Daniel Zamora-Valdés

Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease

Background and Aim: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes.

Gallstones are associated with carotid atherosclerosis.

Background/Aims: Gallstone disease (GD) and cardiovascular disease (CD) are common diseases worldwide with considerable economical impact and they are strongly associated. Carotid atherosclerosis is an excellent marker of risk for CD like stroke and myocardial infarction. The aim of this study was to assess the association between gallstones and carotid atherosclerosis.

Adiponectin, structure, function and pathophysiological implications in non-alcoholic fatty liver disease.

Obesity is a major risk factor for the development of the metabolic syndrome, a cluster of diseases including insulin resistance, type 2 diabetes, dyslipidemia, hypertension, microalbuminuria, atherosclerosis, and non-alcoholic steatohepatitis. On the other hand, it is now generally accepted that adipose tissue acts as an endocrine organ producing a number of substances with an important role in the regulation of food intake, energy expenditure and a series of metabolic processes. Adiponectin is a recently discovered hormone produced exclusively by adipocytes. In fact, adiponectin is considered currently as a major factor in obesity-related insulin resistance and atherosclerosis. This new hormone differs from other adipocytokines in that its production and concentrations are actually decreased in insulin resistant subjects. The aim of this review is to summarize the current knowledge about the chemistry and physiology of adiponectin and to discuss its implications in the pathophysiology and potential treatment of insulin resistance and non-alcoholic fatty liver disease.

Importance of Iron and Iron Metabolism in Nonalcoholic Fatty Liver Disease

Iron homeostasis disturbances are associated with liver disease. Non-alcoholic steatohepatitis is part of the spectrum of non-alcoholic fatty liver disease, which can progress to hepatic cirrhosis and end-stage liver disease. Increasing information supports that multiple factors underlie the development and progression of nonalcoholic steatohepatitis. However, the relation between non-alcoholic steatohepatitis and iron metabolism/ overload is still controversial. We review the recent literature, both basic and clinical, regarding iron homeostasis as it pertains to the pathogenesis of nonalcoholic fatty liver disease.

Fighting Mortality in the Waiting List: Liver Transplantation in North America, Europe, and Asia

Liver disease is a major cause of mortality worldwide. Liver transplantation (LT) is the most effective treatment for end stage liver disease. Available resources and social circumstances have led to different ways of implementing LT around the world. The experience with pediatric LT corroborates the hypothesis that a combination of surgical strategies can be beneficial. The goal of this manuscript is to describe the strategies used by LT centers in North America, Europe and Asia and how these strategies can be applied to reduce waitlist mortality and increase access to LT.Liver disease is a major cause of mortality worldwide. Liver transplantation (LT) is the most effective treatment for end stage liver disease. Available resources and social circumstances have led to different ways of implementing LT around the world. The experience with pediatric LT corroborates the hypothesis that a combination of surgical strategies can be beneficial. The goal of this manuscript is to describe the strategies used by LT centers in North America, Europe and Asia and how these strategies can be applied to reduce waitlist mortality and increase access to LT.

Longterm effects of bile duct injuries on health-related quality of life: is a meta-analysis reliable?

Sir, We read with great interest the paper published by Landman et al.1 regarding health-related quality of life (HRQoL) in patients with bile duct injuries. We would like to raise three questions on the reliability of data derived from meta-analyses. Firstly, despite the methodological attempt to overcome heterogeneity through the standardization of effect sizes in this meta-analysis,1 its HRQoL data are summarized from studies reporting on a wide spectrum of bile duct injuries, from bile leak to complete bile duct transection.2–5 Heterogeneity in the type of bile duct injury may result in differences in HRQoL outcomes as diagnostic and therapeutic interventions vary depending on the complexity of the injury. Secondly, three of the studies included reported major patient losses (>15%), which makes it difficult to discern whether the inclusion of data for the missing patients might have changed the final results in these studies.3–5 Finally, three studies were performed outside the USA.2,3,5 How were the different population standards compared with the study results? Was a standardized USA HRQoL population norm used or were specific population norms considered? Although meta-analyses can derive important information from homogeneous observational and analytic studies, their results should be interpreted with caution when heterogeneity is not properly assessed. A single well-designed, observational study may be more accurate than a meta-analysis of several heterogeneous sources.

Hepatocyte transplantation for treating chronic hepatic dysfunction

Chronic liver dysfunction is a major cause of morbidity and mortality worldwide. Orthotopic liver transplantation is positioned as first-line therapy for these patients. However, the limited availability of organ donors has forced scientists around the world to seek bridging or alternative therapies. After more than two decades of preclinical research, hepatocyte transplantation has been initiated. Hepatocyte transplantation has been assessed in experimental models of chronic liver dysfunction and some human cases have been reported. We review the technical, experimental, and clinical aspects of hepatocyte transplantation and assess its future potential as therapy for patients with chronic liver dysfunction.