Demographic characteristics in each fibrosis stage group were evenly distributed, including race, gender, HIV status, and HBsAg status, although persons with more severe fibrosis were generally older (P < 0.01). We observed that SBA (mU/mL) decreased with increasing liver disease stage (Fig. 4B). For reference, serum albumin, bilirubin, and APRI levels were compared at contemporaneous timepoints (Fig 4C-E) and were similarly found to have significant

AZD6244 purchase changes with advanced liver disease. The role of BCHE in the pathogenesis of liver fibrosis is contingent on its decreased expression before the onset of advanced liver fibrosis. To test the temporal relationship of BCHE expression with liver fibrosis, SBA was measured in fibrosis progressors and nonprogressors at four regularly spaced timepoints that spanned the progression of fibrosis from minimal disease to cirrhosis in the progressors (Table 2). The median (range) time between visits was 4 (1.5–6) years in progressors, and 4.4 DMXAA supplier (1.6–6.2) years in non-progressors.

Median SBA was lower in progressors compared with nonprogressors at timepoint 1 (adj. P = 0.04), timepoint 3 (adj. P = 0.04), and timepoint 4 (adj. P = 0.00057). Indeed, all intermediate timepoints showed steady and significant decreases of SBA except between timepoints 1 and 2 (Fig. 5A). These results were compared with serum albumin, a well-characterized clinical marker of impaired liver synthetic function in persons with advanced liver disease. Serum albumin was only significantly lower in progressors compared with nonprogressors Smad inhibitor after the establishment of cirrhosis (Fig. 5b). To confirm that earlier decreases of SBA compared with albumin were not simply due to methodologic differences in the performance of those assays, serum bilirubin was tested in the longitudinal cohort; bilirubin was not different

between and within the two groups at any stage (data not shown). Interestingly, SBA in nonprogressors was significantly lower at timepoint 3 (adj. P = 0.007) and timepoint 4 (adj. P = 0.0001) compared with timepoint 1, confirming that decreased BCHE expression occurs before the onset of significant fibrosis. In contrast, serum albumin levels were not different between any timepoints in the nonprogressors, confirming that its decrease is a result of impaired liver function. In the setting of chronic viral hepatitis, the portal tracts become chronically inflamed and contain mononuclear cells including B cells, T cells, and monocytes. The hepatic lobules also have chronic inflammation in chronic HCV, but generally less so. To confirm enrichment of cellular inflammation in portal tracts, 18 segments from portal tract transcriptomes of the original nine subjects were compared with 54 hepatocyte transcriptomes from the same subjects, yielding 801 differentially expressed genes: 71 genes were up-regulated in portal tracts, whereas 730 genes were up-regulated in hepatocytes.