International Hepatology

According to the World Health Organization, there are currently about 257 million chronic hepatitis B (CHB) patients worldwide, with approximately 70 million HBV (hepatitis B virus) carriers in China, making it one of the countries with a high prevalence of chronic HBV infection. Due to factors such as viral characteristics, immune status, and environmental influences, domestic and international guidelines typically classify the natural history of chronic HBV infection into four phases: immune tolerance, immune active, immune control, and reactivation. Identifying these phases is crucial for predicting patient prognosis and guiding intervention strategies. However, recent studies have shown that a considerable number of chronic HBV infection patients cannot be categorized into any of these four phases based on existing guidelines or natural history criteria, leaving them in an indeterminate phase or gray zone, which is not covered by international and domestic clinical guidelines. Recently, at the 17th National Clinical Conference on Liver Diseases in 2024, Professor Peng Hu presented a report titled "Related Research on Indeterminate Phase of Chronic Hepatitis B." Hepatology Digest conducted an interview with Professor Peng Hu regarding CHB's indeterminate phase. Here is the summarized interview for our readers.

Liver fibrosis is the result of damage to the liver by pathogenic factors, leading to chronic, repeated abnormalities in liver function and the deposition of collagen and other proteins. It is a crucial factor influencing the prognosis of chronic liver disease and a necessary stage in the progression to cirrhosis. Recently, at the 25th National Conference on Traditional Chinese Medicine and Hepatobiliary Diseases organized by the Chinese Association of Traditional Chinese Medicine, Professor Jingtao Li from the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine presented the latest clinical research advancements in the prevention and treatment of liver fibrosis using Traditional Chinese Medicine (TCM). The multi-component, multi-target therapeutic features of TCM, along with the significant efficacy of several representative drugs, provide strong scientific support for the application of TCM in combating liver fibrosis.

Hepatitis B virus (HBV), a hepatotropic DNA virus, is the causative agent of hepatitis B. HBV-infected individuals have three types of particles in their blood: Dane particles, spherical particles, and tubular particles. The characteristics of these particles can be used to detect evidence of HBV infection through immunological methods. Recently, at the 17th National Conference on Clinical Hepatology, Professor Ailong Huang, President of Chongqing Medical University, delivered a report titled "Mechanisms of Persistent HBV Infection." This report provides an in-depth analysis of the mechanisms behind persistent HBV infection, revealing the relationship between abnormal host immune responses and viral evasion of host antiviral effects, offering new perspectives for understanding HBV persistence and developing treatment strategies.

Cholestatic drug-induced liver injury (DILI) is a drug-induced condition characterized primarily or prominently by intrahepatic cholestasis, featuring clinical, biochemical, and histopathological evidence. It is a relatively common and serious adverse drug reaction that can lead to acute liver failure and even death, affecting the clinical application of medications. In recent years, significant breakthroughs in targeted and immunotherapy for cancer have markedly improved the prognosis and survival of patients with malignancies. However, liver injury caused by antitumor drugs, particularly cholestatic DILI, has become a major clinical concern. Recently, at the 8th International Forum on Drug-Induced Liver Injury and the 9th National Conference on Drug-Induced Liver Injury, Professor Enqiang Chen from West China Hospital of Sichuan University, delivered an outstanding report on cholestatic DILI, which is summarized below for our readers.

Cholangiocarcinoma (BTC), often called the "silent killer," constitutes less than 1% of adult cancers and has a poor prognosis with limited patient survival. Current treatments primarily involve surgery and chemotherapy, but their efficacy is limited. Recently, various targeted drugs and immune checkpoint inhibitors (ICIs) have provided new therapeutic options for BTC patients. The 2024 American Society of Clinical Oncology (ASCO) Annual Meeting presented several new drug research updates on BTC. Here, we summarize three oral presentation studies.

Recently, Professor Naga P. Chalasani and his research team from Indiana University published a significant study online in the prestigious hepatology journal JOH. The study, titled "Increases and Decreases in Liver Stiffness Measurements are Independently Associated with the Risk of Liver-Related Events in NAFLD Patients," was initiated by Professor Naga P. Chalasani in collaboration with key researchers in the NAFLD field across the United States, including Professor Arun J. Sanyal from Virginia Commonwealth University. The study aims to provide new insights into disease management and risk assessment for NAFLD patients.

The treatment of advanced hepatocellular carcinoma (HCC) has entered the era of targeted and immunotherapy, with combined regimens becoming the first-line standard. More combination therapies are still under exploration. At the recently concluded 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, the CheckMate 9DW study announced positive results for the dual immunotherapy of anti-PD-L1 and anti-CTLA-4, positioning this "double star" regimen as a potential first-line treatment. Additionally, the conference revealed results from the first Phase II clinical trial of an immune checkpoint inhibitor (ICI) combined with a tyrosine kinase inhibitor (TKI) as a second-line treatment following failure of first-line immunotherapy. Chinese researchers also reported on a Phase I clinical trial of a specific autologous armored-CAR-T cell therapy.

The 29th Annual Meeting of the European Hematology Association (EHA) was held from June 13-16, 2024, in Madrid, Spain. As the largest international conference in the field of hematology in Europe, it attracts numerous renowned experts and scholars each year to share and discuss innovative concepts, the latest scientific research, and clinical study results in hematology. At this year's meeting, several research findings from Professor Huilai Zhang's team at Tianjin Medical University Cancer Institute & Hospital were selected. To gain a deeper understanding of the latest research progress in the field of lymphoma, "Oncology Frontier - Hematology Frontier" has invited Professor Lihua Qiu from the same team for an in-depth interpretation.

In a study conducted by Metzler F et al. from 2005-2007, involving 258 patients who received one course of Rituximab treatment, 46% had received the hepatitis B vaccine, 11% were Anti-HBc/anti-HBs positive, and less than 1% were HBV DNA positive. The study found that the average Anti-HBs level in vaccinated individuals dropped significantly from 80 IU/mL to 38 IU/mL (P<0.05) after Rituximab treatment. Among three patients with inactive HBV infection, HBV DNA became detectable, and ALT levels increased post-treatment. With the increasing use of antitumor drugs in recent years, HBV reactivation and hepatitis B flare-ups have become significant clinical concerns. We have invited Professor Jun Li from the First Affiliated Hospital of Nanjing Medical University to discuss the comprehensive management of HBV reactivation related to antitumor treatment for the benefit of our peers.

Drug-induced autoimmune hepatitis, as a new and complex disease phenotype, has received widespread attention in recent years. On May 25, 2024, at the "8th International Forum on Drug-induced Liver Injury" in Malaga, Spain, Professor Raul J. Andrade of the Malaga Biomedical Research Center at the University of Malaga delivered a fascinating lecture on drug-induced autoimmune hepatitis. Our journal had the privilege of conducting an exclusive interview with Professor Andrade, delving into the specific characteristics of the disease, diagnostic challenges, treatment strategies, and future research directions. We have organized the content into an article, hoping to enhance clinicians' understanding of the disease, optimize patient treatment outcomes, and improve quality of life.