Evidence-based clinical practice guidelines for liver cirrhosis 2015

The treatment of liver cirrhosis is currently being standardized and developed specifically to reduce activation of hepatic stellate cells (HSCs), inhibit fibrosis, increase degradation of matrix components, and reduce activated myofibroblasts. Cell therapy can be applied in the treatment of liver cirrhosis; however, the characteristic features of this therapy differ from those of other treatments because of the involvement of a living body origin and production of multiple cytokines, chemokines, matrix metalloproteinases (MMPs), and growth factors. Thus, cell therapies can potentially have multiple effects on the damaged liver, including alleviating liver cirrhosis and stimulating liver regeneration with affecting the host cells. Cell therapies initially involved autologous bone marrow cell infusion, and have recently developed to include the use of specific cells such as mesenchymal stem cells and macrophages. The associated molecular mechanisms, routes of administration, possibility of allogeneic cell therapy, and host conditions appropriate for cell therapies are now being extensively analyzed. In this review, we summarize the status and future prospects of cell therapy for liver cirrhosis.

Abstract. The aim of the present study was to explore the clinical value of urinary retinol-binding protein (RBP) level in the prognosis of cirrhotic ascites by assessment of the RBP levels prior to and following ascites treatment. The levels of urinary RBP, urinary microalbumin (mAlb), serum urea nitrogen (urea) and serum creatinine (Cr), and the estimated glomerular filtration rate (eGFR) were measured in 90 patients with cirrhosis and ascites hospitalized in a single institution between May 2011 and January 2012, and in 30 healthy controls. The levels of urinary mAlb, serum urea and serum Cr were higher in the cirrhotic patients compared with the healthy controls (P<0.05). Urinary RBP levels were significantly higher and eGFR was significantly lower in the liver cirrhosis group compared with the healthy control group (P<0.01). Urinary RBP, urinary mAlb, serum urea and serum Cr increased and eGFR decreased as the severity of the ascites increased (P<0.05). Urinary RBP was significantly higher in patients whose ascites did not respond or was refractory compared with those in whom it subsided (P<0.05), exhibiting a gradual increase over time in the former and a gradual reduction over time in the latter group (P<0.05). Increased urinary RBP and decreased eGFR in the early stage of cirrhosis ascites suggested impaired renal function, which serves a role in the process of ascites formation. These results indicated that urinary RBP is a sensitive indicator of early renal injury in patients with ascites due to cirrhosis and is closely associated with the progression of cirrhotic ascites. IntroductionCirrhosis is a chronic, progressive, diffuse disease caused by a variety of factors, including hepatitis B virus, alcoholic liver disease and autoimmune liver disease (1-3). Liver cirrhosis mortality increased from 1.54% of global mortality in 1980 to 1.95% in 2010 (4). Ascites is a common complication of cirrhosis decompensation. Approximately 50% of patients with compensated cirrhosis develop ascites within a period of 10 years (5). The emergence of ascites predicts a poor prognosis of decompensated cirrhosis, with a mortality of 15% after 1 year and 44% at the 2 year follow-up. (6). In addition, the quality of life of patients with cirrhosis decreases following the formation of ascites and the 5-year survival rate drops to 50% (7). When ascites progress to refractory ascites, if a liver transplant is not conducted, the prognosis worsens and the 2-year survival rate falls to 35-50% (8). Treatment of ascites not only improves the quality of life of patients, but also reduces the risk of progression to spontaneous bacterial peritonitis, which is the most common fatal complication of liver cirrhosis (9). An improved understanding of the pathophysiological mechanism for ascites in patients with liver cirrhosis is necessary to improve patient treatment and to assist the use of targeted therapies.Ascites formation is the result of the combined action of many factors; however, the mechanism underlying the formation of cirrhoti...

Liver fibrosis is a serious disease that affects around 350-400 million people worldwide. The main approach for fibrosis staging is liver biopsy, which is an invasive procedure that is not endured pretty well by patients. Currently, some serum-based biomarker panels are available for diagnosis and staging of liver fibrosis. Recent high-throughput proteomic studies are also very promising for identification of novel biomarkers for diagnosis and/or treatment of liver fibrosis. We hereby review the application of proteomic profiling studies for identification of fibrosis biomarkers with their advantages and drawbacks.