Title: The liver steatosis severity and lipid characteristics in primary biliary cholangitis
Version: 0 Date: 09 Jul 2021
Reviewer's report:
The manuscript submitted by Zhang et al claims to have discussed the use of controlled
attenuation parameter( CAP) as a tool to study steatosis in primary biliary cholangitis (PBC)
patients. The authors present this study in retrospection of the samples collected from the 387 so
patients and measured the different liver marker enzymes to confirm the disease phenotype. They
also performed multivariate analysis for predictors of CAP. Even though the study is claimed
and presented as a novel retrospective analysis of patient samples, it has some concerns that
need to be addressed before it is considered for publication.
1. CAP has been established and published as a non-invasive technique to evaluate steatosis in
NAFLD and autoimmune liver disease previously. Thus this study cannot be claimed as novel
as mentioned in the discussion section by the authors.
2. The explanation provided in support of the experimental data that shows a decrease in hepatic
steatosis is ambiguous. In the introduction and providing the rationale for the study, the authors
claim that PBC is presented with a high risk of atherosclerosis and other cardiovascular events,
however, the data obtained is strikingly opposite to what has set the rationale for the study. The
authors need to revise the discussion section beyond the present data.
3. Since dyslipidemia has been mentioned as a comorbidity of PBC, did the authors consider
looking into the expression of fatty acid metabolism gene expression in the patient samples
collected.
4. Even though predominantly used for grading NAFLD, did the authors consider verifying the
experimental data with NAS score grading for validating the finding obtained by CAP analysis.
5. Since patient biopsy samples were available, did the authors consider performing experiments
that will reveal details about hepatic lipid peroxidation,  fatty acid transport, storage which might
provide a valuable explanation of the results obtained by CAP analysis.
Title: The liver steatosis severity and lipid characteristics in primary biliary cholangitis
Version: 0 Date: 09 Jul 2021
Reviewer's report:
The manuscript submitted by Zhang et al claims to have discussed the use of controlled
attenuation parameter( CAP) as a tool to study steatosis in primary biliary cholangitis (PBC)
patients. The authors present this study in retrospection of the samples collected from the 387 so
patients and measured the different liver marker enzymes to confirm the disease phenotype. They
also performed multivariate analysis for predictors of CAP. Even though the study is claimed
and presented as a novel retrospective analysis of patient samples, it has some concerns that
need to be addressed before it is considered for publication.
1. CAP has been established and published as a non-invasive technique to evaluate steatosis in
NAFLD and autoimmune liver disease previously. Thus this study cannot be claimed as novel
as mentioned in the discussion section by the authors.
2. The explanation provided in support of the experimental data that shows a decrease in hepatic
steatosis is ambiguous. In the introduction and providing the rationale for the study, the authors
claim that PBC is presented with a high risk of atherosclerosis and other cardiovascular events,
however, the data obtained is strikingly opposite to what has set the rationale for the study. The
authors need to revise the discussion section beyond the present data.
3. Since dyslipidemia has been mentioned as a comorbidity of PBC, did the authors consider
looking into the expression of fatty acid metabolism gene expression in the patient samples
collected.
4. Even though predominantly used for grading NAFLD, did the authors consider verifying the
experimental data with NAS score grading for validating the finding obtained by CAP analysis.
5. Since patient biopsy samples were available, did the authors consider performing experiments
that will reveal details about hepatic lipid peroxidation,  fatty acid transport, storage which might
provide a valuable explanation of the results obtained by CAP analysis.
Please review this paper.
user
Title: The liver steatosis severity and lipid characteristics in primary biliary cholangitis
Version: 0 Date: 09 Jul 2021
Reviewer's report:
The manuscript submitted by Zhang et al claims to have discussed the use of controlled
attenuation parameter( CAP) as a tool to study steatosis in primary biliary cholangitis (PBC)
patients. The authors present this study in retrospection of the samples collected from the 387 so
patients and measured the different liver marker enzymes to confirm the disease phenotype. They
also performed multivariate analysis for predictors of CAP. Even though the study is claimed
and presented as a novel retrospective analysis of patient samples, it has some concerns that
need to be addressed before it is considered for publication.
1. CAP has been established and published as a non-invasive technique to evaluate steatosis in
NAFLD and autoimmune liver disease previously. Thus this study cannot be claimed as novel
as mentioned in the discussion section by the authors.
2. The explanation provided in support of the experimental data that shows a decrease in hepatic
steatosis is ambiguous. In the introduction and providing the rationale for the study, the authors
claim that PBC is presented with a high risk of atherosclerosis and other cardiovascular events,
however, the data obtained is strikingly opposite to what has set the rationale for the study. The
authors need to revise the discussion section beyond the present data.
3. Since dyslipidemia has been mentioned as a comorbidity of PBC, did the authors consider
looking into the expression of fatty acid metabolism gene expression in the patient samples
collected.
4. Even though predominantly used for grading NAFLD, did the authors consider verifying the
experimental data with NAS score grading for validating the finding obtained by CAP analysis.
5. Since patient biopsy samples were available, did the authors consider performing experiments
that will reveal details about hepatic lipid peroxidation,  fatty acid transport, storage which might
provide a valuable explanation of the results obtained by CAP analysis.
assistant