Wiegand, Birgit Bremer, Andreas Geipel, Corinna M Bremer, Anika

Wiegand, Birgit Bremer, Andreas Geipel, Corinna M. Bremer, Anika Wranke, Dieter Glebe Introduction: Hepatitis delta is the most severe

form of viral hepatitis with a fast progression of fibrosis to cirrhosis. Treatment options are still very limited as PEG-interferon alfa is effective only in a minority of patients. Therefore, appropriate determination of stage of liver disease is desired. Non-invasive fibrosis scores used for other liver diseases including APRI-score, AST/ALT ratios or FIB-4 index do not perform well in hepatitis delta. We here aimed to develop novel non-invasive fibrosis scores optimized for patients with hepatitis delta. Methods: In the ongoing HIDIT-2 treatment trial Opaganib 120 patients with chronic hepatitis delta were recruited. Liver biopsies were evaluated centrally by two independent pathologists. Additionally, selleck inhibitor 50 cytokines, chemokines, growth factors and angiogenic factors were measured in sera of 100 of the 120 patients using multiplex technology (Bio-Plex System). Anti-HDV-IgM-testing was performed in all patients by the ETI-DELTA-IGMK-2

assay (Diasorin). T-test was used to identify factors associated with cirrhosis or fibrosis. selleck chemical With ROC curve analysis and calculation of the Youden index cut offs were determined differentiating cirrhosis and non-cirrhosis as well as fibrosis and non-fibrosis for each factor. In a last step logistic regression was used to identify the most important factors differentiating fibrosis and cirrhosis

in order to create the new score. Results: Four factors were identified differentiating between cirrhosis and Ishak scores <5 (MIF, AST/ALT ratio, age, HGF). Defined cut-offs were determined for each factor (MIF >3400 ng/ml, AST/ALT >0.8, age >35 and HGF >370 ng/ml) which were then included in the following equitation (1 point × the indicated factor for each variable if above the cut-off): 5*MIF+2*(AST/ALT)+AGE+HGF. The AUC of the new score was 0.84; >2 points predicted cirrhosis with a sensitivity of 85%, a specificity of 69%, a PPV of 72% and a NPV of 83%. In order to differentiate between fibrosis (Ishak-score >2) and non-fibrosis, another score was similarly determined based on 6 variables: 0.

Treatment endpoints depend on the monitoring used and the special

Treatment endpoints depend on the monitoring used and the specialist clinic, but at least they have to cover two aspects: (1) cognitive performance (improvement in one accepted test as a minimum) and (2) daily life

autonomy (basic and operational abilities). Nutritional aspects: weight loss with sarcopenia may worsen HE, and, accordingly, the nutritional priority is to provide enough protein and energy to favor a positive nitrogen balance and increase in muscle mass, as recommended above. Portosystemic shunt: occlusion of a dominant shunt may improve HE in patients with recurring HE and good liver function.[114] Because the current experience is limited, the risks and benefits must be weighed before employing check details Mdm2 antagonist this strategy. This section deals with research into the management of HE. However, such research should always be based on research into the pathophysiology of HE. It is necessary to gain more insight into which liver

functions are responsible for maintenance of cerebral functions, which alterations in intestinal function and microbiota make failure of these liver functions critical, which brain functions are particularly vulnerable to the combined effects of the aforementioned events, and, finally, which factors outside this axis that result in the emergence of HE (e.g., inflammation, endocrine settings, or malnutrition). Therefore, the research fields into pathophysiology and clinical management should remain in close contact. Such collaboration should result in new causal and symptomatic treatment modalities that need and motivate clinical trials. There is a severe and unmet need for controlled clinical trials on treatment effects on all the different forms of HE. Decisive clinical studies are few, although the number of patients and their resource utilization Chlormezanone is high. There are no data on which factors and patients represent the higher costs, and research is needed

to examine the effect of specific cirrhosis-related complications. At present, there is an insufficient basis for allocating resources and establishing priority policies regarding management of HE. Many drugs that were assessed for HE several decades ago were studied following a standard of care that, at present, is obsolete. Any study of treatment for HE should be reassessed or repeated using the current standard of care. It is critical to develop protocols to identify precipitating factors and ACLF. The benefit of recently assessed drugs is concentrated in the prevention of recurrence, and there is a large need for trials on episodic HE. There is also an unmet need for research into diagnostic methods that is necessary to form a basis for clinical trials. The diagnosis of MHE and CHE has received enormous interest, but it is still not possible to compare results among studies and the precision should be improved.

4 The large degree of HCV genomic variation, the lack of protecti

4 The large degree of HCV genomic variation, the lack of protective immunity generated by HCV infection, and frequent opportunities for re-exposure through ongoing injection behaviors underpin the recognized occurrence of multiple HCV infections.5-10 Multiple infection is classified as either mixed infection (also sometimes referred to as coinfection), superinfection, and/or reinfection (see review by Blackard and Sherman11). Although multiple infection has been well studied for other viruses, relatively little is known about Selleck HIF inhibitor multiple HCV infection. Primary HCV infection in chimpanzees

followed by re-exposure to viruses from either homologous or heterologous HCV strains has been reported to be associated with mild hepatitis and partial immune protection.12, 13 In humans, mixed HCV infection is generally transient, with evidence of replacement with the new strain or persistence of the primary strain.8,

14, 15 The reasons for the transient nature of mixed infection have yet to be elucidated but may relate to a more effective immune response against one virus (in contrast to the other),16 competition between the two viruses (with the fitter strain selleck kinase inhibitor having an advantage),17 or a combination of these factors. There are limited data regarding the clinical associations of multiple infections. One cross-sectional study by Fujimura et al.10 of 96 HCV-infected patients with hemophilia reported higher alanine aminotransferase levels reflecting greater hepatocellular injury in nine patients (12%) who had mixed HCV genotypes. Another study by Kao et al.18 observed that mixed infection was more often associated with acute exacerbations during chronic hepatitis C infection than monotypic infection. The reported prevalence of multiple infection in HCV-infected

subjects ranges from 5% in a cohort of patients coinfected with HCV and human immunodeficiency virus19 to 39% in a cohort of IDUs.5 The high prevalence of multiple infection in IDUs and the association with high-risk behavior indicates that ongoing injection and needle sharing following primary infection can lead to subsequent acquisition of new HCV strains.5, 6, 20 Longitudinal studies to estimate the incidence of multiple infection include a small number of case series8-10, Thalidomide 15 as well as prospective5-7, 21 and retrospective22, 23 analyses of stored samples. One of the retrospective studies within an IDU population reported a 1.8-fold higher incidence of reinfection (31/100 person-years; 95% confidence interval [CI] 17-62/100 person-years) compared with naïve infection (17/100 person-years; 95% CI 14-20/100 person years).22 In a recent IDU-based prospective study, the incidence rate of reinfection was 2.5-fold higher than primary infection and was associated with injection risk behavior.

4 The large degree of HCV genomic variation, the lack of protecti

4 The large degree of HCV genomic variation, the lack of protective immunity generated by HCV infection, and frequent opportunities for re-exposure through ongoing injection behaviors underpin the recognized occurrence of multiple HCV infections.5-10 Multiple infection is classified as either mixed infection (also sometimes referred to as coinfection), superinfection, and/or reinfection (see review by Blackard and Sherman11). Although multiple infection has been well studied for other viruses, relatively little is known about Nutlin-3 supplier multiple HCV infection. Primary HCV infection in chimpanzees

followed by re-exposure to viruses from either homologous or heterologous HCV strains has been reported to be associated with mild hepatitis and partial immune protection.12, 13 In humans, mixed HCV infection is generally transient, with evidence of replacement with the new strain or persistence of the primary strain.8,

14, 15 The reasons for the transient nature of mixed infection have yet to be elucidated but may relate to a more effective immune response against one virus (in contrast to the other),16 competition between the two viruses (with the fitter strain JQ1 chemical structure having an advantage),17 or a combination of these factors. There are limited data regarding the clinical associations of multiple infections. One cross-sectional study by Fujimura et al.10 of 96 HCV-infected patients with hemophilia reported higher alanine aminotransferase levels reflecting greater hepatocellular injury in nine patients (12%) who had mixed HCV genotypes. Another study by Kao et al.18 observed that mixed infection was more often associated with acute exacerbations during chronic hepatitis C infection than monotypic infection. The reported prevalence of multiple infection in HCV-infected

subjects ranges from 5% in a cohort of patients coinfected with HCV and human immunodeficiency virus19 to 39% in a cohort of IDUs.5 The high prevalence of multiple infection in IDUs and the association with high-risk behavior indicates that ongoing injection and needle sharing following primary infection can lead to subsequent acquisition of new HCV strains.5, 6, 20 Longitudinal studies to estimate the incidence of multiple infection include a small number of case series8-10, Loperamide 15 as well as prospective5-7, 21 and retrospective22, 23 analyses of stored samples. One of the retrospective studies within an IDU population reported a 1.8-fold higher incidence of reinfection (31/100 person-years; 95% confidence interval [CI] 17-62/100 person-years) compared with naïve infection (17/100 person-years; 95% CI 14-20/100 person years).22 In a recent IDU-based prospective study, the incidence rate of reinfection was 2.5-fold higher than primary infection and was associated with injection risk behavior.

1C) To better understand the molecular functions of SIRT7 in HCC

1C). To better understand the molecular functions of SIRT7 in HCC tumorigenesis, SIRT7 knockdown was attempted by way of RNA-interference and studied in the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell proliferation assays. SIRT7 knockdown resulted in a significant reduction in SIRT7 protein expression and in reduced proliferation rates of the Hep3B, SNU-368, Buparlisib price and SNU-449 liver cancer cells, respectively (Fig. 1D-F). This antigrowth effect could be partially explained by the disruption of cell growth regulation, such as cell cycle arrest,

cellular senescence, or apoptosis, on SIRT7-targeting. Thus, we next explored the effects of SIRT7 knockdown on cell cycle regulation and cell death mechanism. In an attempt to identify molecular targets associated with oncogenic SIRT7 activity, FK228 solubility dmso whole genome expression analysis was applied to mock (negative control shRNA-expressing plasmid) or shSIRT7 (SIRT7 shRNA-expression plasmid) transfected Hep3B cells. Such analysis revealed SIRT7 knockdown to restore expression of p21WAF1/Cip1 and to influence the expression of genes involved in cellular growth and death pathways (Supporting Fig. 2A,C). This result implies that SIRT7 inactivation may disturb the

G1/S phase by deregulating cell cycle regulatory proteins. To clarify the role of SIRT7 in cell cycle progression, SIRT7 knockdown Hep3B and SNU-449 cells were treated with nocodazole.

This treatment synchronizes the cells in the G2/M phase. After release from nocodazole block, the proportions of cells in the G1-phase were determined by flow cytometry. SIRT7 knockdown caused a significant ZD1839 chemical structure increase of liver cancer cells in the G1/S phase and delayed cell cycle transition, suggesting that the proliferative defect and/or growth retardation of liver cancer cells by SIRT7 inactivation, at least in part, is due to interference with the cell cycle (Fig. 2A; Supporting Fig. 2D). We then observed that SIRT7 knockdown selectively induced p21WAF1/Cip1 expression, and simultaneously suppressed the expression of cyclin D1 among G1/S cell cycle regulators, and that SIRT7 knockdown also selectively induced the proautophagy factor Beclin-1 and LC3B-II conversion in Hep3B cells by western blot analysis (Fig. 2B,C; Supporting Fig. 2B). Recent studies showed that SIRT7 could be a positive regulator of the RNA polymerase I transcription machinery and its levels are high in metabolically active tissues, such as liver, spleen, testis, and types of carcinoma.9 Because altering the protein synthesis machinery, such as ribosome biogenesis, are essential cellular processes that are governed by malignant progression, we explored the biological function of SIRT7 in the protein synthesis machinery of liver cancer cells.

1C) To better understand the molecular functions of SIRT7 in HCC

1C). To better understand the molecular functions of SIRT7 in HCC tumorigenesis, SIRT7 knockdown was attempted by way of RNA-interference and studied in the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell proliferation assays. SIRT7 knockdown resulted in a significant reduction in SIRT7 protein expression and in reduced proliferation rates of the Hep3B, SNU-368, selleck chemicals and SNU-449 liver cancer cells, respectively (Fig. 1D-F). This antigrowth effect could be partially explained by the disruption of cell growth regulation, such as cell cycle arrest,

cellular senescence, or apoptosis, on SIRT7-targeting. Thus, we next explored the effects of SIRT7 knockdown on cell cycle regulation and cell death mechanism. In an attempt to identify molecular targets associated with oncogenic SIRT7 activity, Proteasome inhibitor drugs whole genome expression analysis was applied to mock (negative control shRNA-expressing plasmid) or shSIRT7 (SIRT7 shRNA-expression plasmid) transfected Hep3B cells. Such analysis revealed SIRT7 knockdown to restore expression of p21WAF1/Cip1 and to influence the expression of genes involved in cellular growth and death pathways (Supporting Fig. 2A,C). This result implies that SIRT7 inactivation may disturb the

G1/S phase by deregulating cell cycle regulatory proteins. To clarify the role of SIRT7 in cell cycle progression, SIRT7 knockdown Hep3B and SNU-449 cells were treated with nocodazole.

This treatment synchronizes the cells in the G2/M phase. After release from nocodazole block, the proportions of cells in the G1-phase were determined by flow cytometry. SIRT7 knockdown caused a significant BCKDHB increase of liver cancer cells in the G1/S phase and delayed cell cycle transition, suggesting that the proliferative defect and/or growth retardation of liver cancer cells by SIRT7 inactivation, at least in part, is due to interference with the cell cycle (Fig. 2A; Supporting Fig. 2D). We then observed that SIRT7 knockdown selectively induced p21WAF1/Cip1 expression, and simultaneously suppressed the expression of cyclin D1 among G1/S cell cycle regulators, and that SIRT7 knockdown also selectively induced the proautophagy factor Beclin-1 and LC3B-II conversion in Hep3B cells by western blot analysis (Fig. 2B,C; Supporting Fig. 2B). Recent studies showed that SIRT7 could be a positive regulator of the RNA polymerase I transcription machinery and its levels are high in metabolically active tissues, such as liver, spleen, testis, and types of carcinoma.9 Because altering the protein synthesis machinery, such as ribosome biogenesis, are essential cellular processes that are governed by malignant progression, we explored the biological function of SIRT7 in the protein synthesis machinery of liver cancer cells.

The sensitivities of antibodies reactive to the N-terminal region

The sensitivities of antibodies reactive to the N-terminal region (90.0%, 81/90) and at least one epitope (93.3%, 84/90) were higher than antibodies reactive to others (Table 5). The specificities against HC of anti-M3R antibodies reactive to each epitope,

at least one epitope and all four epitopes were relatively high (95.2% for N-terminal, 92.9% for first loop, 97.6% Everolimus for second loop, 97.6% for third loop, 90.5% for at least one and 100.0% for all four) (Table 5). On the other hand, the specificities for disease controls (CHC, NASH, PSC, obstructive jaundice and drug-induced liver injury) with anti-M3R antibodies reactive to the first extracellular loop (80.0–100.0%) and all four epitopes (80.0–100.0%) were higher than antibodies reactive to others (Table 5). The accuracy

of antibodies reactive to the first extracellular loop between PBC and CHC (78.5%) was highest among all epitopes of anti-M3R antibodies, as well as between PBC and all controls (all disease controls plus HC) (84.6%) (Table 5). These findings indicated that antibodies reactive Idasanutlin solubility dmso to the first extracellular loop had the highest diagnostic value for PBC with moderate sensitivity (73.3%), and with both high specificity (80.0–100.0%) and high accuracy (74.0–84.6%) between PBC and all controls (Table 5). THE RESULTS OF the present study showed a high frequency of positivity for anti-M3R antibodies in patients with PBC (93.3%), similar to positivity for AMA. We also analyzed the epitopes of anti-M3R antibodies in patients with PBC and demonstrated the presence of several B-cell epitopes on the extracellular domains of M3R in anti-M3R antibodies, and that many patients with PBC carried anti-M3R antibodies that recognized several extracellular domains of M3R. Although PBC is regarded as an autoimmune liver disease, its etiopathogenesis Tolmetin remains obscure. Various factors such as genetic disposition, microorganism, apoptosis and environmental factors have been suggested to have important roles in the development and persistence of PBC.[1] AMA

by indirect immunofluorescent assay is detected in over 90% of patients with PBC. ELISA is also performed for detection of AMA against each component (from M1 to M9 components). Among the nine components, the M2 component is specific for PBC. M2 antigens localize in the mitochondrial inner membrane, and four protein fractions (40, 47, 50 and 70 kDa) have been identified in M2 antigens by immunoblot assay. The 70-kDa fraction is the major M2 antigens, and corresponds to the E2 component of PDC (PDC-E2). Both the branched chain 2-oxo-acid dehydrogenase complex and oxoglutarate dehydrogenase complex are also M2 antigens specific for PBC.[8] In addition to AMA, anticentromere antibody and anti-gp210 antibody have been reported to be detected in patients with PBC (frequencies range 20–30%).

79 Overall, these data indicate that these HLA class II alleles m

79 Overall, these data indicate that these HLA class II alleles may influence the maintenance of immune tolerance as well as the penetrance of infectious agents, thus having implications in light of the proposed infectious theory in PBC etiology.1 In accordance with this, because the protective HLA alleles are associated with resistance to several infections, it can be hypothesized that the lack of such alleles might contribute to the molecular mimicry of infectious agents, leading to immune tolerance breakdown in PBC.1 The field of human genetics has rapidly changed since the recent completion of the human genome sequence, and novel, challenging

theories have been selleck chemical proposed. Lorlatinib Overall, thanks to dramatic advances in molecular technology linked to the field of genetics,81 we are now witnessing an explosion of new information about the allelic architecture of human complex diseases, such as PBC.82 In particular,

the ability to evaluate the entire human genome for common polymorphisms (i.e., those present in more than 5% of the general population) has allowed us to disclose more than 80 disease-susceptibility loci. The catalog of the National Cancer Institute–National Human Genome Research Institute reports an updated list of published GWAS (http://www. genome. gov/26525384). It is of great interest that the recent GWAS approaches have allowed the identification of an extended major histocompatibility complex, spanning approximately 7.6 megabases of the human genome.83 Indeed, many additional loci (most with a putative immunoregulatory role) were identified outside the well-known HLA class I, II, and III regions.83 A growing number of studies are providing evidence of genetic complexity within the MHC region in a number of disorders. In PBC, the first GWAS was recently performed in cases from Canada and the United States15 and reported significant associations with HLA, as

well as with other non-HLA loci including IL-12A, and IL-12RB2 polymorphisms. This first study manifested a sufficient statistical power by cAMP including 536 patients with PBC and 1536 controls typed for approximately 300,000 common variants, but more solid data were soon provided by combining data sets from the Canadian–US GWAS with a separate Italian GWAS16 (Fig. 2 and Table 2). More than 610,000 common variants were examined in 457 Italian PBC cases and more than 1 million in 947 controls. When considered alone, the Italian cohort association data set achieves genome-wide significance at the HLA locus, with several other loci showing suggestive association signals (Fig. 2A,B). Analysis of the combined data set (998 cases and 8777 controls) showed many more loci to have reached the conservative genome-wide threshold P value (P < 5 × 10−8), most of these also showed P values < 5 × 10−5 in the Italian-alone cohort.

Effects of antiportal hypertensive therapy, such as nonselective

Effects of antiportal hypertensive therapy, such as nonselective beta-blockers or transjugular PLX4032 intrahepatic portosystemic shunt (TIPS) implantation, on vWF-Ag levels will provide further mechanistic insights in the mechanism regulating vWF-Ag levels in patients with cirrhosis and PH. vWF-Ag levels can be easily determined in standard laboratories at a cost of less than 6 US$€ per patient sample. To increase the probability of a proper testing, it is advisable that

the measurement should be done at a facility with immediate on-site processing in their own specialized coagulation laboratory,24 which is not always found in small hospitals. However, certain known limitations to the application of vWF-Ag levels in patients with cirrhosis have to be considerd (e.g., infections, malignancies, physical training or IFN therapy),14,

15 which have been shown to elevate vWF-Ag levels. Hereditary vWF-Ag deficiency or acute bleeding may diminish vWF-Ag levels and the degree of PH might be underestimated. On the other hand, measurement of HVPG is invasive, expensive, not widely available and technically not successful in up to 4% of patients.25 TE, investigated as another promising noninvasive tool for the assessment of patients with liver disease, may not be successful in up to 25% of cases, not to mention the cost of the system and maintenance, and is therefore inferior when standard probes are used. selleck compound Clinical consequences of cirrhosis are foremost related to CSPH more than to any other cause,26 which prompted the proposal of a new staging system for patients with cirrhosis.5 The invasiveness and lack of general availability of HVPG measurement prevents the broad use of pressure-guided diagnostic and therapeutic algorithms

in patients with cirrhosis. In our large cohort, we could show an impressive correlation between portal pressure and vWF-Ag levels, which is independent of CPS.8 Thus, vWF-Ag can be used for the selection of high-risk patients within respective Child Metalloexopeptidase Pugh stages. This is of particular importance in patients with CPS A and B, who might not be considered for liver transplantation. We additionally could show that the reported increase of vWF-Ag with higher CPS stages9 is probably more related to PH, because patients with cirrhosis without PH had only slightly elevated vWF-Ag levels. Furthermore, we demonstrated a correlation of vWF-Ag with clinical outcome parameters and a high predictive value of disease-related mortality. In line with our results, La Mura et al.12 investigated the effect of vWF-Ag levels on clinical outcome in 42 patients with cirrhosis and PH. The investigators reported a vWF-Ag cut-off value of 216 U/dL to disclose between patients with cirrhosis with a highly different probability of survival free of PH-related events and transplantation. This cut-off level is similar to our 241%, which represents the optimal cutoff to discriminate between the presence or absence of CSPH in patients with cirrhosis.

Key Word(s): 1 SirT1; 2 iTRAQ; 3 fatty liver; 4 lipid metabol

Key Word(s): 1. SirT1; 2. iTRAQ; 3. fatty liver; 4. lipid metabolism; Presenting Author: AJAY DUSEJA Additional Authors: learn more SHWETA KAPIL, PALLAB RAY, ASHIM DAS, ANURADHA

CHAKRABORTI, RADHAK DHIMAN, YOGESH CHAWLA Corresponding Author: AJAY DUSEJA Affiliations: PGIMER Objective: Background: Nonalcoholic fatty liver disease (NAFLD) is a multifactorial disease. Genetic polymorphisms of Toll like receptors (TLRs) and its co-receptor CD14 (Cluster of differentiation 14) may be involved in the pathogenesis of NAFLD. Aim: To study the role of genetic variants of CD14 gene [C (-550) T and C (-159) T] in the pathogenesis of NAFLD. Methods: Methods: In a prospective study, 130 patients with NAFLD (Cases) (M:F =78:52, mean age 38.47 ± 10.6 years) and 50 healthy volunteers (Controls) (M:F = 38:12, Mean age 36.56 ± 4.2 years) were included. Genotyping of C(-550)T and C(-159)T polymorphisms in the promoter region of CD14 gene was done using polymerase chain reaction and restriction fragment length polymorphism. Results were confirmed by DNA sequencing and data analyzed

using multiplicative, Cochran armitage test for trend (CATT), Panobinostat dominant and recessive models for the association of these polymorphisms with NAFLD. Results: Results: Among C(-550)T polymorphism, frequency of different genotypes among cases and controls were CC [77/130 (59.2%) vs.34/50 (68%)], CT [45(34.6%) Vs 14(28%), OR = 1.41(0.68-2.92) p =0.34] and TT [(8(6.1%) Vs 2(4%), OR = 1.76 (0.35-8.75) p =0.48]. There was no difference in the T allele frequency between cases and controls [(23.46% Vs 18%) p =0.262] and no association of C(-550)T polymorphism with NAFLD on multiplicative, CATT, dominant and recessive models of analysis. Among C(-159)T polymorphism frequency of different genotypes among cases and controls were CC [20(15.8%) Vs. 10(20%)], CT [51(39.2%) Vs. 30(60%), OR = 0.85(0.35-2.0) p =0.71] and TT [59/130(45.38%) vs.10/50(20%),

OR = 2.9(1.07-8.12) p =0.03]. T allele frequency (65% Vs 50%, p = 0.009) was higher among cases than controls with significant association of C(-159)T polymorphism with NAFLD on recessive model (p = 0.0001). Conclusion: Conclusion: Amino acid C(-159)T polymorphism of TLR co-receptor CD14 is associated with NAFLD. Key Word(s): 1. NAFLD; 2. NASH; 3. Toll like receptor; 4. Gene polymorphism; Presenting Author: ELENAVITALYEVNA PELLO Additional Authors: SOFIAKONSTANTINOVNA MALYUTINA, GALINAILYNICHNA SIMONOVA, YURIPETROVICH NIKITIN Corresponding Author: ELENAVITALYEVNA PELLO, SOFIAKONSTANTINOVNA MALYUTINA, GALINAILYNICHNA SIMONOVA, YURIPETROVICH NIKITIN Affiliations: Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences Objective: Background and aims: In the world the rapidly growing prevalence of fatty liver disease (FLD) evokes anxiety.