Background and Aims: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA.

Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA <200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281.

Results: At the end of 48 and 96 weeks’ treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks’ treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg <1500 IU/mL and week 24 HBsAg <200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss.

Conclusions: Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.

The role of metabolism (basal metabolic rate (BMR)) in asthma remains dubious. Seasonal variations are reported in both BMR and asthma, with the former increasing in winter and decreasing in summer. Correlation between metabolism and asthma treatment is not obvious in the literature; therefore, it was planned to assess role of substances which alter metabolism in managing asthma.

This was a randomized double-blind active control trial, in which 400 confirmed asthma cases were divided into two groups (group 1 (control) and group 2 (study)), with group 2 further subdivided into two (subgroups 2A and 2B). The study period was from January to December 2016. During attack, group 2A was given kitchen spices (cloves, bay leaf, black pepper; substance A) and 2B was given cool substances (rose petal jam; substance B). The control group was given inhaled levosalbutamol. Symptoms and peak expiratory flow rate (PEFR) were recorded. Improvement was suggested by reduction in symptoms and improvement in PEFR. Review of symptoms was done at 24 and 72 h and of PEFR at 72 h after the therapy. Statistical significance of differences between group 1 and 2A and 2B was calculated by the chi-square test by using SPSS 20 software.

Exacerbations were found in February (season: winter), March (spring), August (rainy) and October (autumn). In February and March, the response was significant with substance A (p < 0.001), but substance B had poor response. In August and October, the response was significant with substance B (p < 0.001), and substance A had insignificant response.

Substances which increase BMR are helpful in winters and high metabolic state of the body, and conversely. Change in metabolism possibly effects heat and water losing/preserving effect of the body, including related to the respiratory tract (thermoregulation), and lessens inflammation in the respiratory tract.

Background and Aims: DNA methylation and histone modification are epigenetic modifications essential for normal function of mammalian cells. The processes are mediated by biochemical interactions between DNA methyltransferases (DNMTs) and histone deacetylases. Promoter hypermethylation and deacetylation of tumor suppressor genes play major roles in cancer induction, through transcriptional silencing of these genes. DNA hypermethylation is carried out by a family of DNMTs including DNMT1, DNMT3a and DNMT3b. In hepatocellular carcinoma, a significant positive correlation between over-expression of these genes and cancer induction has been reported. The DNA demethylating agent genistein (GE) has been demonstrated to reduce different cancers. Previously, we reported that GE can induce apoptosis and inhibit proliferation in hepatocellular carcinoma PLC/PRF5 and HepG2 cell lines. Besides, histone deacetylase inhibitors, such as trichostatin A (TSA), were successfully used to inhibit cancer cell growth. The present study was designed to assess the effect of GE in comparison with TSA on DNMT1, DNMT3a and DNMT3b gene expression, cell growth inhibition and apoptosis induction in the HepG2 cell line.

Methods: Cells were seeded and treated with various doses of GE and TSA. The MTT assay, flow cytometry assay, and real-time RT-PCR were used to determine viability, apoptosis, and DNMT1, DNMT3a and DNMT3b gene expression respectively.

Results: Both agents inhibited cell growth, induced apoptosis and reactivated DNMT1, DNMT3a and DNMT3b gene expression. Furthermore, TSA demonstrated a significantly greater apoptotic effect than the other agent, whereas GE improved gene expression more significantly than TSA.

Conclusions: Our findings suggest that GE and TSA can significantly inhibit cell growth, induce apoptosis and restore DNMT1, DNMT3a and DNMT3b gene reactivation.

Many clinical conditions exist in which it is desirable to stimulate or suppress the immune system, and many different drugs are able to do this. It is also well known that nutrition may affect human health and immune responses. Nutritional factors are crucial components of the diet, essential for the normal growth and development of both vertebrate and invertebrate organisms. Many of these components have been shown to play different roles in the immune response, and under different circumstances they can significantly modulate the immune system to create an effective response. The aim of the present review was to show the effect of a biomarine lipofishin (E-JUR-94013) obtained from the species T. trachurus, present on the Galician coast of the Atlantic Ocean, in the improvement of immune system function. In humans, the results obtained under different clinical conditions clearly demonstrated the ability of E-JUR-94013 to improve the host innate and acquired immune responses. In three different clinical studies, 56, 205 and 1,500 patients were included, respectively. All patients were supplemented with 750 mg/day of E-JUR-94013. In the first study, significant increases in IgA (p = 0.033) and IgG, and a reduction in IgE (p = 0.033) were observed. In the second study, a normalization in leukocyte cell counts after treatment was observed (p < 0.05). The main objective of the last study was to correlate inflammatory genotypes with response to E-JUR-94013. The results obtained indicated that high ultrasensitive C-reactive protein was down-regulated. In addition, both IL-6-C573G and IL1β-T3954C genotypes clearly correlated with response to E-JUR-94013 treatment. Taken together, these results suggest that supplementation of diets with E-JUR-94013 can be employed to improve, enhance and regulate certain immune responses and lead to increased resistance to disease.

Chronic stress plays a central role in the pathogenesis of psychiatric disorders. A sensory contact model induces mixed anxiety/depression-like behaviors. Repeated experience of victories or defeats may change neurophysiological status, the immune system and brain neurochemistry in opposite directions. The objective of this study was, therefore, to establish a sensory contact model for studying the impact of psychosocial stress in mice and investigate its influence on behavioral, neurochemical and immunological changes of both winners and losers.

Four groups of male mice were used, including two groups that received saline and either in normal housing or caged individually for 5 days; the others were subjected to sensory contact modeling for 21 days. All mice were subjected to open-field test, after which blood samples were collected for evaluation of total and differential leukocyte count and brain homogenate was used to estimate monoamines.

Social isolation reduces serotonin and neutrophils while elevating most other parameters. Winners also showed reduction in serotonin and neutrophils, as compared to controls which showed reduction in grooming time, total leukocyte count, neutrophils associated with elevation in monocytes and eosinophils as compared to isolation group. On the other hand, losers showed elevation in grooming time, dopamine, norepinephrine, lymphocytes, monocytes, eosinophils associated with reduction in ambulation, serotonin and neutrophils as compared to all groups. They also showed reduction in rearing and elevation in total leukocyte count as compared to winners.

Social stress leads to severe depression and anxiety-related behaviors; losers were more depressed than winners. However, aggressive behavior was increased in winners, while locomotor and exploratory activities were decreased, indicating decreased anxiety and emotional distress. The immune function was enhanced to higher extent in losers than winners, which can be attributed to sensation of threat and trauma in losers.

Alzheimer’s disease (AD) is a major health problem in developed countries. The absence of specific biomarkers for diagnosis and the multiple limitations of available screening methods have slowed down the efficient implementation of AD population-based screening programs. Based on recent developments, we have designed and tested a new AD vaccine tool kit as an effective framework for large-scale animal model screening. The AD vaccine tool kit was developed for transgenic animal models of AD in order to evaluate their neuropathological characteristics via multiple screening strategies.

This vaccine consists of the inoculation of a new immunogen-adjuvant designed to specifically activate antibodies against the generation of neuritic plaques produced by the toxic excess of amyloid-β (Aß) and simultaneously to deal with the autoimmune activation that triggers acute meningoencephalitis, as observed in human trials in the past.

In the present study, we show the current status of the AD vaccine tool kit, with a special focus on the evaluated data and its available settings. We also review the strengths and limitations of this kit in the context of its applicability in experimental research.

We focus our attention on the ‘framework experimental immunization guidelines’ for AD screening, which have recently been boosted by numerous research lines implemented throughout the scientific community.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide. Early diagnosis is essential for correct management and improvement of prognosis. Proposed for the first time in 2011 and updated for the last time in 2017, the Liver Imaging-Reporting and Data System (LI-RADS) is a comprehensive system for standardized interpretation and reporting of computed tomography (CT) and magnetic resonance imaging (MRI) liver examinations, endorsed by the American College of Radiology to achieve congruence with HCC diagnostic criteria in at-risk populations. Understanding its algorithm is fundamental to correctly apply LI-RADS in clinical practice. In this pictorial review, we provide a guide for beginners, explaining LI-RADS indications, describing major and ancillary features and eventually elucidating the diagnostic algorithm with the use of some clinical examples.

Imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as well as in determining treatment efficacy, or complications, following therapy. Unlike other cancers, HCC is most commonly treated by locoregional therapies (LRTs) such as thermal ablation, transarterial chemoembolization, and transarterial radioembolization. These treatments can lead to changes on imaging that make determination of residual/recurrent disease difficult. This literature-based review discusses the expected postimaging findings following LRT.

Background and Aims: Hypercholesterolemia is a common finding in patients with primary biliary cholangitis (PBC) and is a well-defined risk factor for cardiovascular disease. However, studies have been mixed on whether PBC patients do, in fact, have higher cardiovascular risk. The aim of this study is to review the current literature and provide an evidence-based assessment of cardiovascular risk in PBC patients.

Methods: We performed a systematic literature search on PubMed regarding patients with PBC and cardiovascular events from the database inception to July 1, 2017. A total of 33 articles fulfilling our inclusion criteria were found.

Results: The majority of the studies evaluated yielded no statistically significant difference in cardiovascular disease in the PBC population compared to the general public. However, some reports found a statistically significantly increase in coronary artery disease. Several studies have looked at the specific lipid profile of patients with PBC with hypocholesteremia. While these lipid abnormalities differ by stage of disease, there is evidence to suggest that the specific lipid profile in PBC may have lower atherogenicity than in patients with hypercholesterolemia without PBC. Studies looking at patients with PBC with other risk factors for cardiovascular disease, such as hypertension and metabolic syndrome, have consistently found a higher risk for cardiovascular disease in these patients. Statin treatment is effective in reducing lipid levels and possibly improving endothelial inflammation in patients with PBC with hypercholesterolemia.

Conclusions: There is not enough evidence to suggest an increased risk of cardiovascular disease in patients with PBC with hypercholesterolemia, except for those individuals with concomitant features of metabolic syndrome. In patients with PBC with no additional cardiovascular risk factors, individual risk/benefit discussion on lipid-lowering treatment should be considered.

Background and Aims: Acetaminophen (APAP) and HMG-CoA reductase inhibitors are common causes of drug-induced liver injury (DILI). This study aimed to determine the ability to reduce APAP- and statins-mediated liver injury by using formulations that combine glycosphingolipids and vitamin E.

Methods: Mice were injected with APAP or with statins and treated before and after with β-glucosylceramide (GC), with or without vitamin E. Mice were followed for changes in liver enzymes, liver histology, hepatic expression of JNK, STAT3 and caspase 3, as well as intrahepatic natural killer T cells (NKT) and the serum cytokine levels by flow cytometry.

Results: Administration of GC before or after APAP alleviated the liver damage, as noted by a reduction of the liver enzymes, improvement in the liver histology and decreased hepatic caspase 3 expression. Beneficial effect was associated with a reduction of the intrahepatic NKT, JNK expression in the liver, and increased glutathione in the liver, and decreased TNF-α serum levels. Synergistic effect of co-administration of GC with vitamin E was observed. Similar protective effect of GC on statin-mediated liver damage was documented by a reduction in liver enzymes and improved liver histology, which was mediated by reduction of NKT, increased STAT3 expression in the liver, and reduced the TGF-β and IL17 levels.

Conclusions: β-glycosphingolipids exert a hepatoprotective effect on APAP- and statins-mediated liver damage. Vitamin E exerted a synergistic effect to that of GC. The generation of “safer drug” formulations, which include an active molecule combined with a hepatoprotective adjuvant, may provide an answer to the real unmet need of DILI.

Occult hepatitis C virus (HCV) infection (OCI), first described in 2004, is defined as the presence of HCV RNA in hepatocytes or peripheral blood mononuclear cells without detectable HCV RNA in the serum. Here, we aimed to review the epidemiology, diagnostic methods, clinical implications and potential management recommendations currently described in the literature, as well as the future directions for investigation of this entity. PubMed and Cochrane databases were searched with combination of the following keywords: “occult”, “hepatitis C virus”, and “occult HCV infection”. There are data to support OCI as a potential culprit in cryptogenic liver disease. There are also consistent data demonstrating the existence of OCI in specific populations, such as dialysis, human immunodeficiency virus-infected and hepatitis B virus-infected patients, and also in the general population. While the gold standard for diagnosis is liver biopsy, examination of peripheral blood mononuclear cells may be a reliable, safer alternative method of diagnosis. Occult HCV infection is likely associated with liver fibrosis and progression of liver disease. Additional studies are required to determine the infectivity of OCI patients, as well as clarify the natural course and specific clinical implications of OCI. Lastly, studies are needed to determine whether treatment of OCI leads to decreased morbidity and/or mortality.

Background and Aims: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their relationship with disease advancement in these patients.

Methods: Vitamin D levels were checked in 125 chronic liver disease patients. The patients were classified in three stages according to Child-Pugh score: A, B and C. The relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency coefficient. Correlation and logistic regression analyses were also carried out to find additional predictors of low vitamin D levels.

Results: Among the patients, 88% had either insufficient or deficient stores of vitamin D, while only 12% had sufficient vitamin D levels (p >0.05). Vitamin D levels were notably related to Child-Pugh class (contingency coefficient = 0.5, p <0.05). On univariate and multinomial regression analyses, age, female sex, MELD and Child-Pugh class were predictors of low vitamin D levels. Age, model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels (p <0.05).

Conclusions: Vitamin D deficiency is notably related to age, female sex and model of end-stage liver disease score, in addition to Child-Pugh class of liver cirrhosis. Vitamin D levels should be routinely checked in patients with advanced liver cirrhosis (Child-Pugh class B and C) and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.

Dietary fat type can differentially modulate the fatty acid oxidation and secretion of lipoproteins in hepatocytes. The purpose of the present study was to investigate how the nature of fatty acids present in dietary oils influences fatty acid oxidation as well as secretion of apolipoproteins.

Primary rat hepatocytes were cultured with major fatty acids present in common cooking oils, which vary in their degree of saturation: viz. coconut oil (lauric acid; C12:0); olive oil (oleic acid; C18:1); and sunflower oil (linoleic acid; C18:2). Each fatty acid was used at a dose of 500 µM for 12 hours.

Cells treated with laurate beneficially modulated the secretion of apolipoproteins relative to cells treated with oleate and linoleate (p < 0.05). These results correlated with the respective apolipoproteins’ mRNA expression. Laurate increased activities and mRNA expression of enzymes involved in β-oxidation (viz. carnitine palmitoyl transferase I and acyl CoA oxidase) and also up-regulated the respective transcription factor, peroxisome proliferator-activated receptor alpha (PPARα), when compared to other fatty acids (p <0.05). Studies using the PPARα agonist WY 14643 revealed that lauric acid may act as a natural ligand for PPARα and mediates its effects partly via PPARα-dependent pathways in hepatocytes.

These results clearly indicate that lauric acid, the major fatty acid present in oil extracted from coconut, acts as a natural ligand for PPARα, beneficially regulating secretion of apolipoproteins and enhancing fatty acid oxidation via PPARα signaling pathways in hepatocytes.

Whereas statistical association of hepatitis C virus (HCV) infection with cardiomyopathy is long known, establishment of a causal relationship has not been achieved so far. Patients with advanced heart failure (HF) are mostly unable to tolerate interferon (IFN)-based treatment, resulting in limited experience regarding the possible pathogenic role of HCV in this patient group. HCV infection often triggers disease in a broad spectrum of extrahepatic organs, with innate immune and autoimmune pathogenic processes involved. The fact that worldwide more than 70 million patients are chronically infected with HCV illustrates the possible clinical impact arising if cardiomyopathies were induced or aggravated by HCV, resulting in progressive HF or severe arrhythmias. A novel path has been opened to finally resolve the long-standing question of cause-effect relationship between HCV infection and cardiac dysfunction, by the recent development of IFN-free, highly efficient, and well tolerable anti-HCV regimens. The new direct-acting antiviral (DAA) agents are highly virus-specific and lack unspecific side-effects upon cardiac function which have always confounded the interpretation of IFN treatment data. The actual frequency of unexplained HF in chronic HCV infection will be determined from a planned large-scale study. Whereas such patients probably constitute a rather small fraction of all those harboring HCV, they have major clinical relevance. It is not yet known which fraction of these patients will significantly benefit from HCV eradication, but this issue will be addressed now in a prospective study.