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. 2020 Mar 26;70(1):157–169. doi: 10.1136/gutjnl-2019-318918

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Risk for hepatocellular carcinoma (HCC) development and prognostic liver signature (PLS) expression in patients with advanced liver disease. (A) The probabilities of future hepatocarcinogenesis and overall survival according to the presence of the epigenetic dysregulation. The dysregulation was significantly associated with future HCC development and mortality in patients with HCV-related early stage cirrhosis. (B) The prevalence of the presence of the epigenetic dysregulation in patients with non-alcoholic steatohepatitis (NASH). The dysregulation was more frequently observed in patients with advanced fibrosis, one of the well-known HCC risks, compared with those with mild fibrosis. (C) The probabilities of future hepatocarcinogenesis and overall survival according to the presence of dysregulation of a gene subset termed the ‘prognostic epigenetic signature’ (PES). (D) The prevalence of the presence of the epigenetic dysregulation in patients with NASH. The PES, including 25 genes, showed better or similar capability to identify patients with higher HCC risk compared with the full signature. The PES was defined as commonly prognostic genes in both HCV and NASH (FDR<0.25). (E) Heatmap of the 186-gene PLS including modulation of the HCC high-risk (top) and low-risk (bottom) genes based on patient-liver transcriptome (left panel) and epigenome (right panel). Expression and H3K27ac changes of the gene members of the PLS in NASH, chronic hepatitis C (CHC) and DAA/HCC-cured compared with control patient livers measured using the RNA-Seq and ChIP-Seq experiments shown in figure 1A. (F) H3K27ac modifications correlate (Spearman’s rank correlation coefficients and p values) with transcriptomic changes of gene members of the PLS in patients with NASH (left panel) or CHC (right panel).