Chisato Hirayama

A multicenter randomized controlled clinical trial of Shosaiko-to in chronic active hepatitis

SummaryThe efficacy of Shosaiko-to (SST) on 222 patients with chronic active hepatitis was studied in a double-blind multicenter clinical study. One hundred and sixteen patients received SST in a daily oral dose of 5.4 g for 12 weeks, followed by the same dose for a further 12 weeks. One hundred and six patients received a placebo containing 0.5 g of SST for 12 weeks, followed by a cross-over to SST for a further 12 weeks. Among the liver tests, serum AST and ALT values decreased significantly with the admisnistration of SST. The difference of the mean value between the SST group and the placebo group was significant after 12 weeks. In patients with chronic active type B hepatitis, a tendency towards a decrease of HBeAg and an increase of Anti-HBe antibodies was also observed. No remarkable side effects were noticed.

Nonoxidative metabolism of ethanol in the pancreas; implication in alcoholic pancreatic damage

Alcohol dehydrogenase activity and fatty acid ethyl ester synthase activity were measured in various organs of male Wistar strain rats. The mean (+/- SE) values of alcohol dehydrogenase activity in liver, testis, pancreas and brain were 223 +/- 34, 35 +/- 13, 27 +/- 17 and 24 +/- 15 nmol/hr/mg protein, respectively, but not detectable in heart and skeletal muscle. Fatty acid ethyl ester synthase activity in pancreas, liver, testis and heart were 1348 +/- 263, 23 +/- 14, 17 +/- 3 and 2 +/- 1 nmol/hr/mg protein, respectively, but not detectable in brain and skeletal muscle. Alcohol dehydrogenase activity, fatty acid ethyl ester synthase activity, fatty acid ethyl ester content and amylase activity were measured in pancreas of rat after 7 weeks of ethanol feeding. Compared with control rats, ethanol-fed rats had normal fatty acid ethyl ester synthase activity and alcohol dehydrogenase activity. However, fatty acid ethyl ester content increased five-fold and amylase activity decreased up to 20% of the control group. Fatty acid ethyl ester content was inversely correlated with amylase activity. These results suggest that fatty acid ethyl ester may be responsible for the development of pancreatic damage by ethanol.

Mechanism of the protective action of thiol compounds in ethanol-induced liver injury

The protective action of cysteine or mercaptopropionylglycine (MPG) in acute ethanol-induced liver injury has been investigated in the rat. Cysteine accelerated clearance of ethanol and acetaldehyde from blood and liver and prevented an increase in hepatic content of triglyceride and serum ornithine carbamoyl transferase activity. MPG accelerated clearance of ethanol and acetaldehyde less efficiently but prevented an increase in these variables to the same degree. The mode of action of thiol compounds in acute ethanol-induced liver injury has been discussed.

Plasma amino acid patterns in hepatocellular carcinoma

Plasma amino acid levels were determined in 23 patients in comparison with 16 normal subjects and 17 patients with liver cirrhosis. Patients with hepatocellular carcinoma had elevated levels of the aromatic amino acids and lowered levels of the branched-chain amino acids, as seen in liver cirrhosis; however, they had lowered levels of alanine and glutamine as compared with normal subjects and with liver cirrhosis patients. Following treatment with intraarterial chemotherapy and/or transcatheter arterial embolization, plasma levels of alanine and glutamine recovered. These results suggest that the consumption of alanine and glutamine increase in hepatocellular carcinoma.

Propagermanium: a nonspecific immune modulator for chronic hepatitis B

Although antiviral agents have been adopted for the management of chronic hepatitis B, they have only limited efficacy because of the underlying impaired immune status. Propagermanium, a hydrophilic polymer of 3-oxygermyl propionate, has been reported to have potent immune modulatory activity associated with antiinflammatory and antineoplastic properties. For example, propagermanium augments lymphocyte functions in CD4 and CD8 cells, and in natural killer (NK) cells, and induces the production of several cytokines. A controlled pilot study of 16-week treatment with propagermanium for chronic hepatitis B (of moderate and mild grades on hepatic histology) revealed a sustained clearance of hepatitis B e (HBe) antigen and a favorable biochemical response at week 16 of treatment and at week 48 post-treatment. An open study also supported the clearance of hepatitis B virus from the blood and the possible improvement of histologic grading in the liver. There were few adverse events. A postmarketing survey, however, revealed the occurrence of moderate to severe liver damage after the treatment in about 4% of patients. Despite the exact nature of the liver damage being unclear, a putative cause is the swift removal of virus-infected hepatocytes by an immune reaction through the treatment. A subtle balance between host and viral conditions is the factor which most determines hepatitis B virus persistence. The rationale for a nonspecific immune modulator for the treatment of chronic hepatitis B will be the restoration of cellular immune responsiveness to viral infection. Although the cellular immunity for hepatitis B virus prior to the treatment should be studied, adequate observation of hepatic functions and viral markers in the recipients is clinically useful to predict liver failure during the treatment. In summary, the propagermanium regimen offers a potent and safe approach that is cost-effective for appropriate chronic hepatitis B patients with reserve hepatic capacity, and will provide new perspectives for immune therapy in chronic hepatitis B.

Aberrant porphyrin metabolism in hepatocellular carcinoma

In 15 patients with hepatocellular carcinoma (HCC) and 14 patients with liver cirrhosis (LC), urinary excretions of delta-aminolevulinic acid (ALA), porphobilinogen (PBG), uroporphyrin (UP), coproporphyrin (CP), and erythrocyte contents of CP and protoporphyrin (PP) were examined. In patients with HCC, urinary excretions of ALA and PBG and erythrocyte contents of CP and PP were not increased, but urinary excretions of UP and CP were significantly increased more than those of LC patients. Urinary excretions of UP and CP had no correlations with liver function tests and excretion of UP correlated slightly with blood hemoglobin level. After administration of ALA intravenously, urinary excretions of UP and CP were clearly increased in patients with HCC compared to normal controls. A Red fluorescent area was present at the cancerous area but not in the noncancerous cirrhotic area in a patient with HCC. These results suggest that aberrant porphyrin metabolism occurred in patients with HCC compared to other liver diseases.

Combined hepatocellular-cholangiocarcinoma associated with dermatomyositis.

A 56 year old female developed combined hepatocellular cholangiocarcinoma associated with dermatomyositis. Serum tumour markers except for carbohydrate antigen (CA 19‐9; 6400 ng/ml) were within normal range. Despite extensive chemotherapy, no clinical response was obtained and the patients course deteriorated after 4 months. Macroscopically, the liver was mainly occupied by hepatocellular carcinoma but cholangiocarcinoma was found in the hilum. This is the first case of a rare association of combined hepatocellular‐cholangiocarcinoma and dermatomyositis.

Serum type IV collagen in various liver diseases in comparison with serum 7S collagen, laminin, and type III procollagen peptide.

The clinical significance of the immunoreactive triple helical domain of type IV collagen in serum was evaluated in 73 healthy controls and 161 patients with various biopsy-proven liver diseases. Although serum levels of type III procollagen peptide were increased in all liver diseases, those of type IV collagen, 7S collagen, and laminin were principally increased in chronic liver diseases associated with hepatic fibrogenesis/fibrosis. In both non-alcoholic and alcoholic liver diseases, 7S collagen was increased in serum, while type IV collagen and laminin in serum were particularly increased in alcoholic liver diseases and in hepatocellular carcinoma, in which latter the sensitivity was greater for type IV collagen than for laminin. Gel filtration analysis in Sephacryl S-400 revealed type IV collagen in serum to be a single molecular form with a molecular weight that correspond to type IV collagen, whereas 7S collagen was recognized as several heterogeneous macromolecules. These findings indicate that serum type IV collagen is derived from the type IV protocollagen pool, and is a sensitive marker for the fibrogenetic process in hepatic basement membranes.

OSTEOCLAST-LIKE GIANT CELL TUMOR OF THE LIVER

A 66‐year‐old male with osteoclast‐like giant cell tumor of the liver that arose in the non‐cirrhotlc liver is presented. The liver tests were almost normal, and plasma levels of alpha‐fetoprotein and carcinoembryonic antigen were within normal limits. The findings of liver scan by 99mTc phytate, celiac angiography, and CT scans are described for the first time for this rare neoplasm, showing a large, unresectable liver tumor. Histologically, the tumor mainly consisted of osteoclast‐like giant cells and mononuclear cells, which were focally arranged in a vaguely trabecular pattern and sarcomatous pattern. By an electromicroscopic study, however, no definitive evidence was obtained whether it arose from epithelial cells or nonepithellal cells. Various clinicopathological features were described and compared with previously reported cases including two cases arising in the liver.

Hepatocellular carcinoma metastatic to the oral cavity including the maxilla and the mandible: report of two cases and review of the literature

SummaryTwo cases of hepatocellular carcinoma metastatic to the oral cavity are presented. One patient had metastases to the maxilla and finally, to the mandible, and the other patient, to the mandible. Both cases histologically showed highly-differentiated trabecular hepatocellular carcinoma which had vascularized stroma, explaining the frequently observed oral hemorrhage. The clinical signs and symptoms described here suggested the existence of a tumor metastatic to the oral cavity, and might indicate an unusual manifestation of hepatocellular carcinoma. Reports of metastatic lesions of hepatocellular carcinoma to the oral cavity, including the mandible, maxilla and gingiva proper, are reviewed.