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Focal liver lesions, especially asymptomatic and incidental liver lesions, have become an increasingly common finding on abdominal imaging, with gastroenterologists and hepatologists often tasked with making recommendations for their diagnosis and management.

To support clinical practice and suggest preferable approaches based on the currently available published literature, the American College of Gastroenterology released a clinical guideline on the diagnosis and management of common focal liver lesions, encouraging health care providers to incorporate the guidance when exercising clinical judgment.

Test your knowledge of the guidelines with this clinical quiz!

Discontinuation of exogenous hormones and weight loss if applicable

Multiphase MRI with hepatobiliary-specific contrast agents

Expectant management without surveillance/intervention

Frenette C, Mendiratta-Lala M, Salgia R, et al. ACG Clinical Guideline: Focal Liver Lesions. The American Journal of Gastroenterology 119(7):p 1235-1271, July 2024. doi:10.14309/ajg.0000000000002857

Articles

The prevalence of asymptomatic and incidental focal liver lesions has increased, necessitating informed diagnostic and management strategies by gastroenterologists and hepatologists. The American College of Gastroenterology has issued a clinical guideline to aid in the diagnosis and management of these lesions, drawing on current literature to recommend best practices. This guideline serves as a resource for healthcare providers to enhance clinical decision-making. A clinical quiz is available to test knowledge of these guidelines, ensuring practitioners are well-versed in the recommended approaches.

Test your knowledge of the 2024 American College of Gastroenterology focal liver lesion diagnosis and management guidelines with this clinical quiz!

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Clinical Quiz: Diagnosing, Managing Common Focal Liver Lesions

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Methotrexate (MTX) treatment may lead to lower antibody responses after vaccination in people with 

 according to a recent study that found reduced vaccine-induced CD4 T cell activation after treatment.

“MTX is considered the gold standard for treating RA and is also often used in the treatment of other immune-mediated inflammatory diseases (IMID) such as psoriatic arthritis (PsA) and spondyloarthritis (SpA). MTX is primarily known for its inhibitory effect on purine and pyrimidine synthesis required for cell division, making it a key anticancer treatment. While the exact anti-inflammatory mechanism of MTX in IMID treatment is still unknown, proposed modes of action include increased adenosine release, inhibition of nuclear factor-κB (NF-κB) signaling, increased expression of long intergenic non-coding RNA regulating inflammatory processes and promotion of nitric oxide synthase uncoupling leading to T cell apoptosis

,” lead investigator Laura YL Kummer, Doctorate Student / Research Assistant. Department of Immunopathology, Sanquin Research, and colleagues wrote.

Kummer and colleagues analyzed data in 59 patients with rheumatic disease, including 18 with RA and 2 with PsA on MTX monotherapy, 10 patients with RA without immunosuppressive treatment, and 29 healthy controls. The investigators analyzed CD4 T and B cell responses 7 days and 3–6 months after 2 SARS-CoV-2 messenger RNA vaccinations. They used high-dimensional flow cytometry analysis to analyze fresh whole blood, an activation-induced marker assay to measure antigen-specific CD4 T cells, and spike probes to study antigen-specific B cells.

The investigators found that 7 days after 2 SARS-CoV-2 vaccinations, total B and T cell counts were similar between MTX-treated patients and controls. Spike-specific B cell frequencies were unaffected.

Notably, the frequency of antigen-specific CD4 T cells was reduced in patients using MTX and correlated strongly with anti-RBD IgG antibodies, but not in healthy controls, suggesting that decreased CD4 T cell activity may result in slower vaccination antibody responses in MTX-treated patients. Specifically, patients treated with MTX had a median induction IQR of 0.17 (95% CI, 0.12-0.21) compared with 0.29 (95% CI, 0.18-0.39) in patients not on MTX (

= .017). The total number of CD4 T cells were not affected by MTX treatment.

“Overall, these data present evidence of reduced vaccine-specific CD4 T cell responses in MTX-treated patients with RA, which is associated with slower antibody kinetics in these patients. Although it remains unclear to what extent lower CD4 T cell responses impact clinical outcomes in these patients, it is wise to consider that CD4 T cell immunity may be less robust in these patients during future vaccinations or emerging infections. Furthermore, these data potentially contribute to elucidating the anti-inflammatory mechanism of action of MTX in Immunomodulatory drugs,” Kummer and colleagues concluded.

The investigators noted that study limitations included a relatively small number of participants, the spread in sample timing, and the rare population of control patients with RA without systemic immunosuppressive treatment, which may have skewed the study group to have lower disease activity. They were also unable to characterize spike-specific cTfh cells due to technical constraints.

Kummer LYL, Fernández Blanco L, Kreher C On behalf of the T2B! Immunity Against SARS-CoV-2 Study Group, et al. Methotrexate treatment hampers induction of vaccine-specific CD4 T cell responses in patients with IMID.

2024;10:e004664. doi: 10.1136/rmdopen-2024-004664

Freeman ML, Clagett BM, Moisi D, et al. Methotrexate Inhibits T Cell Proliferation but Not Inflammatory Cytokine Expression to Modulate Immunity in People Living With HIV. 

 2022;13:924718. doi:10.3389/fimmu.2022.92471

Methotrexate (MTX) treatment in rheumatoid arthritis (RA) patients may lead to reduced vaccine-induced CD4 T cell activation, impacting antibody responses post-vaccination. MTX, a standard treatment for RA and other immune-mediated inflammatory diseases, affects purine and pyrimidine synthesis, influencing cell division. A study involving 59 patients revealed that MTX-treated individuals had lower antigen-specific CD4 T cell frequencies post-vaccination compared to those not on MTX. This suggests potential implications for vaccine efficacy and highlights the need to consider CD4 T cell immunity in MTX-treated patients during vaccinations or infections.

Investigators analyzed antibody response after 2 SARS-CoV-2 vaccinations. 

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Methotrexate May Lower Vaccine Response in Patients With RA 

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

The medical world has been steadily transformed by the use of artificial intelligence (AI) and machine learning, with some experts in fields such as 

 having uncovered benefits from AI’s application and exploring new options for utilization.

, a conversation about AI in lung imaging featured Rachel Eddy, PhD, assistant professor in the departments of radiology and pediatrics at the University of British Columbia, and an investigator at the BC Children’s Hospital. Eddy joined to guide listeners through the current and future uses of AI in lung imaging.

In this episode, Eddy and Rizzo highlight a variety of functions and ongoing research related to the implementation of AI in imaging. During the above segment of Lungcast spoke about recent use of generative AI as well as terms commonly used.

Additionally, Eddy covers her own work and its implementation of AI technology. She also notes the impact on patients with COPD or asthma.

 is a monthly respiratory health podcast series which is hosted by Albert Rizzo, MD, the chief medical officer of the American Lung Association (ALA), and produced by the ALA and HCPLive.

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In the most recent Lungcast, Rachel Eddy, PhD, joined host Al Rizzo, MD, to speak to listeners about the current and future uses of AI in lung imaging.

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Join the American Lung Association and HCPLive every month as Dr. Al Rizzo interviews world-leading experts on the great challenges, accomplishments, and stories in respiratory medicine.

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How Artificial Intelligence is Being Used in Lung Imaging, with Rachel Eddy, PhD

Chelsie Derman is an assistant editor for 

who covers psychiatry, sleep medicine, and geriatrics. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

A new study has identified 19 genes, including MT1H, MY0M2, and RPL18, showing significant expression changes in both 

infection and Parkinson Disease, suggesting a potential connection between the 2 conditions.

“…some gene expression changes frequently occurred in both sexes, but there were also gene expression changes unique to each sex,” wrote investigators, led by Isis Narvéez-Bandera, PhD, from the University of Puerto Rico-Mayagüez.

Over the last decade, researchers have found 90 risk alleles for Parkinson Disease, a condition that led to 5.8 million years of disability-adjusted life lost in 2019. However, only 20% of Parkinson Disease risk can be explained by these genes, leaving 80% unexplained. There’s evidence that bacterial or viral infections, like influenza, could increase the risk for sporadic Parkinson Disease.

HCV infection, like Parkinson Disease, also poses serious health risks. While some people clear the virus naturally, > 50% develop a chronic illness. Symptoms, often associated with advanced liver disease, include fatigue, jaundice, dark urine, swollen legs, and hepatic encephalopathy, among others, according to the Mayo Clinic.

Earlier research has suggested a link between HCV infection and Parkinson Disease.

To further investigate this, the study aimed to uncover biomarkers and pathways potentially involved in both diseases.

The team analyzed 22 datasets (microarray and RNAseq) from patients with Parkinson Disease and HCV, totaling 1064 samples (Parkinson Disease: 6 microarrays and 2 RNAseq and HCV infection (12 microarrays and 2 RNAseq). They identified 367 genes related to Parkinson Disease and 418 genes associated with HCV infection, with 34 genes overlapping between the two diseases.

Of those, 19 genes showed significant expression changes in both conditions, including 

were upregulated during HCV infection, while the expression of 

 were downregulated. The gene INFIT1 plays a role in cGAS/STING immune pathway that the virus can block early on. However, in a chronic HCV infection, the host cells active this pathway as a defense mechanism, which could lead to inflammation.

The study suggests that prolonged inflammation caused by chronic HCV infection could lead to brain inflammation, increasing the risk of Parkinson Disease. Genes such as RPL18, KRT23, MT1H, and SLC30A also contribute to inflammation, oxidative stress, and neuron damage, potentially aiding HCV persistence and causing long-term damage that might lead to Parkinson Disease.

When analyzing gene expression by sex, the study found 604 genes linked to sex-related effects, with 470 genes showing changes unrelated to sex.

 was the most observed gene in both conditions.

The analysis showed these gene expression changes were primarily linked to immune response regulation in females and immune cell activation in males.

“These results provide interesting leads for future experiments that could follow the role of each of these genes in a possible increase (or decrease) in the risk of developing [Parkinson Disease], and how these changes might help explain why HCV and [Parkinson Disease] affect males and females differently,” investigators wrote.

As for signaling pathways, a change in MST1 expression was strongly correlated with changes in the expression of the 

 expression were strongly associated with changes in the expression of the 

 was also strongly correlated with changes in the expression of 

“These findings suggest a potential link between HCV infection and [Parkinson Disease], highlighting the importance of further investigation into the underlying mechanisms and potential therapeutic targets involved,” investigators concluded.

Narváez-Bandera I, Suárez-Gómez D, Castro-Rivera CDM, et al. Hepatitis C virus infection and Parkinson's disease: insights from a joint sex-stratified BioOptimatics meta-analysis. 

. 2024;14(1):22838. Published 2024 Oct 1. doi:10.1038/s41598-024-73535-0

https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278

A recent study identified 19 genes with significant expression changes in both hepatitis C virus (HCV) infection and Parkinson Disease, suggesting a potential link between the two. Researchers analyzed 22 datasets, finding 34 overlapping genes, with 19 showing significant changes. The study highlights prolonged inflammation from chronic HCV infection as a possible risk factor for Parkinson Disease. Gene expression changes were linked to immune response regulation, with sex-specific differences observed. The findings underscore the need for further research into the mechanisms and therapeutic targets involved.

A study links hepatitis C infection and Parkinson's disease, identifying 19 genes with shared expression changes and highlighting sex-specific immune responses.

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New Data Reveals 19 Genes Exhibit Expression Changes in HCV, Parkinson Disease

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Compelling results from the SAGA trial, a two-year randomized, double-masked, placebo-controlled study, found oral gildeuretinol (ALK-001) notably reduced the progression of 

 secondary to age-related macular degeneration (AMD), compared with placebo.

128th Annual American Academy of Ophthalmology (AAO) Meeting

, showed the investigational agent designed to mimic vitamin A achieved a trend toward slower GA lesion growth rate from baseline to 24 months, and a statistically significant visual function benefit in low-luminance visual acuity (LLVA).

“Decreasing vitamin A dimerization is a potential mechanism of action to treat GA compared to placebo, and we see that there is a trend toward slow GA lesion growth from baseline to Month 24 and a statistically significant functional vision benefit on LLVA, the first investigational oral agent to demonstrate this,” said presenting investigator Alex Melamud, MD, The Retina Group of Washington.

By mimicking vitamin A, oral gildeuretinol is designed to reduce the dimerization of vitamin A, a process implicated in the progression of GA related to AMD. By slowing this dimerization, Gildeuretinol aims to decrease the lesion growth rate and preserve visual function in affected patients. It is also being evaluated in Stargardt disease, which shares a common pathophysiology with GA.

SAGA is a 2-year trial that enrolled patients aged 60 or older with ≥1 well-demarcated GA lesion. Participants were randomized in a 2:1 ratio to receive either gildeuretinol or placebo, with follow-up visits every six months. The study’s primary endpoint was the rate of lesion growth from baseline to month 24, measured by fundus autofluorescence (FAF) and confirmed by optical coherence tomography (OCT). Key secondary endpoints included LLVA and best-corrected visual acuity (BCVA).

Overall, SAGA retained 70% of participants, with demographics revealing a mean age of 78, predominantly female and Caucasian. Most subjects had subfoveal lesions, with the majority presenting multifocal GA lesions.

Upon analysis, SAGA did not show a statistically significant difference in lesion growth rates between the Gildeuretinol and placebo groups (

 = 0.075). However, these data revealed a notable trend, indicating a 13.4% reduction in lesion growth rate at the final follow-up.

Given that pharmacokinetic studies suggest a lag in achieving therapeutic levels of deuterated vitamin A, a pre-specified sensitivity analysis from months 6 to 24 demonstrated a statistically significant 15.3% reduction in GA lesion growth with gildeuretinol compared with placebo.

LLVA was a key secondary endpoint and found significant benefits with gildeuretinol. These patients experienced a lower loss in visual acuity than those receiving placebo. Melamud indicated this finding is particularly noteworthy as it marks the first oral therapy to demonstrate improvements or stabilization in LLVA.

There were no statistically significant benefits noted in BCVA over the study, but patients treated with gildeuretinol preserved 3.3 letters on visual acuity testing more than placebo at the end of the study.

Safety analysis indicated that most treatment-emergent adverse events (TEAEs) were mild to moderate and no deaths were attributed to gildeuretinol. A lower rate of choroidal neovascularization (CNV)-related adverse events were observed among at-risk patients.

Overall, these SAGA data indicated the potential of gildeuretinol as a novel therapeutic option for slowing the progression of GA. Particularly with a favorable safety profile, and its unique mechanism of action, gildeuretinol could emerge as the first oral therapy in this therapeutic category, warranting further investigation into its use in treatment regimens for patients with GA secondary to AMD.

“Gildeuretinol was well-tolerated and exhibited a favorable safety profile, consistent with other studies in the gildeuretinol Stargardt program,” Melamud added.

Melamud A. Gildeuretinol in Geographic Atrophy: Results from SAGA, a 2-year, Randomized, Double-masked, Placebo-controlled Study. Presented at the American Academy of Ophthalmology (AAO) 2024 Meeting. Chicago, Illinois. October 18-21, 2024.

The SAGA trial evaluated the efficacy of oral gildeuretinol (ALK-001) in reducing geographic atrophy (GA) progression in age-related macular degeneration (AMD). Results showed a trend towards slower GA lesion growth and significant improvement in low-luminance visual acuity (LLVA) compared to placebo. Although the primary endpoint of lesion growth rate did not reach statistical significance, a sensitivity analysis indicated a 15.3% reduction in GA lesion growth. Gildeuretinol was well-tolerated with a favorable safety profile, suggesting its potential as a novel oral therapy for GA secondary to AMD.

Decreasing Vitamin A dimerization could be a potential mechanism to treat geographic atrophy, according to results from the two-year SAGA study at AAO 2024.

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Geographic Atrophy

Gildeuretinol Shows Promise in Slowing Geographic Atrophy Progression

Novo Nordisk will present more detailed data in 2025 and plans to file for an expanded label for Rybelsus for this population. 

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Oral Semaglutide Reduces MACE Risk in People With Type 2 Diabetes and CVD  

Pegcetacoplan injection showed increased benefit for subfoveal GA, with as few as 6 injections, over 3 years in the GALE extension trial.

GALE: Pegcetacoplan Achieves Increasing Efficacy in Subfoveal Geographic Atrophy

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At AAO 2024, Pearlman discusses how an innovative oral approach may provide an alternative pathway to existing treatments for DME.

Joel A. Pearlman, MD, PhD: Phase 2a Data on Oral RZ402 for DME

These data suggest more immediate benefits to alitretinoin, though ultraviolet therapy was shown to be cost-effective after 10 years of use.

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Alitretinoin Superior to UV Therapy in Rapid Improvements to Chronic Hand Eczema

Endophthalmitis incidence remained similar between face masking and non-face masking groups during anti-VEGF treatment.

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Face Masking Did Not Affect Endophthalmitis Rates After Anti-VEGF Injections

Medical experts share their final thoughts on the future of atopic dermatitis treatment with oral systemic agents.

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Latest News

Clinical Quiz: Diagnosing, Managing Common Focal Liver Lesions

Methotrexate May Lower Vaccine Response in Patients With RA

How Artificial Intelligence is Being Used in Lung Imaging, with Rachel Eddy, PhD

New Data Reveals 19 Genes Exhibit Expression Changes in HCV, Parkinson Disease

Gildeuretinol Shows Promise in Slowing Geographic Atrophy Progression