20, 21 Thus, it will be critical to determine in the context

20, 21 Thus, it will be critical to determine in the context

of AR signaling whether enhanced CCRK-driven β-catenin activation is globally contributing to tumorigenesis or in some cases may in fact be an oxidative stress-driven response promoting cell proliferation and regeneration in the setting of chronic liver injury and fibrosis. 10 “
“Background and Aim:  We investigated the efficacy and effectiveness of entecavir in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients. Methods:  We enrolled 231 nucleoside-naïve chronic hepatitis B (CHB) patients primarily treated with entecavir 0.5 mg/day for at least 6 months in Dasatinib purchase our institution. Of these, 71 patients had HCC at the start of entecavir treatment (HCC group) and 160 did not (non-HCC group). We compared antiviral responses to entecavir in the two groups, and evaluated the effects of entecavir on the clinical outcomes of curatively-treated Sotrastaurin solubility dmso HCC patients. Results:  The HCC and non-HCC

groups had similar cumulative rates of HBV-DNA negativity, alanine aminotransferase normalization, and hepatitis e antigen loss in year 2 (100% vs 95.4%, 94.7% vs 97.3%, and 40.8% vs 41.8%, respectively; P > 0.05). Entecavir treatment for 12 months decreased mean Model for End-Stage Liver Disease scores in patients with cirrhosis and HCC (7.2 vs 5.6, P < 0.001). Of the 71 HCC patients, 16 underwent curative therapies concurrently with entecavir; hepatectomy in six and radiofrequency ablation in 10, and the 55 remaining patients received transarterial chemoembolization or conservative treatment. In a subgroup of 16 HCC patients receiving curative treatments, patients who became serum HBV DNA negative by week 24 had better overall survival (P = 0.039), but not recurrence-free survival (P = 0.961), than those who did not. Conclusions: 

First-line entecavir monotherapy medchemexpress is comparably effective in CHB patients with and without HCC, and improves hepatic function in HBV-related HCC patients. An early virological response to entecavir is prognostic of improved survival following curative therapy against HBV-related HCC. “
“Nonalcoholic fatty liver disease (NAFLD), the accumulation of lipid within hepatocytes, is increasing in prevalence. Increasing fructose consumption correlates with this increased prevalence, and rodent studies directly support fructose leading to NAFLD. The mechanisms of NAFLD and in particular fructose-induced lipid accumulation remain unclear, although there is evidence for a role for endoplasmic reticulum (ER) stress and oxidative stress. We have evidence that NAFLD models demonstrate activation of the target of rapamycin complex 1 (Torc1) pathway.

PCS significantly improved with both, whereas

PCS significantly improved with both, whereas Z-VAD-FMK ic50 the MCS significant improved with rabeprazole. In D-S, Q-R and Q-D significant improved with rabeprazole, but neither improved with lafutidine. QOL did not improve with either. With overlap, neither scale nor the QOL reached a significant difference. Conclusion:  Both PPI and H2RA have a positive effect on P-S, but H2RA therapy is limited for R-S and D-S, whereas PPI therapy is generally effective. Therefore, careful prescription

based on symptoms is important. “
“Emerging evidence supports the concept of a rebalanced hemostatic state in liver disease as a result of a commensurate decline in prohemostatic and antihemostatic drivers. In the present study, we assessed levels and functionality of the platelet-adhesive protein von Willebrand factor (VWF) and its cleaving protease ADAMTS13 in the plasma of patients with acute liver injury and acute liver failure

(ALI/ALF). Furthermore, we explored possible associations between VWF, ADAMTS13, and disease outcome. We analyzed the plasma of 50 patients taken on the day of admission for ALI/ALF. The plasma of 40 healthy volunteers served as controls. VWF antigen levels were highly elevated in PD0325901 nmr patients with ALI/ALF. In contrast, the collagen-binding activity and the ratio of the VWF ristocetin cofactor activity and VWF antigen was significantly decreased when compared with healthy controls. Also, the proportion of high molecular weight VWF multimers was reduced, despite severely decreased ADAMTS13 levels. In spite of these functional defects, platelet adhesion and aggregation were better supported by plasma of patients with ALI/ALF when compared with control plasma. Low ADAMTS13

activity, but not high VWF antigen, was associated with poor outcome in patients with ALI/ALF as evidenced by higher grades of encephalopathy, higher transplantation rates, and lower survival. VWF or ADAMTS13 levels were not associated with 上海皓元医药股份有限公司 bleeding or thrombotic complications. Conclusion: Highly elevated levels of VWF in plasma of patients with ALI/ALF support platelet adhesion, despite a relative loss of function of the molecule. Furthermore, low ADAMTS13 activity is associated with progressive liver failure in the patient cohort, which might be attributed to platelet-induced microthrombus formation in the diseased liver resulting from a substantially unbalanced VWF/ADAMTS13 ratio. (Hepatology 2013;58:752–761) Concepts of the clinical consequences of the hemostatic disorders in patients with liver failure have changed considerably over the last decade. It is now well established that patients with chronic liver failure and abnormal routine coagulation tests do not necessarily have an increased bleeding tendency and that thrombotic complications may occur in these patients.[1, 2] Moreover, recent studies of the coagulopathy of liver failure suggest a link between intrahepatic thrombosis and the progression of liver failure.

Large-scale studies are needed to better define which patients wi

Large-scale studies are needed to better define which patients with cancer are most likely to benefit from simultaneous antiviral therapy and cytotoxic chemotherapy. Notably, antiviral treatment with pegylated interferon-α and ribavirin should not be used early in the post-transplant period

(<2 years after transplantation) in patients who have undergone allogeneic HSCT as interferon-α therapy may precipitate or induce the development of GVDH.[57] "
“T-cell responses against hepatitis C are believed to be critical in achieving both natural and treatment-induced clearance. However, STA-9090 molecular weight rapid clearance of antigen with early treatment of primary infection may result in reduced or poorly sustained cellular immunity. This study longitudinally examined Th1 and Th2 hepatitis C virus (HCV)-specific cytokine production and T-cell effector function from subjects enrolled in the Australian Trial in Acute Hepatitis C comparing Galunisertib manufacturer three groups:

treatment-induced clearance (sustained virological response [SVR]), treatment non-response, and untreated spontaneous clearance. HCV-specific T-cell responses were characterized by HCV peptide ELISpot, in vitro cytokine production, and T-cell flow cytometry assays. Treated subjects with a sustained virological response (SVR) displayed a better maintenance of HCV-specific Th1 responses compared to treatment non-responders (higher interferon [IFN]-γ and interleukin (IL)-2 magnitude at week 24, broader IFN-γ responses at weeks 24 and 48, P < 0.05) and significantly increased IFN-γ responses between screening and week 48 (magnitude P = 0.026, breadth P = 0.009). Treatment-induced viral clearance was also associated with a trend toward decreased IL-10 responses (screening to week 48, P = 0.070), higher expression of CD45RO (P = 0.042) and CD38 (P = 0.088) on CD4+ T cells, and higher IFN-γR expression (CD56+IFN-γR+ P = 0.033) compared to treatment non-responders. Untreated subjects with viral clearance also displayed MCE公司 high magnitude and broad HCV-specific IFN-γ and IL-2 responses early in infection; however, IFN-γ responses were not as well maintained compared to treated subjects with a SVR (week

48 magnitude, breadth P = 0.064). Treatment-induced viral clearance of recent HCV infection is associated with maintenance of HCV-specific Th1 responses. “
“Control of hepatitis C virus (HCV) infection remains a huge challenge of global medical importance. Using a variety of in vitro approaches, neutralizing antibodies (nAbs) have been identified in patients with acute and chronic hepatitis C. The exact role these nAbs play in the resolution of acute HCV infection still remains elusive. We have previously shown that purified polyclonal antibodies isolated from plasma obtained in 2003 from a chronic HCV patient (Patient H) can protect human liver chimeric mice from a subsequent challenge with the autologous HCV strain isolated from Patient H in 1977 (H77).

The patient recovered and a reconstructive surgery using a retros

The patient recovered and a reconstructive surgery using a retrosternal gastric tube was performed 3 weeks MI-503 molecular weight later. The resected oesophagus showed full thickness oesophageal inflammation with large numbers of eosinophils (Figure 2). “
“We read with great interest the report by Björnsson et al.1 regarding the clinical characteristics

and prognosis of patients with drug-induced autoimmune hepatitis (DIAIH). In their study, the authors described 24 patients with DIAIH resulting from nitrofurantoin and minocycline use. Tumor necrosis factor α (TNF-α) blocking agents are drugs commonly used in the treatment of rheumatological, dermatological, and gastroenterological autoimmune diseases. Minor abnormalities in liver function tests are relatively common with the use of anti–TNF-α STA-9090 purchase agents, but the development of serious hepatic failure and the reactivation of viral hepatitis might be possible as well. Autoimmune hepatitis (AIH) is a rare but increasingly

reported complication with the use of anti–TNF-α agents. To the best of our knowledge, 11 cases of AIH due to anti–TNF-α agents were reported between 2001 and 2010, and all these patients showed serological findings of type 1 AIH.2–12 The induction of ANA and the elevation of serum immunoglobulin G levels, which are diagnostic criteria for AIH, have been reported in patients treated with anti–TNF-α therapy for spondylarthropathy, rheumatoid arthritis, and psoriasis.13, 14 For these reasons, reliance on only serological and laboratory findings

may lead to diagnostic confusion. Moreover, after a careful review of the literature, we noticed that none of the patients with AIH induced by anti–TNF-α agents had histologically proven cirrhosis or advanced fibrosis at presentation, and all of them responded well to immunosuppressive treatment. Therefore, these findings suggest that the prognosis of DIAIH is favorable, regardless of the underlying, offending drugs. In conclusion, DIAIH is a rare entity, and only a few drugs have been reported 上海皓元医药股份有限公司 as offending agents. We think that anti–TNF-α agents, in addition to well-known drugs, should be considered noxious agents in the differential diagnosis of DIAIH. Moreover, anti–TNF-α agents share some similarities with nitrofurantoin and minocycline with respect to AIH. All these drugs show the same histological findings, and their clinical characteristics with respect to therapeutic outcomes are nearly identical. However, anti–TNF-α agents have many hepatic side effects such as drug-induced hepatitis, reactivation of hepatitis B or C, and fulminant hepatic failure, which may require orthotopic liver transplantation. Therefore, we think that liver enzyme abnormalities should be carefully evaluated in patients who are receiving anti–TNF-α agent therapy.

Briefly, cell cultures were carried out as previously described,

Briefly, cell cultures were carried out as previously described, and RNA extraction and reverse-transcription Venetoclax research buy were performed using Trizol Reagent and Ready-To-Go First Strand kit (see section on RNA isolation and gene expression by real-time PCR). The PCR reaction was performed as previously described, in a 50 μL reaction mixture containing 5 μL complementary DNA, 20 mM Tris-HCl, 50 mM MgCl2, 200 μM of each deoxynucleotide triphosphate, 0.3 mM of each specific primer (sense: 5′-TCA CAC TCC TCG CCC TAT T-3′ and antisense: 5′-CGA TGT GGT CAG CCA ACT-3′), and 0.03 U/μL Taq DNA polymerase (GibcoBRL, Grand Island, NY). PCR of β-actin was used as an endogenous control. The expected sizes of the PCR products of osteocalcin

and β-actin were 246 and 285 base pairs, respectively. A pool of primary osteoblastic cells from 10 donors were plated in 24-well tissue

plates and were incubated in DMEM/HAM F-12 (1:1) medium, supplemented with 10% of FBS and 10 μg/mL of ascorbic acid. In order to synchronize after reaching osteoblast subconfluence, culture medium was replaced with DMEM/HAM F-12 containing 100 μg/mL of ascorbic acid and incubated for 24 hours. Cells were subsequently incubated for 24, 48, and 72 hours with different concentrations of unconjugated bilirubin (10, 50, 100, and 1000 μM) or pooled samples from cholestatic patients with normal and high bilirubin levels, and pooled samples from healthy controls, in DMEM/HAM F-12 medium with 10 μg/mL ascorbic acid. Cell viability was measured in duplicate using a colorimetric assay based on the cleavage of the tetrazolium salt U0126 purchase WST-1 by mitochondrial dehydrogenase in viable cells (Cell Proliferation Reagent WST-1; Roche, Basel, Switzerland). The absorbance was read at 450 nm wavelength with an enzyme-linked immunosorbent assay reader. Osteoblast 上海皓元医药股份有限公司 differentiation was measured by the determination of alkaline phosphatase activity. Briefly, primary osteoblasts from three subjects were plated in 12-well tissue plates and incubated in supplemented

medium. After synchronization, cells were incubated for 24, 48, and 72 hours in 10 μg/mL of ascorbic acid with different concentrations of unconjugated bilirubin (10, 50, 100, and 1000 μM) or pooled samples from patients with normal and high bilirubin levels, and samples from healthy controls. Then, cells were washed with phosphate-buffered saline and lysed with a lysis buffer (CelLytic M; Sigma Aldrich). Cell extracts were incubated with 2 mg/mL of p-nitrophenylphosphate (pNPP) in a 0.05 M glycine buffer containing 0.5 mM MgCl2 (pH 10.5) at 37°C for 30 minutes. The reaction was stopped by the addition of 0.4 N NaOH to the reaction mixture, and the alkaline phosphatase activity was quantified by absorbance at 405 nm. Total protein content was determined with Bradford’s method in aliquots of the same samples with the Quick Start Bradford Protein Assay (Bio-Rad Laboratories, Madrid, Spain).

To verify this hypothesis the computer fluid dynamics (CFD) study

To verify this hypothesis the computer fluid dynamics (CFD) study of tag performance was carried out. A virtual model presenting authentic geometry of a dolphin with tag attached to the dorsal fin was constructed. The same model without tag was used as a reference object to calculate tag impact as regards drag, lift, and moments coefficients. Flow around the models was simulated

for the range of velocities as well as the ranges of pitch and yaw angles. It was shown that in 33 of 35 CFD scenarios the streamlined shape of a tag generates the lift force that facilitates keeping a tag attached to the fin. Throughout the set of calculations the tag-associated drag coefficient does not exceed 4%, which indicates low impact. Acalabrutinib purchase Data obtained present a baseline for the further development of non-invasive dolphin telemetry tags. “
“Department of Biological Sciences, Virginia Polytechnic Institute selleck compound and State University, Blacksburg, Virginia, U.S.A The Seas, Epcot, Walt Disney World Resort, Lake Buena Vista, Florida,

U.S.A The development of motor synchrony in dolphins has been described qualitatively, but seldom quantified. We provide a detailed description of the development of synchrony in 12 calves for periods ranging from birth to a few days up to 22 wk. We observed the presence of synchrony, relative positions, and proximity medchemexpress and undertook a videotape analysis of one calf for initiations/terminations of synchrony, response time to breaks in synchrony, and the development of complex behaviors by the calf relative to synchrony. Synchrony was uniformly present more than 90% of the time during month 1, then began to decline gradually. Echelon position was most frequent but calves also spent time in infant position. Initially all calves were most frequently in direct physical contact with their mothers, but by 2 wk of age, all pairs were more likely

to be near each other (<0.5 m) without touching. Behavioral complexity increased gradually over the study, and adults frequently performed behaviors during synchronous swimming, providing opportunities for social learning. Synchrony is a predominant behavior in mother-calf interactions, and we speculate that it may be an important mechanism through which calves learn from their mothers via their tandem interactions with the environment. "
“Due to the highly predictable patterns of occupancy on land, pinnipeds are one of the main marine resources observed by tourists, which, in turn, could strongly perturb their behavior. We analyzed the behavioral responses of the South American sea lion (Otaria byronia) to the presence of tourists and its variation according to temporal (2012 vs. 2013 austral summer months), spatial (breeding vs. nonbreeding sites of the colony), and age/sex class (adult males vs. subadult males vs.

Several authors have demonstrated that lithocholic acid is a phys

Several authors have demonstrated that lithocholic acid is a physiologic ligand of VDR33 and modulates bile acid detoxification. Han et al.22 identified VDR protein and messenger RNA in primary cultures of human hepatocytes and demonstrated that this receptor plays a critical role in the inhibition of the synthesis

of bile Obeticholic Acid mw acids, protecting the hepatocytes from cholestatic injury. VDR can be activated by either lithocholic acid acetate or 1α,25(OH)2D3 and exerts its activity through the transcriptional inhibition of CYP7A1, the initial and rate-limiting enzyme of bile acid synthesis, reducing the synthesis of bile acids in human hepatocytes.21 Interestingly, in beta-catenin assay NASH patients, we found that VDR expression on cholangiocytes was inversely associated with NAS, suggesting a possible role of VDR, expressed on biliary cells, in modulating the inflammatory process in course of liver disease. Studies in animal models and in patients with biliary disorders and CHC have shown that the ductal epithelium can express several profibrogenic and chemotactic proteins, the latter capable of attracting

and activating inflammatory and fibrogenic cells.34-36 In this study, we demonstrated that liver expression of both CYP2R1 and CYP27A1 is preserved in NASH patients. This observation may question the hypothesis of a loss of hydroxylation capacity of hepatocytes in the course of NASH. Conversely, low 25(OH)D3 levels could favor, along with known risk factors, the intrahepatic accumulation of lipids, insulin resistance, progressive hepatic steatosis, and the development of steatohepatitis. Overall, the present study suggests that vitamin D may influence the inflammatory response to chronic liver injury both

in NASH and in CHC patients by means of its specific VDR, widely expressed on hepatic cell lines. In addition to the immunomodulator MCE and antiproliferative activities on inflammatory cells, it is plausible to hypothesize that vitamin D exerts its action on cholangiocytes, in which the expression of VDR is particularly pronounced. Low hepatic VDR expression, closely associated with more severe liver histology in this study, could represent the primary event leading to progression of hepatitis. VDR polymorphisms have been investigated in the context of chronic liver diseases such as primary biliary cirrhosis and autoimmune hepatitis, where they seem to contribute to the risk of liver disease development.16, 17 Indeed, because serum 25(OH)D3 levels in our population of NASH patients are comparable to those observed in obese subjects without liver disease, it is plausible that VDR polymorphisms affecting liver VDR expression may play a role in the development and progression of NASH independently from serum vitamin D status.

91 and specificity of 078 Conclusion:  IFN-beta induction thera

91 and specificity of 0.78. Conclusion:  IFN-beta induction therapy resulted in acceptable SVR rates despite short therapy duration. Steep reduction of HCV by IFN-beta enables us to predict

SVR in the first week of therapy. “
“Patients with acute-on-chronic liver failure (ACLF) represent a complex population with differential prognosis. The aim of the study was to categorize ACLF according to the severity of underlying chronic HSP inhibitor liver diseases (CLD). A total of 540 ACLF patients were recruited, including 127 with prior decompensated cirrhosis and 413 without prior decompensation (PD) including 193 with underlying chronic hepatitis and 220 with prior compensated cirrhosis. The clinical characteristics and prognosis of subgroups were compared. Cox proportional hazard model and multinominal logistic regression analysis were performed to identify significant prognostic parameters. The 28-day, 3-month and 1-year survival of ACLF

patients with or without PD were Apoptosis Compound Library purchase 58.9% versus 61.4%, 36.2 versus 52.5% and 29.1% versus 49.6%, respectively. On multinominal logistic regression analysis or time-to-death analysis by Cox proportional hazard model, PD was significantly associated with post-28-day mortality but not within-28-day mortality. On multivariate time-to-death analysis, elder age, high INR and serum bilirubin, low levels of serum sodium and platelet count, and presence of hepatic encephalopathy (HE), upper gastrointestinal bleeding, respiratory or circulation dysfunction were predictors of within-28-day mortality

in patients without PD, whereas the risk factors in patients with PD were high INR, creatinine, presence of HE, respiratory or circulation dysfunction. ACLF patients with or without PD had comparable short-term prognosis but differential 1-year mortality. ACLF patients with PD were distinct from those without PD in age, types of acute insults, severity of hepatic damage and distribution of complications and the former group was characterized by increased delayed mortality. “
“The role of progenitor cells in liver repair and fibrosis has been extensively described, but their purification remains a challenge, hampering their characterization and MCE公司 use in regenerative medicine. To address this issue, we developed an easy and reproducible liver progenitor cell (LPC) isolation strategy based on aldehyde dehydrogenase (ALDH) activity, a common feature shared by many progenitor cells. We demonstrate that a subset of nonparenchymal mouse liver cells displays high levels of ALDH activity, allowing the isolation of these cells by fluorescence-activated cell sorting. Immunocytochemistry and qPCR analyses on freshly isolated ALDH+ cells reveal an enrichment in cells expressing liver stem cell markers such as EpCAM, CK19, CD133, and Sox9.

The second limitation is the ethnic homogeneity of the Japanese p

The second limitation is the ethnic homogeneity of the Japanese population. Because the baseline incidence of HCC development differs among population groups, longer-term longitudinal studies in larger cohorts with various population subgroups are required to verify the generality of our results. With the development of potent direct-acting antiviral agents combinations, IFN-free therapy is likely to be approved in the near future. This raises the question of whether posttreatment ALT and/or AFP levels will remain a significant predictor of HCC risk. Moreover, it

is uncertain whether the suppressive effect of viral eradication by IFN-free regimens on hepatocarcinogenesis will be identical to that obtained by IFN-based regimens. Therefore, it is extremely interesting to prove these issues in future studies. In conclusion, see more post-IFN treatment ALT and AFP levels are strictly associated with hepatocarcinogenesis risk in patients with CHC. Measurement of these values is useful for predicting future HCC risk in IFN-treated patients. Suppression of these values after IFN therapy reduces HCC risk even in patients without HCV eradication, while SVRs with increased ALT and/or AFP levels are at risk for HCC development. The present results have potentially important clinical implications for physicians and may influence their decisions regarding Caspase inhibitor treatment strategy and HCC surveillance

for individual patients. Additional Supporting Information may be found in the online version of this article. “
“Background and Aims:  The effects of an EP4 agonist/antagonist on the healing of lesions produced by indomethacin in the small intestine were examined in rats, especially in relation to the expression of vascular endothelial growth factor (VEGF) and angiogenesis. Methods:  Animals were given indomethacin (10 mg/kg s.c.) and killed at various

time points. To impair the healing of these lesions, a small dose of indomethacin (2 mg/kg p.o.) or AE3-208 (EP4 antagonist: 3 mg/kg i.p.) was given once daily for 6 days after the ulceration was induced, with or without MCE公司 the co-administration of AE1-329 (EP4 agonist: 0.1 mg/kg i.p.). Results:  Indomethacin (10 mg/kg) caused severe damage in the small intestine, but the lesions healed rapidly decreasing to approximately one-fifth of their initial size within 7 days. The healing process was significantly impaired by indomethacin (2 mg/kg) given once daily for 6 days after the ulceration. This effect of indomethacin was mimicked by the EP4 antagonist and reversed by co-administration of the EP4 agonist. Mucosal VEGF expression was upregulated after the ulceration, reaching a peak on day 3 followed by a decrease. The changes in VEGF expression paralleled those in mucosal cyclooxygenase-2 expression, as well as prostaglandin E2 (PGE2) content.

DCA is formed after bacterial 7 alpha dehydroxylation of CA in th

DCA is formed after bacterial 7 alpha dehydroxylation of CA in the colon and is a potent natural TGR5 agonist20, 21 and a ligand activating FXR.22-24 Using mouse 3T3 cells as adipocytes, the authors could further demonstrate

that both TGR5 and FXR activation was able to induce adiponectin expression. However, it must be kept in mind that the presence of FXR in adipose tissue may be questionable25 and that in addition to adipocytes also inflammatory cells could significantly contribute to TGR5 expression within fat.21 Since TGR5 and FXR have different affinities Temozolomide ic50 for DCA, the absolute serum concentrations would have been of interest in order to estimate which receptor may be most likely involved. Moreover, the possibility to activate TGR5 and FXR in vivo by specific ligands

and using specific knockout mice should help to decipher in the near future which receptor plays a key role in regulation of adiponectin expression. Whether such agonists regulate adiponectin in humans could be addressed in ongoing and future clinical trials with FXR and TGR5 activators. On the other hand, it is important to consider that high adiponectin levels are associated with increased cardiovascular mortality despite improved inflammatory, atherogenic, and insulin-sensitizing effects,26 which might result from adiponectin Bioactive Compound Library resistance.27 It is known that DCA represses

endogenous BA synthesis MCE公司 by way of Cyp7a1, but without suppressing cholesterol synthesis, in contrast to CDCA.28 Increased hepatic cholesterol synthesis promotes progression of NAFLD.29 Therefore, a DCA increase in patients with advanced burnt-out NASH might also contribute to deterioration of the liver condition by failing to repress the endogenous cholesterol synthesis (Fig. 1). In addition, a high fat diet is known to increase DCA levels in mouse, which in turn increases the intestinal permeability and thus propagates inflammation.30 It is therefore possible that a fat-enriched diet in human favors ectopic fat storage in the liver and DCA formation, which then keeps endogenous cholesterol synthesis at a high level and promotes intestinal leakage by enhancing bacterial translocation promoting inflammation and fatty liver development. The identification of DCA as an important BA in NASH patients in the current study could also indicate a potential role of the gut flora. In the gut, FXR maintains epithelial barrier integrity by induction of multiple genes involved in intestinal mucosal defense against inflammation and microbes, which, together with direct antibacterial detergent actions, help to control the gut microbiota.