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Full-Text Articles in Hepatology

Management Of Recurrent Hepatitis C After Liver Transplantation: A Concise Review, Gyongyi Szabo, Eliezer Katz, Herbert Bonkovsky Apr 2010

Management Of Recurrent Hepatitis C After Liver Transplantation: A Concise Review, Gyongyi Szabo, Eliezer Katz, Herbert Bonkovsky

Gyongyi Szabo

Recurrent hepatitis C infection and subsequent graft failure are increasingly recognized problems after orthotopic liver transplantation. Although many prospective therapeutic, controlled trials in primary hepatitis C disease have been reported, large-scale studies are yet to be performed in patients with posttransplant recurrent hepatitis C after liver transplantation. In this review, we summarize the current literature on the therapeutic approaches for recurrent hepatitis C and discuss the results of published studies on therapy with ribavirin or interferon (IFN) alone and on combination therapy with IFN plus ribavirin. Further, we discuss results of prophylactic approaches to the problem of recurrent hepatitis C …


A Recent Perspective On Alcohol, Immunity, And Host Defense, Gyongyi Szabo, Pranoti Mandrekar Apr 2010

A Recent Perspective On Alcohol, Immunity, And Host Defense, Gyongyi Szabo, Pranoti Mandrekar

Gyongyi Szabo

BACKGROUND: Multiple line of clinical and experimental evidence demonstrates that both acute, moderate, and chronic, excessive alcohol use result in various abnormalities in the functions of the immune system.

METHODS: Medline and PubMed databases were used to identify published reports with particular interest in the period of 2000-2008 in the subject of alcohol use, infection, inflammation, innate, and adaptive immunity.

RESULTS: This review article summarizes recent findings relevant to acute or chronic alcohol use-induced immunomodulation and its consequences on host defense against microbial pathogens and tissue injury. Studies with in vivo and in vitro alcohol administration are both discussed. The …


Pattern Recognition Receptors: A Contemporary View On Liver Diseases, Gyongyi Szabo, Angela Dolganiuc, Pranoti Mandrekar Apr 2010

Pattern Recognition Receptors: A Contemporary View On Liver Diseases, Gyongyi Szabo, Angela Dolganiuc, Pranoti Mandrekar

Gyongyi Szabo

Pattern recognition receptors (PRRs) function as sensors of microbial danger signals enabling the vertebrate host to initiate an immune response. PRRs are present not only in immune cells but also in liver parenchymal cells and the complexity of the cell populations provide unique aspects to pathogen recognition and tissue damage in the liver. This review discusses the role of different PRRs in pathogen recognition in the liver, and focuses on the role of PRRs in hepatic inflammation, cholestasis, ischemia, repair and fibrosis. PRRs as novel therapeutic targets are evaluated.


Severe Cholestatic Hepatitis Caused By Thiazolidinediones: Risks Associated With Substituting Rosiglitazone For Troglitazone, Herbert Bonkovsky, Riad Azar, Steven Bird, Gyongyi Szabo, Barbara Banner Apr 2010

Severe Cholestatic Hepatitis Caused By Thiazolidinediones: Risks Associated With Substituting Rosiglitazone For Troglitazone, Herbert Bonkovsky, Riad Azar, Steven Bird, Gyongyi Szabo, Barbara Banner

Gyongyi Szabo

Troglitazone maleate (Rezulin) has been associated with severe hepatotoxicity, which led to its withdrawal from the U.S. market in March 2000. Rosiglitazone maleate (Avandia) is being marketed as a safe alternative in the treatment of type 2 diabetes mellitus. We report a case of severe thiazolidinedione-induced cholestatic hepatitis in a 56-year-old female patient at a university hospital who was given rosiglitazone, 8 mg/day, after she developed milder hepatotoxicity while taking troglitazone. Rosiglitazone was discontinued, and the patient was treated with prednisone, azathioprine, and ursodiol. Clinical evaluation and liver biopsy were performed and liver function tests were monitored. After being switched …


Viral And Host Factors Induce Macrophage Activation And Loss Of Toll-Like Receptor Tolerance In Chronic Hcv Infection, Angela Dolganiuc, Oxana Norkina, Karen Kodys, Donna Catalano, Gennadiy Bakis, Christopher Marshall, Pranoti Mandrekar, Gyongyi Szabo Apr 2010

Viral And Host Factors Induce Macrophage Activation And Loss Of Toll-Like Receptor Tolerance In Chronic Hcv Infection, Angela Dolganiuc, Oxana Norkina, Karen Kodys, Donna Catalano, Gennadiy Bakis, Christopher Marshall, Pranoti Mandrekar, Gyongyi Szabo

Gyongyi Szabo

BACKGROUND and AIMS: Persistent inflammation contributes to progression of liver damage in chronic HCV (cHCV) infection. Repeated exposure to toll-like receptor (TLR) ligands results in tolerance, a protective mechanism aimed at limiting inflammation.

METHODS: Monocytes/macrophages were repeatedly stimulated via proinflammatory cytokine-inducing TLRs and evaluated for activation markers.

RESULTS: Unlike monocytes of controls or patients with nonalcoholic steatohepatitis, the monocytes of cHCV patients were hyperresponsive and failed to show homo- or heterotolerance to TLR ligands, manifested by elevated tumor necrosis factor (TNF)-alpha production. Serum levels of interferon (IFN)-gamma, endotoxin (TLR4 ligand), and HCV core protein (TLR2 ligand) were elevated in cHCV …


Herbal Product Use By Persons Enrolled In The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (Halt-C) Trial, Leonard Seeff, Teresa Curto, Gyongyi Szabo, Gregory Everson, Herbert Bonkovsky, Jules Dienstag, Mitchell Shiffman, Karen Lindsay, Anna Lok, Adrian Di Bisceglie, William Lee, Marc Ghany Apr 2010

Herbal Product Use By Persons Enrolled In The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (Halt-C) Trial, Leonard Seeff, Teresa Curto, Gyongyi Szabo, Gregory Everson, Herbert Bonkovsky, Jules Dienstag, Mitchell Shiffman, Karen Lindsay, Anna Lok, Adrian Di Bisceglie, William Lee, Marc Ghany

Gyongyi Szabo

Herbal products, used for centuries in Far Eastern countries, are gaining popularity in western countries. Surveys indicate that persons with chronic hepatitis C (CHC) often use herbals, especially silymarin (milk thistle extract), hoping to improve the modest response to antiviral therapy and reduce side effects. The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial, involving persons with advanced CHC, nonresponders to prior antiviral therapy but still willing to participate in long-term pegylated interferon treatment, offered the opportunity to examine the use and potential effects of silymarin. Among 1145 study participants, 56% had never taken herbals, 21% admitted past use, …


Additive Inhibition Of Dendritic Cell Allostimulatory Capacity By Alcohol And Hepatitis C Is Not Restored By Dc Maturation And Involves Abnormal Il-10 And Il-2 Induction, Angela Dolganiuc, Karen Kodys, Andrea Kopasz, Christopher Marshall, Pranoti Mandrekar, Gyongyi Szabo Apr 2010

Additive Inhibition Of Dendritic Cell Allostimulatory Capacity By Alcohol And Hepatitis C Is Not Restored By Dc Maturation And Involves Abnormal Il-10 And Il-2 Induction, Angela Dolganiuc, Karen Kodys, Andrea Kopasz, Christopher Marshall, Pranoti Mandrekar, Gyongyi Szabo

Gyongyi Szabo

BACKGROUND: Excessive alcohol use results in impaired immunity, and it is associated with increased incidence and progression of chronic hepatitis C virus (HCV) infection. Here we investigated the effects of HCV infection and alcohol on myeloid dendritic cells (DC) that are critical in antiviral immunity.

METHODS: Immature and mature DCs were generated from monocytes of chronic HCV infected patients (HCV-DC) and controls (N-DC) with IL-4 plus granulocyte-macrophage colony stimulating factor (GM-CSF) in the presence or absence of alcohol (25 mM). DC allostimulatory capacity was tested in mixed lymphocyte reaction (MLR) and cytokine production by ELISA.

RESULTS: Allostimulatory capacity of HCV-DCs …


Pathogenic Interactions Between Alcohol And Hepatitis C, Gyongyi Szabo Apr 2010

Pathogenic Interactions Between Alcohol And Hepatitis C, Gyongyi Szabo

Gyongyi Szabo

Alcohol is the most commonly abused substance in the United States, and alcohol abuse leads to alcoholic liver disease, a long recognized major public health concern. The high prevalence of chronic hepatitis C virus (HCV) infection, along with the clinical observation that HCV infection is common in alcoholic patients presenting with liver disease, has directed attention to the interaction between alcohol and HCV infection. Clinical studies have identified alcohol use as an independent risk factor for progression of fibrosis in chronic HCV infection. Experimental evidence suggests additive inhibitory effects between HCV and alcohol on antiviral immune responses. In addition, specific …


Complete Resolution Of Gastric Amyloidosis After Autologous Stem Cell Transplantation., Dinu Cherian, Kristin Braun, Neal Flomenberg, Juan P. Palazzo, David Kastenberg Sep 2008

Complete Resolution Of Gastric Amyloidosis After Autologous Stem Cell Transplantation., Dinu Cherian, Kristin Braun, Neal Flomenberg, Juan P. Palazzo, David Kastenberg

Division of Gastroenterology and Hepatology Faculty Papers

A 48-year-old female with multiple myeloma (MM) and amyloidosis presented with massive upper gastrointestinal (GI) bleeding one week after autologous stem cell transplantation (autologous-SCT). Esophagogastroduodenoscopy (EGD) demonstrated necrotic, purple, pigmented, friable lesions throughout the stomach (Figure 1a), along with a bleeding ulcer in the cardia (Figure 1b, Video 1) which was successfully treated with epinephrine (1:10,000) injections. Biopsies demonstrated nodular amyloid deposition (Figures 2) which was Congo red positive. The patient had no further hematemesis and was discharged home 4 days later. Ten months after autologous-SCT, EGD revealed a normal stomach (Figure 3, Video 2) with …