We observed that PAR-2 deficiency in experimental liver fibrosis leads to a reduction in hepatic collagen content and histological fibrosis accompanied by decreased HSC activation, as demonstrated by the reduced expression of αSMA. These findings were paralleled by a decrease in gene and protein expression of the principal profibrogenic cytokine,

TGFβ, and altered MMP and TIMP gene expression. We confirmed a specific effect on HSC in vitro by showing that PAR-2 activation stimulated proliferation, collagen production, and TGFβ protein production. These data suggest that PAR-2 activation promotes hepatic fibrosis by inducing a profibrogenic phenotype in HSCs. PAR-1 has been studied in animal models of hepatic necroinflammation and fatty liver disease10 and in human and murine lung injury.13 PAR-1-deficient mice appear to be protected from CCl4-induced liver fibrosis.14 Thus, there is compelling selleck kinase inhibitor evidence that thrombin/Xa-induced PAR-1 signaling plays an important role in tissue fibrogenesis.4, 5 Interest in the role of PAR-2 in hepatic fibrosis has developed based on evidence that PAR-2 activation is associated with inflammatory and fibrogenic

events in the kidney and pancreas9, 15 and its expression is increased in models of lung injury,8, 16 suggesting an important role for PAR-2 in mediating tissue repair. Cellular mechanisms underlying this role have been proposed by Borensztajn et al., who showed that Factor Xa signaling via PAR-2 induced fibroblast see more proliferation, migration, and differentiation into myofibroblasts.17 The role of PAR-2 in hepatic inflammation and fibrosis has been examined, to date, only in HSC derived from experimental animals. Gaca et al. demonstrated PAR-2 expression in rat HSC, and showed that PAR-2 agonists induced HSC proliferation and collagen production.18 Fiorucci et al. similarly showed that PAR-2 agonist stimulation of rat HSCs resulted in proliferation and activation.10 To our knowledge, the current study is the first to explore the role of the PAR-2 receptor

in liver fibrosis in vivo in PAR-2 knockout mice and in vitro in human HSCs. The use learn more of the KO model is a particular strength of the study that allows us to ascribe a profibrogenic role to PAR-2 unequivocally, because antagonist studies can be troubled by a lack of molecular specificity. These findings significantly expand the evidence linking PAR-2 ligation with hepatic fibrogenesis that occurs most likely through a direct effect on HSC proliferation and collagen production. We confirmed the role of PAR-2 in HSC activation through studies using the human HSC line, LX-2, which expresses PAR-2. We observed a significant dose response to a specific PAR-2 agonist that achieved a proliferative response comparable to PDGF, the most potent cytokine in regard to stimulating HSC proliferation.

However, the generation of this chimeric humanized mouse requires advanced technical skills and the scarcity of adequate human primary material remains a significant logistical challenge.[41, 42] Selleckchem CYC202 Our model showed in the present study is easy to create, and it has Ag-specific T-cell exhaustion and Ag persistent in the liver seen in chronic HCV patients. These features suggest that this system is useful for therapeutic HCV vaccine development. THIS WORK WAS supported by grants from a Saitama Medical University Internal Grant (24-A-1-01 and 24-B-1-06), Grant from Ochiai Memorial Award 2011 and the Ministry of Health, Labor, and Welfare, Japan. The authors thank Hiroe Akatsuka

for technical assistance. “
“Considerable progress has been made in developing antifibrotic agents and other strategies to treat liver fibrosis; however, significant long-term restoration of functional liver mass has not yet been achieved. Therefore, we investigated whether transplanted hepatic stem/progenitor cells can effectively repopulate Navitoclax ic50 the liver with advanced fibrosis/cirrhosis. Stem/progenitor cells derived from fetal livers or mature hepatocytes

from DPPIV+ F344 rats were transplanted into DPPIV− rats with thioacetamide (TAA)-induced fibrosis/cirrhosis; rats were sacrificed 1, 2, or 4 months later. Liver tissues were analyzed by histochemistry, hydroxyproline determination, reverse-transcription polymerase chain reaction (RT-PCR), and immunohistochemistry. After chronic TAA administration, DPPIV− F344 rats exhibited progressive fibrosis, cirrhosis, and severe hepatocyte damage. Besides stellate cell activation, increased numbers of stem/progenitor cells (Dlk-1+, AFP+, CD133+, Sox-9+, FoxJ1+) were observed. In conjunction with partial hepatectomy (PH), transplanted stem/progenitor cells engrafted, proliferated competitively compared to host hepatocytes, differentiated into hepatocytic and biliary

epithelial cells, and generated new liver mass with extensive long-term liver repopulation (40.8 ± 10.3%). Remarkably, more than 20% liver repopulation was achieved in the absence of PH, associated with reduced fibrogenic activity (e.g., expression of alpha smooth muscle actin, platelet-derived selleck products growth factor receptor β, desmin, vimentin, tissue inhibitor of metalloproteinase-1) and fibrosis (reduced collagen). Furthermore, hepatocytes can also replace liver mass with advanced fibrosis/cirrhosis, but to a lesser extent than fetal liver stem/progenitor cells. Conclusion: This study is a proof of principle demonstration that transplanted epithelial stem/progenitor cells can restore injured parenchyma in a liver environment with advanced fibrosis/cirrhosis and exhibit antifibrotic effects. (Hepatology 2014;58:284–295) Chronic liver disease with cirrhosis is the twelfth leading cause of death in the United States.

Liver histology is the gold standard for the diagnosis of NASH; however, it is invasive and there is a risk of sampling errors in some cases. It has been anticipated that it should be possible to use serum biochemical markers to diagnose NASH, and various parameters reflecting oxidative stress, insulin resistance, inflammation, apoptosis, and fibrosis have been proposed to discriminate between SS and NASH. A NASH test that allows prediction on the basis of 13 parameters has been reported in Europe but, in recent years, Gholam et al. designed a more convenient differential

formula based on only two criteria: the AST level and the presence or absence of diabetes mellitus (DM).41 Campos et al. proposed a clinical scoring system for NASH42 in which the scored criteria consist of hypertension (HTN), type 2 DM, AST, ALT, sleep apnea syndrome, and race (exception for blacks). However, these Target Selective Inhibitor Library research buy reports are from Europe and the USA. Recently, it was reported that the serum level of soluble fraction in cytokeratin 18 (soluble CK-18) was able to discriminate between SS and NASH,43 and this has been adopted for our Japanese patients (unpublished data). We reported previously the importance of serum ferritin

and thioredoxin levels, reflecting status of oxidative stress, in the differential diagnosis between SS and NASH.44,45 Recently, Sumida et al. proposed the NAFIC (NASH, Ferritin, Insulin, Collagen) scoring using Japanese patients. This comprises three measurements: serum ferritin, Tanespimycin supplier insulin, and type-4 collagen 7s.46 To determine the utility of this score, we conducted a validation study in collaboration with ten centers all over Japan (Japan Study Group of NAFLD; JSG-NAFLD).46 Various indicators have been proposed for the evaluation of the degree of fibrosis in NASH. From a study based on the analysis of 50 NASH patients including nine with cirrhosis, Fujii et al. reported that the cirrhosis check details determinant score (CDS) and the hepatitis C antiviral long-term treatment against cirrhosis (HALT-C) model were valuable for the differentiation of cirrhosis induced by NASH and HCV infection.47 A French group proposed the BAAT score48 and Fibrotest,49 which assign one

point to each of the following items: BMI, ALT, age, and triglycerides. Angulo et al. proposed the NAFLD fibrosis score which can be calculated from parameters such as age, platelet count, albumin, AST/ALT ratio, fasting hyperglycemia/DM, and BMI.50 The NAFLD fibrosis score is simple and has advantages. However, the major problem is that liver biopsy cannot be avoided in around 25% cases, which are classified as intermediate because of scores halfway between the high cut-off level and the low cut-off level. Harrison et al. proposed the simple and easy BARD score based on BMI ≥ 28 kg/m2, AST/ALT ratio, and DM; and reported that the odds ratio increased 17-fold for cases with scores of two points or higher, associated with F3 or higher stages of fibrosis.51 However, Fujii et al.

After realizing the current gaps in knowledge regarding bleeding in women with VWD, the Angelo Bianchi Bonomi Thrombosis and Haemophilia Centre, University of Milan, established a data collection scheme, through collaboration with centres in the UK, Germany, Serbia and Iran, to evaluate the epidemiology and clinical characteristics of bleeding episodes in women affected with different types of VWD. Preliminary data from 193 patients show that menorrhagia occurred in 70% of patients compared with 46% of controls, and 81% of patients

required treatment. GDC 0068 In addition, acute bleeding episodes occurred at least once in all women, sufficient to require a blood transfusion. These preliminary data should help to identify the optimal management approach for this patient population.

In conclusion, despite the relatively small sample sizes and the type of data collection in studies reported to date, women with VWD are at increased risk of bleeding; however, it is necessary to increase the sample size of different types find more of VWD and to include controls. Appropriate treatment could significantly improve the quality of life (academic, social and professional) of these patients. The low incidence of haemophilia in the general population necessitates close cooperation among haemophilia treatment centres (HTC) to optimize treatment strategies. To achieve this goal, the Kompentenznetzwerk Hämorrhagische Diathesen Ost (Network for Coagulation Disorders) was founded in the eastern part of Germany. All HTCs in this region were requested to participate in the network. Of the 37 known haemophilia treatment centres in the area, 31 (83%) actively participated. Unlike patients in other countries, those in Germany resist travelling long

distances for treatment. Most patients prefer to visit local clinicians rather than attend comprehensive centralized treatment clinics such as the eastern region’s only large centre in Berlin. Some centres treat very few patients: in the eastern part of Germany there are 17 centres where clinicians see only 1–10 patients with severe haemophilia. The aim of the network is therefore to collect epidemiological data, deliver knowledge to practitioners in these small centres to provide standardized treatment regardless of town size or location and, in turn, to selleck compound acquire data on treatment practice and regimens. The present project undertook the collection of data in patients with severe haemophilia A according to treatment modalities and annual FVIII consumption in the eastern part of Germany. Data from 224 patients with severe haemophilia A were analysed, with a focus on findings obtained in 2007 and 2009. Results demonstrate that the incidence of severe haemophilia A is highest in the age group 40–49 years (n = 71) and declines thereafter (Fig. 1). A total of 65% of adult patients (20 years and older) received prophylactic treatment with FVIII.

As discussed, in the absence of insulin, Akt activity is suppressed and FOXO1 is transcriptionally active. This effect results in an increase in MTP, the rate-limiting enzyme in hepatic VLDL production, Everolimus increasing VLDL secretion. In addition,

FOXO1 also results in increased transcriptional activity and hepatic secretion of ApoC-III. In the circulation, this apolipoprotein inhibits the activity of lipoprotein lipase, responsible for hydrolysis and uptake of the triglyceride component of VLDL and chylomicrons, thus prolonging the persistence of VLDL.[24] In response to feeding, FOXO1 is inactivated, shutting down both these mechanisms and preventing post-prandial hyperglycemia. In states of insulin resistance, this suppression of FOXO1 activity may fail to occur resulting in both hyperglycemia and hypertriglyceridemia.[25] Additional factors appear to be involved in the lipid effects of FOXO1 as well. Early attempts to understand the effects of FOXO on hepatic lipid metabolism involved expression of various mutated forms of FOXO1 that were felt to represent selleckchem constitutively active forms of the protein. These studies seemed to imply both positive and negative effects of FOXO on lipid production and accumulation. One model for expression of constitutively active FOXO1 using a single S-253 mutated phosphorylation site led to increased hepatic triglyceride

levels but lower levels in the circulation.[26] Another model for expression of constitutively active FOXO1 using alanine substitution at all three Akt phosphorylation sites

had normal hepatic triglyceride levels[15] but showed that increased FOXO1 activity led to suppression of a number of proteins required for lipid synthesis including sterol regulatory element binding protein (SREBP)-1c, acetyl-CoA carboxylase-α (ACC), and fatty acid synthase (FAS).[15] These data are difficult to interpret unambiguously because the mutated forms of FOXO may behave differently in unanticipated selleck compound ways. Perhaps the best systems in which to study the net effects of FOXO proteins on hepatic and serum lipid homeostasis is in liver-specific multiple FOXO knockouts. Zhang et al.[27] showed that ablation of FOXO1 caused a decrease in plasma glucose without a significant effect on lipid metabolism, but simultaneous knock out of FOXO1 and FOXO3 caused hepatic steatosis, increased hepatic lipid secretion, and increased serum triglycerides.[27] While the precise mechanism for these effects could not be determined, these authors showed a negative transcriptional effect of FOXO3 and particularly the FOXO1/FOXO3 combination on two important genes of lipid synthesis, FAS, and 3-hydroxy-3-methyl-glutaryl-CoA reductase. A similar phenomenon was also observed by Tao et al.[28] who produced a hepatic-specific knockout of the combination of FoxO1, FoxO3, and FoxO4 in mice.

Much less differentiation was found between southern Zanzibar and South Africa, suggesting a more recent common evolutionary

history for these populations than for the northern and southern Zanzibar populations. “
“As part of population dynamics studies of the South American fur seal (Arctophoca australis gracilis) rookery at Punta Weather in Guafo Island (43°36′S, 74°43’W), the causes and extent of pup mortality were monitored. During four breeding seasons, daily counts of live and dead pups were carried out to determine pup production and pup mortality. Dead pups were retrieved from the rookery to perform necropsies. The mean pup production was 1,735.5 ± 336 pups and the mean pup mortality up to 12 wk old was 6.0%± 2.6%. The major causes of death were enteritis with microscopic lesions of bacteremia (28.4%), starvation (23.5%), drowning (21%), trauma (19.8%), and stillbirths (2.5%). Enteritis Cell Cycle inhibitor with microscopic lesions of bacteremia, and starvation had higher incidence during January (beginning and middle of the breeding season) while

most trauma and drowning occurred during February (end of the breeding season). In the 2006–2007 breeding season there was an increase in mortality due to starvation and trauma. Most pup deaths at Guafo Island are generated by extrinsic factors; therefore, additional studies that assess the impact of environmental changes and fishing activities, are needed in order to determine Akt inhibitor the exact causes of the decline of this species along Chilean coasts. “
“Coastal and offshore bottlenose dolphins in California waters are currently assessed and managed as separate stocks. Recent molecular studies (of mtDNA haplotypes and microsatellites) have shown the two populations to be genetically differentiated. This study investigated cranial osteological differentiation of the forms. The sample analyzed included 139 skulls from live captures,

direct selleck chemical takes, fishery bycatch, and strandings; the skulls were assigned to form based on collection locality or mtDNA haplotype. The coastal form differs from the offshore form mainly in features associated with feeding: larger and fewer teeth, more robust rostrum, larger mandibular condyle, and larger temporal fossa. This suggests that it may feed on larger and tougher prey than the offshore form. Differences between the forms in other features of the skull may reflect differences in diving behavior and sound production. Approximately 86% of the stranded specimens were estimated to be of coastal origin; based on relative estimated sizes of the two populations and assuming similar mortality rates, this suggests that a coastal carcass is about 50 times more likely to beach than an offshore one. The morphological differences between the two ecotypes indicate evolutionary adaptation to different environments and emphasize the importance of conserving the relatively small coastal population and its habitat.

In total, 80 female outpatients were interviewed, Wnt inhibitor and after implementing inclusion/exclusion criteria, thirty females were considered eligible to participate in the study. Half (n = 15) were randomly selected to participate in the treatment group. Four participants of this group failed to complete the treatment sessions (n = 11). The Acceptance and Commitment Therapy group received the medical treatment as usual and 8 sessions of Acceptance and Commitment Therapy. The other half (n = 15) served as the control group that received only medical treatment as usual. The short form of McGill pain questionnaire, the migraine disability assessment scale, and the trait subscale of the state-trait anxiety

inventory were administered, which operationalized 3 dimensions of impact of chronic headache, sensory pain, disability, and emotional distress, respectively, to explore the impact of recurrent headache episodes. Pretest and post-test measures on these 3 dimensions of impact were the primary outcome measures of this study. Analyses of covariance with the pretreatment score used as a covariate were conducted on pain intensity, degree of disability, and level SCH772984 of affective distress before and after therapy to assess therapeutic intervention effectiveness. Results.— Chronic tension type of headache (63%) and chronic migraine without aura (37%) were the headache types reported by the participants. Data analyses

indicated the significant reduction in disability (F[1,29] = 33.72, P < .0001) and affective distress (F[1,29] = 28.27, P < .0001), but not in reported sensory aspect of pain (F[1,29] = .81, P = .574), in the treatment group in comparison with the control group. Conclusions.— The effectiveness of a brief acceptance and commitment additive therapy in the treatment of Iranian

outpatient females with chronic headache represents a significant scientific finding and clinical progress, as it implies that this this website kind of treatment can be effectively delivered in a hospital setting. “
“Patients with vestibular migraine (VM) suffer attacks of vertigo that often occur in isolation from headache attacks. We aimed to assess and compare vestibular function interictally in patients with VM and patients with migraine without vertigo (M). Thirty-eight patients diagnosed with definite VM according to the Neuhauser criteria, and 32 patients diagnosed with M according to the International Headache Society criteria were examined between attacks using a broad battery of bedside vestibular tests, a caloric test, and videonystagmography. Overall, 70% of the VM patients and 34% of the M patients showed abnormalities on one or more of the 14 performed vestibular tests (P = .006). Abnormal findings were more frequent in VM than in M patients on Romberg’s test, test for voluntary fixation suppression of the vestibular ocular reflex and test for static positional nystagmus (P = .03, .01 and .04, respectively).

Serial immunostaining showed that ∼43% of these cells were CD103+ and that ∼63% were CD11c+ (Table 1; Fig. 2C); some were also CD25+ and/or CD86+ (Fig. 2D). The mean Sirolimus survival time of the Irr(−) and Irr(+) groups were 10.3 ± 1.6 (n = 9) and 8.8 ± 1.0 days (n = 4) after LT, respectively (Fig. 5A), indicating that irradiation enhanced rejection slightly, but not significantly. The ratio of the sinusoidal area to the total surface area was significantly higher in the Irr(+) group than in the Irr(−) group’s on day 5, but became

comparable by day 7 (Fig. 5B). The CD8+ T-cell responses were comparable in the Irr(+) and Irr(−) groups, as shown by the kinetics of BrdU+CD8β+ cell numbers in the graft portal and sinusoidal areas (Fig. 5C-F). In both the Irr(−) and Irr(+) groups, donor MHCII+ DC-like cells were observed in clusters with BrdU+ cells that were found in the graft portal and hepatic vein areas on days 2-4 after LT (Fig. 6A). FACS analysis to detect nonparenchymal cells on day 3 after LT showed that the sessile donor DCs were mainly in the CD172a+CD11b+

population in both groups and that they expressed similar levels of CD25 and CD86 (Fig. 6B-D). Immunostained serial sections showed that of these donor MHCII+ cluster-forming cells, ∼65% were CD103+ and ∼82% were CD11c+ (Table 1; Fig. 6E,F). Furthermore, some also coexpressed CD86 (Fig. 6F). Cytosmears of FACS-sorted selleck chemical liver DC subsets showed their DC cytology (Fig. 7A). The positive stimulator control of the donor splenic DCs induced a dose-dependent proliferation

of responder T cells. The CD172a+CD11b+ DCs (3 × 103/well) that were isolated from the donor liver with or without irradiation and from the irradiated donor hepatic lymph induced high proliferation comparable to the control splenic DCs (3 × 103/well) (Fig. 7B). In contrast, CD172a−CD11b+ DCs isolated from the nonirradiated donor liver (3 × 103/well) showed a lower this website stimulation index (Fig. 7B). The CD172a+CD11b+ DCs formed huge clusters in vitro that were larger than clusters formed by the CD172a−CD11b+ DCs (Fig. 7C). The number of BrdU+FoxP3+ regulatory T cells was suppressed slightly on day 2 in both the spleen and graft portal areas in the Irr(+) group, compared to the Irr(−) group (Supporting Fig. 3A,B); however, suppression was not significantly different over the entire examination period. The total number of FoxP3+ cells in the portal areas was also comparable (Supporting Fig. 3C). The 35,129-element oligonucleotide microarray of graft tissues used to analyze the Irr(+) group identified 117 up-regulated and 79 down-regulated genes on day 2 and 95 up-regulated and 79 down-regulated genes on day 3 after LT, compared to the Irr(−) group. Among these, several genes were related to immune responses.

5(3.5-76.6) vs. 6.8%(0.05-48.5), p<0.0001. Three patients with genetically confirmed BSEP defect (PFIC-2), have low median THBA

level of 1.21 nmole/mmole Cr (0.96-2.28). Using receiver operating characteristic analysis, we found urine THBA ratio > 7.5% predicted good prognosis find more in infantile intrahepatic cholestasis (sensitivity 95.2%, specificity 85.2%), area under curve 0.90, p<0.0001. Conclusions: Elevation of THBA level was found to be associated with good prognosis in infantile intrahepatic cholestasis. Human PFIC patients have no increased levels of urinary THBA, unlike the mice model. The potential beneficial roles of THBA in cholestatic patients deserve further investigations. Disclosures: Mei-Hwei Chang - Grant/Research Support: Gilead, BMS The following people have nothing to disclose: Chee-Seng Lee, Kimura

Akihiko, Jia-Feng Wu, Yen-Hsuan Ni, Hong-Yuan Hsu, Huey-Ling Chen Objectives: Gastroesophageal(GE) varices are a manifestation of portal hypertension(PHT) due to advanced liver disease or portal vein thrombosis(PVT).We present here the prognostic management and evolution of our PHT program. Methods: All patients presenting in our centre with hypersplenism, suspected PHT or gastrointestinal (GI) bleeding and undergoing a first oesophagogastroduodenoscopy (OGD) between 200512 were included and data were collected. Results: 170 patients(91M), mean age 8.8y, were included.126 were diagnosed with liver disease-group A[biliary atresia(62) check details AIH, CF, CHF and other] and 44(PVT)-group B.46 patients presented with bleeding and were enrolled in an endoscopy program. In group A, 17 patients

underwent liver transplantation(LT), 2 died during follow-up(sepsis) and 1(group B) had a meso-Rex shunt. In group A at first OGD there were no oesophageal varices, grade 1, 2 or 3 in 39(31%), 15(12%), 23(18%) and 49(39%) with gastric varices present in 1, 2, 4, and 20, respectively. Mean values for haemoglobin(Hb), learn more platelet count(PLT), white cell count(WCC), INR, serum albumin(Alb), bilirubin, aspartate aminostransferase(AST), spleen size in cm and z-score, Clinical Prediction Rule(CPR), AST/platelet ratio index(APRI) were 11g/ dL, 131×10^9/l, 6.2×10^9/l, 1.19, 38g/L, 44mmol/L,114 IU/L,16cm, 8.35, 103.76, 2.56, respectively. In group B mean values for same variables were 10.8g/dL, 101x10A9/l, 4.3x10A9/l, 1.29, 41g/L, 15mmol/L, 55IU/L, 15.6, 7.35, 107.37, 1.54, respectively. No oesophageal varices, grade 1, 2 or 3 were recorded in 9(20%), 9(20%), 5(11%) and 21(48%) with gastric varices in 4, 2, 4, 7 and 11, respectively. Likelihood of (grade >2) varices PLT, WCC, INR, bilirubin, Alb, spleen size, CPR, APRI showed significance (p<0.05 for all) in group A and Hb(p<0.05) in group B.CPR delimited an AUROC of 0.722 and 0.662 for significant varices in group A and B, respectively.

Among 89 patients with a follow-up longer than 60 months, 65 (73%) had aminotransferase levels lower than twice the upper limit of normal (2002 criteria), but only 23 (25.8%) consistently maintained normal aminotransferase levels (2010 criteria) with low steroid doses (2-4

mg of methylprednisolone daily or every other day). Interestingly, from a clinical standpoint, after a mean follow-up longer than 100 months, only 1 of the 23 patients (4%) fulfilling the 2010 criteria of remission experienced buy Kinase Inhibitor Library histological worsening of the disease (mild to severe liver histology), whereas 36 of the 66 patients (54.5%) whose aminotransferase levels did not normalize had histological (14 with severe histology and 9 with cirrhosis) or clinical evidence (11 with end-stage liver disease, 1 with decompensated cirrhosis, and 1 with hepatocellular carcinoma) of uncontrolled and evolving liver disease. In summary, in our experience, the application of the 2010 criteria flips the previously codified remission rate from

73% to 26%. Complete-response patients have a very good long-term prognosis virtually free of significant clinical events, whereas patients whose serum aminotransferases see more are unable to be stably normalized are those www.selleckchem.com/products/Everolimus(RAD001).html with the highest probability of developing long-term complications, which not rarely may prove to be lethal. These are the patients most likely to benefit from new pharmacological, cellular, and molecular therapies.4, 5 Luigi Muratori M.D.* †, Paolo Muratori M.D.* †, Giulia Lanzoni M.D.* †, Silvia Ferri M.D.* †, Marco Lenzi M.D.* †, * Department of Clinical Medicine, Alma Mater Studiorum–University of Bologna,

Bologna, Italy, † Sant’Orsola-Malpighi Polyclinic, Bologna, Italy. “
“We read with great interest the article by Pascale et al.,[1] reporting a man with chronic hepatitis C virus (HCV) genotype 1b infection who relapsed after telaprevir-based triple therapy and achieved sustained virologic response (SVR) with a subsequent 48-week course of dual therapy (peginterferon alfa/ribavirin). We think the definition of failure to respond to telaprevir-based triple therapy seems not appropriate. This patient received telaprevir, peginterferon alfa-2a, and ribavirin for only 12 weeks in the phase 2 study.