Page 15 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Progress in the research of pathology and therapy in liver fibrosis

have been proven to be accurate and suitable for assessing and F4 fibrosis, with areas under the curve of 99.8%,
advanced fibrosis in patients with chronic virus hepatitis, 66.7%, 70.4%, and 96.3% in patient samples, respectively.
NAFLD, or alcoholic liver disease. 41-43 However, while TE, shear wave elastography, and MRE, each providing
fibrosis-related scores can improve the identification of LSM, are the most studied imaging-based non-invasive
individuals at high risk of severe liver disease through liver disease assessment techniques. In adults, sensitivities
repeated testing, serological biomarkers or indexes alone for the identification of F2 – 4 ranged from 51% to 95%,
are not ideal for detecting early-stage fibrosis. 44 for F3 – 4 from 70% to 100%, and for F4 from 60% to 100%
across all techniques and diseases, whereas specificities
2.2.2. Ultrasound ranged from 36% to 100%, 74% to 100%, and 67% to 99%,
Recently, elastography has emerged as a promising non- respectively. The largest body of evidence available supports
invasive method for quantitatively detecting hepatic TE, while MRE appears to be the most accurate method.
55
fibrosis. It can obtain liver stiffness measurement (LSM) The optimization and standardization of these joint models
through ultrasound or magnetic resonance imaging are still under further exploration. Undeniably, emerging
(MRI). Ultrasound-based methods, including point-shear non-invasive fibrosis multi-modality assessments reduce
wave elastography and transient elastography (TE), show the need for liver biopsy in fibrosis staging (Figure 2).
good diagnostic performance in distinguishing different
stages of liver fibrosis. Moreover, a prospective cohort 3. Clinical and experimental treatment for
45
analysis from six international medical centers determined liver fibrosis
that TE is an optimal screening tool for identifying patients 3.1. Etiological treatment for liver fibrosis
with liver fibrosis in the general population due to its cost-
effectiveness and improved survival benefits, especially for Etiological treatment is the primary approach to managing
patients in early-stage fibrosis (≥F2). 46 liver fibrosis. When a definite and controllable cause,
such as hepatitis virus infection, alcoholic steatohepatitis
2.2.3. MRI (ASH), or non-alcoholic steatohepatitis (NASH) is
Conventional MRI and magnetic resonance elastography identified, the etiology treatment should be initiated
(MRE) provide a comprehensive liver evaluation, from promptly. Chronic liver diseases and fibrosis caused by
morphological to parenchymal changes, without being hepatitis virus infections can now be effectively cured with
affected by patient-related factors (age, sex, and body antiviral treatment. For chronic hepatitis B virus (HBV)
mass index) or liver-related factors (iron overload infection, recommended treatments include interferon and
and necroinflammation). 47 Recently, gadolinium- nucleos(t)ide analogs. In addition, interferon-stimulated
labeled cyclic peptides, an MRI tracer targeting hepatic gene therapy has recently been proposed to regulate HBV
PDGFR-β, have been developed to accurately stage liver infection through intervening in different stages of the
fibrosis by visualizing PDGFR-β expression in carbon viral life cycle. 56-58 For hepatitis C virus (HCV)-associated
tetrachloride (CCl4)-treated mice. MRE has reported cirrhosis, direct-acting antivirals (DAAs) are the standard
48
higher accuracy in detecting all liver fibrosis stages treatment. 59-61 The latest European Association for the
compared to TE, with diagnostic accuracy increasing as Study of the Liver guidelines recommend an increasing
fibrosis advances. In addition, numerous non-invasive number of DAA regimens, including sofosbuvir (SOF),
49
stiffness-based models (combining blood makers with SOF/velpatasvir (VEL), SOF/VEL/voxilaprevir (VOX),
elastography) have been proposed for routine screening glecaprevir/pibrentasvir, or grazoprevir/elbasvir for
and identification of early-stage liver fibrosis (≥F2), 50,51 as cirrhotic patients to achieve sustained virological response
62
well as disease surveillance. 47,52 Recently, Keegan et al. (SVR), which corresponds to HCV elimination. A multi-
53
validated ultrasonography-based photoacoustic imaging center study on the long-term effect of DAAs in HCV-
with MRI, showing its effectiveness in detecting liver associated cirrhosis showed that high SVR is related
adiposity and fibrosis, enabling the non-invasive detection to the decreased rate of complications in patients with
63
of changes in liver pathology associated with metabolic compensated cirrhosis. In addition, alcohol withdrawal
dysfunction. Furthermore, Gao et al. established a and weight control play crucial roles in reducing liver
54
53
fibroblast activation protein alpha (FAPα)-activated MRI burden in ASH and NASH. 64-66
nanoprobe for precise grading of clinical liver fibrosis. The
nanoprobe is composed of superparamagnetic amorphous 3.2. Commonly used drugs for liver fibrosis
iron nanoparticles (NPs) and paramagnetic gadoteric Sorafenib is a multi-kinase inhibitor that is mainly applied
acid (Gd-DOTA) connected by FAPα-responsive peptide in HCC patients but is rarely used to inhibit the progression
chains (ASGPAGPA). It effectively identifies F1, F2, F3, of liver fibrosis. There is only one multicenter, open-label,

Volume 9 Issue 3 (2025) 7 doi: 10.36922/ejmo.8125