Ectopic lymphoid structures function as microniches for tumor progenitor cells in hepatocellular carcinoma.

Ectopic lymphoid-like structures (ELSs) are often observed in cancer, yet their function is obscure. Although ELSs signify good prognosis in certain malignancies, we found that hepatic ELSs indicated poor prognosis for hepatocellular carcinoma (HCC). We studied an HCC mouse model that displayed abundant ELSs and found that they constituted immunopathological microniches wherein malignant hepatocyte progenitor cells appeared and thrived in a complex cellular and cytokine milieu until gaining self-sufficiency. The egress of progenitor cells and tumor formation were associated with the autocrine production of cytokines previously provided by the niche. ELSs developed via cooperation between the innate immune system and adaptive immune system, an event facilitated by activation of the transcription factor NF-κB and abolished by depletion of T cells. Such aberrant immunological foci might represent new targets for cancer therapy.

[New oncological indications for liver transplantation]. / Nouvelles indications oncologiques à la transplantation hépatique.

Transplantation oncology represents a specificity of liver transplantation. Hepatocellular carcinoma is now an accepted indication with very good long-term results. Cholangiocarcinoma, hepatic -metastases from colorectal cancer and neuroendocrine tumors are emerging indications with outcome superior to those that can be achieved with systemic treatments in very selected patients.

La transplantation pour des indications oncologiques représente une particularité exclusive de la transplantation hépatique. Le carcinome hépatocellulaire est désormais une indication confirmée par de très bons résultats à long terme. Le cholangiocarcinome, les métastases hépatiques du cancer colorectal et neuro­endocrine représentent des indications émergentes avec des ­résultats supérieurs à ceux obtenus avec les traitements systémiques, sous réserve d'une rigoureuse sélection des patients.

[Population screening for hepatic fibrosis : who to screen, why and how ?] / Dépistage de la fibrose hépatique dans la population.

The development of liver fibrosis is the consequence of histological remodeling of the liver parenchyma, reflecting chronic inflammatory liver disease or hepatocyte necrosis. These tissue modifications result in structural changes to the extracellular matrix, predisposing to progression to cirrhosis and hepatocellular carcinoma, whatever the underlying etiology. Recent data demonstrate the potential benefits of screening for hepatic fibrosis, in particular in order to detect and treat the cause of the underlying liver disease as early as possible, which could ultimately lead to the many known complications in cirrhotic patients. Early identification of the population at risk of hepatic fibrosis should precede screening, which may be initiated in the primary care physician's office and continued at a later stage by the specialist.

L'apparition d'une fibrose hépatique est souvent la conséquence d'une atteinte inflammatoire chronique du foie ou d'une ­nécrose hépatocytaire. Ces modifications tissulaires ont pour conséquence un changement structurel de la matrice extracellulaire, prédisposant à la progression vers une cirrhose ainsi qu'un carcinome hépatocellulaire, quelle que soit l'étiologie sous-jacente. Des données récentes démontrent le bénéfice ­potentiel du dépistage de la fibrose hépatique, afin de détecter et traiter au plus tôt la cause de la maladie ­hépatique sous-jacente qui pourrait, à terme, conduire aux nombreuses complications connues chez le patient cirrhotique. Une identification précoce de la population à risque de fibrose hépatique peut être initié au cabinet du médecin de premier recours et se poursuivre ultérieurement chez le ­spécialiste.

[Elevated liver enzymes: update 2024]. / Élévation des tests hépatiques et maladies stéatosiques du foie : nouveautés 2024.

Elevated liver enzymes are a common finding in primary care medicine, with an estimated prevalence of 8 %. Steatotic liver diseases are the most frequently encountered etiologies and r-epresent the main cause of liver-related morbidity and mortality. This article looks at the latest developments in these diseases, with a particular focus on MASLD (Metabolic dysfunction associated steatotic liver disease). Recommendations include biological monitoring every 1-3 years in the presence of risk factors, and the use of the FIB-4 score to detect fibrosis in cases of MASLD. Therapeutic management aims to improve metabolic function by treating risk factors and through lifestyle and dietary measures.

La découverte d'une élévation des tests hépatiques est courante en médecine de premier recours, sa prévalence est estimée à 8 %. Les maladies hépatiques stéatosiques sont les étiologies les plus fréquemment retrouvées et représentent la principale cause de morbimortalité liée au foie. Cet article aborde les nouveautés concernant ces maladies et plus particulièrement la MASLD ou « Metabolic Dysfunction Associated Steatotic Liver Disease ¼. Les recommandations préconisent un suivi biologique tous les 1-3 ans en présence de facteurs de risque et l'utilisation du score FIB-4 (fibrosis-4) pour dépister la fibrose en cas de MASLD. La prise en charge thérapeutique vise à améliorer la dysfonction métabolique par des mesures hygiénodiététiques et le traitement des facteurs de risque.

Molecular Signature Predictive of Long-Term Liver Fibrosis Progression to Inform Antifibrotic Drug Development.

BACKGROUND & AIMS: There is a major unmet need to assess the prognostic impact of antifibrotics in clinical trials because of the slow rate of liver fibrosis progression. We aimed to develop a surrogate biomarker to predict future fibrosis progression. METHODS: A fibrosis progression signature (FPS) was defined to predict fibrosis progression within 5 years in patients with hepatitis C virus and nonalcoholic fatty liver disease (NAFLD) with no to minimal fibrosis at baseline (n = 421) and was validated in an independent NAFLD cohort (n = 78). The FPS was used to assess response to 13 candidate antifibrotics in organotypic ex vivo cultures of clinical fibrotic liver tissues (n = 78) and cenicriviroc in patients with nonalcoholic steatohepatitis enrolled in a clinical trial (n = 19, NCT02217475). A serum protein-based surrogate FPS was developed and tested in a cohort of compensated cirrhosis patients (n = 122). RESULTS: A 20-gene FPS was defined and validated in an independent NAFLD cohort (adjusted odds ratio, 10.93; area under the receiver operating characteristic curve, 0.86). Among computationally inferred fibrosis-driving FPS genes, BCL2 was confirmed as a potential pharmacologic target using clinical liver tissues. Systematic ex vivo evaluation of 13 candidate antifibrotics identified rational combination therapies based on epigallocatechin gallate, which were validated for enhanced antifibrotic effect in ex vivo culture of clinical liver tissues. In patients with nonalcoholic steatohepatitis treated with cenicriviroc, FPS modulation was associated with 1-year fibrosis improvement accompanied by suppression of the E2F pathway. Induction of the PPARα pathway was absent in patients without fibrosis improvement, suggesting a benefit of combining PPARα agonism to improve the antifibrotic efficacy of cenicriviroc. A 7-protein serum protein-based surrogate FPS was associated with the development of decompensation in cirrhosis patients. CONCLUSION: The FPS predicts long-term fibrosis progression in an etiology-agnostic manner, which can inform antifibrotic drug development.

[Liver transplantation in adults : choosing the appropriate candidate and timing]. / Quel patient adresser à un centre de transplantation hépatique ?

Liver transplantation is the best treatment option for patients with end-stage liver failure, as well as for various oncological (hepatic or extrahepatic), metabolic and genetic indications. Cirrhosis and its complications represent the most frequent indication for transplantation. This treatment option should be considered for cirrhotic patients with significant liver failure, the development of hepatocellular carcinoma or when complications linked to portal hypertension appear. In view of the limited availability of organs and a waiting time on the list estimated at around one year in Switzerland, careful assessment of the risk-benefit ratio and correct timing of evaluation in a transplant center are crucial to optimize the benefits of this procedure.

La transplantation du foie est la meilleure option thérapeutique pour les patients atteints d'une insuffisance hépatique terminale ainsi que pour différentes indications oncologiques (hépatiques ou extrahépatiques), métaboliques et génétiques. La cirrhose et ses complications représentent l'indication la plus fréquente à la transplantation. Celle-ci doit être évoquée chez un patient cirrhotique en cas d'insuffisance hépatique marquée, d'apparition d'un carcinome hépatocellulaire ou lors de complications liées à l'hypertension portale. Vu la disponibilité limitée des organes et d'un temps d'attente en liste de transplantation pouvant être supérieur à un an en Suisse, l'évaluation du rapport bénéfices-risques de la transplantation ainsi que du meilleur moment pour un bilan pré-greffe permet d'optimiser les bénéfices de cette intervention.

[Updated recommandations for the follow-up of a patient with cirrhosis]. / Actualisation du suivi d'un patient atteint de cirrhose.

A close collaboration between the general practitioner and the gastroenterologist is necessary to optimize the management of a patient with cirrhosis, a frequent and serious complication of chronic liver diseases. Both the treatment of the etiological factor of liver disease and the surveillance of potential complications of cirrhosis are key issues in the proper management of cirrhosis. Preventive measures aim at keeping the patient in a compensated form of cirrhosis which is associated with a better survival. We address here the updated management strategies regarding the most frequent complications of cirrhosis.

La prise en charge d'un patient atteint de cirrhose implique une collaboration étroite entre le médecin généraliste et le spécialiste, combine le traitement de la maladie causale ainsi que la mise en place d'une surveillance des complications pouvant occasionner une décompensation avec un impact pronostique négatif. Nous passons en revue les principales situations cliniques de la cirrhose pour lesquelles des recommandations actualisées ont pour but d'améliorer la prise en charge de cette maladie fréquente grevée d'une importante morbimortalité.

[Polycystic liver disease]. / Polykystoses hépatiques.

Polycystic liver disease (PLD) includes three entities in adults : biliary hamartomas which develop as a result of ductal plate malformation, autosomal dominant polycystic liver disease (ADPLD) and autosomal dominant polycystic kidney disease (ADPKD) which occur in the setting of genetic disorders. Hamartomas are asymptomatic and benign. PLD are marked by a steady growth of cysts over time, clinically silent in the majority of cases. Symptomatic forms mainly affect women due to the influence of estrogens on the growth of cysts therefore estrogen treatments are contraindicated in this setting. Diagnosis is based on imaging. Complications are rare but must be identified early in order to offer appropriate care in an expert center.

Les polykystoses hépatiques (PKH) de l'adulte regroupent les hamartomes biliaires, conséquence d'une malformation congénitale de la plaque ductale, la polykystose hépatorénale autosomique dominante (PKHRAD) et la polykystose hépatique isolée (PKHI), de cause génétique. Les hamartomes sont asymptomatiques et bénins. Les PKH sont marquées par une croissance régulière des kystes au fil du temps, silencieuse dans la majorité des cas. Les formes symptomatiques concernent majoritairement les femmes, la croissance des kystes étant influencée par les œstrogènes. De ce fait, les traitements œstrogéniques doivent être proscrits. Le diagnostic repose sur l'imagerie. Les complications sont rares mais doivent être identifiées précocement afin de proposer une prise en charge adaptée en centre expert.

Chronic hepatitis D and hepatocellular carcinoma: A systematic review and meta-analysis of observational studies.

BACKGROUND & AIMS: Chronic hepatitis D (CHD) is the most severe form of chronic viral hepatitis but its role in the development of hepatocellular carcinoma (HCC) remains debated. We conducted a systematic review and meta-analysis of epidemiological studies to examine whether CHD is associated with an increased risk of HCC. METHODS: We searched PubMed, Embase and Web of Science, as well as study references and conference proceedings. We considered cohort and case-control studies allowing the calculation of effect estimates for the association between CHD (exposure) and HCC (outcome) in comparison to chronic hepatitis B. Data extraction and quality evaluation (using the Newcastle-Ottawa scale) were performed independently by 2 authors. Data were pooled using random-effects models. RESULTS: Ninety-three studies (68 case-control studies including 22,862 patients and 25 cohort studies including 75,427 patients) were included. Twelve studies accounted for confounders, in either study design or analysis (10 of which were cohorts), and 11 cohorts were prospective. The overall analysis showed a significantly increased risk of HCC in patients with CHD, despite substantial study heterogeneity (pooled odds ratio 1.28; 95% CI 1.05-1.57; I2 = 67.0%). The association was particularly strong in the absence of heterogeneity for prospective cohort studies (pooled odds ratio 2.77; 95% CI 1.79-4.28; I2 = 0%), and studies with HIV-infected patients (pooled odds ratio 7.13; 95% CI 2.83-17.92; I2 = 0%). CONCLUSIONS: We found a significantly higher risk of HCC in patients with CHD. Although further studies are needed to definitively exclude a potential bias due to antiviral treatments, our findings highlight the rationale for improved screening of hepatitis D virus infection in patients with chronic hepatitis B, and the urgent need for novel and effective antiviral therapies. LAY SUMMARY: Hepatitis D virus (HDV) is a defective pathogen requiring hepatitis B virus (HBV) to complete its life cycle. Chronic hepatitis D is the most severe form of chronic viral hepatitis, increasing the risk of cirrhosis, liver decompensation and death compared to HBV monoinfection. However, the association between HDV infection and increased risk of hepatocellular carcinoma is debated. We conducted a systematic review and found that patients with HDV infection had a significantly higher risk of developing hepatocellular carcinoma than those with HBV monoinfection.

Gene signature-MELD score and alcohol relapse determine long-term prognosis of patients with severe alcoholic hepatitis.

BACKGROUND: The gene-signature-model for end stage liver disease (gs-MELD) score has been shown to be a strong predictor of 6-month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long-term prognosis of patients with severe AH. AIM: To assess the prognostic value of the gs-MELD score at 5 years in patients with severe AH. METHODS: Forty-eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48-56]) were included. RESULTS: The median gs-MELD score was 2.6 (95% CI: 2.2-3.0). According to the gs-MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow-up of 29 months (95% CI: 4-43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41-81) and 26% (95% CI: 11-55) in patients with low and high gs-MELD scores (P = .001), and 81% (95% CI: 58-96) and 22% (95% CI: 10-47) in abstainers and in consumers (P < .001) respectively. In multivariable competing risk regression modelling, gs-MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17-15.38, P < .001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16-46.95, P < .001) were independently associated with 5-year mortality. CONCLUSIONS: Both gs-MELD score and alcohol consumption drive AH long-term prognosis. The gs-MELD score may guide the development of molecularly targeted therapies in AH.

Tolerogenic properties of liver macrophages in non-alcoholic steatohepatitis.

BACKGROUND & AIMS: Our understanding of non-alcoholic fatty liver disease (NAFLD) pathogenesis is improving, but there is still limited data on the function of resident liver macrophages in this context, especially when considering their contribution in dampening liver inflammation. METHODS: Liver macrophages were studied in mouse models of prolonged diet-induced liver steatohepatitis and carbon tetrachloride-induced liver injury. We assessed liver macrophages phenotype and costimulatory/inhibitory properties upon exposure to lipopolysaccharide or interleukin 4. We did phagocytosis and antigen presentation assays to investigate liver macrophages function as scavengers and immune response initiators. Using immunofluorescence staining, we further determined, in human liver tissue of patients with simple steatosis, non-alcoholic steatohepatitis and chronic hepatitis B infection, the expression of the co-inhibitory protein CD274 (Programmed-death ligand 1) and major histocompatibility complex (MHC) class II. RESULTS: Both in humans and mice, within chronically inflamed fatty livers, liver macrophages acquired immunomodulatory properties by reducing the expression of MHC class II, and by enhancing co-inhibitory signalling. Liver macrophages circumscribed endotoxin-mediated inflammatory response by upregulating anti-inflammatory genes arginase 1 and interleukin-10. While hepatic macrophages isolated from mice with normal livers were capable of achieving endotoxin tolerance, our results indicated an impairment of this protective mechanism in the presence NASH-like parenchymal abnormalities. CONCLUSIONS: Liver macrophages can achieve endotoxin tolerance, but in the chronically inflamed fatty liver, while they acquire an immunomodulatory phenotype, liver macrophages fail to dampen immune-mediated damage. Therefore, loss of tolerogenicity induced by ongoing liver insult may be a mechanism contributing to the worsening of NAFLD.

[Bacterial infections in the context of chronic liver disease]. / Cirrhose hépatique et infections bactériennes.

Cirrhosis results from chronic liver disease and is associated with a high mortality. The most frequent causes for chronic liver disease include alcoholic liver disease, non-alcoholic fatty liver disease and viral hepatitis B and C. Bacterial infections often complicate decompensated cirrhosis. It is estimated that up to 35% of patients with decompensated cirrhosis have an infection at admission or during hospital stay. There are considerable consequences to these bacterial infections. Whilst evidence supports the use of prophylactic antibiotics, the emergence of multi-resistant bacteria is changing the spectrum of antibiotics that have to be used.

La cirrhose, résultat d'une maladie chronique du foie, est grevée d'une mortalité élevée. Les causes les plus fréquentes sont les hépatopathies alcoolique et dysmétabolique ainsi que les hépatites virales B et C. Les infections bactériennes sont une cause fréquente de complication de la décompensation cirrhotique. Il est estimé que 25 à 35 % des patients en décompensation cirrhotique présentent une infection à leur admission ou durant le séjour hospitalier. Les conséquences de l'infection bactérienne chez un patient cirrhotique sont considérables. L'évidence soutient l'utilisation d'une antibiothérapie prophylactique, mais la présence de plus en plus fréquente de germes avec des profils de résistance étendus pousse à recourir aux antibiotiques à spectre large.

[NASH: new terminology and what else is new in 2020]. / NASH†: nouvelle terminologie et nouveautés en 2020.

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of hepatic pathology ranging from non-alcoholic fatty liver, non-alcoholic steatohepatitis (NASH) occasionally complicated with hepatic fibrosis or even cirrhosis. In order to propose a diagnosis with positive criteria, a panel of experts recently proposed the use of an alternative nomenclature, metabolic-dysfunction-associated fatty liver disease (MAFLD) whose use remains debated. In addition, in Switzerland and elsewhere, there is strong epidemiological growth of NAFLD. The next years will probably see the approval of new therapies for NAFLD/NASH but, at present, management remains focused on lifestyle interventions and joint monitoring by the primary care physician and, when necessary, the specialist.

La stéatopathie non alcoolique (NAFLD) comprend un spectre de pathologies allant de la stéatose hépatique non alcoolique à la stéatohépatite non alcoolique (NASH) parfois compliquée d'une fibrose hépatique, voire d'une cirrhose. Afin de proposer un diagnostic avec des critères positifs, un panel d'experts a récemment proposé l'utilisation d'une nomenclature alternative, la stéatopathie associée à la dysfonction métabolique (Metabolic-Dysfunction-Associated Fatty Liver Disease, MAFLD) dont l'utilisation reste discutée. D'autre part, la NAFLD est en pleine croissance épidémiologique en Suisse comme ailleurs. Les prochaines années vont probablement voir l'approbation de nouvelles thérapeutiques pour la NAFLD/NASH mais, à l'heure actuelle, la prise en charge reste centrée sur les mesures hygiéno-diététiques et le suivi conjoint par le médecin de premier recours et, si nécessaire, par le spécialiste.

[Management of gastrointestinal and hepatic diseases during the COVID-19 outbreak]. / Prise en charge des patients avec maladies digestives et hépatiques durant la pandémie COVID-19.

The current epidemic of SARS-CoV-2 infection poses new challenges in the management of patients with gastrointestinal or liver disease. Consultations with patients with chronic diseases should ideally be done via telemedicine and treatments administered at home if possible. The latter should be maintained in non-infected subjects to limit the risk of decompensation of their underlying disease. In the event of proven infection, immunomodulatory or biological treatments will tend to be reduced or discontinued unless the disease is in a severely active phase. Elective endoscopy should be postponed, and urgent procedures should be performed with appropriate personal protective equipment.

L'épidémie actuelle d'infection par le SARS-CoV-2 pose de nouveaux défis dans la prise en charge des patients avec pathologies gastroentérologique ou hépatologique. Les consultations avec les patients atteints de maladies chroniques devraient se faire idéalement par télémédecine et les traitements administrés à domicile si possible. Ces derniers doivent être maintenus chez les sujets non infectés pour limiter le risque de décompensation de leur maladie de base. En cas d'infection avérée, on aura tendance à diminuer voire interrompre les traitements immunomodulateurs ou biologiques sauf si la maladie est en phase sévèrement active. Les examens endoscopiques électifs doivent être reportés. Les interventions urgentes doivent être effectuées en appliquant des mesures de protection adéquates.

Combination of Gene Expression Signature and Model for End-Stage Liver Disease Score Predicts Survival of Patients With Severe Alcoholic Hepatitis.

BACKGROUND & AIMS: Patients with severe alcoholic hepatitis (AH) have a high risk of death within 90 days. Corticosteroids, which can cause severe adverse events, are the only treatment that increases short-term survival. It is a challenge to predict outcomes of patients with severe AH. Therefore, we developed a scoring system to predict patient survival, integrating baseline molecular and clinical variables. METHODS: We obtained fixed liver biopsy samples from 71 consecutive patients diagnosed with severe AH and treated with corticosteroids from July 2006 through December 2013 in Brussels, Belgium (derivation cohort). Gene expression patterns were analyzed by microarrays and clinical data were collected for 180 days. We identified gene expression signatures and clinical data that are associated with survival without liver transplantation at 90 and 180 days after initiation of corticosteroid therapy. Findings were validated using liver biopsies from 48 consecutive patients with severe AH treated with corticosteroids, collected from March 2010 through February 2015 at hospitals in Belgium and Switzerland (validation cohort 1) and in liver biopsies from 20 patients (9 received corticosteroid treatment), collected from January 2012 through May 2015 in the United States (validation cohort 2). RESULTS: We integrated data on expression patterns of 123 genes and the model for end-stage liver disease (MELD) scores to assign patients to groups with poor survival (29% survived 90 days and 26% survived 180 days) and good survival (76% survived 90 days and 65% survived 180 days) (P < .001) in the derivation cohort. We named this assignment system the gene signature-MELD (gs-MELD) score. In validation cohort 1, the gs-MELD score discriminated patients with poor survival (43% survived 90 days) from those with good survival (96% survived 90 days) (P < .001). The gs-MELD score also discriminated between patients with a poor survival at 180 days (34% survived) and a good survival at 180 days (84% survived) (P < .001). The time-dependent area under the receiver operator characteristic curve for the score was 0.86 (95% confidence interval 0.73-0.99) for survival at 90 days, and 0.83 (95% confidence interval 0.71-0.96) for survival at 180 days. This score outperformed other clinical models to predict survival of patients with severe AH in validation cohort 1. In validation cohort 2, the gs-MELD discriminated patients with a poor survival at 90 days (12% survived) from those with a good survival at 90 days (100%) (P < .001). CONCLUSIONS: We integrated data on baseline liver gene expression pattern and the MELD score to create the gs-MELD scoring system, which identifies patients with severe AH, treated or not with corticosteroids, most and least likely to survive for 90 and 180 days.

Activation of the oncogenic miR-21-5p promotes HCV replication and steatosis induced by the viral core 3a protein.

BACKGROUND & AIMS: miR-21-5p is a potent oncogenic microRNA targeting many key tumour suppressors including phosphatase and tensin homolog (PTEN). We recently identified PTEN as a key factor modulated by hepatitis C virus (HCV) to promote virion egress. In hepatocytes, expression of HCV-3a core protein was sufficient to downregulate PTEN and to trigger lipid droplet accumulation. Here, we investigated whether HCV controls PTEN expression through miR-21-5p-dependent mechanisms to trigger steatosis in hepatocytes and to promote HCV life cycle. METHODS: MiR-21-5p expression in HCV-infected patients was evaluated by transcriptome meta-analysis. HCV replication and viral particle production were investigated in Jc1-infected Huh-7 cells after miR-21-5p inhibition. PTEN expression and steatosis were assessed in HCV-3a core protein-expressing Huh-7 cells and in mouse primary hepatocytes having miR-21-5p inhibited or genetically deleted respectively. HCV-3a core-induced steatosis was assessed in vivo in Mir21a knockout mice. RESULTS: MiR-21-5p expression was significantly increased in hepatic tissues from HCV-infected patients. Infection by HCV-Jc1, or transduction with HCV-3a core, upregulated miR-21-5p expression and/or activity in Huh-7 cells. miR-21-5p inhibition decreased HCV replication and release of infectious virions by Huh-7 cells. HCV-3a core-induced PTEN downregulation and steatosis were further prevented in Huh-7 cells following miR-21-5p inhibition or in Mir21a knockout mouse primary hepatocytes. Finally, steatosis induction by AAV8-mediated HCV-3a core expression was reduced in vivo in Mir21a knockout mice. CONCLUSION: MiR-21-5p activation by HCV is a key molecular step, promoting both HCV life cycle and HCV-3a core-induced steatosis and may be among the molecular changes induced by HCV-3a to promote carcinogenesis.

[Abdominal surgery in patients with portal hypertension†: clinical implication and management]. / Chirurgie abdominale chez les malades avec hypertension portale†: implications et prise en charge.

Abdominal surgery is sometimes needed in patients with portal hypertension. The indication may be related to the underlying liver disease, including liver resection for liver cancer and parietal surgery. Surgery may also be performed for another indication, unrelated to the liver disease. Portal hypertension increases both morbidity and mortality after abdominal surgery, and it should be taken into account when planning surgery timing and surgical strategy. This article provides an overview of the main etiologies of portal hypertension, and the post-operative outcomes after liver resection and non-hepatic abdominal surgery, underlining the importance of a multidisciplinary approach.

Une chirurgie abdominale est parfois nécessaire chez les patients atteints d'hypertension portale. Son indication peut être en lien avec une complication de la maladie du foie, comme une résection de tumeur hépatique ou une chirurgie pariétale, ou avec une affection non liée à la pathologie hépatique. L'hypertension portale augmente la morbidité et la mortalité de cette chirurgie, et l'indication ainsi que la stratégie doivent être définies avec soin. Cet article décrit les causes d'hypertension portale, les risques associés à sa présence lors d'une résection hépatique ou d'une chirurgie abdominale non hépatique. Enfin, il propose une approche multidisciplinaire, associant les chirurgiens, les hépatologues, les anatomopathologistes et les anesthésistes-réanimateurs.

Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine.

Patients who develop chronic fibrotic liver disease, caused by viral or metabolic aetiologies, are at a high risk of developing hepatocellular carcinoma (HCC). Even after complete HCC tumour resection or ablation, the carcinogenic tissue microenvironment in the remnant liver can give rise to recurrent de novo HCC tumours, which progress into incurable, advanced-stage disease in most patients. Thus, early detection and prevention of HCC development is, in principle, the most impactful strategy to improve patient prognosis. However, a "one-size-fits-all" approach to HCC screening for early tumour detection, as recommended by clinical practice guidelines, is utilised in less than 20% of the target population, and the performance of screening modalities, including ultrasound and alpha-fetoprotein, is suboptimal. Furthermore, optimal screening strategies for emerging at-risk patient populations, such as those with chronic hepatitis C after viral cure, or those with non-cirrhotic, non-alcoholic fatty liver disease remain controversial. New HCC biomarkers and imaging modalities may improve the sensitivity and specificity of HCC detection. Clinical and molecular HCC risk scores will enable precise HCC risk prediction followed by tailoured HCC screening of individual patients, maximising cost-effectiveness and optimising allocation of limited medical resources. Several aetiology-specific and generic HCC chemoprevention strategies are evolving. Epidemiological and experimental studies have identified candidate chemoprevention targets and therapies, including statins, anti-diabetic drugs, and selective molecular targeted agents, although their clinical testing has been limited by the lengthy process of cancer development that requires long-term, costly studies. Individual HCC risk prediction is expected to overcome the challenge by enabling personalised chemoprevention, targeting high-risk patients for precision HCC prevention and substantially improving the dismal prognosis of HCC.

A simple diet- and chemical-induced murine NASH model with rapid progression of steatohepatitis, fibrosis and liver cancer.

BACKGROUND AND AIMS: Although the majority of patients with non-alcoholic fatty liver disease (NAFLD) have only steatosis without progression, a sizeable fraction develop non-alcoholic steatohepatitis (NASH), which can lead to cirrhosis and hepatocellular carcinoma (HCC). Many established diet-induced mouse models for NASH require 24-52 weeks, which makes testing for drug response costly and time consuming. METHODS: We have sought to establish a murine NASH model with rapid progression of extensive fibrosis and HCC by using a western diet (WD), which is high-fat, high-fructose and high-cholesterol, combined with low weekly dose of intraperitoneal carbon tetrachloride (CCl4), which serves as an accelerator. RESULTS: C57BL/6J mice were fed a normal chow diet ±â€¯CCl4 or WD ±â€¯CCl4 for 12 and 24 weeks. Addition of CCl4 exacerbated histological features of NASH, fibrosis, and tumor development induced by WD, which resulted in stage 3 fibrosis at 12 weeks and HCC development at 24 weeks. Furthermore, whole liver transcriptomic analysis indicated that dysregulated molecular pathways in WD/CCl4 mice and immunologic features were similar to those of human NASH. CONCLUSIONS: Our mouse NASH model exhibits rapid progression of advanced fibrosis and HCC, and mimics histological, immunological and transcriptomic features of human NASH, suggesting that it will be a useful experimental tool for preclinical drug testing. LAY SUMMARY: A carefully characterized model has been developed in mice that recapitulates the progressive stages of human fatty liver disease, from simple steatosis, to inflammation, fibrosis and cancer. The functional pathways of gene expression and immune abnormalities in this model closely resemble human disease. The ease and reproducibility of this model make it ideal to study disease pathogenesis and test new treatments.

Using Big Data to Discover Diagnostics and Therapeutics for Gastrointestinal and Liver Diseases.

Technologies such as genome sequencing, gene expression profiling, proteomic and metabolomic analyses, electronic medical records, and patient-reported health information have produced large amounts of data from various populations, cell types, and disorders (big data). However, these data must be integrated and analyzed if they are to produce models or concepts about physiological function or mechanisms of pathogenesis. Many of these data are available to the public, allowing researchers anywhere to search for markers of specific biological processes or therapeutic targets for specific diseases or patient types. We review recent advances in the fields of computational and systems biology and highlight opportunities for researchers to use big data sets in the fields of gastroenterology and hepatology to complement traditional means of diagnostic and therapeutic discovery.