Degree Of Fibrosis In Patients Research Articles

Relationship between NKT cell phenotype and liver fibrosis degree in patients with chronic hepatitis C before and after treatment

Relationship between NKT cell phenotype and liver fibrosis degree in patients with chronic hepatitis C before and after treatment

Left atrial myocardial strain, assessed by the method of speckle-tracking echocardiography, as a marker of fibrosis in patients with ischemic stroke

Introduction. Cardioembolic stroke (CE) is one of the main etiopathogenetic subtypes of ischemic stroke and accounts for approximately 17% of all patients with ischemic stroke. Currently, there is a search for widely accessible radiological diagnostic methods that allow for the accurate diagnosis of left atrial (LA) dysfunction. Among these methods is transthoracic strain echocardiography (EchoCG), which provides additional information about the degree of deformation and change in shape of the LA during the cardiac cycle. To date, the association between strain EchoCG parameters and the severity of fibrotic changes in the LA among patients with CE remains unstudied.Objective. To evaluate the relationship between myocardial deformation parameters of the left atrium and the degree of fibrosis in patients with CE, as well as the impact of LA myocardial deformation changes on the prognosis of patients with CE.Materials and Methods. A prospective cross-sectional study included 132 patients who underwent evaluation and treatment in the Department of Emergency Neurology at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2020 to 2022. Group 1 consisted of 12 patients who died during hospitalization, while Group 2 comprised 120 patients who were discharged from the department after receiving treatment.Results. Deceased patients, compared to survivors, were characterized by the presence of LA myocardial remodeling. Statistically significant differences in LA myocardial deformation parameters were found between the study groups. Correlation analysis revealed statistically significant associations between LA myocardial deformation parameters and the severity of fibrotic changes. In the multifactorial logistic regression model, significant effects on the prognosis of patients were observed for LA strain peak systolic circumferential strain rate (LA-Scs) and LA strain peak systolic longitudinal strain rate (LA-Sls), with each 1% increase in the parameter associated with a 1.128-fold and 1.075-fold increase in the odds of a lethal outcome, respectively (OR: 1.128, 95% CI: 1.021–1.25, p = 0.017, and OR: 1.075, 95% CI: 1.009–1.15, p = 0.025).Conclusions. The conducted study established a strong correlation between LA myocardial deformation and LA fibrosis and the degree of fibrosis in the LA. LA myocardial deformation parameters can be used in risk stratification for the development of a lethal outcome in patients with CE.

Quantitative measurements of M2BPGi depend on liver fibrosis and inflammation.

The relationship between liver fibrosis and inflammation and Mac-2-binding protein glycosylation isomer (M2BPGi) in patients with chronic liver disease (CLD) other than hepatitis C remains uncertain, owing to the limitations of qualitative methods. Here, we evaluated the influence of liver fibrosis and inflammation on quantitative M2BPGi (M2BPGi-Qt) in CLD, considering each etiology. We recruited 1373 patients with CLD. To evaluate the influence of liver fibrosis and inflammation on M2BPGi-Qt levels, we assessed M2BPGi-Qt levels at each fibrosis and activity stage within different etiologies of CLD based on pathological findings. Subsequently, we evaluated if the accuracy of fibrosis staging based on M2BPGi-Qt could be improved by considering the influence of liver inflammation. In patients with viral hepatitis, non-alcoholic fatty liver disease, and primary biliary cholangitis, the median M2BPGi-Qt levels increased liver fibrosis progression. Median M2BPGi-Qt levels were not associated with the degree of fibrosis in patients with autoimmune hepatitis (AIH). Median M2BPGi-Qt levels increased with the progression of liver activity in all etiologies. A significant difference was found at each stage in AIH. Considering the liver inflammation, we established an algorithm, M2BPGi-Qt, to determine the alanine aminotransferase-to-platelet ratio (MAP-R) in liver cirrhosis (LC). The area under the receiver operating characteristic curve (AUC) of MAP-R was higher than that of the M2BPGi-Qt for detecting LC (AUC MAP-R = 0.759 and M2BPGi-Qt = 0.700, p < 0.001). The quantitative measurement system for M2BPGi depends on liver fibrosis and inflammation, regardless of etiology. Liver inflammation complicates the interpretation of M2BPGi-Qt results when assessing the fibrosis stage.

Autopsy analysis reveals increased macrophage infiltration and cell apoptosis in COVID-19 patients with severe pulmonary fibrosis

Clinical data indicates that SARS-CoV-2 infection-induced respiratory failure is a fatal condition for severe COVID-19 patients. However, the pathological alterations of different types of respiratory failure remained unknown for severe COVID-19 patients. This study aims to evaluate whether there are differences in the performance of various types of respiratory failure in severe COVID-19 patients and investigate the pathological basis for these differences. The lung tissue sections of severe COVID-19 patients were assessed for the degree of injury and immune responses. Transcriptome data were used to analyze the molecular basis in severe COVID-19 patients. Severe COVID-19 patients with combined oxygenation and ventilatory failure presented more severe pulmonary fibrosis, airway obstruction, and prolonged disease course. The number of M2 macrophages increased with the degree of fibrosis in patients, suggesting that it may be closely related to the development of pulmonary fibrosis. The co-existence of pro-inflammatory and anti-inflammatory cytokines in the pulmonary environment could also participate in the progression of pulmonary fibrosis. Furthermore, the increased apoptosis in the lungs of COVID-19 patients with severe pulmonary fibrosis may represent a critical factor linking sustained inflammatory responses to fibrosis. Our findings indicate that during the extended phase of COVID-19, antifibrotic and antiapoptotic treatments should be considered in conjunction with the progression of the disease.

Serum infrared spectral profile is predictive of the degree of hepatic fibrosis in chronic hepatitis C patients

Assessment of liver fibrosis is crucial to guide the therapeutic strategy in patients with chronic liver disease. We investigated the potential of serum Fourier transform infrared (FTIR) spectroscopy for assessing the degree of hepatic fibrosis in patients with chronic hepatitis C (CHC). The study was conducted on dried serum samples from 94 CHC patients at different histological stages of hepatic fibrosis: METAVIR F0 (n = 20), F1 (n = 17), F2 (n = 20), F3 (n = 20) and F4 (n = 17). Transmission FTIR spectra were acquired in the 4000–400 cm−1 range. Wavenumbers were selected by genetic algorithm (GA) according to their diagnostic performance as assessed by a partial least squares discriminant analysis (PLS-DA) model using a training and a validation set to differentiate severe stages of fibrosis from mild or moderate ones. The GA procedure was applied 50 times on randomly selected sets. Furthermore, the best set of wavenumbers was re-tested in 1000 randomly selected validation sets. Wavenumbers selected by GA corresponded to functional groups present in lipids, proteins, and carbohydrates. This model allowed to identify patients with cirrhosis (METAVIR F4), patients with advanced fibrosis (METAVIR F3 and F4), and patients with significant fibrosis (METAVIR F2, F3 and F4), with AUROC (Area Under the Receiver Operating Characteristic) of 0.88, 0.85 and 0.85, respectively. Thus, serum FTIR spectroscopy appears to have a strong potential as a new diagnostic tool for assessing the degree of fibrosis in patients with chronic liver disease.

Association between Helicobacter pylori Infection and Risk of Non-Alcoholic Fatty Liver Disease

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is an epidemic liver disease affecting approximately 25% of the general population. It has a wide range of clinical phenotyping from hepatic steatosis to non- alcoholic steatohepatitis (NASH), advanced fibrosis and liver cirrhosis. Aim of the Work To find out the link between H. Pylori infection and the onset of Non-alcoholic fatty liver disease. Patients and Methods This cross sectional, case control study was conducted on 80 patients presented with H-Pylori in Ain Shams University Hospitals during the period from September 2020 to June 2021, after taking informed consents from the patients. Results Our study shows a statistically significant association between age and NAFLD occurrence. Our study showed that gender has no influence on occurrence of NAFLD. Also, we found that NAFLD is associated with elevated levels of TG, Cholesterol &amp;LDL. Our study showed that high SBP, DBP is associated with increased risk of NAFLD. The levels of AST and ALT in our study were significantly higher in risky group patients than in non-risky group patients. Regarding the degree of fibrosis in patients with NAFLD using NFS we found that risky patients were associated with increased risk of fibrosis. Conclusion Our study suggested that H-Pylori infection may have a role in NAFLD occurrence. However, other metabolic risk factors such as dyslipidemia and obesity may have the major role in developing and progression of NAFLD taking in consideration the limitations of case-control study and the small sized population included.

Therapeutic targeting of adipose tissue macrophages ameliorates liver fibrosis in non-alcoholic fatty liver disease

Background & Aims: The accumulation of adipose tissue macrophages (ATMs) in obesity has been associated with hepatic injury. However, the contribution of ATMs to hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) remains to be elucidated. Herein, we investigate the relationship between ATMs and liver fibrosis in patients with patients with NAFLD and evaluate the impact of modulation of ATMs over hepatic fibrosis in an experimental non-alcoholic steatohepatitis (NASH) model. MethodsAdipose tissue and liver biopsies from 42 patients with NAFLD with different fibrosis stages were collected. ATMs were characterised by immunohistochemistry and flow cytometry and the correlation between ATMs and liver fibrosis stages was assessed. Selective modulation of the ATM phenotype was achieved by i.p. administration of dextran coupled with dexamethasone in diet-induced obesity and NASH murine models. Chronic administration effects were evaluated by histology and gene expression analysis in adipose tissue and liver samples. In vitro crosstalk between human ATMs and hepatic stellate cells (HSCs) and liver spheroids was performed. ResultsPatients with NAFLD presented an increased accumulation of pro-inflammatory ATMs that correlated with hepatic fibrosis. Long-term modulation of ATMs significantly reduced pro-inflammatory phenotype and ameliorated adipose tissue inflammation. Moreover, ATMs modulation was associated with an improvement in steatosis and hepatic inflammation and significantly reduced fibrosis progression in an experimental NASH model. In vitro, the reduction of the pro-inflammatory phenotype of human ATMs with dextran–dexamethasone treatment reduced the secretion of inflammatory chemokines and directly attenuated the pro-fibrogenic response in HSCs and liver spheroids. ConclusionsPro-inflammatory ATMs increase in parallel with fibrosis degree in patients with NAFLD and their modulation in an experimental NASH model improves liver fibrosis, uncovering the potential of ATMs as a therapeutic target to mitigate liver fibrosis in NAFLD. Impact and implicationsWe report that human adipose tissue pro-inflammatory macrophages correlate with hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD). Furthermore, the modulation of adipose tissue macrophages (ATMs) by dextran-nanocarrier conjugated with dexamethasone shifts the pro-inflammatory phenotype of ATMs to an anti-inflammatory phenotype in an experimental murine model of non-alcoholic steatohepatitis. This shift ameliorates adipose tissue inflammation, hepatic inflammation, and fibrosis. Our results highlight the relevance of adipose tissue in NAFLD pathophysiology and unveil ATMs as a potential target for NAFLD.

CD4+CD25+ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an innovative surgical approach for the treatment of massive hepatocellular carcinoma (HCC), the key to successful planned stage 2 ALPPS is future liver remnant (FLR) volume growth, but the exact mechanism has not been elucidated. The correlation between regulatory T cells (Tregs) and postoperative FLR regeneration has not been reported.To investigate the effect of CD4+CD25+ Tregs on FLR regeneration after ALPPS.Clinical data and specimens were collected from 37 patients who developed massive HCC treated with ALPPS. Flow cytometry was performed to detect changes in the proportion of CD4+CD25+ Tregs to CD4+ T cells in peripheral blood before and after ALPPS. To analyze the relationship between peripheral blood CD4+CD25+ Treg proportion and clinicopathological information and liver volume.The postoperative CD4+CD25+ Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume, proliferation rate, and kinetic growth rate (KGR) of the FLR after stage 1 ALPPS. Patients with low Treg proportion had significantly higher KGR than those with high Treg proportion (P = 0.006); patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion (P = 0.043). The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume, proliferation rate, and KGR were all greater than 0.70.CD4+CD25+ Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients' livers. Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

Relationship of cytokine gene polymorphism and the development of liver fibrosis in patients with chronic hepatitis B&amp;C

One of the features of the spread of infectious diseases is an increase in the number of mixed infections caused by various types of microorganisms: bacteria, viruses, protozoa, fungi, mycoplasmas, chlamydia, etc. In mixed infections, the simultaneous presence of several pathogens leads to not only to the complex interaction of pathological processes, but also complicates the diagnosis and choice of treatment. Mixed hepatitis is characterized by high biochemical activity and histological changes, the presence of signs of portal hypertension. Infection with two viruses increases the risk of developing hepatocellular carcinoma. It should be noted that in patients with HBV infection, the development of hepatocellular carcinoma is possible at the stage of chronic hepatitis before the onset of liver cirrhosis. The aim of the study: to investigate a comprehensive assessment of the allelic polymorphism of the IL-4 (rs2243250), IL-10 (rs1800896), TNFα (rs1800620), SMAD family member 7 (rs4939827) and eIF3h (rs16892766) genes with the degree of fibrosis in patients with chronic hepatitis B&amp;C. Materials and methods. In the course of the study, 62 patients with chronic hepatitis B&amp;C were examined before the start of treatment and after the end of the course of antiviral therapy. The degree of liver fibrosis was established by FibroScan. Molecular genetic studies included the determination of polymorphic variants of the IL-4 (rs2243250), IL10 (rs1800896), TNFα (rs1800620), SMAD family member 7 (rs4939827), eIF3h (rs16892766) genes. Polymorphism was studied by amplification of the corresponding regions of the genome by PCR. Results and discussions. Genotypes CC IL-4 (rs2243250), GG IL-10 (rs1800896), GG TNFα (rs1800620), AA SMAD family member 7 (rs4939827), TT eIF3h (rs16892766) have a protective effect on the course of chronic hepatitis B&amp;C, as they are established in patients with chronic hepatitis B&amp;C with a lower degree of fibrosis. Heterozygous CT IL-4 (rs2243250), GA IL-10 (rs1800896), GA TNFα (rs1800620), CC SMAD family member 7 (rs4939827), CC eIF3h (rs16892766) have a profibrotic effect on the course of chronic hepatitis B&amp;C, therefore that they are established in patients with chronic hepatitis B&amp;C with a greater degree of fibrosis.In patients with a low stage of fibrosis, the genotypes CC IL-4 (rs2243250), GG IL-10 (rs1800896), GG TNFα (rs1800620), AA SMAD family member 7 (rs4939827), TT eIF3h (rs16892766), are most often determined. In patients with a degree of fibrosis, other genotypes were detected, namely CT IL-4 (rs2243250), GA IL-10 (rs1800896), GA TNFα (rs1800620), CC SMAD family member 7 (rs4939827), CC eIF3h (rs16892766). Сonclusions. The revealed differences in the frequency of occurrence of various gene polymorphisms in healthy subjects and patients with chronic hepatitis indicate a certain predisposition to the development of a chronic inflammatory process in the liver.

Noninvasive diagnosis of periportal fibrosis in schistosomiasis mansoni: A comprehensive review.

Schistosomiasis mansoni is a neglected disease and key public health problem, mainly due to its high prevalence, the scarcity of public policies, and the severity of some clinical forms. Periportal fibrosis (PPF) is the commonest complication of chronic schistosomiasis mansoni and its diagnosis requires different techniques. Even though wedge biopsy of the liver is considered the gold standard, it is not justified in non-surgical patients, and percutaneous liver biopsy may be informative but does not have sufficient sensitivity. Noninvasive PPF tests mostly include biological (serum biomarkers or combined scores) or physical assessments (imaging assessment of fibrosis pattern or tissue stiffness). Moreover, imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging, and elastography are applied not only to support the diagnosis of schistosomiasis, but also to assess and detect signs of portal hypertension and organ damage due to chronic schistosomiasis. A combination between a comprehensive history and physical examination with biomarkers for liver fibrosis and imaging methods seems to offer the best approach for evaluating these patients. In addition, understanding their strengths and limitations will allow a more accurate interpretation in the clinical context and can lead to greater accuracy in estimating the degree of fibrosis in patients with Schistosomiasis mansoni (S. mansoni) infection. This review will discuss the different noninvasive methods that are currently available for the evaluation of PPF in S. mansoni infection, and their application, advantages, and limitations in clinical practice.

GPR, King's Score and S-Index are superior to other non-invasive fibrosis markers in predicting the liver fibrosis in chronic Hepatitis B patients.

In this study, we investigated the efficacy of nine non-invasive fibrosis markers in the assessment of the degree of fibrosis in patients with chronic Hepatitis B (CHB) in comparison with liver biopsy. A total of 1454 untreated CHB patients from two different centers who underwent liver biopsy were included in the study. Laboratory results of patients were reviewed retrospectively and the pathology slides were re-evaluated in accordance with the Ishak score. Degree of fibrosis ≥ 3 was accepted as "significant fibrosis", ≥ 4 as "advanced fibrosis", and ≥ 5 as cirrhosis. The diagnostic performance of the markers Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 score (FIB-4), Aspartate aminotransferase to Alanine aminotransferase Ratio (AAR), AAR to Platelet Ratio Index (AAPRI), Gamma-glutamyl transpeptidase to Platelet Ratio (GPR), King's Score, Fibro quotient (Fibro-Q), S Index and Platelet to Lymphocyte Ratio (PLR) were evaluated with ROC analysis. In detecting significant fibrosis, APRI, GPR, King's Score and S Index had AUROC values over 0.70. For advanced fibrosis, all of the models except AAPRI; and for cirrhosis, all of the models had AUROC values over 0.70. In accordance with the chosen staging system, GPR, King's Score and S Index had high diagnostic efficacy whereas APRI, FIB-4, FibroQ and PLR had moderate diagnostic efficacy, AAR and AAPRI had low diagnostic efficacy. GPR, King's Score and S Index had moderate diagnostic performance in detecting significant fibrosis and advanced fibrosis, and high diagnostic performance in detecting cirrhosis.

MiR-21/Sonic Hedgehog (SHH)/PI3K/AKT Pathway is Associated with NSCLC of Primary EGFR-TKI Resistance

Background: Non-small cell lung cancer (NSCLC), caused by abnormal gene drive, may have primary drug resistance after treatment with tyrosine kinase inhibitors (EGFR-TKIs). Therefore, we explore whether the primary drug-resistant NSCLC treated with EGFR-TKI is related to the miR-21/Sonic Hedgehog (SHH)/PI3K/AKT pathway. Methods: The patients from our hospital who meet the AJCC TNM staging (7th edition) stage IIIB and stage IV NSCLC were selected in this case study. Thereafter, the treatment response of EGFR-TKIs was evaluated according to the solid tumor efficacy evaluation standard (version 1.1). The patients were divided into the EGFR-TKIs primary drug resistance group (EGFR-TKIs-Primary-R) and the EGFR-TKIs sensitive group (EGFR-TKIs-Primary-S). Apoptosis level and degree of fibrosis in patients’ tumor tissues were detected by the TUNEL assay and Masson staining, respectively. The levels of miR-21 and GLI1 were measured by qRT-PCR technique. The contents of E-cadherin and Snail were detected by IF method, and the degree of PI3K/AKT phosphorylation was measured using IHC technique. Results: Compared with the EGFR-TKIs-Primary-S group, the EGFR-TKIs-Primary-R group showed lower levels of apoptosis and tumor tissue fibrosis. The levels of miR-21, GLI1, Snail, p-PI3K and p-AKT increased, while the level of E-cadherin decreased. However, the levels of total protein PI3K and AKT remained the same. Conclusion: NSCLC of primary EGFR-TKI resistance was found to be related to miR-21/SHH, the process of epithelial to mesenchymal transition (EMT), and PI3K/AKT phosphorylation. The present study provides a reference for future research in drug resistance, and paves the way to discover new therapeutic gene targets to alleviate lung cancer drug resistance.

A relation between T cell phenotypic profile and virus genotype in patients with chronic viral hepatitis (before and after treatment with direct antiviral agents)

The aim of the study was to investigate the phenotype of effector T lymphocytes in patients with chronic viral hepatitis C (CVHC) before and after of treatment with direct antiviral drugs depending on the genotype of the virus. 50 patients with CVHC without signs of liver cirrhosis were examined. The diagnosis was made on the basis of epidemiological and clinical laboratory data as recommended by the European Association for the Study of the Liver when specific serological markers of CHCV and RNA of hepatitis C virus (HCV) were detected (EASL, 2016). The determination of HCV RNA was carried out by the method of quantitative polymerase chain reaction in real time. The degree of liver fibrosis in patients with CVHC was assessed using ultrasound elastography. Patients were treated for 3 months with direct antiviral drugs according to the recommendations of the European Association for the Study of the Liver (2016). The control group included 46 practically healthy individuals with severe chronic diseases of various organs and systems excluded during a routine examination, no health complaints, having normal clinical and biochemical blood tests in the absence of markers for viral hepatitis B and C, antibodies to opisthorchis and denying history of alcohol abuse. The study of the subpopulation composition of helper and cytotoxic T lymphocytes was carried out by direct immunofluorescence of whole peripheral blood. We obtained a 100% sustained virological response in patients with 1, 2 and genotypes of CHCV without signs of liver cirrhosis when using therapy with Sofosbuvir (400 mg) and Daclatasvir (60 mg) for 12 weeks. It was found that in CVHC patients were found characteristic features in the phenotypic composition of effector T lymphocytes before and after treatment with direct antiviral drugs in depending on the genotype of HCV. Patients with HCV genotypes 1 and 3 had an increase in the content of terminal differentiated effector (TEMRA) T helpers and effector memory (EM). Only patients with HCV genotype 2 had a decrease in the level of EM T-helper cells in the blood. A decrease in the relative number of T helpers of central memory (СM) was independent of the HCV genotype. The level of effector subpopulations of cytotoxic T lymphocytes in patients with CVHC was consistent with or exceeded control levels in depending on the genotype of HCV. The level of all investigated subpopulations of effector cytotoxic T lymphocytes in patients with HCV genotype 1 was equal to the control values. The number of naïve cytotoxic T cells and CM in peripheral blood in patients with HCV genotype 2 was increased. The content of naïve cytotoxic T lymphocytes, CM and TEMRA in patients with genotype 3 HCV in the blood was increased. The highest viral load was detected in patients with CVHC with genotype 1 HCV. Liver fibrosis was most pronounced in patients with CVHC infection with HCV genotypes 2 and 3. After 3 months of treatment with direct antiviral drugs the patients with CVHC had a reduced content of CM T helpers regardless of the HCV genotype. In addition, patients with HCV genotypes 1 and 3 had a decrease in the number of naïve T helpers and patients with HCV genotypes 2 and 3 had a normalization of the content of naïve cytotoxic T lymphocytes.

Correlation between adiponectin level and the degree of fibrosis in patients with NAFLD

Abstract Background Non-alcoholic Fatty Liver Disease (NAFLD) is one of the most prevalent chronic liver diseases particularly in Egypt. It is defined as accumulation of lipids inside the hepatocytes, in absence of other etiologies of hepatic damage. It is frequently associated with obesity, diabetes mellitus and metabolic syndrome. Objective To find out the correlation between the degree of liver fibrosis in Non-alcoholic Fatty Liver Disease patients and their serum Adiponectin level as a future non-invasive method for assessment of liver fibrosis to substitute liver biopsy to avoid its hazardous complication. Also to study the correlation between diabetes mellitus as well as obesity and serum Adiponetctin level. Patients and Methods 50 patients were selected to participate in our study based on our inclusion criteria. They were recruited from the Internal Medicine department, Gastro-intestinal clinic in AlDemerdash Hospital using a convenient sampling method. Diagnoses of NAFLD (Non-alcoholic fatty liver disease) was confirmed by laboratory markers (AST, ALT, Lipid profile), ultrasound as well as fibroscan examination. Results Analyzing adiponectin levels showed that -besides its significant correlation with BMI, hypertension, diabetes mellitus and dyslipidemia- it was significantly lower in high grade fibrosis group compared to low grade fibrosis group with P-value of (0.000) and a cutoff value for stage 3/4 fibrosis of about 2.31μg/ml which marked a promising hope of adeponictin being of protective value against liver fibrosis. However, more studies performed on populations of different sizes and characteristics are recommended to allow more accurate generalization of the results and hopefully exploring a new horizon for the follow up and treatment of patients with chronic liver disease especially NAFLD. Conclusion Adiponectin is an abundant adipocyte-derived protein with well-established antiatherogenic, insulin-sensitizing and anti-inflammatory properties. The liver is a major target organ for adiponectin especially in fatty liver diseases and this adipocytokine has the ability to control many liver functions including metabolism, inflammation and fibrosis. Both serum levels and hepatic adiponectin receptor expression are decreased in NAFLD. Therefore, either adiponectin itself or adiponectin-inducing agents might be of key therapeutic interest in the near future in the treatment of NAFLD.

Shear Wave Elastography in Assessment of Liver Fibrosis

Abstract Background Liver fibrosis is major medical issues in patients with chronic hepatitis C (CHC). It may lead to cirrhosis, hepatocellular carcinoma (HCC) and liver-related death. Therefore, assessing the degree of fibrosis in patients with chronic liver diseases, especially before the advanced stage, is clinically important to allow early care and prevent fatal liver disease. Objective The plan was to do shear-wave Elastography after fibroscan (TE) in order to assess the stiffness of the liver, detect the changes occurred in hepatitis C patients and measure diagnostic accuracy of 2D- SWE by using TE as reference standard. Methods A cross-section study included 30 persons with positive hepatitis C. They were referred to Radiology department at National Hepatology and tropical medicine research institute. Results Our study included (30) patients who have hepatitis C positive, their ages ranged from (18) years old to (60) years old with mean SD of 52.97 ± 9.43. They were 17 females (56.7%) and 13 males (43.3%). Different liver fibrosis stages were observed by 2D-SWE as following: (FO) 4 patients (13.3%), (Fl) 4 patients (13.3%), (F2) 9 patients (30.0%), (F3) 10 patients (33.3%), (F4) 3 patients (10.0%). While TE (fibroscan) shows (FO) 6 (20.0%), (Fl) 3 patients (10.0%), (F2) 7 patients (23.3%), (F3) 8 patients (26.7%) (F4) 6 patients (20.0%). Our study showed that the relation between TE (fibroscan) and SWE finding had positive correlation of most patients with liver fibrosis with (p-value 0.006 and r-value 0.487). Because the impoltant of significant fibrosis for initiate antiviral protocol therapy, 30 patients classified into FO—FI (non-significant liver fibrosis) versus F2—F4 (significant liver fibrosis). Our study show significant discrimination was found between no/mild fibrosis (FO-FI) and significant fibrosis (F2-F4), shows the sensitivity of SWE in detection of significant fibrosis results is 95.2% and the specificity is 77.8%, PPV 90.91 %, NPV 87.5% and the accuracy 90.0% with cutoff value &amp;gt;5.7kPa. Conclusion SD-SWE is accurate in prediction significant fibrosis (2F2), Thus is expected to overcome the limitation of TE as a reliable method to assess fibrosis induce by hepatitis.

Correlation between adiponectin level and the degree of fibrosis in patients with non-alcoholic fatty liver disease

BackgroundNon-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases, particularly in Egypt. It is defined as the accumulation of lipids inside the hepatocytes, in the absence of other etiologies of hepatic damage. It is frequently associated with obesity, diabetes mellitus, and metabolic syndrome. Adiponectin is an abundant adipocyte-derived protein with well-established anti-atherogenic, insulin-sensitizing, and anti-inflammatory properties. The liver is a major target organ for adiponectin especially in fatty liver diseases, and this adipocytokine has the ability to control many liver functions including metabolism, inflammation, and fibrosis. In this study, we aimed to find out the correlation between the degree of liver fibrosis in NAFLD patients and their serum adiponectin level as a future non-invasive method for the assessment of liver fibrosis to substitute liver biopsy to avoid its hazardous complication and also to study the correlation between diabetes mellitus as well as obesity and serum adiponectin level.ResultsFifty patients were selected to participate in our study based on our inclusion criteria. They were recruited from the Internal Medicine Department, Gastroenterology Clinic in Al-Demerdash Hospital using a convenient sampling method. Diagnosis of NAFLD was confirmed by laboratory markers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, ultrasound, and FibroScan examination. Analyzing the adiponectin levels showed that besides its significant correlation with body mass index (BMI), hypertension, diabetes mellitus, and dyslipidemia, it was significantly lower in the high-grade fibrosis group compared to the low-grade fibrosis group with a P-value of (0.000) and a cutoff value for stage 3/4 fibrosis of about 2.31 μg/ml which marked a promising hope of adiponectin being of protective value against liver fibrosis.ConclusionBoth serum levels and hepatic adiponectin receptor expression are decreased in NAFLD. Therefore, either adiponectin itself or adiponectin-inducing agents might be of key therapeutic interest in the near future in the treatment of NAFLD.

P-57 LIVER STEATOSIS AND STEATOHEPATITIS IN LIVER DISEASES OTHER THAN ALCOHOLIC AND NON-ALCOHOLIC FATTY LIVER

Fatty liver disease (FLD) alcoholic and non-alcoholic are prevalent conditions. The damage is determined by steatosis and steatohepatitis with or without fibrosis. There is little information on its role in the progression to significant fibrosis (SF) of chronic liver diseases (CLD) other than FLD. To describe the frequency of steatosis and steatohepatitis in liver biopsies of patients with CLD other than FLD. Observational, retrospective study with biopsies performed between 2015-2018. The presence and degree of steatosis, steatohepatitis and fibrosis were recorded according to the METAVIR scale; F3-F4 is considered SF. 268 biopsies analyzed; 93 with FLD are excluded. 175 are included: 53% autoimmune hepatitis (AIH), 27% primary biliary cholangitis (PBC), 7% viral hepatitis (VH) and 13% others. 74% women; age 52 (18-82) years; 58% had steatosis and 46% had steatohepatitis; 67% fibrosis, which was SF in 61%. Steatosis/steatohepatitis/fibrosis according to etiology: AIH 34%/46%/69%; PBC 19%/9%/53%; VH 77%/15%/39%. When analyzing the presence of SF according to the presence of steatosis or steatohepatitis: in steatosis 36% vs 48% without steatosis; In steatohepatitis there were more SF (65% vs 36%; p = 0.004). According to aetiology SF/non SF: HAI 92%/38% (p = 0.001); PBC 20%/24%; VH 50%/22% (NS). There was a high frequency of steatosis and steatohepatitis in patients with CLD. The presence of steatohepatitis is associated with a higher degree of fibrosis in patients with CLD, particularly in AIH, which may have an impact on the evolution and treatment.

413-P: Renal Tubular Damage Marker, Urinary N-acetyl-b-d-glucosaminidase, as a Predictive Marker of Hepatic Fibrosis in Type 2 Diabetes

Background: Nonalcoholic steatohepatitis is closely associated with the progression of diabetic kidney disease (DKD) in type 2 diabetes (T2D). We investigated whether urinary N-acetyl-β-D- glucosaminidase(u-NAG), an early renal tubular damage biomarker in DKD, could be related to the degree of hepatic fibrosis in patients with T2D. Methods: A total of 300 patients with T2D were enrolled in the study. Hepatic steatosis and fibrosis were determined using transient elastography. The levels of urinary biomarkers, including u-NAG, albumin, protein, and creatinine, and glucometabolic parameters were measured. Results: Based on the median value of u-NAG to creatinine (u-NCR), subjects were divided into normal and high u-NCR groups. The high u-NCR group showed a significantly longer duration of diabetes, worsened hyperglycemia, and a more enhanced hepatic fibrosis index. A higher u-NCR was associated with a greater odds ratio for the risk of higher hepatic fibrosis stage (F2 OR 1.99; 95% CI [1.04-3.82]; F3 and F4 OR 2.40, 95% CI [1.52-3.80]). In addition, u-NCR was an independent predictive marker for more advanced hepatic fibrosis even after adjusting for several confounding factors (β = 1.58, P &amp;lt;0.01). Conclusions: The elevation of u-NAG was independently associated with a higher degree of hepatic fibrosis in patients with T2D. Considering the common metabolic milieu of renal and hepatic fibrosis in T2D, the potential use of u-NAG as an effective urinary biomarker reflecting hepatic fibrosis in T2D needs to be validated in the future. Disclosure H. Kim: None. Y. Kim: None. M. Lee: None. Y. Lee: None. E. Kang: None. B. Cha: None. B. Lee: None.

Non-invasive staging of liver fibrosis by two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis C and B

BackgroundNon-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases. Two-dimensional shear wave elastography provides in real-time, a tow dimensional quantitative map of tissue stiffness and enables measuring the stiffness by adjustment of a region of interest of tissue. The aim of this study was to highlight the role of tow dimensional shear wave elastography (2D-SWE) in detecting the degree of liver fibrosis in patients with chronic hepatitis C and B, in correlation with liver enzymes level and fibrotest.ResultsThis study included 50 patients with chronic hepatitis C and B whose ages were (range, 30-65 years; mean, 48 years). Shear wave elastography cutoff values were 1.35 m/s, 5.48 KPa for (F>0); 1.66 m/s, 8.29 kPa for (F>1); 1.77 m/s, 9.40 kPa for (F>2); and 1.99 m/s, 11.9 kPa for (F>3). An excellent agreement was found between shear wave elastography and Fibrotest in staging of liver fibrosis in 88% of patients (κw=0.943, 95% CI, 0.88 to 1.00) achieving a highly statistical significance (P<0.001). There was a significant moderate positive concordance between US scoring and staging by 2D-SWE and staging by Fibrotest (rs, 0.49; P<0.01) and (rs, 0.48; P<0.01) respectively. However, no significant concordances were noticed between staging by AST and ALT and 2D-SWE and staging by Fibrotest (P>0.05).Conclusions2D shear wave elastography showed better diagnostic performance than visual assessment by conventional US for detection of chronic liver diseases, as well as for evaluation of their severity and prognosis. Elastograhy—Fibrotest combination gives best diagnostic performance in detecting the degree of fibrosis non-invasively and can be used reliably as a first-line pre-therapeutic evaluation of fibrosis in HCV and HBV-infected patients.

Autotaxin as a Marker for Liver Fibrosis in Chronic HCV Patients

ABSTRACT: Background: Chronic hepatitis C is a major health problem. Noninvasive markers were developed to overcome liver biopsy complications. Autotaxin (ATX) is a lysophospholipase D enzyme that regulates lysophosphatidic acid (LPA) blood concentrations. Studies have suggested that the phenotypic changes during liver fibrosis may lead to changes in ATX level in the serum. Objectives: to determine the serum Autotaxin levels and its correlation to the liver fibrosis and whether it can be used as a non-invasive diagnostic biomarker of fibrosis in Egyptian Chronic viral hepatitis C individuals. Methodology: This study was conducted on 40 patients divided into 2 groups: Group I comprised of 20 patients with chronic viral hepatitis C patients in compensated stage and Group II comprised of 20 patients with chronic viral hepatitis C patients in decompensated stage together with 20 apparently healthy controls group. All patients were subjected to the following: complete history taking، complete clinical examination، routine lab investigations، abdominal ultrasound and measurement of serum ATX level detected by ELISA technique. Results: 40 patients were enrolled. Serum ATX was significantly higher according to liver fibrosis worsen stage (p=0.002) ،ATX was significantly higher in decompensated chronic hepatitis C patients (CHC) compared to patients with compensated CHC and controls with mean values (646.7 ± 247.4) ، (615.3 ± 266) and (469.9 ± 62.3) ng/ml respectively (p=0.005). Conclusion: Autotaxin was shown to be a potential serum marker for estimating the degree of fibrosis in patients with chronic HCV.