Significant Decrease In Liver Enzymes Research Articles

Wilson's Disease: A Prevalence Study in a Portuguese Population.

Introduction Wilson's disease (WD) is a rare and underdiagnosed genetic disorder caused by anomalous tissue copper deposition, and for which epidemiological studies, specifically in Portugal, are scarce. Objectives This study aimed to evaluate the prevalence and incidence of WD and provide a description of its main clinical and laboratory features. Methods A retrospective study was carried out, with a search between 1995 and 2015, of all patients with a minimum follow-up of three months and birth confirmed in the northern region of Portugal, with an estimated population of 3,689,682 inhabitants. Database collection was based on the Portuguese National Health Service's clinical coding system, relying on clinical data from 13 northern Portuguese hospitals, liver biopsy histology results, and hospital prescription records. Clinical and biochemical correlations were statistically assessed using chi-square, Mann-Whitney U, Friedman, and Wilcoxon tests. Results Over the 20-year period, a prevalence of 1:37.000 and an incidence of one per million person-year was found. A total of 94 patients were analyzed, with a slight male predominance (53%), the majority with the onset of clinical manifestations in pediatric age (56%), with a median age at diagnosis of 16.6 years (interquartile range of 12.3-20,.8 years). Most patients presented with predominant liver disease (54.8%), with more than a third with cirrhosis; mixed hepatic and neurological manifestations in 17.9%; and mainly neurological symptoms in 10.7% of the patients. Neurological impairment was strongly associated with delayed development of the manifestations of the disease (p = 0.001) and also a higher detection of Kayser-Fleischer rings (p < 0.001), present in 27.0% of the patients. Regarding therapy, penicillamine has been the most widely used, with adverse reactions reported in 24.8%. At six and 12 months after initiation of therapy, a significant decrease in liver enzymes was found (ALT: p = 0.002; AST: p = 0.002, respectively), but no significant reduction was observed in urinary copper excretion. Conclusion This was one of the first studies regarding WD prevalence in a Portuguese population, contributing to a better understanding of the epidemiology, diagnosis, and management of WD in the northern region of Portugal. WD should be considered in any individual with unexplained hepatic or neurological manifestations, and initial symptoms may manifest at an early age, even in children less than five years old.A high percentage of patients were identified in the early stages of the disease by asymptomatic elevation of transaminases. Following copper chelation therapy, cytolysis markers appear to be more sensitive indicators of treatment response.

Systemic sclerosis and primary biliary cholangitis: Longitudinal data to determine the outcomes.

Several studies described the cross-sectional characteristics of systemic sclerosis patients and coexisting primary biliary cholangitis, but longitudinal prognostic data are lacking. To describe the systemic sclerosis-primary biliary cholangitis phenotype, including baseline characteristics and outcomes. We performed a multicentre the European Scleroderma Trials and Research Group study of systemic sclerosis patients with primary biliary cholangitis or with primary biliary cholangitis-specific antibodies, matched with systemic sclerosis controls free from hepatobiliary involvement matched for disease duration and cutaneous subset. Data were recorded at baseline and at the last available visit. A total of 261 patients were enrolled (115 primary biliary cholangitis-systemic sclerosis, 161 systemic sclerosis). At baseline, systemic sclerosis-primary biliary cholangitis patients had a higher prevalence of anti-centromere antibodies (p = 0.0023) and a lower prevalence of complete absence of digital ulcers. The milder vascular involvement was confirmed at follow-up when crucial differences emerged in the percentage of patients experiencing digital ulcers; a significantly higher number of patients who never experienced digital ulcers were observed among primary biliary cholangitis-systemic sclerosis patients (p = 0.0015). Moreover, a greater incidence of pulmonary arterial hypertension (p < 0.001) and of conduction blocks (p = 0.0256) was observed in systemic sclerosis patients without primary biliary cholangitis. Patients with primary biliary cholangitis had higher levels of liver enzymes at baseline than systemic sclerosis patients; a significant decrease in liver enzymes was observed at follow-up. Out of 18 patients with cholangitis, one received a liver transplant at follow-up. Our data show that systemic sclerosis-primary biliary cholangitis exhibit a mild systemic sclerosis and primary biliary cholangitis phenotype with outcomes being in general favourable.

Exenatide improves cardiovascular risk factors in obese patients with type 2 diabetes mellitus: a prospective study

Background/aim The aim of this study was to evaluate the effects of a 6-month treatment regimen with exenatide on the lipid profile, high-sensitivity C-reactive protein (hsCRP), carotid intima media thickness (CIMT), visceral adiposity, and nonalcoholic fatty liver disease (NAFLD), all of which are important cardiovascular risk factors. Materials and methodsThis study included 45 obese patients with type 2 diabetes mellitus (T2DM). Baseline clinical findings, laboratory parameters, and ultrasonography findings were recorded. An exenatide recipe was given twice daily to the patients and, after 6 months of therapy, the same variables were compared. The compared parameters were lipid profiles, hsCRP, aspartat aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, liver craniocaudal diameter, visceral fat volume, subcutaneous fat thickness, and CIMT. Liver diameter, visceral fat volume, subcutaneous fat thickness, and CIMT were measured by ultrasonography. ResultsAfter therapy, statistically significant improvements were achieved in lipid profile, hsCRP, liver enzymes, body mass index, and waist and hip circumferences. Also, statistically significant decreases were obtained in liver craniocaudal diameter, subcutaneous fat thickness, visceral fat volume, and CIMT. The reduction of CIMT and liver diameter were not correlated with BMI and HbA1c reduction. ConclusionThis study showed improvement in lipid profile and hsCRP levels with exenatide treatment. We also showed decrease in both visceral fat volume and subcutaneous fat thickness. We demonstrated significant decrease in liver enzymes with significant decrease in liver diameter. These findings support the use of exenatide in patients with NAFLD and T2DM. Additionally, this study showed that exenatide treatment given twice daily reduces CIMT in obese T2DM patients.

A randomized controlled clinical trial comparing calcitriol versus cholecalciferol supplementation to reduce insulin resistance in patients with non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world with no definite treatment. Insulin resistance (IR) and low serum vitamin D are closely linked to NAFLD. Since there is no comparative study on the effect of calcitriol with cholecalciferol on NAFLD based on homeostasis model of insulin resistance (HOMA-IR) as an IR indicator, so we designed this research. A double blind randomized clinical trial was conducted on patients with NAFLD with concomitant vitamin D deficiency/insufficiency at two referral tertiary teaching medical centers, from July 2017 to January 2019. Patients were randomly divided into two groups: calcitriol (1mcg/day) and cholecalciferol (50,000IU/week) for 8 weeks. Before and after the intervention, anthropometric and laboratory data were measured and HOMA-IR was calculated for each patient. 54 patients completed the trial. In total, calcitriol supplementation improved serum insulin levels as well as IR based on the HOMA-IR index, significantly compared to the cholecalciferol group. HOMA-IR decreased 1.8 times more in patients receiving calcitriol than in those receiving cholecalciferol, which was clinically meaningful. The observed changes were more pronounced in patients with higher baseline body mass index. Moreover, calcitriol was more associated with a significant decrease in liver enzymes and cholesterol levels comparing to cholecalciferol. Based on the findings of this study, the use of calcitriol supplementation significantly reduced HOMA-IR as an IR indicator in NAFLD patients, compared to cholecalciferol. To confirm this findings, further studies with larger sample sizes are recommended.

Hepatoprotective effect of Moringa oleifera extract on TNF-\u03b1 and TGF-\u03b2 expression in acetaminophen-induced liver fibrosis in rats

BackgroundIt has been reported that Moringa oleifera (MO) has different medicinal properties. The aim of this study was to evaluate the hepatoprotective role of Moringa oleifera extract on acetaminophen-induced liver fibrosis in albino rats on a biochemical and histological basis. Forty male albino rats were divided into four groups: group I (control group), healthy rates; group II (acetaminophen group), rates received acetaminophen for induction of liver fibrosis; group III (treated group), liver fibrosis of rates treated with Moringa oleifera extract; and group IV (prophylactic group), rates treated with Moringa oleifera extract before and after induction of liver fibrosis. Serum liver function parameters were quantified using a spectrophotometer, while tumor necrosis factor α (TNF-α) and transformed growth factor beta (TGF- β) in liver tissue homogenate by means of enzyme-linked immunosorbent assay (ELISA), and expression of liver tissue TNF-α and TGF-genes was measured by real-time PCR after extraction and purification. Hepatic tissue was also evaluated under a microscope for histopathological changes.ResultsOur results showed a significant decrease in liver enzymes, TNF-α, and TGF-β in the treated and prophylactic groups compared to the acetaminophen group, and our biochemical data were consistent with the histopathological findings confirming the hepatoprotective effect of Moringa oleifera extract.ConclusionsBiochemical parameters and histopathology results provide evidence that Moringa oleifera ethanolic extract has a great potential to prevent and improve liver damage due to its protective activity.

Chronic Hepatitis C Virus Infection After Kidney Transplantation With or Without Direct-Acting Antivirals in a Real-Life Setting: A French Multicenter Experience

PurposeKidney transplant recipients (KTRs) are frequently infected with chronic hepatitis C virus (HCV), which can increase the risk of graft loss. Active HCV infections among KTRs are associated with shorter survival times. The emergence of very efficient interferon-free treatments (direct-acting antivirals [DAAs]) has revolutionized prognoses for chronic viral hepatitis. We performed a multicenter study where HCV (+)/RNA (+) KTRs were followed up and either received DAAs (group A) or not (group B) according to the transplant center. The aim was to assess, in a real-life setting, the impact of DAA therapy and to compare these results with those from HCV RNA (+) KTRs where HCV infection was not treated during the same period. MethodsThis study included 66 patients from 11 centers: 44 patients (66.7%; group A) received DAAs, whereas 22 patients did not (group B); the 2 groups were comparable according to baseline data. Most patients (88.6%) received sofosbuvir, 50% received ledipasvir, and 34.7% received daclatasvir. The duration of treatments ranged from 8 to 24 weeks. ResultsHCV RNA clearance (ie, a sustained virologic response) was observed in 95.4% of treated patients. Eradication of HCV led to a significant decrease in liver enzymes (50% reduction for alanine aminotransferase [P ≤ .001] and 41% for gamma glutamyl transpeptidase [P < .001]). Conversely, liver enzymes did not decrease in group B. Death occurred significantly more frequently in nontreated than treated patients (3 in group B vs none in group A, P = .003). Of the 10 treated patients with severe renal impairment before DAA therapy, 6 experienced graft loss. ConclusionDAAs are very effective at treating chronic HCV and have an excellent tolerance profile.

1127-P: Real-World Clinical Outcomes Associated with Canagliflozin 100mg and with Intensification of SGLT2 Inhibitor Therapy Switching to Canagliflozin 300mg in Patients with Type 2 Diabetes Mellitus: The Real-WECAN Study

The aims of this multicentric retrospective study were to assess in a real-world setting the effectiveness and safety of canagliflozin 100 mg/d (CANA100) as add-on to the background antihyperglycemic therapy, and to evaluate the intensification of SGLT2 inhibitor (SGLT2i) therapy by switching to canagliflozin 300 mg/d (CANA300) in patients with T2DM. 583 patients were included, 279 in the cohort of CANA100 (men 54.8%, age 59.7 y, A1C 8.05%, weight 94.9 kg) and 304 in the cohort of CANA 300 (men 55.9%, age 61.1 y, A1C 7.51%, weight 92.0 kg). Median follow-up periods in both cohorts were 9.1 and 15.4 months respectively. The primary outcome of the study was the mean change in A1C over the follow-up time. CANA100 was associated to significant reductions in A1C (-0.90%), weight (-4.1 kg) and systolic BP (-4.8 mmHg) at the end of the follow-up. The percentage of patients with A1C&amp;lt;7% significantly increased from 25.2% to 50.6%. In those patients with poor glycemic control (A1C &amp;gt;8%, mean 9.2%) CANA100 lowered A1C levels by 1.51%. There was a significant decrease in serum uric acid and liver enzymes. In the second cohort, patients with prior background SGLT2i therapy (dapagliflozin 10 mg 51%, CANA100 30.6%, empagliflozin 10/25 mg 7.3%/11.1%) switched to CANA300. Significant improvements in A1C (-0.35%), weight (-2.1 kg) and systolic BP (-3.2 mmHg) were observed over the follow-up period. There was a significant decrease in liver enzymes after SGLT2i intensification with CANA300. The percentage of patients with A1C&amp;lt;7% significantly increased from 28.9% to 46.6%. In those patients with poor glycemic control (A1C &amp;gt;8%, mean 8.9%) CANA300 lowered A1C levels by 1.12%. No unexpected adverse events were reported. In summary, CANA100 (as add-on therapy) and CANA300 (switching from CANA100 or other SGLT2i) significantly improved several cardiometabolic parameters in patients with T2DM. Disclosure J.J. Gorgojo-Martinez: Advisory Panel; Self; Abbott, AstraZeneca, Grunenthal Group, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Mundipharma International, Novo Nordisk Inc., Pfizer Inc. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Celgene, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Mundipharma International, Novo Nordisk Inc. M.A. Gargallo-Fernandez: Speaker’s Bureau; Self; Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi. A. Galdon: Speaker’s Bureau; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Mundipharma International, Novo Nordisk Inc. T. Antón-Bravo: Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Mundipharma International, Novo Nordisk Inc. M. Brito-Sanfiel: Advisory Panel; Self; Abbott, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi-Aventis. Speaker’s Bureau; Self; Almirall, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Esteve, Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Mylan, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi-Aventis. J.E.M. Wong-Cruz: None.

Liver disease in children and Adolescents with Type1 Diabetes Mellitus

Abstract Glycogenic hepatopathy (GH) is a very rare complication seen mostly in patients with type 1 diabetes mellitus (T1DM) in whom glycemic control has been poor for a long time. We assessed liver diseases in children and adolescents with type 1 diabetes mellitus by detection of elevated liver transaminases and confirmed by fibro scan and ultrasound. One hundred and seven children and adolescents with T1DM were subjected to detailed history, physical examination, laboratory investigation and radiological investigation. Liver transaminases, mean HbA1c and pelviabdominal ultrasound were done for all patients while fibro scan for those with elevated liver enzymes only. Patients with elevated liver enzymes were reassessed after one year. Only nine of our patients have elevated liver enzymes. HbA1c and fibro scan abnormalities (F stage) were significantly higher in patients with elevated liver enzymes. (p &amp;lt; 0.001) After follow up a significant decrease in liver enzymes, fibro scan abnormalities and HbA1c in the group with elevated liver enzymes initially was detected. (p &amp;lt; 0.001) We concluded that liver disease is not a common complication in patients with long standing uncontrolled diabetes which can be reversed after proper control.

Salvia hispanica (Chia) seeds afford hepatoprotection against Isoniazid and Rifampicin induced toxicity in a murine model

Salvia hispanica L. (chia) seeds are a rich source of omega-3 fatty acid and polyphenolic compounds with documented antioxidant property protecting against oxidative stress, which is implicated in the pathophysiology of drug-induced hepatotoxicity. Hence, the present study evaluates the effects of Salvia hispanica seeds in an animal model of antitubercular drug induced hepatic damage. Adult wistar rats were divided into six groups; normal control, hepatotoxic control, test groups treated orally with ground Salvia hispanica seeds at doses 250,500 and 1000mg/day respectively, standard control receiving silymarin at a dose of 50mg/kg orally. Hepatotoxicity was induced by administering isoniazid with rifampicin at a dose of 100mg/kg each intraperitoneal. After administration of drugs for a period of 21 days, the blood samples were evaluated for estimation of liver enzymes (AST, ALT, and ALP), total protein, albumin and total bilirubin and the liver was dissected and sent for histopathological evaluation. The hepatotoxic group showed a significant increase in liver enzymes and total bilirubin compared to normal control. There was a significant decrease in liver enzymes and total bilirubin in the drug treated and silymarin treated groups when compared to the control. However, there was no significant difference in protein and albumin between groups. Histopathological evaluation of the liver further confirmed the hepatoprotective potential of the seeds of Salvia hispanica. Salvia hispanica seeds protect against drug induced liver injury in a murine model and the underlying mechanism can be accorded to its antioxidant activity.

Relation between microRNA‐21, transforming growth factor β and response to treatment among chronic hepatitis C patients

Persistence of hepatitis C virus(HCV) infection and response to antiviral therapy has been shown to be associated with inappropriate levels of cytokines and microRNAs (miRNAs). miRNA levels have been reported to fluctuate during treatment. Thus they could be useful predictors for responses to treatment among HCV infected patients, thereby reducing ineffective treatments. The current study aimed to investigate the relation between miRNA-21 expression profiles, transforming growth factor β (TGF-β) serum levels and response to treatment with the new direct antiviral drugs (sofosbuvir + daclatasvir ± ribavirin), among HCV infected Egyptian patients. This prospective study was conducted on 50 HCV infected patients (before and after treatment) and 20 healthy volunteers. miRNA expression profiles were determined by real-time polymerase chain reaction and TGF-β1 serum levels were measured by using enzyme-linked immunosorbent assay. There was a significant increase in serum albumin, platelets count and a significant decrease in liver enzymes, serum bilirubin, and prothrombin time after treatment. Significant reduction of viral load among HCV patients after receiving the treatment was reported. Concomitantly, there was an increase in the relative quantity of miRNA-21 (P = .001*) and serum levels of TGF-β1 ( P = .337) among HCV patients after receiving treatment. Nearly all responders to direct antiviral drugs showed increased levels of both miRNA-21 and TGF-β1. This may indicate an interplay between TGF-β1 and miRNA-21 during remission or progression of viral infection. Thus miRNA-21 could be used as promising serum biomarker, for assessment of antiviral treatment efficacy and improvement of fibrosis among chronically infected HCV patients.

COMPARATIVE EVALUATION OF IN VITRO ANTIOXIDANT AND IN VIVO HEPATOPROTECTIVE ACTIVITIES OF ETHANOLIC LEAF AND ROOT EXTRACTS OF CLEOME GYNANDRA

In vitro antioxidant and in vivo hepatoprotective activities of Cleome gynandra ethanolic leaf and root extracts were assessed. In vitro antioxidant activity was carried by DPPH, Nitric oxide, hydroxyl radical and phosphomolybdenum assays. Hepatoprotective activity was evaluated by Carbon tetrachloride (CCl4) induced hepatotoxicity in albino rats.The animals were divided into seven groups (Four test groups - Ethanolic Leaf and Root Extracts of Cleome gynandra of 100 mg/kg and 200 mg/kg, standard silymarin (100 mg/kg), toxic control-carbon tetrachloride and vehicle). On the eight day, the blood was collected and parameters like serum glutamic oxaloacetic transaminase (SGOT), Serum glutamic pyruvic transaminase (SGPT), Alkaline phosphatase (ALP) and Total bilirubin (TB) were estimated. Significant antioxidant status with good IC50 values similar to standard ascorbic acid was obtained. A significant decrease in liver enzymes was observed in test groups comparable to silymarin. From the results obtained, ethanolic leaf extract has contributed better hepatoprotection compared with root extract in experimental rats.

Oral Administration of CardioAid and Lunasin Alleviates Liver Damage in a High-Fat Diet Nonalcoholic Steatohepatitis Model

Background: Several of the drugs in development for treatment of nonalcoholic steatohepatitis (NASH) target liver fibrosis or have side effects that prohibit their long-term use in patients with mild to moderate disease. Lunasin is a soy-derived peptide with anti-inflammatory properties. ADM's CardioAid™ is a plant sterol extract that exerts cholesterol- and triacylglycerol-lowering effects. Aim: To determine the immunomodulatory effects of CardioAid and lunasin in a high-fat diet (HFD) animal model of NASH. Methods: C57BL/6 mice on an HFD were orally administered CardioAid or lunasin for 25 weeks. The effects on the immune system, liver function, insulin resistance and lipid profile were studied. Results: Treatment with CardioAid and lunasin was associated with a significant decrease in the CD4/CD8 ratio and an increase in CD4+CD25+ lymphocytes. A decrease in interleukin 1-alpha serum levels and an increase in transforming growth factor beta serum levels were noted. These were associated with alleviation of liver damage as indicated by a significant decrease in liver enzymes and improvement in the histological nonalcoholic fatty liver disease activity score (NAS). Decreases in both serum triglyceride and serum glucose levels were observed in treated mice. A decrease in total body fat measured by EchoMRI was also observed in treated mice. Conclusions: CardioAid and lunasin exerted hepatoprotective and glucose-protective effects in an HFD NASH model. These data and the high-safety profiles of CardioAid and Lunasin support their use in patients in the early stages of NASH to prevent deterioration due to the disease.

Comparative study of antidiabetic activity of two herbal extracts in alloxan-induced diabetic rats

Due to the increasing prevalence of diabetes and side effects of chemical medicines, it is worthwhile to discover non-pharmacological treatments for this disease. Fenugreek (Trigonella foenum-graecum L) and Cordia myxa, are among the widely used medicinal herbs.The present study aimed to compare the antidiabetic activities of Trigonella foenum graecum seed aqueous extract (TE) with Cordia myxa fruit aqueous extract (CE) in alloxan-induced diabetic rats. Diabetes was induced in male Wistar rats by intraperitoneal injection of alloxan (120 mg/kg BW) and afterwards, rats were randomly allocated into four groups as the following: Group 1: Normal rats, Group 2: Diabetic control rats, Group 3: diabetic rats received TE (870 mg/kg BW), Group 4: diabetic rats received CE (500 mg/kg BW).The extracts were administered orally for 30 days. Treatment with both extracts caused a significant reduction in blood glucose and glycated hemoglobin of diabetic rats in comparison with diabetic control group (P < 0.001). The activities of catalase and superoxide dismutase in diabetic rats were decreased while there was an increase in the concentration of malondialdehyde in the liver. After a period of one-month oral administration, both extracts significantly decreased the altered parameters in diabetic rats compared to untreated controls (P < 0.05).Treatment with CE significantly decreased the elevated levels of alanine aminotransferase (ALT), aspartate transaminase (AST) and ALP (alkaline phosphatase) compared with untreated diabetic group (P < 0.05).Moreover, TE supplementation resulted in a significant decrease in liver enzymes except ALP compared to the diabetic control group (P < 0.05). Despite the comparable therapeutic efficacy, Cordia myxa fruit could be superior to Trigonella foenum graecum seeds due to its sweet taste and fewer side-effects.

Acute, sub-acute toxicity and antioxidant activities (in vitro and in vivo) of Reichardia picroide crude extract

Ethnopharmacological relevanceReichardia picroide is a species mainly used for alimentary purposes, but it is traditionally known to be used as hypoglycemiant, diuretic, depurative, galactagogue and tonic. Aim of the studyTo date, there are no studies corroborating both its safety and antioxidant activities. The objective of the present study, thus, was to assess the safety profile of Reichardia picroide methanolic extract (RPE) and as well as on its antioxidant and antihemolytic activities. Materials and methodsThe acute toxicity of RPE was carried out based on OECD guidelines 425. Signs accompanying toxicity and possible death of animals were monitored for two weeks to ascertain the median lethal dose (LD50) of the RPE. In sub-acute toxicity study, the extract was administered by gavage at the doses of 250, 500 and 1000mg/kg/day for 21 consecutive days. The antioxidant activity of RPE was investigated through various methods both in vitro and in vivo. ResultsThe admistrated doses did not produce mortality or changes in general behaviors of the tested males and females mice. The LD50 was found to be superior to 5000mg/kg DW. Moreover, daily administration of RPE at doses ranged from 500 to 1000mg/kg could result in alteration of liver and kidney histology. Significant decrease in liver enzymes (ALT and AST), urea and creatinine levels in female plasma was recorded. The RPE was, in vitro, strong in DPPH scavenging and hemolytic inhibition, benificial in lipid peroxidation inhibition and reducing power. In addition, it exhibited, in vivo, a strong effect on GSH level increasing and lipid peroxidation inhibition in liver and kidney. ConclusionsIt can be suggested, based on the results of this study, that the crude extract of Reichardia picroide was non-toxic in acute administration and the use of this extract is safe at doses ≤ 250mg/kg. This study supports the application of Reichardia picroides in alimentary and traditional medicine purposes. Moreover, antioxidant activity results suggested that Reichardia picroide had potent antioxidant activities and could be utilized as new natural antioxidant in food and therapeutics.

Probiotic Therapy in Patients with Nonalcoholic Steatohepatitis in Zagazig University Hospitals.

Aim:Nonalcoholic fatty liver disease (NAFLD) is probably the most common liver disorder in the world. A subgroup of NAFLD patients is characterized by injury to the hepatocytes and inflammation in addition to excessive fat (steatohepatitis), the latter condition is nominated nonalcoholic steatohepatitis (NASH). This work aimed to evaluate the role of probiotics on the outcome of NASH in patients admitted to the Tropical Medicine Department, Faculty of Medicine, Zagazig University (inpatients and outpatients).Materials and methods:This study was performed on 30 patients (17 males and 13 females), with body mass index from 30 to 35 and average age of 44 years with bright fatty liver in ultrasonography and raised alanine transaminase (ALT) and aspartate transaminase (AST) and positive liver biopsy findings. The patients were divided into group I (case group) that included 15 patients who received probiotics and group II of 15 patients as control group who did not receive probiotics; the study was conducted between November 2014 and April 2016. Clinical assessment, laboratory evaluation, pelvic-abdominal ultrasound, and liver biopsy of all cases were carried out.Results:In this study, there was significant decrease in liver enzymes (ALT and AST) and no statistically significant other laboratory findings. Also there was relief for dyspepsia in some patients.Conclusion:Probiotics treatment is effective, safe, well-tolerated, inexpensive, appropriate for long-term use, and optimally, works at multiple levels to downregulate inflammatory mediators, and therefore, probiotics could be an option in the treatment of NASH.How to cite this article: Monem SMA. Probiotic Therapy in Patients with Nonalcoholic Steatohepatitis in Zagazig University Hospitals. Euroasian J Hepato-Gastroenterol 2017;7(1):101-106.

Effects of lactulose and silymarin on liver enzymes in cirrhotic rats.

Silymarin, a mixture of antihepatotoxic flavonolignans used in the treatment of liver diseases, and lactulose, a nonabsorbable synthetic disaccharide, were investigated to analyze their probable synergic and healing effects in a hepatic cirrhotic rat model. Liver damage was induced by the administration and subsequent withdrawal of thioacetamide. The significant decrease in liver enzymes and malondialdehyde levels confirmed the curative effects of silymarin and lactulose. In the silymarin + lactulose group, liver enzyme and malondialdehyde levels were significantly reduced compared with those in the thioacetamide group. All treatments led to liver regeneration and triggered enhanced regeneration. Silymarin and lactulose alone or in combination have potent curative effects and reduce thioacetamide-induced liver damage.

Shiitake Culinary-Medicinal Mushroom, Lentinus edodes (Agaricomycetes): A Species with Antioxidant, Immunomodulatory, and Hepatoprotective Activities in Hypercholesterolemic Rats.

Lentinus edodes is a culinary-medicinal mushroom that has an established history of use in Asian therapies. The mushroom offers well-documented beneficial health effects such as antihypercholesterolemic, antitumor, and antibacterial activities. In this study, dried powder of L. edodes fruiting bodies was used to evaluate immunomodulatory, hepatoprotective, and antioxidant effects in hypercholesterolemic rats. Albino rats (n = 24) were divided into 3 groups: the control (CON) group, the hypercholesterolemia-only group (HCG), and the L. edodes group (LEG). Hypercholesterolemia was induced in rats in the HCG and LEG by feeding cholesterol and cholic acid in a chow maintenance diet (CMD) for 24 days. The CON group was fed the CMD throughout the experiment. The HCG continued on the high-cholesterol diet without any L. edodes supplement. The LEG was fed the high-cholesterol diet supplemented with L. edodes for an additional 42 days. Various biological health biomarkers, such as total antioxidant capacity, total oxidant status, arylesterase, paraoxonase activity, and liver enzymes in serum were studied to evaluate antioxidant and hepatoprotective responses. Cell-mediated immunity was evaluated in each group through a delayed type of hypersensitivity reaction. The total oxidant status decreased significantly (P ≤ 0.05) after administration of L. edodes in the diet. The cell-mediated immune response significantly increased (P ≤ 0.05) in the LEG. The significant decrease in liver enzymes supports the hepatoprotective effect of L. edodes. In conclusion, the results show the immunomodulatory, hepatoprotective, and antioxidant activities of L. edodes supplementation in hypercholesterolemic rats.

Protective capacity of cercarial transformation fluid alone or in combination with crude cercarial antigen against challenge infections of Schistosoma mansoni in mice.

Schistosomiasis is the second major parasitic disease in the world after malaria. It affects 201.5 million cases in Africa alone. The aim of this research was to explore alternative vaccination strategies against experimental schistosomiasis mansoni. We assessed the effect of cercarial transformation fluid (CTF) singly and in combination with crude cercarial antigen (CCA) using alum as an adjuvant. The combined antigens gave the best results, as evidenced by a significant reduction in the worm load (62.07%), tissue egg count (78.16%, 86.46%) in liver and intestine respectively, and hepatic granuloma size (29.96%). Scanning electron microscopy revealed changes in the tegument, in the form of roughness and appearance of vesicles and furrows between the tegumental tubercles. Also, resorption of the ventral sucker and dimples replacing its spines were observed. The female tegument was irregular and its posterior end showed loss of spines and sensory bulbs. Moreover, there was a significant decrease in liver enzymes (alanine transaminase (ALT) and aspartate transaminase (AST)) compared to infected control mice. A significant elevation in CD4+T-lymphocytes, denoting amelioration of the immune status, in mice that received combined antigens was also observed. It can be concluded that combined antigens demonstrate potential as a vaccine against Schistosoma mansoni.

Hepatoprotective Effect of Zizyphus vulgaris on Carbon Tetrachloride (CCl4) Induced Liver Damage in Rats as Animal Models

Background: Finding protective agents with fewer adverse effects against toxin-induced liver injuries, as a key detoxifier and excreter organ, have always been a concern for researchers. Carbon tetra-chloride (CCl4)-induced liver damage has been introduced as an experimental model of liver damage. This study aimed to investigate the protective effect of ethanolic extract of Zizyphus vulgaris (ZV) against hepatic injury induced by CCl4 in laboratory rats.&#x0D; Methods: Fifty healthy male Wistar rats (200±20 g) were randomly divided into 5 groups (n=10) as following for a 45days study: Base, which received 1 cc/Kg olive oil intraperitoneally (IP) twice a week and 0.5cc distilled water orally; Control, which received 0.5 cc/kg olive oil+0.5 cc/Kg CCl4 IP+0.5cc distilled water orally; experimental groups, which received 0.5 cc/kg olive oil+0.5 cc/Kg CCl4 IP+0.5cc distilled water plus ZV extract in dosages of 200 mg/Kg (group E200),400 mg/Kg (group E400) and 600 mg/Kg (group E600) PO. Levels of aspartate-aminotransferase (AST), alanine-aminotransferase (ALT), alkaline-phosphatase (Alk-P), Albumin, total-protein, and bilirubin were measured as well as pathological assessment of the liver samples for scoring of portal inflammation and hepatocellular necrosis.&#x0D; Result: Results of this study revealed that although there was a significant decrease in liver enzymes of the ZV treated groups (P&lt;0.05) there were insignificant differences in protein and albumin concentrations between the 5 experimental groups. In addition, ZV treatment reduced hepatic necrosis and portal inflammation compared with the control group.&#x0D; Conclusion: ZV showed hepatoprotective impact against CCl4-induced liver injury according to both serological and pathological investigations.

Gas chromatography-mass spectrometry analysis, hepatoprotective and antioxidant activities of the essential oils of four Libyan herbs

Following an ethnobotanical survey for hepatoprotective remedies, four Libyan medicinal plants from family Lamiaceae; Ajuga iva (L.) Schreber, Marrubium vulgare L., Rosmarinus officinalis L. and Thymus capitatus Hoff. et Link growing widely in Beida, Libya, were selected for our study. The chemical composition of essential oils hydrodistilled from the dried aerial parts, were analyzed by gas chromatography-mass spectrometry (GC-MS). The major constituents of the essential oils of A. iva and R. officinalis were carvacrol (35.07%) and 1,8-cineol (35.21%), respectively, thymol was the major constituent of the essential oil ofM. vulgare (20.11%) and T. capitatus (90.15%). The oil of M. vulgare had the most powerful antioxidant activity by restoring glutathione levels in the blood of alloxan-induced diabetic rats. The rats treated with the essential oils of M. vulgare, R. officinalis and T. capitatus (50 mg/kg) showed a significant decrease in liver enzymes which were elevated by CCl4 (p E‚ 0.01). The essential oil of M. vulgare had the most potent hepatoprotective activity. Key words: Ajuga iva, Marrubium vulgare, Rosmarinus officinalis, Thymus capitatusantioxidant, hepatoprotective.