1 3251 93 HEPATITIS B VIRUS INFECTION: AN INSIGHT INTO THE CLINICAL CONNECTION AND MOLECULAR INTERACTION BETWEEN HEPATITIS B VIRUS AND HOST EXTRAHEPATIC CANCER RISK. THE EVIDENCE FOR CHRONIC HEPATITIS B VIRUS (HBV) INFECTION AND HEPATOCELLULAR CARCINOMA (HCC) OCCURRENCE IS WELL ESTABLISHED. THE HEPATOCYTE EPITHELIUM CARCINOGENESIS CAUSED BY HBV HAS BEEN INVESTIGATED AND REVIEWED IN DEPTH. NEVERTHELESS, RECENT FINDINGS FROM PRECLINICAL AND OBSERVATIONAL STUDIES SUGGESTED THAT CHRONIC HBV INFECTION IS EQUALLY IMPORTANT IN EXTRAHEPATIC CANCER OCCURRENCE AND SURVIVAL, SPECIFICALLY GASTROINTESTINAL SYSTEM-DERIVED CANCERS. IMMUNE MICROENVIRONMENT CHANGES (IMMUNE-SUPPRESSIVE CYTOKINE INFILTRATION), EPIGENETIC MODIFICATION (N6-METHYLADENOSINE), MOLECULAR SIGNALING PATHWAYS (PI3K-AKT AND WNT), AND SERUM BIOMARKERS SUCH AS HEPATITIS B VIRUS X (HBX) PROTEIN ARE POTENTIAL UNDERLYING MECHANISMS IN CHRONIC HBV INFECTION-INDUCED EXTRAHEPATIC CANCERS. THIS NARRATIVE REVIEW AIMED TO COMPREHENSIVELY SUMMARIZE THE MOST RECENT ADVANCES IN EVALUATING THE ASSOCIATION BETWEEN CHRONIC HBV INFECTION AND EXTRAHEPATIC CANCER RISK AND EXPLORE THE POTENTIAL UNDERLYING MOLECULAR MECHANISMS IN THE CARCINOGENESIS INDUCTION OF EXTRAHEPATIC CANCERS IN CHRONIC HBV CONDITIONS. 2023 2 6778 26 [BILIARY TRACT CANCERS : MOLECULAR CHARACTERIZATION AND IDENTIFICATION OF NOVEL PROGNOSTIC MARKERS]. BACKGROUND: BILE DUCT CANCERS (BTCS) ARE HIGHLY AGGRESSIVE TUMORS WITH A DISMAL PROGNOSIS AND AN INCREASING INCIDENCE. BTC IS A TUMORBIOLOGICALLY AND CLINICALLY HETEROGENEOUS TUMOR GROUP AND CAN BE SUBDIVIDED ACCORDING TO ANATOMICAL ASPECTS INTO INTRAHEPATIC CHOLANGIOCARCINOMAS (ICCA), EXTRAHEPATIC CHOLANGIOCARCINOMAS (ECCA) AND GALLBLADDER CARCINOMAS (GBC). NEW THERAPY OPTIONS: CHRONIC INFLAMMATORY PROCESSES OF THE BILIARY SYSTEM SEEM TO PLAY A ROLE IN THE DEVELOPMENT OF THESE TUMORS. INSIGHTS INTO MOLECULAR CHOLANGIOCARCINOGENESIS COULD MAKE AN IMPORTANT CONTRIBUTION TO NOVEL AND MORE PRECISE CLASSIFICATION ATTEMPTS AND TO THE DEVELOPMENT OF NEW, TARGETED THERAPIES FOR BTC. EPIGENETIC AND GENETIC ALTERATIONS IN CHOLANGIOCARCINOMAS: THE FIRST DESCRIPTION OF GENOME-WIDE DNA METHYLATION PATTERNS IN CCA SHOWED DRASTIC GLOBAL METHYLATION DIFFERENCES BETWEEN CCA AND CORRESPONDING NON-NEOPLASTIC TISSUE (MATCHED-PAIR ANALYSES). MOREOVER, SIGNIFICANT METHYLATION DIFFERENCES BETWEEN THE CCA SUBTYPES (ECCA AND ICCA) COULD BE FOUND. USING IMMUNOHISTOCHEMISTRY AND SANGER SEQUENCING, IT WAS SHOWN THAT THE ACTUAL BRAF V600E MUTATION RATE SEEMS TO BE SIGNIFICANTLY LOWER (1.3%) THAN PREVIOUSLY DESCRIBED IN THE LITERATURE. IMMUNEPHENOTYPING IN BILIARY TRACT CANCERS: A COMPREHENSIVE, SUBTYPE-SPECIFIC CHARACTERIZATION OF TUMOR-INFILTRATING IMMUNE CELLS AS WELL AS AN EXPRESSION ANALYSIS OF MAJOR HISTOCOMPATIBILITY COMPLEX I WAS PERFORMED IN A LARGE AND WELL-CHARACTERIZED BTC COHORT. FOR FURTHER STUDIES ON THE EFFICACY OF IMMUNOMODULATORY THERAPY APPROACHES FOR BTC, THE PRESENTED RESULTS PROVIDE A SOLID BASIS. 2017 3 2936 33 GENETIC AND EPIGENETIC ABNORMALITIES IN PRIMARY SCLEROSING CHOLANGITIS-ASSOCIATED CHOLANGIOCARCINOMA. PRIMARY SCLEROSING CHOLANGITIS (PSC) IS A CHOLESTATIC LIVER DISEASE OF UNKNOWN ETIOLOGY, CHARACTERIZED BY CHRONIC INFLAMMATION OF THE BILIARY TREE WITH SUBSEQUENT FIBROSIS AND CIRRHOSIS OF THE LIVER. PATIENTS WITH PSC ARE AT INCREASED RISK FOR THE DEVELOPMENT OF CHOLANGIOCARCINOMA (CCA), A HIGHLY MALIGNANT EPITHELIAL TUMOR ARISING FROM THE INTRAHEPATIC AND EXTRAHEPATIC BILE DUCTS. CURRENTLY, ORTHOTOPIC LIVER TRANSPLANTATION IS THE ONLY CURATIVE TREATMENT. THE LACK OF EFFICIENT DIAGNOSTIC METHODS FOR EARLY DETECTION AND THE LIMITED THERAPEUTIC OPTIONS FOR CCA ARE MAJOR PROBLEMS AND ARE ASSOCIATED WITH POOR SURVIVAL. THE PATHOGENESIS OF PSC-ASSOCIATED CCA IS COMPLEX AND POORLY UNDERSTOOD. IT SEEMS THAT PRO-INFLAMMATORY CYTOKINES PLAY AN IMPORTANT ROLE IN GENETIC AND EPIGENETIC CHANGES THAT CONTRIBUTE TO THE CARCINOGENIC PROCESS. THE MAPPING OF GENETIC ALTERATIONS MAY ELUCIDATE MOLECULAR TARGETS THAT MAY BE APPLIED AS BIOMARKERS TO FACILITATE EARLY DIAGNOSIS OF MALIGNANT DEGENERATION TO IMPROVE PATIENT OUTCOME. IN THE LAST DECADE, THE INTRODUCTION OF SEVERAL NOVEL MOLECULAR TECHNIQUES AVAILABLE FOR GENOME-WIDE SCREENING HAS ADVANCED OUR KNOWLEDGE ON MANY OF THE GENETIC ABNORMALITIES THAT ARE PREVALENT IN CCA AND PSC-ASSOCIATED CCA. THIS REVIEW SUMMARIZES GENETIC AND EPIGENETIC ABNORMALITIES, WHICH HAVE IMPORTANT POTENTIAL FOR CLINICAL APPLICATION. 2013 4 4108 17 MECHANISMS AND DISEASE CONSEQUENCES OF NONALCOHOLIC FATTY LIVER DISEASE. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS THE LEADING CHRONIC LIVER DISEASE WORLDWIDE. ITS MORE ADVANCED SUBTYPE, NONALCOHOLIC STEATOHEPATITIS (NASH), CONNOTES PROGRESSIVE LIVER INJURY THAT CAN LEAD TO CIRRHOSIS AND HEPATOCELLULAR CARCINOMA. HERE WE PROVIDE AN IN-DEPTH DISCUSSION OF THE UNDERLYING PATHOGENETIC MECHANISMS THAT LEAD TO PROGRESSIVE LIVER INJURY, INCLUDING THE METABOLIC ORIGINS OF NAFLD, THE EFFECT OF NAFLD ON HEPATIC GLUCOSE AND LIPID METABOLISM, BILE ACID TOXICITY, MACROPHAGE DYSFUNCTION, AND HEPATIC STELLATE CELL ACTIVATION, AND CONSIDER THE ROLE OF GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS THAT PROMOTE FIBROSIS PROGRESSION AND RISK OF HEPATOCELLULAR CARCINOMA IN NASH. 2021 5 852 28 CHOLANGIOCARCINOMA IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS (PSC): A COMPREHENSIVE REVIEW. CHOLANGIOCARCINOMA (CCA) IS THE MOST COMMON MALIGNANCY IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS (PSC) AND CARRIES A HIGH RATE OF MORTALITY. ALTHOUGH THE PATHOGENESIS OF CCA IN PSC IS LARGELY UNKNOWN, INFLAMMATION-DRIVEN CARCINOGENESIS CONCOMITANT WITH VARIOUS GENETIC AND EPIGENETIC ABNORMALITIES ARE UNDERLYING FACTORS. THE MAJORITY OF CCA CASES DEVELOP FROM A DOMINANT STRICTURE (DS), WHICH IS DEFINED AS A STRICTURE WITH A DIAMETER < 1.5 MM IN THE COMMON BILE DUCT OR < 1.0 MM IN THE HEPATIC DUCT. IN PSC PATIENTS PRESENTING WITH AN ABRUPT AGGRAVATION OF JAUNDICE, PAIN, FATIGUE, PRURITUS, WEIGHT LOSS, OR WORSENING LIVER BIOCHEMISTRIES, CCA SHOULD BE SUSPECTED AND EVALUATED UTILIZING A VARIETY OF DIAGNOSTIC MODALITIES. HOWEVER, EARLY RECOGNITION OF CCA IN PSC REMAINS A MAJOR CHALLENGE. IMPORTANTLY, 30-50% OF CCA IN PSC PATIENTS ARE OBSERVED WITHIN THE FIRST YEAR FOLLOWING THE DIAGNOSIS OF PSC FOLLOWED BY AN ANNUAL INCIDENCE RANGING FROM 0.5 TO 1.5 PER 100 PERSONS, WHICH IS NEARLY 10 TO 1000 TIMES HIGHER THAN THAT IN THE GENERAL POPULATION. CUMULATIVE 5-YEAR, 10-YEAR, AND LIFETIME INCIDENCES ARE 7%, 8-11%, AND 9-20%, RESPECTIVELY. WHEN PSC-ASSOCIATED CCA IS DIAGNOSED, MOST TUMORS ARE UNRESECTABLE, AND NO EFFECTIVE MEDICATIONS ARE AVAILABLE. GIVEN THE POOR THERAPEUTIC OUTCOME, THE SURVEILLANCE AND MANAGEMENT OF PSC PATIENTS WHO ARE AT AN INCREASED RISK OF DEVELOPING CCA ARE OF IMPORTANCE. SUCH PATIENTS INCLUDE OLDER MALES WITH LARGE-DUCT PSC AND POSSIBLY CONCURRENT ULCERATIVE COLITIS. THUS, MORE ATTENTION SHOULD BE PAID TO PATIENTS WITH THESE CLINICAL FEATURES, IN PARTICULAR WITHIN THE FIRST YEAR AFTER PSC DIAGNOSIS. IN CONTRAST, CCA IS LESS FREQUENTLY OBSERVED IN PEDIATRIC OR FEMALE PSC PATIENTS OR IN THOSE WITH SMALL-DUCT PSC OR CONCURRENT CROHN'S DISEASE. RECENTLY, NEW BIOMARKERS SUCH AS ANTIBODIES TO GLYCOPROTEIN 2 HAVE BEEN FOUND TO BE ASSOCIATED WITH AN INCREASED RISK OF DEVELOPING CCA IN PSC. HEREIN, WE REVIEW THE LITERATURE ON THE PATHOGENESIS, INCIDENCE, CLINICAL FEATURES, AND RISK FACTORS, WITH A FOCUS ON VARIOUS DIAGNOSTIC MODALITIES OF PSC-ASSOCIATED CCA. 2020 6 1348 24 DETERMINANTS OF FIBROSIS PROGRESSION AND REGRESSION IN NASH. CIRRHOSIS HAS BECOME THE MAJOR LIVER-RELATED CLINICAL ENDPOINT IN NON-ALCOHOLIC STEATOHEPATITIS (NASH). HOWEVER, PROGRESSION TO CIRRHOSIS IS LESS PREDICTABLE IN NASH THAN IN OTHER CHRONIC LIVER DISEASES. THIS IS DUE TO THE COMPLEX AND MULTIFACTORIAL AETIOLOGY OF NASH, WHICH IS DETERMINED BY LIFESTYLE AND NUTRITION, MULTIPLE GENETIC AND EPIGENETIC FACTORS, AND A PROMINENT ROLE OF HEPATIC AND EXTRAHEPATIC COMORBIDITIES. THUS, MODEST CHANGES IN THESE COFACTORS CAN ALSO INDUCE FIBROSIS REGRESSION, AT LEAST IN PATIENTS WITH PRECIRRHOTIC LIVER DISEASE. FIBROGENESIS IN NASH CORRELATES WITH, BUT IS INDIRECTLY COUPLED TO, CLASSICAL INFLAMMATION, SINCE FIBROSIS PROGRESSION IS DRIVEN BY REPETITIVE PERIODS OF REPAIR. WHILE HEPATOCYTE LIPOAPOPTOSIS IS A KEY DRIVING FORCE OF FIBROSIS PROGRESSION, ACTIVATED HEPATIC STELLATE CELLS, MYOFIBROBLASTS, CHOLANGIOCYTES, MACROPHAGES AND COMPONENTS OF THE PATHOLOGICAL EXTRACELLULAR MATRIX ARE MAJOR FIBROGENIC EFFECTORS AND THUS PHARMACOLOGICAL TARGETS FOR THERAPIES AIMED AT INHIBITION OF FIBROSIS PROGRESSION OR INDUCTION OF FIBROSIS REVERSAL. THE ADVENT OF NOVEL, HIGHLY SENSITIVE AND SPECIFIC SERUM BIOMARKERS AND IMAGING METHODS TO ASSESS THE DYNAMICS OF LIVER FIBROSIS IN NASH WILL IMPROVE DETECTION, STRATIFICATION AND FOLLOW-UP OF PATIENTS WITH PROGRESSIVE NASH . THESE NON-INVASIVE TOOLS WILL ALSO PROMOTE THE CLINICAL DEVELOPMENT OF ANTIFIBROTIC DRUGS, BY PERMITTING THE DESIGN OF LEAN PROOF-OF-CONCEPT STUDIES, AND ENABLING DEVELOPMENT OF A PERSONALISED ANTIFIBROTIC THERAPY FOR PATIENTS WITH RAPID FIBROSIS PROGRESSION OR ADVANCED DISEASE. 2018 7 4454 31 MOLECULAR MECHANISMS DRIVING PROGRESSION OF LIVER CIRRHOSIS TOWARDS HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS B AND C INFECTIONS: A REVIEW. ALMOST ALL PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC), A MAJOR TYPE OF PRIMARY LIVER CANCER, ALSO HAVE LIVER CIRRHOSIS, THE SEVERITY OF WHICH HAMPERS EFFECTIVE TREATMENT FOR HCC DESPITE RECENT PROGRESS IN THE EFFICACY OF ANTICANCER DRUGS FOR ADVANCED STAGES OF HCC. HERE, WE REVIEW RECENT KNOWLEDGE CONCERNING THE MOLECULAR MECHANISMS OF LIVER CIRRHOSIS AND ITS PROGRESSION TO HCC FROM GENETIC AND EPIGENOMIC POINTS OF VIEW. BECAUSE ~70% OF PATIENTS WITH HCC HAVE HEPATITIS B VIRUS (HBV) AND/OR HEPATITIS C VIRUS (HCV) INFECTION, WE FOCUSED ON HBV- AND HCV-ASSOCIATED HCC. THE LITERATURE SUGGESTS THAT GENETIC AND EPIGENETIC FACTORS, SUCH AS MICRORNAS, PLAY A ROLE IN LIVER CIRRHOSIS AND ITS PROGRESSION TO HCC, AND THAT HBV- AND HCV-ENCODED PROTEINS APPEAR TO BE INVOLVED IN HEPATOCARCINOGENESIS. FURTHER STUDIES ARE NEEDED TO ELUCIDATE THE MECHANISMS, INCLUDING IMMUNE CHECKPOINTS AND MOLECULAR TARGETS OF KINASE INHIBITORS, ASSOCIATED WITH LIVER CIRRHOSIS AND ITS PROGRESSION TO HCC. 2019 8 4478 29 MOLECULAR PATHOGENESIS OF NONALCOHOLIC STEATOHEPATITIS- (NASH-) RELATED HEPATOCELLULAR CARCINOMA. THE PROPORTION OF OBESE OR DIABETIC POPULATION HAS BEEN ANTICIPATED TO INCREASE IN THE UPCOMING DECADES, WHICH RISES THE PREVALENCE OF NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND ITS PROGRESSION TO NONALCOHOLIC STEATOHEPATITIS (NASH). RECENT EVIDENCE INDICATES THAT NASH IS THE MAIN CAUSE OF CHRONIC LIVER DISEASES AND IT IS AN IMPORTANT RISK FACTOR FOR DEVELOPMENT OF HEPATOCELLULAR CARCINOMA (HCC). ALTHOUGH THE LITERATURE ADDRESSING NASH-HCC IS GROWING RAPIDLY, LIMITED DATA IS AVAILABLE ABOUT THE ETIOLOGY OF NASH-RELATED HCC. EXPERIMENTAL STUDIES ON THE MOLECULAR MECHANISM OF HCC DEVELOPMENT IN NASH REVEAL THAT THE CARCINOGENESIS IS RELEVANT TO COMPLEX CHANGES IN SIGNALING PATHWAYS THAT MEDIATE CELL PROLIFERATION AND ENERGY METABOLISM. GENETIC OR EPIGENETIC MODIFICATIONS AND ALTERATIONS IN METABOLIC, IMMUNOLOGIC, AND ENDOCRINE PATHWAYS HAVE BEEN SHOWN TO BE CLOSELY RELATED TO INFLAMMATION, LIVER INJURY, AND FIBROSIS IN NASH ALONG WITH ITS SUBSEQUENT PROGRESSION TO HCC. IN THIS REVIEW, WE PROVIDE AN OVERVIEW ON THE CURRENT KNOWLEDGE OF NASH-RELATED HCC DEVELOPMENT AND EMPHASIZE MOLECULAR SIGNALING PATHWAYS REGARDING THEIR MECHANISM OF ACTION IN NASH-DERIVED HCC. 2018 9 251 29 ADVANCED THERAPEUTIC MODALITIES IN HEPATOCELLULAR CARCINOMA: NOVEL INSIGHTS. HEPATOCELLULAR CARCINOMA (HCC), THE MOST COMMON TYPE OF LIVER CANCER, IS USUALLY A LATENT AND ASYMPTOMATIC MALIGNANCY CAUSED BY DIFFERENT AETIOLOGIES, WHICH IS A RESULT OF VARIOUS ABERRANT MOLECULAR HETEROGENEITY AND OFTEN DIAGNOSED AT ADVANCED STAGES. THE INCIDENCE AND PREVALENCE HAVE SIGNIFICANTLY INCREASED BECAUSE OF SEDENTARY LIFESTYLE, DIABETES, CHRONIC INFECTION WITH HEPATOTROPIC VIRUSES AND EXPOSURE TO AFLATOXINS. DUE TO ADVANCED INTRA- OR EXTRAHEPATIC METASTASIS, RECURRENCE IS VERY COMMON EVEN AFTER RADICAL RESECTION. IN THIS PAPER, WE HIGHLIGHTED NOVEL THERAPEUTIC MODALITIES, SUCH AS MOLECULAR-TARGETED THERAPIES, TARGETED RADIONUCLIDE THERAPIES AND EPIGENETIC MODIFICATION-BASED THERAPIES. THESE TOPICS ARE TRENDING HEADLINES AND THEIR COMBINATION WITH CELL-BASED IMMUNOTHERAPIES, AND GENE THERAPY HAS PROVIDED PROMISING PROSPECTS FOR THE FUTURE OF HCC TREATMENT. MOREOVER, A COMPREHENSIVE OVERVIEW OF CURRENT AND ADVANCED THERAPEUTIC APPROACHES IS DISCUSSED AND THE ADVANTAGES AND LIMITATIONS OF EACH STRATEGY ARE DESCRIBED. FINALLY, VERY RECENT AND APPROVED NOVEL COMBINED THERAPIES AND THEIR PROMISING RESULTS IN HCC TREATMENT HAVE BEEN INTRODUCED. 2021 10 4464 29 MOLECULAR MECHANISMS OF NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)/NONALCOHOLIC STEATOHEPATITIS (NASH). NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS ONE OF THE MOST COMMON CHRONIC LIVER DISEASES WORLDWIDE AND HAS GARNERED INCREASING ATTENTION IN RECENT DECADES. NAFLD IS CHARACTERIZED BY A WIDE RANGE OF LIVER CHANGES, FROM SIMPLE STEATOSIS TO NONALCOHOLIC STEATOHEPATITIS (NASH), CIRRHOSIS, AND HEPATOCELLULAR CARCINOMA. THE PATHOGENESIS OF NAFLD/NASH IS VERY COMPLICATED AND INVOLVES LIPID ACCUMULATION, INSULIN RESISTANCE, INFLAMMATION, AND FIBROGENESIS. IN ADDITION, NAFLD IS CLOSELY ASSOCIATED WITH COMPLICATIONS SUCH AS OBESITY, DYSLIPIDEMIA, AND TYPE 2 DIABETES. IN PARTICULAR, THE CLINICAL SPECTRUM, PATHOPHYSIOLOGY, AND THERAPEUTIC OPTIONS OF NAFLD SHARE MANY THINGS IN COMMON WITH DIABETES. INSULIN RESISTANCE IS AN UNDERLYING BASIS FOR THE PATHOGENESIS OF DIABETES AND NAFLD. THIS CHAPTER FOCUSES ON THE MOLECULAR MECHANISM INVOLVED IN THE PATHOGENESIS OF INSULIN RESISTANCE, DIABETES, AND NASH/NAFLD INCLUDING THOSE THAT DRIVE DISEASE PROGRESSION SUCH AS OXIDATIVE STRESS, GENETIC AND EPIGENETIC MECHANISMS, ADIPONECTIN, CYTOKINES, AND IMMUNE CELLS. 2021 11 3270 26 HEPATOCELLULAR CARCINOMA IN THE CONTEXT OF NON-ALCOHOLIC STEATOHEPATITIS (NASH): RECENT ADVANCES IN THE PATHOGENIC MECHANISMS. HEPATOCELLULAR CARCINOMA (HCC) IS THE MOST COMMON TYPE OF LIVER CANCER. HCC IS PARTICULARLY AGGRESSIVE AND IS ONE OF THE LEADING CAUSES OF CANCER MORTALITY. IN RECENT DECADES, THE EPIDEMIOLOGICAL LANDSCAPE OF HCC HAS UNDERGONE SIGNIFICANT CHANGES. WHILE CHRONIC VIRAL HEPATITIS AND EXCESSIVE ALCOHOL CONSUMPTION HAVE LONG BEEN IDENTIFIED AS THE MAIN RISK FACTORS FOR HCC, NON-ALCOHOLIC STEATOHEPATITIS (NASH), PARALLELING THE WORLDWIDE EPIDEMIC OF OBESITY AND TYPE 2 DIABETES, HAS BECOME A GROWING CAUSE OF HCC IN THE US AND EUROPE. HERE, WE REVIEW THE RECENT ADVANCES IN EPIDEMIOLOGICAL, GENETIC, EPIGENETIC AND PATHOGENIC MECHANISMS AS WELL AS EXPERIMENTAL MOUSE MODELS THAT HAVE IMPROVED THE UNDERSTANDING OF NASH PROGRESSION TOWARD HCC. WE ALSO DISCUSS THE CLINICAL MANAGEMENT OF PATIENTS WITH NASH-RELATED HCC AND POSSIBLE THERAPEUTIC APPROACHES. 2020 12 4326 26 MICRORNAS IN THE PATHOGENESIS OF NONALCOHOLIC FATTY LIVER DISEASE. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD), OR, MORE ACCURATELY, METABOLIC ASSOCIATED FATTY LIVER DISEASE, ACCOUNTS FOR A LARGE PROPORTION OF CHRONIC LIVER DISORDERS WORLDWIDE AND IS CLOSELY ASSOCIATED WITH OTHER CONDITIONS SUCH AS CARDIOVASCULAR DISEASE, OBESITY, AND TYPE 2 DIABETES MELLITUS. NAFLD RANGES FROM SIMPLE STEATOSIS TO NONALCOHOLIC STEATOHEPATITIS (NASH) AND CAN PROGRESS TO CIRRHOSIS AND, EVENTUALLY, ALSO HEPATOCELLULAR CARCINOMA. THE MORBIDITY AND MORTALITY ASSOCIATED WITH NAFLD ARE INCREASING RAPIDLY YEAR ON YEAR. CONSEQUENTLY, THERE IS AN URGENT NEED TO UNDERSTAND THE ETIOLOGY AND PATHOGENESIS OF NAFLD AND IDENTIFY EFFECTIVE THERAPEUTIC TARGETS. MICRORNAS (MIRNAS), IMPORTANT EPIGENETIC FACTORS, HAVE RECENTLY BEEN PROPOSED TO PARTICIPATE IN NAFLD PATHOGENESIS. HERE, WE REVIEW THE ROLES OF MIRNAS IN LIPID METABOLISM, INFLAMMATION, APOPTOSIS, FIBROSIS, HEPATIC STELLATE CELL ACTIVATION, INSULIN RESISTANCE, AND OXIDATIVE STRESS, KEY FACTORS THAT CONTRIBUTE TO THE OCCURRENCE AND PROGRESSION OF NAFLD. ADDITIONALLY, WE SUMMARIZE THE ROLE OF MIRNA-ENRICHED EXTRACELLULAR VESICLES IN NAFLD. THESE MIRNAS MAY COMPRISE SUITABLE THERAPEUTIC TARGETS FOR THE TREATMENT OF THIS CONDITION. 2021 13 6393 19 THE ROLE OF THE HISTONE METHYLTRANSFERASE EZH2 IN LIVER INFLAMMATION AND FIBROSIS IN STAM NASH MICE. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS A LEADING FORM OF CHRONIC LIVER DISEASE, WITH FEW BIOMARKERS AND TREATMENT OPTIONS CURRENTLY AVAILABLE. NON-ALCOHOLIC STEATOHEPATITIS (NASH), A PROGRESSIVE DISEASE OF NAFLD, MAY LEAD TO FIBROSIS, CIRRHOSIS, AND HEPATOCELLULAR CARCINOMA. EPIGENETIC MODIFICATION CAN CONTRIBUTE TO THE PROGRESSION OF NAFLD CAUSING NON-ALCOHOLIC STEATOHEPATITIS (NASH), IN WHICH THE EXACT ROLE OF EPIGENETICS REMAINS POORLY UNDERSTOOD. TO IDENTIFY POTENTIAL THERAPEUTICS FOR NASH, WE TESTED SMALL-MOLECULE INHIBITORS OF THE EPIGENETIC TARGET HISTONE METHYLTRANSFERASE EZH2, TAZEMETOSTAT (EPZ-6438), AND UNC1999 IN STAM NASH MICE. THE RESULTS DEMONSTRATE THAT TREATMENT WITH EZH2 INHIBITORS DECREASED SERUM TNF-ALPHA IN NASH. IN THIS STUDY, WE INVESTIGATED THAT INHIBITION OF EZH2 REDUCED MRNA EXPRESSION OF INFLAMMATORY CYTOKINES AND FIBROSIS MARKERS IN NASH MICE. IN CONCLUSION, THESE RESULTS SUGGEST THAT EZH2 MAY PRESENT A PROMISING THERAPEUTIC TARGET IN THE TREATMENT OF NASH. 2020 14 3931 22 LIVER INJURY AND THE ACTIVATION OF THE HEPATIC MYOFIBROBLASTS. LIVER FIBROSIS IS A WOUND HEALING PROCESS, THE END RESULT OF CHRONIC LIVER INJURY ELICITED BY DIFFERENT NOXIOUS STIMULI. ACTIVATED HEPATIC STELLATE CELLS OR MYOFIBROBLASTS AND PORTAL MYOFIBROBLASTS ARE CONSIDERED AS THE MAIN PRODUCERS OF THE EXTRACELLULAR MATRIX IN THE LIVER. UPON LIVER INJURY THE QUIESCENT STELLATE CELLS TRANSDIFFERENTIATE INTO MYOFIBROBLASTS A PROCESS HIGHLIGHTED BY THE LOSS OF VITAMIN A STORES, UPREGULATION OF INTERSTITIAL TYPE COLLAGENS, SMOOTH MUSCLE ALPHA ACTIN, MATRIX METALLOPROTEINASES, PROTEOGLYCANS, AND THE INDUCTION OF CELL SURVIVAL PATHWAYS. ACTIVATION OF HEPATIC STELLATE CELLS IS A RESULT OF A COMPLEX INTERPLAY BETWEEN THE PARENCHYMAL CELLS, IMMUNE CELLS, EXTRACELLULAR MATRIX MECHANICS AND EXTRAHEPATIC MILIEU SUCH AS THE GUT MICROBIOME. IN THIS REVIEW WE WILL FOCUS ON THE PATHOMECHANISM OF STELLATE CELL ACTIVATION FOLLOWING CHRONIC LIVER INJURY; WITH THE AIM OF IDENTIFYING POSSIBLE TREATMENT TARGETS FOR ANTI-FIBROGENIC AGENTS. 2013 15 6269 28 THE NEXT CHALLENGE IN PEDIATRIC CHOLESTASIS: DECIPHERING THE PATHOGENESIS OF BILIARY ATRESIA. CHOLESTASIS IS A COMMON PRESENTING SYMPTOM OF LIVER DISEASE IN INFANTS. CHIEF AMONG DISEASES PRESENTING AS NEONATAL CHOLESTASIS IS BILIARY ATRESIA, THE MOST COMMON CAUSE OF CHRONIC LIVER DISEASE IN CHILDREN, BUT LITTLE IS KNOWN ABOUT THE PATHOGENESIS OF THIS DISEASE. IN SEARCH FOR THE MOLECULAR BASIS OF BILIARY ATRESIA, WE BEGAN TWO AREAS OF INVESTIGATION. IN THE FIRST, WE INTERROGATED THE HEPATIC TRANSCRIPTOME OF CHILDREN WITH BILIARY ATRESIA AND FOUND AN INTERFERON-GAMMA (IFNGAMMA)-RICH PROINFLAMMATORY FOOTPRINT AT THE TIME OF DIAGNOSIS. TO DIRECTLY EXPLORE IF IFNGAMMA PLAYS AN IMPORTANT ROLE IN BILIARY INJURY AND OBSTRUCTION, WE USED A MOUSE MODEL OF EXPERIMENTAL BILIARY ATRESIA AND FOUND THAT INACTIVATION OF THE MURINE IFNGAMMA GENE DECREASES THE TROPISM OF LYMPHOCYTES TO NEONATAL BILE DUCTS AND PREVENTS THE INFLAMMATORY OBSTRUCTION OF THE DUCT LUMEN. FURTHER ANALYSIS OF THE EXTRAHEPATIC BILIARY TRACT ALSO OUTLINED A BROADER NETWORK OF PROINFLAMMATORY GENES AT THE ONSET AND DURING PROGRESSION TO DUCT OBSTRUCTION, WITH THE TIME-SPECIFIC ACTIVATION OF IFNGAMMA-, APOPTOSIS-, AND COMPLEMENT-DRIVEN NETWORKS. IN THE SECOND APPROACH, WE SEARCHED FOR MOLECULAR PROFILES THAT DIFFERENTIATE CLINICAL FORMS OF BILIARY ATRESIA BY ANALYZING THE HEPATIC TRANSCRIPTOME OF AGE-MATCHED SUBJECTS AT THE TIME OF DIAGNOSIS. WE FOUND A PRELIMINARY PROFILE THAT DIFFERENTIATES THE EMBRYONIC FROM THE PERINATAL FORMS OF BILIARY ATRESIA. THE PROFILE CONTAINED THE DIFFERENTIAL ACTIVATION OF GENES INVOLVED IN EPIGENETIC MECHANISMS OF DISEASE. COLLECTIVELY, THESE STUDIES PROVIDE NEW INSIGHT INTO PATHOGENESIS OF BILIARY ATRESIA AND IDENTIFY POTENTIAL THERAPEUTIC TARGETS TO FOSTER LONG-TERM OUTCOME WITH THE NATIVE LIVER. 2006 16 4884 26 OVERVIEW OF THE PATHOGENESIS, GENETIC, AND NON-INVASIVE CLINICAL, BIOCHEMICAL, AND SCORING METHODS IN THE ASSESSMENT OF NAFLD. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS THE MOST PREVALENT CHRONIC LIVER DISEASE WORLDWIDE. IT REPRESENTS A RANGE OF DISORDERS, INCLUDING SIMPLE STEATOSIS, NONALCOHOLIC STEATOHEPATITIS (NASH), AND LIVER CIRRHOSIS, AND ITS PREVALENCE CONTINUES TO RISE. IN SOME CASES, HEPATOCELLULAR CARCINOMA (HCC) MAY DEVELOP. THE DEVELOP;MENT OF NON-INVASIVE DIAGNOSTIC AND SCREENING TOOLS IS NEEDED, IN ORDER TO REDUCE THE FREQUENCY OF LIVER BIOPSIES. THE MOST PROMISING METHODS ARE THOSE ABLE TO EXCLUDE ADVANCED FIBROSIS AND QUANTIFY STEATOSIS. IN THIS STUDY, NEW PERSPECTIVE MARKERS FOR INFLAMMATION, OXIDATIVE STRESS, APOPTOSIS, AND FIBROGENESIS; EMERGING SCORING MODELS FOR DETECTING HEPATIC STEATOSIS AND FIBROSIS; AND NEW GENETIC, EPIGENETIC, AND MULTIOMIC STUDIES ARE DISCUSSED. AS ISOLATED BIOCHEMICAL PARAMETERS ARE NOT SPECIFIC OR SENSITIVE ENOUGH TO PREDICT THE PRESENCE OF NASH AND FIBROSIS, THERE IS A TENDENCY TO USE VARIOUS MARKERS AND COMBINE THEM INTO MATHEMATICAL ALGORITHMS. SEVERAL PREDICTIVE MODELS AND SCORING SYSTEMS HAVE BEEN DEVELOPED. CURRENT DATA SUGGESTS THAT PANELS OF MARKERS (NAFLD FIBROSIS SCORE, FIB-4 SCORE, BARD SCORE, AND OTHERS) ARE USEFUL DIAGNOSTIC MODALITIES TO MINIMIZE THE NUMBER OF LIVER BIOPSIES. THE REVIEW UNVEILS PATHOPHYSIOLOGICAL ASPECTS RELATED TO NEW TRENDS IN CURRENT NON-INVASIVE BIOCHEMICAL, GENETIC, AND SCORING METHODS, AND PROVIDES INSIGHT INTO THEIR DIAGNOSTIC ACCURACIES AND SUITABILITY IN CLINICAL PRACTICE. 2019 17 74 34 A MULTIDISCIPLINARY APPROACH AND CURRENT PERSPECTIVE OF NONALCOHOLIC FATTY LIVER DISEASE: A SYSTEMATIC REVIEW. IN RECENT TIMES, NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) HAS BEEN CONSIDERED ONE OF THE MAJOR CAUSES OF LIVER DISEASE ACROSS THE WORLD. NAFLD IS DEFINED AS THE DEPOSITION OF TRIGLYCERIDES IN THE LIVER AND IS ASSOCIATED WITH OBESITY AND METABOLIC SYNDROME. HYPERINSULINEMIA, INSULIN RESISTANCE (IR), FATTY LIVER, HEPATOCYTE INJURY, UNBALANCED PROINFLAMMATORY CYTOKINES, MITOCHONDRIAL DYSFUNCTION, OXIDATIVE STRESS, LIVER INFLAMMATION, AND FIBROSIS ARE THE MAIN PATHOGENESIS IN NAFLD. RECENT STUDIES SUGGEST THAT THE ACTION OF INTESTINAL MICROBIOTA THROUGH CHRONIC INFLAMMATION, INCREASED INTESTINAL PERMEABILITY, AND ENERGY UPTAKE PLAYS A VITAL ROLE IN NAFLD. MOREOVER, POLYCYSTIC OVARIAN SYNDROME ALSO CAUSES NAFLD DEVELOPMENT THROUGH IR. AGE, GENDER, RACE, ETHNICITY, SLEEP, DIET, SEDENTARY LIFESTYLE, AND GENETIC AND EPIGENETIC PATHWAYS ARE SOME CONTRIBUTING FACTORS OF NAFLD THAT CAN EXACERBATE THE RISK OF LIVER CIRRHOSIS AND HEPATOCELLULAR CARCINOMA (HCC) AND EVENTUALLY LEAD TO DEATH. NAFLD HAS VARIOUS PRESENTATIONS, INCLUDING FATIGUE, UNEXPLAINED WEIGHT LOSS, BLOATING, UPPER ABDOMINAL PAIN, DECREASED APPETITE, HEADACHE, ANXIETY, POOR SLEEP, INCREASED THIRST, PALPITATION, AND A FEELING OF WARMTH. SOME STUDIES HAVE SHOWN THAT NAFLD WITH SEVERE CORONAVIRUS DISEASE 2019 (COVID-19) HAS POOR OUTCOMES. THE GOLD STANDARD FOR NAFLD DIAGNOSIS IS LIVER BIOPSY. OTHER DIAGNOSTIC TOOLS ARE IMAGING TESTS, SERUM BIOMARKERS, MICROBIOTA MARKERS, AND TESTS FOR EXTRAHEPATIC COMPLICATIONS. THERE ARE NO SPECIFIC TREATMENTS FOR NAFLD. THEREFORE, THE MAIN CONCERN FOR NAFLD IS TREATING THE COMORBID CONDITIONS SUCH AS ANTI-DIABETIC AGENTS FOR TYPE 2 DIABETES MELLITUS, STATINS TO REDUCE HCC PROGRESSION, ANTIOXIDANTS TO PREVENT HEPATOCELLULAR DAMAGE, AND BARIATRIC SURGERY FOR PATIENTS WITH A BMI OF >40 KG/M(2) AND >35 KG/M(2) WITH COMORBIDITIES. LIFESTYLE AND DIETARY CHANGES ARE CONSIDERED PREVENTIVE STRATEGIES AGAINST NAFLD ADVANCEMENT. INADEQUATE TREATMENT OF NAFLD FURTHER LEADS TO CARDIAC CONSEQUENCES, SLEEP APNEA, CHRONIC KIDNEY DISEASE, AND INFLAMMATORY BOWEL DISEASE. IN THIS SYSTEMATIC REVIEW, WE HAVE BRIEFLY DISCUSSED THE RISK FACTORS, PATHOGENESIS, CLINICAL FEATURES, AND NUMEROUS CONSEQUENCES OF NAFLD. WE HAVE ALSO REVIEWED VARIOUS GUIDELINES FOR NAFLD DIAGNOSIS ALONG WITH EXISTING THERAPEUTIC STRATEGIES FOR THE MANAGEMENT AND PREVENTION OF THE DISEASE. 2022 18 3269 23 HEPATOCELLULAR CARCINOMA IN ALCOHOLIC AND NON-ALCOHOLIC FATTY LIVER DISEASE-ONE OF A KIND OR TWO DIFFERENT ENEMIES? HEPATOCELLULAR CANCER (HCC) IS A CANCER WITH AN OVERALL POOR PROGNOSIS AND AN ALARMING GLOBALLY RISING INCIDENCE. WHILE VIRAL ETIOLOGY OF CHRONIC LIVER DISEASE AND HCC IS DOWN-TRENDING, ALCOHOL AND EXCESS CALORIE INTAKE HAVE EMERGED AS MAJOR CULPRITS. ALCOHOL RELATED LIVER DISEASE (ALD) AND NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) SHARE SIMILAR PATHOGENETIC MECHANISM OF HEPATIC INJURY AND IN PROMOTING DEVELOPMENT OF HCC; YET SOME GENETIC AND EPIGENETIC FEATURES ARE DISTINCT AND MAY PROMISE CLINICAL UTILITY. POPULATION BASED INTERVENTION ARE URGENTLY NEEDED TO REDUCE ALCOHOL USE AND IMPROVE METABOLIC FACTORS SUCH AS OBESITY AND DIABETES. THE GOAL IS TO IDENTIFY AT-RISK PATIENTS, TO LINK THESE PATIENTS TO CARE AND TO PROVIDE EFFECTIVE MANAGEMENT OF CHRONIC LIVER DISEASE AND HCC. THIS REVIEW FOCUSES ON THE EPIDEMIOLOGY, PATHOPHYSIOLOGY INCLUDING GENETIC AND EPIGENETIC ALTERCATION AS WELL AS CLINICAL ASPECTS OF ALD AND NAFLD ASSOCIATED HCC. 2019 19 2422 20 EPIGENETIC SIGNATURES DISCRIMINATE PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS AND ULCERATIVE COLITIS FROM PATIENTS WITH ULCERATIVE COLITIS. BACKGROUND: PRIMARY SCLEROSING CHOLANGITIS (PSC) IS A CHRONIC INFLAMMATORY LIVER DISEASE AFFECTING THE INTRA- AND EXTRAHEPATIC BILE DUCTS, AND IS STRONGLY ASSOCIATED WITH ULCERATIVE COLITIS (UC). IN THIS STUDY, WE EXPLORED THE PERIPHERAL BLOOD DNA METHYLOME AND ITS IMMUNE CELL COMPOSITION IN PATIENTS WITH PSC-UC, UC, AND HEALTHY CONTROLS (HC) WITH THE AIM TO DEVELOP A PREDICTIVE ASSAY IN DISTINGUISHING PATIENTS WITH PSC-UC FROM THOSE WITH UC ALONE. METHODS: THE PERIPHERAL BLOOD DNA METHYLOME OF MALE PATIENTS WITH PSC AND CONCOMITANT UC, UC AND HCS WAS PROFILED USING THE ILLUMINA HUMANMETHYLATION INFINIUM EPIC BEADCHIP (850K) ARRAY. DIFFERENTIALLY METHYLATED CPG POSITION (DMP) AND REGION (DMR) ANALYSES WERE PERFORMED ALONGSIDE GRADIENT BOOSTING CLASSIFICATION ANALYSES TO DISCERN PSC-UC FROM UC PATIENTS. AS OBSERVED DIFFERENCES IN THE DNA METHYLOME COULD BE THE RESULT OF DIFFERENCES IN CELLULAR POPULATIONS, WE ADDITIONALLY EMPLOYED MASS CYTOMETRY (CYTOF) TO CHARACTERIZE THE IMMUNE CELL COMPOSITIONS. RESULTS: GENOME WIDE METHYLATION ANALYSIS DID NOT REVEAL LARGE DIFFERENCES BETWEEN PSC-UC AND UC PATIENTS NOR HCS. NONETHELESS, USING GRADIENT BOOSTING WE WERE CAPABLE OF DISCERNING PSC-UC FROM UC WITH AN AREA UNDER THE RECEIVER OPERATOR CURVE (AUROC) OF 0.80. FOUR CPG SITES ANNOTATED TO THE NINJ2 GENE WERE FOUND TO STRONGLY CONTRIBUTE TO THE PREDICTIVE PERFORMANCE. WHILE CYTOF ANALYSES CORROBORATED THE LARGELY SIMILAR BLOOD CELL COMPOSITION AMONG PATIENTS WITH PSC-UC, UC AND HC, A HIGHER ABUNDANCE OF MYELOID CELLS WAS OBSERVED IN UC COMPARED TO PSC-UC PATIENTS. CONCLUSION: DNA METHYLATION ENABLES DISCERNING PSC-UC FROM UC PATIENTS, WITH A POTENTIAL FOR BIOMARKER DEVELOPMENT. 2022 20 5220 15 PRIMARY BILIARY CHOLANGITIS: A TALE OF EPIGENETICALLY-INDUCED SECRETORY FAILURE? PRIMARY BILIARY CHOLANGITIS (PBC) IS A CHRONIC CHOLESTATIC LIVER DISEASE ASSOCIATED WITH AUTOIMMUNE-RELATED DESTRUCTION OF SMALL TO MEDIUM SIZE INTRAHEPATIC BILE DUCTS. THE AETIOLOGY OF PBC IS UNKNOWN AND ITS PATHOGENESIS REMAINS OBSCURE. BOTH GENETIC VARIANTS AND ENVIRONMENTAL FACTORS HAVE BEEN LINKED TO INCREASED PBC SUSCEPTIBILITY, WITH OTHER ALTERATIONS KNOWN TO COOPERATE IN DISEASE PATHOBIOLOGY. INCREASING EVIDENCE INDICATES THE PRESENCE OF EPIGENETIC ABNORMALITIES IN PBC, PARTICULARLY ALTERATIONS OF CHOLANGIOCELLULAR MICRORNAS (MIRNAS OR MIRS). THIS REVIEW HIGHLIGHTS AND DISCUSSES THE MOST RELEVANT EPIGENETIC ALTERATIONS FOUND IN PATIENTS WITH PBC, FOCUSING ON THE ROLE OF MIR-506 IN THE PROMOTION OF CHOLESTASIS AND IMMUNE ACTIVATION. 2018