Ashraf Elbahrawy

Continuous cell supply from a Sox9-expressing progenitor zone in adult liver, exocrine pancreas and intestine

The liver and exocrine pancreas share a common structure, with functioning units (hepatic plates and pancreatic acini) connected to the ductal tree. Here we show that Sox9 is expressed throughout the biliary and pancreatic ductal epithelia, which are connected to the intestinal stem-cell zone. Cre-based lineage tracing showed that adult intestinal cells, hepatocytes and pancreatic acinar cells are supplied physiologically from Sox9-expressing progenitors. Combination of lineage analysis and hepatic injury experiments showed involvement of Sox9-positive precursors in liver regeneration. Embryonic pancreatic Sox9-expressing cells differentiate into all types of mature cells, but their capacity for endocrine differentiation diminishes shortly after birth, when endocrine cells detach from the epithelial lining of the ducts and form the islets of Langerhans. We observed a developmental switch in the hepatic progenitor cell type from Sox9-negative to Sox9-positive progenitors as the biliary tree develops. These results suggest interdependence between the structure and homeostasis of endodermal organs, with Sox9 expression being linked to progenitor status.

High false-negative rate of anti-HCV among Egyptian patients on regular hemodialysis

Routine serological testing for hepatitis C virus (HCV) infection among hemodialysis (HD) patients is currently recommended. A dilemma existed on the value of serology because some investigators reported a high rate of false‐negative serologic testing. In this study, we aimed to detect the false‐negative rate of anti‐HCV among Egyptian HD patients. Seventy‐eight HD patients, negative for anti‐HCV, anti‐HIV, and hepatitis B surface antigen, were tested for HCV RNA by reverse transcriptase polymerase chain reaction (RT‐PCR). In the next step, the viral load was quantified by real‐time PCR in RT‐PCR‐positive patients. Risk factors for HCV infection, as well as clinical and biochemical indicators of liver disease, were compared between false‐negative and true‐negative anti‐HCV HD patients. The frequency of false‐negative anti‐HCV was 17.9%. Frequency of blood transfusion, duration of HD, dialysis at multiple centers, and diabetes mellitus were not identified as risk factors for HCV infection. The frequency of false‐negative results had a linear relation to the prevalence of HCV infection in the HD units. Timely identification of HCV within dialysis units is needed in order to lower the risk of HCV spread within the HD units. The high false‐negative rate of anti‐HCV among HD patients in our study justifies testing of a large scale of patients for precious assessment of effectiveness of nucleic acid amplification technology testing in screening HD patient.

Conventional Narrow-Band Imaging Has Good Correlation with Histopathological Severity of Helicobacter pylori Gastritis

Background and AimNarrow-band imaging (NBI) is an optical image enhancement technique that enhances the vessels and patterns of gastric mucosal surface. Here we aim to test the diagnostic role of conventional NBI (C-NBI) in identifying Helicobacter pylori (HP) infection, severity of gastritis, and gastric atrophy.MethodsInitially, the endoscopic records of 300 patients were retrospectively searched for specific C-NBI gastric mucosal patterns, where five different C-NBI mucosal patterns were identified. In a second step, 20 patients with different C-NBI mucosal patterns were subjected to gastric mucosal biopsy for HP testing and histopathological assessment.ResultsFive different histopathological grades of HP gastritis, in terms of grade of gastric atrophy, intestinal metaplasia, infiltration by inflammatory cells, and density of HP infection, were recognized among the different C-NBI mucosal patterns.ConclusionsC-NBI seems to be a promising method for HP infection identification and gastric cancer risk stratification of patients.

Antibody levels against hepatitis B virus after hepatitis B vaccination in Egyptian diabetic children and adolescents.

Background: The remarkable effectiveness of universal infantile hepatitis B (HB) vaccination is well documented in many countries. Nevertheless, the influence of insulin-dependent diabetes mellitus (IDDM) on the sero-protective level of antibody to hepatitis B surface antigen (anti-HBs) after HB vaccination has not been investigated in Egyptian children. The aim of this study was to investigate long-term anti-HBs sero-protective levels after infantile HB vaccination in Egyptian IDDM children. Results: The mean age of the healthy children was 10.86 ± 1.21 y (range, 5.5–15 y); 49 (45.8%) were boys and 58 (54.2%) were girls. The mean age of the IDDM children was 10.29 ± 3.04 y (range, 4–17 y); 32 (50.8%) were boys and 31 (49.2%) were girls. There were no significant differences between the healthy and IDDM children with respect to age and sex (p > 0.05). Among the 107 healthy children, 43 (40%) did not have a protective anti-HBs level (anti-HBs < 10 IU/L) and 64 (60%) had a protective level (anti-HBs ≥ 10 IU/L). In contrast, among the IDDM children, 44 (69.8%) and 19 (30.2%) did not and did have protective anti-HBs levels, respectively. This difference in anti-HBs concentration between healthy and diabetic children was highly significant (p < 0.001). None of the vaccinated healthy or IDDM children was reactive to HBsAg or total anti-HBc. Patients and Methods: A total of 170 children (81 boys, 89 girls) who had been routinely vaccinated against HB were included. Their mean age was 10 ± 2.1 y. The enrolled children were divided into healthy (n = 107) and IDDM (n = 63) cohorts. Body Mass Index and levels of hepatitis B surface antigen (HBsAg), total antibody to hepatitis B core antigen (anti-HBc), and anti-HBs were evaluated in all children. In addition, the duration of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) were measured in IDDM children. Conclusion: Our results are alarming. It appears that the majority of Egyptian diabetic children vaccinated against HB may not have sufficient anti-HBs levels to protect them from HB. Moreover, this study emphasizes the need for a population-based strategy for the management of patients without an anti-HBs protective level after HB vaccination and justifies the need to elucidate the heritability of those children.

Absence of occult hepatitis B virus infection in sera of diabetic children and adolescents following hepatitis B vaccination

Background The prevalence of occult hepatitis B (HB) infection (OBI) in HB-vaccinated diabetic children has not yet been tested. Here, we aimed to determine the prevalence of OBI among HB-vaccinated children and adolescents with insulin-dependent diabetes mellitus (IDDM). Results Eighty-seven (51.2%) children had a titer for antibodies to HB surface antigen (anti-HBs) of <10 IU/L. These included 44 (70%) IDDM children and 43 (40.2%) healthy children. Eighty-three (48.8%) children had an anti-HBs titer of ≥10 IU/L; they included 19 (30%) with IDDM and 64 (59.8%) healthy children. None of the enrolled children (n = 170) were reactive for total antibody to HB core antigen (anti-HBc) as determined by enzyme-linked immunosorbent assay. HB virus DNA was not detected in HB-vaccinated IDDM or healthy children and adolescents. Method An amount of 170 HBsAg-negative sera samples from HB-vaccinated children and adolescents was included. They were classified into the IDDM group (n = 63) and the healthy control group (n = 107). HBsAg, anti-HBc, and anti-HBs were tested by enzyme-linked immunosorbent assay, and HB virus DNA was tested by nested polymerase chain reaction using 3 pairs of surface, core, and X genes. In Conclusion Primary HB vaccination confers long-term protection against OBI in Egyptian diabetic children and adolescents. However, the number of cases tested in this study was relatively low, and further studies and long-term follow-up of large populations are needed to draw solid and convincing conclusions.

Pegylated interferon de novo-induce autoimmune haemolytic anaemia in chronic hepatitis C patient

A 55-year-old Egyptian woman with chronic hepatitis C undergoing treatment with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin was referred to our hospital on November 2010 with prolonged easy fatigability and an attack of syncope; she had no prior history of autoimmune disorders or allergy. Laboratory investigations documented the presence of Peg-IFN induced autoimmune haemolytic anaemia and autoimmune thyroiditis. Intravenous γ globulin (IVGG) failed to correct the autoimmune process; on the other hand steroid therapy dramatically corrected both haematological and thyroid values, and step down the immune process. Our report indicated that Peg-IFN de novo-induce autoimmune haemolysis, documenting a previous report. IVGG failed to step down the immune process in our case.

Occult hepatitis B virus infection in Egypt.

The emerging evidence of the potentially clinical importance of occult hepatitis B virus (HBV) infection (OBI) increases the interest in this topic. OBI may impact in several clinical contexts, which include the possible transmission of the infection, the contribution to liver disease progression, the development of hepatocellular carcinoma, and the risk of reactivation. There are several articles that have published on OBI in Egyptian populations. A review of MEDLINE database was undertaken for relevant articles to clarify the epidemiology of OBI in Egypt. HBV genotype D is the only detectable genotype among Egyptian OBI patients. Higher rates of OBI reported among Egyptian chronic HCV, hemodialysis, children with malignant disorders, and cryptogenic liver disease patients. There is an evidence of OBI reactivation after treatment with chemotherapy. The available data suggested that screening for OBI must be a routine practice in these groups of patients. Further studies needed for better understand of the epidemiology of OBI among Egyptian young generations after the era of hepatitis B vaccination.

Augmented damage of islets by impaired exocrine acinar cells undergoing apoptosis that is possibly converted to necrosis during isolation

Islet damage attributed to impaired exocrine cells during pancreas preservation and isolation procedure remains elusive, although released exocrine enzymes could directly damage islets. The aim of this study is to investigate the cellular mechanisms associated with exocrine cells and their possible impact on the islet cell survival and function after isolation. Mouse pancreata were stored in cold University of Wisconsin preservation solution for 0, 24 and 48 h and incubated with or without collagenase at 37℃ for 15 min. During preservation, the percentage of exocrine cells with necrosis, which means impaired cellular membrane that allows intracellular enzymes to be released, remains low (

Hepatitis C virus exposure rate among health-care workers in rural Lower Egypt governorates

Abstract Background and Objectives Studies on hepatitis C virus (HCV) in Egypt supported a strong role for various exposures in the health-care setting. In this study, we attempted to estimate the frequency of HCV exposure among Egyptian health-care workers (HCWs). Methods Five hundred and sixty-four (564) HCWs were included in this study. Two hundred and fifty-eight (45.74%) were health-care providers and 306 (54.25%) were non-health-care providers. All HCWs completed both the study questionnaire and provided a blood sample for anti-HCV testing by third-generation enzyme-linked immunosorbent assay. Subsequently, anti-HCV-positive samples were tested for HCV RNA using nested polymerase chain reaction (PCR). Results The mean age of included HCWs was 33.0 ± 9.8 years; of them, 319 (56.56%) were males and 245 (43.44%) were females. The mean duration of health-care work was 9.3 ± 6.7 years. The frequency of antibody against hepatitis C virus (anti-HCV) among included HCWs was 8.7% (n = 49). Old age and prolonged duration of health-care work were significantly associated with anti-HCV seropositivity. Forty (81.63%) of 49 with anti-HCV-positive HCWs had positive hepatitis C viremia. The frequency of HCV RNA positivity increased with age. The frequency of eradicated past infection among nurses (36.85%) was markedly higher than that (6.7%) detected in non-health-care providers. Conclusion High rate of HCV infection is detected in Egyptian HCWs in rural Lower Egypt governorates. Health-care providers seem to eradicate HCV infection more frequently than non-health-care providers. National screening and treatment of infected HCWs are recommended.

Liver-specific Prox1 inactivation causes hepatic injury and glucose intolerance in mice

Previous reports have revealed that Prospero‐related homeobox 1 (Prox1) is required for the migration and differentiation of hepatoblasts during embryonic liver formation. However, the role of Prox1 in adults remains to be elucidated. We created liver‐specific Prox1 knockout mice to verify the role of Prox1 in adult hepatocytes. The mutant mice exhibit hepatic injury and a nonobese, insulin‐resistant diabetic phenotype in vivo. Hepatocyte injury is observed predominantly in the perivenous region and is characterized by the formation of vacuoles and emergence of round‐shaped mitochondria, suggesting that the effect of Prox1 on the maintenance of adult hepatocytes is region dependent. Furthermore, glycolysis is suppressed, and both oxidative phosphorylation and autophagy are upregulated in the livers of Prox1 knockout mice, indicating that Prox1 has a role in regulating energy homeostasis in hepatocytes.