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Cornelia Yasmin Gunawan

Fibrosis and Ductular Proliferation Comparison between CCl4-induced and 2AAF/CCl4-induced Liver Injury in Mouse Model = Perbandingan Fibrosis dan Proliferasi Duktular antara Kerusakan Hati Akibat Induksi CCl4 dan 2AAF/CCl4 pada Model Tikus

"mengalami kerusakan dan sirosis hati. Walaupun tidak ada data terbaru mengenai insiden kerusakan hati di Indonesia, Riskesdas 2013 menyampaikan adanya prevalensi yang tinggi dari persentase HBsAg, anti-HBs, dan anti-HBc. Selain itu, dalam kurun waktu 30 tahun (1980—2010), terdapat peningkatan tingkat kematian sirosis hati sebanyak 25,1%. Model hewan yang sesuai sangatlah penting dalam meneliti kerusakan hati. Karbon tetraklorida (CCl4) sudah lama digunakan untuk menginduksi fibrosis hati pada model tikus. Walaupun dapat menginduksi pengendapan jaringan ikat, regenerasi hepatoseluler, proliferase sel stelata, dan infiltrasi sel-sel inflamasi, kerusakan pada model tikus yang diinduksi CCl4 hanya merepresentasikan kerusakan hati sampai batas tertentu, mirip dengan kerusakan hati akibat obat. Dengan tujuan meniru kerusakan hati yang lebih parah, penelitian ini mengkombinasikan penggunaan CCl4 dengan asetilaminofluorena-2 (2AAF) karena 2AAF terbukti dapat menekan proliferasi hepatosit sehingga terjadi proliferasi sel oval yang berakibat pada proliferasi duktular. Metode: Desain penelitian ini adalah penelitian observasional terhadap penelitian analitik eksperimental dengan bahan biologis tersimpan yang diambil dari Departemen Patologi Anatomi Fakultas Kedokteran Universitas Indonesia. Penelitian ini menggunakan data primer eksperimental dengan 15 sampel yang dikategorikan dalam 3 kelompok: kontrol sehat, diinduksi CCl4, dan diinduksi 2AAF/CCl4, dan dianalis di bawah mikroskop dalam hal tingkat fibrosis, daerah cakupan fibrosis, dan jumlah proliferasi duktus. Analisis statistik yang digunakan meliputi uji Fisher, Shapiro-Wilk, Kruskal Wallis, dan Mann Whitney menggunakan program SPSS. Hasil: Kelompok 2AAF/CCl4 dan CCl4 memiliki perbedaan derajat fibrosis yang signifikan dengan kontrol sehat (p=0,024 dan p=0,048 secara berurutan), tanpa perbedaan signifikan di antara kedua kelompok tersebut (p=0,286). Perbedaan cakupan area fibrosis antara kedua kelompok juga tidak signifikan (p=0,055), walau kelompok 2AAF/CCl4 dan CCl4 berbeda signifikan dengan kontrol sehat (p=0,007 dan p=0,008 secara berurutan). Dalam hal proliferasi duktular, kelompok CCl4 tidak menunjukkan perbedaan signifikan dengan kontrol sehat (p=0,101), namun berbeda signifikan dengan kelompok 2AAF/CCl4 (p=0,000). Kesimpulan: Tidak terdapat perbedaan derajat dan cakupan area fibrosis yang signifikan antara kelompok 2AAF/CCl4 dan CCl4. Namun demikian, terjadi proliferasi duktular yang secara signifikan lebih tinggi pada kelompok 2AAF/CCl4 dibandingkan kelompok CCl4 saja.

Background: In 2017, approximately 1.8% of adult in United States suffer from chronic liver disease and cirrhosis. Although there is not any recent data, Riskesdas 2013 showed a high percentage of HBsAg, anti-HBs, and anti-HBc prevalence in Indonesia. On top of that, in Indonesia, in the course of 30 years (1980—2010), liver cirrhosis mortality rate increased by 25,1%. In order to study liver disease, having an appropriate animal model is crucial. Carbon tetrachloride (CCl4) has been used to induce liver fibrosis in mouse model. Although able to induce connective tissue deposition, hepatocellular regeneration, stellate cells proliferation, and inflammatory infiltration, CCl4-induced rat models only represent liver injury to some extent, similar to drug-induced liver injury. In order to mimic a more severe liver injury, this study combined the use of CCl4 with 2- acetylaminofluorene (2AAF), as 2AAF has proven to be able to suppress hepatocyte proliferation and allow oval cells proliferation that leads to ductular proliferation. Method: This research design is an observational research on an analytic experimental study with stored biological material taken from the Department of Anatomy Faculty of Medicine University of Indonesia. This research uses experimental primary data, with 15 samples categorized into three groups: healthy control, CCl4-induced, and 2AAF/CCl4- induced, and analysed for the degree of fibrosis, fibrosis-affected area, and number of proliferating ductules under the microscope. A statistical analysis is then conducted using Shapiro-Wilk, Kruskal Wallis, and Mann Whitney by using SPSS programme. Result: There is a significant difference in the degree of fibrosis between both 2AAF/CCl4 and CCl4 groups with the healthy control (p=0,024 dan p=0,048 respectively), without any significant difference in between the two groups (p=0,286). The affected fibrosis area difference between the two groups is also insignificant (p=0,055), though the 2AAF/ CCl4 and CCl4 groups are significantly different to the healthy control (p=0,007 and p=0,008 respectively). For ductular proliferation, CCl4 group did not show any significant difference compared to the healthy group (p=0,101), but was significantly different to the 2AAF/CCl4 group (p=0,000). Conclusion: There is not any significant difference regarding the degree of fibrosis and its affected area between the 2AAF/CCl4 and CCl4 groups. However, there is a significant difference between the two groups in terms of ductular proliferation, in which the 2AAF/CCl4 group’s ductular proliferation was higher."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022

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Sianturi, Dahlan

Pengaruh kombinasi recombinant humun Hepatocyte Growtth Factor dan vesikel ekstraseluler terhadap fibrosis hati (skor Laennec), penanda cedera hati (AST dan ALT) serta Hepatocyte Growth Factor pada model tikus ligasi duktus bilier = The effect of combination of recombinant human hepatocyte growth factor and extracellular vesicles in liver fibrosis (score Laennec), liver injury markers (AST and ALT), and hepatocyte growth factor un the rat bile duct ligation model

"Latar Belakang: Fibrosis hati disebabkan cedera hati kronis akan menjadi sirosis. Vesikel ekstraseluler (VE) dan Hepatocyte Growth Factor (HGF) banyak dipelajari sebagai terapi fibrosis dan regenerasi hati. Penelitian ini memanfaatkan kombinasi VE dan recombinant human-HGF ( rh-HGF) sebagai terapi alternatif fibrosis hati pada model tikus ligasi duktus bilier (LDB).

Metode: Sebelas tikus Sprague Dawley (SD) menjalani LDB, 5 tikus kontrol dan 6 tikus mendapat perlakuan injeksi VE 150 uL dan rh-HGF 0,1 mg intravena sejak 3 minggu pasca LDB, selama 7 hari. Satu tikus kontrol diterminasi 3 minggu pasca LDB sebagai data dasar. Tikus-tikus kelompok kontrol dan perlakuan diterminasi pada 1 hari dan 2 minggu setelah injeksi terakhir. Dilakukan penilaian skor Laennec hati serta kadar HGF, alanine aminotransferase (ALT) dan aspartate aminotransferase (AST).

Hasil: Histopatologi 3 minggu pasca LDB menunjukkan skor Laennec 2. Skor fibrosis kelompok kontrol (KK) dan kelompok perlakuan (KP) 1 minggu dan 2 minggu pasca injeksi VE dan rh-HGF seluruhnya dengan skor 2. Kadar HGF pada KP lebih rendah secara signifikan dibandingkan dengan KK 1 hari pasca injeksi terakhir (1,35+0,06 vs 1,53+0,06; p<0,001), semakin menurun setelah 2 minggu pasca injeksi terakhir namun tidak bermakna secara statistik 0,83 (0,73-0,84) vs 0,76 (0,73-0,80) p=0,248). Kadar AST 1 hari pasca injeksi terakhir; KK 1,66+0,05 KP 0,91+0,12 debgan p = 0,001. Setelah 2 minggu pasca injeksi; kadar AST pada kedua kelompok menurun 1,12 (1,11-1,22) vs (0,96+0,03); p=0,021). Kadar ALT pada kelompok perlakuan lebih rendah secara signifikan pada 1 hari pasca injeksi dan 2 minggu pasca injeksi dengan nilai p<0,001 dan 0,033a

Background: Fibrosis of the liver due to a chronic liver injury will become cirrhosis at the end-stage. The Extracellular Vesicles (EV) and hepatocyte growth factor (HGF) are recently learned as much as fibrosis and liver regeneration therapy. This study aims to know the result of using a combination of EV and recombinant human HGF (rh-HGF) as an alternative therapy due to liver fibrosis on the rat bile duct ligation (BDL) model.
Methods: Eleven BDL Sprague Dawley (SD) were divided into two groups, five mice as the untreated control group and six mice as the treatment group was getting an EV 150 ul and rh-hgf 0.1 mg intravenous injection three weeks after BDL, for seven days. One control rat is expanded three weeks after BDL as baseline data. The control and treatment group mice were projected at day one and two weeks after the final injection. This study was assessed from liver fibrosis by using Laennec score, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Hepatocyte Growth Factor (HGF) level.
Results: Scoring of histopathology by using the Laennec score at 3 weeks after BDL was 2. Meanwhile scoring of fibrosis of the control group and treatment group at 1 week and 2 weeks after ve and rh-hgf injection were 2. HGF level of the treatment group was lower significantly than control group at day 1 after last injection (1,35+0,06 vs 1,53+0,06; p<0,001), and within 2 weeks, the number of HGF levels decreased but statistically insignificant; 0,83 (0,73-0,84) vs 0,76 (0,73-0,80) p=0,248). AST level at day 1 after last injection; control group vs treatment group ;1,66+0,05 vs 0,91+0,12, p value = 0,001. 2 weeks after injection; AST level for both group were become lower 1,12 (1,11-1,22) vs (0,96+0,03); p=0,021), and ALT level on treatment group was significantly lower at day 1 and 2 weeks after injection with p value <0,001 and 0, 033a"

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Tesis Membership Universitas Indonesia Library

Sianturi, Dahlan

Pengaruh kombinasi recombinant human Hepatocyte Growth Factor dan vesikel ekstraseluler terhadap fibrosis hati (skor Laennec), penanda cedera hati (AST dan ALT) serta Hepatocyte Growth Factor pada model tikus ligasi duktus bilier = The effect of the combination of recombinant human hepatocyte growth factor and extracellular vesicles in liver fibrosis (score Laennec), liver injury markers (AST and ALT), and hepatocyte growth factor in the rat bile duct ligation model

Background: Fibrosis of the liver due to a chronic liver injury will become cirrhosis at the end-stage. The Extracellular Vesicles (EV) and hepatocyte growth factor (HGF) are recently learned as much as fibrosis and liver regeneration therapy. This study aims to know the result of using a combination of EV and recombinant human HGF (rh-HGF) as an alternative therapy due to liver fibrosis on the rat bile duct ligation (BDL) model.
Methods: Eleven BDL Sprague Dawley (SD) were divided into two groups, five mice as the untreated control group and six mice as the treatment group was getting an EV 150 ul and rh-hgf 0.1 mg intravenous injection three weeks after BDL, for seven days. One control rat is expanded three weeks after BDL as baseline data. The control and treatment group mice were projected at day one and two weeks after the final injection. This study was assessed from liver fibrosis by using Laennec score, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Hepatocyte Growth Factor (HGF) level.
Results: Scoring of histopathology by using the Laennec score at 3 weeks after BDL was 2.Meanwhile scoring of fibrosis of the control group and treatment group at 1 week and 2weeks after ve and rh-hgf injection were 2. HGF level of the treatment group was lower significantly than control group at day 1 after last injection (1,35+0,06 vs 1,53+0,06; p<0,001), and within 2 weeks, the number of HGF levels decreased but statistically insignificant; 0,83 (0,73-0,84) vs 0,76 (0,73-0,80) p=0,248). AST level at day 1 after last injection; control group vs treatment group ;1,66+0,05 vs 0,91+0,12, p value = 0,001. 2 weeks after injection; AST level for both group were become lower 1,12 (1,11-1,22) vs (0,96+0,03); p=0,021), and ALT level on treatment group was significantly lower at day 1 and 2 weeks after injection with p value <0,001 and 0, 033a"

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Tesis Membership Universitas Indonesia Library

Wulan Ayudyasari

Peran Vesikel Ekstrasel Sel Punca Tali Pusat Pre-Conditioned terhadap Fibrosis dan Regenerasi Hati Model Tikus Atresia Bilier = The Role of Pre-Conditioned Huc-Mscs Extracellular Vesicles in Liver Fibrosis and Regeneration

"Latar Belakang: Vesikel ekstrasel (VE) dari sel punca mesenkimal (MSCs) telah banyak dipelajari dan memberikan hasil yang baik terhadap fibrosis dan regenerasi hati. Prekondisi MSCs dengan sitokin spesifik dapat meningkatkan aktivitas terapeutik dari VE. TNF-a dan TGF-b telah terbukti menghambat respon inflamasi dan memicu perbaikan jaringan bila digunakan untuk prekondisi MSCs pada penelitian bidang urologi dan ortopedi. Penelitian ini menggunakan VE dari sel punca mesenkimal tali pusat manusia (hUC-MSC) yang diprekondisikan dengan serum pasien atresia bilier yang mengandung TNF-a dan TGF-b sebagai terapi atresia bilier pada model tikus. Metode: Vesikel ekstrasel dari hUC-MSCs dikultur dalam medium komplit dan diprekondisikan dengan serum pasien atresia bilier. Dilakukan ekstraksi VE dengan sentrifugasi serial pada conditioned medium (CM) hUC-MSC tersebut. Sebelas tikus Sprague Dawley menjalani ligasi duktus koledokus (CBD), lima tikus sebagai kontrol dan enam tikus sebagai penerima perlakuan. Kelompok perlakuan mendapatkan injeksi EV intravena ekor yang dimulai 3 minggu pascaligasi CBD, sebanyak tujuh dosis 150 uL selama tujuh hari berturut-turut. Satu ekor tikus kontrol diterminasi 3 minggu pascaligasi CBD untuk melihat skor fibrosis sebelum diberikan perlakuan. Tikus-tikus kelompok kontrol dan perlakuan diterminasi pada 1 hari dan 2 minggu setelah injeksi VE terakhir. Dilakukan penilaian skor Laennec jaringan hati serta kadar hepatocyte growth factor (HGF), aspartate transaminase (AST), dan alanine transaminase (ALT) darah. Hasil: Pemeriksaan histopatologi jaringan hati 3 minggu pascaligasi CBD menunjukkan skor fibrosis 2. Skor fibrosis kelompok kontrol dan perlakuan 1 hari dan 2 minggu pascainjeksi VE seluruhnya mendapatkan nilai 2. Kadar HGF pada kelompok perlakuan lebih rendah secara signifikan dibandingkan dengan kelompok kontrol 1 hari pascainjeksi VE (1,04+0,11 vs 1,53+0,06; p<0,001), namun lebih tinggi pada 2 minggu pascainjeksi VE meskipun tidak bermakna secara statistik (1,18 (1,18-1,18) vs 0,83 (0,73-0,84); p=0,064). Kadar AST 1 hari pascainjeksi VE kelompok kontrol 1,66+0,05 dan kelompok perlakuan 1,29+0,15 dengan nilai p 0,001. Dua minggu pascainjeksi VE, perbedaan kadar AST pada kedua kelompok menurun (1,12(1,11-1,22) vs 0,74(0,70-0,78); p=0,064). Kadar ALT pada kelompok perlakuan lebih rendah secara signifikan pada 1 hari dan 2 minggu pascainjeksi VE dengan nilai p <0,001 dan 0,025. Kesimpulan: Vesikel ekstrasel dari hUC-MSC yang diprekondisikan dengan serum pasien atresia bilier tidak menurunkan skor fibrosis, namun dapat meningkatkan kadar HGF dan menurunkan penanda cedera hati.

Introduction: Mesenchymal stem cells (MSCs)-derived extracellular vesicles (EVs) have long been studied and yield a satisfactory result in liver fibrosis and regeneration. Preconditioning of MSCs by specific cytokines can enhance the therapeutic activities of EVs. TNF-a and TGF-b were cytokines that has the potency to inhibit inflammatory responses and promote tissue repair when used as pre-conditioning agent of MSCs in nonliver studies. This study used serum of biliary atresia patients that contain TNF-a and TGF-b as pre-conditioning agent of human umbilical cord mesenchymal stem cells (hUCMSCs)- derived EVs for the treatment of biliary atresia rat model. Methods: hUC-MSCs were cultured in complete medium and pre-conditioned with serum of human biliary atresia patient. The conditioned medium (CM) from preconditioned hUC-MSCs underwent serial centrifugation to extract EVs. Eleven 5 weeks old Sprague Dawley rats underwent bile duct ligation (BDL). Five rats among the BDL group act as control while six rats were given EVs injection 3 weeks after BDL procedure, seven doses in seven consecutive days, 150 uL each dose. One rat were sacrificed 3 weeks post BDL for fibrosis staging prior to treatment. Rats from control and EVs group were sacrificed at 1 day and 2 weeks after the last EVs injection. Liver tissue were assessed for fibrosis score and blood were analysed for hepatocyte growth factor (HGF), aspartate transaminase (AST), and alanine transaminase (ALT). Results: Liver histopathology 3 weeks post BDL showed Laennec score 2. Fibrosis score of control and EVs group 1 day and 2 weeks after the last EVs injection were all 2. Hepatocyte growth factor level on EVs group were significantly lower than control group on 1 day post EVs injection (1,04+0,11 vs 1,53+0,06; p<0,001), but higher on EVs group on 2 weeks post EVs injection although not statistically significant (1,18 (1,18-1,18) vs 0,83 (0,73-0,84); p=0,064). The level of AST were 1,66+0,05 in control group and 1,29+0,15 in EVs group 1 day after EVs injection, with p value 0,001. Two weeks post EVs injection, the AST levels decreased furthermore (1,12(1,11-1,22) vs 0,74(0,70-0,78); p=0,064). Alanine transaminase level were significantly lower on EVs group both 1 day and 2 weeks post EVs injection, with p value <0,001 and 0,025. Conclusion: Extracellular vesicles from hUC-MSCs pre-conditioned with serum of biliary atresia patients could not lessen fibrosis score, but can increase HGF level and decrease markers of liver injury."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Tesis Membership Universitas Indonesia Library

Dimas Kirana Mahaputra

Efek Nanokurkumin pada Histologi Fibrosis Hati yang Diinduksi 7,12-dimethylbenz(a)anthracene dan Cisplatin sebagai Model Kanker Ovarium pada Tikus = The Effects of Nanocurcumin on Histology of Liver Fibrosis Induced with 7,12-dimethylbenz(a)anthracene and Cisplatin as a Rat Ovarian Cancer Model

"Latar Belakang: Cisplatin sebagai agen kemoterapi merupakan salah satu modalitas terapi pada kanker padat seperti kanker ovarium. Sejumlah studi membuktikan adanya efek samping hepatotoksik cisplatin. Hal ini dapat mengakibatkan kemoterapi tidak efektif, karena dosis cisplatin dikurangi atau bahkan dihentikan pemberiannya. Dewasa ini, obat berbasis tanaman banyak diteliti, salah satunya kurkumin. Kurkumin mempunyai efek hepatoprotektif namun bioavailabilitasnya sangat rendah. Sejumlah penelitian membuat formula nanokurkumin untuk meningkatkan bioavaibilitasnya. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian nanokurkumin pada gambaran histologis jejas liver yang diinduksi oleh cisplatin pada tikus model kanker ovarium. Metode: Penelitian ini menggunakan bahan biologis tersimpan dari penelitian sebelumnya. Terdapat 5 kelompok perlakuan; kontrol, DMBA; DMBA+Cisplatin; DMBA+Cis+kurkumin; dan DMBA+Cis+nanokurkumin. Pewarnaan Masson Trichrome dipakai untuk mengamati akumulasi kolagen sebagai penanda fibrosis. Selanjutnya dilakukan kuantifikasi jaringan kolagen /Collagen Proportionate Area (CPA), serta skoring fibrosis hati (skor ISHAK). Hasil: Induksi DMBA dan terapi cisplatin dapat mengakibatkan fibrosis hati, ditandai dengan deposisi kolagen yang lebih tinggi dibanding kelompok kontrol. Pemberian nanokurkumin menunjukkan adanya perbaikan secara histologis berupa fibrosis periportal yang ringan dan skor fibrosis yang lebih rendah secara signifikan (p<0.05) dibanding kelompok lainnya. Pemberian nanokurkumin juga menunjukkan persentase akumulasi kolagen (CPA) yang rendah, namun tidak signifikan (p>0.05) secara statistik. Kesimpulan: Pemberian nanokurkumin pada model kanker ovarium yang diterapi dengan cisplatin pada tikus menunjukkan efek hepatoprotektor dengan memperbaiki skor fibrosis dan mengurangi akumulasi kolagen pada jaringan liver. Diperlukan penelitian lebih lanjut yang membandingkan beragam dosis dan formulasi untuk mengetahui efikasi nanokurkumin yang paling baik sebagai hepatoprotektor pada model kanker ovarium yang diterapi dengan cisplatin.

Background: Cisplatin as a chemotherapy is one of the main modalities of therapy in patients with solid tumours like ovarian cancer. Studies have proven the hepatotoxicity of cisplatin, which causes dose reduction and even termination. Nowadays, herbal based drug is intensively studied, one of them is curcumin. Curcumin is known to have a hepatoprotective effect, albeit with very low bioavailability. To solve this, many research have formulated nanocurcumin to increase its bioavailability. This research aims to find out the effect of nanocurcumin in liver fibrosis induced by cisplatin in ovarian cancer of rat’s model. Method: Our study uses stored biological materials from previous study. The groups are; Control; DMBA; DMBA+Cisplatin; DMBA+Cisplatin+Curcumin; DMBA+Cisplatin+Nanocurcumin. Liver fibrosis is observed with Masson Trichrome stain to view collagen accumulation as fibrosis marker. Afterwards, quantification of collagen fibers (CPA) and liver fibrosis grading (ISHAK) is done. Results: Induction of DMBA with cisplatin treatment causes liver fibrosis, indicated by higher collagen deposition compared to the normal group. Administration of nanocurcumin shows improvement in histological structure such as milder periportal fibrosis and significantly lower liver fibrosis grade (p<0.05) compared to other groups. Administration of nanocurcumin also results in lower collagen percentage (CPA), however it is statistically insignificant (p>0.05). Conclusion: Administration of nanocurcumin in rat ovarian cancer model treated with cisplatin shows hepatoprotective effect by reducing both fibrosis grade and collagen accumulation in the liver. Further study is required with varying dose and formulations to know the nanocurcumin’s best efficacy as hepatoprotector in ovarian cancer model treated with cisplatin.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019

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Darryl Darian Suryadi

Analysis of Liver Fibrosis in CCl4-Induced Rat Liver by Administering Different Doses of Umbilical Cord-Derived Mesenchymal Stem Cell = Analisis Fibrosis Hati Tikus Perlakuan CCl4 dengan Pemberian Dosis Sel Punca Tali Pusat yang Berbeda

"Pendahuluan Fibrosis hati adalah kondisi ketika hati mengalami cedera kronis dan terbentuk jaringan parut termasuk kolagen sehingga tidak lagi mampu berfungsi dengan baik. Terapi sel punca mesenkimal asal tali pusat merupakan terapi regeneratif yang dikembangkan untuk penyembuhan penyakit jejas hati kronis. Hasil penelitian terdahulu terhadap tikus yang diinduksi dengan 2AAF/CCl4 dan diberi sel punca mesenkimal asal tali pusat dosis 1 x 106 menunjukkan adanya perbaikan fibrosis hati yang ditimbulkan akibat pemberian 2AAF/CCl4 tersebut. Penelitian ini akan menggunakan CCl4, suatu zat yang akan merusak hati tikus secara akut dan akan membandingkan dua dosis sel punca mesenkim asal tali pusat yaitu dosis 1 x 106 dan 3 x 106. Metode Penelitian ini menggunakan bahan biologis tersimpan blok parafin dari jaringan hati tikus Wistar yang dipulas dengan pulasan khusus Masson’s Trichrome. Terdapat empat kelompok sampel yang digunakan, yaitu kelompok CCl4, kelompok 1 x 106 sel punca, kelompok 3 x 106 sel punca, dan kelompok kontrol sehat. Seluruh pulasan dari tiap kelompok difoto menggunakan kamera yang terhubung ke mikroskop. Derajat fibrosis pada setiap lapangan pandang dihitung menggunakan kriteria NASH beserta luas hati yang terkena fibrosis. Data yang diperoleh dianalisis secara statistik untuk mengetahui dosis mana yang lebih baik untuk memperbaiki fibrosis hati.

Hasil Kelompok tikus dengan induksi CCl4 saja menunjukkan 100% sampel mengalami fibrosis, sedangkan kelompok sehat memperlihatkan hanya sekitar 30% sampel yang mengalami fibrosis. Kelompok tikus dengan induksi CCL4 dan diberikan 1 x 106 sel punca menunjukkan 71% sampel masih mengalami fibrosis, sedangkan pada kelompok dengan pemberian 3 x 106 sel punca jumlah sel yang mengalami fibrosis adalah 87%. Tidak terdapat perbedaan bermakna antara derajat fibrosis di semua kelompok uji. Di sisi lain, pemberian 1 x 106 sel punca berhasil menurunkan luas hati yang terkena fibrosis.

Background Liver fibrosis is the excessive accumulation of extracellular matrix proteins including collagen that occurs in most types of chronic liver diseases. Previous studies have shown that the injection of mesenchymal stem cell is beneficial to alleviate liver fibrosis. However, the optimum dose of stem cell that must be administered is not yet fully understood. Previous research used 1 x 106 stem cells to treat 2AAF/CCl4 – induced rat liver which simulates a chronic liver injury. Results show that the degree of fibrosis was significantly reduced. In this study, only CCl4 will be used to simulate an acute liver injury and two doses of human umbilical cord-derived mesenchymal stem cell (hUC-MSC), 1 x 106 and 3 x 106, is used to analyze which dose is better to treat liver fibrosis. Methods This study uses archived biological materials on Wistar rat livers as formalin-fixed-paraffin-embedded (FFPE) which has been treated with Masson’s Trichrome staining. Four group samples were used in this study, which are the CCl4 group, 1 x 106 hUC-MSC group, 3 x 106 hUC-MSC group, and healthy control group. Slide samples were photographed using a microscope and the results collected. The degree of fibrosis is then investigated using the NASH criteria and the mean percentage affected area is calculated. Further statistical analysis is conducted to know which treatment is better at reducing liver fibrosis. Results The group with the highest degree of fibrosis is the CCl4 group with 100% of the samples experiencing fibrosis. On the other side, the healthy control group has the lowest degree of fibrosis where around 70% of the samples showing no fibrosis. Both the 1 x 106 and 3 x 106 hUC-MSC group show some samples having no fibrosis while the majority still had fibrosis of different degrees. Approximately 29% of the samples of the 1 x 106 hUC-MSC group did not show fibrosis while only 13% of the samples showed no fibrosis in the 3 x 106 hUC-MSC group. However, there were no statistical difference in the degree of fibrosis found in all the samples. On the contrary, analysis of the fibrosis affected area showed that the 1 x 106 group is beneficial to reduce the affected area of liver fibrosis. Conclusion The administration of 3 x 106 stem cells does not create a better outcome in terms of liver fibrosis. In contrast, the group which was treated with only 1 x 106 stem cells showed that there is a decrease in the affected area of fibrosis even if the degree of fibrosis was not significantly decreased."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022

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UI - Skripsi Membership Universitas Indonesia Library

Nasution, Andy Janitra

Perbedaan rerata splenic artery pulsatility index antara fibrosis hepar non signifikan dan fibrosis hepar signifikan pada hepatitis c kronik = Mean difference of splenic artery pulsatility index between non significant liver fibrosis and significant liver fibrosis in chronic hepatitis c patients

"Latar belakang dan tujuan: Fibrosis hepar merupakan hal yang perlu diketahui untuk memulai terapi antiviral pada pasien hepatitis C kronik. Pemeriksaan USG Doppler yang bersifat non invasif, tersedia luas dan relatif murah dipertimbangkan sebagai metode alternatif untuk menentukan derajat fibrosis di daerah yang tidak memiliki fibroscan. Parameter splenic artery pulsatility index (SAPI) dipikirkan dapat digunakan sebagai indikator derajat fibrosis. Namun saat ini belum ditemukan nilai titik potong SAPI untuk populasi di Indonesia.

Metode: Studi observasional potong lintang dilakukan pada 34 pasien dengan hepatitis C kronik di Divisi Hepatologi Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo dalam kurun waktu Desember 2015 hingga Februari 2016. Indeks dan parameter Doppler lainnya merupakan data primer. Subjek dibagi menjadi dua kelompok, yaitu kelompok fibrosis non signifikan dan kelompok fibrosis signifikan. Uji komparatif dilakukan untuk membandingkan rerata indeks dan parameter Doppler lainnya diantara kedua kelompok tersebut. Analisis kurva receiver operating characteristic (ROC) dilakukan pada SAPI untuk mendapatkan nilai sensitifitas dan spesifisitasnya.

Hasil: Median SAPI pada kelompok fibrosis signifikan adalah 1.02 dengan range 0.7-1.8 sedangkan median SAPI pada kelompok fibrosis non signifikan adalah 0.89 dengan range 0.7-1.3 dengan nilai p=0.021. Dengan analisis ROC didapatkan titik potong indeks 0.96 yang memberikan sensitifitas 73.9% dan spesifisitas 81.8% untuk membedakan kelompok fibrosis signifikan dan fibrosis non signifikan.

Kesimpulan: Terdapat hubungan yang bermakna antara indeks SAPI secara USG dengan derajat fibrosis yang didapat dari fibroscan dan indeks tersebut dapat digunakan sebagai indikator fibrosis signifikan dengan akurasi yang cukup tinggi.

Background and Objective: Liver fibrosis needs to be evaluated in order to begin anti viral therapy in chronic hepatitis C patients. Doppler ultrasound which is non invasive, widely available and relatively cheap is being considered as an alternative method to determine the degree of fibrosis in areas which do not have a fibroscan available. Splenic artery pulsatility index (SAPI) can be used as an indicator of significant fibrosis, however the cut off value for Indonesian population has yet to be determined.
Method: A cross-sectional observational study is conducted in 34 patients with chronic hepatitis C in the Hepatology Division Department of Internal Medicine Cipto Mangunkusumo Hospital during December 2015 to February 2016. The index and other Doppler parameters are primary data. Subjects are divided into two groups: significant fibrosis group and non significant fibrosis group. Comparative test is conducted to compare the mean index and other Doppler parameters among the two group. Analysis of receiver operating characteristic (ROC) curve was performed on parameters that are statistically significant in order to obtain the sensitivity and specificity value.
Results: Median SAPI in significant fibrosis group is 1.02 with a range of 0.7-1.8 while the median SAPI in non significant group is 0.89 with a range of 0.7-1.3, p=0.021. From ROC curve analysis, we obtained the optimal cutting point index 0.96 which gives 73.9% sensitivity and 81.8% specificity to differentiate significant fibrosis group and non significant fibrosis group.
Conclusion: There is a significant association between SAPI which is obtained by Doppler and the degree of fibrosis obtained from fibroscan which can be used as an indicator for significant liver fibrosis with quite high accuracy."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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UI - Tugas Akhir Universitas Indonesia Library

Rizky Eka Putra Yuriza

Pengaruh Ekstrak Biji Jengkol (Archidendron pauciflorum) terhadap Aktivitas Alkali Fosfatase Plasma pada Kerusakan Hati Tikus yang Diintoksikasi Karbon Tetraklorida (CCl4) = The Effect of Jengkol Beans Extract (Archidendron pauciflorum) on Plasma Alkaline Phosphatase Activity of CCl4-induced Liver Injury in Rats

"Pajanan terhadap radikal bebas yang berperan dalam kerusakan dan degenerasi jaringan semakin meningkat. Antioksidan menjadi penangkal dari kerusakan yang disebabkan oleh radikal bebas. Sebagai antioksidan eksogen, Archidendron pauciflorum atau yang lebih dikenal sebagai jengkol dinilai berpotensi karena adanya vitamin C, polifenol dan asam jengkolat yang terkandung di dalamnya.

Penelitian ini dilakukan untuk menilai kemampuan protektif biji jengkol sebagai antioksidan pada hati dengan aktivitas alkali fosfatase plasma sebagai indikator kerusakan. Dua puluh delapan ekor tikus jantan Sprague Dawley dibagi ke dalam 4 kelompok yaitu, tanpa perlakuan, jengkol, jengkol-CCl4 dan CCl4. Aktivitas alkali fosfatase diukur dari plasma tikus tiap kelompok perlakuan menggunakan substrat p-NPP. Data kemudian dianalisis menggunakan One-way ANOVA.

Hasil penelitian menunjukkan peningkatan aktivitas alkali fosfatase yang bermakna pada kelompok jengkol-CCl4 (p=0,000) dan CCl4 (p=0,007) dibanding kelompok tanpa perlakuan. Pada kelompok jengkol tidak terdapat perbedaan bermakna dibanding kelompok tanpa perlakuan (p=1,000). Dari penelitian ini disimpulkan bahwa potensi biji jengkol sebagai antioksidan belum terbukti apabila dilihat dari tingkat aktivitas alkali fosfatase plasma.

Exposure to free radicals that play role in tissue damage and degeneration is increasing. Antioxidants prevent from damage caused by free radicals. As exogenous antioxidants, Archidendron pauciflorum or better known as jengkol considered potential as antioxidants as vitamin C, polyphenols and Jengkolat acid contained in it.
This study was conducted to evaluate the protective effect of jengkol beans as antioxidants in the liver with plasma alkaline phosphatase activity as an indicator of damage. Twenty eight male Sprague Dawley rats were divided into 4 groups, namely, without treatment, jengkol, jengkol-CCl4 and CCl4. Alkaline phosphatase activity was measured from the plasma of rats for each treatment group using p-NPP substrate. The data obtained were analyzed by using One-way ANOVA.
The results showed an increase in alkaline phosphatase activity significantly in jengkol-CCl4 group (p = 0.000) and CCl4 (p = 0.007) compared to the untreated group. The jengkol group not significantly different than the untreated group (p = 1.000). This study suggests that the antioxidant potential of jengkol beans still unproven when seen from the level of plasma alkaline phosphatase activity because jengkol-CCl4 group actually has the highest value of enzyme activity."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015

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UI - Skripsi Membership Universitas Indonesia Library

Ari Rahman Iskandar

Hubungan Biomarker Fibrosis Hati Transforming Growth Factor-B, Matrix Metalloproteinase-7, dan Ultrasonografi Acoustic Radiation Force Impulse Dengan Derajat Fibrosis Hati Pada Pasien Atresia Bilier = Correlation Between Liver Fibrosis Biomarkers Transforming Growth Factor-B, Matrix Metalloproteinase-7, and Acoustic Radiation Force Impulse Ultrasoung with Degree of Liver Fibrosis in Biliary Atresia Patients

"Latar belakang: Atresia bilier merupakan penyebab paling umum fibrosis hati pada anak, dan menjadi indikasi terbanyak transplantasi hati. Fibrosis hati dapat dinilai dengan pemeriksaan histopatologis dan kuantifikasi skor Laennec. Pemeriksaan biomarker dari darah dan metode pencitraan radiologis merupakan upaya lain untuk menilai derajat fibrosis hati. Penelitian ini dimaksudkan untuk meneliti perbandingan biomarker penanda fibrosis transforming growth factor (TFG-β), matrix metalloproteinase (MMP)-7, dan ultrasonografi (USG) Acoustic Radiation Force Impulse (ARFI) dengan derajat fibrosis berdasarkan pemeriksaan histopatologi. Metode penelitian: Penelitian ini merupakan penelitian desain cross sectional pada pasien anak dengan kolestasis yang dicurigai akibat atresia bilier di ruang rawat anak RSUPN Cipto Mangunkusumo. Data penelitian ini adalah data primer dari anamnesis, pemeriksaan fisik, serta data sekunder dari rekam medis untuk melihat riwayat penyakit pasien. Dilakukan pemeriksan serum biomarker TGF-β dan MMP-7, dan USG ARFI oleh operator yang telah ditentukan. Dibandingkan hasil pemeriksaan TGF-β, MMP-7, USG ARFI dengan hasil skoring fibrosis biopsi hati.

Hasil penelitian: Dari total 15 pasien dengan AB, terdapat 6 pasien F2-F3, dan 9 pasien F4 berdasarkan derajat fibrosis biopsi hati. Terdapat peningkatan kadar TGF-β dengan adanya peningkatan derajat fibrosis biopsi hati, namun tidak terdapat hubungan bermakna antara derajat fibrosis hati dengan kadar TGF-β (uji Mann-Whitney, p=0.768). Pada penelitian ini, rerata kadar MMP-7 pada kelompok F2-3 dan F4 menunjukan peningkatan, namun tidak terdapat hubungan yang bermakna (Uji Mann-Whitney, p=0.409). Terdapat hubungan bermakna antara derajat fibrosis hati F2-F3 dengan derajat F4 yang diperoleh berdasarkan hasil USG ARFI dan hasil biopsi hati (p<0,01). Kesimpulan: TGF-β dan MMP-7 merupakan biomarker yang cukup efektif namun memiliki keterbatasan tidak spesifik untuk AB. USG ARFI merupakan pemeriksaan minimal invasive yang efektif untuk menentukan derajat fibrosis.

Background: Biliary atresia is the most common cause of liver fibrosis and the highest indication for liver transplantation in pediatrics. Liver fibrosis is quantified through Laennec score based on histopathology of liver biopsy. Blood serum biomarkers and radiological examinations are alternative methods that could determine liver fibrosis. This study aimed to compare the significance of serum biomarkers transforming growth factor (TFG-β), matrix metalloproteinase (MMP)-7, and Acoustic Radiation Force Impulse (ARFI) ultrasonography (USG) in determining the degree of liver fibrosis compared to histopathology score from liver biopsy. Method: This was a cross-sectional study, on patients in the pediatric ward at dr. Cipto Mangunkusumo National Hospital, that were admitted with cholestasis with biliary atresia as the suspected etiology. Primary data was obtained through anamnesis, and physical examination, and secondary data was obtained through patients’ medical records. Serum biomarkers TGF-β and MMP-7, and USG ARFI were examined by related experts and results were obtained through medical records. Results of TGF-β, MMP-7, and USG ARFI were compared with fibrosis scores based on liver biopsy.
Result: From a total of 15 patients with AB, there were 6 F2-F3 patients, and 9 F4 patients according to the biopsy results. TGF-β levels showed and increasing trend alongside increase in liver biopsy fibrosis score, however it was not statistically significant (Mann- Whitney test, p=0.768). In this study, there was an increase in MMP-7 levels in F2-3 group compared to f4 group, however there was no statically significant difference (Mann-Whitney test, p=0.409). The ARFI USG results showed significant difference between F2-F3 group and F4 group based on ARFI USG compared to liver biopsy (p<0.01). Conclusion: TGF-β and MMP-7 are effective serum biomarkers, however, lacked specificity to determine fibrosis levels in biliary atresia. A minimally invasive test that is effective in determining the degree of fibrosis can be done through ARFI USG. "

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023

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UI - Tugas Akhir Universitas Indonesia Library

Zakiyah

Ekspresi DLK1 dan Ki67 pada regenerasi hati tikus pasca induksi 2AAF/CCl4 yang diberi sel punca mesenkim asal tali pusat = Expression of DLK1 and Ki67 on rat liver regeneration post 2AAF/CCl4 induction after umbilical cord derived mesenchymal stem cell injection

"Hati merupakan organ yang memiliki kemampuan regenerasi tinggi setelah mengalami kerusakan. Sel punca mesenkimal asal tali pusat merupakan sumber progenitor hati yang dapat ditranplantasikan dan dapat digunakan pada kasus kerusakan hati yang parah. Kerusakan hati yang parah akan memunculkan sel oval sebagai pertahanan tingkat ke dua. Proses regenerasi hati yang diperantarai sel oval sangat kompleks karena melibatkan sitokin, faktor pertumbuhan, hormon dan morfogen. DLK1 (Delta-Like 1 homolog) merupakan salah satu morfogen yang diekspresikan kembali pada kasus kerusakan hati dengan kondisi proliferasi hepatosit yang dihambat. DLK1 diekspresikan oleh sel oval dalam jumlah yang terbatas.

Penelitian ini bertujuan mengetahui ekspresi DLK1 dan proliferasi hepatosit yang dinilai menggunakan Ki67 pada kerusakan yang diinduksi 2AAF/CCl₄. Selain itu juga akan dinilai pengaruh sel punca pada ekspresi DLK1 dan proliferasi hepatosit yang dinilai menggunakan Ki67 pada saat proses regenerasi hati. Penelitian ini menggunakan 30 tikus jantan strain Wistar berusia 8 minggu yang dibagi menjadi 5 kelompok (n=6). Proses Induksi kerusakan hati menggunakan 2AAF/CCl₄ selama 12 minggu kemudian diberikan injeksi sel punca mesenkimal asal tali pusat manusia dengan dosis 1x10⁶sel melalui vena ekor. Dua kelompok (kontrol dan induksi 2AAF/CCl₄) diterminasi pada akhir minggu ke-12 sebagai model kerusakan hati sedangkan tiga kelompok lainnya (kontrol, kelompok dengan sel punca dan kelompok tanpa sel punca diterminasi pada akhir minggu ke-14.

Pada penelitian ini ditemukan bahwa terdapat perbedaan signifikan ekspresi DLK1 namun tidak terdapat perbedaan signifikan pada tingkat proliferasi hepatosit yang dinilai dengan Ki67 pada kerusakan hati yang diinduksi 2AAF/CCl₄. Sedangkan pada regenerasi hati tidak ditemukan perbedaan signifikan ekspresi DLK1 dan Ki67 antara kelompok yang diberikan sel punca dan tidak diberikan sel punca.

The liver is an organ that has a high regeneration ability after being injured. Mesenchymal stem cells from the human umbilical cord are transplanted sources of liver progenitors and can be used in cases of severe liver injury. Severe liver damage will bring out oval cells as a second level defense. The process of liver regeneration which is mediated by oval cells is very complex because it involves cytokines, growth factors, hormones and morphogens. DLK1 (Delta-Like 1 homologue) is one of the morphogens that is expressed again in cases of liver injury with inhibited hepatocyte proliferation. DLK1 is expressed in subpopulation in oval cells compartement of rat liver.
This study aims to determine the expression of DLK1 and hepatocyte proliferation which was assessed using Ki67 in the 2AAF/CCl₄ induced severe injury. It will also be assessed the effect of mesenchymal stem cells on DLK1 expression and hepatocyte proliferation which was assessed using Ki67 during the liver regeneration process. This study used 30 male 8-week-old Wistar strain rats divided into 5 groups (n = 6). The process of induction of liver injury using 2AAF/CCl₄ for 12 weeks was then given mesenchymal stem cell injection from human umbilical cord at a dose of 1x10⁶ cells through the tail vein. Two groups (control and 2AAF/CCl₄groups) were terminated at the end of the 12th week as models of liver injury while the other three groups (control, groups with stem cells and groups without stem cells were terminated at the end of week 14.
In this study it was found that there was a significant difference in DLK1 expression but there was no significant difference in the rate of hepatocyte proliferation assessed by Ki67 in 2AAF/CCl₄ induced liver injury, whereas in liver regeneration there was no significant difference in DLK1 and Ki67 expression between groups given stem cells and not given stem cells. "

Jakarta: Fakultas Kedokteran Universitas Indonesia , 2020

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