OA Hepatology http://www.oapublishinglondon.com/oa-hepatology OA Hepatology Quantification of HBsAg in serum: characteristics of the assays. http://www.oapublishinglondon.com/article/395   Introduction The presence of hepatitis B virus (HBV) surface antigen (HBsAg) in serum is the hallmark of HBV infection, and qualitative tests for its detection have been used since 1969. Recently, HBsAg quantification has been applied for monitoring chronic HBV infection during its natural history as well as for the prediction of the response to treatment. As HBsAg titres are becoming an integral part in the monitoring of chronic hepatitis B, knowledge of the characteristics of HBsAg quantitative assays is of great importance. Two automated assays are currently commercially available, namely the Architect QT (Abbott Laboratories) and the Elecsys HBsAg II Quant (Roche Diagnostics). Although the correlation between the currently approved methods for HBsAg quantification is quite good, the use of the same assay in the monitoring of individual patients with chronic HBV infection appears to be mandatory. The aim of this review is to discuss the characteristics and comparisons of available HBsAg quantitative assays. Conclusion Correlation of HBsAg quantification is good, but using the same assay in the monitoring of patients with chronic HBV infection is mandatory. Dilution steps for commercial assays minimize human error. We call for further studies to be conducted so that we are able to improve the techniques we have and further our understanding. 07/11/2020 04:57:24 am Hepatic flares induced by disease-modifying treatments in patients with multiple sclerosis. http://www.oapublishinglondon.com/article/863 Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system of autoimmune origin. during the last decades, several disease-modifying therapies (DMT) have been licensed that ameliorate the course of the disease. The purpose of these DMT is to reduce inflammation, disease activity as measured by MRI, and relapse rate. However, DMT, and interferons in particular, are associated with a number of adverse reactions which include transient liver function abnormalities. Regular testing of ALT, AST, AP and bilirubin, at least monthly for the first 6 months, then 6 monthly thereafter probably can minimise Type A or dose-dependent reactions and a pretreatment screen might be useful to eliminate other causes of liver test elevations in patients on treatment with interferon beta. Liver enzyme monitoring should be undertaken in patients with MS during Glatiramer acetate (GA) treatment, especially where there is a history of HF during previous treatment with IFN beta-1a. Furthermore, autoimmune disease, especially AIH, should be excluded, and caution is advisable before prescribing GA in patients with concomitant liver disease. -With regard to natalizumab, autoantibody screening should be obtained before starting biological therapies, as well as on-treatment monitoring to detect early signs of immune-mediated diseases; positive autoantibodies represent a controversial issue for biological therapy and treatment should be considered on a case-by-case basis. No data are available to suggest a schedule in liver monitoring in patients treated with mitoxantrone, fingolimod or teriflunomide; however, regular monitoring of blood cell counts and liver enzymes is required. 07/11/2020 04:57:24 am Risk factors and management of hepatitis C recurrence after liver transplantation. http://www.oapublishinglondon.com/article/926 Liver disease associated with Hepatitis C virus infection is the most common indication for liver transplantation. Patients with detectable HCV RNA at the time of liver transplantation, inevitably experience graft re-infection.  This can lead to 30% of patients developing cirrhosis in 5 years post liver transplantation, with a rate of decompensation at 1 year of 40%. Achievement of sustained virological response is associated with stabilization of fibrosis and improvement in graft survival. Standard antiviral therapies using pegylated interferon, ribavirin and retransplanatation in decompensated patients were the only options of treatment. Direct acting antivirals such as protease inhibitors, polymerase or other non –structural protein inhibitors are the new modalities of treatment of Hepatitis C. However their use in the field of liver transplant is limited due to their safety and tolerance. Combination therapy with telaprevir or boceprevir added to pegylated interferon and ribavirin is anticipated to be beneficial but with increased rates of adverse effects and challenges in managing drug-drug interactions between the protease inhibitors and calcineurin inhibitors or sirolimus. 07/11/2020 04:57:24 am Acute-on-chronic liver failure: an update. http://www.oapublishinglondon.com/article/976 Acute-on-chronic liver failure occurs in patients with cirrhosis, either spontaneously or after a precipitating event.It is characterized by highshort term mortality, resulting from the development of organ failures, infections and immune system dysfunction.New diagnostic criteria have recently been proposed, which will probably redefine this syndrome.Specific therapeutic guidelines have not yet been created. It is the main challenge to do so in the following years.For the moment, prevention and early detection of patients at risk are crucial in the management of acute-on-chronic liver failure. 07/11/2020 04:57:24 am Alcoholic hepatitis: an update on best practice medicine. http://www.oapublishinglondon.com/article/977 Alcoholic hepatitis, with its significant associated morbidity and mortality, remains a plague affecting the United States. Several advancements have been made in the field of alcohol associated liver disease, yet the pathophysiology behind alcoholic hepatitis remains uncertain. The major barrier in attempting to better understand the pathophysiology and ultimately reduce the associated morbidity and mortality lies in the limited available data.  This article reviews the proposed pathophysiology of alcoholic hepatitis, its prognostic indicators, mechanism for use of corticosteroids and pentoxifylline, hepatorenal syndrome, the importance of nutritional status, and future considerations in therapy. 07/11/2020 04:57:24 am Primary sclerosing cholangitis: An update. http://www.oapublishinglondon.com/article/988 Primary sclerosing cholangitis (PSC) is a chronic and progressive liver disorder. The disease is characterized by progressive inflammation leading to stricturing and fibrosis of the medium and large biliary ducts in intra and/or extrahepatic ductal system. PSC is more common in men. It is classically associated with inflammatory bowel disease, specifically ulcerative colitis (UC). The disease is progressive resulting in complications including, cholestasis, malignancy, and hepatic failure necessitating liver transplantation.  The median survival following diagnosis is 10-12 years, but shorter when disease is advanced at the time of diagnosis. Approximately 50% of patients meet criteria for liver transplantation within 10-15 years of becoming symptomatic. Unfortunately, PSC can recur after transplantation. Herein we present a review for the clinician of this fascinating and difficult disease. 07/11/2020 04:57:24 am Hepatitis B-related hepatocellular carcinoma. http://www.oapublishinglondon.com/article/1146 Hepatocellular carcinoma is one of the most deadly cancers in the world and has been found to be prevalent in hepatitis B virus endemic regions. The association of hepatitis B virus as a major factor in the development of hepatocellular carcinoma has been observed in the past. However the mechanisms of hepatocarcinogenesis are not fully understood. Multiple studies have shown that treatment of hepatitis B with anti-viral therapy has lead to the decreased incidence of hepatocellular carcinoma. More emerging data suggest that anti-viral therapy may also have a role in preventing the recurrence of hepatocellular carcinoma. 07/11/2020 04:57:24 am Comparison of patient and doctor perceptions of barriers to hepatitis C treatment: a survey and literature review. http://www.oapublishinglondon.com/article/1470 Background/Aims: Although Hepatitis C (HCV) infection is widespread, only a minority of patients receives the currently standard of care. The rationale for this disparity may be multifactorial. However, overcoming known psychosocial barriers, particularly in the doctor-patient relationship, remains essential in providing HCV care. In this cross-sectional study, we aim to not only identify these perceived barriers in treating our HCV-prevalent population from both patients and physicians’ responses, but also cross-analyze for association between the two cohorts’ perceptions. Methods: We surveyed 100 patients and their physicians, anonymously and separately, during their visit to our outpatient hepatology clinic about their views on twelve psychosocial barriers. Results: Differences in perceptions of patients and their doctors regarding medical adherence (p<0.001), substance abuse (p=0.01), knowledge of risks (p=0.046), and social support (p<0.001) were found in patients undergoing evaluation and not yet treated, but were not evident when comparing to patients with Hepatitis C that have already initiated treatment. Conclusion: Using the above information, we hope to plan smarter road maps for successful HCV treatment delivery to reduce and bridge these barriers. 07/11/2020 04:57:24 am Unexplained liver damage, cryptogenic liver cirrhosis, and steatohepatitis may be caused by latent chronic toxoplasmosis. http://www.oapublishinglondon.com/article/1519 T. gondiiis a globally distributed intracellular protozoan parasite affecting approximately 5-90% of human population and causing a variety of so far neglected  diseases and clinical entities in both immunocompromised and immunocompetent individuals. Acute infection of the parasite in mice caused a marked reduction in serum butyrylcholinesterase (BChE) activity and liver damage. BChE and AChE are biomarkers of low-grade systemic inflammation and earlier it was suggested that the elevation of these two bioparameters may predict development of type 2 diabetes mellitus and Alzheimer’s disease. Serum BChE activity was found to be also associated with overweight, obesity, body fat distribution parameters, and recently a positive association between T. gondii seropositivity and obesity has been reported. Infection with the parasite was linked with increase in the number of hepatic stellate cells known to play an important role in development of fibrosis and its advancement to cirrhosis.of any etiology. Moreover, several authors suggested that hepatitis with a clinical picture resembling acute viral hepatitis result from T. gondii infection. Abnormalities associated with cryptogenic liver cirrhosis markedly affect acquired immunity of the host and probably participate in triggering and persistence of several autoimmune diseases, especially that  anti-T. gondii IgG antibodies have been found in the sera of both patients suffering from these clinical entities and in healthy individuals. Oxidative stress and immunosuppresion due to the infection play an important role in these processes. It should be also noted that mammalian as well as the parasite cells, express two cholesteryl ester-synthesizing enzymes, ACAT1 and ACAT2, which share 44-47% of amino acid homology. ACAT1 is present in various cells and tissues, while ACAT2 expression is restricted to hepatocytes and intestinal mucosal cells. The parasite enzymes TgACAT1 and TgACAT2 localized to endoplasmic reticulum can synthesize and store abundant esters of cholesterol and triglycerides. The lifelong persistence and resulting surplus of ACAT1 and ACAT2, and TgACAT1 and TgACAT2 enzymatic activities especially in the hepatocytes and/or intestinal cells of the host may therefore at least in part be responsible for development of steatohepatitis, and generation of ballooning hepatocytes, foamy macrophages, and clear cells (foamy) colitis. These abnormalities can be explained by the suppressed autophagy in the liver due to proliferation of T. gondii. In alcoholic steatohepatitis, ballooning degeneration of hepatocytes may also at least partly result from the fact that ethanol dose-dependently stimulate microneme secretion in T. gondii tachyzoites and parasite attachment to host cells, thus facilitating infection of the hepatic cells. The increased serum iron levels and hepatic iron overload reported in patients with nonalcoholic hepatitis may be caused by the excess of NO produced by activated macrophages and hepatic cells of the host, as a defense molecule against infection with the parasite. NO intercepts iron before incorporation into ferritin and directly mobilizes iron from the serum protein in a glutathione-dependent manner. Finally, several reports provided data suggesting that the generation of Mallory-Denk bodies is linked with latent chronic hepatic toxoplasmosis, and T. gondii cathepsin L and B proteases play an important role in this process. 07/11/2020 04:57:24 am