Autor: Sergio Solor

In the realm of hepatitis elimination, recognizing and celebrating individuals who go above and beyond in their commitment to advancing impactful policies and programs is crucial. Today, we extend our heartfelt congratulations to Dr. Javier Crespo, a distinguished researcher and healthcare professional who has been nominated as one of the 2023 Elimination Champions by CGHE.

Dr. Crespo’s dedication to investigating liver diseases and viral hepatitis has positioned him as a key figure in the field. His remarkable contributions are not only recognized in his home country, Spain, but also on the international stage. Named by the Ministry of Health in Spain to be a member of the working group for the design and development of the Spanish National Plan to combat hepatitis C, Dr. Crespo has played a pivotal role in shaping strategic approaches to tackle this pressing health issue.

As a doctor and researcher at the University Hospital Marques de Valdecilla, Dr. Crespo has focused his career on a comprehensive understanding of liver diseases, with a particular emphasis on hepatitis C management, epidemiology, and treatment. His expertise has led to his appointment as the leader of the Hepatitis C Elimination Strategy in Cantabria, where he spearheaded a groundbreaking program that encompassed both macro-elimination pillars and innovative micro-elimination strategies.

One notable achievement in Dr. Crespo’s portfolio is the publication of a decalogue aimed at promoting hepatitis C elimination in hospitals. This comprehensive guide advocates for reflex-testing, improved point-of-care diagnostic tests, and widened treatment delivery to reach vulnerable populations, reflecting Dr. Crespo’s commitment to holistic and inclusive healthcare practices.

A standout success in his career has been the JailFree-C project, a pioneering initiative that showcased the possibility of eliminating hepatitis C in prison settings. Dr. Crespo implemented a test-and-treat strategy, supported by a multidisciplinary team and a telemedicine tool, demonstrating the feasibility of eliminating HCV in prison environments. This groundbreaking model of care was not only successful in its original implementation but was also effectively replicated in other prisons across Spain.

Dr. Javier Crespo’s tireless efforts, groundbreaking initiatives, and unwavering commitment to hepatitis elimination make him a deserving recipient of the 2023 Elimination Champions nomination. His contributions have not only advanced the field of liver health but have also set a benchmark for others to follow. We extend our warmest congratulations to Dr. Crespo and express our gratitude for his outstanding dedication to improving public health.

The International Symposium on Rare Liver Diseases 2024 promises to be a landmark event for medical professionals and researchers dedicated to advancing knowledge in the field of liver diseases. Scheduled for April 11 and 12, 2024, at the Centro Botín in Santander, Spain, this symposium, directed by renowned experts Javier Crespo and José Luis Calleja, is set to address a spectrum of rare liver diseases and provide a platform for collaborative learning.

Program Overview: The symposium starts on Thursday, April 11, with an opening ceremony at 11:30, followed by an inaugural lecture by Ángel Carracedo. The program covers various topics, including minority liver diseases, non-inherited liver diseases like Primary Biliary Cholangitis, Wilson’s disease, Hepatitis Delta Virus, and vascular diseases of the liver. On Friday, April 12, the focus shifts to other inherited rare liver diseases.

Los días 20 y 21 de octubre tendrá lugar la decimoquinta reunión de «Aula Abierta Multidisciplinar en Hepatología», un curso que se llevará a cabo con la colaboración de Gilead a lo largo de dos días. El objetivo de este evento será analizar las estrategias, experiencias y los retos que depara el futuro para el abordaje de las enfermedades hepáticas, convirtiéndose en un futuro referente sobre enfermedades hepáticas de gran interés científico en nuestro país

Esperamos que puedan unirse a esta valiosa oportunidad de aprendizaje y colaboración.

Dra. Marta Alonso Peña ha sido seleccionada recientemente para formar parte del grupo joven (Young Investigator Task Force) de la Asociación Europea para el Estudio del Hígado (European Association for the Study of the Liver, EASL).

La EASL es una organización médica y científica que se dedica a investigar y tratar los problemas del hígado. Tiene más de 5,300 miembros de 112 países diferentes. Su objetivo es compartir conocimientos y avances científicos en este campo y ayudar a los pacientes, así como trabajar con autoridades de salud para dar consejos y mejorar la atención médica y organizar conferencias y escuelas de formación para los profesionales de la salud.

Dentro de la EASL, el grupo Joven tiene como objetivo promover y desarrollar actividades dirigidas a investigadores jóvenes, construir una comunidad activa y dinámica de investigadores jóvenes involucrados en sus actividades y fomentar y facilitar la discusión e intercambio de información a través de los foros en línea y eventos de la EASL.

Más información sobre la Young Investigator Task Force de la EASL en https://easl.eu/easl/leadership-and-governance/young-investigator-task-force/

Para conocer todas las actividades en las que participa la Young Investigator Task Force de la EASL puede consultar https://easl.eu/young-investigators-learning-hub/

El próximo lunes 22 y martes 23 de mayo tendrá lugar el siguiente módulo del Foro Internacional de Medicina de Precisión que revisará las diferentes líneas de investigación en el ámbito del hígado graso.

Un curso totalmente interactivo con sesiones de dos horas de duración con una o dos presentaciones iniciales de 30 minutos. Habrá una discusión entre los ponentes, alumnos y resto de profesores que lo deseen, haciendo hincapié en el manejo terapéutico actual y en el futuro inmediato y en los nichos de investigación clínica (y traslacional en su caso) en cada una de las áreas abordadas durante el curso.

El programa está coordinado por el Dr. Javier Crespo, Jefe de Servicio, la Dra. Mª Teresa Arias Loste, Médico Adjunto y la Dra. Paula Iruzubieta, Médico Adjunto del Hospital Universitario Marqués de Valdecilla.

El programa está avalado por la plataforma ITEMAS, la plataforma de Biobancos y Biomodelos del Instituto de Salud Carlos III, la Sociedad española de Farmacología Clínica, la Asociación Española para el Estudio del Hígado Graso y la Sociedad Española de Patología Digestiva.

Un encuentro dirigido a personal clínico, investigador y de soporte que quiera profundizar de la mano de expertos, en aspectos relacionados con la investigación y la medicina de precisión en la enfermedad de hígado graso. El alumnado que participará presencialmente ya ha sido seleccionado pero animamos a cualquier otro profesional interesado en NAFLD a visualizar las sesiones en streaming a través de la plataforma Zoom.

Se facilitará un diploma a todos los asistentes que cumplan con el 80% de la asistencia, tanto presencial como telemáticamente.

Se requiere inscripción previa al foro en el siguiente link:  https://zoom.us/meeting/register/tJAvdu2rrD8iGtall_S3h2UsSF4UUM4IsKEd

programa NASH Preceptorship

Authors: Aitor Odriozola, Alvaro Santos-Laso, María del Barrio, Joaquín Cabezas, Paula Iruzubieta, María Teresa Arias-Loste, Coral Rivas, Juan Carlos Rodríguez Duque, Ángela Antón, Emilio Fábrega, Javier Crespo.

Link: https://www.mdpi.com/1422-0067/24/9/7791

Abstract:

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, and its incidence has been increasing in recent years because of the high prevalence of obesity and metabolic syndrome in the Western population. Alcohol-related liver disease (ArLD) is the most common cause of cirrhosis and constitutes the leading cause of cirrhosis-related deaths worldwide. Both NAFLD and ArLD constitute well-known causes of liver damage, with some similarities in their pathophysiology. For this reason, they can lead to the progression of liver disease, being responsible for a high proportion of liver-related events and liver-related deaths. Whether ArLD impacts the prognosis and progression of liver damage in patients with NAFLD is still a matter of debate. Nowadays, the synergistic deleterious effect of obesity and diabetes is clearly established in patients with ArLD and heavy alcohol consumption. However, it is still unknown whether low to moderate amounts of alcohol are good or bad for liver health. The measurement and identification of the possible synergistic deleterious effect of alcohol consumption in the assessment of patients with NAFLD is crucial for clinicians, since early intervention, advising abstinence and controlling cardiovascular risk factors would improve the prognosis of patients with both comorbidities. This article seeks to perform a comprehensive review of the pathophysiology of both disorders and measure the impact of alcohol consumption in patients with NAFLD.

Keywords: non-alcoholic fatty liver disease; alcohol-related liver disease; cirrhosis; hepatocellular carcinoma

On May 23rd and 24th, the International Network on Health and Hepatitis in Substance Users (INHSU) Prisons is hosting a virtual event that will showcase groundbreaking research on Hepatitis C. The event, titled «Behind the Research,» will provide an overview of research papers highlighted in the Annual INHSU Prisons Bibliography 2022 that were considered of exceptional interest by the INHSU Prisons Executive Committee.

This event will feature three speakers who are authors of the research papers highlighted in the bibliography. Each speaker will present an overview of their research, practical takeaways, and participate in a facilitated panel discussion. The session will be moderated by Dr. Nadine Kronfli from McGill University and Julia Sheehan from the Hepatitis C Trust in the United Kingdom.

The speakers include Dr. Jack Stone from the University of Bristol in the United Kingdom, who will present «Prison-Based Interventions Are Key to Achieving HCV Elimination Among People Who Inject Drugs in New South Wales, Australia: A Modelling Study.» Dr. Timothy Papaluca from St. Vincent’s Hospital in Melbourne, Australia, will present «Care Navigation Increases Initiation of Hepatitis C Treatment After Release From Prison in a Prospective Randomized Controlled Trial: The C-LINK Study.» Finally, Joanne Carson from The Kirby Institute UNSW in Sydney, Australia, will present «Hepatitis C Virus Reinfection Following Direct-Acting Antiviral Treatment in the Prison Setting: The SToP-C Study.»

The INHSU Prisons event will explore strategies for expanding access to hepatitis C prevention, testing, and treatment in prison settings. A new report has been published based on the findings, discussions, and recommendations from the workshop co-convened with the Coalition for Global Hepatitis Elimination (CGHE) at the INHSU 2022 conference.

We encourage all healthcare professionals, researchers, and stakeholders in the field of hepatitis C to join this informative event. The virtual event will take place at different times to accommodate attendees from different time zones. To register for the event, visit the INHSU website. For more information on the International Network on Health and Hepatitis in Substance Users, please visit their website or contact them via email.

Authors: Mateos-Muñoz B, Buti M, Vázquez IF, Conde MH, Bernal-Monterde V, Díaz-Fontenla F, Morillas RM, García-Buey L, Badía E, Miquel M, Amador-Navarrete A, Rodríguez-Tajes S, Ramos-Merino L, Madejón A, García-Retortillo M, Arenas JI, Cabezas J, Santiago JMG, Fernández-Rodríguez C, Cordero P, Diago M, Mancebo A, Pardo A, Rodríguez M, Hoyas E, Moreno JJ, Turnes J, Simón MÁ, Marcos-Fosch C, Calleja JL, Bañares R, Lens S, Garcia-Samaniego J, Crespo J, Romero-Gomez M, Gea F, de Santiago ER, Moreno S, Albillos A.

Dig Dis Sci. 2023 Feb 3:1-7. doi: 10.1007/s10620-022-07817-w. Online ahead of print.

Abstract

Background and aims: HIV-positive patients on tenofovir hydroxyl fumarate (TDF)/emtricitabine have a lower risk of COVID-19 and hospitalization than those given other treatments. Our aim was to analyze the severity of COVID-19 in patients with chronic hepatitis B (CHB) on TDF or entecavir (ETV).

Methods: Spanish hospital databases (n = 28) including information regarding adult CHB patients on TDF or ETV for the period February 1st to November 30th 2020 were searched for COVID-19, defined as a positive SARS-CoV-2 polymerase chain reaction, and for severe COVID-19.

Results: Of 4736 patients, 117 had COVID-19 (2.5%), 67 on TDF and 50 on ETV. Compared to patients on TDF, those on ETV showed (p < 0.05) greater rates of obesity, diabetes, ischemic cardiopathy, and hypertension. COVID-19 incidence was similar in both groups (2.3 vs. 2.6%). Compared to TDF, patients on ETV more often (p < 0.01) had severe COVID-19 (36 vs. 6%), required intensive care unit (ICU) (10% vs. 0) or ventilatory support (20 vs. 3%), were hospitalized for longer (10.8 ± 19 vs. 3.1 ± 7 days) or died (10 vs. 1.5%, p = 0.08). In an IPTW propensity score analysis adjusted for age, sex, obesity, comorbidities, and fibrosis stage, TDF was associated with a sixfold reduction in severe COVID-19 risk (adjusted-IPTW-OR 0.17, 95%CI 0.04-0.67, p = 0.01).

Conclusion: Compared to ETV, TDF seems to play a protective role in CHB patients with SARS-CoV-2 whereby the risk of severe COVID-19 is lowered.

Keywords: COVID-19; Entecavir; Hepatitis B; Tenofovir.

Authors: Crespo J, Calleja JL, Cabezas J, García F, Aguilera A, Jorquera F, Lazarus JV.

Liver Int. 2023 Jan 26. doi: 10.1111/liv.15529. Online ahead of print.

Keywords: HIV; Hepatitis C; automatic referral; bundle; hepatitis B; hepatitis delta; integrated diagnosis; viral hepatitis.

Authors: Carrascosa JM, Vilarrasa E, Belinchón I, Herranz P, Crespo J, Guimerá F, Olveira A; en representación del Grupo de Trabajo para el Abordaje Común de la Psoriasis y la EHmet (GACPE).

Actas Dermosifiliogr. 2023 Jan 28:S0001-7310(23)00056-X. doi: 10.1016/j.ad.2023.01.004. Online ahead of print.

Abstract

Recent years have seen concerted efforts to understand the relation between psoriasis and metabolic-associated fatty liver disease (MAFLD). Not only is MALFD diagnosed more often in patients with psoriasis, but its clinical course is also more aggressive. A common approach is therefore needed to enable early detection of liver disease coincident with psoriasis. Especially important is an analysis of risks and benefits of potentially hepatotoxic treatments. This consensus paper presents the recommendations of a group of experts in dermatology and hepatology regarding screening for MALFD as well as criteria for monitoring patients and referring them to hepatologists when liver disease is suspected.

Keywords: EHmet; Hepatotoxicity; MAFLD; Metabolic-associated fatty liver disease; Psoriasis; esteatosis hepática metabólica; hepatotoxicidad; psoriasis.

Authors: Olveira A, Augustin S, Benlloch S, Ampuero J, Suárez-Pérez JA, Armesto S, Vilarrasa E, Belinchón-Romero I, Herranz P, Crespo J, Guimerá F, Gómez-Labrador L, Martín V, Carrascosa JM.

Life (Basel). 2023 Feb 2;13(2):419. doi: 10.3390/life13020419.

Abstract

Interleukin 17 (IL-17) is an effector cytokine that plays a key role in the pathogenesis of both psoriasis and metabolic-associated fatty liver disease (MAFLD), a condition that is more prevalent and severe in patients with psoriasis. In liver inflammation, IL-17 is mainly produced by CD4+ T (TH17) and CD8+ T cells (Tc17), although numerous other cells (macrophages, natural killer cells, neutrophils and Tγδ cells) also contribute to the production of IL-17. In hepatocytes, IL-17 mediates systemic inflammation and the recruitment of inflammatory cells to the liver, and it is also implicated in the development of fibrosis and insulin resistance. IL-17 levels have been correlated with progression from MAFLD to steatohepatitis, cirrhosis, and even hepatocellular carcinoma. Clinical trials have shown that inhibiting IL-17A in patients with psoriasis could potentially contribute to the improvement of metabolic and liver parameters. A better understanding of the key factors involved in the pathogenesis of these chronic inflammatory processes could potentially lead to more efficient treatment for both psoriasis and MAFLD, and help to develop holistic strategies to improve the management of these patients.

Keywords: IL-17; IL-17A; MAFLD; metabolic-associated fatty liver disease.

Authors: Genua I, Iruzubieta P, Rodríguez-Duque JC, Pérez A, Crespo J.

Gastroenterol Hepatol. 2022 Dec 27:S0210-5705(22)00311-9. doi: 10.1016/j.gastrohep.2022.12.002. Online ahead of print.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is becoming a major cause of liver disease-related morbidity, as well as mortality. Importantly, NAFLD is considered a mediator of systemic diseases including cardiovascular disease. Its prevalence is expected to increase, mainly due to its close association with obesity and type 2 diabetes mellitus (T2D). In addition, T2D and NAFLD share common pathophysiological mechanisms, and one can lead to or worsen the other. Therefore, a close collaboration between primary care physician, endocrinologists and hepatologists is essential to optimize the management of patients with NAFLD and T2D. Here, we summarize relevant aspects about NAFLD and T2D that all clinician managing these patients should know as well as current therapeutic options for the treatment of T2D associated with NAFLD.

Keywords: Agonistas del receptor del péptido similar al glucagón tipo 1; Cribado de fibrosis hepática; Diabetes mellitus tipo 2; Esteatosis hepática metabólica; Fibrosis screening; Glucagon-like peptide-1 receptor agonists; Non-alcoholic fatty liver disease; Pioglitazona; Pioglitazone; Type 2 diabetes mellitus.