Articles in 2015

Despite some advances in our understanding of the molecular characteristics of pancreatic cancer, much more progress is needed. In a new study, RNA profiling of pancreatic cancers was used to identify gene signatures of tumour cells and stromal cells to help predict patient outcomes.

Hepatocellular carcinoma (HCC) is an antigenic lesion infiltrated by T cells, but factors within the tumour and its microenvironment dampen the immune response and prevent effective antitumour immunity. The stepwise elucidation of the various immunosuppressive mechanisms at play in HCC has exposed new therapeutic options. This Review gives a comprehensive overview of the different immunotherapeutic modalities applicable in HCC, including vaccines, adoptive T-cell therapy, cytokines, gene therapy and immune checkpoint inhibitors.

Traditionally, the diagnosis of hepatorenal syndrome has been based on stringent criteria that are not ideal for patients with cirrhosis and kidney injury, leading to underdiagnosis. Acute kidney injury is now proposed to characterize renal disease in patients with cirrhosis. Florence Wong describes the evolution of these criteria that have addressed this issue and improved care for these patients.

The concept that the nervous system can adapt to gastrointestinal disorders is a new concept. In this Review the authors discuss neural plasticity in pancreatic diseases such as pancreatitis and cancer. Given the translational importance of neuropathic changes in pancreatic disorders the authors look at the available mouse models we have to study the phenomenon and highlight areas of research that still need investigation.

Liver transplantation outcomes have improved substantially over the years, but patients still have to deal with a number of consequences and risks that might follow the procedure. Optimal screening and management of recurrent disease or associated pathologies, such as metabolic, renal, cardiac disease and cancer, are essential to provide the best possible care for transplant recipients.

Despite advances in hepatitis C treatment, substantial clinical hurdles remain to achieve universal cure and global control of infection. Saeed et al. identified SEC14L2 as a host factor permitting replication of clinical HCV isolates in cell culture, providing a novel system to model infection of patient-derived viruses.

Bipotential hepatic progenitor cells (HPCs) are recognized as making modest contributions to hepatocyte regeneration, though never credited with major liver repopulation. A new study in mice demonstrates HPCs can make a massive contribution to hepatocyte replacement, suggesting HPCs have the potential to be an effective cell therapy for liver failure.

Liver transplantations for patients who are co-infected with HIV and HCV have always posed a challenge and still do, according to the results of a new study. This article discusses the factors that contribute to an increased risk of poor transplantation outcomes and how new treatment options might affect patient survival.

The gastrointestinal hormones ghrelin and motilin are released during hunger to stimulate appetite and interdigestive movement of the stomach, respectively. Ghrelin and motilin receptor agonists also increase gastric emptying of meals and emerging data shows previously unknown effects on nausea and constipation. In this Review, Sanger and Furness describe the complex interactions of ghrelin and motilin with their receptors and the pathways influencing gastrointestinal functions. Finally, they describe the potential of receptor agonists to treat various gastrointestinal disorders.

A gluten-free diet is the mainstay of treatment for patients with coeliac disease, and is still the only treatment available. In this Review, the authors provide practical insights into implementation of a gluten-free diet as a guide for clinicians, including challenges for patients, considerations for special populations, adherence and follow-up.

A global consensus report on Helicobacter pylori gastritis has been developed. Topics discussed include whether dyspepsia caused by H. pylori infection is separate from functional dyspepsia or not, the evaluation method for H. pylori-induced gastritis, eradication therapy for H. pylori gastritis to prevent gastric carcinogenesis and management after H. pylori eradication.