An international Delphi consensus statement on metabolic dysfunction-associated fatty liver disease and risk of chronic kidney disease

Background: With the rising global prevalence of fatty liver disease related to metabolic dysfunction, the association of this common liver condition with chronic kidney disease (CKD) has become increasingly evident. In 2020, the more inclusive term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace the term non-alcoholic fatty liver disease (NAFLD). The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD. However, to date, there is no appropriate guidance on CKD in individuals with MAFLD. Furthermore, there has been little attention paid to the link between MAFLD and CKD in the Nephrology community. Methods and Results: Using a Delphi-based approach, a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD. Conclusions: This Delphi-based consensus statement provided guidance on the epidemiology, mechanisms, management and treatment of MAFLD and CKD, as well as the relationship between the severity of MAFLD and risk of CKD, which establish a framework for the early prevention and management of these two common and interconnected diseases.Fil: Sun, Dan Qin. Jiangnan University Medical Center; China. Nantong University; ChinaFil: Targher, Giovanni. Azienda Ospedaliera Universitaria Integrata Verona; ItaliaFil: Byrne, Christopher D.. University of Southampton; Reino UnidoFil: Wheeler, David C.. University College London; Estados UnidosFil: Wong, Vincent Wai Sun. Chinese University of Hong Kong; ChinaFil: Fan, Jian Gao. Shanghai Jiao Tong University; ChinaFil: Tilg, Herbert. Medical University Innsbruck; AustriaFil: Yuan, Wei Jie. Shanghai Jiao Tong University; ChinaFil: Wanner, Christoph. Würzburg University Clinic; AlemaniaFil: Gao, Xin. Fudan University; ChinaFil: Long, Michelle T.. Boston University School of Medicine; Estados UnidosFil: Kanbay, Mehmet. Koc University School of Medicine; TurquíaFil: Nguyen, Mindie H.. Stanford University Medical Center; Estados UnidosFil: Navaneethan, Sankar D.. Baylor College of Medicine; Estados UnidosFil: Yilmaz, Yusuf. Marmara University; Turquía. Recep Tayyip Erdoğan University; TurquíaFil: Huang, Yuli. Southern Medical University; ChinaFil: Gani, Rino A.. Universitas Indonesia; IndonesiaFil: Marzuillo, Pierluigi. Università della Campania “Luigi Vanvitelli”; ItaliaFil: Boursier, Jérôme. Angers University; FranciaFil: Zhang, Huijie. Southern Medical University; ChinaFil: Jung, Chan Young. Yonsei University; Corea del SurFil: Chai, Jin. Army Medical University; ChinaFil: Valenti, Luca. Università degli Studi di Milano; ItaliaFil: Papatheodoridis, George. Kapodistrian University of Athens; GreciaFil: Sookoian, Silvia Cristina. Centro de Investigacion Traslacional En Salud (cenitres) ; Facultad de Cs. de la Salud ; Universidad Maimonides; . Universidad Abierta Interamericana; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chunsun, Dai. Nanjing Medical University; ChinaFil: Eslam, Mohammed. University of Sydney; AustraliaFil: Wei, Lai. Tsinghua University; ChinaFil: George, Jacob. University of Sydney; AustraliaFil: Zheng, Ming Hua. Wenzhou Medical University; Chin

An international Delphi consensus statement on metabolic dysfunction-associated fatty liver disease and risk of chronic kidney disease

BACKGROUND: With the rising global prevalence of fatty liver disease related to metabolic dysfunction, the association of this common liver condition with chronic kidney disease (CKD) has become increasingly evident. In 2020, the more inclusive term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace the term non-alcoholic fatty liver disease (NAFLD). The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD. However, to date, there is no appropriate guidance on CKD in individuals with MAFLD. Furthermore, there has been little attention paid to the link between MAFLD and CKD in the Nephrology community. METHODS AND RESULTS: Using a Delphi-based approach, a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD. CONCLUSIONS: This Delphi-based consensus statement provided guidance on the epidemiology, mechanisms, management and treatment of MAFLD and CKD, as well as the relationship between the severity of MAFLD and risk of CKD, which establish a framework for the early prevention and management of these two common and interconnected diseases

Sex Differences in Genomic Features of Hepatitis B–Associated Hepatocellular Carcinoma With Distinct Antitumor ImmunitySummary

Background & Aims: Aflatoxin exposure increases the risk for hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-infected individuals, particularly males. We investigated sex-based differences in the HCC genome and antitumor immunity. Methods: Whole-genome, whole-exome, and RNA sequencing were performed on 101 HCC patient samples (47 males, 54 females) that resulted from HBV infection and aflatoxin exposure from Qidong. Androgen on the expression of aflatoxin metabolism-related genes and nonhomologous DNA end joining (NHEJ) factors were examined in HBV-positive HCC cell lines, and further tested in tumor-bearing syngeneic mice. Results: Qidong HCC differed between males and females in genomic landscape and transcriptional dysfunction pathways. Compared with females, males expressed higher levels of aflatoxin metabolism-related genes, such as AHR and CYP1A1, and lower levels of NHEJ factors, such as XRCC4, LIG4, and MRE11, showed a signature of up-regulated type I interferon signaling/response and repressed antitumor immunity. Treatment with AFB1 in HBV-positive cells, the addition of 2 nmol/L testosterone to cultures significantly increased the expression of aflatoxin metabolism-related genes, but reduced NHEJ factors, resulting in more nuclear DNA leakage into cytosol to activate cGAS-STING. In syngeneic tumor-bearing mice that were administrated tamoxifen daily via oral gavage, favorable androgen signaling repressed NHEJ factor expression and activated cGAS-STING in tumors, increasing T-cell infiltration and improving anti–programmed cell death protein 1 treatment effect. Conclusions: Androgen signaling in the context of genotoxic stress repressed DNA damage repair. The alteration caused more nuclear DNA leakage into cytosol to activate the cGAS-STING pathway, which increased T-cell infiltration into tumor mass and improved anti–programmed cell death protein 1 immunotherapy in HCCs

Efficacy of Neonatal HBV Vaccination on Liver Cancer and Other Liver Diseases over 30-Year Follow-up of the Qidong Hepatitis B Intervention Study: A Cluster Randomized Controlled Trial

<div><p>Background</p><p>Neonatal hepatitis B vaccination has been implemented worldwide to prevent hepatitis B virus (HBV) infections. Its long-term protective efficacy on primary liver cancer (PLC) and other liver diseases has not been fully examined.</p><p>Methods and Findings</p><p>The Qidong Hepatitis B Intervention Study, a population-based, cluster randomized, controlled trial between 1985 and 1990 in Qidong, China, included 39,292 newborns who were randomly assigned to the vaccination group in which 38,366 participants completed the HBV vaccination series and 34,441 newborns who were randomly assigned to the control group in which the participants received neither a vaccine nor a placebo. However, 23,368 (67.8%) participants in the control group received catch-up vaccination at age 10–14 years. By December 2013, a total of 3,895 (10.2%) in the vaccination group and 3,898 (11.3%) in the control group were lost to follow-up. Information on PLC incidence and liver disease mortality were collected through linkage of all remaining cohort members to a well-established population-based tumor registry until December 31, 2013. Two cross-sectional surveys on HBV surface antigen (HBsAg) seroprevalence were conducted in 1996–2000 and 2008–2012. The participation rates of the two surveys were 57.5% (21,770) and 50.7% (17,204) in the vaccination group and 36.3% (12,184) and 58.6% (17,395) in the control group, respectively. Using intention-to-treat analysis, we found that the incidence rate of PLC and the mortality rates of severe end-stage liver diseases and infant fulminant hepatitis were significantly lower in the vaccination group than the control group with efficacies of 84% (95% CI 23%–97%), 70% (95% CI 15%–89%), and 69% (95% CI 34%–85%), respectively. The estimated efficacy of catch-up vaccination on HBsAg seroprevalence in early adulthood was 21% (95% CI 10%–30%), substantially weaker than that of the neonatal vaccination (72%, 95% CI 68%–75%). Receiving a booster at age 10–14 years decreased HBsAg seroprevalence if participants were born to HBsAg-positive mothers (hazard ratio [HR] = 0.68, 95% CI 0.47–0.97). Limitations to consider in interpreting the study results include the small number of individuals with PLC, participants lost to follow-up, and the large proportion of participants who did not provide serum samples at follow-up.</p><p>Conclusions</p><p>Neonatal HBV vaccination was found to significantly decrease HBsAg seroprevalence in childhood through young adulthood and subsequently reduce the risk of PLC and other liver diseases in young adults in rural China. The findings underscore the importance of neonatal HBV vaccination. Our results also suggest that an adolescence booster should be considered in individuals born to HBsAg-positive mothers and who have completed the HBV neonatal vaccination series.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div

<b>Age distribution and diagnostic evidences of liver diseases in HBV vaccination group and control group.</b>

a<p>All deaths related to liver diseases after age three were classified as acute-on-chronic liver failure (ACLF).</p><p>B, B-ultrasonic scan; CT, computed tomography; MRI, magnetic resonance imaging; N/A, not available.</p><p><b>Age distribution and diagnostic evidences of liver diseases in HBV vaccination group and control group.</b></p

Multivariate analysis of risk factors for hepatocellular carcinoma in all patients (n = 468).

<p>Abbreviations: ALT, alanine aminotransferase; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; CI, confidence interval; OR, odds ratio.</p><p>*Adjusted odds ratios were estimated using an unconditional logistic regression analysis.</p

<b>Neonatal and catch-up vaccination (administered at age 10–14 years) on HBsAg seroprevalence.</b>

<p>Catch-up vaccination was not randomized.</p>a<p>Chi-square tests.</p><p><b>Neonatal and catch-up vaccination (administered at age 10–14 years) on HBsAg seroprevalence.</b></p

Validation of hepatocellular carcinoma-related mutations in the reverse transcriptase domain of hepatitis B virus polymerase.

<p>Abbreviations: CI, confidence interval; HCC, hepatocellular carcinoma; OR, odds ratio.</p><p>*Data are presented as <i>n</i> (%).</p>†<p>Crude odds ratios were calculated using a two-by-two frequency table.</p