Non invasive tools for the diagnosis of liver cirrhosis

Liver cirrhosis(LC),the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis.This chronic progressive clinical condition,leads to liver cell failure and portal hypertension,which can favour the onset of hepatocellular carcinoma.Defining the phase of the natural history is crucial for therapeutic choice and prognosis.Liver biopsy is currently considered the best available standard of reference but it has some limits,so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis.Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications.They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores.Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound(US),US Doppler,contrast enhanced US andElastography.US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis,in this case Elastography is more reliable.This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.

Nanotechnology applications for the therapy of liver fibrosis

Chronic liver diseases represent a major global health problem both for their high prevalence worldwide and,in the more advanced stages,for the limited available curative treatment options.In fact,when lesions of different etiologies chronically affect the liver,triggering the fibrogenesis mechanisms,damage has already occurred and the progression of fibrosis will have a major clinical impact entailing severe complications,expensive treatments and death in end-stage liver disease.Despite significant advances in the understanding of the mechanisms of liver fibrinogenesis,the drugs used in liver fibrosis treatment still have a limited therapeutic effect.Many drugs showing potent antifibrotic activities in vitro often exhibit only minor effects in vivo because insufficient concentrations accumulate around the target cell and adverse effects result as other non-target cells are affected.Hepatic stellate cells play a critical role in liver fibrogenesis,thus they are the target cells of antifibrotic therapy.The application of nanoparticles has emerged as a rapidly evolving area for the safe delivery of various therapeutic agents(including drugs and nucleic acid)in the treatment of various pathologies,including liver disease.In this review,we give an overview of the various nanotechnology approaches used in the treatment of liver fibrosis.