The Osteopontin Level in Liver, Adipose Tissue and Serum Is Correlated with Fibrosis in Patients with Alcoholic Liver Disease

<div><h3>Background</h3><p>Osteopontin (OPN) plays an important role in the progression of chronic liver diseases. We aimed to quantify the liver, adipose tissue and serum levels of OPN in heavy alcohol drinkers and to compare them with the histological severity of hepatic inflammation and fibrosis.</p> <h3>Methodology/Principal Findings</h3><p>OPN was evaluated in the serum of a retrospective and prospective group of 109 and 95 heavy alcohol drinkers, respectively, in the liver of 34 patients from the retrospective group, and in the liver and adipose tissue from an additional group of 38 heavy alcohol drinkers. Serum levels of OPN increased slightly with hepatic inflammation and progressively with the severity of hepatic fibrosis. Hepatic OPN expression correlated with hepatic inflammation, fibrosis, TGFβ expression, neutrophils accumulation and with the serum OPN level. Interestingly, adipose tissue OPN expression also correlated with hepatic fibrosis even after 7 days of alcohol abstinence. The elevated serum OPN level was an independent risk factor in estimating significant (F≥2) fibrosis in a model combining alkaline phosphatase, albumin, hemoglobin, OPN and FibroMeter® levels. OPN had an area under the receiving operator curve that estimated significant fibrosis of 0.89 and 0.88 in the retrospective and prospective groups, respectively. OPN, Hyaluronate (AUROC: 0.88), total Cytokeratin 18 (AUROC: 0.83) and FibroMeter® (AUROC: 0.90) estimated significance to the same extent in the retrospective group. Finally, the serum OPN levels also correlated with hepatic fibrosis and estimated significant (F≥2) fibrosis in 86 patients with chronic hepatitis C, which suggested that its elevated level could be a general response to chronic liver injury.</p> <h3>Conclusion/Significance</h3><p>OPN increased in the liver, adipose tissue and serum with liver fibrosis in alcoholic patients. Further, OPN is a new relevant biomarker for significant liver fibrosis. OPN could thus be an important actor in the pathogenesis of this chronic liver disease.</p> </div

Diagnostic performance of FibroTest, SteatoTest and ActiTest in patients with NAFLD using the SAF score as histological reference

BACKGROUND: Blood tests of liver injury are less well validated in non‐alcoholic fatty liver disease (NAFLD) than in patients with chronic viral hepatitis. AIMS: To improve the validation of three blood tests used in NAFLD patients, FibroTest for fibrosis staging, SteatoTest for steatosis grading and ActiTest for inflammation activity grading. METHODS: We pre‐included new NAFLD patients with biopsy and blood tests from a single‐centre cohort (FibroFrance) and from the multicentre FLIP consortium. Contemporaneous biopsies were blindly assessed using the new steatosis, activity and fibrosis (SAF) score, which provides a reliable and reproducible diagnosis and grading/staging of the three elementary features of NAFLD (steatosis, inflammatory activity) and fibrosis with reduced interobserver variability. We used nonbinary‐ROC (NonBinAUROC) as the main endpoint to prevent spectrum effect and multiple testing. RESULTS: A total of 600 patients with reliable tests and biopsies were included. The mean NonBinAUROCs (95% CI) of tests were all significant (P < 0.0001): 0.878 (0.864–0.892) for FibroTest and fibrosis stages, 0.846 (0.830–0.862) for ActiTest and activity grades, and 0.822 (0.804–0.840) for SteatoTest and steatosis grades. FibroTest had a higher NonBinAUROC than BARD (0.836; 0.820–0.852; P = 0.0001), FIB4 (0.845; 0.829–0.861; P = 0.007) but not significantly different than the NAFLD score (0.866; 0.850–0.882; P = 0.26). FibroTest had a significant difference in median values between adjacent stage F2 and stage F1 contrarily to BARD, FIB4 and NAFLD scores (Bonferroni test P < 0.05). CONCLUSIONS: In patients with NAFLD, SteatoTest, ActiTest and FibroTest are non‐invasive tests that offer an alternative to biopsy, and they correlate with the simple grading/staging of the SAF scoring system across the three elementary features of NAFLD: steatosis, inflammatory activity and fibrosis

Hépatite virale aiguë associée à une fausse sérologie positive au virus d'Esptein-Barr en rapport avec une réactivation du système immunitaire

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Capside du virus de l'hépatite C et métabolisme lipidique hépatique

PARIS7-Bibliothèque centrale (751132105) / SudocSudocFranceF

Mécanismes de l'inflammation hépatique liée à l'obésité

Les lésions hépatiques observées au cours de l'obésité (NAFLD, stéatopathie non alcoolique) s'étendent de la stéatose isolée à la stéatohépatite (NASH, stéatohépatitie non alcoolique), la fibrose, la cirrhose et au carcinome hépatocellulaire. L'identification des mécanismes de recrutement des cellules immunitaires par le foie stéatosique est une étape clé dans la compréhension du déclenchement de l'inflammation hépatique et la recherche de nouvelles cibles thérapeutiques. Au cours de l obésité, la stéatose sensibilise le foie au lipopolysaccharide (LPS), qui active la voie pro-inflammatoire NF B. Nous avons récemment montré que: 1) la stéatose induisait une augmentation du recrutement lymphocytaire (TCD4+, TCD8+ et B) vers le foie mais également une augmentation de la réponse des lymphocytes TCD4+ à la chimiokine CXCL12 (SDF-1a), dont le récepteur est CXCR4 ; 2) GILZ (Glucocorticoid-Induced Leucine Zipper), une protéine induite par les glucocorticoïdes (GCs), inhibait la voie NFkB et jouait un rôle clé dans l inflammation hépatique au cours de la consommation excessive d alcool.Le but de ce travail était d étudier les mécanismes de l inflammation hépatique liée à l obésité. Au cours de mon travail, nous avons montré que le chimiotactisme des lymphocytes TCD4+ à la chimiokine CXCL12 était augmenté non seulement chez les souris obèses mais également chez des patients ayant une NASH. L augmentation de l effet chimiotactique de CXCL12 était due à une augmentation de l affinité de CXCL12 à son récepteur CXCR4. La migration anormale des lymphocytes T CD4+ vers le foie stéatosique était réversible pharmacologiquement en inhibant la liaison de CXCL12 à CXCR4 par AMD3100 (antagoniste deCXCR4). Le déficit d expression et l altération de l induction du facteur anti-inflammatoire GILZ dans les cellules des Kupffer des souris obèses étaient responsables de la sensibilisation de ces cellules au LPS. Cette altération était liée à la diminution de l expression du récepteur aux glucocorticoïdes (GR) dans les cellules de Kupffer des souris obèses. La surexpression de GILZ dans l obésité en utilisant des souris trangéniques restaurait la tolérance hépatique au LPS. Ces anomalies des lymphocytes TCD4+ et de l expression de GILZ dans les cellules de Kupffer participent au déclenchement d une inflammation hépatique sur un foie stéatosique et pourraient représenter de nouvelles cibles thérapeutiquesNon alcoholic fatty liver disease (NAFLD) includes a spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. The identification of the mechanisms involved in the recruitment of immunity cells by the fatty liver is a key in the comprehension of the onset of liver and the finding of new therapeutic targets. In obesity, steatosis sensitizes the liver to the lipopolysaccharide (LPS) from the gastrointestinal tract and the NFkB pro-inflammatory pathway is activated. We recently showed that: 1) the steatosis led to an increase recruitment of lymphocytes (TCD4+, TCD8+ and B) by the liver but also an hyperresponsive of CD4+T cells to CXCL12 (SDF-1"), the ligand of CXCR4; 2) GILZ(Glucocorticoid-Induced Leucine Zipper), a protein induced by glucocorticoids (GCs), inhibits the nuclear factor kB pathway and plays a key role in alcoholic hepatitis.This aim of my work was to study the mechanisms involved in obesity-related liver inflammation.I demonstrated that the chemotaxis of CD4+T cells to CXCL12 was increased not only in obese mice but also in patients with NASH. This increased chemotactisme of CXCL12 was due to an increase of the affinity ofCXCL12 to its receptor. The abnormal migration of CD4+T lymphocytes to the fatty liver was reversible by pharmacologically inhibiting the binding of CXCL12 to CXCR4 using AMD3100.The decreased expression and the impairment of the induction of the anti-inflammatory factor GILZ in Kupffer cells from obese mice was responsible for a sensitization of these cells to LPS. This impairment was due to a decrease of the glucocorticoid receptor (GR) expression in Kupffer cells from obese mice. The overexpression of GILZ level in obese transgenic mice restored the liver tolerance to LPS. These abnormalities of CD4+T lymphocytes and the GILZ expression in Kupffer cells contribute to the onset of liver inflammation in obesity and may represent new therapeutic targets.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Inflammation hépatique liée à l’obésité (NASH)

Nonalcoholic fatty liver disease (NAFLD) is the liver manifestation of the metabolic syndrome and one of the most common liver diseases in developed countries. NAFLD refers to a wide range of liver damage, ranging from pure steatosis to a more severe pathology namely steatohepatitis (NASH) characterized, in addition to steatosis, by inflammation and fibrosis. Recruitment and/or activation of inflammatory cells is a key issue in the progression of NAFLD. Only patients showing inflammation will develop advanced liver disease whereas patients without inflammation will remain at the steatotic stage. The liver receives blood from the gastrointestinal tract and the systemic venous system and is constantly exposed to food antigens, bacterial products and potential pathogens. Consequently, a specific immune environment exists in the liver. Innate immunity is largely developed with an enrichment of innate lymphocytes, including both NK and NKT cells and a large amount of resident macrophages so called Kupffer cells. Lymphocytes homeostasy is disturbed in the fatty liver: NKT and T regulator lymphocytes are decrease, steatosis induced a higher recruitment of blood lymphocytes and Kupffer cells show a pro-inflammatory phenotype. All together, the lipid accumulation in the liver is correlated to the immune tolerance disruption leading to the initiation of NAS

Microbiota, liver diseases, and alcohol

Being overweight and obesity are the leading causes of liver disease in Western countries. Liver damage induced by being overweight can range from steatosis, harmless in its simple form, to steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Alcohol consumption is an additional major cause of liver disease. Not all individuals who are overweight or excessively consume alcohol develop nonalcoholic fatty liver diseases (NAFLD) or alcoholic liver disease (ALD) and advanced liver disease. The role of the intestinal microbiota (IM) in the susceptibility to liver disease in this context has been the subject of recent studies. ALD and NAFLD appear to be influenced by the composition of the IM, and dysbiosis is associated with ALD and NAFLD in rodent models and human patient cohorts. Several microbial metabolites, such as short-chain fatty acids and bile acids, are specifically associated with dysbiosis. Recent studies have highlighted the causal role of the IM in the development of liver diseases, and the use of probiotics or prebiotics improves some parameters associated with liver disease. Several studies have made progress in deciphering the mechanisms associated with the modulation of the IM. These data have demonstrated the intimate relationship between the IM and metabolic liver disease, suggesting that targeting the gut microbiota could be a new preventive or therapeutic strategy for these diseases

Specific microbiome profile in Takayasu’s arteritis and giant cell arteritis

International audienceRecent studies have provided evidence of a close link between specific microbiota and inflammatory disorders. While the vessel wall microbiota has been recently described in large vessel vasculitis (LVV) and controls, the blood microbiome in these diseases has not been previously reported (LVV). We aimed to analyse the blood microbiome profile of LVV patients (Takayasu's arteritis [TAK], giant cell arteritis [GCA]) and healthy blood donors (HD). We studied the blood samples of 13 patients with TAK (20 samples), 9 patients with GCA (11 samples) and 15 HD patients. We assessed the blood microbiome profile by sequencing the 16S rDNA blood bacterial DNA. We used linear discriminant analysis (LDA) coupled with linear discriminant effect size measurement (LEfSe) to investigate the differences in the blood microbiome profile between TAK and GCA patients. An increase in the levels of Clostridia, Cytophagia and Deltaproteobacteria and a decrease in Bacilli at the class level were found in TAK patients compared with HD patients (LDA > 2, p 2; p < 0.05). Differences highlighted in the blood microbiome were also associated with a shift of bacterial predicted metabolic functions in TAK in comparison with HD. Similar results were also found in patients with active versus inactive TAK. In conclusion, patients with TAK were found to present a specific blood microbiome profile in comparison with healthy donors and GCA subjects. Significant changes in the blood microbiome profiles of TAK patients were associated with specific metabolic functions

Multikinase inhibitor-induced liver injury in patients with cancer: A review for clinicians

International audienceBACKGROUND: Multikinase inhibitors (MKI) are targeted molecular agents that have revolutionized cancer management. However, there is a paucity of data concerning MKI-related liver injury risk and clinical guidelines for the management of liver toxicity in patients receiving MKI for cancer are scarce. DESIGN: We conducted a PubMed search of articles in English published from January 2000 to December 2018 related to hepatotoxicity of the 29 FDA-approved MKIs at doses used in clinical practice. The search terms were the international non-proprietary name of each agent cross-referenced with «hepatotoxicity», «hepatitis», «hepatic adverse event», or «liver failure», and «phase II clinical trial», «phase III clinical trial», or «case report». RESULTS: Following this search, 140 relevant studies and 99 case reports were considered. Although asymptomatic elevation of aminotransferase levels has been frequently observed in MKI clinical trials, clinically significant hepatotoxicity is a rare event. In most cases, the interval between treatment initiation and the onset of liver injury is between one week and two months. Liver toxicity is often hepatocellular and less frequently mixed. Life-threatening MKI-induced hepatic injury has been described, involving fulminant liver failure or death. Starting from existing data, a description of MKI-related liver events, grading of hepatotoxicity risk, and recommendations for management are also given for various MKI molecules. CONCLUSION: All MKIs can potentially cause liver injury, which is sometimes irreversible. As there is still no strategy available to prevent MKI-related hepatotoxicity, early detection remains crucial. The surveillance of liver function during treatment may help in the early detection of hepatotoxicity. Furthermore, the exclusion of potential causes of hepatic injury is essential to avoid unnecessary MKI withdrawal

Atypical as well as anatomical liver resections are feasible by laparoendoscopic single-site surgery

INTRODUCTION: Liver surgery was one of the last fields to be conquered by laparoscopy, which has become safe and effective, especially for left lateral sectionectomy (LLS) and limited peripheral resections. However, major hepatectomies remain challenging. Laparoendoscopic single-site (LESS) surgery is being employed for an increasing variety of surgical sites and indications. PRESENTATION OF CASE: Three patients underwent LESS hepatectomy. A 36-year-old woman had LLS for a 38-mm adenoma, an 85-year-old woman an atypical resection of segment VI for a 12-mm hepatocellular carcinoma and a 41-year-old woman an atypical right anterior resection for a 9 cm symptomatic FNH. Procedures were performed transperitoneally with a single-port device, via a 20-mm or 30-mm incision. Operative times were 110 min for LLS, 100 min for the atypical segment VI resection and 120 min for the atypical right anterior liver resection. Blood loss was less than 50 ml in the first two patients and 150 ml in the third. Postoperative courses were uneventful. The first two patients were discharged on postoperative day 3 and the third on postoperative day 1. DISCUSSION: To date, some case reports and series of LESS liver surgery have been published. We performed the reported hepatectomies after a considerable experience in laparoscopic hepatic surgery and after applying the LESS approach to other procedures. Our hepatectomy technique was not modified by the use of the single-port and results were very encouraging. CONCLUSION: We believe that in selected patients, both peripheral resections and LLS are feasible by LESS surgery, with good intra-operative and post-operative results