Displaying publications 81 - 100 of 110 in total

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  1. Lee, W.S.
    JUMMEC, 2010;13(2):72-79.
    MyJurnal
    The liver is an important organ of the human body, playing a major role in the metabolism and storage of nutrients, synthesis of protein and other nutrients, as well as detoxifying many metabolic by-products. The response of the foetal and newborn liver to external insult and injury is limited. This is because the ability of the closely interdependent structures of a developing liver of expressing in the face of a variety of insults is limited as well. Thus most infants with insults to the liver present as cholestatic jaundice with variable degree of pale stools, enlarged liver and conjugated hyperbilirubinaemia. Biliary atresia, an idiopathic condition characterized by progressive fibrosing obliteration of both intra- and extrahepatic bile ducts, is the most important cause of neonatal cholestasis worldwide, including Malaysia. It is also the most important indication for childhood liver transplantation the world over. Challenges facing infants with biliary atresia include a delay in the diagnosis and late surgery, leading to a poor outcome. This often results from a failure to recognise the potential serious nature of an infant with prolonged cholestatic jaundice and pale stools among health care professionals.
    Matched MeSH terms: Bile Ducts, Extrahepatic
  2. Leow, V.M., Faizah, M.S., Yang, K.F., Hasnan, M.N., Manisekar, S.S.
    MyJurnal
    Tuberculous (TB) biliary stricture with calcified liver nodules rendering obstructive jaundice is a rare clinical phenomenon. Recently, we encountered a young patient with obstructive jaundice who was investigated in a general hospital. He was sent to our hospital for subsequent management after undergoing a series of investigations and biliary stenting. The radiological imagings performed revealed multiple calcified lesions in the liver with proximal bile duct strictures. Blood investigations, tumor markers and tuberculous work up were not remarkable. Subsequently, he underwent laparotomy and biliary reconstruction. Postoperatively, he was discharged well. Histopathological examination of the hepatoduodenal nodes showed chronic infections and granulomatous lymphadenitis, suspicious of a mycobacterium infection.
    Matched MeSH terms: Bile Ducts
  3. La N, Leng M, Arunsan P, Pechdee P, Boonsuya A, Thanchonnang C, et al.
    Trop Biomed, 2023 Dec 01;40(4):383-391.
    PMID: 38308824 DOI: 10.47665/tb.40.4.002
    The southeast Asian fluke Opisthorchis viverrini remains endemic, particularly in Thailand, Lao PDR, Cambodia, Vietnam, and Myanmar. However, there is a lack of data on the prevalence of liver fluke infection in Kratie Province in northeastern Cambodia. The present study aimed to detect O. viverrini DNA in fecal specimens by using the internal transcribed spacer 2 (ITS2) region of ribosomal DNA (rDNA) based on polymerase chain reaction (PCR). The prevalence and percentage of O. viverrini infection were described by data analysis. Bivariate binary logistic regression analysis was used to look at the related prevalence of O. viverrini infection. A total of 6.89% from 377 fecal samples were found positive of O. viverrini DNA. The prevalence of O. viverrini infection was found to be higher in men (8.92%) than in women (5.45%), and to be associated more frequently with younger age groups (13.40%), illiteracy (8.74%), participation in other careers (non-specific occupations) (11.63%), and residence in the Trapaing Srae village (9.94%) of the Snuol district, Kratie Province. Age groups under 20 years old were significantly linked with O. viverrini infection, with ORadj=0.601, 95% CI=0.410-0.882, p=0.009 and significant value established at (P<0.05). This study demonstrates that O. viverrini infection is distributed in rural areas located near freshwater reservoirs. Therefore, active surveillance, clinical examination of association with hepatobiliary, cholangiocarcinoma, and health education are needed.
    Matched MeSH terms: Bile Ducts, Intrahepatic
  4. Stepien M, Fedirko V, Duarte-Salles T, Ferrari P, Freisling H, Trepo E, et al.
    Cancer Epidemiol, 2016 Feb;40:179-87.
    PMID: 26773278 DOI: 10.1016/j.canep.2016.01.002
    INTRODUCTION: Serum liver biomarkers (gamma-glutamyl transferase, GGT; alanine aminotransferase, ALT; aspartate aminotransferase, AST; alkaline phosphatase, ALP; total bilirubin) are used as indicators of liver disease, but there is currently little data on their prospective association with risk of hepatobiliary cancers.

    METHODS: A nested-case control study was conducted within the prospective EPIC cohort (>520,000 participants, 10 European countries). After a mean 7.5 mean years of follow-up, 121 hepatocellular carcinoma (HCC), 34 intrahepatic bile duct (IHBC) and 131 gallbladder and biliary tract (GBTC) cases were identified and matched to 2 controls each. Circulating biomarkers were measured in serum taken at recruitment into the cohort, prior to cancer diagnosis. Multivariable adjusted conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95%CI).

    RESULTS: In multivariable models, 1SD increase of each log-transformed biomarker was positively associated with HCC risk (OR(GGT)=4.23, 95%CI:2.72-6.59; OR(ALP)=3.43, 95%CI:2.31-5.10;OR(AST)=3.00, 95%CI:2.04-4.42; OR(ALT)=2.69, 95%CI:1.89-3.84; OR(Bilirubin)=2.25, 95%CI:1.58-3.20). Each liver enzyme (OR(GGT)=4.98; 95%CI:1.75-14.17; OR(AST)=3.10, 95%CI:1.04-9.30; OR(ALT)=2.86, 95%CI:1.26-6.48, OR(ALP)=2.31, 95%CI:1.10-4.86) but not bilirubin (OR(Bilirubin)=1.46,95%CI:0.85-2.51) showed a significant association with IHBC. Only ALP was significantly associated with GBTC risk (OR(ALP)=1.59, 95%CI:1.20-2.09).

    CONCLUSION: This study shows positive associations between circulating liver biomarkers in sera collected prior to cancer diagnoses and the risks of developing HCC or IHBC, but not GBTC.

    Matched MeSH terms: Bile Duct Neoplasms/metabolism; Bile Duct Neoplasms/epidemiology*; Bile Duct Neoplasms/pathology
  5. Tan SN, Sim SP
    BMC Med Genomics, 2019 01 15;12(1):9.
    PMID: 30646906 DOI: 10.1186/s12920-018-0465-4
    BACKGROUND: It has been found that chronic rhinosinusitis (CRS) increases the risk of developing nasopharyngeal carcinoma (NPC). CRS can be caused by gastro-oesophageal reflux (GOR) that may reach nasopharynx. The major component of refluxate, bile acid (BA) has been found to be carcinogenic and genotoxic. BA-induced apoptosis has been associated with various cancers. We have previously demonstrated that BA induced apoptosis and gene cleavages in nasopharyngeal epithelial cells. Chromosomal cleavage occurs at the early stage of both apoptosis and chromosome rearrangement. It was suggested that chromosome breaks tend to cluster in the region containing matrix association region/scaffold attachment region (MAR/SAR). This study hypothesised that BA may cause chromosome breaks at MAR/SAR leading to chromosome aberrations in NPC. This study targeted the AF9 gene located at 9p22 because 9p22 is a deletion hotspot in NPC.

    METHODS: Potential MAR/SAR sites were predicted in the AF9 gene by using MAR/SAR prediction tools. Normal nasopharyngeal epithelial cells (NP69) and NPC cells (TWO4) were treated with BA at neutral and acidic pH. Inverse-PCR (IPCR) was used to identify chromosome breaks in SAR region (contains MAR/SAR) and non-SAR region (does not contain MAR/SAR). To map the chromosomal breakpoints within the AF9 SAR and non-SAR regions, DNA sequencing was performed.

    RESULTS: In the AF9 SAR region, the gene cleavage frequencies of BA-treated NP69 and TWO4 cells were significantly higher than those of untreated control. As for the AF9 non-SAR region, no significant difference in cleavage frequency was detected between untreated and BA-treated cells. A few breakpoints detected in the SAR region were mapped within the AF9 region that was previously reported to translocate with the mixed lineage leukaemia (MLL) gene in an acute lymphoblastic leukaemia (ALL) patient.

    CONCLUSIONS: Our findings suggest that MAR/SAR may be involved in defining the positions of chromosomal breakages induced by BA. Our report here, for the first time, unravelled the relation of these BA-induced chromosomal breakages to the AF9 chromatin structure.

    Matched MeSH terms: Bile Acids and Salts/pharmacology*
  6. Ranjeev P, Goh Kl
    Gastrointest Endosc, 2000 Apr;51(4 Pt 1):504-6.
    PMID: 10744838
    Matched MeSH terms: Common Bile Duct*
  7. Shahrudin MD, Noori SM
    Hepatogastroenterology, 1997 Mar-Apr;44(14):519-21.
    PMID: 9164529
    To review our experience in managing post-hepatorrhaphy complications in liver trauma.
    Matched MeSH terms: Bile*; Biliary Fistula/etiology*; Biliary Fistula/radiography
  8. Chuah SY, Leong CK, Pang CW
    Singapore Med J, 2003 May;44(5):261-7.
    PMID: 13677363
    Opium addicts (OA) with no biliary symptoms have been shown to have dilated common bile duct (CBD). Endoscopic retrograde cholangio-pancreatography (ERCP) without biliary drainage in such asymptomatic OA is hazardous. Hence it is not indicated unless there are clear clinical and laboratory evidences of biliary stasis.
    Matched MeSH terms: Common Bile Duct/pathology*
  9. Karami A, Christianus A, Ishak Z, Syed MA, Courtenay SC
    Ecotoxicol Environ Saf, 2011 Sep;74(6):1558-66.
    PMID: 21636131 DOI: 10.1016/j.ecoenv.2011.05.012
    This study investigated the dose-dependent and time-course effects of intramuscular (i.m.) and intraperitoneal (i.p.) injection of benzo[a]pyrene (BaP) on the biomarkers EROD activity, GST activity, concentrations of BaP metabolites in bile, and visceral fat deposits (Lipid Somatic Index, LSI) in African catfish (Clarias gariepinus). Intraperitoneal injection resulted in 4.5 times higher accumulation of total selected biliary FACs than i.m. injection. Hepatic GST activities were inhibited by BaP via both injection methods. Dose-response relationships between BaP injection and both biliary FAC concentrations and hepatic GST activities were linear in the i.p. injected group but nonlinear in the i.m. injected fish. Hepatic EROD activity and LSI were not significantly affected by BaP exposure by either injection route. We conclude that i.p. is a more effective route of exposure than i.m. for future ecotoxicological studies of PAH exposure in C. gariepinus.
    Matched MeSH terms: Bile/metabolism
  10. Loh KY, Yushak AW
    N Engl J Med, 2007 Jul 19;357(3):282.
    PMID: 17634463 DOI: 10.1056/NEJMicm063871
    Matched MeSH terms: Common Bile Duct Neoplasms/pathology*
  11. Singh GD, Ganjoo M, Youssouf MS, Koul A, Sharma R, Singh S, et al.
    Food Chem Toxicol, 2009 Oct;47(10):2661-5.
    PMID: 19654032 DOI: 10.1016/j.fct.2009.07.031
    Labisia pumila (Myrsinaceae), is a popular herb among the women in Malaysia known locally as "Kacip Fatimah". Recently many nutraceutical products containing the powdered or extracted parts of the plant have become available for women's health care. However no evaluation of the effect of the repeated dosing of any herbal product of this plant had been undertaken prior to a 28-day sub-acute study presented in this report. The results showed that a dose of 50mg/kg of an aqueous extract of L. pumila corresponded to no-adverse-effect-level (NOAEL), whereas higher doses were associated with some toxicity concerns.
    Matched MeSH terms: Bile Ducts, Intrahepatic/drug effects; Bile Ducts, Intrahepatic/pathology
  12. Cheong AM, Jessica Koh JX, Patrick NO, Tan CP, Nyam KL
    J Food Sci, 2018 Mar;83(3):854-863.
    PMID: 29412455 DOI: 10.1111/1750-3841.14038
    This study aimed to evaluate the effect of kenaf seed oil (KSO), kenaf seed oil-in-water macroemulsion (KSOM), kenaf seed oil-in-water nanoemulsions (KSON), and emulsifier mixtures (EM) on serum lipid profile, liver oxidative status, and histopathological changes in high-cholesterol fed rats. Stability and characteristic of KSOM and KSON were carried out prior to in vivo study. Forty-two Sprague-Dawley rats were divided into 7 groups (6 rats each) and induced hypercholesterolemia by feeding high cholesterol diet (HCD) for 14 days prior to treatments. Different treatments were introduced on day 15 to 29 while supplemented with HCD and removal of HCD during treatment on day 30 to 43, except for HCD group. Body weight and serum lipid profiles were measured at 3 different points: after hypercholesterolemia was induced, on day 29, and at the end of the experiment. Relative liver weight, atherogenic index, coronary risk index, and fecal total bile acids were also determined at the end of experiment. KSON showed significantly higher stability than KSOM and FTIR exhibited good encapsulation of KSO after 1.5 years of storage. Serum total cholesterol, low density lipoprotein cholesterol, lipid peroxidation levels in HCD group without treatment were significantly higher compared to normal control group and all treatment groups. All samples demonstrated hypocholesterolemic effect, but KSON exhibited higher efficiency in cholesterol-lowering properties, weight control and decreased liver fat as confirmed by histopathological evaluation. The overall results revealed that the efficacy of different treatments was in descending order of KSON, KSO, KSOM, and EM.

    PRACTICAL APPLICATION: Kenaf seed oil-in-water nanoemulsion (KSON) has the potential to be used as a natural alternative to the synthetic hypocholesterolemic drug in the future. However, larger sample size and clinical trial are needed to confirm on this potential application. In addition, treatment with KSON was suggested to prevent cardiovascular disease and fatty liver.

    Matched MeSH terms: Bile Acids and Salts/metabolism
  13. Ibrahim E, Diakonov I, Arunthavarajah D, Swift T, Goodwin M, McIlvride S, et al.
    Sci Rep, 2018 05 08;8(1):7110.
    PMID: 29740092 DOI: 10.1038/s41598-018-25569-4
    Bile acids are recognised as bioactive signalling molecules. While they are known to influence arrhythmia susceptibility in cholestasis, there is limited knowledge about the underlying mechanisms. To delineate mechanisms underlying fetal heart rhythm disturbances in cholestatic pregnancy, we used FRET microscopy to monitor cAMP release and contraction measurements in isolated rodent neonatal cardiomyocytes. The unconjugated bile acids CDCA, DCA and UDCA and, to a lesser extent, CA were found to be relatively potent agonists for the GPBAR1 (TGR5) receptor and elicit cAMP release, whereas all glyco- and tauro- conjugated bile acids are weak agonists. The bile acid-induced cAMP production does not lead to an increase in contraction rate, and seems to be mediated by the RI isoform of adenylate cyclase, unlike adrenaline-dependent release which is mediated by the RII isoform. In contrast, bile acids elicited slowing of neonatal cardiomyocyte contraction indicating that other signalling pathways are involved. The conjugated bile acids were found to be partial agonists of the muscarinic M2, but not sphingosin-1-phosphate-2, receptors, and act partially through the Gi pathway. Furthermore, the contraction slowing effect of unconjugated bile acids may also relate to cytotoxicity at higher concentrations.
    Matched MeSH terms: Bile Acids and Salts/metabolism*
  14. Lim PS, Loke CF, Ho YW, Tan HY
    J Appl Microbiol, 2020 Nov;129(5):1374-1388.
    PMID: 32356362 DOI: 10.1111/jam.14678
    AIMS: To determine the mechanism underlying the serum cholesterol reduction effect by probiotics isolated from local fermented tapioca (Tapai).

    METHODS AND RESULTS: Lactic acid bacteria strains were isolated and examined for acid tolerance, bile salt resistance and hypocholesterolemic properties. Among the isolates, Lactobacillus plantarum TAR4 showed the highest cholesterol reduction ability (48·01%). The focus in the in vivo trial was to elucidate the cholesterol balance from findings pertaining to serum cholesterol reduction in rat model fed with high fat diet via oral administration. Rats fed with high-cholesterol diet supplemented with Lact. plantarum TAR4 showed significant reduction in serum total cholesterol (29·55%), serum triglyceride (45·31%) and liver triglyceride (23·44%) as compared to high-cholesterol diet (HCD) group. There was a significant increment in faecal triglyceride (45·83%) and faecal total bile acid (384·95%) as compared to HCD group.

    CONCLUSIONS: The findings showed that probiotic Lact. plantarum TAR4 supplementation reduced the absorption of bile acids for enterohepatic recycling and increased the catabolism of cholesterol to bile acids and not by suppressing the rate of cholesterol synthesis.

    SIGNIFICANCE AND IMPACT OF STUDY: Probiotic supplements could provide a new nonpharmacological alternative to reduce cardiovascular risk factors.

    Matched MeSH terms: Bile Acids and Salts/metabolism
  15. Vasavan T, Ferraro E, Ibrahim E, Dixon P, Gorelik J, Williamson C
    Biochim Biophys Acta Mol Basis Dis, 2018 04;1864(4 Pt B):1345-1355.
    PMID: 29317337 DOI: 10.1016/j.bbadis.2017.12.039
    Cardiac dysfunction has an increased prevalence in diseases complicated by liver cirrhosis such as primary biliary cholangitis and primary sclerosing cholangitis. This observation has led to research into the association between abnormalities in bile acid metabolism and cardiac pathology. Approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy. Bile acids are directly implicated in this, causing QT interval prolongation, cardiac hypertrophy, cardiomyocyte apoptosis and abnormal haemodynamics of the heart. Elevated maternal serum bile acids in intrahepatic cholestasis of pregnancy, a disorder which causes an impaired feto-maternal bile acid gradient, have been associated with fatal fetal arrhythmias. The hydrophobicity of individual bile acids in the serum bile acid pool is of relevance, with relatively lipophilic bile acids having a more harmful effect on the heart. Ursodeoxycholic acid can reverse or protect against these detrimental cardiac effects of elevated bile acids.
    Matched MeSH terms: Bile Acids and Salts/blood; Bile Acids and Salts/metabolism*; Bile Acids and Salts/chemistry
  16. Yiew, X.T., Leong, Z.P., Rahman, N., Watanabe, M., Noordin, M.M., Khor, K.H.
    Jurnal Veterinar Malaysia, 2016;28(1):7-11.
    MyJurnal
    A 5-month-old Siamese cross kitten was presented with jaundice and a palpable abdominal mass at the right cranial quadrant. The extra-hepatic biliary system was markedly distended upon abdominal ultrasonography. Complete bile duct obstruction was ruled out due to the presence of urobilinogen, light brown stool, and consistentlynormal alkaline phosphatase (ALP) levels. Head tremors developed on the second day of hospitalization. Tentative diagnoses of congenital biliary anomaly and hepatic encephalopathy werederived and exploratory laparotomy revealed a severely distended and tortuous bile duct indistinguishable from the gallbladder with negative duodenal filling. Modified cholechoduodenostomy was performed however the kitten did not recover from general anaesthesia. Secondary cholangiohepatitis and hepatic encephalopathy were confirmed upon histopathologic examination.Primary congenital biliary atresia or choledochal cyst with secondary cholangiohepatitis was suspected. Biliary anomalies are rare in cats with only two cases reported in the literature. These conditions are often challenging to diagnose and due to the limited treatment options, have a poor prognosis.
    Matched MeSH terms: Bile Ducts
  17. Choo, Sulin, Chew, Boon How, Amilia Afzan Mohd. Jamil, Chew, Shu Yih, Hadiza Umar Meleh, Leslie Than Thian Lung
    MyJurnal
    Lactobacilli are well-documented probiotics that exert health benefits on their host. They exhibit characteristics that make them potential alternative treatments to address the antimicrobial resistance conundrum and diseases. Their mechanism of action varies with strain and species. Five lactobacilli strains previously isolated from the anogenital region were subjected to several assessments highlighted in the FAO/WHO document, ‘Guidelines for the Evaluation of Probiotics in Food’ to determine its suitability as potential probiotics. Methods: The five lactobacilli strains were subcultured onto Man de Rogosa agar (MRS). Their ability to auto- and co-aggregate was determined spectrophotometrically. Simultaneously, the cell surface hydrophobic properties of these strains towards xylene and toluene were evaluated using the microbial adhesion to hydrocarbon (MATH) test. The lactobacilli strains were also tested for their ability to withstand acid, bile and spermicide to determine their level of tolerance. Results: Lact. reuteri 29A, L. delbrueckii 45E and L. reuteri 29B exhibited the highest degree of auto- and co-aggregation properties. These lactobacilli strains also demonstrated high cell surface hydrophobicity, with the exception of L. delbrueckii 45E. Further tests to evaluate the isolated lactobacilli tolerance identified L. reuteri 29B as the most tolerant strain towards low pH (pH 2.5 for 4 h), high bile concentration (0.5% for 4 h) and high spermicides concentration (up to 10%). Conclusion: Out of the five lactobacilli strains which possessed high antimicrobial activities, L. reuteri 29B portrayed the best probiotic qualities with good auto- and co-aggregation abilities and high tolerance against acid, bile and spermicide.
    Matched MeSH terms: Bile
  18. Nelbon Giloi, Liew, Constance Sat Lin, Payus, Alvin Oliver, Mac Guad, Rhanye, Murugaiah, Chandrika, Soe, May Zaw, et al.
    MyJurnal
    As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.
    Matched MeSH terms: Common Bile Duct
  19. Ghassem, M., Babji, A. S., Forsythe, S. J.
    MyJurnal
    Cronobacter sakazakii is an emerging food borne pathogen which has been associated with outbreaks of a rare form of infant meningitis. Although the origin of the microorganism has not been established, several
    infection cases have been associated with the consumption of contaminated powdered infant formula (PIF). In the present study, growth characteristics of three C. sakazakii strains isolated from PIF samples and C.
    muytjensii strain ATCC 51329, which was formerly the ATCC Preceptrol™ strain for the quality control of
    ‘Enterobacter sakazakii’ prior to the taxonomic revision, were investigated in Tryptone Soya broth (TSB) and
    reconstituted PIF at 4, 10, 25, 37, 45 and 50ºC. The viability of heat treated cells of Cronobacter strains was
    evaluated by plating on Violet Red Bile Glucose agar (VRBGA) and the Druggan-Forsythe-Iversen (DFI)
    chromogenic agar followed by incubation at 37ºC. These strains were also subjected to higher temperatures
    between 52 to 60ºC to measure their thermal tolerance. The mean generation time of all Cronobacter strains
    were slightly lower in PIF than in TSB. C. muytjensii ATCC 51329 showed lower generation time in all culture
    media and all temperatures compared to the Cronobacter food isolates, but the results were not significantly
    different (P>0.05). The results also indicated that combination of PIF: DFI culture media had higher recovery at
    all temperatures compared to other combinations. Survival study also indicated that C. muytjensii ATCC 51329
    had higher D-value compared to food isolates at all incubation temperatures.
    Matched MeSH terms: Bile
  20. Noor Alicezah Mohd Kasim, Chua Yung An, Hapizah Nawawi
    MyJurnal
    Familial hypercholesterolaemia (FH), the commonest and serious but potentially treatable
    form of inherited dyslipidaemias, is characterised by severely elevated plasma low-density
    lipoprotein-cholesterol (LDL-C) level, which subsequently leads to premature coronary artery
    disease (pCAD). Effectiveness of FH early detection and treatment is supported by the
    outcome of several international cohort studies. Optimal FH management relies on
    prescription of statins either alone or together with other lipid-lowering therapies (LLT).
    Intensive lifestyle intervention is required in parallel with LLT, which should be commenced at
    diagnosis in adults and childhood. Treatment with high intensity statin should be started as
    soon as possible. Combination with ezetimibe and/or bile acid sequestrants is indicated if
    target LDL-C is not achieved. For FH patients in the very-high risk category, if their LDL-C
    targets are not achieved, despite being on maximally tolerated statin dose and ezetimibe,
    proprotein convertase subtilisin/kexin type1 inhibitor (PCSK9i) is recommended. In statin
    intolerance, ezetimibe alone, or in combination with PCSK9i may be considered. Clinical
    evaluation of response to treatment and safety are recommended to be done about 4-6 weeks
    following initiation of treatment. Homozygous FH (HoFH) patients should be treated with
    maximally tolerated intensive LLT and, when available, with lipoprotein apheresis. This review
    highlights the overall management, and optimal treatment combinations in FH in adults and
    children, newer LLT including PCSK9i, microsomal transfer protein inhibitor, allele-specific
    oligonucleotide to ApoB100 and PCSK9 mRNA. Family cascade screening and/or screening
    of high-risk individuals, is the most cost-effective way of identifying FH cases and initiating
    early and adequate LLT.
    Matched MeSH terms: Bile Acids and Salts
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