Publications by authors named "David E Kleiner"

Saliva contains antimicrobial peptides considered integral components of host innate immunity, and crucial for protection against colonizing microbial species. Most notable is histatin-5 which is exclusively produced in salivary glands with uniquely potent antifungal activity against the opportunistic pathogen Candida albicans. Recently, SARS-CoV-2 was shown to replicate in salivary gland acinar cells eliciting local immune cell activation.

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Objectives: Concerns about drug-induced liver injury (DILI) may deter physicians from prescribing medications for alcohol use disorder (MAUD). We aim to explore DILI due to MAUD in Drug-Induced Liver Injury Network (DILIN) prospective study.

Methods: High-confidence DILI cases (ie, definite, highly likely, or probable) due to MAUD in DILIN prospective study (2004-2024) were included.

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Article Synopsis
  • Intra and inter-pathologist variability complicates the evaluation of metabolic dysfunction-associated steatohepatitis (MASH) biopsy results, hindering patient selection and assessment quality in clinical trials.
  • A study analyzed 120 histology slides with and without AI assistance to evaluate its impact on pathologists' reliability in fibrosis staging, especially for early fibrosis stages.
  • Results showed that AI assistance significantly improved concordance among pathologists, increasing agreement rates for clinical trial inclusion and exclusion, which could enhance the overall efficiency and reliability of MASH-related clinical research.
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Since the Asian Pacific Association for the Study of the Liver (APASL) published guidelines on non-cirrhotic portal fibrosis/idiopathic portal hypertension in 2007, there has been a surge in new information, especially with the introduction of the term porto-sinusoidal vascular disorder (PSVD). Non-cirrhotic intra-hepatic causes of portal hypertension include disorders with a clearly identifiable etiology, such as schistosomiasis, as well as disorders with an unclear etiology such as non-cirrhotic portal fibrosis (NCPF), also termed idiopathic portal hypertension (IPH). This entity is being increasingly recognized as being associated with systemic disease and drug therapy, especially cancer therapy.

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Drug-induced liver injury (DILI) presents unique challenges in clinical practice. While some types of DILI are mild and resolve quickly after removing the drug, other situations are more complex, with competing aetiologies or underlying liver disease. Guidelines from professional societies agree that the liver biopsy retains a role in understanding and managing DILI in certain situations.

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Article Synopsis
  • Metabolic dysfunction-associated steatohepatitis (MASH) is a serious fatty liver disease that can get worse over time, and doctors are finding better ways to check its progress using advanced technology.
  • A study looked at liver samples from 57 patients to see how their liver fibrosis (scarring) changed after treatment, using special microscopy and artificial intelligence for detailed analysis.
  • The results showed that many patients on placebo got worse even if regular tests said they didn’t change, highlighting how the new method can give clearer information about liver health.
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Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in people with HIV (PWH). The morphological spectrum of MASLD compared to matched controls and of the correlation between the NAFLD activity score (NAS) and fibrosis stage in PWH remains unknown.

Methods: Overall, 107 liver biopsies from PWH with MASLD (MASLD-PWH) were matched to 107 biopsies from individuals with MASLD and without HIV (MASLD controls) on age at biopsy, race/ethnicity, sex, type 2 diabetes, body mass index (BMI) and alanine aminotransferase (ALT) level.

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  • Liver disease is a recognized complication of common variable immunodeficiency (CVID), with nodular regenerative hyperplasia (NRH) and portal hypertension (PH) as common manifestations.
  • A study reviewed 40 patients with CVID-related liver disease from 1990 to 2020, noting that many presented with NRH and some showed significant progression of fibrosis over time.
  • The findings suggest that while NRH is prevalent initially, a subgroup of patients experiences worsening liver fibrosis, highlighting the need for further research into the disease's progression and causes.
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Background And Aims: There are limited data on the progression of liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) in people with type 2 diabetes mellitus (T2DM) versus those without T2DM in biopsy-proven metabolic dysfunction-associated steatotic liver disease. We examined LSM progression in participants with T2DM versus those without T2DM in a large, prospective, multicenter cohort study.

Approach And Results: This study included 1231 adult participants (62% female) with biopsy-proven metabolic dysfunction-associated steatotic liver disease who had VCTEs at least 1 year apart.

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Background: Azithromycin (AZ) is a widely used antibiotic. The aim of this study was to characterise the clinical features, outcomes, and HLA association in patients with drug-induced liver injury (DILI) due to AZ.

Methods: The clinical characteristics of individuals with definite, highly likely, or probable AZ-DILI enrolled in the US Drug-Induced Liver Injury Network (DILIN) were reviewed.

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Identifying cell types and states remains a time-consuming, error-prone challenge for spatial biology. While deep learning is increasingly used, it is difficult to generalize due to variability at the level of cells, neighborhoods, and niches in health and disease. To address this, we developed TACIT, an unsupervised algorithm for cell annotation using predefined signatures that operates without training data.

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Background: Bile acids mediate gut-liver cross-talk through bile acid receptors. Serum, hepatic, and microbial bile acid metabolism was evaluated in HCV-compensated chronic liver disease.

Methods: Patients underwent liver biopsy; portal and peripheral blood were obtained before (HCVi), and 6 months after sustained virologic response (SVR), splenic blood was obtained only after SVR.

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Identifying cell types and states remains a time-consuming and error-prone challenge for spatial biology. While deep learning is increasingly used, it is difficult to generalize due to variability at the level of cells, neighborhoods, and niches in health and disease. To address this, we developed TACIT, an unsupervised algorithm for cell annotation using predefined signatures that operates without training data, using unbiased thresholding to distinguish positive cells from background, focusing on relevant markers to identify ambiguous cells in multiomic assays.

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Histological subtyping of hepatocellular carcinoma (HCC) is challenging in the presence of histological heterogeneity, where distinctly different morphological patterns are present within the same tumor. Current approaches rely on percent cut-offs. We hypothesized that morphologic intratumor heterogeneity is a non-random biological feature and that incorporating recurrent patterns would improve histological subtyping of HCC.

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Article Synopsis
  • Autoimmune polyendocrine syndrome type 1 (APS-1) is a severe genetic disorder resulting from AIRE deficiency, leading to self-reactive T cells causing autoimmune damage in various organs.
  • The study investigated the role of interferon-γ in APS-1 by analyzing patient samples and conducting experiments with mice, finding that high levels of interferon-γ correlate with disease activity.
  • Treatment with the JAK inhibitor ruxolitinib significantly reduced interferon-γ levels and improved symptoms in APS-1 patients, suggesting that targeting this pathway may be a viable therapeutic approach.
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  • Liver biopsies have been crucial in understanding the causes and development of acute liver diseases, although their role has evolved with new diagnostic methods.
  • While they are not mandatory in clinical guidelines for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF), many medical centers continue to perform them because they are relatively safe and provide important prognostic information.
  • The increasing use of liver biopsies for diagnosing less severe acute liver injuries has led to a shift in the types of specimens analyzed, emphasizing the need for histopathologists to be prepared for these complex cases.
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Background & Aims: The clinical significance of change in liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) in patients with non-alcoholic fatty liver disease (NAFLD) is not well-understood. We prospectively defined rates of progression to and regression from LSM-defined compensated advanced chronic liver disease (cACLD) and their associations with liver-related events (LREs).

Methods: Participants in the NASH Clinical Research Network-led NAFLD Database 2 and 3 studies were included.

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  • Leptin replacement therapy with metreleptin shows significant improvements in metabolic health for patients with generalized lipodystrophy (GLD), especially in those who receive treatment early.
  • A study analyzed data from 63 patients with GLD and found that those who started metreleptin therapy earlier had better long-term metabolic outcomes compared to those who started later, including lower levels of HbA1c and triglycerides.
  • The findings suggest that initiating metreleptin treatment before severe complications develop could lead to better management of diabetes and liver health, though more research is needed to fully understand its impact on liver disease.
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Objective: Gene therapy by convection-enhanced delivery of type 2 adeno-associated virus-glial cell derived neurotrophic factor (AAV2-GDNF) to the bilateral putamina seeks to increase GDNF gene expression and treat Parkinson's disease (PD).

Methods: A 63-year-old man with advanced PD received AAV2-GDNF in a clinical trial. He died from pneumonia after anterior cervical discectomy and fusion 45 months later.

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  • Porphyria is a genetic disorder affecting heme biosynthesis, leading to a buildup of porphyrins in organs, especially the liver, which can result in severe conditions like cholestasis and liver cirrhosis.* -
  • Congenital erythropoietic porphyria (CEP) is a rare type of porphyria caused by a specific enzyme deficiency, primarily causing skin issues but also potentially affecting the liver with fibrosis.* -
  • A unique case is reported of a CEP patient who developed porto-sinusoidal vascular disease, leading to complications like portal hypertension that required liver transplantation.*
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  • Non-cirrhotic portal hypertension (NCPH) includes liver diseases with portal hypertension but no cirrhosis, and the understanding of its progression and diagnosis is limited.
  • A study evaluated 50 patients, categorizing them based on the presence of specific portal hypertension features, and assessed their liver health over an average of 50 months.
  • Both patient groups had similar survival rates; however, lower platelet counts and higher liver stiffness measurements indicated poorer outcomes, highlighting the need for close monitoring of patients without specific PH features due to their risk for progression.
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Objectives: Inflammatory cytokines that signal through the Janus kinases-signal transducer and activator of transcription (JAK-STAT) pathway, especially interferons (IFNs), are implicated in Sjögren's disease (SjD). Although inhibition of JAKs is effective in other autoimmune diseases, a systematic investigation of IFN-JAK-STAT signalling and the effect of JAK inhibitor (JAKi) therapy in SjD-affected human tissues has not been fully investigated.

Methods: Human minor salivary glands (MSGs) and peripheral blood mononuclear cells (PBMCs) were investigated using bulk or single-cell (sc) RNA sequencing (RNAseq), immunofluorescence (IF) microscopy and flow cytometry.

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