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e178
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
P.10.2
EFFECTS OF SILYBIN ADMINISTRATION ON THE REDOX STATE
AND OXIDATIVE STRESS RESPONSE OF HUMAN ENDOTHELIAL
CELLS IN PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS
Federico A.
1
, Dallio M.*
1
, Conti V.
2
, Russomanno G.
2
, Stiuso P.
3
,
Tuccillo C.
1
, Manzo V.
2
, Filippelli A.
2
, Loguercio C.
1
1
Division of Hepatogastroenterology, Second University of Naples,
Italy,
2
Department of Medicine and Surgery, University of Salerno,
Italy,
3
Department of Biochemistry, Biophysics and General Pathology,
Second University of Naples, Italy
Background and aim:
Nonalcoholic fatty liver disease (NAFLD) has
been identified as independent risk factor for the development of
cardiovascular diseases, because of oxidative stress induction.
Literature data documented that silybin presents a marked
antioxidant activity both in vitro and in vivo.
The aim of this study was: 1) to compare the levels of oxidants
and antioxidants in sera collected from patients with nonalcoholic
steatohepatitis (NASH) treated with Silybin conjugated with
phosphatidilcholine and vitamin E (Realsil®, R, IBI-Lorenzini, Italy)
or placebo (P) at time 0 and after 12 months of treatment; and 2) to
investigate the effects of these sera on endothelial cells exposed or
not exposed to oxidative stress.
Material and methods:
Twenty-seven patients with histological
diagnosis of NASH were recruited (11 P and 16 R).
We evaluated peroxidative damage with the Thiobarbituric Acid
Reactive Substances (TBARS) method, Superoxide dismutase (SOD)
and catalase (Cat) activities in sera and cell lysates.
Human Umbilical Vein Endothelial Cells (HUVEC) were used for
the in vitro experiments, exposed or not to oxidative stress with
hydrogen peroxide H2O2.
Results:
We stratified patients (both P and R) in two groups on the
basis of the trend in the TBARS serum levels: the first group patients
showed a reduction of TBARS at T12 and second group patients
showed an increase of TBARS at T12. No differences in the activity
of SOD between T0 and T12, both in P and R groups were found.
Cat activity decreased exclusively in the R-II group (p<0.01) after 12
months of R administration. A significant reduction of procollagen
I after 12 months of R administration in both group R-I (p=0.018)
and R-II (p=0.030) was found. In the R-II group we also recorded
a significant reduction of ALT (p=0.041) and transforming growth
factor (TGF)-
b
(p=0.015) after 12 months of R administration.
In RI-ECs, an increase of Cat activity at T12 when compared with T0
(p<0.05) was detected, and in RII-ECs we recorded a drastic increase
of Cat activity at T12 (p<0.02) when compared with levels at T0.
The treatment with H2O2 induces a drastic increase of Cat activity
between T0 and T12 in both RI-ECs and RII-ECs (both, p<0.01).
Conclusions:
The use of R, which has anti-inflammatory, antioxidant
and anti-fibrotic properties, determines a slowdown of the liver
damage and could help contribute to the reduction of the incidence
of cardiovascular diseases in patients with NAFLD at least in part,
through perturbation of the redox state homeostasis.
P.10.3
COUPLED PLASMA FILTRATION ADSORPTION (CPFA) REDUCES
BILIRUBIN. CASE REPORT WITH A SYSTEMATIC REVIEW OF THE
LITERATURE
Cerasi C.*, Viscido A., Del Pinto R., Giorgini P., Cheli P., Ludovici V.,
Stamerra C.A., Biferi E., Pasetti A., Onori E.G., Natali L.,
Moscardelli S., Ferri C.
Ospedale San Salvatore - Università degli studi dell’Aquila, L’Aquila,
Italy
Background and aim:
Severe hyperbilirubunemia frequently occurs
in liver failure and may rapidly progress to kidney and neurologic
damage leading to death. While looking for definitive treatments
of liver disease, hyperbilirubinemia can be treated by means of
artificial liver support devices. The most appropriate artificial
liver support device is considered to be Molecular Adsorbent
Recirculating System (MARS). However MARS is generally available
only in Liver Transplant Unit.
Material and methods:
We describe the case of a patients affected
by portal cavernoma cholangiopathy who developed acute severe
hyperbilirubinemia and that, due to unavailability of MARS, was
treated with 2 cycles of coupled plasma filtration adsorption (CPFA).
Bilirubin was reduced by 40% after each cycle. CPFA resulted effective
in lowering the concentration of bilirubin and allowed to refer the
patient to a Liver Transplant Unit.
Results:
A systematic literature search was performed using
PubMed with the aim to identify studies on the treatment of
hyperbilirubinemia using CPFA. Only four papers were retrieved,
and they describe, overall, 15 cases of hyperbilirubinemia due to
acute liver failure treated using CPFA; in all cases bilirubin promptly
decreased.
Conclusions:
Summarizing, this is the fifth literature report
describing theuseof CPFA inapatientwithacutehyperbilirubunemia.
Each treatment cycle lowered the initial plasma level of bilirubin by
about 40%. CPFA is a effective tool in hyperbilirubunemia following
acute liver failure.
P.10.4
SPLEEN ELASTOGRAPHY WITH ACOUSTIC RADIATION FORCE
IMPULSE IMAGING IN CIRRHOSIS WITH PORTAL HYPERTENSION
Montanari M.*
1
, Todeschini A.
1
, Recaldini C.
2
, Lucchina N.
2
,
Fugazzola C.
2
, Segato S.
1
1
Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero
Universitaria Macchi, Varese, Italy,
2
Dipartimento di Radiologia.
Azienda Ospedaliero Universitaria Macchi Varese, Varese, Italy
Background and aim:
Spleen elastography is a promising non-
invasive method for the characterization of portal hypertension in
cirrhotic patients.
We assessed diagnostic performance of spleen stiffness using
acoustic radiation force imaging impulse (ARFI) for diagnosing
portal hypertension and oesophageal varices.
Material and methods:
Our study included 60 subjects (33 healthy
volunteers, 27 cirrhotic patients with portal hypertension). All
patients were prospectively enrolled from April 2014 to May
2015; they were submitted to liver function blood tests, upper
gastrointestinal endoscopy and spleen stiffness measurement with
ARFI elastography (IU22 Philips) to determine a cut-off value for the
presence of portal hypertension. We performed 10 measurements in
each patient expressed in kiloPascal, mean and median values were
obtained.
Results:
We only experienced patients with portal hypertension
above 41,39 kPa, whereas only healthy volunteers were below 12,74
kPa. Nevertheless an overlap of values of the two subjects’ classes
was observed for the intermediate values (22,1<kPa<32,88). For a
cut-off value of >20,9 kPa of spleen stiffness, ARFI had 84.9% Se,
71.4% Sp (AUROC=0,833) for detection of oesophageal varices.
Conclusions:
Spleen stiffness showed promising results for the
detection of oesophageal varices but is not yet sufficiently robust for
clinical practice owing to overlap of values.