Volume 135, Issue 3, Pages 840-848.e3 (September 2008) Acute Liver Cell Damage in Patients With Anorexia Nervosa: A Possible Role of Starvation-Induced Hepatocyte Autophagy  Pierre–Emmanuel Rautou, Dominique Cazals–Hatem, Richard Moreau, Claire Francoz, Gérard Feldmann, Didier Lebrec, Éric Ogier– Denis, Pierre Bedossa, Dominique Valla, François Durand  Gastroenterology  Volume 135, Issue 3, Pages 840-848.e3 (September 2008) DOI: 10.1053/j.gastro.2008.05.055 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 Light (A, B) and electron microscopy (C, D, E, F). (A) Diffuse hepatocytic swelling due to a marked glycogen deficit according to the PAS staining (original magnification, ×250). (B) Centrilobular fibrosis and atrophy better identified after reticulin staining (original magnification, ×250; Gordon Sweet stain). (C) Hepatocytes observed by electron microscopy show low density of organelles and absence of glycogen in the cytoplasm (original magnification, ×7500). (D) Partial view of a hepatocyte. Disse space (D) with collagen (C). In the center of the figure, a typical autophagosome (arrows) sequestering cytoplasmic components such as a fragment of mitochondrion (M) and circular membranes (original magnification, ×20,000). (E) Low-magnification image showing a hepatocyte containing numerous mature lysosomes (L) (original magnification, ×3000). N, nucleus. (F) A hepatocyte with features of autophagic cell death, including several autophagosomes (arrows) visible in the cytoplasm, the irregular shape of the nucleus (N), and disorganized chromatin. Note that most mitochondria (m) appear normal (original magnification, ×5000). Gastroenterology 2008 135, 840-848.e3DOI: (10.1053/j.gastro.2008.05.055) Copyright © 2008 AGA Institute Terms and Conditions

Figure 2 Course of AST elevations in 12 patients with anorexia nervosa and acute liver insufficiency. Gastroenterology 2008 135, 840-848.e3DOI: (10.1053/j.gastro.2008.05.055) Copyright © 2008 AGA Institute Terms and Conditions