国际肝病采访贾继东教授

Jidong Jia  Liver Research Center, Beijing University, Beijing, China

Hepatology Digest:  As we know, you will be the 2010 APASL President. Can you introduce to our readers the history, background, and mission of APASL?

Prof. Jia: APASL is one of the most important regional associations for the study of liver disease. It was established in the 1970s by Professor Okuda, Professor Lawrie Powell, and several other senior professors at that time. It was a very small group at the beginning but it has grown very rapidly during the last decade, especially during the past five years. The participants and the academic level have been raised very rapidly. It is now one of the five most important associations for the study of liver disease.

For the 2010 Beijing APASL annual meeting, we are supposed to have a large attendance of about 5,000 participants. A brand new national convention center will be used and we hope that doctors and professors from this region as well as other parts of the world will come to discuss the frontiers of hepatology. A slogan of APASL is “changing hepatology in the Asia-Pacific region”.

Hepatology Digest:  Do you think that since the meeting will be held in Beijing in 2010, it will help the local Chinese doctors to attend APASL?

Prof. Jia: Definitely yes. I think this is very important for Chinese doctors. Although nowadays it has become easier to leave China to attend international meetings, it is much easier for Chinese doctors to attend meetings in China and this will help Chinese doctors a lot.

Hepatology Digest:  Perhaps this will help this attendance of some of the less senior doctors and young investigators who would normally have difficulty in traveling out of China?

Prof. Jia: Yes, it is really a big chance for the young trainees and fellows to attend this high level academic meeting.

Hepatology Digest:  Your article entitled “Pay Emphasis on the Diagnosis and Treatment of Liver Fibrosis” was published in August 2008. We know that the cause of liver fibrosis in China is still mainly hepatitis B, but in recent years the disease spectrum has undergone some changes. Would you please discuss some of the factors and influences involved in these changes?

Prof. Jia: While hepatitis B and C are still the main causes of chronic liver disease, liver fibrogenesis, and associated liver cirrhosis, other etiologies are becoming more and more important along with the economic and social development of China. For example, alcoholic liver disease is becoming increasingly important in some areas of China. Other causes of liver disease like autoimmune liver disease and metabolic liver disease have also increased. One reason is increased awareness of the disease among doctors and also because of increased availability of specific tests for these kinds of diseases. In general, besides the more common chronic viral hepatitis B and C, we are seeing more cases of chronic liver disease due to autoimmune, metabolic, and other rare conditions.

Hepatology Digest:  Are there other Asian countries that have seen a similar rise in these kinds of conditions as well?

Prof. Jia: Yes, in Japan, Korea, Singapore, and other Asian countries it has been reported that all of these so-called rare diseases have increased. I think of the reasons for this is increased awareness and increased availability of diagnostic tools, and perhaps also because of increased living standards and the environment. All of these factors contribute to the changing spectrum of liver disease.

Hepatology Digest:  Last year you published an article entitled “Reevaluation of Diagnostic Value of Serum Fibrosis Markers to Liver Fibrosis Staging in Patients with Chronic Hepatitis”. You ascertained that while using serology hepatic fibrosis index to evaluate the degree of hepatic fibrosis, the influence caused by the inflammation of hepatic tissue should be considered. Besides the inflammation of hepatic tissue, which factors do you think could influence the index?

Prof. Jia: The so-called fibrosis markers can be roughly divided into two categories-one category is non-specific biochemical variables that are routinely used for liver function tests. Usually, by statistical modelling we can formulate a model. These kinds of variables themselves are not liver-specific, but as a formulation, it can be used to predict liver fibrogenesis. Another category is extracellular matrix-specific variables, which are not liver-specific, but are fibrogenesis specific. Both of these types of variables are well established in clinical practice and can be used to monitor liver fibrogenesis, but while we can easily identify those patients with minimal fibrosis or significant fibrosis, it is difficult to differentiate in-between. By using seromarkers or other non-invasive tools, we can avoid liver biopsy in some patients, but not all of them.

Hepatology Digest:  In a previous article you stated that in treating patients with PEG-IFN-a-2b for 52 weeks, the degree of hepatic fibrosis of HBeAg-positive patients was reduced among responders. Could you give some treatment advice for non-responders?

Prof. Jia: For hepatitis B patients it is somewhat complex. For those with good efficacy after a standard course of 6 months or one year of therapy, if the patient can achieve e-seroconversion and decrease of HBV DNA, and normalization of ALT, the fibrogenesis and fibrosis stage will be improved significantly. For those who can not achieve this after 6 months or one year of therapy, one possibility to consider is to prolong the duration of therapy. Of course, it is very expensive and has side effects, so we have to consider another approach like oral antiviral therapy. It is a very complex issue and we have to discuss with the patient the possibility of continuing to use Pegasys. We must consider the advantages and disadvantages of oral antiviral therapy. We also have to consider age, if they have children, work or study factors, and any other information before we can make a decision.

Hepatology Digest:  We have entered an era gene therapy and gene therapy is gaining attention with the public. Can you discuss the role of AAV (adeno-associated virus) in gene therapy for liver disease?

Prof. Jia: Gene therapy is an exciting approach and we have studied it for many years, but until now, these studies have been restricted to either in vitro or animal experimental studies because there are some issues that haven’t been resolved. For example, the control of gene expression, the safety of the vectors, and the safety of these exogenous genes in the human body. Only after all these problems have been solved can it become a reality. From my own point of view, gene therapy is the future and we hope that one day it will become reality, but in the near future we still have to optimize available therapy to improve the clinical outcome.