ResumoObjetivos: Apresentar uma revisão atualizada sobre atresia das vias biliares extra-hepáticas, com ênfase em etiopatogenia, abordagens diagnósticas e terapêuticas e prognóstico. Conclusão:A atresia das vias biliares extra-hepáticas continua sendo a principal indicação de transplante hepático em crianças, e a mudança deste panorama depende de um melhor entendimento da etiopatogenia da obstrução biliar nos diferentes fenótipos da doença.Investigações futuras a respeito do papel do interferon gama e de outras citocinas são necessárias para avaliar se esses aspectos seriam potenciais alvos de intervenção terapêutica.J Pediatr (Rio J). 2007;83(2):105-120: Atresia das vias biliares extra-hepáticas, etiopatogenia, diagnóstico, tratamento e prognóstico. AbstractObjective: To provide an updated review on extrahepatic biliary atresia, focusing mainly on its etiopathogenesis, diagnosis, treatment and prognosis.Sources: MEDLINE and PubMed databases were searched using the following keywords: biliary atresia, etiopathogenesis, diagnosis, treatment, prognosis, children. Summary of the findings:Extrahepatic biliary atresia is the main indication for liver transplantation among pediatric patients. As to its

Hepatitis E is the fifth known form of human viral hepatitis. Although not very common in our clinical practice, the incidence in Western countries is increasing. Infection with the hepatitis E virus (HEV) may be related to acute illness, liver failure, chronic hepatitis and cirrhosis. HEV itself is an RNA virus, with eight described genotypes (HEV 1–8), four of which more commonly affect humans and have, thus, been better studied. Besides liver manifestations, genotype 3 is also related to extra-hepatic manifestations, such as neurological, renal and rheumatological. Evolution to chronic disease occurs especially in patients who underwent transplantation, have hematological malignancies requiring chemotherapy, or have infection with the human immunodeficiency virus. The diagnosis may be difficult because of the low availability of tests and due to low sensibility and specificity. The acute form of illness does not have to be treated, but the chronic one does. We present here a literature review of hepatitis E and the relation between chronic hepatitis E and transplantation.

Biliary atresia is an obstructive cholangiopathy of unknown etiology. Although the adaptive immune system has been shown to regulate the obstruction of bile ducts in a rotavirus-induced mouse model, little is known about the virus-induced inflammatory response. Here, we hypothesized that cholangiocytes secrete chemoattractants in response to rotavirus. To test this hypothesis, we infected cholangiocyte and macrophage cell lines with rhesus rotavirus type A (RRV), quantified cytokines and chemokines and measured the migration of splenocytes. We also used PCR and immunostaining to search for new cellular targets of RRV in the liver. We found that RRV-infected cholangiocytes induced the mRNA expression for chemokines, but conditioned media failed to promote chemotaxis of splenocytes. Analyzing livers after viral challenge, we detected RRV in hepatic macrophages and demonstrated that media from RRV-infected macrophages have high concentrations of cytokines and chemokines and induced chemotaxis of neutrophils. Most notably, addition of anti-Mip2/Cxcl2 antibodies depleted this chemokine in the conditioned media and completely prevented neutrophil chemotaxis. In conclusion, infected cholangiocytes did not promote chemotaxis of inflammatory cells. Investigating alternate cellular targets of RRV, we detected the virus in hepatic macrophages and found that infected macrophages promoted neutrophil chemotaxis by release of Mip2/Cxcl2 in response to RRV. (Pediatr Res 67: 345-351, 2010) B iliary atresia, the most common cause of neonatal cholestasis, results from an inflammatory and fibrosing obstruction of extrahepatic bile ducts. The etiology is unknown, but studies in an experimental mouse model of rotavirus-induced biliary atresia indicate that pathogenic mechanisms of disease begin with an injury to the biliary epithelium, followed by a robust inflammatory infiltration of the wall of extrahepatic bile ducts, obstruction of the lumen by inflammatory cells, and final progression to fibrosis (1). These pathologic changes in the liver and extrahepatic bile ducts closely resemble human biliary atresia (2,3). Studies of livers of infants at the time of diagnosis have long recognized an activation of inflammatory cells (4), and a broad analysis of the hepatic gene expression profile identified a prominent proinflammatory signature (5). Disruption of this signature by loss of IFN-␥ or the loss of CD8ϩ lymphocytes in the mouse model largely prevented duct obstruction and the phenotype of experimental biliary atresia (6,7). Interestingly, in vivo depletion of CD4ϩ lymphocytes or the genetic loss of IL-12, or the depletion of TNF-␣ later in the course of biliary injury did not alter the progression to biliary atresia phenotype (7-9), which supported the coexistence of accessory pathways regulating the pathology of extrahepatic bile ducts. Despite the progress in deciphering key elements regulating duct obstruction and atresia, little is known about molecular circuits that are activated in early stages of the disease.Cellu...

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The results point to the effectiveness of second-generation direct-acting antivirals in hepatitis C virus Brazilian patients, especially those with genotype 1. Furthermore, that patients with genotype 3 need more attention and adjustments in available treatment options.