FIB, Fibrinogen
- FP, Follow-up period
- Fatty acid
- GPCs, Glycerophosphocholines
- HGB, Hemoglobin
- LY, Lymphocyte
- Metabolism
- NG, Neutrophilic granulocyte
- NK, Natural killer
- PCT, Procalcitonin
- PLS-DA, Partial least squares-discriminant analysis
- PLSR, Partial least squares regression
- PT, Prothrombin time
- PTC, Phosphatidylcholine
- RDW, Red cell distribution width
- RR, Respiratory rate
- S1P, Sphingosine-1-phosphate
- SARS-CoV
- Sex difference
- TBL, Total B lymphocyte
- TTL, Total T lymphocyte
- WBC, White blood cell
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Affiliation(s)
- Hong Zheng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Shengwei Jin
- Department of Anesthesia and Critical Care, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Ting Li
- Clinical Research Unit, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Weiyang Ying
- Department of Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Binyu Ying
- Department of Critical Care Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Dong Chen
- Wenzhou Central Hospital, Wenzhou 325015, China
| | - Jie Ning
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Chanfan Zheng
- Clinical Research Unit, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China
| | - Chen Li
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Chengshui Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China
| | - Xiaokun Li
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Hongchang Gao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
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20
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Datta A, Alam MJ, Khaleda L, Al-Forkan M. Protective effects of Corchorus olitorius and Butea monosperma against Arsenic induced aberrant methylation and mitochondrial DNA damage in wistar rat model. Toxicol Rep 2021; 8:30-37. [PMID: 33391994 PMCID: PMC7772721 DOI: 10.1016/j.toxrep.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/07/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022] Open
Abstract
Arsenic exposure through food causes genotoxic effects in vivo. Sub chronic exposure to Arsenic causes pre-cancerous changes. C. olitorious & B. monosperma have significant nephro & hepato protective potential. Protective effect of both plants species is evident in molecular level. Potent use as readily available food supplement to minimize Arsenic toxicity.
Millions of people around the world are chronically exposed to Arsenic (As) through food and drinking water. Studies revealed that Arsenic is genotoxic and causes damage to DNA. In this study, we evaluated Corchorus olitorius and Butea monosperma for their alleviative properties against Arsenic induced genotoxicity in vivo using Wistar Rat model. Arsenic exposed rats were given C. olitorius leaf powder and B. monosperma flower powder as supplementation with normal food. Methylation status of p53 promoter was measured using Methylation Sensitive Restriction Endonuclease PCR (MSRE-PCR) assay and mitochondrial DNA (mtDNA) copy number as well as occurrence of a common deletion in mtDNA in liver and kidney tissue was determined through quantitative realtime PCR (qPCR). Arsenic exposed rats after supplementation showed relatively less severe effects of toxicity evident by significantly higher amount of (p<0.05) mtDNA copy number and reduced occurrence of deletion containing mtDNA as well as lower levels of methylation in p53 gene promoter. Histopathological analysis revealed less severe histopathological changes of liver and kidney and normal liver and kidney function parameters in supplemented rats. So, the protective properties of B. monosperma and C. olitorius against Arsenic toxicity is evident in molecular level.
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Affiliation(s)
- Amit Datta
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, 4331, Bangladesh
| | - Md Jibran Alam
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, 4331, Bangladesh
| | - Laila Khaleda
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, 4331, Bangladesh
| | - Mohammad Al-Forkan
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, 4331, Bangladesh
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21
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Sunil Kumar N, Remalayam B, Thomas V, Ramachandran TM, Sunil Kumar K. Outcomes and Predictors of Mortality in Patients With Drug-Induced Liver Injury at a Tertiary Hospital in South India: A Single-Centre Experience. J Clin Exp Hepatol 2021; 11:163-170. [PMID: 33746440 PMCID: PMC7952999 DOI: 10.1016/j.jceh.2020.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Drug-induced liver injury (DILI) is an important cause of acute liver failure with significant morbidity and mortality. The outcome of DILI varies widely according to the drug implicated and the type of liver injury. Owing to the heterogeneous nature of liver injury, knowledge on clinical course and prognosis of DILI is limited. We had undertaken this study to determine the clinical characteristics, outcomes, and predictors of mortality in patients with DILI. MATERIALS AND METHODS This prospective study was conducted from January 2015 through December 2018. We analyzed the drugs implicated, clinical course, and the outcome. Causality assessment was performed by using Roussel Uclaf Causality Assessment Method scoring. Patients were followed for 6 months until recovery/death or liver transplantation. RESULTS There were 133 cases with DILI. The mean age was 47.6 years, and 51.9% of them were men. Drugs causing DILI were antitubercular drugs (37.5%) followed by neuropsychiatric drugs (16.5%), antibiotics/antifungals (12%), complementary and alternative medicine (10.5%), immunomodulatory/chemotherapeutic drugs (10.5%), and nonsteroidal antiinflammatory drugs (7.5%). Eighty-two (61.6%) patients were classified as hepatocellular, 30 (22.5%) as mixed and 21 (15.7%) as cholestatic type of injury. There was no significant difference in the mortality and morbidity between the three types of liver injury. There were 18 deaths (13.5%), of which antitubercular drugs constituted the majority (55.5%) followed by neuropsychiatric drugs (27.7%) and complementary and alternative medicine (16.6%). Based on receiver operating characteristic curve analysis, model for end-stage liver disease (MELD) score >28, mean international normalized ratio (INR) >1.97, mean bilirubin level >15.6 mg/dl, and creatinine level >1.35 mg/dl were associated with mortality. CONCLUSION Although DILI is uncommon, it has significant morbidity and mortality. Antitubercular drugs were the most common cause for DILI and DILI-related mortality in our study. Variables such as MELD, INR, bilirubin, albumin, and creatinine help in predicting severity of liver injury and may help in triaging the patient for referral for liver transplantation.
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Key Words
- ALF, Acute liver failure
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- ATT, Antitubercular therapy
- BMI, Body mass index
- CAM, Complementary and alternative medicine
- DILI
- DILI, Drug induced liver injury
- DOTS, Directly observed therapy short course
- DRESS, Drug reaction with eosinophilia and systemic symptoms
- Hb, Hemoglobin
- INR, International normalized ratio
- LFT, Liver function test
- MELD, Model for end stage liver disease
- MRCP, Magnetic resonance cholangio pancreatography
- NSAID, Non-steroidal anti-inflammatory drugs
- PT, Prothrombin time
- RBS, Random blood sugar
- RUCAM, Roussel Uclaf Causality Assessment Method
- SD, Standard deviation
- ULN, Upper limit normal
- WBC, White blood cell
- antitubercular drugs
- complementary and alternative medicine (CAM)
- mortality
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Affiliation(s)
| | | | - Varghese Thomas
- Address for correspondence: Varghese Thomas, Former HOD and Professor
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Mukund A, Bhardwaj K, Choudhury A, Sarin SK. Survival and Outcome in Patients Receiving Drug-Eluting Beads Transarterial Chemoembolization for Large Hepatocellular Carcinoma (>5 cm). J Clin Exp Hepatol 2021; 11:674-681. [PMID: 34866846 PMCID: PMC8617544 DOI: 10.1016/j.jceh.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to study the outcome and survival of patients with large hepatocellular carcinoma (HCC) receiving drug-eluting beads (DEBs) transarterial chemoembolization (TACE). In addition, tumor morphologies were correlated with the response and survival to analyze the association of morphology with the outcome. METHODS Patients with large HCC (>5 cm) who underwent DEB-TACE for palliation were analyzed retrospectively. Patients were assessed for objective response (OR) and overall survival (OS), which was calculated from the first session of DEB-TACE to the last follow-up/death. OR and OS were calculated for the entire study group and were compared among the subgroups consisting of solitary versus multifocal HCC, unilobar versus bilobar disease, well-defined versus ill-defined HCC, and HCC with homogeneous enhancement versus HCC with heterogeneous enhancement. RESULTS Sixty-seven DEB-TACE procedures were performed in 25 patients (average: 2.7 ± 1.4 sessions per patient). The mean lesion size was 9.9 ± 4.5 cm. Of 25 patients, 13 (52%) had multifocal HCC. Unilobar disease was seen in 15 patients (60%). The mean duration of follow-up was 24.4 months. OR at 6 and 12 months were 56% and 48%, respectively, with well-defined lesions showing better OR. The median OS was 28 months (95% confidence interval, 12.3-43.6). OS rate at 12 and 24 months was 92% and 57%, respectively. OS was seen to be superior in well-defined HCC and unilobar disease. CONCLUSION In this study, DEB-TACE has shown to have a good response in patients having large/multifocal HCC with preserved liver functions. Well-defined HCC and unilobar disease have a better response and survival.
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Key Words
- AFP, Alpha-fetoprotein
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCLC, Barcelona-Clinic Liver Cancer Classification
- CBC, Complete blood count
- CR, Complete response
- CT, Computed tomography
- DEB-TACE
- DEB-TACE, Drug-eluting beads TACE
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- INR, International normalized ratio
- MRI, Magnetic resonance imaging
- OR, Objective response
- OS, Overall survival
- PD, Progressive disease
- PR, Partial response
- SD, Stable disease
- TLC, Total leucocyte count
- cTACE, Conventional (Lipiodol) TACE
- hepatocellular carcinoma (HCC)
- loco-regional therapy
- mRECIST, Modified Response Evaluation Criteria in Solid Tumors
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Affiliation(s)
- Amar Mukund
- Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India,Address for correspondence. Amar Mukund, Additional Professor, Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India.
| | - Krishna Bhardwaj
- Department of Radiology, VMMC & Safdarjung Hospital, Ansari Nagar, New Delhi, India
| | - Ashok Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
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Devarbhavi H, Joseph T, Sunil Kumar N, Rathi C, Thomas V, Prasad Singh S, Sawant P, Goel A, Eapen CE, Rai P, Arora A, Leelakrishnan V, Gopalakrishnan G, Vardhan Reddy V, Singh R, Goswami B, Venkataraman J, Balaraju G, Patil M, Patel R, Taneja S, Koshy A, Nagaraja Rao P, Kumar Sarin S, Rathi P, Dhiman R, Duseja AK, Vargese J, Kumar Jain A, Wadhawan M, Ranjan P, Karanth D, Ganesh P, Nijhawan S, Krishna Dhali G, Adarsh CK, Jhaveri A, Nagral A, Rao P, Shalimar. The Indian Network of Drug-Induced Liver Injury: Etiology, Clinical Features, Outcome and Prognostic Markers in 1288 Patients. J Clin Exp Hepatol 2021; 11:288-298. [PMID: 33994711 PMCID: PMC8103312 DOI: 10.1016/j.jceh.2020.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Etiology of and outcomes following idiosyncratic drug-induced liver injury (DILI) vary geographically. We conducted a prospective study of DILI in India, from 2013 to 2018 and summarize the causes, clinical features, outcomes and predictors of mortality. METHODS We enrolled patients with DILI using international DILI expert working group criteria and Roussel Uclaf causality assessment method. Follow-up was up to 3 months from onset of DILI or until death. Multivariate logistics regression was carried out to determine predictors of non-survival. RESULTS Among 1288 patients with idiosyncratic DILI, 51.4% were male, 68% developed jaundice, 68% required hospitalization and 8.2% had co-existing HIV infection. Concomitant features of skin reaction, ascites, and encephalopathy (HE) were seen in 19.5%, 16.4%, and 10% respectively. 32.4% had severe disease. Mean MELD score at presentation was 18.8 ± 8.8. Overall mortality was 12.3%; 65% in those with HE, 17.6% in patients who fulfilled Hy's law, and 16.6% in those that developed jaundice. Combination anti-TB drugs (ATD) 46.4%, complementary and alternative medicines (CAM) 13.9%, anti-epileptic drugs (AED) 8.1%, non-ATD antimicrobials 6.5%, anti-metabolites 3.8%, anti-retroviral drugs (ART)3.5%, NSAID2.6%, hormones 2.5%, and statins 1.4% were the top 9 causes. Univariate analysis identified, ascites, HE, serum albumin, bilirubin, creatinine, INR, MELD score (p < 0.001), transaminases (p < 0.04), and anti-TB drugs (p = 0.02) as predictors of non-survival. Only serum creatinine (p = 0.017), INR (p < 0.001), HE (p < 0.001), and ascites (p = 0.008), were significantly associated with mortality on multivariate analysis. ROC yielded a C-statistic of 0.811 for MELD and 0.892 for combination of serum creatinine, INR, ascites and HE. More than 50 different agents were associated with DILI. Mortality varied by drug class: 15% with ATD, 13.6% with CAM, 15.5% with AED, 5.8% with antibiotics. CONCLUSION In India, ATD, CAM, AED, anti-metabolites and ART account for the majority of cases of DILI. The 3-month mortality was approximately 12%. Hy's law, presence of jaundice or MELD were predictors of mortality.
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Key Words
- AED, Anti-epileptic drugs
- ALF, Acute liver failure
- ALT, Alanine aminotransferase
- ART, Anti-retroviral drugs
- AST, Aspartate aminotransferase
- ATD, Anti- tuberculosis drugs
- Anti-tuberculosis drugs
- C.I, Confidence interval
- CAM, Complementary and alternative medicine
- Complimentary medicines
- DILI, Drug-induced liver injury
- DILIN, Drug induced liver injury network
- HE, Hepatic encephalopathy
- HIV, Human immunodeficiency virus
- INR, International normalised ratio
- Isoniazid
- Jaundice
- MELD, Model for end stage liver disease
- Mortality
- NSAID, Nonsteroidal anti-inflammatory drugs
- OR, Odds ratio
- Prognosis
- Pyrazinamide
- ROC, Receiver operating characteristic
- RUCAM, Roussel uclaf causality assessment method
- Rifampicin
- TB, Tuberculosis.
- TCM, Traditional chinese medicines.
- Traditional medicines
- ULN, Upper limit of normal
- USA, United states of america
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Affiliation(s)
- Harshad Devarbhavi
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India,Address for correspondence. Harshad Devarbhavi, Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, India.
| | - Tarun Joseph
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India
| | | | - Chetan Rathi
- Department of Gastroenterology, LTM Medical College Hospital, Mumbai, India
| | - Varghese Thomas
- Department of Gastroenterology, Government Medical College, Kozhikode, India
| | | | - Prabha Sawant
- Department of Gastroenterology, LTM Medical College Hospital, Mumbai, India
| | - Ashish Goel
- Department of Gastroenterology, Christian Medical College, Vellore, India
| | | | - Prakash Rai
- Department of General Medicine, Holy Spirit Hospital, Mumbai, India
| | - Anil Arora
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Vishnu Vardhan Reddy
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India
| | - Rajvir Singh
- Acute Care Surgery, HGH, Hamad Medical Corporation, Doha, Qatar
| | - Bhabadev Goswami
- Department of Gastroenterology, Dispur Hospitals, Guwahati, India
| | | | - Girisha Balaraju
- Department of Gastroenterology, Kasturba Medical College Hospital, Manipal, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India
| | - Rakesh Patel
- Department of Gastroenterology, Suyash Endoscopy Centre, Thane, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Abraham Koshy
- Department of Gastroenterology, Lakeshore Hospital, Kochi, India
| | - Padaki Nagaraja Rao
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pravin Rathi
- Department of Gastroenterology, B.Y.L. Nair Hospital, Mumbai, India
| | - Radhakrishna Dhiman
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ajay K. Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Joy Vargese
- Department of Hepatology, Gleneagles Global Health City, Chennai, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Centre, Indore, India
| | - Manav Wadhawan
- Department of Gastroenterology, BLK Super Speciality Hospital, New Delhi, India
| | - Piyush Ranjan
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dheeraj Karanth
- Department of Gastroenterology, Vikram Hospital, Bangalore, India
| | | | - Sandeep Nijhawan
- Department of Gastroenterology, Sawai Man Singh Medical College, Jaipur, India
| | - Gopal Krishna Dhali
- School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Channagiri K. Adarsh
- Department of Gastroenterology, BGS Gleneagles Global Hospitals, Bangalore, India
| | - Ajay Jhaveri
- Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India
| | - Prasanna Rao
- Department of Gastroenterology, Apollo Hospitals, Bangalore, India
| | - Shalimar
- Department of Gastroenterology and Hepatology, AIIMS, New Delhi, India
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Shetty D, Amarapurkar A, Shukla A. Primary Versus Secondary NAFLD: Perspective on Advanced Fibrosis. J Clin Exp Hepatol 2021; 11:557-64. [PMID: 34511816 DOI: 10.1016/j.jceh.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The presence of macrovesicular steatosis on liver biopsy is the commonest histopathological finding. Nonalcoholic fatty liver disease (NAFLD) is the presence of ≥5% macrovesicular steatosis without significant alcohol use. It is subdivided into primary and secondary NAFLD; information on their differences is limited. AIM To determine the histopathological differences between primary and secondary NAFLD and establish whether the prevalence of advanced fibrosis varies between the two types. METHODOLOGY Three years of retrospective study of 90 liver biopsies with ≥5% macrovesicular steatosis. Age, gender, clinical history, serum transaminase levels were noted. The biopsy was reviewed for steatosis, inflammation, and fibrosis. Differences between primary and secondary NAFLD for age, gender, AST/ALT ratio, histopathological features were determined. Descriptive statistical analysis, 2-tailed Student's t test, Chi-square test, Fisher's exact test were used, where p < 0.05 was considered significant. RESULT Primary and secondary NAFLD were 42 (46.7%) and 48 (53.3%), respectively. Inflammation was noted in 50 (55.5%) and fibrosis in 31 (34.4%). The prevalence of advanced fibrosis was 24.4%. Primary and secondary NAFLD differed significantly on ballooning degeneration, Mallory Denk bodies (MDBs), glycogenated nuclei, and fibrosis stage (p < 0.05). There were no significant differences among AST/ALT ratio, steatosis, and inflammation grade. CONCLUSION Primary NAFLD is a more severe type of liver disease. On histopathology, ballooning degeneration, MDBs, glycogenated nuclei, and advanced fibrosis was more prevalent in primary than secondary NAFLD.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HIV, Human immunodeficiency virus
- MDB, Mallory hyaline bodies
- MTX, Methotrexate
- NAFLD, Nonalcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH, Nonalcoholic steatohepatitis
- advanced fibrosis
- inflammation
- non-alcoholic fatty liver disease
- primary NAFLD
- secondary NAFLD
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25
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Ajayi AF, Olaleye BS. Age-related changes in haematological parameters and biochemical markers of healing in the stomach of rats with acetic acid induced injury. Toxicol Rep 2020; 7:1272-1281. [PMID: 32995300 PMCID: PMC7511975 DOI: 10.1016/j.toxrep.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
This study examined the changes in haematological and biochemical variables in response to gastric mucosa injury in male Wistar rats divided into four groups according to their ages (3, 6, 12, and 18 months). 0.2 ml of acetic acid was injected intraluminal into the stomach glandular portion of each rat for 45 seconds under anaesthesia. Collection of blood and stomach samples occurred on days 3, 7, 14 and 21 post-induction of gastric ulcer. The results obtained from this study showed 100 % area of gastric mucosa healed in 3-month old rats, 91.72 %, 68.52 % and 62.81 % area of mucosa treated in 6, 12 and 18-month old rats respectively on day 21 post-induction of gastric ulcer. Increased circulation of blood cells in younger rats occurred, neutrophil-lymphocyte ratio (NLR) was decreased in younger rats (3 and 6 months) significantly (p < 0.05) when compared to older rats (12 and 18 months). Lipid peroxidation and glutathione (GSH) levels were elevated in older rats (12 and 18 months) significantly (p < 0.05) when compared to younger rats (3 and 6 months). In comparison, superoxide dismutase (SOD) and catalase levels were decreased in older rats (12 and 18 months) significantly (p < 0.05) when compared to younger rats (3 and 6 months). Histological evaluation showed evidence of early healing with re-epithelialisation and angiogenesis in younger rats, but older rats showed delayed healing. The study showed that the slower rate of healing of gastric ulcer with advancing age in rats might be due to reducing circulating blood cells and anti-inflammatory activities during healing via a lipid peroxidation-dependent mechanism.
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Key Words
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- ANOVA, Analysis of variance
- AST, Aspartate aminotransferase
- Age
- Angiogenesis
- DTNB, 5, 5' –Dithiobis-2-nitrobenzoic acid
- EGF, Epithelial growth factor
- GSH, Glutathione
- HB, Haemoglobin
- Haematology
- KIM-1, Kidney injury molecule-1
- Lipid peroxidation
- MDA, Malondialdehyde
- MDA-TBA, Malondialdehyde-thiobarbituric acid
- NLR, Neutrophil-lymphocyte ratio
- NSAID, Nonsteroidal anti-inflammatory drugs
- Neutrophil-lymphocyte ratio
- PDEGF, Platelet-derived endothelial growth factor
- PLT, Platelets
- RBC, Red blood cell
- ROS, Reactive oxygen species
- Re-epithelialisation
- SOD, Superoxide dismutase
- TFF, 3 Trefoil factor 3
- VEGF, vascular endothelial growth factor
- WBC, White blood cell
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Affiliation(s)
- Ayodeji F Ajayi
- Department of Physiology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Babafemi S Olaleye
- Department of Physiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Rouf R, Uddin SJ, Sarker DK, Islam MT, Ali ES, Shilpi JA, Nahar L, Tiralongo E, Sarker SD. Antiviral potential of garlic ( Allium sativum) and its organosulfur compounds: A systematic update of pre-clinical and clinical data. Trends Food Sci Technol 2020; 104:219-234. [PMID: 32836826 PMCID: PMC7434784 DOI: 10.1016/j.tifs.2020.08.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Garlic (Allium sativum L.) is a common herb consumed worldwide as functional food and traditional remedy for the prevention of infectious diseases since ancient time. Garlic and its active organosulfur compounds (OSCs) have been reported to alleviate a number of viral infections in pre-clinical and clinical investigations. However, so far no systematic review on its antiviral effects and the underlying molecular mechanisms exists. SCOPE AND APPROACH The aim of this review is to systematically summarize pre-clinical and clinical investigations on antiviral effects of garlic and its OSCs as well as to further analyse recent findings on the mechanisms that underpin these antiviral actions. PubMed, Cochrane library, Google Scholar and Science Direct databases were searched and articles up to June 2020 were included in this review. KEY FINDINGS AND CONCLUSIONS Pre-clinical data demonstrated that garlic and its OSCs have potential antiviral activity against different human, animal and plant pathogenic viruses through blocking viral entry into host cells, inhibiting viral RNA polymerase, reverse transcriptase, DNA synthesis and immediate-early gene 1(IEG1) transcription, as well as through downregulating the extracellular-signal-regulated kinase (ERK)/mitogen activated protein kinase (MAPK) signaling pathway. The alleviation of viral infection was also shown to link with immunomodulatory effects of garlic and its OSCs. Clinical studies further demonstrated a prophylactic effect of garlic in the prevention of widespread viral infections in humans through enhancing the immune response. This review highlights that garlic possesses significant antiviral activity and can be used prophylactically in the prevention of viral infections.
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Key Words
- AGE, Aged garlic extract
- AIV-H9N2, Avian influenza virus-H9N2
- ALT, Alanine aminotransferase
- ARVI, Acute respiratory viral infection
- AdV-3, Adenovirus-3
- AdV-41, Adenovirus-41
- Allium sativum
- CBV-3, Coxsackie B −3
- CPE, Cytopathic effect
- CoV, Coronavirus
- DADS, Diallyl disulfide
- DAS, Diallyl sulfide
- DATS, Diallyl trisulfide
- DDB, Dimethyl-4,4′-dimethoxy-5,6,5′,6′-dimethylene dioxybiphenyl-2,2′-dicarboxylate
- ECHO11, Echovirus-11
- ECM, Extracellular matrix
- ERK, Extracellular-signal-regulated kinase
- FDA, Food and drug administration
- Functional food
- GE, Garlic extract
- GLRaV‐2, Grapevine leafroll‐associated virus 2
- GO, Garlic oil
- GRAS, Generally regarded as safe
- HAV, Hepatitis A virus
- HCMV, Human cytomegalovirus
- HIV-1, Human immunodeficiency virus-1
- HPV, Influenza B virus Human papillomavirus
- HRV-2, Human rhinovirus type 2
- HSV-1, Herpes simplex virus-1
- HSV-2, Herpes simplex virus-2
- Hp, Haptoglobin
- IAV-H1N1, IBV Influenza A virus-H1N1
- IEG1, Immediate-early gene 1
- IEGs, Immediate-early genes
- Immunomodulatory
- LGE, Lipid garlic extract
- MAPK, Mitogen activated protein kinase
- MARS-CoV, Middle East respiratory syndrome coronavirus
- MDCK cells, Madin-darby canine kidney cells
- MeV, Measles virus
- NA, Not available
- NDV, Newcastle disease virus
- NK, Natural killer
- OSCs, Organosulfur compounds
- Organosulfur compounds
- PGE, Powdered garlic extract
- PIV- 3, Parainfluenza virus-3
- PRRSV, Porcine reproductive and respiratory syndrome virus
- PRV, Porcine Rotavirus
- PVY, Potato Virus Y
- Pandemic
- RCTs, Randomized clinical trials
- RMCW, Recalcitrant multiple common warts
- RV-SA-11, Rotavirus SA-11
- SAC, Serum antioxidant concentration
- SAMC, S-allyl-mercaptocysteine
- SAMG, S-allyl-mercapto-glutathione
- SARS-CoV, Severe acute respiratory syndrome coronavirus
- SI, Selectivity index
- SRGE, Sustained release garlic extract
- SWV, Spotted wilt virus
- VSV, Vesicular stomatitis virus
- VV, Vaccinia virus
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Affiliation(s)
- Razina Rouf
- Department of Pharmacy, Faculty of Life Science, Bangabandhu Sheikh Mujibur Rahman Science & Technology University, Gopalganj, 8100, Bangladesh
| | - Shaikh Jamal Uddin
- Laboratory of Theoretical and Computational Biophysics, Ton Duc Thang University, Ho Chi Minh City, 700000, Viet Nam.,Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, 700000, Viet Nam
| | - Dipto Kumer Sarker
- Pharmacy Discipline, Life Science School, Khulna University, Khulna 9208, Bangladesh
| | - Muhammad Torequl Islam
- Department of Pharmacy, Faculty of Life Science, Bangabandhu Sheikh Mujibur Rahman Science & Technology University, Gopalganj, 8100, Bangladesh
| | - Eunus S Ali
- Department of Biochemistry and Molecular Genetics, Northwestern University, Chicago, IL 60611, USA
| | - Jamil A Shilpi
- Pharmacy Discipline, Life Science School, Khulna University, Khulna 9208, Bangladesh
| | - Lutfun Nahar
- Centre for Natural Products Discovery, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Evelin Tiralongo
- School of Pharmacy and Pharmacology, Griffith University, Southport, Qld, Australia
| | - Satyajit D Sarker
- Centre for Natural Products Discovery, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool, L3 3AF, UK
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Maguolo A, Rodella G, Dianin A, Nurti R, Monge I, Rigotti E, Cantalupo G, Salviati L, Tucci S, Pellegrini F, Molinaro G, Lupi F, Tonin P, Pasini A, Campostrini N, Ion Popa F, Teofoli F, Vincenzi M, Camilot M, Piacentini G, Bordugo A. Diagnosis, genetic characterization and clinical follow up of mitochondrial fatty acid oxidation disorders in the new era of expanded newborn screening: A single centre experience. Mol Genet Metab Rep 2020; 24:100632. [PMID: 32793418 DOI: 10.1016/j.ymgmr.2020.100632] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Mitochondrial fatty acid oxidation disorders (FAODs) are a heterogeneous group of hereditary autosomal recessive diseases included in newborn screening (NBS) program in Italy. The aim of this study was to analyse FAODs cases, identified either clinically or by NBS,for clinical and genetic characterization and to evaluate a five years' experience of NBS, in the attempt to figure out the complexity of genotype-phenotype correlation and to confirm the clinical impact of NBS in our centre experience. Materials and methods We analysed FAODs patients diagnosed either by NBS or clinically, followed since February 2014 to April 2019 at the Regional Screening Centre and Inherited Metabolic Diseases Unit of Verona. Diagnosis was confirmed by plasma acylcarnitines, urinary organic acids, enzymatic and genetic testing. For not clear genotypes due to the presence of variants of uncertain significance, in silico predictive tools have been used as well as enzymatic activity assays. Patients underwent clinical, nutritional and biochemical follow up. Results We diagnosed 30 patients with FAODs. 20 by NBS: 3 CUD, 6 SCADD, 5 MCADD, 4 VLCADD, 2 MADD. Overall incidence of FAODs diagnosed by NBS was 1:4316 newborns. No one reported complications during the follow up period. 10 patients were diagnosed clinically: 2 CUD, 2 CPT2D, 1 VLCADD, 5 MADD. Mean age at diagnosis was 29.3 years. Within this group, complications or symptoms were reported at diagnosis, but not during follow-up. 12 mutations not previously reported in literature were found, all predicted as pathogenic or likely pathogenic. Discussion and conclusions Our study highlighted the great phenotypic variability and molecular heterogeneity of FAODs and confirmed the importance of a tailored follow up and treatment. Despite the short duration of follow up, early identification by NBS prevented diseases related complications and resulted in normal growth and psycho-motor development as well. Early identification by newborn screening prevents disease related complications. Newborn screening is changing prevalence clinical and molecular heterogeneity of FAODs. Genotype-phenotype correlation helps to achieve personalized follow-up and treatment. Enzymatic assay may be pivotal in predicting phenotype and symptoms severity. Diagnosis on clinical grounds is anyway important to change disease course.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- CACTD, carnitine-acylcarnitine translocase deficiency
- CK, creatine kinase
- CPT1/2 D, carnitine palmitoyl-CoA transferase 1/2 deficiency
- CUD, carnitine uptake defect
- DBS, dried blood spots
- DNA, Deoxyribonucleic acid
- Enzymatic activity
- Expanded newborn screening
- FAODs, fatty acid oxidation disorders
- Fatty acid oxidation defects
- Hypoglycaemia
- LCHADD, Long chain 3-hydroxyacyl-CoA dehydrogenase deficiency
- MADD, multiple acyl-CoA dehydrogenase deficiency
- MCADD, medium-chain acyl-CoA dehydrogenase deficiency
- Myopathy
- NBS, newborn screening
- NGS, next generation sequencing
- PCR, polymerase chain reaction
- SCADD, short chain acyl-CoA dehydrogenase deficiency
- Synergistic heterozygosity
- TFPD, trifunctional protein deficiency
- TMS, tandem mass spectrometry
- VLCADD, very-long-chain acyl-CoA dehydrogenase deficiency
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Geerlofs L, He Z, Xiao S, Xiao ZC. Repeated dose (90 days) oral toxicity study of ursolic acid in Han-Wistar rats. Toxicol Rep 2020; 7:610-623. [PMID: 32435599 PMCID: PMC7229404 DOI: 10.1016/j.toxrep.2020.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/26/2020] [Accepted: 04/14/2020] [Indexed: 01/17/2023] Open
Abstract
Ursolic acid was administered at a dose of 100, 300 or 1000 mg/kg/day. No Ursolic acid related effects were found after administrating orally for 90 days. The no observed adverse effect level is likely to be higher than 1000 mg/kg/day.
Background Ursolic acid (UA) has been used in alternative medicine for decades, and there has been a great interest in its medicinal properties. Despite this increased interest, a detailed long-term toxicity study has not been performed. The objective of this study was to determine the long-term toxic effect of UA on clinical chemistry, haematology, coagulation, pathology/morphology, behaviour and motor skills in rats. Methods A solution was made by dissolving UA in a mixture of 0.1% Tween 80 and 0.5% hydroxypropyl methylcellulose in Milli-Q Water. The control group received the vehicle, and the test groups received a dose up to 1000 mg/kg/day via oral gavage. The solution was administered to both male and female (Han-Wistar) rats for 90 consecutive days. Results UA did not cause any deaths, abnormal body weights or abnormal pathology at all test doses. In addition to that, no toxicological changes were observed in behaviour, neurotoxicity, coagulation, haematology or clinical chemistry that are related to the administration of UA. Conclusion This study indicates that oral dosing of UA for 90 consecutive days does not lead to toxic effects at any of the doses. Therefore, the NOAEL for UA is likely to be higher than 1000 mg/kg/day.
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Key Words
- 90 days
- A/G, Albumin/globulin ratio
- ALB, Albumin
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- APTT, Activated partial thromboplastin time
- AST, Aspartate aminotransferase
- BASO, Basophils
- CA, Calcium
- CHOL, Cholesterol
- CK, Creatine kinase
- CL, Chloride
- CREAT, Creatine
- EOS, Eosinophils
- FIB, Fibrogen
- GGT, Gamma-glutamyl transferase
- GLOB, Globulin
- GLUC, Glucose
- HGB, Haemoglobin
- HPLC, High Performance Liquid Chromatography
- HPMC, Hydroxypropyl methylcellulose
- K, Potassium
- LUC, Large unstained cells percent
- LYMPH, Lymphocytes
- MCH, Mean corpuscular haemoglobin
- MCHC, Mean corpuscular haemoglobin concentration
- MCV, Mean corpuscular volume
- MONO, Monocytes percent
- N.V.L, No visible lesions
- NA, Sodium
- NEUT, Neutrophils percent
- NOEL, No observed effect level
- No observed adverse effect level
- OA, Oleanonic acid
- OECD
- OECD, Organisation for Economic Co-operation and Development
- PHOS, Inorganic phosphate
- PLT, Platelet count
- PT, Prothrombin time
- RBC, Red blood cell count
- RDWG, Red blood cell distribution width gated
- RETIC, Reticulocytes
- Repeated dose toxicity
- TBIL, Total bilirubin
- TPROT, Total protein
- TRIG, Triglycerides
- UA, Ursolic acid
- Ursolic acid
- WBC, White blood cell count
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Affiliation(s)
- Lotte Geerlofs
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, 3168, Australia.,iRiccorgpharm Health Pty Ltd, Melbourne, 3168, Australia
| | - Zhiyong He
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, 3168, Australia.,iRiccorgpharm Health Pty Ltd, Melbourne, 3168, Australia
| | - Sa Xiao
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, 3168, Australia.,iRiccorgpharm Health Pty Ltd, Melbourne, 3168, Australia
| | - Zhi-Cheng Xiao
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, 3168, Australia.,iRiccorgpharm Health Pty Ltd, Melbourne, 3168, Australia
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Birchall C, Prentice D, Pauli J. Elevated international normalized ratio (INR) and new diagnosis of hepatitis C associated with severe intrahepatic cholestasis of pregnancy (ICP): A case report. Case Rep Womens Health 2020; 26:e00178. [PMID: 32055455 PMCID: PMC7005562 DOI: 10.1016/j.crwh.2020.e00178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Severe intrahepatic cholestasis of pregnancy (ICP), defined as a serum bile acid (SBA) level > 100 μmol/l, remains poorly understood in its mechanism and implications. Case A patient with a missed diagnosis of mild ICP went on to develop clinical jaundice and liver function abnormalities in the setting of newly diagnosed hepatitis C and severe ICP on repeat SBA testing. Conclusion This case highlights and adds to the growing body of evidence supporting the need for universal screening for hepatitis C in ICP patients and the potential role for repeat SBA testing, which would be a notable change from the traditional care of these individuals. Patient who presented with clinical jaundice and was diagnosed with ICP and previously undiagnosed Hepatitis C. Evaluation of hepatic synthetic function is important in patients with severe intrahepatic cholestasis of pregnancy. The case presented supports for the role of repeat serum bile acid testing in patients with Intrahepatic Cholestasis of Pregnancy.
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Affiliation(s)
- Courtney Birchall
- Obstetrics and Gynecology Penn State Health Milton S. Hershey Medical Center, USA
| | - Danielle Prentice
- Maternal Fetal Medicine Penn State Health Milton S. Hershey Medical Center, USA
| | - Jaimey Pauli
- Maternal Fetal Medicine Penn State Health Milton S. Hershey Medical Center, USA
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de Sá Hyacienth BM, Tavares Picanço KR, Sánchez-Ortiz BL, Barros Silva L, Matias Pereira AC, Machado Góes LD, Sousa Borges R, Cardoso Ataíde R, dos Santos CBR, de Oliveira Carvalho H, Gonzalez Anduaga GM, Navarrete A, Tavares Carvalho JC. Hydroethanolic extract from Endopleura uchi (Huber) Cuatrecasas and its marker bergenin: Toxicological and pharmacokinetic studies in silico and in vivo on zebrafish. Toxicol Rep 2020; 7:217-232. [PMID: 32042599 PMCID: PMC6997909 DOI: 10.1016/j.toxrep.2020.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 02/07/2023] Open
Abstract
E. uchi stem bark hydroethanolic extract in zebrafish. Evaluating the in silico pharmacokinetic and toxicological parameters. Behavioral, biochemical and histopathological changes was dose dependent. In silico bergenin and its metabolites showed high intestinal absorption. Bergenin inhibited CYP2C9, CYP3A4 and CYP2C19.
Endopleura uchi, is used for the treatment of inflammatory disease and related to the female reproductive tract. The aim of this study was to evaluate the acute toxicity of the Endopleura uchi stem bark hydroethanolic extract (EEu) in zebrafish, emphasizing the histopathological and biochemical parameters, as well as evaluating the in silico pharmacokinetic and toxicological parameters of the phytochemical/pharmacological marker, bergenin, as their metabolites. The animals were orally treated with EEu at a single dose of 75 mg/kg, 500 mg/kg, 1000 mg/kg and 3000 mg/kg. the oral LD50 of the EEu higher to the dose of 3000 mg/kg. Behavioral, biochemical and histopathological changes were dose dependent. In silico pharmacokinetic predictions for bergenin and its metabolites showed moderate absorption in high human intestinal absorption (HIA) and Caco-2 models, reduced plasma protein binding, by low brain tissue binding and no P-glycoprotein (P-Gp) inhibition. Their metabolism is defined by the CYP450 enzyme, in addition to bergenin inhibition of CYP2C9, CYP3A4 and CYP2C19. In the bergenin and its metabolites in silico toxicity test it have been shown to cause carcinogenicity and a greater involvement of the bergenin with the CYP enzymes in the I and II hepatic and renal metabolism’s phases was observed. It is possible to suggest that the histopathological damages are involved with the interaction of this major compound and its metabolites at the level of the cellular-biochemical mechanisms which involve the absorption, metabolization and excretion of these possible prodrug and drug.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BBB, Brain-blood partition coefficient (C.brain/C.blood)
- Bergenin
- Biotrasformation
- EEu, Endopleura uchi stem bark hydroethanolic extract
- Endopleura uchi
- HAI, Index of Histopathological Changes
- HBA, Hydrogen bonding acceptors
- HBD, Hydrogen bonding donors
- HIA, Human intestinal absorption
- Hepatoxity
- IAN, Regional Herbarium of the Eastern Amazonian Embrapa
- MM, Molecular mass
- Nephrotoxity
- P-Gp, P-glycoprotein
- PPB, Plasma protein binding
- Toxicology
- hERG, ether-a-go-related human gene
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Affiliation(s)
- Beatriz Martins de Sá Hyacienth
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
- Postgraduate Program in Biodiversity and Biotechnology of the Legal Amazon of the BIONORTE Network, Department of Biological Sciences and Health, Federal University of Amapá, Macapá, AP, Brazil
| | - Karyny Roberta Tavares Picanço
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Brenda Lorena Sánchez-Ortiz
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
- Laboratory of Natural Product Pharmacology, Department of Pharmacy, Faculty of Chemistry, National Autonomous University of Mexico, University City, Coyoacán, Zip Code 04510 Mexico City, Mexico
| | - Luciane Barros Silva
- Federal University of Amapá, Laboratory of Modeling and Computational Chemistry, Department of Biological Sciences and Health, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Arlindo César Matias Pereira
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Larissa Daniele Machado Góes
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Raphaelle Sousa Borges
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Rodrigo Cardoso Ataíde
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Cleydson Breno Rodrigues dos Santos
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
- Federal University of Amapá, Laboratory of Modeling and Computational Chemistry, Department of Biological Sciences and Health, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Helison de Oliveira Carvalho
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
| | - Gloria Melisa Gonzalez Anduaga
- Laboratory of Natural Product Pharmacology, Department of Pharmacy, Faculty of Chemistry, National Autonomous University of Mexico, University City, Coyoacán, Zip Code 04510 Mexico City, Mexico
| | - Andrés Navarrete
- Laboratory of Natural Product Pharmacology, Department of Pharmacy, Faculty of Chemistry, National Autonomous University of Mexico, University City, Coyoacán, Zip Code 04510 Mexico City, Mexico
| | - José Carlos Tavares Carvalho
- Laboratory of Pharmaceutical Research, Department of Biological Sciences and Health, Federal University of Amapá, Juscelino Kubitschek Street, Marco Zero Campus, Zip Code 68903-419, Macapá, AP, Brazil
- Postgraduate Program in Biodiversity and Biotechnology of the Legal Amazon of the BIONORTE Network, Department of Biological Sciences and Health, Federal University of Amapá, Macapá, AP, Brazil
- Corresponding author.
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Devarbhavi H. Rolandic Epilepsy as a Heralding Manifestation of Wilson Disease in a 6-Year-Old Girl. J Clin Exp Hepatol 2020; 10:633-635. [PMID: 33311898 PMCID: PMC7720023 DOI: 10.1016/j.jceh.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Wilson disease (WD) manifesting as seizure is rare. Rolandic epilepsy as presenting feature of WD has been reported only once before. METHODS A 6-year-old girl of nonconsanguineous parentage presented with focal seizures. There was associated fatty hepatomegaly and elevated aminotransferases. RESULTS Brain magnetic resonance imaging (MRI) was unremarkable. Electroencephalogram demonstrated bilateral centrotemporal spike classical of Rolandic epilepsy. Serum ceruloplasmin was low and 24-h urinary copper levels were elevated. Genetic mutational analysis showed she carried the rare homozygous p.Asn1270Ser genetic mutation. Administration of d-penicillamine gradually halted seizure activity together with near normalization of serum aminotransferases. CONCLUSIONS Rolandic epilepsy associated with elevated liver enzymes should undergo evaluation for WD. Chelators have a salutary effect on seizure activity, as well as elevated serum aminotransferases.
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Affiliation(s)
- Harshad Devarbhavi
- Address for correspondence: Harshad Devarbhavi, MD, Department of Gastroenterology & Hepatology, St. John's Medical College Hospital, Bangalore 560034, India.
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Gargi K, Parikshaa G, Saha PK, Rohit M, Madhumita P, Rajvanshi A. Bilateral Adnexal Masses in a Young Female: Rare Presentation of Hepatocellular Carcinoma With Review of the Literature. J Clin Exp Hepatol 2020; 10:636-40. [PMID: 33311899 DOI: 10.1016/j.jceh.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
Ovaries are a common niche for metastasis. Metastatic malignancies account for 5-30% of all ovarian malignancies. Hepatocellular carcinoma (HCC) is one of the rare malignancies to metastasize to the ovaries. Of all the variants of HCC, fibrolamellar HCC (FLHCC) variant is extremely uncommon and accounts for around 1% of all HCC cases. FLHCC metastasizing to ovaries, at presentation, is an exceptional occurrence. We present a case of a young female who presented with bilateral adnexal masses and was diagnosed as metastatic FLHCC on histopathological examination and confirmed by immunohistochemistry. In addition, a thorough literature review highlighting the previously reported cases is also presented.
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Key Words
- AFP, Alpha-fetoprotein
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- CA-125, Cancer antigen-125
- CA19-9, Cancer antigen 19-9
- CD68, Cluster differentiation 68
- CEA, Carcinoembryonic antigen
- CK19, Cytokeratin 19
- CK7, Cytokeratin-7
- CT, Computerized tomography
- FLHCC, Fibrolamellar hepatocellular carcinoma
- HBsAg, Hepatitis B surface antigen
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- HIV, Human Immunodeficiency virus
- HepPar-1, Hepatocyte paraffin antigen-1
- Krukenberg tumor
- PAX8, Paired box gene 8
- fibrolamellar carcinoma
- fibrolamellar variant
- hepatocellular carcinoma
- ovarian metastasis
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Mukund A, Vats P, Jindal A, Patidar Y, Sarin SK. Early Hepatocellular Carcinoma Treated by Radiofrequency Ablation-Mid- and Long-Term Outcomes. J Clin Exp Hepatol 2020; 10:563-573. [PMID: 33311893 PMCID: PMC7719976 DOI: 10.1016/j.jceh.2020.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a standard treatment for small inoperable hepatocellular carcinoma (HCC). Studies on mid- and long-term outcome of RFA as first-line therapy for HCC from India are limited. METHODS We evaluated consecutive HCC patients who underwent RFA as primary treatment modality at our institute between July 2009 and April 2016. The median follow-up period was 26 months, range 1-84 months. We evaluated post-RFA tumor response, disease-free survival (DFS), overall survival (OS), and local tumor progression (LTP). Prognostic factors were also analyzed. RESULTS In 147 patients (male:female = 121:26; mean age, 59.2 years), 209 RFA sessions were done for 228 lesions (mean size of 21.5 ± 8.3 mm, range 10-50 mm). Primary success rate was 94.2%. The estimated cumulative proportion survival at 1, 3, and 5 years was 90.2%, 63.8%, and 60.2%, respectively. The cumulative incidence of LTP estimated at 1, 3, and 5 years was 13.1%, 19.7%, and 20.1%, respectively. The mean estimate of LTP-free survival was 53.6 months (95% confidence interval: 0.49-0.58) which is 58.2 months in <3 cm lesions and 20.4 months in >3 cm lesions (P < 0.01). There was no significant difference in LTP rates between lesions in perivascular versus nonperivascular location (P = 0.71) and surface versus parenchymal lesions (P = 0.66). The mean DFS was 30.3 months (95% CI: 25.6-35.0). For OS, age and Child-Turcotte-Pugh class B were significant factors while for LTP, tumor size >3 cm was significant. Higher baseline alpha-fetoprotein level and LTP were poor predictors for DFS. Complication rate per RFA session was 7/209 (3.3%). CONCLUSIONS RFA is a safe and effective curative modality for first-line treatment of HCC < 3 cm.
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Key Words
- AASLD, The American Association for the Study of Liver Diseases
- AFP, Alpha-fetoprotein
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCLC, Barcelona Clinic Liver Cancer
- CTP, Child–Turcotte–Pugh score
- DFS, Disease-free survival
- FNAC, Fine needle aspiration cytology
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- INR, International normalized ratio
- LT, Liver transplantation
- LTP, Local tumor progression
- MELD, Model for end-stage liver disease
- MWA, Microwave ablation
- NASH, Nonalcoholic steatohepatitis
- OS, Overall survival
- PIVKA-II, Protein induced by vitamin K absence-II
- PS, Performance status
- RFA, Radio-frequency ablation
- SIR, Society of Interventional Radiology
- TACE, Transarterial chemoembolization
- TIPS, Transjugular intrahepatic portosystemic shunt
- USG, Ultrasonography
- alpha-fetoprotein
- cirrhosis
- hepatocellular carcinoma
- mRECIST, Modified response evaluation criteria in solid tumors
- radiofrequency ablation
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Prayas Vats
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India,Address for correspondence. Ankur Jindal, MD, DM, Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
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Kojima Y, Tsuchiya A, Ogawa M, Nojiri S, Takeuchi S, Watanabe T, Nakajima K, Hara Y, Yamashita J, Kikuta J, Takamura M, Ishii M, Terai S. Mesenchymal stem cells cultured under hypoxic conditions had a greater therapeutic effect on mice with liver cirrhosis compared to those cultured under normal oxygen conditions. Regen Ther 2019; 11:269-81. [PMID: 31667206 DOI: 10.1016/j.reth.2019.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/18/2019] [Accepted: 08/29/2019] [Indexed: 01/07/2023] Open
Abstract
Background Mesenchymal stem cells (MSCs) can be easily expanded. They can be acquired from medical waste such as adipose and umbilical cord tissues, are influenced by culturing conditions, and exert anti-inflammatory, antioxidant, anti-fibrotic, and angiogenic effects. We analyzed the multi-directional effects of MSCs cultured under hypoxic conditions and their underlying mechanisms in the treatment of liver cirrhosis in a mouse model. Methods Human bone marrow-derived MSCs cultured under hypoxic (5% O2; hypoMSCs) and normoxic (21% O2; norMSCs) conditions were compared by cap analysis of gene expression (CAGE) with or without serum from liver cirrhosis patients. The therapeutic effects of MSCs, including serum liver enzyme induction, fibrosis regression, and hepatic oxidative stress, were evaluated by injecting 1 × 106, 2 × 105, or 4 × 104 MSCs/mouse into the tail veins of mice with carbon tetrachloride (CCl4)-induced liver cirrhosis. Intravital imaging was performed with a two-photon excitation microscope to confirm the various MSC migration paths to the liver. Results CAGE analysis revealed that the RNA expression levels of prostaglandin E synthase (Ptges) and miR210 were significantly higher in hypoMSCs than in norMSCs. In vivo analysis revealed that both hypoMSCs and norMSCs reduced serum alanine aminotransferase, oxidative stress, and fibrosis compared to that in control mice in a dose-dependent manner. However, hypoMSCs had stronger therapeutic effects than norMSCs. We confirmed this observation by an in vitro study in which hypoMSCs changed macrophage polarity to an anti-inflammatory phenotype via prostaglandin E2 (PGE2) stimulation. In addition, miR210 reduced the rate of hepatocyte apoptosis. Intravital imaging after MSC administration showed that both cell types were primarily trapped in the lungs. Relatively a few hypoMSCs and norMSCs migrated to the liver. There were no significant differences in their distributions. Conclusion The therapeutic effect of hypoMSCs was mediated by PGE2 and miR210 production and was greater than that of norMSCs. Therefore, MSCs can be manipulated to improve their therapeutic efficacy in the treatment of liver cirrhosis and could potentially serve in effective cell therapy. MSCs produce several factors with multidirectional effects and function as “conducting cells” in liver cirrhosis. HypoMSCs decreased liver damage and fibrosis in mice in a dose-dependent manner. HypoMSCs produced more PTGES and miR-210 than norMSCs. HypoMSCs reduced oxidative stress more effectively than norMSCs. HypoMSCs induced anti-inflammatory macrophage growth via prostaglandin E2 production. miR-210 reduced hepatocyte apoptosis.
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Key Words
- 8-OHdG, DNA 8-hydroxy-2’-deoxyguanosine
- ALB, Albumin
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- CAGE, Cap analysis of gene expression
- CCl4, Carbon tetrachloride
- ECM, Extracellular matrix
- HHSteC, Human Hepatic Stellate Cells
- Hypoxic condition
- LC, Liver cirrhosis
- LPS, Lipopolysaccharide
- Liver cirrhosis
- MDA, Malondialdehyde
- MSCs, Mesenchymal stem cells
- Mesenchymal stem cells
- NASH, Non-alcoholic steatohepatitis
- PCR, Polymerase chain reaction
- PGE2
- PGE2, Prostaglandin E2
- SOD, Superoxide dismutase
- T-Bil, Total bilirubin
- hypoMSCs, MSCs cultured under hypoxic oxygen (5% O2) conditions
- id-BMM, Induced Bone Marrow Derived Macrophage
- miR210
- norMSCs, MSCs cultured under normal oxygen (21% O2) conditions
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Soll D, Spira D, Hollstein T, Haberbosch L, Demuth I, Steinhagen-Thiessen E, Bobbert T, Spranger J, Kassner U. Clinical outcome of a patient with lysosomal acid lipase deficiency and first results after initiation of treatment with Sebelipase alfa: A case report. Mol Genet Metab Rep 2019; 20:100479. [PMID: 31249784 PMCID: PMC6587018 DOI: 10.1016/j.ymgmr.2019.100479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 01/28/2023] Open
Abstract
We report on a case of very rare autosomal recessive cholesteryl ester storage disease due to lysosomal acid lipase deficiency (LALD). LALD is caused by mutations in the lysosomal acid lipase A (LIPA) gene resulting in cholesteryl ester accumulation in liver, spleen, and macrophages. It can lead to liver failure, accelerated atherosclerosis and premature death. Until recently, treatment options were limited to lipid-lowering medications to control dyslipidemia. Presently, a long-term enzyme replacement therapy with Sebelipase alfa, a recombinant human lysosomal acid lipase, is available for patients with LALD. Our patient's condition became conspicuous at the age of two due to a xanthogranuloma of the chin together with increased lipid levels, elevated liver enzymes and hepatomegaly. It took another five years until our patient was diagnosed with LALD after genetic testing. A bi-weekly therapy with intravenous Sebelipase alfa was started at the age of 26 years. It led to normalization of lipid levels, reduction of liver enzymes and beginning regression of hepatomegaly in the absence of adverse drug reactions after 46 infusions. Since LALD can take a fatal course even in patients with a long-term stable condition, it is essential to identify affected patients early and to treat them appropriately by enzyme replacement therapy. LALD should be suspected in patients with low high-density lipoprotein cholesterol (HDL-C) and high low-density lipoprotein cholesterol (LDL-C) in conjunction with elevated liver enzymes or hepatomegaly. A registry for LALD patients shall help to advance our understanding of the disease as well as improve patient care (NCT01633489).
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Affiliation(s)
- Dominik Soll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Dominik Spira
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Tim Hollstein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Linus Haberbosch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Ilja Demuth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany.,Berlin-Brandenburg Center for Regenerative Medicine (BCRT), Charité University Medicine Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Thomas Bobbert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Joachim Spranger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
| | - Ursula Kassner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Lipid Clinic, Interdisciplinary Metabolism Center, Germany
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Adhikari RB, Gawarammana IB, De Silva D, Dangolla A, Mallawa C, Premarathna A, Silva ID. Clinico-epidemiology and management of Russell's viper ( Daboia russelii) envenoming in dogs in Sri Lanka. Toxicol Rep 2019; 6:809-818. [PMID: 31453112 PMCID: PMC6702329 DOI: 10.1016/j.toxrep.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Russell's viper envenoming in dogs is a significant problem in Sri Lanka. The current study focused on investigating clinical profile, laboratory findings of three selected tests and to develop a treatment strategy with Indian polyvalent Anti-Venom Serum (AVS). It was also intended to report adverse effects and complications caused by both Russell's viper venom (RVV) and AVS in Russell's Viper (RV) envenomed dogs. OBJECTIVE To evaluate and report the clinical manifestations, to find out the minimum effective vials of AVS and to record AVS induced adverse reactions of RV envenoming in dogs. MATERIALS AND METHODS A prospective study was conducted on Russell's viper bitten dogs (n = 65) admitted to the Veterinary Teaching Hospital (VTH) in Sri Lanka. Indian polyvalent AVS was used to treat all the envenomed dogs. The number of vials of AVS that was administered to a patient was decided upon by a second degree polynomial model with a number of vials of AVS in the X axis verses Prothrombine Time (PT), Activated Partial Thromboplastine Time (aPTT) and Clotting Time (CT) in the Y axis respectively. RESULTS Varying degrees of pain were exhibited by all the victim dogs. Mild swelling and necrosis at the site of bite was seen in 54% (n = 35) and 37% (n = 24) of dogs respectively. Prolonged values of, PT, aPTT and CT were seen from all the RV envenomed dogs. The mean leukocyte count in these dogs was 39.79 × 103/μL (normal range; 4-20 × 103/μL) (IQR:29.05 × 103/μL-45.92 × 103/μL). Statistical analysis showed that the initial vials of 7 AVS would be the minimum required vials. Therefore, a range of 6-15 AVS vials in total were administered to these dogs and in 7.6% (n = 5) of dogs, the results of PT, aPTT and CT became normal with 6 AVS vials at 32-97 minutes. Acute Renal Failure (ARF) was detected from 29% (n = 19) of dogs as a complication. CONCLUSIONS Systemic clinical signs of haemorrhagic lesions, cardio respiratory toxicities were common in Russell's viper envenomed dogs. Initially 6 vials of AVS must be administered. AVS induced reactions were reported commonly. Russell's viper envenoming was found to be lethal in dogs.
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Key Words
- (BP), Blood pressure
- (BUN), Blood Urea Nitrogen
- (TP), Total protein
- (UO), Urine output
- ALT, Alanine aminotransferase
- ARF, Acute Renal Failure
- AST, Aspartate aminotransferase
- AVS, Anti-Venom Serum
- Activated partial thromboplastine time
- Anti-Venom serum
- CT, Clotting Time
- Clotting time
- Daboia russelii
- Dogs
- PT, Prothrombine Time
- Prothrombine time
- RV, Russell’s Viper
- RVV, Russell's viper venom
- VTH, Veterinary Teaching Hospital
- aPTT, Activated Partial Thromboplastine Time
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Affiliation(s)
- Ranjith B. Adhikari
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika B. Gawarammana
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - D.D.N. De Silva
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ashoka Dangolla
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chandima Mallawa
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - A.D. Premarathna
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indira D Silva
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
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Morimoto S, Takahashi S, Fukushima K, Saya H, Suzuki N, Aoki M, Okano H, Nakahara J. Ropinirole hydrochloride remedy for amyotrophic lateral sclerosis - Protocol for a randomized, double-blind, placebo-controlled, single-center, and open-label continuation phase I/IIa clinical trial (ROPALS trial). Regen Ther 2019; 11:143-166. [PMID: 31384636 PMCID: PMC6661418 DOI: 10.1016/j.reth.2019.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is an intractable and incurable neurological disease. It is a progressive disease characterized by muscle atrophy and weakness caused by selective vulnerability of upper and lower motor neurons. In disease research, it has been common to use mouse models carrying mutations in responsible genes for familial ALS as pathological models of ALS. However, there is no model that has reproduced the actual conditions of human spinal cord pathology. Thus, we developed a method of producing human spinal motor neurons using human induced pluripotent stem cells (iPSCs) and an innovative experimental technique for drug screening. As a result, ropinirole hydrochloride was eventually discovered after considering such results as its preferable transitivity in the brain and tolerability, including possible adverse reactions. Therefore, we explore the safety, tolerability and efficacy of ropinirole hydrochloride as an ALS treatment in this clinical trial. Methods The ROPALS trial is a single-center double-blind randomized parallel group-controlled trial of the safety, tolerability, and efficacy of the ropinirole hydrochloride extended-release tablet (Requip CR) at 2- to 16-mg doses in patients with ALS. Twenty patients will be recruited for the active drug group (fifteen patients) and placebo group (five patients). All patients will be able to receive the standard ALS treatment of riluzole if not changed the dosage during this trial. The primary outcome will be safety and tolerability at 24 weeks, defined from the date of randomization. Secondary outcome will be the efficacy, including any change in the ALS Functional Rating Scale-Revised (ALSFRS-R), change in the Combined Assessment of Function and Survival (CAFS), and the composite endpoint as a sum of Z-transformed scores on various clinical items. Notably, we will perform an explorative search for a drug effect evaluation using the patient-derived iPSCs to prove this trial concept. Eligible patients will have El Escorial Possible, clinically possible and laboratory-supported, clinically probable, or clinically definite amyotrophic lateral sclerosis with disease duration less than 60 months (inclusive), an ALSFRS-R score ≥2 points on all items and age from 20 to 80 years. Conclusion Patient recruitment began in December 2018 and the last patient is expected to complete the trial protocol in November 2020. Trial registration Current controlled trials UMIN000034954 and JMA-IIA00397. Protocol version version 1.6 (Date; 5/Apr/2019).
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Key Words
- %FVC, Forced vital capacity
- 6-OHDA, 6-hydroxydopamine
- 8-OHdG, 8-Hydroxydeoxyguanosine
- ADR, Adverse reaction
- AE, Adverse effect
- ALP, Alkaline phosphatase
- ALS, Amyotrophic lateral sclerosis
- ALSAQ-40, Amyotrophic Lateral Sclerosis Assessment Questionnaire-40
- ALSFRS-R, ALS Functional Rating Scale-Revised
- ALT, Alanine aminotransferase
- APTT, Activated partial thromboplastin time
- AST, Aspartate aminotransferase
- Amyotrophic lateral sclerosis
- BUN, Blood urea nitrogen
- CAFS, Combined Assessment of Function and Survival
- CK, Creatine kinase
- CPK, Creatine phosphokinase
- CRP, C-reactive protein
- CTCAE, Common terminology Criteria for Adverse Events
- EDC, Electronic data capture
- FALS, Familial ALS
- FAS, Full analysis set
- GCP, Good clinical practice
- HBs, Hepatitis B surface
- HCG, Human chorionic gonadotropin
- HCV, Hepatitis C virus
- HDL, High-density lipoprotein
- HIV, Human immunodeficiency virus
- HTLV-1, Human T-cell leukemia virus type 1
- IRB, Institutional review board
- LDH, Lactate dehydrogenase
- LDL, Low-density lipoprotein
- MMT, Manual muscle testing
- NfL, Neurofilament light chain
- PPS, Per protocol set
- PT, Prothrombin time
- QOL, Quality of life
- Requip CR
- Ropinirole hydrochloride
- SAE, Severe adverse effect
- SALS, sporadic ALS
- SOD, Superoxide dismutase
- TDP-43, Transactive response DNA-binding protein 43
- TPHA, Treponema pallidum hemagglutination
- iPSC-drug discovery
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Affiliation(s)
- Satoru Morimoto
- Department of Physiology, Keio University School of Medicine, Japan
- Department of Neurology, Keio University School of Medicine, Japan
| | | | - Komei Fukushima
- Department of Physiology, Keio University School of Medicine, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Graduate School of Medicine, Keio University, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Japan
- Department of Neurology, Shonan Keiiku Hospital, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University, School of Medicine, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Japan
- Corresponding author. Keio University Graduate School of Medicine, Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. Fax: +81 3 3357 5445.
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Japan
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Divya N, Rengarajan R, Radhakrishnan R, Fathi Abd_Allah E, Alqarawi AA, Hashem A, Manikandan R, Vijaya Anand A. Phytotherapeutic efficacy of the medicinal plant Terminalia catappa L. Saudi J Biol Sci 2019; 26:985-988. [PMID: 31303829 PMCID: PMC6600790 DOI: 10.1016/j.sjbs.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/03/2022] Open
Abstract
Diabetes is a chronic, lifelong condition due to inadequate production of insulin or the cells does not properly respond it. Recently, the significance and effectiveness of herbal drugs associated with diabetes has emerged. The aim of the present study was to determine the anti-diabetic effects of Terminalia catappa L. leaves on streptozotocin (STZ)-treated rats. Two different concentrations of ethanolic leaf extract (300 and 500 mg/kg) of T. catappa were used to treat diabetic rats, and biochemical parameters were analyzed in blood samples. The results of herbal treatments were compared with the standard drug, glibenclamide. The ethanol extract (500 mg/kg) had significant anti-diabetic activity by altering blood glucose, glycosylated hemoglobin, liver glycogen, glucose 6-phosphatase, fructose 1,6-bisphosphatase, glucokinase, aspartate transaminase, alanine transaminase, alkaline phosphatase, urea, uric acid and creatinine levels while increasing insulin levels. Thus, the present study suggests that the supplementation of the diabetic patients with T. catappa leaves can lead to recovery from diabetic effects.
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Affiliation(s)
- Natarajan Divya
- Department of Biochemistry, Bharathiar University, Coimbatore 641 046, Tamil Nadu, India
| | - R.L. Rengarajan
- Centre for Pheromone Technology, Department of Animal Science, Bharathidasan University, Trichirappalli, Tamil Nadu, India
| | | | - Elsayed Fathi Abd_Allah
- Plant Production Department, College of Food and Agricultural Sciences, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia
| | - Abdulaziz A. Alqarawi
- Plant Production Department, College of Food and Agricultural Sciences, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia
| | - Abeer Hashem
- Botany and Microbiology Department, College of Science, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia
- Mycology and Plant Disease Survey Department, Plant Pathology Research Institute, ARC, Giza 12511, Egypt
| | - Ramasamy Manikandan
- Department of Biochemistry, M.I.E.T Arts and Science College, Tiruchirappalli, Tamil Nadu, India
| | - Arumugam Vijaya Anand
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore 641 046, Tamil Nadu, India
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Amr KS, Elmawgoud Atia HA, Elazeem Elbnhawy RA, Ezzat WM. Early diagnostic evaluation of miR-122 and miR-224 as biomarkers for hepatocellular carcinoma. Genes Dis 2017; 4:215-221. [PMID: 30258925 PMCID: PMC6150115 DOI: 10.1016/j.gendis.2017.10.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/23/2017] [Indexed: 12/22/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the common lethal types of tumor all over the world. The lethality of HCC accounts for many reasons. One of them, the lack of reliable diagnostic markers at the early stage, in this context, serum miRNAs became promising diagnostic biomarkers. Herein, we aimed to identify the predictive value of two miRNAs (miR-122 and miR-224) in plasma of patients with HCC preceded by chronic HCV infection. Taqman miRNA assays specific for hsa-miR-122 and hsa-miR-224 were used to assess the expression levels of the chosen miRNAs in plasma samples collected from three groups; 40 patients with HCC related to HCV, 40 with CHC patients and 20 healthy volunteers. This study revealed that the mean plasma values of miRNA-122 were significantly lower among HCC group when compared to CHC and control groups (P < 0.001). Whereas, miR-224 mean plasma values were significantly higher among HCC group when compared to both CHC group and control group. Moreover, it was found that miR-122 can predict development of HCC at cut-off value <0.67 (RQ) and (AUC = 0.98, P < 0.001). As regards miR-224, it can predict development of HCC at cut-off value >1.2 (RQ) and (AUC = 0.93, P < 0.001), while the accuracy of AFP to diagnose HCC was (AUC: 0.619; P = 0.06). In conclusion, the expression plasma of miR-122 and miR-224 could be used as noninvasive biomarkers for the early prediction of developing HCC at the early stage.
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Key Words
- ADAM17, A disintegrin and metalloprotease domain-containing protein 17
- AFP, Alpha-fetoprotein
- AKT, AKT/Protein kinase B
- ALP, Alkaline phosphatase
- ALT, Alanine aminotransferase
- ANOVA, Analysis of variance
- API-5, Apoptosis inhibitor-5
- AST, Aspartate aminotransferase
- AUC, Area under the curve
- BCLC, Barcelona Clinic Liver Cancer
- Bcl-2, B cell leukemia/lymphoma 2 like protein
- CT, Computed tomography
- CTP, Child-Turcotte-Pugh
- Ccgn1, Cyclin G1 protein
- Ct, Cycle threshold
- Diagnosis
- ELISA, Enzyme-linked immunosorbent assay
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- Hepatocellular carcinoma
- NF-κβ, nuclear factor kappa-light-chain-enhancer of activated B cells
- PCR, Polymerase chain reaction
- RNA, Ribonucleic acid
- ROC, Receiver operating characteristic
- RQ, Relative quantity
- SE, standard error
- Sensitivity
- has-miR-122, Homo sapien-micro RNA-122
- mRNA, Messenger RNA
- miR-122
- miR-224
- miRNA/miR, Micro-RNA
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Affiliation(s)
- Khalda S Amr
- Medical Molecular Genetics Department, National Research Centre, Cairo, Egypt
| | | | | | - Wafaa M Ezzat
- Internal Medicine Department, National Research Center, Cairo, Egypt
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Fitzpatrick JA, Kim JU, Cobbold JF, McPhail MJ, Crossey MM, Bak-Bol AA, Zaky A, Taylor-Robinson SD. Changes in Liver Volume in Patients with Chronic Hepatitis C Undergoing Antiviral Therapy. J Clin Exp Hepatol 2016; 6:15-20. [PMID: 27194891 DOI: 10.1016/j.jceh.2015.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022] Open
Abstract
AIM Liver volumetric analysis has not been used to detect hepatic remodelling during antiviral therapy before. We measured liver volume (LV) changes on volumetric magnetic resonance imaging during hepatitis C antiviral therapy. METHODS 22 biopsy-staged patients (median [range] age 45(19-65) years; 9F, 13M) with chronic hepatitis C virus infection were studied. LV was measured at the beginning, end of treatment and 6 months post-treatment using 3D T1-weighted acquisition, normalised to patient weight. Liver outlines were drawn manually on 4 mm thick image slices and LV calculated. Inter-observer agreement was analysed. Patients were also assessed longitudinally using biochemical parameters and liver stiffness using Fibroscan™. RESULTS Sustained viral response (SVR) was achieved in 13 patients with a mean baseline LV/kg of 0.022 (SD 0.004) L/kg. At the end of treatment, the mean LV/kg was 0.025 (SD 0.004, P = 0.024 cf baseline LV/kg) and 0.026 (SD 0.004, P = 0.008 cf baseline LV/kg) 6 months post-treatment (P = 0.030 cf baseline, P = 0.004). Body weight-corrected end of treatment LV change was significantly higher in patients with SVR compared to patients not attaining SVR (P = 0.050). End of treatment LV change was correlated to initial ALT (R (2) = 0.479, P = 0.037), but not APRI, AST, viral load or liver stiffness measurements. There was a correlation of 0.89 between observers for measured slice thickness. CONCLUSIONS LV increased during anti-viral treatment, while the body weight-corrected LV increase persisted post-antiviral therapy and was larger in patients with SVR.
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Key Words
- ALT, Alanine aminotransferase
- APRI, Aspartate transaminase to platelet ratio index
- AST, Aspartate transaminase
- CHC, Chronic hepatitis C
- CLD, Chronic liver disease
- CT, Computed tomography
- EASL, European Association for the Study of the Liver
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- LV, Liver volume
- MRI, Magnetic resonance imaging
- NAFLD, Non-alcoholic fatty liver disease
- NI, Necroinflammatory
- SVR, Sustained viral response
- hepatitis C virus
- liver volume
- magnetic resonance imaging
- sustained viral response
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Nakano S, Katsuno K, Isaji M, Nagasawa T, Buehrer B, Walker S, Wilkison WO, Cheatham B. Remogliflozin Etabonate Improves Fatty Liver Disease in Diet-Induced Obese Male Mice. J Clin Exp Hepatol 2015; 5:190-8. [PMID: 26628836 PMCID: PMC4632078 DOI: 10.1016/j.jceh.2015.02.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/27/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH) are serious conditions and are being diagnosed at an increased rate. The etiology of these hepatic disorders is not clear but involves insulin resistance and oxidative stress. Remogliflozin etabonate (Remo) is an inhibitor of the sodium glucose-dependent renal transporter 2 (SGLT2), and improves insulin sensitivity in type 2 diabetics. In the current study, we examined the effects of Remo in a diet-induced obese mouse model of NAFLD. METHODS After 11-weeks on High-Fat-Diet 32 (HFD32), C57BL/6J mice were obese and displayed characteristics consistent with NAFLD. Cohorts of obese animals were continued on HFD32 for an additional 4-week treatment period with or without Remo. RESULTS Treatment with Remo for 4 weeks markedly lowered both plasma alanine aminotransferase (76%) and aspartate aminotransferase (48%), and reduced both liver weight and hepatic triglyceride content by 42% and 40%, respectively. Remo also reduced hepatic mRNA content for tumor necrosis factor (TNF)-α (69%), and monocyte chemoattractant protein (MCP)-1 (69%). The diet-induced increase in thiobarbituric acid-reactive substances, a marker of oxidative stress, was reduced following treatment with Remo, as measured in both liver homogenates (22%) and serum (37%). Finally, the oxygen radical absorbance capacity (ORAC) in three different SGLT2 inhibitors was determined: remogliflozin, canagliflozin and dapagliflozin. Only remogliflozin had any significant ORAC activity. CONCLUSIONS Remo significantly improved markers associated with NAFLD in this animal model, and may be an effective compound for the treatment of NASH and NAFLD due to its insulin-sensitizing and antioxidant properties.
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Key Words
- AAPH, 2,2′-azobis-2-methyl-propanimidamide dihydrochloride
- ALT, Alanine aminotransferase
- AST, aspartate aminotransferase
- DIO, Diet-induced obesity
- ER, Endoplasmic reticulum
- FFA, Free fatty acids
- FXR, Farnesoid X receptor
- HFD32, High fat diet 32
- MCP-1, Monocyte chemoattractant protein-1
- NAFLD
- NAFLD, Nonalcoholic fatty liver disease
- NASH
- NASH, Nonalcoholic steatohepatitis
- ORAC, Oxygen radical absorbance capacity
- ROS, Reactive oxygen species
- Remo, Remogliflozin etabonate
- SGLT2
- SGLT2, sodium glucose-dependent renal transporter 2
- TBARS, Thiobarbituric acid-reactive substances
- TG, Triglyceride
- TNF-α, Tumor necrosis factor alpha
- Trolox, 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid
- hepatic steatosis
- obesity
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Affiliation(s)
- Shigeru Nakano
- Discovery Research R&D, Kissei Pharmaceutical Co. Ltd., Nagano 399-8304, Japan
| | - Kenji Katsuno
- Discovery Research R&D, Kissei Pharmaceutical Co. Ltd., Nagano 399-8304, Japan
| | - Masayuki Isaji
- Research and Development Division, Kissei Pharmaceutical Co. Ltd., Nagano 399-8304, Japan
| | - Tatsuya Nagasawa
- Toxicology Research Laboratory, Kissei Pharmaceutical Co. Ltd., Nagano 399-8305, Japan
| | | | | | | | - Bentley Cheatham
- BHV Pharma, RTP, NC 27709, USA
- Address for correspondence: Bentley Cheatham, BHV Pharma, P.O. Box 13765, Research Triangle Park, NC 27709, USA. Tel.: +1 919 904 4248.
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Gupta V, Kumar A, Sharma P, Bansal N, Singla V, Arora A. Most Patients of Hepatitis C Virus Infection in India Present Late for Interferon-Based Antiviral Treatment: An Epidemiological Study of 777 Patients from a North Indian Tertiary Care Center. J Clin Exp Hepatol 2015; 5:134-41. [PMID: 26155041 PMCID: PMC4491643 DOI: 10.1016/j.jceh.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/03/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interferon-based antiviral therapy is offered only to those HCV patients who have either chronic hepatitis or early cirrhosis. Advanced cirrhotics do not tolerate interferon-based therapy. Since HCV is asymptomatic in early stages and usually presents late, the eligibility for interferon-based therapy is thus limited. There are scarce studies from India, which looked specifically the eligibility of interferon-based therapy in HCV patients. AIM To study the spectrum of presentation of HCV infection, determine their eligibility for interferon-based therapy, and follow for SVR. METHODS The records of all consecutive patients of HCV, >14 years age, who presented to our department between 2008 and 2014, were analyzed for categorization into chronic hepatitis, cirrhosis and hepatocellular carcinoma. Patients with detectable HCV RNA who have chronic hepatitis or Child A cirrhosis were considered eligible for Peg-interferon and ribavirin. Patients who received treatment were followed for SVR. RESULTS 777 patients (median age 49 [range 15-95] years, males 69%) were included. Cirrhosis was the most common presentation (56%, 439/777) followed by chronic hepatitis (37%, 287/777) and HCC (7%, 51/777). Of patients who had cirrhosis (including those with HCC), 36% (174/490) were Child A; 51% (250/490) were Child B and 14% (66/490) were Child C. Only 347/777 (45%) were eligible for Peg-interferon-alpha and Ribavirin. Among the remaining 430 patients, in 326 (76%) the disease was far too advanced. Of eligible patients only 54% actually received Peg-interferon-alpha and Ribavirin and 81% patients could complete the course. Of them only 70% could achieve SVR. CONCLUSIONS Most HCV patients in India present late and only about 45% are eligible for Interferon-based antiviral treatment. At presentation 56% patients already have cirrhosis and 7% have HCC. Since HCV is usually asymptomatic in early stages, awareness about screening should be increased so that more patients are diagnosed early before they develop cirrhosis or HCC.
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Key Words
- AFP, Alphafetoprotein
- ALT, Alanine aminotransferase
- ANA, Antinuclear antibody
- BCLC, Barcelona Clinic Liver Cancer
- DAA, Directly acting agents
- FNAC, Fine needle aspiration cytology
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- HIV, Human immunodeficiency virus
- PCR, Polymerase chain reaction
- PEG-IFN, Pegylated Interferon
- RBV, Ribavirin
- RNA, Ribonucleic acid
- SMA, Smooth Muscle Antibody
- SVR, Sustained virological response
- WHO, World health organization
- chronic liver disease
- cirrhosis
- epidemiology
- hepatitis C
- hepatocellular carcinoma
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Affiliation(s)
| | | | | | | | | | - Anil Arora
- Address for correspondence. Anil Arora, Chairman, Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India. Tel.: +91 9311638779.
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Sharma M, Mitnala S, Vishnubhotla RK, Mukherjee R, Reddy DN, Rao PN. The Riddle of Nonalcoholic Fatty Liver Disease: Progression From Nonalcoholic Fatty Liver to Nonalcoholic Steatohepatitis. J Clin Exp Hepatol 2015; 5:147-58. [PMID: 26155043 PMCID: PMC4491606 DOI: 10.1016/j.jceh.2015.02.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/09/2015] [Indexed: 02/07/2023] Open
Abstract
Nonalcoholic fatty liver (NAFL) is an emerging global epidemic which progresses to nonalcoholic steatohepatitis (NASH) and cirrhosis in a subset of subjects. Various reviews have focused on the etiology, epidemiology, pathogenesis and treatment of NAFLD. This review highlights specifically the triggers implicated in disease progression from NAFL to NASH. The integrating role of genes, dietary factors, innate immunity, cytokines and gut microbiome have been discussed.
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Key Words
- AGE, Advanced glycation end products
- ALT, Alanine aminotransferase
- AMPK, AMP-activated protein Kinase
- APPL1 and 2, Adaptor protein 1 and 2
- ATP, Adenosine tri-phosphatase
- BMI, Basal Metabolic Index
- CD, Cluster of differentiation
- COL13A1, Collagen, type XIII, alpha 1
- DAMP, Damage assocauted molecular pattern molecules
- EFCAB4B, EF-hand calcium binding domain 4B
- FA, Fatty acid
- FDFT1, Farnesyl-diphosphate farnesyltransferase 1
- FFA, Free fatty acid
- GCKR, Glucokinase regulatory protein
- GLUT 5, Glucose transporter type 5
- GWAS, Genome wide association studies
- HDL, High density lipoprotein
- HMGB1, High-mobility group protein B1
- HOMA-IR, Homoestatic model assessment-insulin resistance
- HSC, Hepatic Stellate Cells
- Hh, Hedgehog
- IL6, Interleukin 6
- IR, Insulin Resistance
- KC, Kupffer Cells
- LPS, Lipopolysacharrides
- LYPLAL1, Lypophospholipase like 1
- MCP, Monocyte chemotactic protein
- NAD, Nicotinamide adenine dinucleotide
- NAFL, Nonalcoholic fatty liver
- NAFLD, Nonalcoholic fatty liver disease
- NASH, Nonalcoholic steatohepatitis
- NCAN, Neurocan gene
- NF-KB, Nuclear Factor Kappa B
- NK, Natural Killer
- NKL, Natural Killer T cells
- NLR, NOD like receptor
- NNMT, Nicotinamide N-methyltransferase gene
- OXLAM, Oxidized linolenic acid metabolite
- PAMP, Pathogen-associated Molecular pattern
- PARVB, Beta Parvin Gene
- PDGF, Platelet-derived growth factor
- PNPLA3
- PNPLA3, Patatin-like phospholipase domain-containing protein 3
- PPAR-α, Peroxisome proliferator activated receptor alpha
- PPP1R3B, Protein phosphatase 1 R3B
- PUFA, Poly unsaturated fatty acid
- PZP, Pregnancy-zone protein
- ROS, Reactive oxygen species
- SAMM, Sorting and assembly machinery component
- SCAP, SREBP cleavage-activating protein
- SFA, Saturated fatty acid
- SNP, Single nucleotide polymorphism
- SOCS3, Suppressor of cytokine signaling 3
- SOD2, Superoxide dismutase 2 gene
- SREBP-1C, Sterol regulatory Element—Binding Protein 1-C gene
- TLR, Toll like receptor
- TNF α, Tumor necrosis factor Alpha
- UCP3, Uncoupling protein 3 gene
- adiponectin
- cytokines
- gut microbiota
- lipotoxicity
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Affiliation(s)
- Mithun Sharma
- Department of Hepatology and Nutrition, Asian Institute of Gastroenterology, Hyderabad, Telangana, India,Address for correspondence: Mithun Sharma, Consultant Hepatologist, Asian Institute of Gastroenterology, 6-3-661, Red Rose Café Lane, Somajigudda, Hyderabad 500082, India. Tel.: +91 8790622655.
| | - Shasikala Mitnala
- Research Labs, Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Ravi K. Vishnubhotla
- Department of Genetics, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rathin Mukherjee
- Department of Molecular Biology, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Duvvur N. Reddy
- Department of Gastroenterology, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Padaki N. Rao
- Department of Hepatology and Nutrition, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Hu Y, Chen J, Yang L, Chen P, Li J, Chen L, Chen J, Huang X, Zhang Y, Bu S, Huang Q. The value of neck circumference (NC) as a predictor of non-alcoholic fatty liver disease (NAFLD). J Clin Transl Endocrinol 2014; 1:133-9. [PMID: 29159094 DOI: 10.1016/j.jcte.2014.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/19/2014] [Accepted: 07/01/2014] [Indexed: 12/14/2022]
Abstract
Aims To analyze the correlation between neck circumference (NC) and non-alcoholic fatty liver disease (NAFLD) and compare the predictive value of NC for NAFLD with that of other simple anthropometric measures and other biochemical profiles. Methods 2761 subjects, undergoing a medical check-up at the Changhai Hospital between October 01, 2012 and November 30, 2012, were recruited to the study. NC, other simple anthropometric measures, and biochemical profiles were analyzed. Results NC in NAFLD subjects with or without elevated ALT were 38.94 ± 2.62 cm and 37.21 ± 3.06 cm respectively, which was significantly higher than that in subjects with other metabolic disorders (NC: 35.33 ± 3.03 cm) and in normal controls (NC: 32.60 ± 2.37) (both P < 0.001). NC in women with NAFLD increased by 1 cm and fasting insulin (FINS) and homeostasis model assessment-insulin resistance (HOMA-IR) increased by 1.87 mIU/L and 1.43, respectively. Compared with other anthropometric measures, neck circumference-height ratio (NHtR) had a significant impact both on the incidence of NAFLD. After adjustment for sex, abdominal obesity and other influencing factors, the incidence of NAFLD still tended to positively correlate with NC. Optimal cut-off points of NC and NHtR for predicting NAFLD in males were 37.25 cm and 0.224, respectively, and such points in females were 32.90 cm and 0.208, respectively. Conclusion NC was wider in NAFLD patients than in healthy subjects and other metabolic disorder sufferers. NC and NHtR could be used as simple predictive tools for NAFLD.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- AUC, Area under the curve
- BMI, Body mass index
- BUN, Blood urea nitrogen
- CVD, Cardiovascular diseases
- FBG, Fasting blood glucose
- FINS, Fasting insulin
- FT3, Free triiodothyronine 3
- FT4, Free thyroxine
- HC, Hip circumference
- HDL-C, High-density lipoprotein cholesterol
- HOMA-IR, Homeostasis model assessment-insulin resistance
- HUA, Hyperuricemia
- HbA1c, Hemoglobin A1c
- IR, Insulin resistance
- Insulin resistance
- LDL-C, Low-density lipoprotein cholesterol
- MS, Metabolic syndrome
- NAFLD, Nonalcoholic fatty liver disease
- NC, Neck circumference
- NHtR, Neck circumference-height ratio
- NWtR, Neck circumference-weight ratio
- Neck circumference
- Non-alcoholic fatty liver disease
- OR, Odd ratio
- QUICKI, Quantitative insulin-sensitivity check index
- SUA, Serum uric acid
- Scr, Serum creatinine
- T2DM, Type 2 diabetes mellitus
- TC, Total cholesterol
- TG, Triglyceride
- TSH, Thyroid stimulating hormone
- VAT, Visceral adipose tissue
- WC, Waist circumference
- Waist circumference
- γ-GT, gamma-glutamyltransferase
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Tanaka Y, Ishitsuka Y, Yamada Y, Kondo Y, Takeo T, Nakagata N, Higashi T, Motoyama K, Arima H, Matsuo M, Higaki K, Ohno K, Irie T. Influence of Npc1 genotype on the toxicity of hydroxypropyl-β-cyclodextrin, a potentially therapeutic agent, in Niemann-Pick Type C disease models. Mol Genet Metab Rep 2014; 1:19-30. [PMID: 27896072 DOI: 10.1016/j.ymgmr.2013.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 11/20/2022] Open
Abstract
Hydroxypropyl-β-cyclodextrin (HPBCD) is an attractive drug candidate against Niemann-Pick Type C (NPC) disease. However, the safety of HPBCD treatment for NPC patients remains to be elucidated. In this study, we examined the acute toxicity of HPBCD in Npc1-deficient mice. When treated with HPBCD (20,000 mg/kg, subcutaneously), over half of the wild-type (Npc1+/+) or Npc1+/- mice died by 72 h after the injection. In contrast, all of the Npc1-/- mice survived. Marked pathophysiological changes, such as an elevation in serum transaminase and creatinine levels, hepatocellular necrosis, renal tubular damage, interstitial thickening, and hemorrhages in lungs, were induced by the HPBCD treatment in Npc1+/+ or Npc1+/- mice. However, these pathophysiological changes were significantly alleviated in Npc1-/- mice. In addition, in vitro analysis showed that the Npc1 gene deficiency and treatment with U18666A, an Npc1 inhibitor, remarkably attenuated the cytotoxicity of HPBCD in Chinese hamster ovary cells. These results suggest that the NPC1 genotype exacerbates the cytotoxicity of HPBCD and Npc1-/- mice have substantial resistance to the lethality and the organ injury induced by HPBCD injection compared with Npc1+/+ or Npc1+/- mice. We suggest that the Npc1 genotype should be considered in the safety evaluation of HPBCD using experimental animals and cells.
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