ABSTRACT
The aim of the present review is to have an in-depth analysis of the published scientific literature relating to the clinical use of ademetionine in various etiologies of liver disease. Literature search was performed using electronic databases like Pubmed/Medline/others to identify studies on ademetionine in patients with intrahepatic cholestasis, alcoholic liver disease, non-alcoholic fatty liver disease, drug induced liver injury and viral hepatitis. Ademetionine has been studied in various etiologies of liver disease with varying dosing and durations. In patients with chronic and alcoholic liver disease, ademetionine was found to be beneficial in improving liver enzyme levels, increasing glutathione levels, improving signs and symptoms of fatigue, pruritus and jaundice. Positive effects of ademetionine therapy have also been documented in multiple studies in patients with non-alcoholic fatty liver disease, with improvements observed in triglyceride, total cholesterol, alanine transaminase and asprtate transaminase levels and ultrasound grading of fatty change. In patients with drug induced liver injury, improvements were observed in liver biochemical markers and symptoms such as pruritus, fatigue and jaundice. Ademetionine has also been studied in patients with viral hepatitis with improvement in laboratory markers and signs and symptoms. Published data suggest that there is clinical evidence to substantiate the use of ademetionine across indications. Its use has resulted in sustained improvement in biochemical markers; signs and symptoms of liver disease has been observed in both acute and chronic liver disease. Further data is warranted through clinical studies to focus on specific end points of therapy areas, in existing and new indications.
ABSTRACT
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become an Important entity globally, including in India and other Asian countries. Morphological evaluation of a liver biopsy is necessary for the diagnosis, staging and possibly management of this disease. However, the spectrum of changes in the liver, their evolution, Interrelationships and implications are incompletely understood. We aimed to study the spectrum of histological abnormalities in NAFLD. METHODS: The study material was drawn from a pool of 80 liver biopsies diagnosed in our laboratory as NAFLD, 67 retrieved retrospectively from our records and 13 obtained prospectively with complete clinical data. After comprehensive histological assessment, a detailed analysis was done of 32 of those categorized as definitive NAFLD on the basis of a dependable history of no alcohol Intake and seronegativity for hepatitis virus B and C Infections. RESULTS: Fatty change was preferentially seen in acinar zones 2 and 3, more so in the former. Steatotic cells varied in size; some large ones were non-spherical. Steatosis alone was present in more than a quarter of the cases and steatosis along with inflammation was present in half. The magnitude of steatosis correlated with inflammation, while both these seemed to correlate with hepatocyte Injury and fibrosis. CONCLUSION: A proportion of patients with NAFLD show only hepatic steatosis. An Increasing grade of steatosis is associated with greater Inflammation, hepatocyte injury and acinar fibrosis. Preferential involvement of acinar zone 2 by steatosis, the morphology of the steatotic cells, and nature and location of inflammation are important in the diagnosis of NAFLD and its differentiation from other causes of fatty liver.