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Yuan X, Ma C, Li J, Li J, Yu R, Cai F, Qu G, Yu B, Liu L, Zeng D, Jiao Q, Liao Q, Lv X. Indirect bilirubin impairs invasion of osteosarcoma cells via inhibiting the PI3K/AKT/MMP-2 signaling pathway by suppressing intracellular ROS. J Bone Oncol 2023; 39:100472. [PMID: 36876225 PMCID: PMC9982672 DOI: 10.1016/j.jbo.2023.100472] [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: 12/01/2022] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Background Osteosarcoma is most prevalently found primary malignant bone tumors, with primary metastatic patients accounting for approximately 25% of all osteosarcoma patients, yet their 5-year OS remains below 30%. Bilirubin plays a key role in oxidative stress-associated events, including malignancies, making the regulation of its serum levels a potential anti-tumor strategy. Herein, we investigated the association of osteosarcoma prognosis with serum levels of TBIL, IBIL and DBIL, and further explored the mechanisms by which bilirubin affects tumor invasion and migration. Methods ROC curve was plotted to assess survival conditions based on the determined optimal cut-off values and the AUC. Then, Kaplan-Meier curves, along with Cox proportional hazards model, was applied for survival analysis. Inhibitory function of IBIL on the malignant properties of osteosarcoma cells was examined using the qRT-PCR, transwell assays, western blotting, and flow cytometry. Results We found that, versus osteosarcoma patients with pre-operative higher IBIL (>8.9 μmol/L), those with low IBIL (≤8.9 μmol/L) had shorter OS and PFS. As indicated by the Cox proportional hazards model, pre-operative IBIL functioned as an independent prognostic factor for OS and PFS in total and gender-stratified osteosarcoma patients (P < 0.05 for all). In vitro experiments further confirmed that IBIL inhibits PI3K/AKT phosphorylation and downregulates MMP-2 expression via reducing intracellular ROS, thereby decreasing the invasion of osteosarcoma cells. Conclusions IBIL may serve as an independent prognostic predictor for osteosarcoma patients. IBIL impairs invasion of osteosarcoma cells through repressing the PI3K/AKT/MMP-2 pathway by suppressing intracellular ROS, thus inhibiting its metastatic potential.
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Key Words
- AUC, area under curve
- BRNP, PEGylated bilirubin nanoparticles
- CCK-8, cell counting kit-8
- CI, confidence interval
- DBIL, direct bilirubin
- DMSO, dimethyl sulfoxide
- ECM, extracellular matrix
- H2O2, hydrogen peroxide
- HIF-1α, hypoxia inducible factor-1α
- HR, hazard ratio
- IBIL
- IBIL, indirect bilirubin
- Invasion
- MDA, malondialdehyde
- MMP, matrix metalloproteinase
- OS, overall survival
- Osteosarcoma
- PFS, progression-free survival
- PI3K/AKT/MMP-2
- PVDF, polyvinylidene fluoride
- Prognosis
- ROC, receiver operative characteristic
- ROS, reactive oxygen species
- SD, standard deviation
- SOD, superoxide dismutase
- TBIL, total bilirubin
- TIMP, tissue inhibitor of matrix metalloproteinase
- VEGF, vascular endothelial growth factor
- qRT-PCR, real-time quantitative PCR
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Affiliation(s)
- Xuhui Yuan
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - Cong Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jiayu Li
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - Junhong Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ronghui Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Feng Cai
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Gaoyang Qu
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Bo Yu
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Lang Liu
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Duo Zeng
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - QuanHui Jiao
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Qi Liao
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.,Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - Xiaobin Lv
- Jiangxi Key Laboratory of Cancer Metastasis and Precision Treatment, Central Laboratory, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
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2
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Samidoust P, Esmaeili Delshad MS, Navid Talemi R, Mojtahedi K, Samidoust A, Jahangiri S, Ashoobi MT. Incidence, characteristics, and outcome of COVID-19 in patients on liver transplant program: a retrospective study in the north of Iran. New Microbes New Infect 2021; 44:100935. [PMID: 34493955 PMCID: PMC8413100 DOI: 10.1016/j.nmni.2021.100935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/10/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
The risk of severe coronavirus disease-2019 (COVID-19) disease seems to be higher in individuals with solid organ transplantation. Therefore, the purpose of the present research is to investigate the incidence of COVID-19 and laboratory data and epidemiologic factors in liver transplant recipients and the patients on the waiting list for liver transplantation. In this study, we evaluated the records of patients on the waiting list for liver transplantation and of recipients of a liver transplant. Demographic data, underlying disease, history of drug use and participants' outcomes were collected. The diagnosis of SARS-CoV-2 infection for all patients was confirmed using a nasopharyngeal swab specimen with real-time RT-PCR. During the study period, 172 patients were enrolled, among whom 85 patients (49.4%) were on the waiting list for liver transplantation, and 87 patients (50.6%) were recipients of a liver transplant. Out of them, 10 (5.8%) had a positive result for SARS-CoV-2. Of these patients, 7.05% (6/85) and 4.6% (4/87) of patients on the waiting list and recipients of liver transplants were positive for SARS-CoV-2, respectively. Patients on the waiting list with COVID-19 infection had a higher median of albumin, ALT, AST, TBIL, DBIL, HDL and LDL value. In summary, the incidence of COVID-19 in liver transplant patients was slightly higher. The existence of underlying liver diseases should be well known as one of the poor predictive factors for worse outcomes in patients with COVID-19. So, comparative studies are recommended to identify risk factors for COVID-19 in patients with liver injury.
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Key Words
- ACE2, angiotensin-converting enzyme-2
- AST, aspartate aminotransferase
- CDC, Centers for Disease Control
- COVID-19
- CTscan, computed tomography scan
- DBIL, direct bilirubin
- HBV, Hepatitis B
- HDL, High-density lipoprotein
- Iran
- NASH, Non-alcoholic steatohepatitis
- NSAIDs, nonsteroidal anti-inflammatory drugs
- PSC, primary sclerosing cholangitis
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SD, standard deviation
- TBIL, total bilirubin
- liver transplant recipients
- liver transplantation
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Affiliation(s)
- P Samidoust
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - M S Esmaeili Delshad
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - R Navid Talemi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - K Mojtahedi
- Gastrointestinal and Liver Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - A Samidoust
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - S Jahangiri
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - M T Ashoobi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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3
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Lin Y, Yuan J, Long Q, Hu J, Deng H, Zhao Z, Chen J, Lu M, Huang A. Patients with SARS-CoV-2 and HBV co-infection are at risk of greater liver injury. Genes Dis 2021; 8:484-492. [PMID: 33225036 PMCID: PMC7672332 DOI: 10.1016/j.gendis.2020.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/31/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
To date, it remains unclear if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection exacerbates liver injury in patients with chronic hepatitis B virus (HBV) infection. In this study, we present a retrospective study of 133 hospitalized confirmed mild coronavirus disease 2019 (COVID-19) cases, including 116 patients with COVID-19 with negative serum hepatitis B antigen and 17 HBV inactive carriers with COVID-19. We found that there were no significant differences for the discharge rate or duration of hospitalization between the two groups. However, inactive HBV carriers with SARS-CoV-2 co-infection are at a higher risk of abnormal liver function tests. The enhanced liver injury induced by SARS-CoV-2 and HBV co-infection was identified as the hepatocyte type rather than the cholangiocyte type. Moreover, the inflammatory response, including abnormal lactate dehydrogenase, D-dimer and interleukin-6 production, may contribute to this injury following SARS-CoV-2 co-infection. Collectively, SARS-CoV-2 and HBV co-infection exacerbates liver function of the patients with COVID-19.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Abnormal liver function
- COVID-19
- COVID-19, coronavirus disease 2019
- GGT, gamma-glutamyltransferase
- HBV
- HBV, hepatitis B virus
- IQR, interquartile range
- Inactive HBV carriers
- LDH, lactate dehydrogenase
- Liver injury
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- TBIL, total bilirubin
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Affiliation(s)
- Yong Lin
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
| | - Jun Yuan
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, PR China
| | - Quanxin Long
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
| | - Jieli Hu
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
| | - Haijun Deng
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
| | - Zhenyu Zhao
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
| | - Juan Chen
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
| | - Mengji Lu
- Institute for Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, 45122, Germany
| | - Ailong Huang
- Key Laboratory of Molecular Biology of Infectious Diseases (Chinese Ministry of Education), Chongqing Medical University, Chongqing, 400016, PR China
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4
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Ji D, Chen GF, Niu XX, Zhang M, Wang C, Shao Q, Wu V, Wang Y, Cheng G, Hurwitz SJ, Schinazi RF, Lau G. Non-alcoholic fatty liver disease is a risk factor for occurrence of hepatocellular carcinoma after sustained virologic response in chronic hepatitis C patients: A prospective four-years follow-up study. Metabol Open 2021; 10:100090. [PMID: 33889834 PMCID: PMC8050772 DOI: 10.1016/j.metop.2021.100090] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/21/2022] Open
Abstract
Background and aim The incidence of hepatocellular carcinoma (HCC) decreases significantly in chronic hepatitis C (CHC) patients with sustained virologic response (SVR) after pegylated-interferon plus ribavirin (PR) or direct-acting antiviral (DAAs) therapy. We follow-up a single cohort of CHC patients to identify risk factors associated with HCC development post-SVR. Method CHC patients with SVR in Beijing/Hong Kong were followed up at 12–24 weekly intervals with surveillance for HCC by ultrasonography and alpha-fetoprotein (AFP). Multivariate Cox proportional hazards regression analysis was used to explore factors associated with HCC occurrence. Results Between October 2015 and May 2017, SVR was observed in 519 and 817 CHC patients after DAAs and PR therapy respectively. After a median post -SVR follow-up of 48 months, HCC developed in 54 (4.4%) SVR subjects. By adjusted Cox analysis, older age (≥55 years) [HR 2.4, 95% CI (1.3–4.3)], non-alcoholic fatty liver diseases [HR 2.4, 95%CI (1.3–4.2), higher AFP level (≥20 ng/ml) [HR 3.4, 95%CI (2.0–5.8)], higher liver stiffness measurement (≥14.6 kPa) [HR 4.2, 95%CI (2.3–7.6)], diabetes mellitus [HR 4.2, 95%CI (2.4–7.4)] at pre-treatment were associated with HCC occurrence. HCC patients in the DAAs induced SVR group had a higher prevalence of NAFLD as compared with those in the PR induced SVR group, 62% (18/29) vs 28% (7/25), p = 0.026. A nomogram formulated with the above six independent variables had a Concordance-Index of 0.835 (95% CI 0.783–0.866). Conclusion Underlying NAFLD is associated with increased incidence of HCC in chronic HCV patients post-SVR, particularly in those treated with DAA. Patients with chronic hepatitis C infection are still at risk of HCC after achieving sustained virus clearance (SVR). Non-alcoholic liver disease (NAFLD) is emerging as an important risk factor for hepatocellular carcinoma. Underlying NAFLD is associated with increased incidence of HCC in patients with chronic HCV infection after sustained virologic response SVR.
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Key Words
- AFP, alpha-fetoprotein
- ALT, alanine aminotransferase
- ANGPTL, angiopoietin-like proteins
- AST, aspartate aminotransferase
- ASV, asunaprevir
- BCLC, Barcelona-Clinic Liver Cancer Group
- BMI, body mass index
- CHC, chronic hepatitis C
- CI, confidence intervals (CI)
- Chronic hepatitis C
- DAAs, direct-acting antiviral agents
- DCV, daclatasvir
- FGF, fibroblast growth factor
- HCC
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, Hazard Ratio
- IFN, interferon
- LDV, ledipasvir
- LSM, liver stiffness measurement
- NAFLD
- PLT, platelet count
- PR, Peg-IFN-α with RBV
- Peg-IFN, Pegylated interferon
- RBV, ribavirin
- SMV, simeprevir
- SOF, sofosbuvir
- SVR, sustained virologic response
- Sustained virologic response
- TBIL, total bilirubin
- TNF, tumor necrosis factor
- ULN, upper limit of normal
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Affiliation(s)
- Dong Ji
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Guo-Feng Chen
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Xiao-Xia Niu
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Mingjie Zhang
- Faculty of Health Science, Macau University, Taipa, Macau
| | - Cheng Wang
- Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Qing Shao
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Vanessa Wu
- Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Yudong Wang
- Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Gregory Cheng
- Faculty of Health Science, Macau University, Taipa, Macau.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Selwyn J Hurwitz
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Raymond F Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - George Lau
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
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5
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Gao Y, Fan S, Li H, Jiang Y, Yao X, Zhu S, Yang X, Wang R, Tian J, Gonzalez FJ, Huang M, Bi H. Constitutive androstane receptor induced-hepatomegaly and liver regeneration is partially via yes-associated protein activation. Acta Pharm Sin B 2021; 11:727-37. [PMID: 33777678 DOI: 10.1016/j.apsb.2020.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/10/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/15/2022] Open
Abstract
The constitutive androstane receptor (CAR, NR3I1) belongs to nuclear receptor superfamily. It was reported that CAR agonist TCPOBOP induces hepatomegaly but the underlying mechanism remains largely unknown. Yes-associated protein (YAP) is a potent regulator of organ size. The aim of this study is to explore the role of YAP in CAR activation-induced hepatomegaly and liver regeneration. TCPOBOP-induced CAR activation on hepatomegaly and liver regeneration was evaluated in wild-type (WT) mice, liver-specific YAP-deficient mice, and partial hepatectomy (PHx) mice. The results demonstrate that TCPOBOP can increase the liver-to-body weight ratio in wild-type mice and PHx mice. Hepatocytes enlargement around central vein (CV) area was observed, meanwhile hepatocytes proliferation was promoted as evidenced by the increased number of KI67+ cells around portal vein (PV) area. The protein levels of YAP and its downstream targets were upregulated in TCPOBOP-treated mice and YAP translocation can be induced by CAR activation. Co-immunoprecipitation results suggested a potential protein–protein interaction of CAR and YAP. However, CAR activation-induced hepatomegaly can still be observed in liver-specific YAP-deficient (Yap–/–) mice. In summary, CAR activation promotes hepatomegaly and liver regeneration partially by inducing YAP translocation and interaction with YAP signaling pathway, which provides new insights to further understand the physiological functions of CAR.
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Key Words
- ALB, albumin
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ANKRD1, ankyrin repeat domain 1
- AST, aspartate transaminase
- AhR, aryl hydrocarbon receptor
- CAR, constitutive androstane receptor
- CCNA1, cyclin A1
- CCND1, cyclin D1
- CCNE1, cyclin E1
- CITCO, 6-(4-chlorophenyl)imidazo[2,1-b][1,3]thiazole-5-carbaldehyde O-(3,4-dichlorobenzyl)oxime
- CTGF, connective tissue growth factor
- CTNNB1, β-catenin
- CV, central vein
- CYR61, cysteine-rich angiogenic inducer 61
- Co-IP, co-immunoprecipitation
- Constitutive androstane receptor
- EGFR, epidermal growth factor receptor
- FOXM1, forkhead box M1
- FXR, farnesoid X receptor
- H&E, haematoxylin and eosin
- Hepatomegaly
- Liver enlargement
- Liver regeneration
- Nuclear receptors
- PHx, partial hepatectomy
- PPARα, peroxisome proliferators-activated receptor alpha
- PV, portal vein
- Partial hepatectomy
- Protein–protein interaction
- TBA, total bile acid
- TBIL, total bilirubin
- TCPOBOP, 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene
- TEAD, TEA domain family member
- YAP, yes-associated protein
- Yes-associated protein
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Ju Y, Liu X, Wang H, Yang J. Central nervous system solitary fibrous tumour/hemangiopericytoma presenting as nausea, vomiting and hepatic dysfunction after the first trimester of pregnancy: A case report. Case Rep Womens Health 2021; 29:e00285. [PMID: 33511039 PMCID: PMC7817527 DOI: 10.1016/j.crwh.2021.e00285] [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: 12/05/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/08/2022] Open
Abstract
Background Solitary fibrous tumour/haemangiopericytoma (SFT-HPC) is a rare fibroblastic mesenchymal neoplasm that develops as a result of the uncontrolled proliferation of mesenchymal fibroblasts and occurs rarely during pregnancy. Case Presentation A 26-year-old woman (G2P1) with an intrauterine pregnancy at 34+4weeks presented at a university hospital with a history of nausea and vomiting since 20 weeks. Other symptoms included slight headache and 5-kg weight loss. She had attended and been admitted to several hospitals during that time. Laboratory evaluation revealed evidence of hepatic dysfunction with elevated liver enzymes. The patient's headache worsened, and magnetic resonance imaging (MRI) showed an extra-axial mass in the right tentorial and supratentorial spaces, with brain herniation. Caesarean section and brain tumour resection were performed under general anaesthesia at the same time. Histopathological analysis revealed HPC (World Health Organization [WHO] grade III). Nausea and vomiting symptoms gradually improved. Postoperatively, the patient underwent fractional external radiotherapy (total amount 50 Gy). There was no evidence of local recurrence of metastases in the follow-up 6 months after surgery. Conclusions Nausea and vomiting are commonly experienced during pregnancy. This often makes patients ignore other aetiologies that cause nausea and vomiting. Central nervous system tumours can mimic the common pregnancy complaint of nausea and vomiting. Although rare in pregnancy, they can adversely affect maternal and fetal survival if untreated. Clinicians should exclude other pathology when the onset of nausea and vomiting is after the first trimester. Haemangiopericytoma is a rare and aggressive type of soft tissue sarcoma that arises from pericytes of the capillaries and involves mostly the musculoskeletal system. Its presentation [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]] in the central nervous system is very rare. Diagnosis was made at 34 weeks of pregnancy after several hospital admissions for nausea and vomiting starting at 20 weeks gestation. There should be a suspicion of pathology when the onset of nausea and vomiting is after the first trimester.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BC, conjugated bilirubin
- CD34, Cell differentiation factor 34
- CNS, Central nervous system
- CT, computed tomography
- Central nervous system
- EMA, epithelial membrane antigen
- HCG, human chorionic gonadotrophin
- HG, hyperemesis gravidarum
- Hemangiopericytoma
- Hepatic dysfunction
- MRI, magnetic resonance imaging
- Nausea and vomiting
- PABC, pregnancy-associated breast cancer
- PET, positron emission tomography
- PLGF
- PLGF, placental growth factor
- Pregnancy
- S-100, soluble protein-100
- SFT-HPC, Solitary fibrous tumour/hemangiopericytoma
- STAT6, signal transducer and activator of transcription 6
- TBIL, total bilirubin
- VEGF, Vascular endothelial growth factor
- WHO, World Health Organization
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Affiliation(s)
- Ying Ju
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Xu Liu
- Department of Anesthesiology, the First Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Huiling Wang
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Jun Yang
- Department of Gynaecology and Obstetrics, the First Affiliated Hospital of Xinxiang Medical University, Henan, China
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7
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Hu J, Chen F, Qiu G, Sun T, Yang H, Shen H, Tong P, Chai Y, Zhang X, Zhang W, Yang Z, Jiang H, Pan Y, Zhu T, He C, Xiao W. Jingshu Keli for treating cervical spondylotic radiculopathy: The first multicenter, randomized, controlled clinical trial. J Orthop Translat 2020; 27:44-56. [PMID: 33376673 PMCID: PMC7758457 DOI: 10.1016/j.jot.2020.10.010] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Jingshu Keli (or Jingshu granules), a traditional Chinese medicine, are widely used for treating cervical spondylotic radiculopathy in China; however, no randomized, double-blind, controlled study has verified their effectiveness. Purpose To evaluate the efficacy and safety of Jingshu Keli for the treatment of cervical spondylotic radiculopathy in a randomized controlled trial. Design From August 2015 to July 2017, a multicenter, randomized, double-blind, placebo-controlled trial was conducted at 13 large- and medium-sized hospitals in China. Patient sample A total of 360 and 120 patients were initially enrolled in the Jingshu and control groups, respectively; 386 patients completed the study, with 299 in the Jingshu group and 87 in the control group. Outcome measures The main index for evaluating the curative effect was the pain score on a visual analogue scale (VAS; 0–100 points). Methods All patients were administered a bag of Jingshu Keli or placebo 3 times a day for 4 weeks, and were interviewed at the second and fourth weeks. The decrease in pain scores and rate of change in pain scores after treatment were calculated, related laboratory indices were reviewed, and adverse reactions were recorded. Results In the Per Protocol Set (PPS) analysis, the baseline pain VAS scores in the control and Jingshu groups were 49.31 ± 6.97 and 50.06 ± 7.33, respectively, with no significant difference between the groups (P > 0.05). While there were no differences at 2 weeks between groups, at four weeks the pain VAS scores in the control and Jingshu groups decreased by 12.86 ± 13.45 and 22.72 ± 15.08, respectively relative to the values at baseline, with significant group differences (P < 0.0001). While there were similar significant differences between the groups (P < 0.0001) in the Full Analysis Set (FAS) analyses neither group achieved the minimal clinically important difference at any time point. Conclusions Jingshu Keli are effective for the treatment of cervical spondylotic radiculopathy. Translational potential statement This is the first prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial that confirmed the clinical efficacy and safety of Jingshu Keli for treating cervical spondylotic radiculopathy, which can provide evidence for clinical treatment.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ANCOVA, analysis of covariance
- AST, aspartate aminotransferase
- BUN, blood urea nitrogen
- Cervical spondylotic radiculopathy
- Cr, creatine
- FAS, full analysis set
- Herbal medicine
- ITT, intention-to-treat
- Jingshu keli
- LOCF, last observation carried forward
- NAG, urine N-acetyl-beta-d-glucosaminidase
- PPS, per-protocol set
- PT, preferred term
- RCT, randomized controlled trial
- Randomized controlled trial
- SAS, safety analysis set
- SNL, spinal nerve ligation
- SOC, system organ class
- TBIL, total bilirubin
- Traditional Chinese medicine
- VAS, visual analogue scale
- γ-GT, γ-glutamyl transpeptidase
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Affiliation(s)
- Jianhua Hu
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Feng Chen
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Guixing Qiu
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Tiansheng Sun
- Department of Orthopedics, People's Liberation Army General Hospital, Peking, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
| | - Huiyong Shen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peijian Tong
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang, China
| | - Yimin Chai
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xueli Zhang
- Department of Spine Surgery, Tianjin People's Hospital, Tianjin, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhidong Yang
- Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hong Jiang
- Department of Orthopedics, Suzhou Hospital of Traditional Chinese Medicine, Soochow, Jiangsu, China
| | - Yalin Pan
- Department of Orthopedics, People's Hospital of Anyang City, Anyang, Henan, China
| | - Tianliang Zhu
- Department of Orthopedics, Chongqing General Hospital, Chongqing, China
| | - Chengjian He
- Department of Orthopedics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Weiping Xiao
- Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi China
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Rao H, Liu H, Wu E, Yang M, Feng B, Lin A, Fei R, Fontana RJ, Wei L, Lok AS. Comparison of clinical outcomes and impact of SVR in American and Chinese patients with chronic hepatitis C. JHEP Rep 2020; 2:100136. [PMID: 32715286 PMCID: PMC7369613 DOI: 10.1016/j.jhepr.2020.100136] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/30/2020] [Accepted: 05/23/2020] [Indexed: 02/06/2023] Open
Abstract
Background & Aims Chronic HCV infection is an important cause of hepatocellular carcinoma (HCC) and liver failure in the US but limited data are available in China. We compared the incidence of clinical outcomes among adults with chronic HCV infection in the US and China and examined factors associated with outcomes. Methods A parallel prospective study of 2 cohorts of patients with HCV RNA+ recruited in 1 site in the US (UMHS) and 3 sites (PUHSC) in China between September 2011 and July 2015 was carried out. Composite liver outcomes (liver-related deaths, HCC, liver transplantation or liver decompensation), were analysed using competing-risk Cox proportional hazards model to determine incidence and associated factors. Results A total of 795 UMHS and 854 PUHSC patients were followed for a median of 3.06 and 3.99 years, respectively. At enrolment, a significantly higher percentage of UMHS patients had cirrhosis (45.4% vs. 16.2%). The 5-year cumulative incidence of composite liver outcomes was significantly higher in UMHS than in PUHSC patients (25.3% vs. 6.6%, p <0.0001). Stratification by stage of liver disease at enrolment showed this difference persisted only in the subgroup without cirrhosis due to higher aspartate aminotransferase to platelet ratio index (APRI) in the UMHS cohort. A total of 493 UMHS and 502 PUHSC patients received HCV treatment, and sustained virologic response (SVR) was achieved in 88.0% UMHS and 86.8% PUHSC treated-patients. SVR as time-dependent variable was associated with 80% lower risk of composite liver outcomes among patients with decompensated cirrhosis but not the overall cohorts. Conclusions When accounting for disease severity at entry, the incidence of composite liver outcomes was similar in patients with HCV in the US and China. Achievement of SVR had the greatest short-term impact on patients with decompensated cirrhosis. Lay summary Patients with chronic hepatitis C virus infection were recruited from centres in the United States and China. During follow-up, a higher percentage of the American patients had clinical outcomes: liver failure, liver cancer, liver transplant or liver-related deaths than the Chinese patients, mainly because more American patients had cirrhosis at enrolment. Older age and more advanced liver disease were associated with higher incidence of outcomes overall and viral clearance after hepatitis C treatment was associated with a lower incidence of outcomes in patients with advanced cirrhosis. Our findings highlight the importance of improving diagnosis and treatment of hepatitis C before advanced liver disease develops. The incidence of clinical outcomes in US and Chinese patients with chronic HCV infection was compared. Outcome rates were higher in the US cohort, in which cirrhosis was more common. SVR rates were similar in the 2 cohorts. SVR decreased the incidence of clinical outcomes in patients with decompensated cirrhosis over a median 3-year follow-up.
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Key Words
- AFP, alpha fetoprotein
- AIC, Akaike Information Criterion
- ALB, albumin
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- APRI, aspartate aminotransferase to platelet ratio index
- AST, aspartate aminotransferase
- BMI, body mass index
- Cirrhosis
- DAA, direct-acting antiviral
- Decompensation
- Direct-acting antiviral therapy
- FIB-4, fibrosis-4
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- Hepatocellular carcinoma
- INR, international normalized ratio
- LT, liver transplantation
- LrD, liver-related deaths
- MELD, model for end-stage liver disease
- PUHSC, Peking University Health Science Center
- SVR, sustained virologic response
- TBIL, total bilirubin
- UMHS, University of Michigan Health System
- anti-HBc, antibody to HBcAg
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Affiliation(s)
- Huiying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Huixin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People's Hospital, Beijing, China
| | - Elizabeth Wu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Ming Yang
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Bo Feng
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Andy Lin
- The Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - Ran Fei
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Robert J Fontana
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Anna S Lok
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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Ong KJ, Ede JD, Pomeroy-Carter CA, Sayes CM, Mulenos MR, Shatkin JA. A 90-day dietary study with fibrillated cellulose in Sprague-Dawley rats. Toxicol Rep 2020; 7:174-182. [PMID: 32021807 PMCID: PMC6994281 DOI: 10.1016/j.toxrep.2020.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 10/25/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 12/31/2022] Open
Abstract
Novel forms of fibrillated cellulose offer improved attributes for use in foods. Conventional cellulose and many of its derivatives are already widely used as food additives and are authorized as safe for use in foods in many countries. However, novel forms have not yet been thoroughly investigated using standardized testing methods. This study assesses the 90-day dietary toxicity of fibrillated cellulose, as compared to a conventional cellulose, Solka Floc. Sprague Dawley rats were fed 2 %, 3 %, or 4 % fibrillated cellulose for 90 consecutive days, and parallel Solka Floc groups were used as controls. Survival, clinical observations, body weight, food consumption, ophthalmologic evaluations, hematology, serum chemistry, urinalysis, post-mortem anatomic pathology, and histopathology were monitored and performed. No adverse observations were noted in relation to the administration of fibrillated cellulose. Under the conditions of this study and based on the toxicological endpoints evaluated, the no-observed-adverse-effect level (NOAEL) for fibrillated cellulose was 2194.2 mg/kg/day (males) and 2666.6 mg/kg/day (females), corresponding to the highest dose tested (4 %) for male and female Sprague Dawley rats. These results demonstrate that fibrillated cellulose behaves similarly to conventional cellulose and raises no safety concerns when used as a food ingredient at these concentrations.
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Key Words
- % RET, percent reticulocyte
- 90-day subchronic study
- ABAS, absolute basophil
- AEOS, absolute eosinophil
- ALB, albumin
- ALKP, alkaline phosphatase
- ALT, alanine aminotransferase
- ALUC, absolute large unstained cell
- ALYM, absolute lymphocyte
- AMON, absolute monocyte
- ANEU, absolute neutrophil
- ANOVA, one-way analysis of variance
- ARET, absolute reticulocyte
- AST, aspartate aminotransferase
- BUN, urea nitrogen
- CAS, Chemical Abstracts Service
- CHOL, cholesterol
- CREAT, creatinine
- Cellulose
- DLS, dynamic light scattering
- EDXS, energy-dispersive X-ray spectroscopy
- EFSA, European Food Safety Authority
- FDA, U.S. Food and Drug Administration
- Fibrillated cellulose
- GLOB, globulin
- GLP, good laboratory practice
- GLU, glucose
- GRAS, generally recognized as safe
- HBG, hemoglobin
- HCT, hematocrit
- MCH, mean corpuscular cell hemoglobin
- MCHC, mean corpuscular cell hemoglobin concentration
- MCV, mean corpuscular cell volume
- NOAEL
- NOAEL, no-observed-adverse-effect level
- OECD 408
- OECD, Organisation for Economic Co-operation and Development
- Oral exposure
- PLT, platelet count
- RBC, red blood cell count
- RDW, red cell distribution width
- SCOGS, Select Committee on GRAS Substances
- SDH, sorbitol dehydrogenase
- SEM, scanning electron microscopy
- TBA, total bile acids
- TBIL, total bilirubin
- TEM, transmission electron microscopy
- TEMPO, 2,2,6,6-tetramethyl-piperidinyloxyl
- TP, total protein
- TRIG, triglycerides
- WBC, white blood cell count
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Affiliation(s)
| | - James D. Ede
- Vireo Advisors, LLC, Boston, MA 02130-4323, United States
| | | | - Christie M. Sayes
- Baylor University, Department of Environmental Science, One Bear Place #97266, Waco, TX 76798- 7266, United States
| | - Marina R. Mulenos
- Baylor University, Department of Environmental Science, One Bear Place #97266, Waco, TX 76798- 7266, United States
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Cheng Z, Lv Y, Pang S, Bai R, Wang M, Lin S, Xu T, Spalding D, Habib N, Xu R. Kallistatin, a new and reliable biomarker for the diagnosis of liver cirrhosis. Acta Pharm Sin B 2015; 5:194-200. [PMID: 26579446 PMCID: PMC4629233 DOI: 10.1016/j.apsb.2015.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 11/02/2014] [Revised: 02/01/2015] [Accepted: 02/14/2015] [Indexed: 12/27/2022] Open
Abstract
Kallistatin, which protects organs and cells against inflammation, fibrosis and oxidative stress, is mainly synthesized and secreted in liver. However, its relationship to human liver disease remains unclear. The purpose of this study was to explore the relationship between serum kallistatin and clinical evidence of both cirrhosis and hepatocellular carcinoma (HCC), and to determine if serum kallistatin levels could be used as a diagnostic indicator of hepatic health status, especially human liver cirrhosis (LC). Our cohort consisted of 115 patients with clinically proven liver fibrosis (LF), LC, or HCC by liver biopsies, and 31 healthy controls (CON). Serum kallistatin levels were quantified by ELISA. Results of the present study demonstrated that irrespective of the underlying etiology, serum kallistatin levels were significantly lower in the LF/LC group when compared with the CON group. A decrease in serum kallistatin levels appeared to reflect the extent of cirrhosis, with the lowest levels associated with higher grades of cirrhosis. Patients with LC had a noticeable correlation between serum kallistatin levels and other serum biochemical indicators. The area under the curve (AUC) for LC, viral liver cirrhosis (VLC) and alcoholic liver cirrhosis (ALC) was 0.845, 0.757 and 0.931, respectively. In conclusion, our findings demonstrated that kallistatin, a plasma protein produced by the liver, can be a useful and reliable diagnostic indicator of hepatic health status, especially for LC.
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Key Words
- ALB, albumin
- ALC, alcoholic liver cirrhosis
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate aminotransferase
- AUC, area under the curve
- Biomarker
- CAP, community-acquired pneumonia
- CE, choline esterase
- CON, controls
- DBIL, direct bilirubin
- GGT, gamma-glutamyl transpeptidase
- GLB, globulin
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- IBIL, indirect bilirubin
- KBP, kallikrein-binding protein
- Kallistatin
- LC, liver cirrhosis
- LF, liver fibrosis
- Liver cirrhosis
- Liver fibrosis
- NASH, non-alcoholic steatohepatitis
- PA, prealbumin
- STP, serum total protein
- TBA, total bile acid
- TBIL, total bilirubin
- VLC, viral liver cirrhosis
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