Helicobacter pylori e as doenças hepatobiliares: atualização 2023 / Helicobacter and hepatobiliary diseases: update 2023

ABSTRACT Helicobacter Pylori (H. pylori) is one of the main infectious causes of gastroduodenal diseases, however, its role in developing different extragastric diseases has been proven. The possible involvement of H. pylori in the pathogenesis of cardiovascular, metabolic, neurodegenerative, skin, and hepatobiliary diseases is suggested. The bacterium has been found in tissue samples from the liver, biliary tract, and gallstones of animals and humans. However, the role of H. pylori infection in the pathogenesis of liver and biliary diseases has not been finally established. The histopathological confirmation of the positive effect of H. pylori eradication is needed. In addition, there are discussions on the clinical significance of other Helicobacter species. The review presents the data available for and against the involvement of H. pylori in hepatobi­liary disease development and progression.

RESUMO Helicobacter pylori (H. pylori) é uma das principais causas infecciosas de doenças gastroduodenais, no entanto, seu papel no desenvolvimento de diferentes doenças extragástricas tem sido comprovado. Sugere-se o possível envolvimento do H. pylori na patogênese de doenças cardiovasculares, metabólicas, neurodegenerativas, cutâneas e hepatobiliares. A bactéria tem sido encontrada em amostras de tecido do fígado, trato biliar e cálculos biliares de animais e humanos. No entanto, o papel da infecção por H. pylori na patogênese de doenças do fígado e das vias biliares ainda não foi estabelecido definitivamente. A confirmação histopatológica do efeito positivo da erradicação do H. pylori é necessária. Além disso, existem discussões sobre a importância clínica de outras espécies de Helicobacter. A revisão apresenta os dados disponíveis a favor e contra o envolvimento do H. pylori no desenvolvimento e progressão das doenças hepatobiliares.

NKT cells in liver diseases / 医学前沿

Natural killer T cells are innate-like and tissue-resident lymphocytes, which recognize lipid antigens and are enriched in the liver. Natural killer T cells play important roles in infections, tumors, autoimmune diseases, and metabolic diseases. In this study, we summarize recent findings on biology of natural killer T cells and their roles in hepatitis B virus and hepatitis C virus infection, autoimmune liver diseases, alcoholic liver disease, nonalcoholic fatty liver disease, and hepatocellular carcinoma. Controversial results from previous studies are discussed, and indicate the dynamic alteration in the role of natural killer T cells during the progression of liver diseases, which might be caused by changes in natural killer T subsets, factors skewing cytokine responses, and intercellular crosstalk between natural killer T cells and CD1d-expressing cells or bystander cells.

Autoimmune Liver Diseases and Liver Transplantation / 胃肠病学

Liver transplantation is a well accepted treatment for patients with end-stage liver disease. The indications of liver transplantation for autoimmune liver diseases such as autoimmune hepatitis,primary biliary cholangitis,and primary sclerosing cholangitis are similar to that with other acute or chronic liver diseases. Despite liver transplantation has a favorable overall outcome in these patients,the recurrence of autoimmune liver diseases is relatively common and challenges remain in terms of the management and survival of graft. It should be noted that de novo autoimmune hepatitis can arise in patients transplanted for non-autoimmune liver diseases. In this article,the indications and outcomes of liver transplantation in patients with autoimmune liver diseases were discussed for the better understanding of liver transplantation in this setting.

Pathological Features of Autoimmune Liver Diseases / 胃肠病学

Autoimmune hepatitis (AIH),primary biliary cholangitis (PBC,formerly known as primary biliary cirrhosis),primary sclerosing cholangitis (PSC),IgG4-related sclerosing cholangitis (IgG4-SC) and IgG4-related hepatopathy are the main categories of autoimmune liver diseases (AILDs),and liver biopsy is important for their diagnosis and management. The characteristic histological features of AIH are interface hepatitis with portal lymphoplasmacytic infiltration,hepatic rosette formation and emperipolesis. Chronic nonsuppurative destructive cholangitis and epithelioid granuloma are frequently seen in PBC. PSC is characterized by 'onion-skin'type periductal fibrosis,while storiform fibrosis with IgG4-positive plasmacytic infiltration usually indicates IgG4-SC. Closer cooperation between clinicians and pathologists may improve the diagnosis and management of AILDs.

Challenges to Diagnosis and Management of Autoimmune Liver Diseases / 胃肠病学

Autoimmune liver diseases (AILDs),including mainly autoimmune hepatitis (AIH),primary biliary cholangitis (PBC),primary sclerosing cholangitis (PSC),IgG4-related sclerosing cholangitis (IgG4-SC),and overlap syndromes,are characterized by circulating autoantibodies,inflammatory liver histology,and increased level of serum immunoglobulins. Early diagnosis and management can significantly improve the prognosis of patients and their quality of life. This editorial focused on the research progress and difficulties encountered in studies on AILDs in China.

Management Strategies for Liver Fibrosis

Abstract: Liver fibrosis resulting from chronic liver injury are major causes of morbidity and mortality worldwide. Among causes of hepatic fibrosis, viral infection is most common (hepatitis B and C). In addition, obesity rates worldwide have accelerated the risk of liver injury due to nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Also liver fibrosis is associated with the consumption of alcohol, or autoimmune hepatitis and chronic cholangiophaties. The response of hepatocytes to inflammation plays a decisive role in the physiopathology of hepatic fibrosis, which involves the recruitment of both pro- and anti-inflammatory cells such as monocytes and macrophages. As well as the production of other cytokines and chemokines, which increase the stimulus of hepatic stellate cells by activating proinflammatory cells. The aim of this review is to identify the therapeutic options available for the treatment of the liver fibrosis, enabling the prevention of progression when is detected in time.

Analysis on detection results of different dilution titers of antinuclear antibodies in children / 国际检验医学杂志

Objective To compare the influences of different dilution titers on the ANA detection by the indirect immunofluores‐cence assay(IIF) in children for investigating the necessity of reducing serum initial dilution titer .Methods Serum ANA was detec‐ted by using the indirect immunofluorescence assay at a serial of dilution titer in 110 healthy controls and the results were compared with the results of specific ANAs by the linear immunoassay (LIA);meanwhile the ANA‐LIA results in clinical children patients with ANA‐IIF negative were also analyzed .Results With the dilution titers gradual decrease from 1∶80 ,1∶40 and 1∶20 in the samples of the health group ,the positive detection rates of ANA‐IIF were risen ,which were 7 .3% ,9 .1% and 10 .9% respectively , but the differences were not statistically significant (P>0 .05) ,the weak‐positive rates were 7 .3% ,15 .5% and 31 .8% respective‐ly ,the differences were statistically significant (P<0 .01) .Among 110 healthy children under going the physical examination ,the specific ANA was detected out in 8 samples ,the positive rate was 7 .3% .Among 8 positive cases at the dilution titer of 1∶80 by the IIF method ,specific ANA was in 2 cases;in 4 added cases of fluorescence ANA positive samples at the dilution titers of 1∶40 and 1∶20 ,specific ANA was in 1 case .If with any positive of ANA‐IIF(1∶80) or ANA‐LIA as the ANA positive ,the ANA positive rate was risen from 7 .3% to 12 .7% .In the clinical samples among 29 cases of ANA‐IIF(1∶80) negative autoimmune liver disease related autoantibody detection ,the specific ANA‐LIA positive was detected in 5 cases (17 .2% ) .Conclusion Reducing the initial ti‐ter of children serum is unable to obviously increase the ANA‐IIF positive detection rate ,on the contrary increases the non‐specific weak positive .Therefore ,clinical laboratory does not change the dilution titer of children routine ANA sample .The detection by combining with the specific ANA‐LIA spectrum is conducive to find ANA .

Association of vitamin D receptor gene polymorphisms with autoimmune liver diseases risk / 中国医师进修杂志

Objective To investigate the association of vitamin D receptor gene (Apa1,Bsm1,Taq1) polymorphisms with autoimmune liver diseases risk.Metiods Case control test documents were retrieved through Pubmed,Ovid,Medline,and Web of science databases,according to the inclusion and exclusion criteria included in this study.The design of experiments,the characteristics of the object of study,research results was excerpted,STATA version 12.0 software were used.The correlation intensity was demonstrated with odds ratio (OR) and 95％ confidence interval (CI).Results A total of 6 publications containing 9 studies (7 studies about primary biliary cirrhosis,2 studies about autoimmune hepatitis) published from January 2000 to February 2012 were identified and 844 cases and 1 522 controls were included.The combined results based on all studies showed that there was a statistically significant link between Apa 1 and autoimmune liver diseases (OR =0.85,95％ CI 0.74-0.96,P =0.058,for a vs.A; OR =0.75,95％ CI 0.58-0.97,P =0.212,for aa vs.AA;OR =0.78,95％ CI 0.63-0.98,P =0.235,for Aa vs.AA; OR =0.77,95％ CI 0.63-0.94,P =0.231,for Aa/aa vs.AA),while the Bsm 1 and Taq 1 didn' t show the association with autoimmune liver diseases.Conclusion The current meta-analysis shows that Apal may be a low-penetrant risk factor for autoimmune liver diseases.Bsm1 and Taq1 don't show the association with autoimmune liver diseases.

Changes of IL-12 and IL-17 levels in patients with autoimmune liver disease and its clinical significance / 第二军医大学学报

Objective To investigate the expression of interleukin (IL)-12 and IL-17 in the serum and liver tissues of patients with autoimmune liver disease (AILD) and to discuss the relevant significance. Methods The peripheral blood and liver tissues were collected from 21 patientswith autoimmune hepatitis (AIH), 21 with primary biliary cirrhosis (PBC), and 9 with AIH-PBC overlap syndrome (AIH-PBC OS). The serum IL-12 and IL-17 levels were assayed by ELISA, and the expression and location of IL-12 and IL-17 in the liver tissues were detected by immunohistochemistry method. Alamine transaminase(ALT) and y-glutamyltransferase (GGT) were measured by automatic biochemical analyzer. The correlation of serum IL-12 and IL-17 expressions with ALT and GGT levels was analyzed. Ten healthy participants taking a physical examination and 10 normal liver tissues were used as controls. Results The serum levels of IL-12 in AIH, PBC, and AIH-PBC OS groupswere significantly lower than that in the control group(P<0. 01), and the serum levels of IL-17 in the three groups were significantly higher than that in the control group(P<0. 01). A negative correlation was found between serumIL-12 and IL-17 in AIH andPBCgroups (AIH: r= -0.752, P<0. 05; PBC: r = - 0. 436, P<0. 05), and serumIL-17 was positively correlated with ALT and GGT (AIH: r = 0. 825, P<0. 05;PBC:r = 0. 571, P<0. 05). IL-12 was mainly expressed in bile duct epithelium and Kupffer cells, and the expression rates in the 3 experimental groups were significantly lower than that in the control group (AIH: 19.05% [4/21], PBC: 9.52% [2/21], AIH-PBC OS: 11.11% [1/9], control: 90.00% [9/10]; P< 0. 01). IL-17 was mainly expressed in lymphocytes and monocytes, and the expression rates in the 3 experimental groups were significantly higher than that in control group (AIH: 71. 43% [15/21], PBC: 76. 19% [16/21], AIH-PBC OS: 77. 78% [7/ 9], control: 10.00% [1/10]; P<0. 01). IL-12 expression in the liver tissueswas negatively correlated with IL-17 expression in AIH andPBCgroups(AIH: r = - 0. 499, P = 0.021; PBC: r = 0. 580, P = 0. 006). Conclusion IL-12 expression is reduced in AILD patients, decreasing the inhibition againstTh17 cell differentiation, leading to IL-17 increase and mediating inflammatory injury, which indicates that IL-12/IL-17 inflammatory pathway may participate in the development and progression of AILD.