Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/81427
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Heterogeneity of fibrosis patterns in non-alcoholic fatty liver disease supports the presence of multiple fibrogenic pathways
Author: Skoien, R.
Richardson, M.
Jonsson, J.
Powell, E.
Brunt, E.
Neuschwander-Tetri, B.
Bhathal, P.
Dixon, J.
O'Brien, P.
Tilg, H.
Moschen, A.
Baumann, U.
Brown, R.
Couper, R.
Manton, N.
Ee, L.
Weltman, M.
Clouston, A.
Citation: Liver International, 2013; 33(4):624-632
Publisher: Wiley-Blackwell Publishing Inc
Issue Date: 2013
ISSN: 1478-3223
1478-3231
Statement of
Responsibility: 
Richard Skoien, Michelle M. Richardson, Julie R. Jonsson, Elizabeth E. Powell, Elizabeth M. Brunt, Brent A. Neuschwander-Tetri, Prithi S. Bhathal, John B. Dixon, Paul E. O’Brien, Herbert Tilg, Alexander R. Moschen, Ulrich Baumann, Rachel M. Brown, Richard T. Couper, Nicholas D. Manton, Looi C. Ee, Martin Weltman and Andrew D. Clouston
Abstract: <h4>Background</h4>Adult non-alcoholic fatty liver disease (NAFLD) involves lobular necroinflammatory activity and fibrosis is typically centrilobular, whereas paediatric NAFLD has predominantly portal fibrosis. The reasons for these differences are unclear. We aimed to determine (a) how centrilobular and portal fibrosis in children relate to histological parameters; and (b) whether atypical fibrosis patterns exist in adults that are unexplained by current fibrogenesis models.<h4>Methods</h4>Histological features of paediatric (n = 38) and adult (n = 56) NAFLD were assessed using conventional scoring systems. Keratin-7 immunostaining was used to assess hepatic progenitor cell numbers and the ductular reaction. Centrilobular and portal components of fibrosis were independently scored and fibrosis patterns were classified according to accepted types. Post-treatment (rosiglitazone/gastric banding) biopsies were also examined in adults.<h4>Results</h4>Twenty-six children (68.4%) had portal-predominant fibrosis, although the typical "adult" pattern was seen in 11 (28.9%). Portal fibrosis was associated with a ductular reaction (P = 0.021) and hepatic progenitor cell expansion (P < 0.001), whereas centrilobular fibrosis was associated with lobular inflammation (P = 0.026) and ballooning (P = 0.001). Before intervention, six adults (10.7%) had atypical fibrosis including 3 (5.4%) with a previously unrecognized pattern of very fine, non-zonal sinusoidal fibrosis. Despite improvements in steatosis and inflammation, more patients developed this unusual pattern after intervention with most having had surgery (9 of 10 adults; P < 0.001).<h4>Conclusion</h4>Differing associations with portal and centrilobular fibrosis in children and atypical fibrosis patterns in adults suggest that multiple fibrogenic pathways exist in NAFLD. This has implications for therapy and understanding pathogenesis.
Keywords: Bariatric surgery; Fatty liver; Fibrosis; Histology; Steatohepatitis
Rights: © 2013 John Wiley & Sons A/S.
RMID: 0020132373
DOI: 10.1111/liv.12100
Appears in Collections:Paediatrics publications

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.