RNA editing blood biomarkers for predicting mood alterations in HCV patients

Treatment-emergent depression is a common complication in patients with chronic hepatitis C virus (HCV) infection undergoing antiviral combination therapy with IFN-α and ribavirin. It has recently been shown that changes in A-to-I RNA editing rates are associated with various pathologies such as inflammatory disorders, depression and suicide. Interestingly, IFN-α induces gene expression of the RNA editing enzyme ADAR1-1 (ADAR1a-p150) and alters overall RNA editing activity. In this study, we took advantage of the high prevalence of pharmacologically induced depression in patients treated with IFN-α and ribavirin to test the interest of RNA editing–related biomarkers in white blood cells of patients. In this 16-week longitudinal study, a small cohort of patients was clinically evaluated using standard assessment methods prior to and during antiviral therapy and blood samples were collected to analyse RNA editing modifications. A-I RNA editing activity on the phosphodiesterase 8A (PDE8A) gene, a previously identified RNA editing hotspot in the context of lupus erythematosus, was quantified by using an ultra-deep next-generation sequencing approach. We also monitored gene expression levels of the ADAR enzymes and the PDE8A gene during treatment by qPCR. As expected, psychiatric evaluation could track treatment-emergent depression, which occurred in 30% of HCV patients. We show that PDE8A RNA editing is increased in all patients following interferon treatment, but differently in 30% of patients. This effect was mimicked in a cellular model using SHSY-5Y neuroblastoma cells. By combining the data of A-I RNA editing and gene expression, we generated an algorithm that allowed discrimination between the group of patients who developed a treatment-emergent depression and those who did not. The current model of drug-induced depression identified A-I RNA editing biomarkers as useful tools for the identification of individuals at risk of developing depression in an objective, quantifiable biological blood test.

[Study of hepatitis C virus leukotropism by characterization of viral quasispecies in the liver transplantation setting]

Besides hepatocytes, representing the main replication site of hepatitis C virus, peripheral blood mononuclear cells also represent a crucial target for viral infection. Hepatitis C virus compartmentalization (i.e., non-random distribution) of viral variants between plasma and peripheral blood mononuclear cells, more frequently observed in liver transplant patients compared to non-transplanted patients, makes liver transplantation an interesting model for the analysis of hepatitis C leukotropism. This article aims to present, firstly, in clinical and biological features arguing favour of hepatitis C virus infection leukotropism and, secondly, to review current knowledge about compartmentalization between plasma and peripheral blood mononuclear cells, especially in the liver transplantation setting.

[Hepatitis C, cirrhosis and hepatocellular carcinoma]

The screening for the detection of hepatocellular carcinoma is based on ultrasound sonography which should be realised in patients with post-hepatitis C cirrhosis with a delay between 3 and 6 months according to the most identified risk factors, in particular age and sex male. In the case of discovery of hypoechogen nodule < or = 1cm, a follow-up is mandatory because it is usually untypical by ultrasound sonography and to propose a liver biopsy in the case of an increasing in size is shown. The ultrasound guided cutting biopsy can precise the histological characteristics of the nodule, the grade, and indicate prognostic factors. The liver biopsy is also mandatory in the case of a nodule > 2 cm and when the ultrasound sonography is not contributive, especially when the nodule is between 1 and 2 cm in size.

[Neutralizing antibodies in hepatitis C virus infection]

Hepatitis C virus (HCV) results in persistent infection in more than 70% of infected individuals despite the development of humoral and cellular immune responses. Following infection, although antibodies targeting epitopes of both structural and non structural proteins are elicited, the virus evades antibody-mediated neutralization. Studies of host neutralizing responses against HCV have been limited by the lack of a convenient tissue culture system for HCV infection. In the past five years in vitro models have been developed to characterize interaction of HCV glycoproteins with host cell entry factors and detect antibodies interfering with HCV entry and infection. These models have been used to characterize targets of neutralizing responses and better understand their impact on the pathogenesis of infection.

Prognosis of hepatocellular carcinoma (HCC): Comparison of four staging systems in two French clinical trials

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Background: The aims of our study were to compare performances of 4 staging systems and to explore how to improve prognostic classification among French patients with HCC whose main aetiology is alcoholic cirrhosis. Methods: We have pooled 2 RCTs in palliative condition from Federation Francophone de Cancerologie Digestive (FFCD): - FFCD 9403 comparing tamoxifen vs symptomatic treatment and - FFCD 9402 comparing chemoembolization + tamoxifen vs tamoxifen alone. They had respectively included 416 and 122 patients. Performance of Okuda, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer group (BCLC) and GRoupe d’Etude et de Traitement du Carcinome Hépatocellulaire scores have been compared using: Akaike information criteria (AIC), discriminatory ability (Harrell’s c and the Royston’s D statistics), monocity of gradients and predictive accuracy (Schemper statistics Vs). To explore how to improve classifications univariate and multivariate Cox model were performed. Variables with univariate p< 0.10 have been retained for multivariate analyses. A forward selection procedure has then been implemented. Bootstraps validation was performed to test the robustness of our results. Analyses were done for each trial and for the pooled database with trial stratification. Results: Median OS was 5,3 months (IC 95%: [4,6; 6,2]), 402 patients had (75%) an alcoholic cirrhosis aetiology . As shown in Table 1 , CLIP staging had the best properties, followed by Okuda and BCLC. Performances of all staging systems were rather disappointing. WHO staging for CLIP or alphafetoprotein for BCLC allowed a significant improvement of prognostic information. Conclusions: Our results suggest that CLIP staging seems to be most adapted to french patients, it could be better by associating WHO PS. An external validation of our result will be performed on another trial in palliative condition.

[Table: see text]

No significant financial relationships to disclose.

Changing of hepatitis C virus genotype patterns in France at the beginning of the third millenium: The GEMHEP GenoCII Study

This cross-sectional study aimed to investigate, during a short period between 2000 and 2001, in a large population of patients with chronic hepatitis C, the epidemiological characteristics of hepatitis C virus (HCV) genotypes in France. Data from 26 referral centres, corresponding to 1769 patients with chronic hepatitis C were collected consecutively during a 6-month period. HCV genotyping in the 5'-non-coding region (NCR) was performed in each center using the line probe assay (LiPA, in 63% of cases), sequencing (25%) or primer-specific polymerase chain reaction (PCR) (12%). HCV genotypes 1a, 1b, 2, 3, 4, 5, non-subtyped 1 and mixed infection were found in 18, 27, 9, 21, 9, 3, 11 and 1% of our population, respectively. HCV genotype distribution was associated with gender, age, source and duration of infection, alanine aminotransferase (ALT) levels, cirrhosis, alcohol consumption, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection. In multivariate analysis, only the source of infection was the independent factor significantly associated with genotype (P = 0.0001). In conclusion, this study shows a changing pattern of HCV genotypes in France, with i.v. drug abuse as the major risk factor, an increase of genotype 4, and to a lesser extent 1a and 5, and a decrease of genotypes 1b and 2. The modification of the HCV genotype pattern in France in the next 10 years may require new therapeutic strategies, and further survey studies.

[Benefits of a preventive psychiatric accompaniment in patients Hepatitis C Virus seropositive (HCV): prospective study concerning 39 patients]

Hepatitis C represents a major public health challenge due to its chronic evolution and major complications (eg liver tumor and cirrhosis). New treatment strategies (interferon pégylé +/- ribavirine) have recently improved the prognosis except in case of poor compliance. Psychiatric comorbidity, especially affective disorders, is commonly associated with hepatitis C and constitutes the main cause of poor compliance, therapeutic discontinuations and treatment contra-indication. At this moment of new therapeutic protocols and the possibility of curing HCV infections, it is of utmost importance to widen antiviral treatment in many indications, to upgrade compliance, and to limit therapeutic discontinuations. In this context, where anxious and depressive disorders are the main reasons for failure in curing, it is necessary to anticipate the appearance of these troubles within an earlier multidisciplinary taking in charge. The primary aim of our study is to emphasize the utility of a multi-disciplinary approach including psychiatric evaluation, preventive follow-up and preventive treatment. The secondary objective is to show that a previous story of depression or use of drugs should not be considered as an insuperable contra-indication provoding the implementation of a specific follow-up. Thirty nine interferon treated patients were included in a prospective study. Our data confirm the high rate (28%) of Major Depressive Disorders among the population of hepatitis C treated patients in a preventive follow-up. A previous story of alcoholism, of suicide attempt or break off treatment with Major Depressive disorders might be predictive of such a complication. According to the subjective feeling of these patients with previous break'off treatment associated, specific psychiatric follow-up may improve tolerance for the treatment.

METHODS AND OBJECTIVES

39 patients (17 men and 22 women) accepted, on (or after) the non-systematic proposal of their hepatologist, to consult the psychiatrist of the network, prior to any therapeutic decision. The first objectives of the consultations were to inform the patient (and, with his agreement, his -relatives), about the risk of depressive disorders while under treatment by interferon, as well as their potential consequences. Moreover, the psychiatrist answers their questions concerning this issue, and proposes him a long-term psychotherapeutic follow up (up to several months after the antiviral treatment end) including availability in emergency if necessary and preventive antidepressive treatment. In this framework, we assessed in a prospective way the frequency, the intensity and the time (or moments) when major depressive episode (MDE) (according to the DSM IV) appeared under interferon alpha, the predictive factors for these MDE, the interest and the quality of a preventive antidepressive treatment prescription and the psycho-social benefits of this taking in charge for the patient.

RESULTS

Among these 39 patients -regularly followed during and after the antiviral therapy, 11 (28%) had a MDE while under treatment. These MDE, except for 2 (5%) of them which led to an hospitalization, were mild to moderate. They mainly appeared within the 2 first quarters of treatment without significant difference. Patients with antecedents of suicide attempt (80%), drug addiction (50%) or alcohol addiction (50%) are more likely to have a MDE under interferon alpha than other patients, but these risk factors are not a contra-indication for treatment because 95% of the patients ended their treatment and the 2 antiviral treatment discontinuations observed were secon-dary to (or following) an acute psychotic episode (hospitalization) and a maniac episode in a schizophrenic patient (outpatient care). The existence of antecedents of antiviral treatment discontinuations due to MDE (33%) does not seem to be a risk factor anymore when preventive care is provided. It is interesting to point out the existence of a certain male fragility, men are more psychologically sensitive to interferon alpha than women. About 90% of patients chose to take an antidepressant. The latter was mainly a treatment with sertraline (45% out of cases), with citalopram (40% out of cases), and for 15% of them antidepressive treatment previously prescribed and non modified because they were well-tolerated and efficient. 86% of the first prescriptions were not changed during the follow up. 75% of patients already treated by a previous antiviral treatment with interferon alpha estimated that an earlier psychiatric accompaniment was very beneficial for them, in terms of compliance and socio-professional insertion.

CONCLUSION

A specialized psychiatric accompaniment within a coherent multidisciplinary network provides a major benefit to the patients in terms of compliance and safe care (even for population considered as having higher risks) although it is not possible to define accurately the influence of the preventive prescription of a antidepressant (which is not prejudicial anyway). a previous story of depressive disorder should not be considered as a contra-indication, but should imply a specific psychiatric follow-up especially when alcoholism, previous story of suicidal attempt and previous break'off treatment are reported.

[Reflections on the treatment of EDM in hepatitis C virus patients treated with interferon alpha from a retrospective survey concerning 29 patients]

At this moment of new therapeutic protocols and the possibility of curing HCV infections, it is of utmost importance to widen antiviral treatment in many indications, to upgrade compliance, and to limit therapeutic discontinuations. Depressive disorders are probably the main reason for failure of this treatment. The lack of knowledge about depressive disorders and the little specialized psychiatric accompaniment in this field are obviously not beneficial for the patient and his disease (no access to interferon alpha therapy, poor compliance, frequent discontinuations of treatment.);

METHODS AND OBJECTIVES

24 patients (15 men and 9 women) treated by interferon alpha and having a major depressive episode (MDE) (according to the DSM IV) and who were about to discontinue their treatment, had a emergency consultation with the psychiatrist of the network who took them immediately in charge in the most adapted way (psychotropic therapy, psychotherapy, hospitalization.) as well as a long term specialized follow up (up to several months after the treatment was discontinued). From this follow up and based on a retrospective questionnaire proposed to the patients, we have thought about the existence and the relevance of the risk factors of the appearance of MDE under interferon alpha (personal antecedents of depression, of suicide attempts, of antiviral treatment discontinuations, of the drug addiction-induced contamination.) and about the major interest of a psychiatric accompaniment within an organized network.

RESULTS

Among the 29 patients regularly followed during and after the antiviral therapy, 23 (79.3%) received a psychotropic treatment adapted to the clinical situation (82.6% of initially prescribed antidepressants have not been modified) associated the the psychotherapy, 4 (13.7%) were hospitalized in the psychiatric ward where the network psychiatrist works, one attempted to commit suicide without associated depression disorders (hospitalization, no discontinuation of antiviral therapy). More than 90% of patients were able to complete treatment. However, 7 patients (24,1%) had a MDE within the 3 months following treatments (5 patients consulted after their treatment discontinuations even though this treatment was well tolerated and efficient). The frequency of MDE under interferon alpha in patients with personal antecedents of MDE (10 patients, 41.7%) was not significantly different from that found in patients without antecedents of MDE (14 patients, 58.3%). The frequency of MDE under interferon alpha in patients assuming that they had been obviously contaminated by a risky use of drugs (13 patients, 54%) is not significantly different from that found in patients assuming that they had been obviously contaminated by another risky situation (11 patients, 46%). We can wonder, despite of the poor recruitment, about the potential involvement of driving under the influence of alcohol, antecedents of MDE induced-discontinuation of a last treatment by interferon alpha or antecedents of suicide attempt, in the appearance of MDE under interferon alpha. The results are similar in women and men although almost twice as many men had an emergency consultation; 78.5% (11 patients) of already interferon alpha-treated patients in the past (14 patients) considered that the psychiatric accompaniment was extremely beneficial for their psycho-social well-being.

CONCLUSION

The antecedents of MDE and drug addiction are not predictive of the appearance of MDE under interferon alpha and should not be considered as a contra-indication of this treatment. A psychiatric accompaniment within a multidisciplinary network provides a major benefit to the patients in terms of compliance and safe care. It is essential to follow up the patients in the months following the end of antiviral treatment, above all if this latter was well-tolerated.

Evaluation of efficacy of liver transplantation in alcoholic cirrhosis using matched and simulated controls: 5-year survival. Multi-centre group

BACKGROUND/AIMS

Alcoholic cirrhosis is the most common cause of liver transplantation in US males. The limited number of donor livers calls for "prioritisation", favouring those patients who will benefit most. The aim was to assess the efficacy of liver transplantation in patients with alcoholic cirrhosis.

METHODS

We compared the survival of 169 transplanted patients with two conservatively treated control groups, one of 169 patients matched for prognostic factors (age, cirrhosis severity, bleeding history) and one of 169 simulated patients.

RESULTS

The probability of survival to 5 years in the transplanted group was 66% (95% confidence interval 58-74%) vs. 52% (44-60; p = 0.03) in the matched group and 54% (51-57; p = 0.01) in the simulated controls. Transplantation was associated with survival (relative risk = 1.51; p = 0.02), independently of risk score (risk = 2.07; p<0.001), indication, period of inclusion, centre experience, and alcohol abstinence. Patients with severe disease (Pugh C11-15) benefited most in terms of 5-year survival: 58% (44-72) vs. 31% (17-45; p = 0.008) in the matched and 35% (30-40; p<0.001) in the simulated control groups. For patients at lower risk there was no significant difference.

CONCLUSIONS

Liver transplantation increases the 5-year survival of patients with severe alcoholic cirrhosis. In patients at lower risk, efficacy of transplantation should be confirmed by longer follow-up or by randomised trial.

Effects of corticosteroids on HCV infection

The risk factors for clinical recurrent hepatitis C in liver transplant recipients are not clearly defined. It has been suggested that the corticosteroids included in the treatments of patients undergoing allograft rejection might induce acute hepatitis by increasing HCV replication. In this study we investigated the effects of corticosteroid boluses on HCV viremia in liver allograft recipients treated for acute rejection. Since we had previously developed a model of HCV replication in peripheral blood mononuclear cells (PBMC) in vitro, we also studied the effects of corticosteroids on HCV replication in vitro. A transient peak of HCV viremia was observed in patients treated with corticosteroid boluses for an acute allograft rejection. In the cell cultures, corticosteroids induced an increase of the total amount of viral RNA detectable. Our results demonstrate that corticosteroids induce an increase of hepatitis C virus replication in vivo and in vitro.

Lymphocyte reactivity to hepatitis C virus (HCV) antigens shows evidence for exposure to HCV in HCV-seronegative spouses of HCV-infected patients

Lymphocyte reactivity against hepatitis C virus (HCV) antigens was studied in 20 couples in which 1 member had chronic hepatitis C. This was done to investigate the possibility of HCV transmission between spouses that was not followed by seroconversion. Twenty healthy subjects without any risk factors for HCV transmission served as negative controls. All the patients' spouses and the healthy controls were negative for HCV RNA and for anti-HCV antibody. Lymphocytes were cultured with recombinant HCV core and nonstructural antigens (c22, c33, c100, c200, and NS5) and with control antigens (sperm whale myoglobin, chicken lysozyme, and superoxide dismutase). Lymphocytes from 10 patients and 4 seronegative spouses proliferated in the presence of at least one HCV antigen. No proliferation was shown with nonspecific antigens or in the control group. This study gives evidence for possible in vivo priming with HCV antigens that did not lead to seroconversion in spouses of HCV-positive patients.

Comparison of resection, liver transplantation and transcatheter oily chemoembolization in the treatment of hepatocellular carcinoma

BACKGROUND/AIMS

Resection and liver transplantation are currently considered as the most useful treatments for hepatocellular carcinoma. However, transcatheter oily chemoembolization may be favourably compared with these two surgical treatments in patients with anatomically operable tumors.

METHODS

Between 1985 and 1991, 122 patients with an Okuda stage I tumor were hospitalized in two French hospitals. Among these patients, 33 remained untreated, 42 were treated by transcatheter oily chemoembolization, 30 by resection and 17 by liver transplantation. The four groups were closely comparable except for age, the patients in the two surgical groups being significantly younger. Moreover, the frequency of pTNM II tumor was significantly higher in the resection group.

RESULTS

The 5-year probability of survival was close to 45% in each of the three treated groups and was significantly higher than in the untreated group (0% at 4 years, p < 0.0001). The probability of cancer recurrence and/or metastatic dissemination was lower after transcatheter oily chemoembolization than after surgery.

CONCLUSION

Thus, transcatheter oily chemoembolization seems comparable at 5 years with resection or transplantation for the treatment of resectable hepatocellular carcinoma.

[Hepatosplenic silicosis]

A case of hepatosplenic silicosis complicating a pulmonary silicosis is reported. Numerous calcified splenic nodules seen with conventional radiology, ultrasound or computed tomography, hepatic microcalcifications and "egg shell" abdominal lymph nodes best seen with computed tomography represent the radiologic signs. However, hepatosplenic silicosis can only be confirmed by pathological examination of liver biopsies showing birefringent particles within hyalinized nodules.

Evaluation of efficacy of liver transplantation in alcoholic cirrhosis by a case-control study and simulated controls

To assess the efficacy of liver transplantation in patients with alcoholic cirrhosis, we compared 2-year survival of 169 liver transplantation patients in 12 French centres with survival of two control groups treated conservatively. The matched group was 169 patients of similar age, cirrhosis severity, and bleeding history; the simulated group was 169 patients whose theoretical survival was determined in a cohort of 797 patients with alcoholic cirrhosis. The probability of survival to 2 years in transplanted patients was 73 (95% confidence interval 67-79%) versus 67% (59-75) in the matched and 67% (63-71) in simulated controls. When prognostic factors were taken into account, transplantation was associated with survival (r = 0.527; p = 0.069). Patients with severe liver disease (high-risk group) benefited most for 2-year survival: 64% (42-86) vs 41% (23-59) in the matched and 23% (19-27) in the simulated control groups (p < 0.01). There was no difference for patients at low and at medium risk. Liver transplantation increases the 2-year survival of patients with severe alcoholic cirrhosis. In patients with less severe disease, further studies should be done by non-randomised controlled studies with longer follow-up or by randomised trials.

Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients

BACKGROUND

In Western countries, only a small proportion of patients with hepatocellular carcinoma (HCC) can be treated with surgical resection. For other patients, locoregional management by transcatheter oily chemoembolization seems to be useful and warrants evaluation.

METHODS

One hundred and twenty-seven French patients with an inoperable HCC were treated by transcatheter oily chemoembolization. The efficiency of the treatment was assessed by a comparison of this group with a group of 127 untreated patients. Each patient of the treated group was matched closely with an untreated patient for all the main clinical, anatomic, and biologic features that characterize the spontaneous evolution of HCC.

RESULTS

The overall probabilities of survival in the treated group were 64%, 38%, 27%, and 27% at 1, 2, 3, and 4 years, respectively; those for the untreated group were 18%, 6%, and 5% at 1, 2 and 3 years, respectively (P < 0.0001). The survival was significantly increased in patients with Okuda Stage I and II disease (P < 0.0001), but not in those with Stage III. Karnofsky and Child-Pugh scores remained stable during the follow-up period and dropped only shortly before patients died.

CONCLUSION

Transcatheter oily chemoembolization is an efficient treatment for unresectable HCC for the palliation of symptoms as well as for the prolongation of survival with a good quality of life.

Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients

BACKGROUND

In Western countries, only a small proportion of patients with hepatocellular carcinoma (HCC) can be treated with surgical resection. For other patients, locoregional management by transcatheter oily chemoembolization seems to be useful and warrants evaluation.

METHODS

One hundred and twenty-seven French patients with an inoperable HCC were treated by transcatheter oily chemoembolization. The efficiency of the treatment was assessed by a comparison of this group with a group of 127 untreated patients. Each patient of the treated group was matched closely with an untreated patient for all the main clinical, anatomic, and biologic features that characterize the spontaneous evolution of HCC.

RESULTS

The overall probabilities of survival in the treated group were 64%, 38%, 27%, and 27% at 1, 2, 3, and 4 years, respectively; those for the untreated group were 18%, 6%, and 5% at 1, 2 and 3 years, respectively (P < 0.0001). The survival was significantly increased in patients with Okuda Stage I and II disease (P < 0.0001), but not in those with Stage III. Karnofsky and Child-Pugh scores remained stable during the follow-up period and dropped only shortly before patients died.

CONCLUSION

Transcatheter oily chemoembolization is an efficient treatment for unresectable HCC for the palliation of symptoms as well as for the prolongation of survival with a good quality of life.

Comparison of different lipid substrates on intestinal adaptation in the rat

The relative effects of medium chain (MCT) and long chain triglycerides (LCT) on intestinal morphology and functions were compared. Adult rats received intragastrically for 10 days an isoenergetic mixture containing either 50% MCT/50% LCT or 100% LCT. The other constituents of the diets were identical, and animals fed a standard diet orally were used as a reference group. Animals who were given the MCT/LCT diet showed a higher mucosal mass and protein content and increased villus length and crypt depth in the proximal part of the small intestine compared with the LCT and control diet groups. Administration of [3H] thymidine 12 hours before death resulted in a significant increase in the incorporation of the precursor into cellular DNA in the jejunum of rats given MCT. In rats given LCT as the only fat, the free fatty acid content of the microvillus membrane showed a 20 fold increase and at the same time there was a significant drop in the cholesterol content and in the cholesterol/protein ratio. Differences in the lipid composition of enterol diet or in the microvillus membrane did not effect adversely membrane bound hydrolase activities. These findings suggest that MCT in the diet confers advantages in addition to the provision of rapidly available energy.

Effects of amino acids in mixtures given by enteral or parenteral route on intestinal morphology and hydrolases in rats

This study compares the effects of amino acid addition to an elemental liquid diet containing carbohydrates and triglycerides given either intragastrically or intravenously on the morphology and on hydrolase activities in the jejunum and ileum of adult rats. The isocaloric mixtures were administered for 4 days and control rats received an isocaloric laboratory diet orally. Independent of their content in amino acid, all mixtures given intravenously caused a drop in mucosal weight and a shortening of the height of the villi in both the jejunum and ileum. By enteral route, the addition of amino acids to a carbohydrate-triglyceride liquid diet led to the maintenance of normal villus height (this effect being prominent in the ileum) and to a significant increase of jejunal sucrase and aminopeptidase activities when compared with the carbohydrate-triglyceride mixture. Feeding the mixtures by parenteral route caused a significant drop of both enzyme activities. In contrast, lactase activity was generally not modified by the route of nutrient administration or by the composition of the diets. However, the absence of amino acid in the mixture given intravenously caused a specific drop of lactase activity in the ileum. Ileal sucrase activity was lowered dramatically by intragastric or intravenous feeding of the elemental diets. This effect was not modulated by the presence of amino acids. The presence of amino acids caused a significant drop of aminopeptidase activity in the ileum independently of the route of administration when compared with animals receiving the carbohydrate-triglyceride liquid diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Ileal compensation for age-dependent loss of jejunal function in rats

Adaptive responses of brush border hydrolases and crypt cell proliferation were measured in the jejunum and ileum of 4-mo-old adult and 28-mo-old senescent male Wistar rats. Responses were measured after rats were deprived of food and then refed with a normoprotein diet (17% protein) or an isoenergetic high protein diet (70% protein). The young rats deprived of food then refed for 18 h with the high protein diet showed better body weight recovery than did old animals. Withholding food for 48 h induced a more pronounced drop of sucrase activity in the intestine of the old rats relative to young rats. Refeeding the high protein diet caused a better recovery of sucrase activity in the jejunum of young rats relative to senescent rats. In the aged animals, sucrase activity in the jejunum remained significantly lower after refeeding both diets. Compared with nourished controls, aged rats showed enzyme activity to be completely restored in the ileum. The high protein diet increased aminopeptidase activity in the jejunum and ileum of young rats, in contrast to the senescent rats in which the increase of enzyme activity was restricted to the ileum. In the jejunum of aged rats, the cell migration rate from crypt base to villus tip was reduced after refeeding, but no age-related changes were observed in the ileum. Our results indicate that the jejunum of senescent rats exhibits reduced adaptive capacities that may be partly compensated by enhanced ileal functions.

Transcatheter oily chemoembolization in the management of advanced hepatocellular carcinoma in cirrhosis: results of a Western comparative study in 60 patients

Transcatheter oily chemoembolization is widely used as palliative therapy for inoperable hepatocellular carcinoma in high-incidence Asiatic areas. To assess its usefulness in the Western form of this cancer, 30 French patients were treated between 1987 and 1990 by intraarterial hepatic injection of a Lipiodol-doxorubicin emulsion followed by embolization with 0.5 to 1 mm gelatin sponge particles. The number of procedures ranged from one to five. All patients had advanced, symptomatic and inoperable hepatocellular carcinoma (Okuda's staging: I, n = 8; II, n = 14; III, n = 8); none was found under systematic screening. All had underlying cirrhosis (Child-Pugh's class: A, n = 15; B, n = 12; C, n = 3) that was alcoholic in origin in 27 cases and posthepatitic B in origin in 3 cases. The results of the treatment were assessed by comparison with a group of 30 untreated patients admitted to the same unit between 1984 and 1987. Patients of both groups were closely matched for clinical presentation, global disease staging and precise anatomical extension. The overall 1- and 2-yr survival rate was 59% and 30%, respectively, for the treated patients vs. 0% at 1 yr for the untreated patients. The latter all died from local disease with end-stage liver failure and/or uncontrollable variceal bleeding. In the former, the three patients with Child's class C cirrhosis died after the first procedure. During the follow-up (range = 3 to 26 mo), 11 additional patients died, 8 from metastatic generalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Idiopathic biliary ductopenia in adults: a report of five cases

The clinical and pathological findings of five adult cases of idiopathic nonsyndromatic paucity of interlobular bile ducts are reported. Patients were 18-32 years old at the onset of the disease; four presented with pruritus and/or jaundice and one with bleeding of the esophageal varices. Two patients were siblings. Serum alkaline phosphatase counts ranged from 1 to 16 times the upper normal value, and total bilirubin counts ranged from 0.6 to 8.8 mg/dL (10 to 150 mumol/L). Initial liver biopsy showed portal and periportal fibrosis with cholangiolar proliferation and reduction in the number of interlobular bile ducts. Antimitochondrial antibodies were absent, and bile ducts were normal after opacification. The patients were observed for 3-11 years. Repeated liver biopsies in the five patients showed progression of the lesions, with development of biliary type cirrhosis in four. Two of the four patients with cirrhosis died of hepatic failure 3 and 11 years after onset of the disease. In the two other cases, liver transplantation was performed successfully. These cases suggest that chronic cholestasis with marked ductopenia resembling the nonsyndromatic paucity described in infancy and childhood may reveal itself at an adult age. This disorder, possibly familial, may rapidly progress to severe and even fatal liver disease and could be a new indication for liver transplantation.

Reduced benzo-a-pyrene activation potential in lymphocytes from chronic alcoholics

The effect of chronic ethanol consumption on the cellular metabolism of benzo-a-pyrene (BaP) is investigated in human peripheral lymphocytes obtained from 6 proven alcoholic addicts and 5 healthy donors. Lymphocytes convert BaP to dihydrodiols, diol-epoxides, phenols, quinone derivatives and polyhydroxylated forms. Sulfate, glucuronide and glutathione conjugates are also detected. The average production of metabolites is much lower in lymphocytes of alcoholics and a net global decrease of "active" metabolite production, i.e., diols and BPDE, is also observed. In contrast, conjugated metabolites are formed in increased amounts. The data indicate that the metabolism of BaP in lymphocytes from chronic alcoholics is characterized essentially by a lowered rate of metabolized BaP and a reduction of their BaP activation potential, as seen by the increased production of conjugated metabolites and the markedly decreased protein-bound active mutagen.

Age influence on sucrose hydrolysis and on monosaccharide absorption along the small intestine of rat

The consequences of aging on the hydrolysis and absorption of hexoses was assessed in vitro using everted intestinal segments. Glucose and fructose were given either as a mixture of free monosaccharides or as a disaccharide solution (sucrose). The jejuno-ileum of 3- and 24-month-old rats was everted and divided into four equal segments. For each segment, the mucosal medium contained either sucrose (140 mM) or an equimolar mixture of glucose and fructose (70 mM). Monosaccharide concentrations in the mucosal ans serosal media were measured after 1 h of incubation at 37 degrees C. In the young adult, glucose absorption was enhanced when given as sucrose. In contrast, in the aged rat, free glucose or glucose released from sucrose hydrolysis were similarly absorbed. Independently of age, fructose was better absorbed when provided in a mixture of free monosaccharides. The intestinal segments (and especially the ileum), of the aged animals exhibited higher abilities to hydrolyse sucrose and to absorb monosaccharides indicating a normal or increased intestinal hydrolytic activity and absorptive capacity for dietary sugars.

[Hepatic undifferentiated (or embryonal) sarcoma. Diagnostic and therapeutic problems apropos of botryoid rhabdomyosarcoma]

Primary undifferentiated sarcomas (also called embryonal sarcomas or malignant mesenchymomas) are an exceptional form of cancer of the liver, occurring preferentially in children or adolescents. They can exhibit poor differentiation, embryonal rhabdomyosarcoma being the most frequent. To date, therapeutic success has been reported only rarely. The authors describe the case of a 16 year old boy with primary hepatic sarcoma showing a rhabdomyoblastic differentiation, who is in complete remission two years after total surgical resection and polychemotherapy.

Imbalance between jejunum and ileum in the response of brush border hydrolases to oral feeding after intravenous alimentation in rats

The effect of oral refeeding after total parenteral nutrition (TPN) on brush border hydrolases was measured in the proximal jejunum and ileum of adult rats. The animals received intravenously for 4 days a mixture of Intralipid 10% and Vamine-Glucose. At the end of TPN, oral feeding was reinstituted and the rats were fed with an isocaloric standard diet (60% carbohydrate, 17% protein, 3% lipid). Sucrase, isomaltase, lactase, and aminopeptidase N activities were measured at the end of TPN and at 1, 3, and 5 days after TPN. Sham-operated rats nourished orally with the standard diet were used as controls. In both intestinal segments, lactase activity showed no significant changes at the end of TPN or during oral realimentation. Isomaltase, and especially sucrase activities, exhibited an important drop at the end of TPN. After TPN, a complete restoration of isomaltase and sucrase activities was obtained in the jejunum only. During oral refeeding a 40% deficit in sucrase activity persisted in the ileum throughout the experimental period, whereas normal isomaltase activity was restored in this segment. Aminopeptidase N activity was lowered by TPN and recovered normal values within a few hours after oral realimentation. Thus, reinstitution of oral feeding after TPN should take into account that the intestine is capable of digesting normal amounts of dietary protein but has a reduced tolerance for carbohydrates.

[Hepatitis secondary to current non-steroidal anti-inflammatory agents]

The authors report 83 cases of acute hepatitis secondary to non steroid anti-inflammatory drugs (NSAID), published in the literature. The NSAID in question are: niflumic acid, tolfenamic acid, diclofenac, fenoprofen, ibuprofen, indomethacin, naproxen, piroxicam, pirprofen and sulindac. Six deaths are directly ascribed to NSAID: although rare, these forms of hepatitis deserve therefore to be reported. They are usually mixed immuno-allergic forms of hepatitis (cytolytic as well as cholestatic). They often affect elderly women taking multiple medications. Monitoring of the liver function tests is necessary, during prolonged treatment with NSAID, especially during the first six months.

Age related increase of brush border enzyme activities along the small intestine

Intestinal morphology and brush border hydrolase activities were determined along the small intestine of young adult (three months, n = 10), mature (12 months, n = 10), and senescent (29 months, n = 15) rats. The intestinal segments of the senescent rats contained higher mucosal mass and protein content (p less than 0.05) compared with the young and mature animals. A significant reduction of villus height and crypt depth (p less than 0.05) was found in the proximal intestine during aging. A 35% increase in villus height (p less than 0.05) without changes in crypt depth, was observed in the distal ileum in senescent rats. The activities of sucrase and isomaltase were significantly increased during aging in the duodenum and jejunum (p less than 0.05). Lactase and aminopeptidase activities which showed only minor changes between young and mature animals were significantly enhanced in senescent animals (p less than 0.05) with aminopeptidase exhibiting a three-fold increase in activity in the proximal ileum. The results when combined with those of previous studies suggest that in the aged animal, the increased level of intestinal hydrolase activities may be the consequence of prolonged cellular maturation along the villi in the proximal intestine, and of adaptation to increased concentrations of intraluminal substrates in the distal intestine.

Blood cell superoxide dismutase and enolase activities as markers of alcoholic and nonalcoholic liver diseases

Monitoring of chronic alcoholism would be facilitated by using sensitive biochemical markers in blood cells, mainly to detect differences between alcoholic subjects with or without liver injury. We propose two types of markers: the first one is superoxide dismutase (SOD) activity involved in the conversion of superoxide radicals (O2-.) formed during acetaldehyde oxidation by xanthine oxidase after chronic alcohol consumption; the second one is enolase activity with both isoenzyme forms: nonneuronal enolase (NNE) and neuron specific enolase (NSE) which has been shown to be modified in many injuries related to the glycolytic pathways. For SOD activity we found a significant increase in alcoholic patients with liver injury and mainly in cirrhotic patients with ascitis. Both enolase activities were also found to be significantly increased in alcoholic patients with liver injury but NNE activity was also increased in alcoholics without apparent liver disease. Our results suggest that increased activity of SOD and NSE in blood cells may be related to liver injury mainly in alcoholism while increased NNE activity may also be a marker of alcohol abuse without liver injury.

Calmodulin in normal and cystic fibrosis human intestine at different developmental stages

Calmodulin concentrations and localisation have been analysed as a function of development in human intestinal epithelial cells from normal and cystic fibrosis individuals. In normal fetuses up to eight weeks of gestation intestinal epithelial cells which were still undifferentiated were not immunoreactive and their calmodulin content was low. From eight weeks onwards there was a significant overall increase in calmodulin content concomitant with its segregation to the apical side of epithelial cells. At 14 weeks of gestation calmodulin concentrations and localisation closely resembled those of adults. The developmental pattern of calmodulin appeared to parallel the morphological and functional maturation of brush borders which occurs during the first trimester of pregnancy. In the intestinal epithelial cells from a 19 weeks cystic fibrosis fetus and a cystic fibrosis newborn infant neither calmodulin concentration, nor its localisation were affected. Similarly, brush border calmodulin binding proteins and enzymatic activities were similar in normal subjects and the cystic fibrosis intestine.

Prenatal exposure to alcohol in rat: effect on intestinal enzymes in offspring

Intestinal hydrolase activities were studied during postnatal development in the offspring of rats exposed to 20% ethanol during gestation; alcohol was withdrawn at birth. Controls received water during gestation. Sucrase, lactase, glucoamylase and aminopeptidase activities were determined 2 and 4 weeks after birth in the proximal jejunum. Offspring prenatally exposed to ethanol showed a deficit in body weight and lower aminopeptidase activity during the suckling period (2 weeks). These effects were reversible by 4 weeks when alcohol was withdrawn at birth. The prenatal exposure to ethanol did not change the pattern of sucrase maturation in the intestine of offsprings. The activities of lactase and glucoamylase were not modified following prenatal exposure to ethanol. In conclusion, exposure to ethanol during gestation caused decreased abilities for the intestine of the offspring to digest protein.

A comparison of intestinal adaptation to short-term intravenous versus intragastric diet in adult rats

This study was designed to determine, on intestinal function, the comparative effects of a fat emulsion, a carbohydrate solution, and a mixture of lipids and carbohydrates given for 4 days to adult rats either intragastrically or intravenously. The rats were separated into three groups (n = 24 in each group). Each group was divided into two populations fed either intragastrically or intravenously. Each group received one of the following nutrients: a 20% Intralipid emulsion, a mixture (1:1, V/V) of Intralipid 20% and Vamine N containing 25% glucose (W/V), a solution of Vamine-glucose supplemented with fructose to reach a final concentration of 20% (W/V). Sham-operated rats that received laboratory chow orally were used as controls. The daily caloric intake was 0.21 to 0.22 kcal/g body weight. The studies on villus morphology and on brush border enzyme activities were performed on the proximal part of the jejunum. For all nutrients, intragastric infusion provoked an increase in the villus height. The lipids were the only nutrients to cause villus lengthening by the intravenous route. Intragastric or intravenous infusion of fat provoked a deficiency in intestinal disaccharidases; the presence of carbohydrates in the diet inhibited this effect slightly. Carbohydrates given alone, either intragastrically or intravenously, caused an elevation of lactase activity. Independent of diet composition, aminopeptidase activity was reduced after intravenous feeding. In conclusion, the disaccharidase activities are largely dependent on changes occurring in the nutrient composition given either intragastrically or intravenously, whereas amino-peptidase activity was related to the route of diet administration.

[Effects of discontinuous intravenous infusion of ramified amino acids on blood insulin, blood glucagon and protein metabolism in cirrhotic patients after 10 days. Results of a controlled comparative study with sorbitol]

In order to evaluate the effects of ramified amino acids on insulinaemia, glucagonaemia and protein metabolism, a 3-hour infusion of ramified amino acids (24 g in a 750 ml solution) was given daily during 10 days to 10 cirrhotic patients without hepatic encephalopathy (group I). Changes between the first and tenth day in plasma concentrations of plasma insulin, glucagon, ammonium, ramified and aromatic amino acids and 3 proteins (albumin, prealbumin and transferrin) markers of protein malnutrition were measured comparatively with 10 other cirrhotic patients who received daily a 750 ml infusion of 5 p. 100 sorbitol (group II). The patients, who had been randomized to group I or II, had à 2,200 calorie/day diet representing a 6 to 12 g nitrogen intake. The ramified amino acid infusions were well tolerated. They produced a significant (p less than 0.001) increase in glucagonaemia without significant change in insulinaemia, and a non-significant decrease of the plasma insulin/glucagon molar ratio. The arterial blood ammonium level was significantly (p less than 0.05) lowered in group I as compared to group II. The plasma ramified/aromatic amino acid molar ratio significantly (p less than 0.01) increased in group I but did not reach normal values; this increase was not significant when compared to group II. Finally, plasma concentrations of the 3 proteins indicating protein malnutrition remained low in both groups. These results suggest that daily intravenous administration of ramified amino acids for 10 days, to supplement a conventional diet failed to correct the protein hypercatabolism associated with cirrhosis; induced, however, a decrease in arterial blood ammonium levels.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of malnutrition and immunity in alcoholic liver diseases]

Disorders of immunity and nutritional status are known to be present in alcohol-induced diseases of the liver, but their significance is still debated. Nutrition and immunity were evaluated at different stages of the disease in 58 alcoholic patients with steatosis (n = 20), alcoholic hepatitis (n = 14) or cirrhosis (n = 24). Most of the anthropometric data and biochemical values relating to nutrition were altered to the same degree in these 3 groups. Only patients with cirrhosis had significantly lower blood albumin and zinc levels (P less than 0.01). Humoral immunity was altered in cirrhosis only and cellular immunity in all 3 liver diseases. There was no correlation between immunity and nutrition (except for blood zinc and E rosettes; P less than 0.01) or between these and alcohol consumption. Like several nutritional parameters, blood lymphocyte values correlated negatively with a liver disease severity index. It is concluded that disorders of nutrition and immunity are broadly comparable in alcohol-induced liver diseases; there is no direct statistical correlation between these disorders which seem to be independent of the type of liver disease.

[Splenic pseudocysts. Apropos of a case]

The authors report a case of pseudocyst of the spleen. This is a rare entity which is part of nosological type of nonparasitic splenic cysts. It has most often a post-traumatic origin. The diagnosis is evoked in front of a mass of the left hypochondrium and has to be confirmed by further examinations, in particular by sonography and scanner. A microscopic examination of the surgical specimen is the only way to establish the diagnosis of a pseudocyst. The histological characteristic of pseudocyst is absence of epithelium. The splenic pseudocysts require a surgical treatment. In most cases, a splenectomy is performed. A the moment, cyst resection and partial splenectomies are performed by a few authors. This is the type of technique that we prefer especially when the patient is young.

Relationships between 34 HLA-A, HLA-B and HLA-DR antigens and three serological markers of viral infections in alcoholic cirrhosis

In order to study the genetic risk of alcoholic cirrhosis, the frequency of 26 HLA-A and -B antigens was compared in 184 normal controls, 175 alcoholic cirrhotic patients and 83 alcoholic patients with hepatic steatosis of carefully selected ethnic origin. Eight HLA-DR antigens were also determined in 95 subjects of the normal control group and 63 patients of the alcoholic cirrhosis group. The incidence of hepatitis B virus antibodies (anti-HBc and anti-HBs) was defined in 74 patients of the alcoholic steatosis group, 170 patients of the alcoholic cirrhosis group and 111 normal controls different from the previously mentioned normal control group. The incidence and the titers of cytomegalovirus and rubella antibodies were also determined in 93 patients of the alcoholic cirrhosis group and the 111 normal controls. Serum immunoglobulin concentrations were measured in the same 93 cirrhotic patients. Compared with the controls, the alcoholic cirrhosis group revealed a significantly higher frequency of HLA-B15 (21.7 vs. 9.8%, p less than 0.00025, corrected p less than 0.050) and HLA-DR4 (38.1 vs. 17.9%, p less than 0.005, corrected p less than 0.050) and a significantly lower frequency of HLA-B13 (2.9 vs. 11.4%, p less than 0.025, corrected p less than 0.050). As for the frequency of all other HLA antigens, there was no significant difference between the three groups (normal controls, alcoholic cirrhosis and alcoholic steatosis).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of intravenous and intragastric fat infusion on intestinal brush border enzyme activities in rats

Intralipid was given to adult rats for 4 days either by intragastric or intravenous infusion. The villus height, protein content and the levels of sucrase, lactase and aminopeptidase activities were determined in the jejunum. The results were compared to values found in control rats fed orally with an equilibrated isocaloric diet. Intragastric or intravenous infusion of Intralipid caused a 50% reduction in the protein content of the brush border membrane, a significant drop of the specific (expressed per milligram protein) and segmental (expressed per centimeter intestinal length) activities of the disaccharidases, the maintenance of aminopeptidase activity and the lengthening of the villi in the jejunum. The major loss in disaccharidase activities was obtained when fat was given intravenously. Arguments favoring a hormone-mediated effect of the infused lipids on the intestinal function are presented and discussed.

Frequencies of glyoxalase I phenotypes as biological markers in chronic alcoholism

Biological markers for alcoholism would be a valuable tool for early diagnosis. We have studied the phenotype frequencies of genetically determined erythrocyte enzymes in 397 alcoholics, including two populations with liver disease: steatosis (n = 86) and cirrhosis (n = 128) and a population of alcoholics without apparent liver disease (n = 183) compared to a well selected control population (n = 177). Only for Glyoxalase I (GLO) phenotypes (1,2 and 2-1) were significant differences found between the male controls and the male alcoholics. In the total male alcoholic population the frequency of phenotype 1 was significantly increased (23.2% vs. 11%, p less than 0.02), and the frequency of phenotype 2 was significantly decreased (32.3% vs. 46.3 p less than 0.02) compared to the male control population. For normal women the frequency of phenotype 1 and 2 was significantly different from normal men. (1: +177% p less than 0.001, 2: -45% p less than 0.01), but no significant differences were found between alcoholic and normal women. Our results suggest that in male subjects Glyoxalase I phenotype 1 may provide a marker for predisposition to alcoholism.