Fenofibrate-induced liver injury

TO THE EDITOR Fenofibrate is a member of such fibrate class agents as bezafibrate and it work as a ligand of PPARa, and also shows a potent triglyceride-lowering effect. The elevation of aminotransferase levels has been frequendy observed after the administration of fenofibrate and this phenomenon is considered to be non-pathological because fenofibrate activates the gene expression of the aminotransferases. Recendy, fenofibrate has been used not only for hypercholesterolemia but also for primary biliary cirrhosis (PBC). However, the occurrence of liver injury induced by fenofibrate has not yet been reported written in the English literature. We herein report a rare case of liver injury due to the oral use of this drug.     

Evaluation of effect of hybrid bioartificial liver using end-stage liver disease model

AIM:To study the role of hybrid bioartificial liver (HBL) inclearing proinflammatory cytokines and endotoxin in patientswith acute and sub-acute liver failure and the effects of HBLon systemic inflammatory syndrome (SIRS) and multipleorgan dysfunction syndrome (MODS).METHODS:Five cases with severe liver failure (3 acuteand 2 subacute) were treated with HBL.The clinical signsand symptoms,total bilirubin (TBIL),serum ammonia,endotoxin TNF-α IL-6 and prothrombin activity (PTA),cholinesterase (CHE) were recorded before,during and aftertreatment.The end-stage liver disease (MELD) was usedfor the study.RESULTS:Two patients were bridged for spontaneousrecovery and 1 patient was bridged for OLT successfully.Another 2 patients died on d 8 and d 21.The spontaneousrecovery rate was 30.0%.PTA and CHE in all patients weresignificantly increased (P<0.01),while the serum TBIL,endotoxin,TNF-α,IL-6 were decreased.MELD score (mean43.6) predicted 100% deaths within 3 mo before treatmentwith HBL.After treatment with HBL,four out of 5 patientshad decreased MELD scores (mean 36.6).The MELD scorepredicted 66% mortalities.CONCLUSION:The proinflammatory Oltokines (TNFα,IL-6 and endotoxin)can be significantly removed by hybridbioartificial liver and HBL appears to be effective in blockingSIRS and MODS in patients with acute and sub-acute liverfailure.MELD is a reliable measure for predicting short-termmortality risk in patients with end-stage liver disease.Theprognostic result also corresponds to clinical outcome.     

Self-testing for liver disease – response to an online liver test questionnaire

Abstract

Background: Elevated liver enzymes and chronic liver disease are associated with increased morbidity and mortality. Broad availability of internet questionnaires obtains representative insights into awareness of (chronic) liver disease in the general population. Also, these tools may be used to identify persons and populations at risk to prevent advanced liver disease.

Methods: An online questionnaire regarding awareness of liver disease, risk behavior and awareness of own liver tests was implemented online. During 43?months study period, 210,230 participants accessed the online questionnaire. Of these, 117,446 individuals completed the survey. All database access and input were registered and collected in a SQL based database for further evaluation.

Results: Awareness of own liver status was lower than expected. About 50.7% of all participants were uncertain about their liver enzyme status. In turn, risk behavior continues to be considerably high as 38.8% of participants stated high-risk behavior for alcohol consumption and 2.2% high-risk substance abuse such as cocaine or heroin. Our questionnaire was predominantly answered by participants under 65?years of age. Participants with high BMI may have been underrepresented.

Conclusion: Our study demonstrated the urgent need for improved liver screening, health education regarding risk behavior and improved awareness campaigns on liver disease. Interest of the general population may be presumed as more than 200,000 people accessed our test of their own accord.     

Fetal liver cell transplantation as a potential alternative to whole liver transplantation?

Because organ shortage is the fundamental limitation of whole liver transplantation, novel therapeutic options, especially the possibility of restoring liver function through cell transplantation, are urgently needed to treat end-stage liver diseases. Groundbreaking in vivo studies have shown that transplanted hepatocytes are capable of repopulating the rodent liver. The two best studied models are the urokinase plasminogen activator (uPA) transgenic mouse and the fumarylacetoacetate hydrolase (FAH)-deficient mouse, in which genetic modifications of the recipient liver provide a tissue environment in which there is extensive liver injury and selection pressure favoring the proliferation and survival of transplanted hepatocytes. Because transplanted hepatocytes do not significantly repopulate the (near-)normal liver, attention has been focused on finding alternative cell types, such as stem or progenitor cells, that have a higher proliferative potential than hepatocytes. Several sources of stem cells or stem-like cells have been identified and their potential to repopulate the recipient liver has been evaluated in certain liver injury models. However, rat fetal liver stem/progenitor cells (FLSPCs) are the only cells identified to date that can effectively repopulate the (near-)normal liver, are morphologically and functionally fully integrated into the recipient liver, and remain viable long-term. Even though primary human fetal liver cells are not likely to be routinely used for clinical liver cell repopulation in the future, using or engineering candidate cells exhibiting the characteristics of FLSPCs suggests a new direction in developing cell transplantation strategies for therapeutic liver replacement. This review will give a brief overview concerning the existing animal models and cell sources that have been used to restore normal liver structure and function, and will focus specifically on the potential of FLSPCs to repopulate the liver.     

Anterior fissure of the right liver — the third door of the liver

Background/Purpose

Although the anterior segment of the liver has been divided into segments 8 and 5, we have, during surgical or interventional procedures, occasionally encountered patients in whom the right anterior portal vein does not bifurcate into the superior and inferior branches. Thus, the in vivo anatomy of the right liver was reevaluated to clarify the segmental anatomy.

Methods

We evaluated the hepatic venous and portal ramification patterns, using three-dimensional images reconstructed from computed tomography. In addition, liver volumetry was performed.

Results

All branches arising from the anterior trunk were divided into two groups: the right ventral portal branches (RVP) and the right dorsal portal branches (RDP), and the anterior fissure vein crossed between the RVP and RDP. The ventral and dorsal regions of the anterior segment were approximately equal from a volumetric point of view.

Conclusions

The anterior segment seems to be divided into the ventral and dorsal segments by the anterior fissure, and we propose a reclassification of the right liver that divides the right liver into three segments. Dissection of the parenchyma along the anterior fissure makes the third door of the liver open, resulting in the exposing of all Glissonian pedicles of the right liver. The introduction of our segmental anatomy and surgical procedure will allow more systematic and limited liver resections.     

Nonalcoholic fatty liver disease and liver transplantation - Where do we stand?

Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis(NAFLD/NASH) is a challenging and multisystem disease that has a high socioeconomic impact. NAFLD/NASH is a main cause of macrovesicular steatosis and has multiple impacts on liver transplantation(LT), on patients on the waiting list for transplant, on posttransplant setting as well as on organ donors. Current data indicate new trends in the area of chronic liver disease. Due to the increased incidence of metabolic syndrome(Met S) and its components, NASH cirrhosis and hepatocellular carcinoma caused by NASH will soon become a major indication for LT. Furthermore, due to an increasing incidence of Met S and, consequently, NAFLD, there will be more steatotic donor livers and less high quality organs available for LT, in addition to a lack of available liver allografts. Patients who have NASH and are candidates for LT have multiple comorbidities and are unique LT candidates. Finally, we discuss long-term grafts and patient survival after LT, the recurrence of NASH and NASH appearing de novo after transplantation. In addition, we suggest topics and areas that require more research for improving the health care of this increasing patient population.     

Detection of alcoholic liver disease

INTRODUCTIONAlcohol has been used in society over centuries andall over the world for its mood-lifting properties andtaste.It is probably,however,the commonest drugof abuse world-wide and unfortunately causesconsiderable morbidity,mortality and socialdisruption.In 1990 the cost to the USA was morethan $100 billion and 100 000 lives.The relationship between alcohol and mankindis well documented from the earliest times.Wine-making equipment was found in the remains of an     

Liver cirrhosis and fatty liver

2007460 Effect of rosiglitazone on insulin resistanceand adiponectin in non-alcoholic fatty liver diseaseinduced by high-fat diet in rats.ZHI Min(郅敏), etal. Dept Gastroenterol, 1st Affili Hosp, Sun Yat-SenUniv, Guangzhou 510080. World Chin J Digestol 2007;15(27):2869 -2974. Objective To investigate the effect of rosiglitazone oninsulin resistance and adiponectin in nonalcoholic fattyliver disease induced by high-fat diet in rats.Methods Thirty Wistar rats were randomly divided into t…     

Can non‐invasive assessment of liver fibrosis replace liver biopsy?

Transient elastgraphy, acoustic radiation force impulse and real-time elastography are the methods with very good or excellent diagnostic accuracy for the assessment of liver fibrosis stage. They do not provide the information on inflammatory activity, steatosis, iron deposition or other findings derived from liver biopsy. Even on account of fibrosis stage, these non-invasive methods do not give us the estimation completely corresponding to that of liver biopsy. However they provide us useful clinical information that liver biopsy has been providing us, such as appropriate time to start antiviral therapy, prediction of response to antiviral therapy, evaluation of effects of antiviral therapy, assessment of natural course of hepatitis and estimation of prognosis of hepatitis. Recently non-invasive methods for assessment of inflammatory activity, steatosis and iron deposition in the liver have been developed. Thus in the near future, non-invasive methods will replace liver biopsy.     

Cyst and tumor of liver

2007462 Dynamic expression of survivin duringhepatocarcinogenesis in rats.FENG Zhenbo (冯震博),et al. Dept Pathol, Guangxi Med Univ, Nanning530021. Chin J Oncol 2007;29(9):662 -665. Objective To determine the dynamic expression ofsurvivin gene in hepatocarcinogenesis of rats induced byaflatoxin B1 (AFB1).Methods 78 Sprague-Dawleyrats were used in this study. Hepatocellular carcinomawas induced in the rats by aflatoxin B1. Liver and HCCtissues were examined by immunohistochemistry and…