Hepatology Communications最新文献

Background: Terlipressin is the only FDA-approved vasoconstrictor for hepatorenal syndrome (HRS). The CONFIRM study is the largest trial of terlipressin versus placebo. Novel predictors of HRS response are required to enrich patient selection and optimize outcomes.

Methods: Samples at treatment initiation were tested using (a) liquid chromatography-mass spectrometry of 1594 plasma/1420 urine metabolites (Metabolon Inc.), (b) aptamer-based array of 7289 plasma proteins (SomaScan), and (c) 14 plasma/urine pre-specified assays. The CONFIRM trial's original definition of HRS response [2 serum creatinine (SCr) <1.5 mg/dL separated by >2 h] was used as the primary outcome.

Results: In all, 115 patients [79 terlipressin-treated (TT) and 36 placebo-treated (PT)] provided samples. Baseline characteristics, outcomes, and 2:1 TT:PT allocation were preserved from the original 300-patient trial. A total of 36 out of 116 (31.0%) patients achieved HRS reversal. HRS reversal was associated with lower SCr (p=0.001), cystatin C (p=0.005), angiopoietin-2 (p=0.04), and beta-2 microglobulin (p=0.006). In metabolite analysis, PT had the most significant differences in HRS reversal [n=26 plasma, n=50 urine, including lower urine levels of those centered on sulfated secondary bile acids (microbiome-derived), N-acetylated amino acids, catechols (both uremic toxins), and phosphocholines (cell membrane integrity)], with fewer in TT (n=1 plasma, n=2 urine), and in all patients (n=3 plasma, n=7 urine). There were no significant aptamers associated with HRS reversal after false-discovery correction.

Conclusions: SCr, cystatin C, angiopoietin-2, and beta-2 microglobulin were associated with HRS reversal. Protein and metabolite signals centered on microbiome function and uremic toxins appeared more robust in PT patients, likely selecting a subgroup that may recover without terlipressin. Use of novel biomarkers may enrich for terlipressin response.

Background: The Barcelona Clinic Liver Cancer (BCLC) system for HCC was updated in 2022. The aim of the study was to assess the suitability and impact on overall survival (OS) of BCLC_2022, along with "clinical decision-making" (CDM), using BCLC_2018 as a benchmark.

Methods: We retrospectively evaluated 798 patients with de novo HCC followed prospectively from 2006 to 2022: 187 in BCLC 0, 371 in A, 132 in B, 87 in C, and 21 in D, all managed by a multidisciplinary team. Patients were followed until death or at the end of the follow-up period in December 2022.

Results: The suitability of the algorithm increased from 51% for BCLC_2018 to 69% for BCLC_2022 (p<0.001). Among those treated with the newly introduced "lower priority options," 22% were in BCLC 0 and 37% in A, showing lower rates of complete response (CR) and shorter OS compared to first-line treatments. In BCLC 0 and A, CDM was associated with a significant decrease in "downward stage migration" with BCLC_2022 (from 33% to 16%, p<0.001). Conversely, in BCLC B and C, "upward stage migration" correlated with higher CR rates and longer OS [63 (36-72) vs. 28 (18-44) months, p=0.003 in BCLC B; 21 (15-44) vs. 11 (4-25) months, p<0.001 in BCLC C]. Independent predictors of mortality included AFP >200 ng/mL, Child-Pugh score C, advanced BCLC stage, and noncurative treatment.

Conclusions: BCLC_2022 and CDM provide greater flexibility in clinical practice without adversely affecting patient survival. Access to curative treatments improves the outcomes of selected patients in all stages.

Liver fibrosis (LF) refers to the excessive deposition and abnormal distribution of the extracellular matrix (ECM) caused by acute or chronic liver injury, which affects the prognosis of liver diseases. Activated HSCs play a central role in LF through their ability to differentiate into myofibroblasts (MFBs) and secrete ECM. Intercellular communication within the liver is important for HSC activation and LF, whether in the initial or persistent stage. Hepatocytes (HCs), the most abundant cell type in the liver, are closely related to hepatic nutrition metabolism and detoxification. Moreover, HC damage is the initiating factor of LF, and interactions between HCs and HSCs may be the most critical event involved in the process of LF. This article reviews the intercellular communication between HCs and HSCs based on paracrine effects, extracellular vesicles, and inflammasomes, which is expected to lead to the development of effective antifibrotic strategies.

Background: HEV is an important cause of morbidity in solid organ transplant (SOT) recipients. However, the total burden of hepatitis E, including subclinical infections in this group, is not well defined. We compared hepatitis E exposures in SOT recipients to non-transplant controls. We also examined the prevalence of rat HEV (rHEV), an emerging hepatitis agent, in this population.

Methods: This study was conducted in the main SOT center in Hong Kong. Quantitative HEV IgG, RT-PCR, IgM, and IgG avidity assays were used to measure conventional HEV and rHEV exposures in 669 SOT recipients and 667 non-transplant hospitalized controls. Follow-up samples from a subset of SOT recipients were assessed to measure longitudinal HEV exposures.

Results: Age-adjusted HEV IgG seroprevalence in SOT recipients (236/669; 35.3%) was significantly higher than non-transplant controls (185/667; 27.7%; p=0.001). Across baseline and follow-up samples, 25 (3.7%) SOT recipients had viremia (n=3) or serological evidence (n=22) of recent hepatitis E. The latter had IgM positivity (n=5), IgG seroconversion (n=16), or a 5-fold increase in longitudinal HEV IgG concentrations (n=1). Chronic hepatitis occurred in all 3 viremic individuals, while transient hepatitis was observed in 10/22 (45.4%) SOT recipients with serological evidence of recent hepatitis E. rHEV IgG levels were similar between SOT recipients and controls (p=0.424), but 2 viremic infections in the SOT group were due to rHEV and both turned chronic.

Conclusions: SOT recipients have higher hepatitis E seroprevalence than the non-transplant population. Increased exposure is driven by viremic infections and a significant burden of subclinical infections in Hong Kong. rHEV is an important cause of chronic hepatitis E in SOT recipients.

Background: Social drivers of health (SDoH) contribute to health disparities among patients with chronic liver disease (CLD). Little is known about the feasibility and acceptability of SDoH screening in hepatology clinics. This study aimed to define SDoH prevalence among CLD patients, identify a feasible and acceptable screening approach, and assess the convergent validity of a locally developed screener.

Methods: Among adult patients with CLD receiving care in hepatology clinics, 2 SDoH screeners were administered to eligible participants: (1) default electronic medical record (EMR) questions and (2) Screener for Intensifying Community Referrals for Health (SINCERE). The primary outcomes were (1) prevalence of SDoH, (2) SDoH screening feasibility and acceptability, and (3) factors associated with screening acceptability. As a secondary outcome, the convergent validity of SINCERE to EMR was assessed.

Results: Among 250 participants, the mean age was 56 years, 56% were women, 22% were Hispanic, 7% were American Indian/Alaska Native, 58% had cirrhosis, 29% completed high school or less, 22% were unemployed/disabled, and 29% had an annual income <$35,000. Based on SINCERE, 26% had food insecurity, 8% transportation needs, 43% financial strain, 5% lack of social support, and 24% housing instability. Most respondents (69%) were comfortable or very comfortable completing SDoH screening. Using the McNemar test, there were statistically significant differences between screeners for financial strain and housing instability.

Conclusions: Among CLD patients at our center, SDoH were prevalent, and screening within the hepatology clinic was feasible and acceptable. To detect social needs, SINCERE, a locally developed screener, had overall acceptable convergent validity. These data support SDoH screening in hepatology clinics. Future multicenter studies evaluating the effective implementation of SDoH screening for CLD patients, including contextualized care plans and connection to available resources, should be conducted.

Background: Steatotic liver disease (SLD) is a significant cause of chronic liver disease. However, the relative prevalence and prognostic significance of various disease entities according to recently defined classification systems (MAFLD vs. the SLD-spectrum of MASLD, Met-ALD, and ALD) is understudied in older adults.

Methods: Post hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) study involving 16,703 Australian community-dwelling adults aged ≥70 years free from significant disability, prior cardiovascular disease events, and with a life expectancy ≥5 years. Steatosis was identified by Fatty Liver Index (FLI) ≥60. Alcohol intake was self-reported. SLD subtypes were classified according to European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) guidelines. Cox regression was used to estimate hazard ratios for adjudicated outcomes: mortality, major adverse cardiovascular events (MACE), and persistent physical disability.

Results: Of 9847 participants with calculable FLI and a median 8.6 years follow-up, 3748 (38.1%) had hepatic steatosis. Substratifying by MAFLD criteria versus the SLD type, 3743 had MAFLD (38.0%), and 3464 (35.2%) met SLD criteria (MASLD 3132 [90.4%], Met-ALD 262 [7.6%], ALD 74 [2.0%]) (excluding steatogenic medication users). There was no increased mortality risk with MAFLD or SLD. MAFLD and MASLD were associated with MACE when adjusted for age and sex (HR 1.42 [95% CI 1.17-1.71] and HR 1.40 [95% CI 1.15-1.71], respectively), but not in the fully adjusted model. MAFLD, MASLD, and ALD were associated with an increased risk of persistent physical disability even when fully adjusted (HR 1.46 [95% CI 1.19-1.79], HR 1.49 [95% CI 1.20-1.83], HR 2.53 [95% CI 1.27-5.05], respectively), but not Met-ALD.

Conclusions: MAFLD and the metabolic-SLD spectrum are common in community-dwelling older adults. No subclassification is associated with increased mortality in this group, although there is an association between both MACE and persistent physical disability with SLD.

Background: As the role of hepatic progenitor cells (HPCs) in constituting ductular reactions in pathogenesis remains ambiguous, we aimed to establish the in vivo cause-and-effect relationship between HPCs and chronic liver disease progression. We previously demonstrated that peritumoral ductules are associated with angiogenesis in liver tumors, and forkhead box L1 (Foxl1)-expressing murine HPCs secrete angiogenic factors in vitro. Therefore, we hypothesized that HPCs are capable of remodeling the portal vascular microenvironment and regulating overall liver disease progression, and this function of HPCs is dependent on recombination signal binding protein for immunoglobulin kappa J region (RBPJ), a key effector of the Notch signaling pathway.

Methods: We generated HPC-specific Rbpj conditional knockout mice (CKO) using Foxl1-Cre, treated them with the DDC diet to induce chronic liver disease, and performed serum biochemistry, gene expression analysis, and immunostaining analysis.

Results: CKO mice exhibited a significant reduction in serum levels of liver injury markers, ductular reactions, vascular and fibrotic areas, and hepatic expression of fibrosis and inflammation markers compared to control mice (WT). Single-nucleus RNA sequencing comparing CKO and WT livers detected transcriptome changes across multiple cell types, including endothelial cells, HSCs, and cholangiocytes. Expression of several reactive cholangiocyte markers, including vascular cell adhesion molecule 1 (VCAM1), in HPCs was significantly downregulated in response to anti-Rbpj shRNAs in vitro. Immunofluorescence analysis indicated that the percentage of VCAM1+ cells was reduced in both HPC and cholangiocyte populations in CKO compared to WT in vivo.

Conclusions: Our findings reveal Rbpj-dependent expression of reactive cholangiocyte markers in HPCs and demonstrate that Rbpj deletion in HPCs attenuates not only endothelial responses but also liver injury, fibrosis, and VCAM1 expression in cholangiocytes, highlighting the crucial role of HPCs in pathogenic progression.