Association of Adipose tissue inflammation with histologic severity of nonalcoholic fatty liver disease

BACKGROUND & AIMS : The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased with the obesity pandemic. We analyzed the transcriptional profiles of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), and phenotypes and functional characteristics of adipocyte tissue macrophages (ATMs), in obese patients undergoing bariatric surgery. METHODS : We collected anthropometric data; plasma samples; and SAT, VAT, and liver tissues from 113 obese patients undergoing bariatric surgery at academic hospitals in Europe (Antwerp and Leuven) and South Africa. Based on clinical and histologic features, patients were assigned to the following groups: obese, NAFLD, nonalcoholic steatohepatitis (NASH), or NASH with fibrosis. Microarray analyses were performed to identify genes expressed differentially among groups. We measured levels of cytokines and chemokines in plasma samples and levels of RNAs in adipose tissues by quantitative reverse-transcription polymerase chain reaction. ATMs were isolated from patients and 13 lean individuals undergoing cholecystectomy (controls), analyzed by flow cytometry, and cultured; immunophenotypes and levels of cytokines and chemokines in supernatants were determined. RESULTS : We observed increased expression of genes that regulate inflammation in adipose tissues from patients with NAFLD and NASH; expression of these genes increased as disease progressed from NAFLD to NASH. We found 111 genes associated with inflammation that were expressed differentially between VAT and SAT. Serum levels of interleukin 8, chemokine (C-C motif) ligand 3, and tumor necrosis factor-a correlated with liver inflammation and NAFLD activity score. We developed 2 models that could be used to determine patients’ liver histology based on gene expression in VAT and SAT. Flow cytometry showed increased proportions of CD11cþCD206þ and CCR2þ macrophages in VAT from patients with NASH, and supernatants of cultured macrophages had increased levels of cytokines and chemokines compared with controls. CONCLUSIONS : VAT and SAT from patients with NAFLD and NASH have an increased expression of genes that regulate inflammation, and ATM produce increased levels of inflammatory cytokines, compared with adipose tissues from controls. We identified an expression profile of 5 genes in SAT that accurately predict liver histology in these patients. Transcript profiling: accession numbers: GSE58979 and GSE59045.Schalk van der Merwe, Chantal Mathieu, Frederik Nevens, David Cassiman, and Sven Francque are recipients of the Flanders fund for scientific research (FWO klinisch mandaat), and Hannelie Korf is a recipient of the FWO postdoctoral mandate. Research at the Department of Endocrinology, Diabetology and Metabolism and the Department of Gastroenterology and Hepatology of the Antwerp University Hospital (Belgium) was supported by the European Union: FP6 (HEPADIP contract LSHM-CT-2005-018734) and FP7-HEALTH (RESOLVE no. 305707). Supported by a fellowship from the South African Gastroenterology Association and a scholarship from the European Association for the Study of the Liver (J.d.P.). This research also was supported by a research grant from the Gastro foundation of South Africa. The authors specifically acknowledge the support of Dr. Chris Kassianides. Also funded in part by a grant from the Deutsche Forschungsgemeinschaft DFG-SFB 1052/1: Obesity Mechanisms (projects A04) and by the Helmholtz Alliance Imaging and Curing Environmental Metabolic Disease through the Initiative and Networking Fund of the Helmholtz Association (M.G.).http://www.journals.elsevier.com/gastroenterology2016-09-30hb2016Internal Medicin

15 Leading misperceptions about bariatric surgery and obesity

There are some mistaken beliefs that exist about bariatric surgery and obesity. Here are 15 common ones.http://www.medicalchronicle.co.zaam2019Internal Medicin

The effect of methylphenidate-OROS® on the narrative ability of children with attention-deficit hyperactivity disorder

BACKGROUND AND OBJECTIVE : Children with attention-deficit hyperactivity disorder (ADHD) experience difficulty with expressive language, including form (e.g. grammatical construction) and content (e.g. coherence). The current study aimed to investigate the effect of methylphenidate- Osmotic Release Oral System® (MPH-OROS®) on the narrative ability of children with ADHD and language impairment, through the analysis of microstructure and macrostructure narrative elements. METHOD : In a single group off–on medication test design, narratives were obtained from 12 children with ADHD, aged 7–13 years, using wordless picture books. For microstructure, number of words, type–token ratio and mean length of utterance were derived from narrative samples using Systematic Analysis of Language Transcripts conventions. For macrostructure, the narratives were coded according to the Narrative Scoring Scheme, which includes seven narrative characteristics, as well as a composite score reflecting the child’s overall narrative ability. RESULTS : The administration of MPH-OROS® resulted in a significant difference in certain aspects of language macrostructure: cohesion and overall narrative ability. Little effect was noted in microstructure elements. CONCLUSION : We observed a positive effect of stimulant medication on the macrostructure, but not on the microstructure, of narrative production. Although stimulant medication improves attention and concentration, it does not improve all aspects of language abilities in children with ADHD. Language difficulties associated with ADHD related to language content and use may be more responsive to stimulant medication than language form, which is likely to be affected by cascading effects of inattention, hyperactivity and impulsivity beginning very early in life and to progress over a more protracted period. Therefore, a combination of treatments is advocated to ensure that children with ADHD are successful in reaching their full potential.The research was conducted by T.L.R. to complete her Master’s Degree in Speech-Language Pathology at the University of Pretoria. (http://hdl.handle.net/2263/46263)A tuition bursary from the University of Pretoria.http://www.sajcd.org.za/index.php/SAJCDam2018Speech-Language Pathology and AudiologyStatistic

Association of Adipose Tissue Inflammation With Histological Severity of Non-alcoholic Fatty Liver Disease

The prevalence of non-alcoholic fatty liver disease has increased with the obesity pandemic. We analyzed the transcriptional profiles of subcutaneous (SAT) and visceral (VAT) adipose tissue, and phenotypes and functional characteristics of adipocyte tissue macrophages (ATM), in obese patients undergoing bariatric surgery.publisher: Elsevier articletitle: Association of Adipose Tissue Inflammation With Histologic Severity of Nonalcoholic Fatty Liver Disease journaltitle: Gastroenterology articlelink: http://dx.doi.org/10.1053/j.gastro.2015.05.044 content_type: article copyright: Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.status: publishe

Histological characteristics in patients admitted to the hospital with alcoholic hepatitis complicated by acute-on-chronic liver failure

Alcoholic hepatitis (AH) is a frequent precipitating event for the development of acute-on-chronic liver failure (ACLF), a syndrome characterised by organ failures due to immune dysfunction. The histological features of this complication are not well characterized. We investigated whether ACLF has specific histological characteristics. Prospective cohort study in consecutive adult patients admitted between 03-2008 and 04-2021 to a tertiary referral centre with suspected AH. Diagnosis of AH was based on clinical presentation and confirmed by transjugular liver biopsy. All biopsies were assessed by a dedicated liver pathologist, blinded for clinical data and outcome. Diagnosis of ACLF was based on EASL-CLIF criteria. Histological and clinical characteristics of patients with and without ACLF at baseline were compared. 184 patients with biopsy-proven AH were enrolled. Median time from hospital admission to transjugular biopsy was 4.5 days (IQR 2-8). At baseline, ACLF was present in 73 patients (39.7%). Out of the 110 patients without ACLF at baseline, 30 (27.3%) developed ACLF within 28 days (median 7.5 days (IQR 2-20)). At baseline, ductular bilirubinostasis (DB) was the only histological feature significantly more frequently present in patients with ACLF compared to patients without ACLF (50.7% vs. 30.6%, p = 0.003). No clear association between histological features and the development of ACLF later on could be demonstrated. In this well-defined cohort of patients with biopsy-proven AH, DB was associated with the presence of ACLF. This finding fits with the pathophysiology of this syndrome, which is characterized by systemic inflammation and an increased risk of infections.</p