Physicians' knowledge and attitude towards fecal microbiota transplant in Iran

Fecal microbiota transplant [FMT] is employed to replace the 'unhealthy' microbiota of the patient with the 'healthy' microbiota of a pre-screened healthy donor. Given the growing importance of gut microbiota dysbiosis in the pathogenesis of intestinal or extraintestinal diseases; it is conceivable that FMT becomes integrated in the routine clinical practice. Our objective was to assess the knowledge and attitude of the Iranian physicians towards FMT. We surveyed the participants of Iranian gastroenterology and hepatology 2014 conference. Overall, 146 [68.5%] were familiar with FMT; of whom 132 [94.28%] were willing to accept FMT if scientifically and ethically approved and 115 [88.46%] were willing to refer their patients for FMT if indicated. In total, 42 [30.7%] had identified stool preparation as the most unappealing aspect of FMT, while 17 [11.6%] reported the therapeutic use of fecal material as the most unappealing and 39 [28.5%] indicated that both are equally unappealing. The doctors who had an overall positive opinion toward FMT reported less negative feelings towards FMT. Iranian physicians are willing to accept FMT as a therapeutic option if it is scientifically justified and ethically approved. Nevertheless, physicians prefer to skip the stool preparation phase; as they are more in favour of synthetic microbiota as opposed to fecal microbiota

Immune-regulatory events in the clearance of HBsAg in chronic hepatitis B: focuses on HLA-DP

Successful clearance of hepatitis B virus [HBV] is a promising event in which host's immune system will attempt to get rid of the virus. The immunological events of HBsAg seroclearance have attracted great attention in both natural history investigations and therapeutic trials. Recent genome-wide association studies [GWAS] has confirmed polymorphisms in the human leukocyte antigen [HLA]-DP locus associated with spontaneous HBV clearance. In this review the impact of host immune response in declining HB5Ag during the natural history of the infection has been discussed

Cohort profile: Golestan hepatitis B cohort study-a prospective long term study in northern Iran

Hepatitis B virus [HBV] infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries remains largely unknown. Therefore, the hepatitis B cohort study [HBCS], nested as part of the Golestan Cohort Study [GCS], Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course of chronic hepatitis B with reference to its epidemiology, viral/host genetic interactions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen [HBsAg] was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree relatives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS

Adult hepatic progenitor cell niche: how it affects the progenitor cell fate

The hepatic progenitor cell [HPC] niche is a special microenvironment composed of different cell types, extracellular matrix [ECM] components, growth factors and cytokines released by the niche cells that help to maintain the characteristics of HPCs and the balance between their activation, proliferation and differentiation

Composition of this special microenvironment, created in response to specific liver damage, together with critical interactions between different partners of the HPC niche can determine the fate decision and differentiation pathways of HPCs

A number of recent studies have shed light on factors and signals from the HPC niche that determines the choice of HPCs differentiation towards a specific cell type depending on the nature of the liver injury and resultant microenvironment created by this injury

This paper seeks to provide an in-depth review, through a literature review and the authors' experiences, of the most recent findings on the role of the HPC niche in fate choice option of HPCs toward either hepatocytes or bile duct epithelial cells and its clinical relevance