Publications by authors named "Ana Lleo"

Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease characterized by the progressive destruction of intrahepatic bile ducts, leading to fibrosis, and potentially cirrhosis. PBC has been considered a prototypical autoimmune condition, given the presence of specific autoantibodies and the immune response against well-defined mitochondrial autoantigens. Further evidence supports the interaction of immunogenetic and environmental factors in the aetiology of PBC.

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  • The study explores the use of AI chatbots, specifically ChatGPT-4, as a tool for personalized counseling for Autoimmune Hepatitis (AIH) patients, assessing their performance on twelve specific patient inquiries.
  • Key metrics evaluated include accuracy, completeness, comprehensiveness, and safety of the chatbot’s responses, rated by a group of 11 experts using various scales.
  • Results reveal that while the chatbot provides good comprehensive information, its reliability is questionable, especially in diagnosing inquiries, indicating a need for further research before integrating it into clinical settings.
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  • The study looked at how patients with a liver disease called primary biliary cholangitis (PBC) respond to a treatment called ursodeoxycholic acid (UDCA).
  • It found that many patients (33%) didn’t have a good response after one year, and those who lost their good response had a higher chance of needing a liver transplant or dying.
  • The research showed that staying or getting back to a good response is important for improving long-term health.
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  • - The study systematically reviewed and analyzed environmental factors linked to gallbladder cancer (GBC), the most common type of cancer in the biliary tract, to assess not just the known risks like cholelithiasis, but also other modifiable exposures.
  • - Researchers conducted a meta-analysis on data from 215 studies, revealing significant links between GBC risk and factors like body mass index, obesity, infections of bile ducts, and high parity, while higher education was associated with lower risk.
  • - The findings emphasize the mixed credibility of many associations, with certain lifestyle and exposure factors showing varying levels of evidence strength and importance for GBC prevention.
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Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used for glucose lowering and weight-loss. However, their association with gastrointestinal cancer remains uncertain. This meta-analysis assesses the risk of gastrointestinal cancer in patients treated with GLP-1 RAs.

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Introduction And Objectives: Autoimmune liver diseases (AILD) are rare causes hepatocellular carcinoma (HCC), and data on the efficacy and tolerability of anti-tumor therapies are scarce. This pan-European study aimed to assess outcomes in AILD-HCC patients treated with tyrosine kinase inhibitors (TKIs) or transarterial chemoembolization (TACE) compared with patients with more common HCC etiologies, including viral, alcoholic or non-alcoholic fatty liver disease.

Materials And Methods: 107 patients with HCC-AILD (AIH:55; PBC:52) treated at 13 European centres between 1996 and 2020 were included.

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  • Systemic inflammation plays a crucial role in intrahepatic cholangiocarcinoma (iCCA), and this study investigates the prognostic importance of inflammatory indexes like the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR).
  • A total of 101 iCCA patients were analyzed, revealing that higher NLR and lower LMR correlate with worse survival outcomes; those with high-risk profiles had significantly lower 5-year overall survival rates compared to low-risk patients.
  • Flow cytometry results showed distinct immune cell profiles, with high-risk patients having more CD4+ T-cells and fewer CD8+ T-cells, suggesting inflammatory indexes can serve as indicators for tumor microenvironment and prognosis
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Background And Aim: VETC (vessel that encapsulate tumor cluster) is a peculiar vascular phenotype observed in hepatocellular carcinoma (HCC), associated with distant metastases and poor outcome. VETC has been linked to the Tie2/Ang2 axis and is characterized by lymphocytes poor (cold) tumor microenvironment (TME). In this setting the role of Tumor Associated Macrophages (TAMs) has never been explored.

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  • The study focused on creating a scoring system called the OCA response score (ORS) to predict how individuals with primary biliary cholangitis (PBC) will respond to the treatment using obeticholic acid (OCA).
  • Data were collected from two large cohorts in Italy to derive and validate the score, which includes various clinical factors both before and after six months of treatment.
  • The scoring system demonstrated good predictive ability for treatment response, which could help healthcare providers customize therapies for patients with PBC more effectively.
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  • - Tumor-associated macrophages (TAMs) play a crucial role in the tumor microenvironment, with smaller TAMs (S-TAMs) linked to better prognosis in colorectal liver metastasis compared to larger TAMs (L-TAMs).
  • - Research using multiparametric flow cytometry and metabolomics identified that L-TAMs show a strong association with riboflavin, which affects the enzyme lysine-specific demethylase 1A (LSD1) and plays a role in TAM morphology.
  • - The study suggests that targeting the riboflavin-LSD1 relationship could reprogram TAM subtypes, offering new strategies for anti-tumor therapies.
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Liver cancer represents the fourth leading cause of cancer-associated death worldwide. The heterogeneity of its tumor microenvironment (TME) is a major contributing factor of metastasis, relapse, and drug resistance. Regrettably, late diagnosis makes most liver cancer patients ineligible for surgery, and the frequent failure of non-surgical therapeutic options orientates clinical research to the investigation of new drugs.

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Background & Aims: Cholangiocarcinoma (CCA) is a primary liver tumour characterised by a poor prognosis and limited therapeutic options. Available 3D human CCA models fail to faithfully recapitulate the tumour niche. We aimed to develop an innovative patient-specific CCA-on-chip platform.

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Background & Aims: Intrahepatic cholangiocarcinoma (iCCA) is a primary liver tumour, characterized by poor prognosis and lack of effective therapy. The cytoskeleton protein Filamin A (FLNA) is involved in cancer progression and metastasis, including primary liver cancer. FLNA is cleaved by calpain, producing a 90 kDa fragment (FLNA ) that can translocate to the nucleus and inhibit gene transcription.

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The introduction of direct-acting antiviral agents (DAAs) into clinical practice has revolutionized the therapeutic approach to patients with chronic hepatitis C virus (HCV) infection. According to the most recent guidelines, the first line of treatment for HCV infection involves the use of one of three pan-genotypic DAA combinations, sofosbuvir/velpatasvir (SOF/VEL), glecaprevir/pibrentasvir (GLE/PIB), and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). These drugs have been shown to be effective and safe in numerous clinical trials and real-world studies, but special populations have been neglected.

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Background And Aims: Autoimmune hepatitis (AIH) is a rare chronic liver disease of unknown aetiology; the risk of hepatocellular carcinoma (HCC) remains unclear and risk factors are not well-defined. We aimed to investigate the risk of HCC across a multicentre AIH cohort and to identify predictive factors.

Methods: We performed a retrospective, observational, multicentric study of patients included in the International Autoimmune Hepatitis Group Retrospective Registry.

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Objective: Cytotoxic agents are the cornerstone of treatment for patients with advanced intrahepatic cholangiocarcinoma (iCCA), despite heterogeneous benefit. We hypothesised that the pretreatment molecular profiles of diagnostic biopsies can predict patient benefit from chemotherapy and define molecular bases of innate chemoresistance.

Design: We identified a cohort of advanced iCCA patients with comparable baseline characteristics who diverged as extreme outliers on chemotherapy (survival <6 m in rapid progressors, RP; survival >23 m in long survivors, LS).

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Background And Aims: The International Autoimmune Hepatitis Group retrospective registry (IAIHG-RR) is a web-based platform with subjects enrolled with a clinical diagnosis of autoimmune hepatitis (AIH). As prognostic factor studies with enough power are scarce, this study aimed to ascertain data quality and identify prognostic factors in the IAIHG-RR cohort.

Methods: This retrospective, observational, multicenter study included all patients with a clinical diagnosis of AIH from the IAIHG-RR.

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Ursodeoxycholic acid (UDCA) was demonstrated to reduce susceptibility to SARS-CoV-2 infection in vitro and improve infection course in chronic liver diseases. However, real-life evidence is lacking. We analyzed the impact of UDCA on COVID-19 outcomes in patients hospitalized in a tertiary center.

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The approval of anticancer therapeutic strategies is still slowed down by the lack of models able to faithfully reproduce in vivo cancer physiology. On one hand, the conventional in vitro models fail to recapitulate the organ and tissue structures, the fluid flows, and the mechanical stimuli characterizing the human body compartments. On the other hand, in vivo animal models cannot reproduce the typical human tumor microenvironment, essential to study cancer behavior and progression.

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Background: Management and follow-up strategies for primary sclerosing cholangitis (PSC) vary. The aim of the present study was to assess patient-reported quality of care to identify the most important areas for improvement.

Methods: Data were collected via an online survey hosted on the EU Survey platform in 11 languages between October 2021 and January 2022.

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Background And Aims: Patients with primary biliary cholangitis (PBC) and insufficient response to ursodeoxycholic acid (UDCA), currently assessed after 1 year, are candidates for second-line therapy. The aims of this study are to assess biochemical response pattern and determine the utility of alkaline phosphatase (ALP) at six months as a predictor of insufficient response.

Methods: UDCA-treated patients in the GLOBAL PBC database with available liver biochemistries at one year were included.

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