Inverse association of plasma level of glutathione peroxidase with liver fibrosis in chronic hepatitis B: potential role of iron

Background: Oxidative stress plays a major pathogenic role in liver injury following chronic hepatitis B. Glutathione peroxidase [Gpx] has a central role in regulating the oxidative state. Hepatitis B virus [HBV] results in down-regulation of Gpx. On the other hand, iron homeostasis is disrupted in HBV infected patients. Therefore, the objective of this study was to assess the interplay of Gpx and serum iron on clinical and virological characteristics of patients with chronic HBV infection

Method: One hundred and fifty adult, treatment-naïve, patients with chronic hepatitis B were randomly selected from an ongoing cohort of patients with HBV. Plasma Gpx1 concentration and HBV DNA quantity were measured. Liver stiffness was measured by transient elastography

Results: Serum iron had a positive association with HBV DNA count in the total population. Serum iron was not associated with liver stiffness. However, HBV DNA was significantly associated with liver stiffness only in male patients. Serum Gpx was inversely associated with liver stiffness. Serum iron and Gpx had indirect effects on liver stiffness via HBV DNA count. We observed distinct effects of serum iron on HBV DNA and Gpx on liver stiffness in male and female patients

Conclusion: We identified interplay of serum iron and Gpx1 in relation to level of liver fibrosis in patients with chronic hepatitis B. Our results suggest that oxidative stress and serum iron are differentially implicated in the progression of chronic hepatitis B in male and female patients

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

Mean polyp per patient is an accurate and readily obtainable surrogate for adenoma detection rate: results from an opportunistic screening colonoscopy program

The incidence of colorectal cancer is rising in several developing countries. In the absence of integrated endoscopy and pathology databases, adenoma detection rate [ADR], as a validated quality indicator of screening colonoscopy, is generally difficult to obtain in practice. We aimed to measure the correlation of polyp-related indicators with ADR in order to identify the most accurate surrogate [s] of ADR in routine practice. We retrospectively reviewed the endoscopic and histopathological findings of patients who underwent colonoscopy at a tertiary gastrointestinal clinic. The overall ADR and advanced-ADR were calculated using patient-level data. The Pearson's correlation coefficient [r] was applied to measure the strength of the correlation between the quality metrics obtained by endoscopists. A total of 713 asymptomatic adults aged 50 and older who underwent their first-time screening colonoscopy were included in this study. The ADR and advanced-ADR were 33.00% [95% CI: 29.52-36.54] and 13.18% [95% CI: 10.79-15.90], respectively. We observed good correlations between polyp detection rate [PDR] and ADR [r=0.93], and mean number of polyp per patient [MPP] and ADR [r=0.88] throughout the colon. There was a positive, yet insignificant correlation between advanced ADRs and non-advanced ADRs [r=0.42,p=0.35]. MPP is strongly correlated with ADR, and can be considered as a reliable and readily obtainable proxy for ADR in opportunistic screening colonoscopy programs

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

Host-microbiota interaction is MyD88-independent in the intestinal tract under physiologic condition

The role of microbiota in health and disease is the subject of rigorous investigation. Several studies have demonstrated that microbiota and the pattern-recognition receptors contribute to intestinal tumourigenesis; the exact mechanism of which is still obscure. MyD88 is the downstream effector of all Toll-like receptors [TLRs] except TLR3. However, the alternative MyD88-independent pathway is functional downstream of not only TLR3, but also TLR1/2, 2/6, 4, and 5. TLR4 stimulation with intraperitoneal lipopolysaccharide exerts distinct functional effect on the intestinal motility via MyD88-dependent and-independent pathways

Inflammation in sporadic colorectal cancer

Chronic inflammation plays a pivotal role in the development of colorectal cancer [CRC] in patients with inflammatory bowel disease [IBD]. An orchestrated interplay of immune cells with numerous inflammatory mediators including reactive oxygen and nitrogen species, cyclooxy-genase 2, and several cytokines promotes colitis-associated cancer [CAC]. Recent findings have shown that inflammatory pathways not only are important in the development of CAC but are also involved in the pathogenesis of sporadic CRC. Hereby, we review the existing experimental and clinical evidence that suggest a link between inflammation and tumorigenesis in sporadic CRC