Pub Date : 2025-09-29DOI: 10.1016/j.jhepr.2025.101611
Marika Rudler , Virginia Hernandez Gea , Hélène Larrue , Charlotte Bouzbib , Bogdan Procopet , Anna Baiges , Fanny Turon , Candido Villanueva , Agustin Albillos , Edilmar Alvarado Tapias , Lise Lott Gluud , Michael Praktiknjo , Joan Genesca , Meritxell Ventura-Cots , Ares Villagrasa , Susanna Rodrigues , Sarah Mouri , Álvaro Giráldez-Gallego , Helena Masnou Ridaura , Wim Laleman , Dominique Thabut
Background & Aims
Severe alcohol-related hepatitis (AH) and acute variceal bleeding (AVB) may occur simultaneously. The impact of a pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) in high-risk patients (patients with Child–Pugh (CP) B and active bleeding or CP C10–13 cirrhosis) with AVB and concomitant severe AH is unknown. The objective of the study was to compare the outcomes of severe AH in patients with high-risk AVB treated with pTIPS or endoscopic and drug treatment (Endo+drugs).
Methods
Patients were screened in four existing cohorts of patients with cirrhosis and AVB treated either with pTIPS or Endo+drugs. The inclusion criteria were AVB, high-risk patients, suspected severe AH (recent onset of jaundice, alcohol-related liver disease, absence of abstinence, model for end-stage liver disease score >20 and aspartate aminotransferase <500 UI/L). The primary endpoint was 42-day mortality, considering liver transplantation as a competing event. Secondary endpoints were rebleeding and further development of ascites or hepatic encephalopathy at 6 months.
Results
A total of 142 patients with AVB were included (pTIPS: n = 47, Endo+drugs: n = 95). Baseline characteristics (age 53, male sex 84%, model for end-stage liver disease score 23.4) were similar between the two groups. Overall, 56% had histologically proven AH. The 42-day mortality was 16% in the pTIPS group vs. 30% in the Endo+drugs group (p = 0.2). The cumulative incidence of rebleeding and ascites was significantly lower in the pTIPS group (2.8% vs. 24%, p = 0.026, and 6% vs. 52%, p <0.001, respectively), whereas hepatic encephalopathy occurrence was similar in the two groups (p = 0.2). Corticosteroid therapy was given in 55% and 46% of patients in the pTIPS and Endo+drugs groups, respectively (p = 0.3).
Conclusions
In severe AH, pTIPS is associated with better outcomes than Endo+drugs, and should not be contraindicated.
Impact and implications
Severe alcohol-related hepatitis and acute variceal bleeding may occur concomitantly, yet the role of pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) placement in this setting remains unclear. In this study, compared to standard of care, pTIPS treatment was associated with lower mortality, although this difference did not reach statistical significance, as well as a significantly reduced risk of rebleeding and recurrent ascites. These findings suggest that severe alcohol-related hepatitis should not be viewed as a contraindication to pTIPS placement when otherwise indicated, such as in patients with Child–Pugh B cirrhosis with a score greater than 7 and active bleeding, or Child–Pugh C10–13 disease.
{"title":"Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis","authors":"Marika Rudler , Virginia Hernandez Gea , Hélène Larrue , Charlotte Bouzbib , Bogdan Procopet , Anna Baiges , Fanny Turon , Candido Villanueva , Agustin Albillos , Edilmar Alvarado Tapias , Lise Lott Gluud , Michael Praktiknjo , Joan Genesca , Meritxell Ventura-Cots , Ares Villagrasa , Susanna Rodrigues , Sarah Mouri , Álvaro Giráldez-Gallego , Helena Masnou Ridaura , Wim Laleman , Dominique Thabut","doi":"10.1016/j.jhepr.2025.101611","DOIUrl":"10.1016/j.jhepr.2025.101611","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Severe alcohol-related hepatitis (AH) and acute variceal bleeding (AVB) may occur simultaneously. The impact of a pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) in high-risk patients (patients with Child–Pugh (CP) B and active bleeding or CP C10–13 cirrhosis) with AVB and concomitant severe AH is unknown. The objective of the study was to compare the outcomes of severe AH in patients with high-risk AVB treated with pTIPS or endoscopic and drug treatment (Endo+drugs).</div></div><div><h3>Methods</h3><div>Patients were screened in four existing cohorts of patients with cirrhosis and AVB treated either with pTIPS or Endo+drugs. The inclusion criteria were AVB, high-risk patients, suspected severe AH (recent onset of jaundice, alcohol-related liver disease, absence of abstinence, model for end-stage liver disease score >20 and aspartate aminotransferase <500 UI/L). The primary endpoint was 42-day mortality, considering liver transplantation as a competing event. Secondary endpoints were rebleeding and further development of ascites or hepatic encephalopathy at 6 months.</div></div><div><h3>Results</h3><div>A total of 142 patients with AVB were included (pTIPS: n = 47, Endo+drugs: n = 95). Baseline characteristics (age 53, male sex 84%, model for end-stage liver disease score 23.4) were similar between the two groups. Overall, 56% had histologically proven AH. The 42-day mortality was 16% in the pTIPS group <em>vs.</em> 30% in the Endo+drugs group (<em>p</em> = 0.2). The cumulative incidence of rebleeding and ascites was significantly lower in the pTIPS group (2.8% <em>vs.</em> 24%, <em>p</em> = 0.026, and 6% <em>vs.</em> 52%, <em>p</em> <0.001, respectively), whereas hepatic encephalopathy occurrence was similar in the two groups (<em>p</em> = 0.2). Corticosteroid therapy was given in 55% and 46% of patients in the pTIPS and Endo+drugs groups, respectively (<em>p</em> = 0.3).</div></div><div><h3>Conclusions</h3><div>In severe AH, pTIPS is associated with better outcomes than Endo+drugs, and should not be contraindicated.</div></div><div><h3>Impact and implications</h3><div>Severe alcohol-related hepatitis and acute variceal bleeding may occur concomitantly, yet the role of pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) placement in this setting remains unclear. In this study, compared to standard of care, pTIPS treatment was associated with lower mortality, although this difference did not reach statistical significance, as well as a significantly reduced risk of rebleeding and recurrent ascites. These findings suggest that severe alcohol-related hepatitis should not be viewed as a contraindication to pTIPS placement when otherwise indicated, such as in patients with Child–Pugh B cirrhosis with a score greater than 7 and active bleeding, or Child–Pugh C10–13 disease.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101611"},"PeriodicalIF":7.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.jhepr.2025.101601
Hui-Ru Kuo , Kwei-Yan Liu , Hsin-Ying Clair Chiou , Yu-Fen Chung , Li-Ting Wang , Chih-Wen Wang , Shih-Hsien Hsu , Shau-Ku Huang , Ming-Hong Lin
Background & Aims
The mechanisms underlying metabolic dysfunction-associated steatotic liver disease (MASLD) remain incompletely understood, and macrophage-associated chronic inflammation has been suggested to play a role. We investigated the potential contribution of mannose receptor type C 2 (MRC2), a transmembrane glycoprotein, to MASLD development.
Methods
Wild-type (WT) and Mrc2-deficient mice were fed a high-fat diet (HFD) for 8 weeks. Mouse primary hepatocytes (MPHs) and bone marrow–derived macrophages (BMDMs) were stimulated with or without palmitic acid (PA) to assess the role of MRC2 in MASLD development.
Results
MRC2 levels were significantly elevated in patients with MASLD (n = 216, p <0.0001) and in the livers of HFD-fed WT mice (n = 6–8, p <0.01), correlating with disease severity. Mrc2-null mice exhibited reduced HFD-induced weight gain and steatosis compared with WT mice (n = 6–8). MRC2 was predominantly expressed in hepatic macrophages, and conditioned medium from WT BMDMs enhanced PA-induced steatosis in MPHs (n = 6, p <0.0001). This effect was absent when conditioned medium from Mrc2-deficient BMDMs was used or when TNF-α–neutralizing antibodies or TNF receptor antagonists were added. Macrophage-specific Mrc2 deficiency also reduced MASLD severity in HFD-fed mice (n = 6). Mechanistically, disruption of the MRC2–CD147 complex impaired CD147-mediated NF-κB signaling and reduced TNF-α release from BMDMs, thereby decreasing steatosis in co-cultured MPHs.
Conclusions
Macrophage MRC2 promotes HFD-induced hepatic steatosis via the MRC2–CD147 complex, revealing a novel mechanism contributing to MASLD progression.
Impact and implications
This study identifies the critical role of MRC2 in the development of high-fat diet-induced metabolic dysfunction-associated steatotic liver disease, providing a mechanistic understanding of its involvement in macrophage-mediated inflammation. Mrc2 deficiency alleviates hepatic inflammation and lipid accumulation by downregulating CD147-regulated TNF-α production in macrophages. The findings are particularly significant for researchers and clinicians focused on liver diseases, as they reveal a novel target – the macrophage MRC2-CD147 complex – for potential therapeutic intervention.
背景和目的代谢功能障碍相关脂肪变性肝病(MASLD)的机制尚不完全清楚,巨噬细胞相关的慢性炎症已被认为在其中发挥作用。我们研究了甘露糖受体2型(MRC2),一种跨膜糖蛋白,对MASLD发展的潜在贡献。方法野生型(WT)和mrc2缺陷型小鼠饲喂高脂饮食(HFD) 8周。用或不加棕榈酸(PA)刺激小鼠原代肝细胞(MPHs)和骨髓源性巨噬细胞(bmdm),以评估MRC2在MASLD发展中的作用。结果MASLD患者(n = 216, p <0.0001)和hfd喂养的WT小鼠肝脏中smrc2水平显著升高(n = 6-8, p <0.01),与疾病严重程度相关。与WT小鼠相比,mrc2缺失小鼠表现出较少的hfd诱导的体重增加和脂肪变性(n = 6-8)。MRC2主要在肝巨噬细胞中表达,WT bmdm的条件培养基增强了pa诱导的mph脂肪变性(n = 6, p <0.0001)。当使用mrc2缺陷bmdm的条件培养基或添加TNF-α -中和抗体或TNF受体拮抗剂时,这种效果不存在。巨噬细胞特异性Mrc2缺乏也降低了饲喂hfd小鼠的MASLD严重程度(n = 6)。从机制上讲,MRC2-CD147复合物的破坏破坏了cd147介导的NF-κB信号传导,减少了bmdm中TNF-α的释放,从而减少了共培养的mph的脂肪变性。结论巨噬细胞MRC2通过MRC2 - cd147复合物促进hfd诱导的肝脂肪变性,揭示了促进MASLD进展的新机制。影响和意义本研究确定了MRC2在高脂肪饮食诱导的代谢功能障碍相关脂肪变性肝病发展中的关键作用,为其参与巨噬细胞介导的炎症提供了机制理解。Mrc2缺乏通过下调巨噬细胞中cd147调控的TNF-α的产生来减轻肝脏炎症和脂质积累。这些发现对于关注肝脏疾病的研究人员和临床医生来说尤其重要,因为它们揭示了一个新的靶点——巨噬细胞MRC2-CD147复合物——用于潜在的治疗干预。
{"title":"Macrophage MRC2 deficiency mitigates HFD-induced MASLD by downregulating CD147-regulated TNF-α production","authors":"Hui-Ru Kuo , Kwei-Yan Liu , Hsin-Ying Clair Chiou , Yu-Fen Chung , Li-Ting Wang , Chih-Wen Wang , Shih-Hsien Hsu , Shau-Ku Huang , Ming-Hong Lin","doi":"10.1016/j.jhepr.2025.101601","DOIUrl":"10.1016/j.jhepr.2025.101601","url":null,"abstract":"<div><h3>Background & Aims</h3><div>The mechanisms underlying metabolic dysfunction-associated steatotic liver disease (MASLD) remain incompletely understood, and macrophage-associated chronic inflammation has been suggested to play a role. We investigated the potential contribution of mannose receptor type C 2 (MRC2), a transmembrane glycoprotein, to MASLD development.</div></div><div><h3>Methods</h3><div>Wild-type (WT) and <em>Mrc</em><em>2</em>-deficient mice were fed a high-fat diet (HFD) for 8 weeks. Mouse primary hepatocytes (MPHs) and bone marrow–derived macrophages (BMDMs) were stimulated with or without palmitic acid (PA) to assess the role of MRC2 in MASLD development.</div></div><div><h3>Results</h3><div>MRC2 levels were significantly elevated in patients with MASLD (n = 216, <em>p <</em>0.0001) and in the livers of HFD-fed WT mice (n = 6–8, <em>p <</em>0.01), correlating with disease severity. <em>Mrc</em><em>2</em>-null mice exhibited reduced HFD-induced weight gain and steatosis compared with WT mice (n = 6–8). MRC2 was predominantly expressed in hepatic macrophages, and conditioned medium from WT BMDMs enhanced PA-induced steatosis in MPHs (n = 6, <em>p <</em>0.0001). This effect was absent when conditioned medium from <em>Mrc</em><em>2</em>-deficient BMDMs was used or when TNF-α–neutralizing antibodies or TNF receptor antagonists were added. Macrophage-specific <em>Mrc2</em> deficiency also reduced MASLD severity in HFD-fed mice (n = 6). Mechanistically, disruption of the MRC2–CD147 complex impaired CD147-mediated NF-κB signaling and reduced TNF-α release from BMDMs, thereby decreasing steatosis in co-cultured MPHs.</div></div><div><h3>Conclusions</h3><div>Macrophage MRC2 promotes HFD-induced hepatic steatosis via the MRC2–CD147 complex, revealing a novel mechanism contributing to MASLD progression.</div></div><div><h3>Impact and implications</h3><div>This study identifies the critical role of MRC2 in the development of high-fat diet-induced metabolic dysfunction-associated steatotic liver disease, providing a mechanistic understanding of its involvement in macrophage-mediated inflammation. <em>M</em><em>rc</em><em>2</em> deficiency alleviates hepatic inflammation and lipid accumulation by downregulating CD147-regulated TNF-α production in macrophages. The findings are particularly significant for researchers and clinicians focused on liver diseases, as they reveal a novel target – the macrophage MRC2-CD147 complex – for potential therapeutic intervention.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101601"},"PeriodicalIF":7.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.jhepr.2025.101602
Haixiang Zheng , Kuangyi Wu , Hong Zheng , Guanlin Chen , Yulong Lan , Shuohua Chen , Gavino Casu , Leonardo Antonio Sechi , Shouling Wu , Gianpaolo Vidili , Youren Chen
<div><h3>Background & Aims</h3><div>The correlation between systemic inflammation response index (SIRI) and both cardiovascular disease (CVD, including myocardial infarction and total stroke) and mortality in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. We examined this association in a large Chinese cohort.</div></div><div><h3>Methods</h3><div>A population of 24,340 patients with MASLD from the Kailuan study were observed over a median of 16.0 years. SIRI was calculated based on neutrophil, monocyte, and lymphocyte counts. Cox proportional hazards models were used to estimate hazard ratios (HRs) for CVD and mortality across SIRI quartiles. Net reclassification improvement assessed SIRI’s predictive value <em>vs.</em> high-sensitivity C-reactive protein and other indices. Mediation analysis assessed the roles of platelet count (PLT), Chinese visceral adiposity index and triglyceride-glucose index.</div></div><div><h3>Results</h3><div>During follow-up, 4,171 CVD events and 4,510 deaths occurred. Elevated SIRI was significantly linked to higher risks of CVD (HR for Q4 <em>vs.</em> Q1 1.21; 95% CI 1.10–1.31; <em>p <</em>0.001), including myocardial infarction (HR 1.22; 95% CI 1.01–1.48; <em>p</em> = 0.045), total stroke (HR 1.18; 95% CI 1.06–1.31; <em>p</em> = 0.003), and mortality (HR 1.34; 95% CI 1.24–1.46; <em>p <</em>0.001) in MASLD. Associations were stronger among women (HR 1.17; 95% CI 1.07–1.29; <em>p <</em>0.01) and physically inactive individuals (HR 1.09; 95% CI 1.05–1.13; <em>p <</em>0.01). SIRI improved outcome prediction over high-sensitivity C-reactive protein and other indices, with significant reclassification gains (5.84; 95% CI 2.57–9.12; <em>p <</em>0.001). Triglyceride-glucose index partially mediated these associations (5.3% for CVD, <em>p</em> = 0.006; 2.9% for mortality, <em>p</em> = 0.003), whereas PLT exhibited a slight inverse mediation effect on mortality (-3.3%, <em>p</em> = 0.032).</div></div><div><h3>Conclusions</h3><div>High SIRI independently correlates with increased risk of CVD and mortality in MASLD. These findings highlight the role of systemic inflammation and support SIRI as a potential biomarker for risk stratification in these individuals.</div></div><div><h3>Impact and implications</h3><div>This study provides important evidence linking systemic inflammation, as measured by the systemic inflammation response index, to increased cardiovascular disease and mortality in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent condition with rising global burden. The findings underscore the clinical relevance of inflammation markers in cardiovascular risk stratification, particularly for patients and healthcare providers managing MASLD. Physicians and policymakers could incorporate systemic inflammation response index into routine assessments to identify patients with MASLD at higher risk of cardiovascu
背景和目的在代谢功能障碍相关脂肪变性肝病(MASLD)患者中,全身性炎症反应指数(SIRI)与心血管疾病(CVD,包括心肌梗死和全卒中)和死亡率之间的相关性尚不清楚。我们在一个庞大的中国队列中检验了这种关联。方法对来自开滦研究的24340例MASLD患者进行了中位数为16.0年的观察。SIRI是根据中性粒细胞、单核细胞和淋巴细胞计数计算的。Cox比例风险模型用于估计SIRI四分位数中心血管疾病和死亡率的风险比(hr)。净重分类改进评估了SIRI与高灵敏度c反应蛋白和其他指标的预测价值。中介分析评估血小板计数(PLT),中国内脏脂肪指数和甘油三酯-葡萄糖指数的作用。结果随访期间共发生4171例CVD事件和4510例死亡。SIRI升高与心血管疾病的高风险显著相关(第4季度的风险比为1.21;95% CI 1.10-1.31; p <0.001),包括心肌梗死(HR 1.22; 95% CI 1.01-1.48; p = 0.045)、总卒中(HR 1.18; 95% CI 1.06-1.31; p = 0.003)和MASLD的死亡率(HR 1.34; 95% CI 1.24-1.46; p <0.001)。女性(HR 1.17; 95% CI 1.07-1.29; p <0.01)和不爱运动的个体(HR 1.09; 95% CI 1.05-1.13; p <0.01)的相关性更强。SIRI改善了对高灵敏度c反应蛋白和其他指标的预后预测,具有显著的再分类增益(5.84;95% CI 2.57-9.12; p <0.001)。甘油三酯-葡萄糖指数部分介导了这些关联(心血管疾病5.3%,p = 0.006;死亡率2.9%,p = 0.003),而PLT对死亡率表现出轻微的反向中介作用(-3.3%,p = 0.032)。结论高SIRI与MASLD患者CVD风险和死亡率增加独立相关。这些发现强调了全身性炎症的作用,并支持SIRI作为这些个体风险分层的潜在生物标志物。影响和意义本研究提供了重要的证据,表明全身性炎症反应指数与代谢功能障碍相关的脂肪变性肝病(MASLD)患者心血管疾病和死亡率增加有关,MASLD是一种全球负担不断增加的普遍疾病。研究结果强调了炎症标志物在心血管风险分层中的临床相关性,特别是对于管理MASLD的患者和医疗保健提供者。医生和决策者可以将全身性炎症反应指数纳入常规评估,以识别心血管事件高风险的MASLD患者,潜在地指导旨在减轻全身性炎症和代谢功能障碍的有针对性的干预措施。然而,由于主要是来自中国北方的以社区为基础的男性队列,在广泛的临床应用之前,有必要对不同人群进行进一步的研究来证实这些关联。临床试验编号chictr - tnc -11001489。
{"title":"High systemic inflammation response index and increased cardiovascular risk and mortality in MASLD: A prospective cohort study","authors":"Haixiang Zheng , Kuangyi Wu , Hong Zheng , Guanlin Chen , Yulong Lan , Shuohua Chen , Gavino Casu , Leonardo Antonio Sechi , Shouling Wu , Gianpaolo Vidili , Youren Chen","doi":"10.1016/j.jhepr.2025.101602","DOIUrl":"10.1016/j.jhepr.2025.101602","url":null,"abstract":"<div><h3>Background & Aims</h3><div>The correlation between systemic inflammation response index (SIRI) and both cardiovascular disease (CVD, including myocardial infarction and total stroke) and mortality in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. We examined this association in a large Chinese cohort.</div></div><div><h3>Methods</h3><div>A population of 24,340 patients with MASLD from the Kailuan study were observed over a median of 16.0 years. SIRI was calculated based on neutrophil, monocyte, and lymphocyte counts. Cox proportional hazards models were used to estimate hazard ratios (HRs) for CVD and mortality across SIRI quartiles. Net reclassification improvement assessed SIRI’s predictive value <em>vs.</em> high-sensitivity C-reactive protein and other indices. Mediation analysis assessed the roles of platelet count (PLT), Chinese visceral adiposity index and triglyceride-glucose index.</div></div><div><h3>Results</h3><div>During follow-up, 4,171 CVD events and 4,510 deaths occurred. Elevated SIRI was significantly linked to higher risks of CVD (HR for Q4 <em>vs.</em> Q1 1.21; 95% CI 1.10–1.31; <em>p <</em>0.001), including myocardial infarction (HR 1.22; 95% CI 1.01–1.48; <em>p</em> = 0.045), total stroke (HR 1.18; 95% CI 1.06–1.31; <em>p</em> = 0.003), and mortality (HR 1.34; 95% CI 1.24–1.46; <em>p <</em>0.001) in MASLD. Associations were stronger among women (HR 1.17; 95% CI 1.07–1.29; <em>p <</em>0.01) and physically inactive individuals (HR 1.09; 95% CI 1.05–1.13; <em>p <</em>0.01). SIRI improved outcome prediction over high-sensitivity C-reactive protein and other indices, with significant reclassification gains (5.84; 95% CI 2.57–9.12; <em>p <</em>0.001). Triglyceride-glucose index partially mediated these associations (5.3% for CVD, <em>p</em> = 0.006; 2.9% for mortality, <em>p</em> = 0.003), whereas PLT exhibited a slight inverse mediation effect on mortality (-3.3%, <em>p</em> = 0.032).</div></div><div><h3>Conclusions</h3><div>High SIRI independently correlates with increased risk of CVD and mortality in MASLD. These findings highlight the role of systemic inflammation and support SIRI as a potential biomarker for risk stratification in these individuals.</div></div><div><h3>Impact and implications</h3><div>This study provides important evidence linking systemic inflammation, as measured by the systemic inflammation response index, to increased cardiovascular disease and mortality in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent condition with rising global burden. The findings underscore the clinical relevance of inflammation markers in cardiovascular risk stratification, particularly for patients and healthcare providers managing MASLD. Physicians and policymakers could incorporate systemic inflammation response index into routine assessments to identify patients with MASLD at higher risk of cardiovascu","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101602"},"PeriodicalIF":7.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.jhepr.2025.101595
Pasquale Lombardi , Jung Sun Kim , Giulia F. Manfredi , Ciro Celsa , Claudia A.M. Fulgenzi , Antonio D’Alessio , Bernardo Stefanini , Niraj C. Doshi , Emily Warmington , Thomas U. Marron , Matthias Pinter , Bernhard Scheiner , Beodeul Kang , Ho Yeong Lim , Wei-Fan Hsu , Brooke Wietharn , Marianna Silletta , Alessandro Parisi , Chun-Yen Lin , Andrea Dalbeni , David J. Pinato
<div><h3>Background & Aims</h3><div>Atezolizumab plus bevacizumab (A+B) is a standard first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). However, optimal sequencing strategies after A+B failure remain undefined.</div></div><div><h3>Methods</h3><div>LEVIATHAN is a multicentre, observational study evaluating efficacy and survival outcomes in patients who progressed on A+B and subsequently received either lenvatinib or sorafenib as second-line therapy. Of 1,210 patients treated with first-line A+B between May 2018 and August 2024, 230 eligible patients were included (lenvatinib, n = 125 [54.3%]; sorafenib, n = 105 [45.7%]). Propensity score matching was applied to adjust for baseline imbalances, incorporating independent predictors of overall survival (OS) and response to prior treatment.</div></div><div><h3>Results</h3><div>In the overall second-line cohort, lenvatinib was associated with superior median progression-free survival (5.5 <em>vs.</em> 2.6 months, hazard ratio [HR] 0.41, <em>p</em> <0.001) and median OS (11.9 <em>vs.</em> 7.4 months, HR 0.67, <em>p</em> = 0.018) compared to sorafenib. From the start of A+B, the A+B-lenvatinib sequence achieved a median OS of 22.4 months <em>vs.</em> 14.3 months with A+B-sorafenib (HR 0.54, <em>p</em> <0.001). These differences persisted in the propensity score-matched cohort (median OS: 19.6 <em>vs.</em> 13.9 months, HR 0.67, <em>p</em> = 0.024). Multivariate analysis identified treatment with lenvatinib as an independent predictor of improved OS alongside alpha-fetoprotein ≤400 ng/ml, neutrophil-to-lymphocyte ratio <3, and absence of portal vein thrombosis.</div></div><div><h3>Conclusions</h3><div>The LEVIATHAN study supports lenvatinib as a more effective second-line option than sorafenib following A+B in unresectable HCC, including in patients with primary resistance to immunotherapy. While limited by the observational study design, these findings highlight the importance of treatment sequencing to optimise outcomes in advanced HCC.</div></div><div><h3>Impact and implications</h3><div>Continuing active treatment after progression on frontline atezolizumab plus bevacizumab (A+B) can benefit patients with advanced hepatocellular carcinoma (HCC), but evidence to guide second-line therapy remains limited. The LEVIATHAN study addresses this gap by evaluating real-world outcomes in a large, prospective, multinational cohort treated with lenvatinib or sorafenib after A+B discontinuation. Our findings show that lenvatinib provides significantly longer progression-free and overall survival than sorafenib, even after adjusting for baseline imbalances with propensity scores. Lenvatinib also achieved higher disease control rates, including in patients with primary resistance to immunotherapy. These results challenge the assumption that all VEGFR-targeting TKIs are equivalent post-ICI and suggest lenvatinib may be superior to sorafenib following anti-VEGF–based immunotherapy
背景:AimsAtezolizumab + bevacizumab (A+B)是不可切除肝细胞癌(HCC)的标准一线全身治疗。然而,A+B失败后的最佳测序策略仍未确定。sleviathan是一项多中心观察性研究,评估a +B治疗进展并随后接受lenvatinib或sorafenib作为二线治疗的患者的疗效和生存结果。在2018年5月至2024年8月期间接受一线A+B治疗的1210例患者中,纳入230例符合条件的患者(lenvatinib, n = 125[54.3%];索拉非尼,n = 105[45.7%])。采用倾向评分匹配来调整基线失衡,结合总生存期(OS)和对既往治疗反应的独立预测因子。结果在整个二线队列中,lenvatinib与索拉非尼相比具有更高的中位无进展生存期(5.5个月vs 2.6个月,风险比[HR] 0.41, p <0.001)和中位OS(11.9个月vs 7.4个月,HR 0.67, p = 0.018)。从A+B开始,A+B-lenvatinib序列的中位OS为22.4个月,而A+B-索拉非尼组为14.3个月(HR 0.54, p <0.001)。这些差异在倾向评分匹配的队列中持续存在(中位生存期:19.6 vs 13.9个月,HR 0.67, p = 0.024)。多变量分析发现lenvatinib治疗与甲胎蛋白≤400ng /ml、中性粒细胞与淋巴细胞比率<;3和门静脉血栓的消失一起是改善OS的独立预测因素。利维坦研究支持lenvatinib作为不可切除HCC(包括对免疫治疗有原发性耐药的患者)a +B后更有效的二线选择。虽然受到观察性研究设计的限制,但这些发现强调了治疗排序对优化晚期HCC预后的重要性。影响和意义一线atezolizumab + bevacizumab (A+B)进展后继续积极治疗可使晚期肝细胞癌(HCC)患者受益,但指导二线治疗的证据仍然有限。LEVIATHAN研究通过评估a +B停药后lenvatinib或sorafenib治疗的大型前瞻性多国队列的实际结果,解决了这一差距。我们的研究结果表明,lenvatinib比sorafenib提供了更长的无进展生存期和总生存期,即使在调整了倾向评分的基线不平衡后也是如此。Lenvatinib也实现了更高的疾病控制率,包括对免疫治疗的原发性耐药患者。这些结果挑战了所有靶向vegfr的TKIs在ici后相同的假设,并表明lenvatinib可能优于基于抗vegf的免疫治疗的索拉非尼。虽然仍需要前瞻性随机试验,但这些真实世界的数据为临床医生提供了有价值的指导,并有助于改进晚期HCC的治疗顺序。
{"title":"Lenvatinib vs. sorafenib as second-line treatment post atezolizumab plus bevacizumab for hepatocellular carcinoma: The LEVIATHAN study","authors":"Pasquale Lombardi , Jung Sun Kim , Giulia F. Manfredi , Ciro Celsa , Claudia A.M. Fulgenzi , Antonio D’Alessio , Bernardo Stefanini , Niraj C. Doshi , Emily Warmington , Thomas U. Marron , Matthias Pinter , Bernhard Scheiner , Beodeul Kang , Ho Yeong Lim , Wei-Fan Hsu , Brooke Wietharn , Marianna Silletta , Alessandro Parisi , Chun-Yen Lin , Andrea Dalbeni , David J. Pinato","doi":"10.1016/j.jhepr.2025.101595","DOIUrl":"10.1016/j.jhepr.2025.101595","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Atezolizumab plus bevacizumab (A+B) is a standard first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). However, optimal sequencing strategies after A+B failure remain undefined.</div></div><div><h3>Methods</h3><div>LEVIATHAN is a multicentre, observational study evaluating efficacy and survival outcomes in patients who progressed on A+B and subsequently received either lenvatinib or sorafenib as second-line therapy. Of 1,210 patients treated with first-line A+B between May 2018 and August 2024, 230 eligible patients were included (lenvatinib, n = 125 [54.3%]; sorafenib, n = 105 [45.7%]). Propensity score matching was applied to adjust for baseline imbalances, incorporating independent predictors of overall survival (OS) and response to prior treatment.</div></div><div><h3>Results</h3><div>In the overall second-line cohort, lenvatinib was associated with superior median progression-free survival (5.5 <em>vs.</em> 2.6 months, hazard ratio [HR] 0.41, <em>p</em> <0.001) and median OS (11.9 <em>vs.</em> 7.4 months, HR 0.67, <em>p</em> = 0.018) compared to sorafenib. From the start of A+B, the A+B-lenvatinib sequence achieved a median OS of 22.4 months <em>vs.</em> 14.3 months with A+B-sorafenib (HR 0.54, <em>p</em> <0.001). These differences persisted in the propensity score-matched cohort (median OS: 19.6 <em>vs.</em> 13.9 months, HR 0.67, <em>p</em> = 0.024). Multivariate analysis identified treatment with lenvatinib as an independent predictor of improved OS alongside alpha-fetoprotein ≤400 ng/ml, neutrophil-to-lymphocyte ratio <3, and absence of portal vein thrombosis.</div></div><div><h3>Conclusions</h3><div>The LEVIATHAN study supports lenvatinib as a more effective second-line option than sorafenib following A+B in unresectable HCC, including in patients with primary resistance to immunotherapy. While limited by the observational study design, these findings highlight the importance of treatment sequencing to optimise outcomes in advanced HCC.</div></div><div><h3>Impact and implications</h3><div>Continuing active treatment after progression on frontline atezolizumab plus bevacizumab (A+B) can benefit patients with advanced hepatocellular carcinoma (HCC), but evidence to guide second-line therapy remains limited. The LEVIATHAN study addresses this gap by evaluating real-world outcomes in a large, prospective, multinational cohort treated with lenvatinib or sorafenib after A+B discontinuation. Our findings show that lenvatinib provides significantly longer progression-free and overall survival than sorafenib, even after adjusting for baseline imbalances with propensity scores. Lenvatinib also achieved higher disease control rates, including in patients with primary resistance to immunotherapy. These results challenge the assumption that all VEGFR-targeting TKIs are equivalent post-ICI and suggest lenvatinib may be superior to sorafenib following anti-VEGF–based immunotherapy","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101595"},"PeriodicalIF":7.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.jhepr.2025.101599
Ahmed Ghallab , Maiju Myllys , Daniela González , Adrian Friebel , Zaynab Hobloss , Reham Hassan , Hannah Schmidt , Qasim Siddiqui , Deng Zhipeng , Rama Hendawi , Brigitte Begher-Tibbe , Joerg Reinders , Katharina Derksen , Ute Hofmann , Julia C. Duda , Lucia Ameis , Kathrin Möllenhoff , Abdellatief Seddek , Noha Abdelmageed , Ellen Strängberg , Jan G. Hengstler
Background & Aims
Cholemic nephropathy (CN) is a severe complication of liver diseases associated with cholestasis and represents an unmet medical need. Recently, we identified the molecular mechanism of CN and showed that the systemic apical sodium-dependent bile acid transporter inhibitor (ASBTi) AS0369 prevented CN in mice. However, it is not clear if ASBTi is effective in a therapeutic rather than a preventive setting.
Methods
AS0369 was administered daily for 4 weeks to bile duct-ligated (BDL) mice at four CN stages: (1) early stage with proximal tubular epithelial cell (pTEC) death (BDL-day 3); (2) inflammation, leaky peritubular capillaries, and tubular dilatation (BDL-day 21); (3) fibrosis (BDL-day 42); and (4) advanced stage with glomerular cysts (BDL-day 63). Disease progression was evaluated by biochemical, histopathological, and RNA-sequencing analysis.
Results
ASBTi increased urinary excretion of bile acids (BAs) and reciprocally reduced BA concentrations in blood and renal tissue at all disease stages. Therapeutic efficacy was highest when ASBTi was given at early disease stages, e.g. urinary BA excretion was increased 9-fold (p <0.001) at the early stage compared to 4-fold (p = 0.021) at the late stage. ASBTi reduced the pTEC injury biomarker KIM-1, tissue damage, replacement proliferation, peritubular capillary damage and renal fibrosis. Additionally, late-stage disease features, such as glomerular cysts, were ameliorated (46% at the late stage, p = 0.005) by the ASBTi. RNA-sequencing revealed that ASBTi attenuated BDL-induced gene deregulation at all stages, with a larger effect size at early stages.
Conclusions
Early systemic ASBTi therapy, initiated at the onset of pTEC death, provides the greatest therapeutic benefit. Nonetheless, even at later stages, ASBTi can ameliorate features of advanced CN.
Impact and implications
This study demonstrates that systemic inhibition of the apical sodium-dependent bile acid transporter (ASBTi) alleviates cholemic nephropathy across disease stages in a bile duct ligation mouse model. The greatest benefit was achieved when treatment was initiated early, coinciding with proximal tubular epithelial cell death, but even advanced features such as glomerular cysts were partially reversed. These findings highlight ASBTi as a promising therapeutic strategy for cholemic nephropathy, addressing a major unmet need in cholestatic liver disease. By targeting bile acid accumulation and related injury pathways, ASBTi may improve renal outcomes and broaden treatment options in affected patients.
{"title":"Stage-dependent effects of systemic ASBT inhibition in a cholestasis-induced cholemic nephropathy mouse model","authors":"Ahmed Ghallab , Maiju Myllys , Daniela González , Adrian Friebel , Zaynab Hobloss , Reham Hassan , Hannah Schmidt , Qasim Siddiqui , Deng Zhipeng , Rama Hendawi , Brigitte Begher-Tibbe , Joerg Reinders , Katharina Derksen , Ute Hofmann , Julia C. Duda , Lucia Ameis , Kathrin Möllenhoff , Abdellatief Seddek , Noha Abdelmageed , Ellen Strängberg , Jan G. Hengstler","doi":"10.1016/j.jhepr.2025.101599","DOIUrl":"10.1016/j.jhepr.2025.101599","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Cholemic nephropathy (CN) is a severe complication of liver diseases associated with cholestasis and represents an unmet medical need. Recently, we identified the molecular mechanism of CN and showed that the systemic apical sodium-dependent bile acid transporter inhibitor (ASBTi) AS0369 prevented CN in mice. However, it is not clear if ASBTi is effective in a therapeutic rather than a preventive setting.</div></div><div><h3>Methods</h3><div>AS0369 was administered daily for 4 weeks to bile duct-ligated (BDL) mice at four CN stages: (1) early stage with proximal tubular epithelial cell (pTEC) death (BDL-day 3); (2) inflammation, leaky peritubular capillaries, and tubular dilatation (BDL-day 21); (3) fibrosis (BDL-day 42); and (4) advanced stage with glomerular cysts (BDL-day 63). Disease progression was evaluated by biochemical, histopathological, and RNA-sequencing analysis.</div></div><div><h3>Results</h3><div>ASBTi increased urinary excretion of bile acids (BAs) and reciprocally reduced BA concentrations in blood and renal tissue at all disease stages. Therapeutic efficacy was highest when ASBTi was given at early disease stages, <em>e.g</em>. urinary BA excretion was increased 9-fold (<em>p</em> <0.001) at the early stage compared to 4-fold (<em>p</em> = 0.021) at the late stage. ASBTi reduced the pTEC injury biomarker KIM-1, tissue damage, replacement proliferation, peritubular capillary damage and renal fibrosis. Additionally, late-stage disease features, such as glomerular cysts, were ameliorated (46% at the late stage, <em>p</em> = 0.005) by the ASBTi. RNA-sequencing revealed that ASBTi attenuated BDL-induced gene deregulation at all stages, with a larger effect size at early stages.</div></div><div><h3>Conclusions</h3><div>Early systemic ASBTi therapy, initiated at the onset of pTEC death, provides the greatest therapeutic benefit. Nonetheless, even at later stages, ASBTi can ameliorate features of advanced CN.</div></div><div><h3>Impact and implications</h3><div>This study demonstrates that systemic inhibition of the apical sodium-dependent bile acid transporter (ASBTi) alleviates cholemic nephropathy across disease stages in a bile duct ligation mouse model. The greatest benefit was achieved when treatment was initiated early, coinciding with proximal tubular epithelial cell death, but even advanced features such as glomerular cysts were partially reversed. These findings highlight ASBTi as a promising therapeutic strategy for cholemic nephropathy, addressing a major unmet need in cholestatic liver disease. By targeting bile acid accumulation and related injury pathways, ASBTi may improve renal outcomes and broaden treatment options in affected patients.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101599"},"PeriodicalIF":7.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.jhepr.2025.101584
Facai Yang , Anfeng Si , Cheng Chi , Weihu Ma , Yinmin Gu , Yongbo Pan , Jingzhan Zhu , Yigang He , Xuewu Tang , Qiushi Yu , Yanuo Chen , Tongfeng Liu , Shan Gao , Fangliang Xie , Zhengqing Lei , Hongping Xia , Zhangjun Cheng
Background & Aims
N6-methyladenosine (m6A) modification regulates mRNA stability and translation to promote cancer progression. FK506-binding protein 9 (FKBP9), a peptidyl-prolyl isomerase, is associated with carcinogenesis, but its role in m6A modification remains unclear. In this study we aimed to explore how FKBP9 regulates m6A modification during the development of hepatocellular carcinoma (HCC).
Methods
The expression of FKBP9 in HCC was profiled by reverse-transcription quantitative PCR, western blot, ELISA, and immunohistochemistry. Cell proliferation, migration, invasion, apoptosis, and mRNA stability were examined using CCK-8, colony formation, flow cytometry, and cycloheximide treatment. An orthotopic allograft tumor model was constructed for in vivo analysis. Immunoprecipitation, mass spectrometry, methylated RNA immunoprecipitation sequencing, and RNA sequencing were performed to elucidate underlying mechanisms.
Results
FKBP9 was significantly upregulated in both HCC tissues and serum (p <0.05) and correlated with unfavorable clinical outcomes in patients (p <0.05). Its overexpression enhanced HCC cell proliferation and metastasis, while its depletion triggered cell cycle arrest and apoptosis. Mechanistically, FKBP9 interacted with the KH3-4 domains of IGF2BP1 through its peptidyl-prolyl isomerase domain, thereby stabilizing the binding of IGF2BP1 to m6A-modified MYC and PDGFB. Clinical analysis further confirmed that FKBP9 expression was positively associated with the expression of MYC and PDGFB at both the mRNA and protein levels (p <0.05). Co-overexpression of FKBP9 with MYC or PDGFB was linked to a worse prognosis (p <0.05).
Conclusions
FKBP9 promotes HCC progression by facilitating IGF2BP1 recognition of m6A-modified transcripts, thereby stabilizing MYC and PDGFB. The FKBP9–IGF2BP1 axis represents a potential therapeutic target in HCC.
Impact and implications
This study highlights the critical role of FKBP9 in hepatocellular carcinoma progression by regulating IGF2BP1-mediated m6A RNA recognition, thereby enhancing the stability of key oncogenic transcripts such as MYC and PDGFB. These findings provide new insights into the molecular mechanisms driving hepatocellular carcinoma and identify potential therapeutic opportunities for patients with poor prognosis linked to high FKBP9 expression. The FKBP9–IGF2BP1 axis may serve as both a biomarker and a therapeutic target to guide the development of new treatment strategies. Further studies are warranted to validate these results in larger patient cohorts and to assess the clinical feasibility of targeting this pathway.
{"title":"FKBP9 enhances IGF2BP1-mediated m6A recognition to promote hepatocellular carcinoma progression","authors":"Facai Yang , Anfeng Si , Cheng Chi , Weihu Ma , Yinmin Gu , Yongbo Pan , Jingzhan Zhu , Yigang He , Xuewu Tang , Qiushi Yu , Yanuo Chen , Tongfeng Liu , Shan Gao , Fangliang Xie , Zhengqing Lei , Hongping Xia , Zhangjun Cheng","doi":"10.1016/j.jhepr.2025.101584","DOIUrl":"10.1016/j.jhepr.2025.101584","url":null,"abstract":"<div><h3>Background & Aims</h3><div>N<sup>6</sup>-methyladenosine (m<sup>6</sup>A) modification regulates mRNA stability and translation to promote cancer progression. FK506-binding protein 9 (FKBP9), a peptidyl-prolyl isomerase, is associated with carcinogenesis, but its role in m<sup>6</sup>A modification remains unclear. In this study we aimed to explore how FKBP9 regulates m<sup>6</sup>A modification during the development of hepatocellular carcinoma (HCC).</div></div><div><h3>Methods</h3><div>The expression of FKBP9 in HCC was profiled by reverse-transcription quantitative PCR, western blot, ELISA, and immunohistochemistry. Cell proliferation, migration, invasion, apoptosis, and mRNA stability were examined using CCK-8, colony formation, flow cytometry, and cycloheximide treatment. An orthotopic allograft tumor model was constructed for <em>in vivo</em> analysis. Immunoprecipitation, mass spectrometry, methylated RNA immunoprecipitation sequencing, and RNA sequencing were performed to elucidate underlying mechanisms.</div></div><div><h3>Results</h3><div>FKBP9 was significantly upregulated in both HCC tissues and serum (<em>p</em> <0.05) and correlated with unfavorable clinical outcomes in patients (<em>p</em> <0.05). Its overexpression enhanced HCC cell proliferation and metastasis, while its depletion triggered cell cycle arrest and apoptosis. Mechanistically, FKBP9 interacted with the KH3-4 domains of IGF2BP1 through its peptidyl-prolyl isomerase domain, thereby stabilizing the binding of IGF2BP1 to m<sup>6</sup>A-modified <em>MYC</em> and <em>PDGFB</em>. Clinical analysis further confirmed that FKBP9 expression was positively associated with the expression of MYC and PDGFB at both the mRNA and protein levels (<em>p</em> <0.05). Co-overexpression of FKBP9 with MYC or PDGFB was linked to a worse prognosis (<em>p</em> <0.05).</div></div><div><h3>Conclusions</h3><div>FKBP9 promotes HCC progression by facilitating IGF2BP1 recognition of m6A-modified transcripts, thereby stabilizing MYC and PDGFB. The FKBP9–IGF2BP1 axis represents a potential therapeutic target in HCC.</div></div><div><h3>Impact and implications</h3><div>This study highlights the critical role of FKBP9 in hepatocellular carcinoma progression by regulating IGF2BP1-mediated m6A RNA recognition, thereby enhancing the stability of key oncogenic transcripts such as <em>MYC</em> and <em>PDGFB</em>. These findings provide new insights into the molecular mechanisms driving hepatocellular carcinoma and identify potential therapeutic opportunities for patients with poor prognosis linked to high FKBP9 expression. The FKBP9–IGF2BP1 axis may serve as both a biomarker and a therapeutic target to guide the development of new treatment strategies. Further studies are warranted to validate these results in larger patient cohorts and to assess the clinical feasibility of targeting this pathway.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101584"},"PeriodicalIF":7.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-20DOI: 10.1016/j.jhepr.2025.101598
Sigurd Breder , Christina Villard , Emma Eide , Benny Wang , Lise Katrine Engesæter , Henrik Mikael Reims , Johannes Roksund Hov , Espen Melum , Lars Aabakken , Pål Dag Line , Jon Lømo , Krzyztof Grzyb , Kristine Wiencke , Annika Bergquist , Trine Folseraas
Background & Aims
Liver transplantation (LT) to prevent cholangiocarcinoma (CCA) in individuals with primary sclerosing cholangitis (PSC) and bile duct dysplasia was introduced in Norway and Sweden in the early 2000s. We aimed to evaluate this practice to potentially improve future selection of candidates for LT.
Methods
We conducted a retrospective study of 512 adults with PSC who underwent first-time LT between 2000–2021 at Oslo and Karolinska University Hospitals. Pre-LT findings in bile duct brush cytology and/or biopsy of low-grade dysplasia (LGD) and high-grade dysplasia (HGD) were compared with histological findings in the explanted livers and survival rates were assessed.
Results
Bile duct dysplasia, low-grade (LGD) or high-grade (HGD), was the primary LT indication in 17% (88/512). Among individuals transplanted for LGD, only 10% (3/29) had HGD or CCA in the explant, compared to 48% (28/59) in the HGD group. No neoplasia was found in 42% (12/29) of LGD and 24% (14/59) of HGD cases, meaning nearly one-third of patients transplanted for suspected bile duct dysplasia had no histological evidence of neoplasia in the explant. Five-year post-transplant survival according to the explant histology was 95% for no neoplasia, 89% for LGD, 85% for HGD, decreasing to 33% in those with CCA in the explant.
Conclusions
While favorable survival in confirmed dysplasia supports the role of preemptive LT, the absence of neoplasia in a substantial proportion of explants, particularly in suspected LGD, calls for a cautious, individualized approach. LT appears more clearly justified in accurately diagnosed HGD, given its strong association with early malignancy and the poor prognosis of advanced CCA.
Impact and implications
Individuals with primary sclerosing cholangitis (PSC) are at increased risk of developing bile duct cancer. In precancerous stages (bile duct dysplasia), liver transplantation (LT) may prevent progression to advanced, incurable cancer. In our evaluation of 512 patients with PSC who underwent LT, we found that the low diagnostic accuracy and unpredictable detection of mild dysplasia support a cautious, individualized approach to LT in precancerous stages of PSC, while more advanced dysplasia remains a valid indication for LT.
{"title":"A retrospective evaluation of preemptive liver transplantation for bile duct dysplasia in primary sclerosing cholangitis: Balancing risks and benefits","authors":"Sigurd Breder , Christina Villard , Emma Eide , Benny Wang , Lise Katrine Engesæter , Henrik Mikael Reims , Johannes Roksund Hov , Espen Melum , Lars Aabakken , Pål Dag Line , Jon Lømo , Krzyztof Grzyb , Kristine Wiencke , Annika Bergquist , Trine Folseraas","doi":"10.1016/j.jhepr.2025.101598","DOIUrl":"10.1016/j.jhepr.2025.101598","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Liver transplantation (LT) to prevent cholangiocarcinoma (CCA) in individuals with primary sclerosing cholangitis (PSC) and bile duct dysplasia was introduced in Norway and Sweden in the early 2000s. We aimed to evaluate this practice to potentially improve future selection of candidates for LT.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 512 adults with PSC who underwent first-time LT between 2000–2021 at Oslo and Karolinska University Hospitals. Pre-LT findings in bile duct brush cytology and/or biopsy of low-grade dysplasia (LGD) and high-grade dysplasia (HGD) were compared with histological findings in the explanted livers and survival rates were assessed.</div></div><div><h3>Results</h3><div>Bile duct dysplasia, low-grade (LGD) or high-grade (HGD), was the primary LT indication in 17% (88/512). Among individuals transplanted for LGD, only 10% (3/29) had HGD or CCA in the explant, compared to 48% (28/59) in the HGD group. No neoplasia was found in 42% (12/29) of LGD and 24% (14/59) of HGD cases, meaning nearly one-third of patients transplanted for suspected bile duct dysplasia had no histological evidence of neoplasia in the explant. Five-year post-transplant survival according to the explant histology was 95% for no neoplasia, 89% for LGD, 85% for HGD, decreasing to 33% in those with CCA in the explant.</div></div><div><h3>Conclusions</h3><div>While favorable survival in confirmed dysplasia supports the role of preemptive LT, the absence of neoplasia in a substantial proportion of explants, particularly in suspected LGD, calls for a cautious, individualized approach. LT appears more clearly justified in accurately diagnosed HGD, given its strong association with early malignancy and the poor prognosis of advanced CCA.</div></div><div><h3>Impact and implications</h3><div>Individuals with primary sclerosing cholangitis (PSC) are at increased risk of developing bile duct cancer. In precancerous stages (bile duct dysplasia), liver transplantation (LT) may prevent progression to advanced, incurable cancer. In our evaluation of 512 patients with PSC who underwent LT, we found that the low diagnostic accuracy and unpredictable detection of mild dysplasia support a cautious, individualized approach to LT in precancerous stages of PSC, while more advanced dysplasia remains a valid indication for LT.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101598"},"PeriodicalIF":7.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.jhepr.2025.101596
Muhammad Atif Zahoor , Nahla FadlElMawla , Adrian Kuipery , Joshua B. Feld , Avisha Chowdhury , Alexander I. Mosa , Adam J. Gehring , Jordan J. Feld
Background & Aims
Chronic HBV infection is a leading cause of liver disease and cancer. Current therapies fail to eliminate covalently closed circular DNA (cccDNA), underscoring the need for novel strategies. We aimed to develop a quantitative cell-based reporter system that detects HBx expression during HBV infection and is suitable for screening compounds with anti-HBV activity.
Methods
We generated an HBx-responsive cell line stably expressing nano-luciferase (nLuc) under the control of a viral cAMP-response element (vCRE) derived from the human T-cell leukemia virus-1 core promoter. The system was used to evaluate various drug inhibitors in HBV-infected cells.
Results
The vCRE-nLuc system was confirmed to be responsive to HBx using pHBV1.3-wild-type, pHBV1.3-null-X and pMyc-HBx constructs (p <0.0001). HBV infection with both culture-derived and patient-derived clinical isolates (genotypes A-E) significantly increased luciferase activity (p <0.0001). Treatment with HBx inhibitors (siRNA, specific HBx inhibitors), as well as IFNα reduced luciferase production (p <0.0001). In contrast, antivirals that do not interfere with protein production (tenofovir), or viral entry (bulevirtide) showed no effect (p <0.05), underscoring the specificity of the system for identifying compounds that inhibit protein production and/or HBx function. Finally, HepG2.2.15 cells carrying HBV and transduced with vCRE-nLuc confirmed the system’s suitability for monitoring HBV infection.
Conclusions
We established a vCRE-nLuc-driven HBx-responsive cell line for quantitative monitoring of HBV infection and evaluation of antiviral drugs. This system holds potential for identifying new anti-HBV agents and advancing our understanding of HBV replication.
Impact and implications
The HBx-responsive vCRE-nLuc reporter system provides a sensitive and scalable platform to monitor HBV infection and evaluate antiviral compounds targeting HBx function. Its ability to detect HBx activity from both laboratory and clinical HBV isolates underscore its translational relevance. By enabling selective screening of HBx-targeting agents, this system may advance efforts to silence covalently closed circular DNA and accelerate the development of curative therapies for chronic hepatitis B.
{"title":"Development of a CRE/CREB-driven HBx responsive HBV cell culture reporter system for antiviral drug evaluation","authors":"Muhammad Atif Zahoor , Nahla FadlElMawla , Adrian Kuipery , Joshua B. Feld , Avisha Chowdhury , Alexander I. Mosa , Adam J. Gehring , Jordan J. Feld","doi":"10.1016/j.jhepr.2025.101596","DOIUrl":"10.1016/j.jhepr.2025.101596","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Chronic HBV infection is a leading cause of liver disease and cancer. Current therapies fail to eliminate covalently closed circular DNA (cccDNA), underscoring the need for novel strategies. We aimed to develop a quantitative cell-based reporter system that detects HBx expression during HBV infection and is suitable for screening compounds with anti-HBV activity.</div></div><div><h3>Methods</h3><div>We generated an HBx-responsive cell line stably expressing nano-luciferase (nLuc) under the control of a viral cAMP-response element (vCRE) derived from the human T-cell leukemia virus-1 core promoter. The system was used to evaluate various drug inhibitors in HBV-infected cells.</div></div><div><h3>Results</h3><div>The vCRE-nLuc system was confirmed to be responsive to HBx using pHBV1.3-wild-type, pHBV1.3-null-X and pMyc-HBx constructs (<em>p <</em>0.0001). HBV infection with both culture-derived and patient-derived clinical isolates (genotypes A-E) significantly increased luciferase activity (<em>p <</em>0.0001). Treatment with HBx inhibitors (siRNA, specific HBx inhibitors), as well as IFNα reduced luciferase production (<em>p <</em>0.0001). In contrast, antivirals that do not interfere with protein production (tenofovir), or viral entry (bulevirtide) showed no effect (<em>p <</em>0.05), underscoring the specificity of the system for identifying compounds that inhibit protein production and/or HBx function. Finally, HepG2.2.15 cells carrying HBV and transduced with vCRE-nLuc confirmed the system’s suitability for monitoring HBV infection.</div></div><div><h3>Conclusions</h3><div>We established a vCRE-nLuc-driven HBx-responsive cell line for quantitative monitoring of HBV infection and evaluation of antiviral drugs. This system holds potential for identifying new anti-HBV agents and advancing our understanding of HBV replication.</div></div><div><h3>Impact and implications</h3><div>The HBx-responsive vCRE-nLuc reporter system provides a sensitive and scalable platform to monitor HBV infection and evaluate antiviral compounds targeting HBx function. Its ability to detect HBx activity from both laboratory and clinical HBV isolates underscore its translational relevance. By enabling selective screening of HBx-targeting agents, this system may advance efforts to silence covalently closed circular DNA and accelerate the development of curative therapies for chronic hepatitis B.</div></div>","PeriodicalId":14764,"journal":{"name":"JHEP Reports","volume":"7 12","pages":"Article 101596"},"PeriodicalIF":7.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}