liver fibrosis

Liver fibrosis (LF) is a critical stage in chronic liver disease progression, and effective therapeutic drugs are currently lacking. Tanshinone IIA (Tan IIA), a monomer extracted from Salvia miltiorrhiza, shows potential in treating LF. This research aims to discuss the antifibrotic efficacy and underlying pharmacological mechanism of Tan IIA. 

The in vivo model was induced with CCl4 to form a LF model in mice, and the in vitro model was induced by TGF-β1 in LX-2 and HSC-T6 cells. Liver pathology was characterized by HE, Masson, and Sirius red staining, and serum levels of ALT, AST, LDH, and γ-GT were examined. Cell viability and proliferation were detected by Cell Counting Kit-8 and colony formation assays. Cell cycle distribution was detected by flow cytometry. The protein levels of p-ERK, cyclin D1, CDK4, and p-Smad3L were assessed through Western blot, immunohistochemistry, or immunofluorescence assays.

Tan IIA markedly decreased serum levels of ALT, AST, LDH, and γ‐GT. Collagen I and α-SMA were reduced, as shown by in vitro and in vivo models. Moreover, while arresting HSCs in the G1 phase was increased, Tan II A markedly inhibited cell viability and colony formation. Mechanistically, Tan IIA decreased the expression of p-ERK, cyclin D1, CDK4, and p-Smad3L proteins in TGF-β1-activated cells and CCl4-induced mice.

Tan IIA may improve LF by regulating the signaling axis of ERK/cyclin D1/p-Smad3L, thereby blocking activated HSCs in the G1 phase and inhibiting their proliferation.

Hepatic fibrosis is a biological response characterized by the accumulation of extracellular matrix (ECM) during the wound healing process. Hepatic stellate cells (HSCs) play a pivotal role in fibrogenesis, transitioning from quiescent to myofibroblast cell types and leading to excessive ECM production. Platelet-derived growth factor (PDGF), a potent mitogen, is produced by activated HSCs, stimulating cell proliferation and migration.

This study aims to analyze the impact of Wharton's jelly mesenchymal stem cell (WJ-MSC)-derived exosomes on HSC activation induced by PDGF during liver fibrosis.

Hepatic stellate cells-T6 cells were treated with PDGF-BB for 24 hours to induce activation, followed by treatment with varying concentrations of WJ-MSC-derived exosomes (0, 25, and 50 μg/mL) for another 24 hours. The effects of exosome treatment on HSC activation were evaluated through flow cytometry, differentiation assays, dynamic light scattering (DLS), transmission electron microscopy (TEM), RT-PCR, and western blot analysis.

Our study yields promising results, highlighting the potential therapeutic effects of WJ-MSC-derived exosomes on liver fibrosis. The dose-dependent decrease in fibrotic markers such as α-SMA, COLA1, and phosphorylated AKT protein in PDGFBB- treated HSC-T6 cells suggests that WJ-MSC exosomes exert an anti-fibrotic effect by inhibiting HSC activation.

These findings suggest that exosomes derived from WJ-MSCs hold therapeutic promise for liver fibrosis treatment by targeting key pathways involved in HSC activation and fibrogenesis. Further investigation into the underlying mechanisms of this anti-fibrotic effect and the potential clinical applications of WJ-MSC-derived exosomes in liver fibrosis management is warranted.

Transforming growth factor (TGF)-β1 is crucial in developing liver fibrosis. Curcumin has been shown to effectively halt the advancement of liver fibrosis by inhibiting the TGF-β1/Smad signaling pathway. Nevertheless, curcumin's impact on liver fibrosis regression remains unclear. This study explored the involvement of curcumin and TGF-β1 in the regression of liver fibrosis.

An experimental male C57BL/6 mice model included  6 treatment groups. The treatment groups were injected with carbon tetrachloride (CCl4) for 4 and 6 weeks to induce liver fibrosis, negative controls were injected with olive oil. After cessation of injection, 2 of the treatment groups were given curcumin for 2 weeks. TGF-β1 expression in liver cells was analyzed by real-time PCR assay. ELISA analyzed hydroxyproline liver tissue levels. Values of p<0.05 were regarded as statistically significant.

CCl4 injection induced liver fibrosis and significantly increased TGF-β1  expression and hydroxyproline levels in tissues. Curcumin administration decreased the expression of TGF-β1 and hydroxyproline levels in the liver and accelerated the regression of liver fibrosis.

Curcumin accelerates regression of liver fibrosis, likely through decreasing TGF-β1 expression in the liver.
Keywords: Liver fibrosis, Carbon tetrachloride, Curcumin, TGF-β1, Hydroxyproline.

Non‑alcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis (accumulation of fat in the liver to over 5% of its weight) in the absence of secondary causes of fat accumulation in the liver such as excessive alcohol use. NAFLD is divided into two types: non‑alcoholic fatty liver (NAFL) and non‑alcoholic steatohepatitis (NASH). Therefore, in this clinical guideline, we sought to determine general and important policies for this disease and modify its managment approaches. We adapted this guideline for the management of NAFLD in Isfahan Province. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of the Iranian Association of Gastroenterology and Hepatology. Biopsy is recommended as the most reliable method (gold standard) to diagnose steatohepatitis and fibrosis in patients with NAFLD. NAFLD fibrosis score (NFS) and fibrosis‑4 (FIB‑4) are recommended as the test with the highest predictive value for advanced fibrosis in patients with NAFLD compared to other serologic tests. Among the noninvasive methods used to assess liver fibrosis, transient elastography (TE) is preferable to other methods.

Liver diseases are a significant global health burden, causing roughly two million deaths annually. Liver Fibrosis, characterized by excessive extracellular matrix accumulation, is a major contributor to morbidity and mortality. Liver transplantation remains the gold standard for severe Fibrosis, but limitations exist. Cell therapy using Mesenchymal Stem Cells offers a promising alternative. Hepatocyte-like Cells derived from human adipose tissue Mesenchymal Stem Cells are particularly attractive due to their potential for liver regeneration. This study aimed to compare the effectiveness of Mesenchymal stem cells and Hepatocyte-like cells in treating CCl4-induced Liver Fibrosis in immunosuppressed mice.

Twenty C57BL/6 mice were divided into four groups: (1) control, (2) Fibrotic/untreated, (3 Mesenchymal stem cell-treated, (4) Hepatocyte-like cell-treated. Fibrosis was induced in groups 2-4 using intraperitoneal CCl4 injection in immunosuppressed (cyclosporine A) mice. Mesenchymal Stem Cells and Hepatocyte-like Cells were transplanted via tail vein injection in groups 3 and 4, respectively. Liver function tests were measured in all groups.

Both Mesenchymal Stem Cells and Hepatocyte-like Cells treatment improved liver function as evidenced by histopathology and biochemical analyses. In the Fibrotic group, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase, and total bilirubin levels were significantly elevated, while Albumin levels decreased compared to the control group. Following treatment, these parameters significantly improved (p < 0.05) in both treatment groups, suggesting partial regression of Fibrosis.

Our findings suggest that both Hepatocyte-like Cells and Mesenchymal Stem Cells have therapeutic potential for moderating Liver Fibrosis regression. However, Mesenchymal Stem Cells therapy may be more cost-effective and time-efficient.

Although bariatric surgery has been introduced as a therapeutic option for patients with obesity, there is still debate on the choice of procedure.

This study aimed to compare two types of bariatric surgeries in patients with obesity: Sleeve gastrectomy (SG) and single anastomosis sleeve ileal (SASI) bypass.

This observational prospective study compares patients with obesity who received either of the two types of bariatric surgeries at Ghadir or Shahid Faghihi hospitals in Shiraz from October 2019 to November 2020. Metabolic profiles, shear wave liver elastography (fibroscan), and cardiac evaluations (echocardiography) were performed at baseline and then seven to eleven months after the surgery.

Forty-five patients with obesity who had undergone SG and SASI bypass entered this study. Fasting plasma glucose (FPG) and triglycerides (TG) decreased during the follow-up in both groups (P = 0.032, P < 0.001, respectively). The fibrosis score decreased significantly from 6.45 (4.55) before surgery to 5.40 (3.60) after surgery, and the cardiac ejection fraction increased significantly from 61.5% (12.5%) before surgery to 65.0% (8.5%) after surgery following the SASI bypass compared to the SG (P = 0.034, P = 0.008, respectively).

Despite the lack of difference in weight reduction, SASI bypass, compared to sleeve gastrectomy, may result in a more rapid improvement in cardiac function and liver fibrosis.

The present study examined the protective potential of human adipose tissue-derived mesenchymal stem cells (hASCs) modified to overexpress alpha-1 antitrypsin (AAT), in a mouse model of the liver fibrosis.

For the treatment of end-stage liver diseases, cell therapy has emerged as a promising noninvasive alternative to liver transplantation. Mesenchymal stem cells (MSCs) are being evaluated due to their dual capabilities of promoting liver regeneration and modulating the pathogenic inflammation of the immune system.

Liver fibrosis was induced in mice via the intraperitoneal injection of carbon tetrachloride (CCl4). MSCs were extracted from the human adipose tissue. After stemness confirmation, the cells were transduced with the lentiviruses containing the AAT gene, and then injected into the mice’s tail vein. Fourteen days’ post-transplantation, mice were sacrificed, and blood and tissue samples were collected for analysis. Important liver enzymes, including alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin, and total bilirubin (TB), were measured. Histological studies were carried out using the hematoxylin and eosin (H&E), as well as Masson’s trichrome (MT) staining.

Compared to hASCs, treatment with AAT-hASCs resulted in greater reductions in ALT, AST, ALP, and TB, as well as normalized albumin levels. AAT-hASCs promoted enhanced liver regeneration histologically, likely attributable to anti-inflammatory and anti-proteolytic properties of AAT.

These findings indicate AAT-engineered hASCs as a promising cell-gene therapy candidate for further study in liver cirrhosis models.

 Macrophages play a significant role in both the development and regression of liver fibrosis, engaging in related pro-inflammatory and anti-inflammatory processes. In recent years, an increasing number of studies have elucidated the mechanisms by which macrophages influence liver fibrosis.

 This bibliometric analysis aims to investigate the research trends in liver fibrosis regulation by macrophages through a systematic literature review.

 We conducted a search for literature, including research articles and reviews, using the keywords 'liver fibrosis and macrophages' and 'liver cirrhosis and macrophages' in the Web of Science database, covering the period from 2007 to 2023. We retrieved and analyzed publications on liver fibrosis mediated by macrophages from the Web of Science Core Collection database on October 8, 2023. Visualization analysis was performed using CreateSpace (version 6.1.R6), VOSviewer (version 1.6.19), and Scimago Graphica (version 1.0.34.0).

 We identified a total of 1732 records in the WoSCC, of which 1664 papers were ultimately included in our analysis. China emerged as the country with the most significant number of publications, while Germany and the University of California San Diego stood out for their influence, with centralities of 0.41 and 0.14, respectively. Frank Tacke was identified as the most prolific author, contributing 49 papers. Hepatology was the journal with the highest number of publications and citations. The most frequently mentioned keywords in this field were liver fibrosis, expression, hepatic stellate cells, activation, inflammation, and macrophages.

 The study of macrophage-mediated liver fibrosis, particularly the mechanisms regulating the heterogeneity of hepatic macrophages, is a mature and promising research area. Macrophage-based therapies for liver fibrosis are anticipated to be crucial topics in the future. Bibliometric analysis offers valuable insights for future basic research directions and clinical practice.

This study aimed to explore the effectiveness of endoscopic ultrasound elastography (EUS-EG) in evaluating liver fibrosis.

The present study involved 11 patients with chronic liver disease who met study criteria and underwent EUS-EG, transabdominal ultrasound transient elastography (TUS-TE), and liver biopsy (LB) examinations at the same time. The Batts-Ludwig scoring system for liver fibrosis was used as the gold standard to analyze the correlation between the EUS-EG strain ratio (SR) and TUS-TE liver stiffness measurement with the pathological stage of liver fibrosis. The optimal cut-off value and area under the receiver operating characteristic curve (AUROC) of EUS-EG and TUS-TE for diagnosing liver fibrosis were calculated by drawing an ROC curve, and the corresponding sensitivity, specificity, and accuracy were also calculated.

Endoscopic ultrasound elastography was highly positively correlated with the pathological stage of liver fibrosis (S ≥ 2, r = 0.759, P = 0.01), and TUS-TE was positively correlated with the pathological stage of liver fibrosis (S ≥ 2, r = 0.857, P = 0.003). The optimal diagnostic cut-off value of cirrhosis undergoing EUS-EG and TUS-TE was 0.84 and 14.2 Kpa, respectively. When the pathological stage was S0 - S1, the sensitivity, specificity, accuracy, and AUROC value of TUS-TE in the diagnosis of liver fibrosis were higher than those of EUS-EG (96.2%, 83.3%, 81.8%, and 0.96 vs. 94.6%, 75%, 72.7%, and 0.8958). When the pathological stage was ≥ S2, the sensitivity, specificity, accuracy, and AUROC values of EUS-EG were higher than those of TUS-TE (100%, 87.5%, 88.9%, and 0.97 vs. 100%, 83.3%, 88.9%, and 0.94).

There is a superior correlation between EUS-EG combined with SR and the pathological stage of liver fibrosis, compared to TUS-TE, and it has the same or even higher diagnostic efficacy as TUS-TE. Larger prospective studies are needed to evaluate the clinical utility of this approach in the assessment of liver fibrosis.

 Hepatitis C and B virus infections significantly contribute to global chronic liver disease mortality.

 This study explores the role of serum markers (AST/ALT ratio, APRI Score, FIB-4 Score, and Forns index) in non-invasively assessing liver damage in patients with chronic hepatitis C and B.

 In this single-center, retrospective, observational study, we analyzed data from 327 patients to establish correlations between serological markers and fibrosis grade using Spearman's correlation. Receiver operator characteristic (ROC) analysis evaluated the ability of these markers to predict advanced fibrosis.

 In hepatitis B and C cohorts, all markers show significant positive correlations with liver fibrosis (P < 0.001). FIB-4 and the Forns index exhibit moderate correlation (Spearman’s rho 0.48), while AST/ALT and APRI score show mild correlation (Spearman’s rho 0.21 and 0.31). In hepatitis C, the Forns index (0.814) and FIB-4 (0.80) outperform other markers. In hepatitis B, Forns (AUC = 0.73), APRI (AUC = 0.68), and FIB-4 (AUC = 0.68) demonstrate significant predictive ability.

 FIB-4 and the Forns index hold clinical significance as fibrosis biomarkers in the management of chronic viral hepatitis. FIB-4 is a universal marker, while the interpretation of the Forns index requires consideration of the etiology of chronic viral hepatitis.

 This study aimed to explore the effectiveness of endoscopic ultrasound elastography (EUS-EG) in evaluating liver fibrosis.

 The present study involved 11 patients with chronic liver disease who met study criteria and underwent EUS-EG, transabdominal ultrasound transient elastography (TUS-TE), and liver biopsy (LB) examinations at the same time. The Batts-Ludwig scoring system for liver fibrosis was used as the gold standard to analyze the correlation between the EUS-EG strain ratio (SR) and TUS-TE liver stiffness measurement with the pathological stage of liver fibrosis. The optimal cut-off value and area under the receiver operating characteristic curve (AUROC) of EUS-EG and TUS-TE for diagnosing liver fibrosis were calculated by drawing an ROC curve, and the corresponding sensitivity, specificity, and accuracy were also calculated.

 Endoscopic ultrasound elastography was highly positively correlated with the pathological stage of liver fibrosis (S ≥ 2, r = 0.759, P = 0.01), and TUS-TE was positively correlated with the pathological stage of liver fibrosis (S ≥ 2, r = 0.857, P = 0.003). The optimal diagnostic cut-off value of cirrhosis undergoing EUS-EG and TUS-TE was 0.84 and 14.2 Kpa, respectively. When the pathological stage was S0 - S1, the sensitivity, specificity, accuracy, and AUROC value of TUS-TE in the diagnosis of liver fibrosis were higher than those of EUS-EG (96.2%, 83.3%, 81.8%, and 0.96 vs. 94.6%, 75%, 72.7%, and 0.8958). When the pathological stage was ≥ S2, the sensitivity, specificity, accuracy, and AUROC values of EUS-EG were higher than those of TUS-TE (100%, 87.5%, 88.9%, and 0.97 vs. 100%, 83.3%, 88.9%, and 0.94).

 There is a superior correlation between EUS-EG combined with SR and the pathological stage of liver fibrosis, compared to TUS-TE, and it has the same or even higher diagnostic efficacy as TUS-TE. Larger prospective studies are needed to evaluate the clinical utility of this approach in the assessment of liver fibrosis.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in the world. Previous studies revealed that cholecystectomy may be considered a risk factor for the development of NAFLD. The aim of this study was to compare the amount of liver fibrosis, determined by elastography, between patients with NAFLD with and without a history of cholecystectomy.

In this descriptive-analytical cross-sectional study, 50 patients with NAFLD were divided into two groups: one with a history of cholecystectomy and the other without. No significant differences were found between these two groups in terms of age or sex distribution. Liver fibrosis was measured for all patients using an elastography imaging system. Subsequently, the data related to liver fibrosis, along with the demographic information of the patients, were statistically analyzed using SPSS software version 22.

The mean elastography score in all patients was 10.66 ± 12.18 kPa (the elasticity scale ranging from 3.80 to 66.40 kPa). The group with a history of cholecystectomy had a significantly higher mean elastography score (13.39 ± 16.20 kPa) compared with the group without cholecystectomy (7.93 ± 4.99 kPa) (P = 0.02). Additionally, there was a significant positive correlation between body mass index (BMI) and the mean elastography score in the group of patients with a history of cholecystectomy.

The mean elastography score of patients with NAFLD with a history of cholecystectomy was approximately twice as high as that of non-cholecystectomy patients.

Persistent liver damage contributes to the development of liver fibrosis, marked by an accumulation of extracellular matrix. Macrophages play a pivotal role in this process, with the CCL2-CCR2 and CX3CR1-CX3CL1 axes serving as key regulators of macrophage recruitment, liver infiltration, and differentiation. In this study, utilizing a rat model of carbon tetrachloride (CCL4)-induced liver fibrosis, we aimed to investigate the impact of imatinib and bone marrow-derived mesenchymal stem cells (BM-MSCs) on the expression of these axis.

Sixteen Sprague-Dawley rats were divided into four groups: healthy, liver fibrosis, imatinib-recipient, and BM-MSC-recipient. Treatment effects were evaluated using histopathology and Sirus-red staining. Quantitative real-time PCR was employed to analyze changes in the expression of the genes CCL2, CCR2, CX3CL1, and CX3CR1.

Histopathological assessments revealed the efficacy of imatinib and BM-MSCs in mitigating liver fibrosis. Our findings demonstrated a significant reduction in CCL2 and CCR2 expression in both imatinib and BM-MSCs treatment groups compared to the liver fibrosis group. Conversely, the gene expression of CX3CL1 and CX3CR1 increased in both therapeutic groups compared to the liver fibrosis groups.

The notable decrease in CCL2-CCR2 genes in both therapeutic groups suggests that BM-MSCs and imatinib may contribute to a decline in inflammatory macrophages within the liver. The lower CCL2-CCR2 expression in imatinib-recipient rats indicates better efficacy in modulating the recruitment of inflammatory macrophages. The elevated expression of CX3CL1 in BM-MSC-recipient rats suggests a greater impact on the polarization of LY6Chigh (inflammatory) to LY6Clow (anti-inflammatory) macrophages, warranting further investigation.

Liver tissue malfunction is a severe worldwide health concern that arises from various chronic liver conditions. The goal of this investigation was to look into the anti-fibrotic effect of apigenin (APG), an antioxidant found in various plants, versus thioacetamide (TAA)-triggered hepatic scarring in rats and the potential mechanisms behind it.

TAA was administered thrice weekly (100 mg/kg, i.p.) for two weeks to produce hepatic scarring. APG was administered after TAA for 14 days (5 or 10 mg/kg, orally). Thereafter, hepatic liver enzymes, inflammatory markers, fibrotic indicators, and histopathological changes were evaluated.

TAA increased the activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), reduced albumin and total protein, elevated hepatic level of lipid peroxidation, focal adhesion kinase (FAK), hypoxia-inducible factor-1α (HIF-1α), and inflammatory cytokines, decreased interleukin-10 (IL-10), reduced hepatic expression of peroxisome proliferator-activated receptor gamma (PPARγ) and nuclear factor-erythroid factor 2-related factor 2 (Nrf2), and elevated serine-threonine protein kinase (AKT) expression. Furthermore, TAA increased hepatic contents of collagen I, connective tissue growth factor (CTGF), hydroxyproline, and alpha-smooth muscle actin. On the other hand, APG evaded these changes and mitigated the harmful effects of TAA in a dose-dependent way. Histopathological and immunohistochemical observations reinforced these biochemical outcomes.

APG can potentially alleviate liver fibrosis mediated via FAK and HIF1 inhibiting signaling pathways.