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A research report submitted to the degree of Master of Medicine in the Department of Surgery for the University of the Witwatersrand Health Sciences, 2013 / Biliary atresia (BA) is characterised by a progressive obliterative cholangiopathy. If surgical treatment by a Kasai Portoenterostomy (KP) is undertaken early on in life there is the potential for successful bile drainage. The natural disease progression without intervention results in fibrosis and cirrhosis, necessitating liver transplantation before two years of life. Despite the advances in the management of biliary atresia over the recent decades we still do not have a good indicator of which patients will do well after surgery and which will require further intervention for their liver dysfunction. There are many clinical and serological indicators that suggest liver failure, but liver histology remains the gold standard indicating the extent of liver damage. This is, however, being slowly replaced by various new less-invasive biological markers, including the Aminotransferase Aspartate to Platelet Ratio Index (APRi). This study looks at this biological marker for patients with biliary atresia with reference to their level of disease at the time of surgery and whether it is a prognostic tool for long-term outcomes in this group of patients.

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Non-alcoholic fatty liver disease is affecting an increasing population worldwide. NAFLD is closely associated with obesity and diabetes. Research has shown that the expression of some important hepatic transporters and enzymes are altered under inflammatory conditions. We examined the effect of NAFLD on the gene expression of several hepatic transporters and enzymes, as well as the impact of exercise in attenuating the effect of NAFLD. We have demonstrated that the mRNA expression of several hepatic transporters and enzymes, as well as FXR were significantly downregulated in liver of rats treated with a HFHCD. We concluded that HFHCD-induced hepatic steatosis, together with the reduced expression of FXR, contributed to the downregulation of expression of hepatic transporters and enzymes. The mRNA expression of TNF-α and IL-1β were unaffected. Interestingly, exercise was found to improve the expression levels of some transporters and enzymes.

Non-alcoholic fatty liver disease is affecting an increasing population worldwide. NAFLD is closely associated with obesity and diabetes. Research has shown that the expression of some important hepatic transporters and enzymes are altered under inflammatory conditions. We examined the effect of NAFLD on the gene expression of several hepatic transporters and enzymes, as well as the impact of exercise in attenuating the effect of NAFLD. We have demonstrated that the mRNA expression of several hepatic transporters and enzymes, as well as FXR were significantly downregulated in liver of rats treated with a HFHCD. We concluded that HFHCD-induced hepatic steatosis, together with the reduced expression of FXR, contributed to the downregulation of expression of hepatic transporters and enzymes. The mRNA expression of TNF-α and IL-1β were unaffected. Interestingly, exercise was found to improve the expression levels of some transporters and enzymes.