| ironjustice@aol.com 2006-09-15, 9:32 pm |
| <<snip>>
suggests that iron reduction therapy by phlebotomy will be one of the
promising therapies for NASH
<<snip>>
Effect of iron reduction by phlebotomy in Japanese patients with
nonalcoholic steatohepatitis: A pilot study.
Sumida Y, Kanemasa K, Fukumoto K, Yoshida N, Sakai K, Nakashima T,
Okanoue T
Hepatol Res. 2006 Sep 11;
Increased hepatic iron deposition may play a role in the pathogenesis
of nonalcoholic steatohepatitis (NASH). This study aimed to test
whether iron removal by phlebotomy improves serum transaminase
activities in patients with NASH. Eleven patients (six males and five
females) with biopsy-proven NASH underwent phlebotomy biweekly until
they reached near-iron deficiency (NID) (serum ferritin concentration
lower than or equal to 30ng/ml). Nine patients completed this study.
Serum ferritin levels in these patients fell from 563+/-322 to
18+/-9ng/ml (p=0.001). The treatment reduced mean serum alanine
aminotransferase (ALT) activity from 126+/-47 to 56+/-17IU/l (p=0.002).
Their weight did not change significantly throughout the study period.
Although two patients withdrew from the study, none was affected by any
side effects of repeated phlebotomy that required discontinuing the
treatment. In conclusion, this pilot study suggests that iron reduction
therapy by phlebotomy will be one of the promising therapies for NASH.
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Advanced fibrosis is reversible
In contrast with the traditional view that cirrhosis is an irreversible
disease, recent evidence indicates that even advanced fibrosis is
reversible
(122). In experimentally induced fibrosis, cessation of liver injury
results
in fibrosis regression (123). In humans, spontaneous resolution of
liver
fibrosis can occur after successful treatment of the underlying
disease. This
observation has been described in patients with iron and copper
overload,
alcohol- induced liver injury, chronic hepatitis C, B, and D,
hemochromatosis,
secondary biliary cirrhosis, NASH, and autoimmune hepatitis (19, 122,
124,125,
Sl, S2) (Figure 4). It may take years for significant regression to be
achieved; the time varies depending on the underlying cause of the
liver
disease and its severity. Chronic HCV infection is the most extensively
studied condition, and therapy (IFN-a plus ribavirin) with viral
clearance
results in fibrosis improvement. Importantly, nearly half of patients
with
cirrhosis exhibit reversal to a significant degree (90). Whether this
beneficial effect is associated with improvements in long-term clinical
outcome, incl\uding decreased portal hypertension, is unknown.
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