Nature Reviews Gastroenterology &Hepatology最新文献

英文中文

Characterizing the genomic landscape of colorectal cancer 描述结直肠癌的基因组特征

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-09-09 DOI: 10.1038/s41575-024-00988-z

Jordan Hindson

引用次数: 0

Ammonia-induced stress response in liver disease progression and hepatic encephalopathy 肝病进展和肝性脑病中氨诱导的应激反应

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-09-09 DOI: 10.1038/s41575-024-00970-9

Rocío Gallego-Durán, Anna Hadjihambi, Javier Ampuero, Christopher F. Rose, Rajiv Jalan, Manuel Romero-Gómez

Ammonia levels are orchestrated by a series of complex interrelated pathways in which the urea cycle has a central role. Liver dysfunction leads to an accumulation of ammonia, which is toxic and is strongly associated with disruption of potassium homeostasis, mitochondrial dysfunction, oxidative stress, inflammation, hypoxaemia and dysregulation of neurotransmission. Hyperammonaemia is a hallmark of hepatic encephalopathy and has been strongly associated with liver-related outcomes in patients with cirrhosis and liver failure. In addition to the established role of ammonia as a neurotoxin in the pathogenesis of hepatic encephalopathy, an increasing number of studies suggest that it can lead to hepatic fibrosis progression, sarcopenia, immune dysfunction and cancer. However, elevated systemic ammonia levels are uncommon in patients with metabolic dysfunction-associated steatotic liver disease. A clear causal relationship between ammonia-induced immune dysfunction and risk of infection has not yet been definitively proven. In this Review, we discuss the mechanisms by which ammonia produces its diverse deleterious effects and their clinical relevance in liver diseases, the importance of measuring ammonia levels for the diagnosis of hepatic encephalopathy, the prognosis of patients with cirrhosis and liver failure, and how our knowledge of inter-organ ammonia metabolism is leading to the development of novel therapeutic approaches. This Review describes inter-organ ammonia metabolism in liver disease and mechanisms underlying the pathogenic effect of hyperammonaemia in hepatic encephalopathy, liver disease progression in metabolic dysfunction-associated steatotic liver disease, immune dysfunction and hepatocellular carcinoma. It also addresses the principles of treating hyperammonaemia.

氨水平由一系列复杂的相互关联的途径协调，其中尿素循环起着核心作用。肝功能异常会导致氨积累，氨具有毒性，与钾平衡紊乱、线粒体功能障碍、氧化应激、炎症、低氧血症和神经传递失调密切相关。高氨血症是肝性脑病的标志，与肝硬化和肝衰竭患者的肝脏相关结果密切相关。除了氨作为神经毒素在肝性脑病发病机制中的既定作用外，越来越多的研究表明，氨可导致肝纤维化进展、肌肉疏松症、免疫功能障碍和癌症。然而，在代谢功能障碍相关脂肪性肝病患者中，全身氨水平升高的情况并不常见。氨引起的免疫功能障碍与感染风险之间的明确因果关系尚未得到明确证实。在这篇综述中，我们将讨论氨产生各种有害影响的机制及其在肝病中的临床意义、测量氨水平对诊断肝性脑病的重要性、肝硬化和肝衰竭患者的预后，以及我们对器官间氨代谢的了解如何促进新型治疗方法的开发。

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引用次数: 0

GLP1 agonists: current and future landscape of clinical trials for patients with metabolic dysfunction GLP1 激动剂：针对代谢功能障碍患者的临床试验现状与未来展望

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-09-06 DOI: 10.1038/s41575-024-00977-2

Jonathan Goldney, Melanie J. Davies

Guidelines currently recommend organ-specific management of obesity-related complications. Agents that agonize glucagon-like peptide 1 receptors, including those that co-agonize other anorexigenic hormone receptors, lead to substantial weight loss and benefits in people with varying obesity-related complications, with further trials underway. These medications enable cause-specific management of obesity complications.

目前，指南建议对肥胖相关并发症进行器官特异性治疗。激动胰高血糖素样肽 1 受体的药物，包括那些共同激动其他厌食激素受体的药物，可使体重大幅下降，并使患有不同肥胖相关并发症的患者获益，目前正在进行进一步的试验。这些药物可针对肥胖并发症的具体病因进行治疗。

引用次数: 0

AI-based tool for scoring MASH histology 基于人工智能的 MASH 组织学评分工具

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-09-06 DOI: 10.1038/s41575-024-00987-0

Jordan Hindson

引用次数: 0

Hepatic immune regulation and sex disparities 肝脏免疫调节与性别差异

IF 65.1 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-09-05 DOI: 10.1038/s41575-024-00974-5

Patrizia Burra, Alberto Zanetto, Bernd Schnabl, Thomas Reiberger, Aldo J. Montano-Loza, Rosanna Asselta, Tom Hemming Karlsen, Frank Tacke

Chronic liver disease is a major cause of morbidity and mortality worldwide. Epidemiology, clinical phenotype and response to therapies for gastrointestinal and liver diseases are commonly different between women and men due to sex-specific hormonal, genetic and immune-related factors. The hepatic immune system has unique regulatory functions that promote the induction of intrahepatic tolerance, which is key for maintaining liver health and homeostasis. In liver diseases, hepatic immune alterations are increasingly recognized as a main cofactor responsible for the development and progression of chronic liver injury and fibrosis. In this Review, we discuss the basic mechanisms of sex disparity in hepatic immune regulation and how these mechanisms influence and modify the development of autoimmune liver diseases, genetic liver diseases, portal hypertension and inflammation in chronic liver disease. Alterations in gut microbiota and their crosstalk with the hepatic immune system might affect the progression of liver disease in a sex-specific manner, creating potential opportunities for novel diagnostic and therapeutic approaches to be evaluated in clinical trials. Finally, we identify and propose areas for future basic, translational and clinical research that will advance our understanding of sex disparities in hepatic immunity and liver disease.

慢性肝病是全球发病和死亡的主要原因。由于性别特异性荷尔蒙、遗传和免疫相关因素的影响，女性和男性在胃肠道和肝脏疾病的流行病学、临床表型以及对疗法的反应方面通常存在差异。肝脏免疫系统具有独特的调节功能，可促进肝内耐受性的诱导，这是维持肝脏健康和平衡的关键。在肝脏疾病中，肝脏免疫改变越来越被认为是导致慢性肝损伤和肝纤维化发生和发展的主要辅助因素。在这篇综述中，我们将讨论肝脏免疫调节中性别差异的基本机制，以及这些机制如何影响和改变自身免疫性肝病、遗传性肝病、门静脉高压和慢性肝病中炎症的发展。肠道微生物群的变化及其与肝脏免疫系统的相互影响可能会以性别特异性的方式影响肝病的进展，从而为在临床试验中评估新型诊断和治疗方法创造潜在的机会。最后，我们确定并提出了未来基础研究、转化研究和临床研究的领域，以促进我们对肝脏免疫和肝病性别差异的理解。

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引用次数: 0

Consequences of bathroom restriction on transgender individuals with gastrointestinal conditions in the United States 浴室限制对美国患有肠胃疾病的变性人的影响

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-09-02 DOI: 10.1038/s41575-024-00975-4

Cass D. Condray, Kira L. Newman, Victor G. Chedid

Bathroom ban legislation is increasing throughout the United States, and little is known about the effect on transgender and gender-nonconforming individuals with chronic gastrointestinal conditions. Efforts should be made to raise awareness and address the knowledge gaps.

美国各地禁止使用卫生间的立法越来越多，但人们对其对患有慢性胃肠道疾病的变性人和性别不符者的影响知之甚少。应努力提高人们的认识，填补知识空白。

引用次数: 0

Intestinal organ chips for disease modelling and personalized medicine 用于疾病建模和个性化医疗的肠道器官芯片。

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-08-27 DOI: 10.1038/s41575-024-00968-3

Alican Özkan, Nina Teresa LoGrande, Jessica F. Feitor, Girija Goyal, Donald E. Ingber

Alterations in intestinal structure, mechanics and physiology underlie acute and chronic intestinal conditions, many of which are influenced by dysregulation of microbiome, peristalsis, stroma or immune responses. Studying human intestinal physiology or pathophysiology is difficult in preclinical animal models because their microbiomes and immune systems differ from those of humans. Although advances in organoid culture partially overcome this challenge, intestinal organoids still lack crucial features that are necessary to study functions central to intestinal health and disease, such as digestion or fluid flow, as well as contributions from long-term effects of living microbiome, peristalsis and immune cells. Here, we review developments in organ-on-a-chip (organ chip) microfluidic culture models of the human intestine that are lined by epithelial cells and interfaced with other tissues (such as stroma or endothelium), which can experience both fluid flow and peristalsis-like motions. Organ chips offer powerful ways to model intestinal physiology and disease states for various human populations and individual patients, and can be used to gain new insight into underlying molecular and biophysical mechanisms of disease. They can also be used as preclinical tools to discover new drugs and then validate their therapeutic efficacy and safety in the same human-relevant model. Studying human physiology and pathophysiology in preclinical animal models has drawbacks. Developments in organ-on-a-chip (organ chip) technology have opened up new ways to model human intestinal physiology. This Review discusses intestinal organ chips as disease models and preclinical tools and their potential for personalized medicine.

肠道结构、力学和生理学的改变是急性和慢性肠道疾病的基础，其中许多疾病受到微生物组、蠕动、基质或免疫反应失调的影响。临床前动物模型很难研究人类肠道生理学或病理生理学，因为它们的微生物组和免疫系统与人类不同。虽然类器官培养技术的进步部分克服了这一难题，但肠类器官仍然缺乏研究肠道健康和疾病的核心功能（如消化或液体流动）所必需的关键特征，以及活体微生物组、蠕动和免疫细胞的长期影响所带来的贡献。在这里，我们将回顾器官芯片（organ chip）微流体培养人体肠道模型的发展，这些模型由上皮细胞衬里，并与其他组织（如基质或内皮细胞）相连接，可以经历液体流动和类似蠕动的运动。器官芯片为模拟不同人群和个体患者的肠道生理和疾病状态提供了强有力的方法，可用于深入了解疾病的潜在分子和生物物理机制。它们还可用作发现新药的临床前工具，然后在相同的人体相关模型中验证其疗效和安全性。

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引用次数: 0

Mapping neuroimmune interactions in the gut 绘制肠道神经免疫相互作用图

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-08-22 DOI: 10.1038/s41575-024-00982-5

Katrina Ray

引用次数: 0

Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions 亚太地区的肝病和肝细胞癌：负担、趋势、挑战和未来方向

IF 65.1 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-08-15 DOI: 10.1038/s41575-024-00967-4

Lung-Yi Mak, Ken Liu, Sakkarin Chirapongsathorn, Kuo Chao Yew, Nobuharu Tamaki, Ruveena Bhavani Rajaram, Mara Teresa Panlilio, Rashid Lui, Hye Won Lee, Jimmy Che-To Lai, Anand V. Kulkarni, Madhumita Premkumar, Cosmas Rinaldi Adithya Lesmana, Yao Chun Hsu, Daniel Q. Huang

Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population. Compared with people of European descent, people from the Asia-Pacific region carry more genetic variants associated with MASLD and its progression. Alcohol is a fast-growing cause of CLD and HCC in Asia as a result of the rising per-capita consumption of alcohol. Drug-induced liver injury is under-recognized and probably has a high prevalence in this region. The epidemiological and outcome data of acute-on-chronic liver failure are heterogeneous, and non-unified definitions across regions contribute to this heterogeneity. CLDs are severely underdiagnosed, and effective treatments and vaccinations are underutilized. In this Review, we highlight trends in the burden of CLD and HCC in the Asia-Pacific region and discuss the rapidly changing aetiologies of liver disease. We examine the multiple gaps in the care cascade and propose mitigating strategies and future directions.

在全球范围内，近一半死于肝硬化和慢性肝病（CLD）的人以及四分之三死于肝细胞癌（HCC）的人都发生在亚太地区。慢性乙型肝炎是该地区绝大多数肝脏相关死亡的原因。代谢功能障碍相关性脂肪性肝病（MASLD）是最常见的CLD形式，估计影响到30%的成年人口。与欧洲后裔相比，亚太地区的人携带更多与代谢功能障碍相关性脂肪肝及其进展有关的基因变异。在亚洲，由于人均饮酒量不断增加，酒精是导致慢性肝病和肝癌的一个快速增长的原因。药物性肝损伤在该地区的发病率可能很高，但却未得到充分认识。急性-慢性肝功能衰竭的流行病学和结果数据各不相同，各地区的定义不统一也是造成这种异质性的原因之一。慢性肝功能衰竭的诊断严重不足，有效的治疗和疫苗也未得到充分利用。在这篇综述中，我们强调了亚太地区慢性肝病和肝癌负担的趋势，并讨论了快速变化的肝病病因。我们研究了护理流程中的多个缺口，并提出了缓解策略和未来发展方向。

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引用次数: 0

EPC 2024 EPC 2024。

IF 45.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Nature Reviews Gastroenterology &Hepatology

Pub Date : 2024-08-12 DOI: 10.1038/s41575-024-00979-0

Jordan Hindson

引用次数: 0

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