Anna Egresi

Antioxidánsok – antioxidánssokk: tények és kérdések, 2015

In the past years great importance has been attributed to antioxidant therapy in the prevention and treatment of disorders developed in connection with oxidative stress. After initial success, undesirable effects, toxicities, and prooxidant effects of antioxidants were reported [CARET, ATBC study]. In addition, metaanalyses failed to confirm the role of antioxidant supplementation in the primary and secondary prevention. The authors review the prooxidant effects of antioxidants, and their role in cell signalling and cell process modulation. Finally, the authors summarize possible explanations why combined use of antiooxidants is more favourable.

A bél–máj tengely vizsgálata colitis ulcerosában. Retrospektív tanulmány

INTRODUCTION Examination of the gut-liver axis came into the spotlight worldwide. Liver enzyme elevations are commonly seen in patients with inflammatory bowel disease (IBD), which is a diagnostic challenge in everyday clinical practice. Liver and biliary diseases are common extra-intestinal manifestations in Crohns disease and ulcerative colitis. The assessment of routine liver function tests could be an inaccurate reflection of liver damage, so its prevalence could be underestimated. There would be a need for non-invasive biomarkers and/or scoring systems, which would help the diagnosis of liver damage associated with intestinal diseases. AIM In our work we considered to highlight the importance of the gut-liver axis significance. We used data of patients suffering from ulcerative colitis, as a model for bowel diseases to understand the underlying factors of the pathogenesis of hepatobiliary manifestations. METHOD In our retrospective study, we investigated the data of 100 ulcerative colitis patients (male = 46, female = 54) (mean age: 42.5 ± 12.7) and compared to healthy controls (n = 42) (male = 17, female = 25) (mean age: 40.2 ± 13.5). Liver function tests (ALT, AST, GGT, ALP, bilirubin, albumin, thrombocyte), bile acid levels were determinated, and various free radical markers (global, enzymatic) were used to assess the redox homeostasis of patients. Hydrogen donor activity, reducing power, superoxide dismutase and glutathione peroxidase activity, total antioxidant status and induced chemiluminescence were measured, considering that the patients received 5-aminosalicilate and/or azathioprin and elemental diet treatment. RESULTS Liver function parameters were increased in ulcerative colitis patients, and total antioxidant status, as well. Reducing power significantly decreased, but there was no significant difference compared to the control group of glutathione peroxidase and H-donor activity, we observed only tendentious decrease. The antioxidant protection of more than 54% of patients had a significantly lower rate, according to all the parameters. With chemiluminescence measurement we measured better free radical scavenging capacity, both in plasma and in erythrocytes as a result of the therapy, however, it showed an increase of superoxide dismutase activity, which warns of inflammatory processes. The cause of the decrease in bile acid levels found in the group of ulcerative colitis patients, can be the accelerated peristaltic. CONCLUSIONS In the daily routine, liver enzyme values do not give an accurate picture of liver damage associated with ulcerative colitis. With the help of various specific parameters determined by us, we can estimate the background processes of the gut-liver axis alterations. The decrease in bile acid levels can be a predictive factor in ulcerative colitis. Our work highlights the need of non-invasive screening for liver diseases in inflammatory bowel disease. Orv Hetil. 2017; 158(26): 1014-1021.INTRODUCTION Examination of the gut-liver axis came into the spotlight worldwide. Liver enzyme elevations are commonly seen in patients with inflammatory bowel disease (IBD), which is a diagnostic challenge in everyday clinical practice. Liver and biliary diseases are common extra-intestinal manifestations in Crohns disease and ulcerative colitis. The assessment of routine liver function tests could be an inaccurate reflection of liver damage, so its prevalence could be underestimated. There would be a need for non-invasive biomarkers and/or scoring systems, which would help the diagnosis of liver damage associated with intestinal diseases. AIM In our work we considered to highlight the importance of the gut-liver axis significance. We used data of patients suffering from ulcerative colitis, as a model for bowel diseases to understand the underlying factors of the pathogenesis of hepatobiliary manifestations. METHOD In our retrospective study, we investigated the data of 100 ulcerative colitis patients (male = 46, female = 54) (mean age: 42.5 ± 12.7) and compared to healthy controls (n = 42) (male = 17, female = 25) (mean age: 40.2 ± 13.5). Liver function tests (ALT, AST, GGT, ALP, bilirubin, albumin, thrombocyte), bile acid levels were determinated, and various free radical markers (global, enzymatic) were used to assess the redox homeostasis of patients. Hydrogen donor activity, reducing power, superoxide dismutase and glutathione peroxidase activity, total antioxidant status and induced chemiluminescence were measured, considering that the patients received 5-aminosalicilate and/or azathioprin and elemental diet treatment. RESULTS Liver function parameters were increased in ulcerative colitis patients, and total antioxidant status, as well. Reducing power significantly decreased, but there was no significant difference compared to the control group of glutathione peroxidase and H-donor activity, we observed only tendentious decrease. The antioxidant protection of more than 54% of patients had a significantly lower rate, according to all the parameters. With chemiluminescence measurement we measured better free radical scavenging capacity, both in plasma and in erythrocytes as a result of the therapy, however, it showed an increase of superoxide dismutase activity, which warns of inflammatory processes. The cause of the decrease in bile acid levels found in the group of ulcerative colitis patients, can be the accelerated peristaltic. CONCLUSIONS In the daily routine, liver enzyme values do not give an accurate picture of liver damage associated with ulcerative colitis. With the help of various specific parameters determined by us, we can estimate the background processes of the gut-liver axis alterations. The decrease in bile acid levels can be a predictive factor in ulcerative colitis. Our work highlights the need of non-invasive screening for liver diseases in inflammatory bowel disease. Orv Hetil. 2017; 158(26): 1014-1021.

A bélflóra patofiziológai jelentosége és szerepe mint terápiás célpont májbetegségekben

The community of microorganisms in the intestine, namely gut microbiome lives in symbiosis with the host, contributing to its homeostasis and influencing it simultaneously. It can be suspected that gut microbiome plays a central role in the pathophysiology of intestinal and extraintestinal diseases: determining their development, progress and complications. Recently, intestinal microbiome has become a highlighted field of interest and important topic in research, especially in hepatology. It is in the focus of relevant research as the liver is the organ which meets nutrients, bacterial components, toxins and metabolites at first, as a filter. The evolvement of different liver diseases - just like alcoholic and non-alcoholic fatty liver disease, steatohepatitis, cirrhosis or hepatocellular carcinoma - correlates with the changed composition and activity of gut microbiome. Thus, it can be hypothesized that pre-, pro- and antibiotics could have an impact on the treatment of these diseases. In our review article, the relationship between intestinal flora and liver diseases with different etiologies as well as therapeutic possibilities are discussed. Orv Hetil. 2018; 159(36): 1465-1474.

Metal- and redox homeostasis in prostate cancer with vitamin D3 supplementation

Vitamin D3 supplementation has a beneficial effect on cancerous patients, although it can influence the redox- and metal homeostasis. The aim of our investigation was to demonstrate the effect of vitamin D3 consumption on the redox- and metal homeostasis in prostate cancer, because of the recommended daily dose increased from 200 IU to 2000 IU in recent years in Hungary. Forty-three volunteers were involved in the study. The grouping was applied according to the clinical routine laboratory parameters (vitamin D3) and the tumor markers (PSA, fPFA). Patients were divided into 5 groups: (A) patient control (N = 8), (B) patient control with vitamin D3 treatment (N = 9), (C) high-risk prostate cancer group (N = 6), (D) high-risk prostate cancer group with vitamin D3 treatment (N = 8) and (E) vitamin D3 treated cancerous group with androgen deprivation therapy (N = 11). The element concentrations were determined with ICP-OES. Among the redox parameters, free radical scavenging capacity and H-donating ability were determined with luminometry and spectrometry. Vitamin D3 treatment caused differences in the metal- and redox homeostasis in either patient control and cancerous groups. The concentration of Fe, Cr, and Pb significantly increased in the erythrocytes of prostate cancer patients. According to the higher scavenging capacity by vitamin D3 treatment, it seems that vitamin D3 helps to equilibrate the redox homeostasis that could affect the outcome of cancer positively. However, the tendency in the metal element status does not give a clear explanation of cancers outcome, but the accumulation of Pb by vitamin D3 supplementation needs to be taken into more serious consideration in set terms of occupational diseases.

Extrahepaticus manifesztációk idült hepatitis C-vírus-fertőzöttekben

The importance of chronic hepatitis C infection is significant. 3% of the Worlds population is infected. There is at least one extrahepatic manifestation in 50% of HCV patients, which makes the prognosis and mortality worse. The pathomechanisms included are cryoglobulin production, immunmechanisms, and direct viral effects. The authors summarize the main extrahepatic manifestations, as well as treatment possibilities. The aim is to draw attention to this colourful infection in order to improve the recognition in the era of the new effective direct antiviral agents. Orv. Hetil., 2017, 158(16), 603-612.

Az idült májbetegségek progressziójához vezető folyamatok

As the result of various effects (viruses, metabolic diseases, nutritional factors, toxic agents, autoimmune processes) abnormal liver function, liver steatosis and connective tissue remodeling may develop. Progression of this process is complex including various pathways and a number of factors. The authors summarize the factors involved in the progression of chronic liver disease. They describe the role of cells and the produced inflammatory mediators and cytokines, as well as the relationship between the disease and the intestinal flora. They emphasize the role of oxidative stress, mitochondrial dysfunction and cell death in disease progression. Insulin resistance and micro-elements (iron, copper) in relation to liver damage are also discussed, and genetic and epigenetic aspects underlying disease progression are summarized. Discovery of novel treatment options, assessment of the effectiveness of treatment, as well as the success and proper timing of liver transplantation may depend on a better understanding of the process of disease progression.

Comments on “The severity of non-alcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota”

Non-alcoholic fatty liver disease (NAFLD) has a rising prevalence worldwide. It is characterized with lipid deposition in hepatocytes that is unrelated to alcohol consumption. Insulin resistance and oxidative damage plays a key role in its pathogenesis. NAFLD is a complex disease, classified in simple steatosis (SS) and non-alcoholic steatohepatitis (NASH). Lifestyle changes and treatment of hyperinsulinaemia could reverse SS. However, 20-30% of NAFLD patients develop to NASH, which could lead to liver fibrosis, cirrhosis and cancer.

A májfibrosis nem invazív jellemzésének lehetoségei a klinikai adatok tükrében

Liver cirrhosis is one of the leading causes of death worldwide. Liver biopsy is considered as the gold standard for the diagnosis of chronic liver diseases. Studies have focused on non-invasive markers for liver fibrosis because of the dangers and complications of liver biopsy. The authors review the non-invasive direct as well as indirect methods for liver fibrosis assessment and present the positive and negative predictive value, sensitivity and specificity of those. Clinical utilities of transient elastography (Fibrsocan) is also reviewed. Non-invasive methods are useful in the assessment of liver fibrosis, monitoring disease progression and therapeutic response. Their accuracy can be increased by the combined or sequential use of non-invasive markers.A majzsugor vilagszerte a vezető halalokok koze tartozik. A maj szovettani vizsgalata ma is a majbetegsegek korismejenek arany standardja. Ujabban a figyelem a maj kotőszovetes atepuleset jellemző nem invaziv probakra es meresekre iranyul, a majbiopszia veszelyei, szovődmenyei miatt. A szerzők osszefoglalo kozlemenyukben attekintik a maj kotőszovetes atepulesenek nem invaziv kozvetlen es kozvetett jellemzesenek lehetősegeit. Bemutatjak a probak sajatossagait (pozitiv–negativ prediktiv ertek, erzekenyseg, fajlagossag). Kiternek a tranziens elasztografia (Fibroscan) klinikai alkalmazasi lehetősegeire is. Az ismertetett modszerek kozott tobb hasznos, nem invaziv eljaras van, amelyek jol hasznalhatok a majfibrosis ertekeleseben, a betegseglefolyas es a terapias valasz nyomon koveteseben. Pontossaguk kombinalt, illetve szekvencialis alkalmazasukkal novelhető. Orv. Hetil., 2015, 156(2), 43–52.

A májfibrosis nem invazív jellemzésének lehetőségei a klinikai adatok tükrében@@@Options of non-invasive assessment of liver fibrosis based on the clinical data

Liver cirrhosis is one of the leading causes of death worldwide. Liver biopsy is considered as the gold standard for the diagnosis of chronic liver diseases. Studies have focused on non-invasive markers for liver fibrosis because of the dangers and complications of liver biopsy. The authors review the non-invasive direct as well as indirect methods for liver fibrosis assessment and present the positive and negative predictive value, sensitivity and specificity of those. Clinical utilities of transient elastography (Fibrsocan) is also reviewed. Non-invasive methods are useful in the assessment of liver fibrosis, monitoring disease progression and therapeutic response. Their accuracy can be increased by the combined or sequential use of non-invasive markers.A majzsugor vilagszerte a vezető halalokok koze tartozik. A maj szovettani vizsgalata ma is a majbetegsegek korismejenek arany standardja. Ujabban a figyelem a maj kotőszovetes atepuleset jellemző nem invaziv probakra es meresekre iranyul, a majbiopszia veszelyei, szovődmenyei miatt. A szerzők osszefoglalo kozlemenyukben attekintik a maj kotőszovetes atepulesenek nem invaziv kozvetlen es kozvetett jellemzesenek lehetősegeit. Bemutatjak a probak sajatossagait (pozitiv–negativ prediktiv ertek, erzekenyseg, fajlagossag). Kiternek a tranziens elasztografia (Fibroscan) klinikai alkalmazasi lehetősegeire is. Az ismertetett modszerek kozott tobb hasznos, nem invaziv eljaras van, amelyek jol hasznalhatok a majfibrosis ertekeleseben, a betegseglefolyas es a terapias valasz nyomon koveteseben. Pontossaguk kombinalt, illetve szekvencialis alkalmazasukkal novelhető. Orv. Hetil., 2015, 156(2), 43–52.

Options of non-invasive assessment of liver fibrosis based on the clinical data

Liver cirrhosis is one of the leading causes of death worldwide. Liver biopsy is considered as the gold standard for the diagnosis of chronic liver diseases. Studies have focused on non-invasive markers for liver fibrosis because of the dangers and complications of liver biopsy. The authors review the non-invasive direct as well as indirect methods for liver fibrosis assessment and present the positive and negative predictive value, sensitivity and specificity of those. Clinical utilities of transient elastography (Fibrsocan) is also reviewed. Non-invasive methods are useful in the assessment of liver fibrosis, monitoring disease progression and therapeutic response. Their accuracy can be increased by the combined or sequential use of non-invasive markers.A majzsugor vilagszerte a vezető halalokok koze tartozik. A maj szovettani vizsgalata ma is a majbetegsegek korismejenek arany standardja. Ujabban a figyelem a maj kotőszovetes atepuleset jellemző nem invaziv probakra es meresekre iranyul, a majbiopszia veszelyei, szovődmenyei miatt. A szerzők osszefoglalo kozlemenyukben attekintik a maj kotőszovetes atepulesenek nem invaziv kozvetlen es kozvetett jellemzesenek lehetősegeit. Bemutatjak a probak sajatossagait (pozitiv–negativ prediktiv ertek, erzekenyseg, fajlagossag). Kiternek a tranziens elasztografia (Fibroscan) klinikai alkalmazasi lehetősegeire is. Az ismertetett modszerek kozott tobb hasznos, nem invaziv eljaras van, amelyek jol hasznalhatok a majfibrosis ertekeleseben, a betegseglefolyas es a terapias valasz nyomon koveteseben. Pontossaguk kombinalt, illetve szekvencialis alkalmazasukkal novelhető. Orv. Hetil., 2015, 156(2), 43–52.