Usefulness of autotaxin for the complications of liver cirrhosis

BACKGROUND Autotaxin(ATX)has been reported as a direct biomarker for estimating the evaluation of liver fibrosis.But available data on ATX as a useful biomarker for the complications of liver cirrhosis(LC)are scant.AIM To assess the clinical usefulness of ATX for assessing the complications of LC.METHODS This multicenter,retrospective study was conducted at six locations in Japan.We include patients with LC,n=400.The ATX level was evaluated separately in men and women because of its high level in female patients.To assess the clinical usefulness of ATX for the complications of LC,the area under the curve(AUC)of ATX assessing for the severe complications was analyzed in comparison with the model for end-stage liver disease score,albumin-bilirubin(ALBI)score,fibrosis-4 index,and aspartate aminotransferase-to-platelet ratio index.RESULTS The mean age was 68.4±11.4 years,240 patients(60.0%)were male.A total of 213(53.3%)and 187(46.8%)patients were compensated and decompensated,respectively.The numbers of patients with varix rupture,hepatic ascites,and hepatic encephalopathy were 35(8.8%),131(32.8%),and 103(25.8%),respectively.The AUCs of ATX in men for hepatic encephalopathy,hepatic ascites,and varix ruptures were 0.853,0.816,and 0.706,respectively.The AUCs of ATX in women for hepatic encephalopathy,hepatic ascites,and varix rupture were 0.759,0.717,and 0.697,respectively.The AUCs of ATX in men were higher than those in women,as were all the other biomarkers used to detect encephalopathy and varix ruptures.However,for detecting ascites,the AUC of ALBI in men was more effective than using ATX.CONCLUSION ATX in men was more effective than any other biomarkers for detecting hepatic encephalopathy and varix ruptures.

Olmesartan for non-alcoholic steatohepatitis complicated with hypertension: An open-label study

Aim: We evaluated the long-term effects of olmesartan, an angiotensin type 1 receptor blocker, in patients with non-alcoholic steatohepatitis (NASH) complicated with hypertension. Methods: All patients were given a standard calorie diet and exercise counseling more than 3 months before the treatment. Seven patients with NASH received olmesartan treatment for 1 year. Liver biopsy, clinical parameters and blood markers of hepatic fibrosis, including serum hyaluronic acid, type IV collagen, and procollagen III N-terminal propeptide levels, were also examined at the beginning and the end of the study. Results: The median dose of the final administration was 20 mg (range, 10 - 40 mg). Olmesartan reduced MAP by –11.3 ± 13.0% (P = 0.046) after 1 year. In the laboratory data, serum AST, ALT, and ferritin significantly decreased after a year of administration (AST, 62 ± 24 vs. 39 ± 20 IU/L, P = 0.018;ALT, 106 ± 79 vs. 55 ± 35 IU/L, P = 0.043;ferritin, 323.8 ± 252.8 vs. 202.3 ± 194.1 ng/ml, P = 0.028). Furthermore, fasting glucose significantly decreased. However, transforming growth factor-beta1, the serum concentration of the fibrosis markers, and all histological features were unchanged at the end of the study. No side effects of the treatment were noted at any time during the study. Conclusion: Olmesartan significantly reduced blood pressure, fasting glucose, aminotransferase, and serum ferritin but could not suppress the hepatic fibrosis markers or histological features after 1 year. Therefore, olmesartan is advisable only for its anti-inflammatory effect in patients with NASH-complicated hypertension.