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Zhou X, Rong Q, Xu M, Zhang Y, Dong Q, Xiao Y, Liu Q, Chen H, Yang X, Yu K, Li Y, Zhao L, Ye G, Shi F, Lv C. Safety pharmacology and subchronic toxicity of jinqing granules in rats. BMC Vet Res 2017. [PMID: 28623915 PMCID: PMC5474005 DOI: 10.1186/s12917-017-1095-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Jinqing granules which are made of a mixture extract that contains Radix Tinosporae and Canarii fructus in proportions according to a longstanding formula have a good effect on the prevention and treatment of gastric ulcer disease. It has not been through safety through systematic toxicological studies, however. To provide basis for clinical application, we performed safety pharmacology and subchronic toxicity experiments in specific pathogen-free Sprague-Dawley rats. Results In safety pharmacology experiments, Jinqing granules had no evident adverse effects on the central nervous, cardiovascular, or respiratory systems. In subchronic toxicity study, 2–8 g/kg of Jinqing granules induced no evident adverse effects on Clinical signs, body weight changes, food and water intake, death daily, indicators of urine, hematological assay, serum biochemistry, organ coefficient and histopathological examination. However, the 16 g/kg dose was associated with slightly slowed weight growth, decreased number of sperm in seminiferous tubules and increased values of serum aspartate aminotransferase and bilirubin. During the 30-day feeding test, 3 rats that received the 16 g/kg dose died, but the deaths were most likely due to trauma of oral gavage, not to drug toxicity. Conclusion Jinqing granules given to Sprague-Dawley rats orally for 30 days at a dose of 8 g/kg or less appears safe, but higher doses were not proven safe. The significance of these observations with respect to animal usage of Jinqing granules deserves thorough investigation.
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Affiliation(s)
| | | | - Min Xu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Yuanli Zhang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Qi Dong
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Yuanling Xiao
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Qiji Liu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Helin Chen
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Xiaoyu Yang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Kaisheng Yu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Yinglun Li
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China.
| | - Ling Zhao
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Gang Ye
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Fei Shi
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
| | - Cheng Lv
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, 611130, People's Republic of China
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Nägele V, Kratzer A, Zugmaier G, Holland C, Hijazi Y, Topp MS, Gökbuget N, Baeuerle PA, Kufer P, Wolf A, Klinger M. Changes in clinical laboratory parameters and pharmacodynamic markers in response to blinatumomab treatment of patients with relapsed/refractory ALL. Exp Hematol Oncol 2017; 6:14. [PMID: 28533941 PMCID: PMC5437652 DOI: 10.1186/s40164-017-0074-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/02/2017] [Indexed: 12/24/2022] Open
Abstract
Background Blinatumomab has shown a remission rate of 69% in an exploratory single-arm, phase II dose-escalation study in adult patients with relapsed/refractory B-precursor acute lymphoblastic leukemia (ALL). We evaluated changes in laboratory parameters and immunopharmacodynamic markers in patients who received blinatumomab in the exploratory phase II study. Methods Data from 36 adults with relapsed/refractory ALL receiving blinatumomab as 4-week continuous IV infusions in various dose cohorts were analyzed for changes in liver enzymes, first-dose parameters, peripheral blood cell subpopulations, and cytokine/granzyme B release. Associations with clinical response were evaluated. Results Liver enzymes and inflammatory parameters transiently increased primarily during the first treatment week without clinical symptoms and reversed to baseline levels thereafter. B and T cells showed expected depletion and redistribution kinetics, respectively. Similarly, thrombocytes and T cells displayed an initial decline in cell counts, whereas neutrophils peaked during the first days after infusion start. T-cell redistribution coincided with upregulation of LFA-1 and CD69. Patients who responded to blinatumomab had more pronounced T-cell expansion, which was associated with proliferation of CD4+ and CD8+ T cells and memory subsets. Release of cytokines and granzyme B primarily occurred during the first week of cycle 1, except for IL-10, which was released in subsequent cycles. Blinatumomab step-dosing was associated with lower cytokine release and lower body temperature. Conclusions In this study of relapsed/refractory ALL, blinatumomab-induced changes in laboratory parameters were transient and reversible. The evaluated PD markers demonstrated blinatumomab activity, and the analysis of cytokines supported the rationale for stepwise dosing. (ClinicalTrials.gov Identifier NCT01209286.) Electronic supplementary material The online version of this article (doi:10.1186/s40164-017-0074-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginie Nägele
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Andrea Kratzer
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Gerhard Zugmaier
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | | | - Youssef Hijazi
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Nicola Gökbuget
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Patrick A Baeuerle
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Peter Kufer
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Andreas Wolf
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Matthias Klinger
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
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153
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Khosla A, Xi Y, Toomay S. Predicting Success in Percutaneous Transhepatic Biliary Drainage. Cardiovasc Intervent Radiol 2017; 40:1586-1592. [DOI: 10.1007/s00270-017-1679-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/28/2017] [Indexed: 12/12/2022]
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154
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Yu YC, Mao YM, Chen CW, Chen JJ, Chen J, Cong WM, Ding Y, Duan ZP, Fu QC, Guo XY, Hu P, Hu XQ, Jia JD, Lai RT, Li DL, Liu YX, Lu LG, Ma SW, Ma X, Nan YM, Ren H, Shen T, Wang H, Wang JY, Wang TL, Wang XJ, Wei L, Xie Q, Xie W, Yang CQ, Yang DL, Yu YY, Zeng MD, Zhang L, Zhao XY, Zhuang H. CSH guidelines for the diagnosis and treatment of drug-induced liver injury. Hepatol Int 2017; 11:221-241. [PMID: 28405790 PMCID: PMC5419998 DOI: 10.1007/s12072-017-9793-2] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/14/2017] [Indexed: 02/07/2023]
Abstract
Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.
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Affiliation(s)
- Yue-Cheng Yu
- Liver Disease Center of PLA, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, 210002, China
| | - Yi-Min Mao
- Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China.
| | - Cheng-Wei Chen
- Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China.
| | - Jin-Jun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jun Chen
- Liver Diseases Center, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Wen-Ming Cong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 201805, China
| | - Yang Ding
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Zhong-Ping Duan
- Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Qing-Chun Fu
- Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China
| | - Xiao-Yan Guo
- Department of Gastroenterology, Second Affiliated Hospital, Xi'an Jiaotong University, Xian, 710004, China
| | - Peng Hu
- Department of Infectious Diseases, Institute for Viral Hepatitis, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Xi-Qi Hu
- Department of Pathology, School of Medicine, Fudan University, Shanghai, 200433, China
| | - Ji-Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, 100069, China
| | - Rong-Tao Lai
- Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Dong-Liang Li
- Department of Hepatobiliary Disease, Fuzhou General Hospital of PLA, Fuzhou, 350025, China
| | - Ying-Xia Liu
- Department of Liver Disease, Shenzhen Third People's Hospital, Shenzhen, 518040, China
| | - Lun-Gen Lu
- Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Shi-Wu Ma
- Department of Infectious Diseases, Kunming General Hospital of PLA, Kunming, 650032, China
| | - Xiong Ma
- Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Yue-Min Nan
- Department of Traditional and Western Medical Hepatology, Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, 050051, China
| | - Hong Ren
- Department of Infectious Diseases, Institute for Viral Hepatitis, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Tao Shen
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Beijing University, Beijing, 100083, China
| | - Hao Wang
- Institute of Hepatology, People's Hospital, Beijing University, Beijing, 100044, China
| | - Ji-Yao Wang
- Department of Gastroenterology, Zhongshan Hospital, School of Medicine, Fudan University, Shanghai, 200032, China
| | - Tai-Ling Wang
- Department of Pathology, China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiao-Jin Wang
- Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China
| | - Lai Wei
- Institute of Hepatology, People's Hospital, Beijing University, Beijing, 100044, China
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100011, China
| | - Chang-Qing Yang
- Department of Gastroenterology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065c, China
| | - Dong-Liang Yang
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan-Yan Yu
- Department of Infectious Disease, Beijing University First Hospital, Beijing, 100034, China
| | - Min-de Zeng
- Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Li Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078c, China
| | - Xin-Yan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, 100069, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Beijing University, Beijing, 100083, China
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Bautista W, Lipschitz J, McKay A, Minuk GY. Cancer Stem Cells are Depolarized Relative to Normal Stem Cells Derived from Human Livers. Ann Hepatol 2017; 16:297-303. [PMID: 28233753 DOI: 10.5604/16652681.1231590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM The inability to distinguish cancer (CSCs) from normal stem cells (NSCs) has hindered attempts to identify safer, more effective therapies for hepatocellular carcinoma (HCC). The aim of this study was to document and compare cell membrane potential differences (PDs) of CSCs and NSCs derived from human HCC and healthy livers respectively and determine whether altered GABAergic innervation could explain the differences. MATERIAL AND METHODS Epithelial cell adhesion molecule (EpCAM) positive stem cells were isolated from human liver tissues by magnetic bead separations. Cellular PDs were recorded by microelectrode impalement of freshly isolated cells. GABAA receptor subunit expression was documented by reverse transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence. RESULTS CSCs were significantly depolarized (-7.0 ± 1.3 mV) relative to NSCs (-23.0 ± 1.4 mV, p < 0.01). The depolarized state was associated with different GABAA receptor subunit expression profiles wherein phasic transmission, represented by GAGAA α3 subunit expression, was prevalent in CSCs while tonic transmission, represented by GABAA α6 subunit expression, prevailed in NSCs. In addition, GABAA subunits α3, β3, ϒ3 and δ were strongly expressed in CSCs while GABAA π expression was dominant in NSCs. CSCs and NSCs responded similarly to GABAA receptor agonists (ΔPD: 12.5 ± 1.2 mV and 11.0 ± 3.5 mV respectively). CONCLUSION The results of this study indicate that CSCs are significantly depolarized relative to NSCs and these differences are associated with differences in GABAA receptor subunit expression. Together they provide new insights into the pathogenesis and possible treatment of human HCC.
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Affiliation(s)
| | - Jeremy Lipschitz
- Department of Surgery, ***Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew McKay
- Department of Surgery, ***Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
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156
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Zhang MM, Gao Y, Zheng YY, Chen Y, Liu F, Ma YT, Xie X. Association of Fasting Serum Bilirubin Levels with Clinical Outcomes After Percutaneous Coronary Intervention: A Prospective Study. Cardiovasc Toxicol 2017; 17:471-477. [DOI: 10.1007/s12012-017-9405-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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157
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Lee MR, Lim YH, Lee BE, Hong YC. Blood mercury concentrations are associated with decline in liver function in an elderly population: a panel study. Environ Health 2017; 16:17. [PMID: 28257627 PMCID: PMC5336614 DOI: 10.1186/s12940-017-0228-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Mercury is a toxic heavy metal and is known to affect many diseases. However, few studies have examined the effects of mercury exposure on liver function in the general population. We examined the association between blood mercury concentrations and liver enzyme levels in the elderly. METHODS We included 560 elderly participants (60 years or older) who were recruited from 2008 to 2010 and followed up to 2014. Subjects visited a community welfare center and underwent a medical examination and measurement of mercury levels up to five times. Analyses using generalized estimating equations model were performed after adjusting for age, sex, education, overweight, alcohol consumption, smoking, regular exercise, high-density lipoproteins cholesterol, and total calorie intake. Additionally, we estimated interaction effects of alcohol consumption with mercury and mediation effect of oxidative stress in the relationship between mercury levels and liver function. RESULTS The geometric mean (95% confidence interval (CI)) of blood mercury concentrations was 2.81 μg/L (2.73, 2.89). Significant relationships were observed between blood mercury concentrations and the level of liver enzymes, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT), after adjusting for potential confounders (P < 0.05). The odds ratios of having abnormal ALT levels were statistically significant in the highest mercury quartile compared to those with the lowest quartile. Particularly, regular alcohol drinkers showed greater effect estimates of mercury on the liver function than non-drinkers groups. There was no mediation effect of oxidative stress in the relationship between blood mercury concentrations and liver function. CONCLUSIONS Our results suggest that blood mercury levels are associated with elevated liver enzymes and interact with alcohol consumption for the association in the elderly.
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Affiliation(s)
- Mee-Ri Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn-Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo-Eun Lee
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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158
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Tapper EB, Herzig SJ. Nondirected Testing for Inpatients With Severe Liver Injury. J Hosp Med 2017; 12:184-187. [PMID: 28272597 DOI: 10.12788/jhm.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Shoshana J Herzig
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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159
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Higuchi Y, Kubo T, Mitsuhashi T, Nakamura N, Yokota I, Komiyama O, Kamimaki I, Yamamoto S, Uchida Y, Watanabe K, Yamashita H, Tanaka S, Iguchi K, Ichimi R, Miyagawa S, Takayanagi T, Koga H, Shukuya A, Saito A, Horibe K. Clinical Epidemiology and Treatment of Febrile and Afebrile Convulsions With Mild Gastroenteritis: A Multicenter Study. Pediatr Neurol 2017; 67:78-84. [PMID: 28094168 DOI: 10.1016/j.pediatrneurol.2016.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/05/2016] [Accepted: 05/21/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND We investigated features and responses to treatment in patients with febrile and afebrile convulsions with mild gastroenteritis and characterized convulsions with rotavirus and norovirus gastroenteritis. METHODS We conducted a prospective, observational study to evaluate patients with febrile and afebrile convulsions with mild gastroenteritis who were hospitalized between November 2011 and March 2014 at 13 facilities in the National Hospital Organization. We classified the patients into two groups: presence or absence of fever. We investigated the background, clinical and laboratory characteristics, viral antigen in stool, and efficacy of anticonvulsant drugs. RESULTS Of 126 patients enrolled in this study, 50 were febrile (Fc group) and 76 were afebrile (aFc group). A family history of febrile seizures was significantly more frequent in the Fc group than in the aFc group (28.0% vs 9.2%, P = 0.005). Clinical characteristics were similar between the rotavirus and norovirus groups, but fever was significantly more frequent in the rotavirus group (46.2% vs 8.3%, P < 0.001). Serum sodium levels were significantly negatively related to the number of seizures in the aFc group (β = -0.13; 95% confidence interval, -0.24, -0.03; P = 0.01). Carbamazepine was significantly more efficacious than diazepam suppositories in the aFc group (odds ratio = 49.3, 95% confidence interval, 2.35, 1037; P = 0.01). CONCLUSION Febrile convulsions with mild gastroenteritis show characteristics of both febrile seizures and convulsions with mild gastroenteritis. Carbamazepine is optimal for convulsions with mild gastroenteritis. Clinical features of convulsions with rotavirus and norovirus gastroenteritis are similar, except for fever. Serum sodium levels may play a major role in the onset of convulsions with mild gastroenteritis.
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Affiliation(s)
- Yousuke Higuchi
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan; Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Okayama, Japan
| | - Toshihide Kubo
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan.
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Naoko Nakamura
- Department of Pediatrics, National Hospital Organization Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
| | - Ichiro Yokota
- Department of Pediatrics, National Hospital Organization Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
| | - Osamu Komiyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Isamu Kamimaki
- Department of Pediatrics, Saitama National Hospital, Wako, Saitama, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan
| | - Yasushi Uchida
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Gifu, Japan
| | - Kyoko Watanabe
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Fukuoka, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Fukuoka, Japan
| | - Shigeki Tanaka
- Department of Pediatrics, National Hospital Organization Miechuo Medical Center, Tsu, Mie, Japan
| | - Kosei Iguchi
- Department of Pediatrics, Mie National Hospital, Tsu, Mie, Japan
| | - Ryouji Ichimi
- Department of Pediatrics, Mie National Hospital, Tsu, Mie, Japan
| | - Shinichiro Miyagawa
- Department of Pediatrics, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Toshimitsu Takayanagi
- Department of Pediatrics, National Hospital Organization Saga National Hospital, Saga, Saga, Japan
| | - Hiroshi Koga
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, Beppu, Oita, Japan
| | - Akinori Shukuya
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Akiko Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya Clinical Research Center, Nagoya, Aichi, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya Clinical Research Center, Nagoya, Aichi, Japan
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160
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Extensive testing or focused testing of patients with elevated liver enzymes. J Hepatol 2017; 66:313-319. [PMID: 27717864 DOI: 10.1016/j.jhep.2016.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Many patients have elevated serum aminotransferases reflecting many underlying conditions, both common and rare. Clinicians generally apply one of two evaluative strategies: testing for all diseases at once (extensive) or just common diseases first (focused). METHODS We simulated the evaluation of 10,000 adult outpatients with elevated with alanine aminotransferase to compare both testing strategies. Model inputs employed population-based data from the US (National Health and Nutrition Examination Survey) and Britain (Birmingham and Lambeth Liver Evaluation Testing Strategies). Patients were followed until a diagnosis was provided or a diagnostic liver biopsy was considered. The primary outcome was US dollars per diagnosis. Secondary outcomes included doctor visits per diagnosis, false-positives per diagnosis and confirmatory liver biopsies ordered. RESULTS The extensive testing strategy required the lowest monetary cost, yielding diagnoses for 54% of patients at $448/patient compared to 53% for $502 under the focused strategy. The extensive strategy also required fewer doctor visits (1.35 vs. 1.61 visits/patient). However, the focused strategy generated fewer false-positives (0.1 vs. 0.19/patient) and more biopsies (0.04 vs. 0.08/patient). Focused testing becomes the most cost-effective strategy when accounting for pre-test probabilities and prior evaluations performed. This includes when the respective prevalence of alcoholic, non-alcoholic and drug-induced liver disease exceeds 51.1%, 53.0% and 13.0%. Focused testing is also the most cost-effective strategy in the referral setting where assessments for viral hepatitis, alcoholic and non-alcoholic fatty liver disease have already been performed. CONCLUSIONS Testing for elevated liver enzymes should be deliberate and focused to account for pre-test probabilities if possible. LAY SUMMARY Many patients have elevated liver enzymes reflecting one of many possible liver diseases, some of which are very common and some of which are rare. Tests are widely available for most causes but it is unclear whether clinicians should order them all at once or direct testing based on how likely a given disease may be given the patient's history and physical exam. The tradeoffs of both approaches involve the money spent on testing, number of office visits needed, and false positive results generated. This study shows that if there are no clues available at the time of evaluation, testing all at once saves time and money while causing more false positives. However, if there are strong clues regarding the likelihood of a particular disease, limited testing saves time, money and prevents false positives.
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161
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Gurney M, Cotter TG, Wittich CM. 28-Year-Old Woman With Malaise, Cough, Myalgia, and Dark Urine. Mayo Clin Proc 2017; 92:e1-e5. [PMID: 28062066 DOI: 10.1016/j.mayocp.2016.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Mark Gurney
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Thomas G Cotter
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Christopher M Wittich
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017; 112:18-35. [PMID: 27995906 DOI: 10.1038/ajg.2016.517] [Citation(s) in RCA: 600] [Impact Index Per Article: 85.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/01/2016] [Indexed: 02/06/2023]
Abstract
Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepatocellular injury is defined as disproportionate elevation of AST and ALT levels compared with alkaline phosphatase levels. Cholestatic injury is defined as disproportionate elevation of alkaline phosphatase level as compared with AST and ALT levels. The majority of bilirubin circulates as unconjugated bilirubin and an elevated conjugated bilirubin implies hepatocellular disease or cholestasis. Multiple studies have demonstrated that the presence of an elevated ALT has been associated with increased liver-related mortality. A true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females and levels above this should be assessed. The degree of elevation of ALT and or AST in the clinical setting helps guide the evaluation. The evaluation of hepatocellular injury includes testing for viral hepatitis A, B, and C, assessment for nonalcoholic fatty liver disease and alcoholic liver disease, screening for hereditary hemochromatosis, autoimmune hepatitis, Wilson's disease, and alpha-1 antitrypsin deficiency. In addition, a history of prescribed and over-the-counter medicines should be sought. For the evaluation of an alkaline phosphatase elevation determined to be of hepatic origin, testing for primary biliary cholangitis and primary sclerosing cholangitis should be undertaken. Total bilirubin elevation can occur in either cholestatic or hepatocellular diseases. Elevated total serum bilirubin levels should be fractionated to direct and indirect bilirubin fractions and an elevated serum conjugated bilirubin implies hepatocellular disease or biliary obstruction in most settings. A liver biopsy may be considered when serologic testing and imaging fails to elucidate a diagnosis, to stage a condition, or when multiple diagnoses are possible.
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Ko SH, Baeg MK, Han KD, Ko SY, Shin SB, Ko SH, Ahn YB. Association between gamma-glutamyltransferase and albuminuria in nondiabetic adults with normal renal function. Clin Exp Nephrol 2016; 21:835-841. [PMID: 27933415 DOI: 10.1007/s10157-016-1356-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/01/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Serum gamma-glutamyltransferase (GGT) has been associated with albuminuria in diabetes patients, but it has not been investigated in the general population. We aimed to investigate the association between serum GGT and albuminuria in the nondiabetic Korean population with normal kidney function. METHODS Study participants (3948; 1549 men and 2399 women) with an estimated glomerular filtration rate ≥60 mL/min/1.73 m2 were analyzed from the fifth Korean National Health and Nutrition Examination Survey (2011). Albuminuria was defined as an albumin-creatinine ratio >30 mg/g. Serum GGT was analyzed by dividing into quartiles. Multiple logistic models were used to analyze the associations between GGT and albuminuria. RESULTS The prevalence of albuminuria was 5.1% and increased linearly according to increasing GGT quartiles (P for trend = 0.005). A linear regression analysis revealed that GGT was positively related with albuminuria (P = 0.008). After adjusting for confounding factors, the odds ratio for albuminuria was 1.80 (95% CI 1.079-3.010, P for trend = 0.029) for the highest quartile group compared with those observed in the lowest quartile of GGT. In addition, this independent relationship did not change when the cut-off value of GGT (30 IU/L) was applied to this analysis. Compared with GGT value ≤30 IU/L, the adjusted odds ratio of albuminuria in participants with GGT >30 IU/L was 1.96 (95% CI 1.319-2.906, P < 0.001). CONCLUSION Higher serum GGT levels within the reference range were significantly associated with albuminuria in nondiabetic Koreans with preserved kidney function, independently of traditional cardio-renal risk factors.
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Affiliation(s)
- Sun-Hye Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
| | - Myong Ki Baeg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Yeon Ko
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae-Bom Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea.
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Gondal B, Aronsohn A. A Systematic Approach to Patients with Jaundice. Semin Intervent Radiol 2016; 33:253-258. [PMID: 27904243 DOI: 10.1055/s-0036-1592331] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Jaundice is a clinical manifestation of disorders of underlying bilirubin metabolism, hepatocellular dysfunction, or biliary obstruction. As clinical presentations of yellowing of eyes or skin can be somewhat nonspecific for the underlying etiology of disease, a stepwise approach to evaluation is necessary for accurate diagnosis and effective treatment plan. In this review, we discuss underlying mechanisms of cholestasis and jaundice as well as laboratory and imaging modalities needed to evaluate a patient presenting with hyperbilirubinemia. Jaundice occurs in settings of cholestasis or inability to effectively secrete bile as well as disorders of bilirubin metabolism and hepatocellular dysfunction. Clinical signs of jaundice occur when the serum bilirubin level exceeds 2.5 to 3 mg/dL. In all cases, evaluation begins with liver chemistry tests which include bilirubin (conjugated and unconjugated), alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and total protein. In patients with hepatobiliary causes of jaundice, the alkaline phosphatase is usually elevated. In these cases, evaluation of hepatic synthetic function is crucial to the formulation of a treatment plant. When serologic evaluation is combined with hepatobiliary imaging, underlying mechanism of disease can often be elucidated. A stepwise approach to evaluation can be cost and time saving as well as a framework to improve patient outcomes. In this review, we will outline a diagnostic approach to jaundice, beginning with pathophysiology of cholestasis followed by hyperbilirubinemia and markers of synthetic dysfunction.
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Affiliation(s)
- Bilal Gondal
- Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medicine, Chicago, Illinois
| | - Andrew Aronsohn
- Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medicine, Chicago, Illinois
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165
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Ning J, Yang Z, Xie S, Sun Y, Yuan C, Chen H. Hepatic function imaging using dynamic Gd-EOB-DTPA enhanced MRI and pharmacokinetic modeling. Magn Reson Med 2016; 78:1488-1495. [PMID: 27785826 DOI: 10.1002/mrm.26520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/17/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine whether pharmacokinetic modeling parameters with different output assumptions of dynamic contrast-enhanced MRI (DCE-MRI) using Gd-EOB-DTPA correlate with serum-based liver function tests, and compare the goodness of fit of the different output assumptions. METHODS A 6-min DCE-MRI protocol was performed in 38 patients. Four dual-input two-compartment models with different output assumptions and a published one-compartment model were used to calculate hepatic function parameters. The Akaike information criterion fitting error was used to evaluate the goodness of fit. Imaging-based hepatic function parameters were compared with blood chemistry using correlation with multiple comparison correction. RESULTS The dual-input two-compartment model assuming venous flow equals arterial flow plus portal venous flow and no bile duct output better described the liver tissue enhancement with low fitting error and high correlation with blood chemistry. The relative uptake rate Kir derived from this model was found to be significantly correlated with direct bilirubin (r = -0.52, P = 0.015), prealbumin concentration (r = 0.58, P = 0.015), and prothrombin time (r = -0.51, P = 0.026). CONCLUSION It is feasible to evaluate hepatic function by proper output assumptions. The relative uptake rate has the potential to serve as a biomarker of function. Magn Reson Med 78:1488-1495, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Jia Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Zhiying Yang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yongliang Sun
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Abstract
Drugs can induce liver injury when taken as an over-dose, or even at therapeutic doses in susceptible individuals. Although severe drug-induced liver injury (DILI) is a relatively uncommon clinical event, it is a potentially life threatening adverse drug reaction and is the most common indication for the drug withdrawal. Areas covered: However, the diagnosis of DILI remains a significant challenge, because the establishment of causality is very difficult, and the histopathologic findings of DILI may be indistinguishable from those of other hepatic disorders, such as viral and alcoholic hepatitis. In this review, we provide an overview of recent advances in identification of serologic markers of diagnosis and prognosis, etiologic factors for susceptibility and diagnostic evaluation of DILI, with a focus on its pathogenic mechanisms and the role of liver biopsy. Expert commentary: Further studies of divergent research platforms, using a systems biology approach such as genomics and transcriptomics, may provide a deeper understanding of human drug metabolism and the causes, risk factors, and pathogenesis of DILI.
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Affiliation(s)
- Sun-Jae Lee
- a Department of Pathology, School of Medicine , Catholic University of Daegu , Daegu , Republic of Korea
| | - Youn Ju Lee
- b Department of Pharmacology, School of Medicine , Catholic University of Daegu , Daegu , Republic of Korea
| | - Kwan-Kyu Park
- a Department of Pathology, School of Medicine , Catholic University of Daegu , Daegu , Republic of Korea
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Zhu Q, Qian Y, Yang Y, Wu W, Xie J, Wei D. Effects of carbonyl iron powder on iron deficiency anemia and its subchronic toxicity. J Food Drug Anal 2016; 24:746-753. [PMID: 28911612 PMCID: PMC9337281 DOI: 10.1016/j.jfda.2016.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/04/2016] [Accepted: 04/01/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Qiaosha Zhu
- State Key Laboratory of Bioreactor Engineering, Department of Food Science and Technology, School of Biotechnology, East China University of Science and Technology, Shanghai 200237,
China
| | - Yang Qian
- State Key Laboratory of Bioreactor Engineering, Department of Food Science and Technology, School of Biotechnology, East China University of Science and Technology, Shanghai 200237,
China
- Department of Radiotherapy of Zhongshan Hospital, Fudan University, Shanghai 200032,
China
| | - Ying Yang
- State Key Laboratory of Bioreactor Engineering, Department of Food Science and Technology, School of Biotechnology, East China University of Science and Technology, Shanghai 200237,
China
| | - Weifeng Wu
- State Key Laboratory of Bioreactor Engineering, Department of Food Science and Technology, School of Biotechnology, East China University of Science and Technology, Shanghai 200237,
China
| | - Jingli Xie
- State Key Laboratory of Bioreactor Engineering, Department of Food Science and Technology, School of Biotechnology, East China University of Science and Technology, Shanghai 200237,
China
- Shanghai Collaborative Innovation Center for Biomanufacturing (SCICB), Shanghai 200237,
China
- Corresponding author. P. O. Box 283#, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China. E-mail address: (J. Xie)
| | - Dongzhi Wei
- State Key Laboratory of Bioreactor Engineering, Department of Food Science and Technology, School of Biotechnology, East China University of Science and Technology, Shanghai 200237,
China
- Shanghai Collaborative Innovation Center for Biomanufacturing (SCICB), Shanghai 200237,
China
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168
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Prevalence and associated factors of abnormal liver values in children with celiac disease. Dig Liver Dis 2016; 48:1023-9. [PMID: 27338852 DOI: 10.1016/j.dld.2016.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence and factors associated with transaminasemia in celiac disease are poorly known. AIMS To investigate these issues in paediatric celiac patients and controls. METHODS Alanine aminotransferase (ALT) was studied in 150 children with untreated celiac disease, 161 disease controls and 500 population-based controls. The association between ALT and clinical and histological variables and the effect of a gluten-free diet were investigated in celiac patients. RESULTS ALT was >30U/l: celiac disease 14.7%, ulcerative colitis 37.2%, Crohn's disease 16.7%, reflux disease 16.2%, functional gastrointestinal symptoms 8.9%, and controls 3.6%. Factors associated with increased ALT were poor growth (45.5% vs 24.2%, P=0.039) and severe villous atrophy (median 23.0U/l vs partial atrophy 19.0U/l, P=0.008), but not age, sex, body-mass index, type or severity of symptoms and co-morbidities. ALT had a moderate correlation with endomysial (r=0.334, P<0.001) and transglutaminase antibodies (r=0.264, P=0.002) and ferritin (r=-0.225, P=0.03), but not with other laboratory values. On gluten-free diet median ALT decreased from 22.0U/l to 18.0U/l (P=0.002) and 80% of the high values normalized. CONCLUSION Increased ALT is associated with more advanced serological and histological celiac disease. Adherence to a gluten-free diet appears to result in normalization or reduction of ALT levels.
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169
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Li W, Jiang H, Ablat N, Wang C, Guo Y, Sun Y, Zhao X, Xu J, Zhang K, Ren R, Pu X. Evaluation of the acute and sub-chronic oral toxicity of the herbal formula Xiaoer Chaigui Tuire Oral Liquid. JOURNAL OF ETHNOPHARMACOLOGY 2016; 189:290-299. [PMID: 27224674 DOI: 10.1016/j.jep.2016.05.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/12/2016] [Accepted: 05/21/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xiaoer Chaigui Tuire Oral Liquid (XCTOL) is a popular Chinese herbal formula. It is used to treat exogenous fever in children by inducing diaphoresis and clearing interior heat. AIM OF THE STUDY To evaluate the acute and sub-chronic toxicity of XCTOL in mice and rats, respectively. MATERIALS AND METHODS In the acute toxicity study, mice were orally administered 100g/kg body weight XCTOL three times a day. General behavior, adverse effects and mortality were recorded for 14 days after treatment. In the sub-chronic toxicity study, rats were orally administered 0, 20 or 80g/kg XCTOL for 30 days. The rats were observed daily for clinical signs and mortality. Body weight changes were measured every three days, and relative organ weights, hematological parameters, urinalysis results, biochemical parameters and pathology were monitored at the end of treatment. After treatment, a 30-day withdrawal study was conducted. RESULTS In the acute toxicity study, after the mice were administered with 300g/kg (3×100g/kg) XCTOL in the first day, no adverse effects or death were observed in the following 14 days. In the 30-day sub-chronic toxicity study, daily oral administration of 80g/kg XCTOL resulted in significant body weight loss in both male and female rats. In the male rats, the red blood cell distribution width standard deviation (RDW-SD) and red blood cell distribution width coefficient of variability (RDW-CV) in the hematological test and total bilirubin (T-Bil) in the blood biochemistry test were significantly increased (RDW-SD, p<0.01; RDW-CV and T-Bil, p<0.05 vs. the control group). In the female rats, the specific gravity of the urinalysis was significantly increased (p<0.05 vs. the control group). Pathological damage was not observed in the main organs in the 80g/kg group. In the 20g/kg group, the lymphocyte % (LYM%) was significantly increased (p<0.05 the control group) in the female rats. CONCLUSIONS The maximum-tolerated dose of XCTOL was greater than 300g/kg in mice. The no-observed-adverse-effect-level was between 20 and 80g/kg body weight for 30 days in rats, which is 2.2-8.8 times higher, respectively, than the dose that has already been used in the clinical practice. Therefore, XCTOL at a dose less than 300g/kg in one day or 20g/kg per day for 30 days is considered safe.
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Affiliation(s)
- Wan Li
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Hanjie Jiang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Nuramatjan Ablat
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Chen Wang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Yongfei Guo
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Yi Sun
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Xin Zhao
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Jiamin Xu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Ke Zhang
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Rutong Ren
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
| | - Xiaoping Pu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, PR China; Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University, Xueyuan Road 38, PR China.
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Ilamathi M, Prabu P, Ayyappa KA, Sivaramakrishnan V. Artesunate obliterates experimental hepatocellular carcinoma in rats through suppression of IL-6-JAK-STAT signalling. Biomed Pharmacother 2016; 82:72-9. [DOI: 10.1016/j.biopha.2016.04.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 02/06/2023] Open
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[Expert panel consensus statement on prevention and standardized treatment of drug-induced liver injury in patients with blood diseases (2016)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:441-52. [PMID: 27431065 PMCID: PMC7348330 DOI: 10.3760/cma.j.issn.0253-2727.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 01/08/2023]
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Popović D, Đukić D, Katić V, Jović Z, Jović M, Lalić J, Golubović I, Stojanović S, Ulrih NP, Stanković M, Sokolović D. Antioxidant and proapoptotic effects of anthocyanins from bilberry extract in rats exposed to hepatotoxic effects of carbon tetrachloride. Life Sci 2016; 157:168-177. [PMID: 27312419 DOI: 10.1016/j.lfs.2016.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
AIMS The aim of this research was to determine the hepatoprotective effects of anthocyanins from bilberry extract in rats exposed to carbon tetrachloride (CCl4) by monitoring the parameters of oxidative stress and apoptosis, and by performing the histopathological and morphometric analyses. MAIN METHODS Animals were divided into four groups: Group I (0.9% NaCl-10days), Group II (bilberry extract, 75mg/kg-10days), Group III (0,9% NaCl-9days, and on the tenth day CCl4-2ml/kg), Group IV (bilberry extract, 75mg/kg-10days and on the tenth day CCl4-2ml/kg). KEY FINDINGS Bilberry extract led to a significant decrease in the activity of biochemical parameters in serum (AST, GGT, LDH, and ALT), the activity of pro-oxidative enzyme xanthine oxidase, as well as the level of lipid peroxidation in the liver in Group IV compared to Group III (p<0.01). Bilberry extract resulted in a significant increase in the activity of the antioxidant markers-catalase (p<0.05), superoxide dismutase, glutathione S-transferase and glutathione peroxidase (p<0.01), and the concentration of reduced glutathione (p<0.05) in Group IV in relation to Group III. The application of bilberry extract resulted in an increase in the number of apoptotic hepatocytes and the activity of caspase-3 in the liver tissue (p<0.01). The reduction of coagulation necrotic areas was proved (p<0.001) as well as the number of macrovesicular hepatocytes (p<0.01), along with an increased mitotic activity (p<0.01) in Group IV compared to Group III. SIGNIFICANCE Anthocyanins from bilberry extract have strong antioxidant properties and therefore can be considered as powerful hepatoprotectives in natural products.
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Affiliation(s)
- Dejan Popović
- Department of Biochemistry, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Davor Đukić
- Department of Biochemistry, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Vukica Katić
- Department of Pathology, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Zorica Jović
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Maja Jović
- Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Jelena Lalić
- Department of Pharmacy, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Ilija Golubović
- Department of Biochemistry, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Svetlana Stojanović
- Department of Biochemistry, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Nataša Poklar Ulrih
- Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia.
| | - Marko Stanković
- Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
| | - Dušan Sokolović
- Department of Biochemistry, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia.
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Correlation analysis between four serum biomarkers of liver fibrosis and liver function in infants with cholestasis. Biomed Rep 2016; 5:107-112. [PMID: 27347413 DOI: 10.3892/br.2016.681] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/12/2016] [Indexed: 12/20/2022] Open
Abstract
The aim of the present study was to investigate the correlation between four serum biomarkers of liver fibrosis and liver function in infants with cholestasis. A total of 30 infants with cholestasis and 20 healthy infants were included in the study. Biochemical assays based on the initial rate method and colorimetric assays were conducted to determine the levels of liver function markers in the serum [such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), γ-glutamyl transferase (γ-GT), cholinesterase (CHE) and total bile acids (TBA)] and four serum biomarkers of liver fibrosis were measured using radioimmunoassays [hyaluronic acid (HA), procollagen type III (PCIII), laminin (LN) and collagen type IV (cIV)]. The serum levels of ALT, AST, TBIL, DBIL, IBIL, γ-GT and TBA in the infants with cholestasis were significantly higher compared to the healthy infants (P<0.01); the serum levels of CHE in the infants with cholestasis were significantly lower compared to the healthy infants (P<0.01). The serum levels of HA, PCIII, and cIV in the infants with cholestasis were significantly higher compared to the healthy infants (P<0.01). Correlation analyses between liver function and the four biomarkers of liver fibrosis showed that HA was positively correlated with AST and γ-GT (P<0.05) and negatively correlated with ALT, CHE and TBA (P<0.05). cIV was positively correlated with γ-GT (P<0.05) and negatively correlated with CHE (P<0.05). In conclusion, statistically significant differences were identified for the liver function markers (ALT, AST, TBIL, DBIL, IBIL, γ-GT and TBA) and the biomarkers HA, PCIII and cIV of liver fibrosis between infants with cholestasis and healthy infants. Thus, the serum levels of HA, cIV, γ-GT and CHE are sensitive markers for cholestatic liver fibrosis in infants.
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174
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Shantakumar S, Landis S, Lawton A, Hunt CM. Prevalence and incidence of liver enzyme elevations in a pooled oncology clinical trial cohort. Regul Toxicol Pharmacol 2016; 77:257-62. [PMID: 27025923 DOI: 10.1016/j.yrtph.2016.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 01/22/2023]
Abstract
Few epidemiologic studies describe longitudinal liver chemistry (LC) elevations in cancer patients. A population-based retrospective cohort was identified from 31 Phase 2-3 oncology trials (excluding targeted therapies) conducted from 1985 to 2005 to evaluate background rates of LC elevations in patients (n = 3998) with or without liver metastases. Patients with baseline liver metastases (29% of patients) presented with a 3% prevalence of alanine transaminase (ALT) ≥ 3x upper limits normal (ULN) and 0.2% prevalence of bilirubin ≥ 3xULN. During follow-up, the incidence (per 1000 person-months) of new onset ALT elevations ≥3xULN was 6.1 (95% CI: 4.5, 8.0) and 2.2 (95% CI: 0.9, 4.5) in patients without and with liver metastases, respectively. No new incident cases of ALT and bilirubin elevations suggestive of severe liver injury occurred among those with liver metastases; a single case occurred among those without metastasis. Regardless of the presence of liver metastases, LC elevations were rare in cancer patients during oncology trials, which may be due to enrollment criteria. Our study validates uniform thresholds for detection of LC elevations in oncology studies and serves as an empirical referent point for comparing liver enzyme abnormalities in oncology trials of novel targeted therapies. These data support uniform LC stopping criteria in oncology trials.
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Affiliation(s)
| | - Sarah Landis
- Worldwide Epidemiology, GlaxoSmithKline, Stockley Park, United Kingdom.
| | - Andy Lawton
- Worldwide Epidemiology, GlaxoSmithKline, Stockley Park, United Kingdom.
| | - Christine M Hunt
- Department of Veterans Affairs, Durham VA Medical Center, North Carolina, USA.
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175
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Lee H, Shin DW, Lee TH, Yang HK, Ahn E, Yoon JM, Lee HK, Suh B, Son KY, Kim JS, Cho B. Association Between Change in Serum Aminotransferase and Mortality: A Nationwide Cohort Study in Korea. Medicine (Baltimore) 2016; 95:e3158. [PMID: 27015199 PMCID: PMC4998394 DOI: 10.1097/md.0000000000003158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is little information on how the change in serum aminotransferase affects mortality. We investigated the association between changes in serum aminotransferase levels and mortality from all causes, cardiovascular disease (CVD), and liver disease.Three percent of men from the Korean National Health Insurance database were sampled randomly at the end of 2002. After excluding patients with cancer, CVD, CVD risk factors, or liver disease, those who participated in 2 consecutive rounds of the national health screening examination were included (n = 68,431). The primary outcome was CVD mortality. Secondary outcomes were liver disease mortality and all-cause mortality. Change in metabolic profiles was analyzed based on changes in liver enzyme levels. Elevated levels of serum aminotransferase were associated with CVD, liver disease, and all-cause mortality. Men who had sustained elevation of serum aminotransferase during 2 subsequent liver enzyme tests showed a significantly higher risk of CVD mortality (adjusted hazard ratio [aHR] 1.95; 95% confidence interval [CI] 1.07-3.56, 2.29; 1.27-4.12) than the sustained normal group. In contrast, the normalization group (aHR 1.52, 95% CI 0.82-2.81 for aspartate aminotransferase [AST]; aHR 1.35, 95% CI 0.70-2.61 for alanine aminotransferase [ALT]) and the new elevation group (aHR 1.27, 0.66-2.44 for AST; aHR 0.99, 95% CI 0.49-2.20 for ALT) were not different from the sustained normal group in CVD mortality.Individuals with serum aminotransferase elevation, particularly when sustained, are at higher risk of mortality, and should receive appropriate medical attention.
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Affiliation(s)
- Hyejin Lee
- From the Department of Family Medicine and Health Promotion Center (HL, DWS, EA, J-MY, H-KL, BS, KYS, JSK, BC), Seoul National University Hospital; Department of Family Medicine (DWS, BC), College of Medicine, Seoul National University, Seoul, Korea; Division of Gastroenterology and Hepatology (THL), Metro Health Medical Center, Case Western Reserve University, Cleveland, OH; and Cancer Policy Branch (H-KY), National Cancer Control Institute, National Cancer Center, Goyang, Korea
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176
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Shahat AA, Alsaid MS, Kotob SE, Ahmed HH. Significance of Rumex vesicarius as anticancer remedy against hepatocellular carcinoma: a proposal-based on experimental animal studies. Asian Pac J Cancer Prev 2016; 16:4303-10. [PMID: 26028090 DOI: 10.7314/apjcp.2015.16.10.4303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Rumex vesicarius is an edible herb distributed in Egypt and Saudi Arabia. The whole plant has significant value in folk medicine and it has been used to alleviate several diseases. Hepatocellular carcinoma (HCC), the major primary malignant tumor of the liver, is one of the most life-threatening human cancers. The goal of the current study was to explore the potent role of Rumex vesicarius extract against HCC induced in rats. Thirty adult male albino rats were divided into 3 groups: (I): Healthy animals received orally 0.9% normal saline and served as negative control group, (II): HCC group in which rats were orally administered N-nitrosodiethylamine NDEA, (III): HCC group treated orally with R. vesicarius extract in a dose of 400 mg/kg b.wt daily for two months. ALT and AST, ALP and γ-GT activities were estimated. CEA, AFP, AFU, GPC-3, Gp-73 and VEGF levels were quantified. Histopathological examination of liver tissue sections was also carried out. The results of the current study showed that the treatment of the HCC group with R. vesicarius extract reversed the significant increase in liver enzymes activity, CEA, AFP, AFU, glypican 3, golgi 73 and VEGF levels in serum as compared to HCC-untreated counterparts. In addition, the favorable impact of R. vesicarius treatment was evidenced by the marked improvement in the histopathological features of the liver of the treated group. In conclusion, the present experimental setting provided evidence for the significance of R. vesicarius as anticancer candidate with a promising anticancer potential against HCC. The powerful hepatoprotective properties, the potent antiangiogenic activity and the effective antiproliferative capacity are responsible for the anticancer effect of this plant.
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Affiliation(s)
- Abdelaaty A Shahat
- Pharmacognosy Department, College of Pharmacy, King Saud University, Giza, Egypt E-mail :
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177
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Brisse E, Imbrechts M, Put K, Avau A, Mitera T, Berghmans N, Rutgeerts O, Waer M, Ninivaggi M, Kelchtermans H, Boon L, Snoeck R, Wouters CH, Andrei G, Matthys P. Mouse Cytomegalovirus Infection in BALB/c Mice Resembles Virus-Associated Secondary Hemophagocytic Lymphohistiocytosis and Shows a Pathogenesis Distinct from Primary Hemophagocytic Lymphohistiocytosis. THE JOURNAL OF IMMUNOLOGY 2016; 196:3124-34. [PMID: 26903481 DOI: 10.4049/jimmunol.1501035] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 01/22/2016] [Indexed: 01/04/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening immunological disorder that is characterized by systemic inflammation, widespread organ damage, and hypercytokinemia. Primary HLH is caused by mutations in granule-mediated cytotoxicity, whereas secondary HLH occurs, without a known genetic background, in a context of infections, malignancies, or autoimmune and autoinflammatory disorders. Clinical manifestations of both HLH subtypes are often precipitated by a viral infection, predominantly with Herpesviridae. Exploiting this knowledge, we established an animal model of virus-associated secondary HLH by infecting immunocompetent wild-type mice with the β-herpesvirus murine CMV. C57BL/6 mice developed a mild inflammatory phenotype, whereas BALB/c mice displayed the clinicopathologic features of HLH, as set forth in the Histiocyte Society diagnostic guidelines: fever, cytopenia, hemophagocytosis, hyperferritinemia, and elevated serum levels of soluble CD25. BALB/c mice also developed lymphadenopathy, liver dysfunction, and decreased NK cell numbers. Lymphoid and myeloid cells were in a hyperactivated state. Nonetheless, depletion of CD8(+) T cells could not inhibit or cure the HLH-like syndrome, highlighting a first dissimilarity from mouse models of primary HLH. Immune cell hyperactivation in BALB/c mice was accompanied by a cytokine storm. Notably, plasma levels of IFN-γ, a key pathogenic cytokine in models of primary HLH, were the highest. Nevertheless, murine CMV-infected IFN-γ-deficient mice still developed the aforementioned HLH-like symptoms. In fact, IFN-γ-deficient mice displayed a more complete spectrum of HLH, including splenomegaly, coagulopathy, and decreased NK cell cytotoxicity, indicating a regulatory role for IFN-γ in the pathogenesis of virus-associated secondary HLH as opposed to its central pathogenic role in primary HLH.
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Affiliation(s)
- Ellen Brisse
- Laboratory of Immunobiology, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Maya Imbrechts
- Laboratory of Immunobiology, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Karen Put
- Laboratory of Immunobiology, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Anneleen Avau
- Laboratory of Immunobiology, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Tania Mitera
- Laboratory of Immunobiology, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Nele Berghmans
- Laboratory of Molecular Immunology, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Omer Rutgeerts
- Laboratory of Experimental Transplantation, University of Leuven, 3000 Leuven, Belgium
| | - Mark Waer
- Laboratory of Experimental Transplantation, University of Leuven, 3000 Leuven, Belgium
| | - Marisa Ninivaggi
- Synapse BV, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, 6229 Maastricht, the Netherlands
| | - Hilde Kelchtermans
- Synapse BV, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, 6229 Maastricht, the Netherlands
| | - Louis Boon
- Epirus Biopharmaceuticals Netherlands, 3584 Utrecht, the Netherlands
| | - Robert Snoeck
- Laboratory of Virology and Chemotherapy, Rega Institute, University of Leuven, 3000 Leuven, Belgium; and
| | - Carine H Wouters
- Laboratory of Pediatric Immunology, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium
| | - Graciela Andrei
- Laboratory of Virology and Chemotherapy, Rega Institute, University of Leuven, 3000 Leuven, Belgium; and
| | - Patrick Matthys
- Laboratory of Immunobiology, Rega Institute, University of Leuven, 3000 Leuven, Belgium;
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178
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Serdaroğlu F, Koca T, Dereci S, Akçam M. The etiology of hypertransaminasemia in Turkish children. Bosn J Basic Med Sci 2016; 16:151-6. [PMID: 26894285 PMCID: PMC4852998 DOI: 10.17305/bjbms.2016.982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to investigate the causes of elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in children. We analyzed the medical records for children aged 3 months to 18 years who presented to the hospital with ALT >45 IU/L and/or AST >50 IU/L, between 2012 and 2014, for various reasons, including those not related to liver disease. In total, 281 children met the study criteria. This group comprised of 125 (44.5%) females and 156 (55.5%) males. At the presentation, the most common patient complaint was fatigue (53.4%), while 15.7% of the patients reported no symptoms. The most common findings on the physical examination were jaundice and hepatomegaly. In 15% of the cases, the findings were normal. According to the diagnosis, the most common cause of the elevated transaminases were infections (34%), with hepatitis A virus (HAV) infection as the leading cause (18.9%). Drug-induced liver injury (DILI) was the cause in 18.1% of the cases and non-alcoholic fatty liver disease (NAFLD) in 11.1%. The highest transaminase levels were associated with HAV infection, while DILI and NAFLD caused only slightly elevated transaminases. Overall, our results show that the elevated transaminases in children are most often caused by infections, DILI, and NAFLD. In a majority of cases, elevated ALT and AST indicate liver disease, however, they could also be associated with conditions other than liver damage. Additionally, the elevated enzymes can be detected in completely healthy individuals.
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Affiliation(s)
- Filiz Serdaroğlu
- Department of Pediatrics, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.
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179
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Fontana RJ. Response to Collyer et al. Am J Gastroenterol 2016; 111:297-8. [PMID: 26882950 DOI: 10.1038/ajg.2015.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Robert J Fontana
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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180
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Jong T, Geake J, Yerkovich S, Bell SC. Idiosyncratic reactions are the most common cause of abnormal liver function tests in patients with cystic fibrosis. Intern Med J 2016; 45:395-401. [PMID: 25644776 DOI: 10.1111/imj.12707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/25/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Beta-lactam antibiotic-related liver enzyme derangement can limit treatment options for infective exacerbations in cystic fibrosis (CF) bronchiectasis. AIM To identify risk factors for elevated liver function tests (LFT) in CF patients receiving parenteral antibiotics. METHODS All patients attending The Prince Charles Hospital (TPCH) Adult CF Centre in 2012 were identified using the CF Research Database and CF Data Registry. Biochemistry and haematology panels between 1 January 2012 and 31 December 2012 for each patient were retrieved from Queensland Health Pathology and private pathology providers. Patients with LFT more than three times the upper limit of normal were identified. For each laboratory test, concurrently administered antibiotic(s) were analysed from TPCH pharmacy dispensing system for patients who received intravenous (IV) antibiotic treatment. RESULTS Abnormal liver enzymes were evident in significantly more patients receiving IV antibiotics than patients who did not (43% vs 18%, P < 0.001). Pre-existing CF-related liver disease and total IV antibiotic treatment days were not associated with abnormal LFT. Higher C-reactive protein and peripheral eosinophil counts were not more common in patients with abnormal LFT. Male sex, poorer lung function and lower leucocyte counts were associated with abnormal LFT; however, these variables only explained 4.2% of the variance in the multivariable logistic model. CONCLUSION Elevated LFT are common during IV antibiotic treatment in CF. Although specific antibiotic exposure may contribute to abnormal LFT in a minority of cases, our study demonstrates that antibiotic-induced liver injury is largely idiosyncratic and unpredictable.
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Affiliation(s)
- T Jong
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia; Department of Pharmacy, The Prince Charles Hospital, Brisbane, Queensland, Australia
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181
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Lonardo A, Romagnoli D. Gamma glutamyl transferase: A novel cardiovascular outfit for an old liver test. Indian J Med Res 2016; 143:4-7. [PMID: 26997005 PMCID: PMC4822367 DOI: 10.4103/0971-5916.178574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Amedeo Lonardo
- Outpatient Liver Clinic & Internal Medicine, Nuovo Ospedale Civile Sant’Agostino Estense (NOCSAE), Baggiovara, Modena, Italy
| | - Dante Romagnoli
- Outpatient Liver Clinic & Internal Medicine, Nuovo Ospedale Civile Sant’Agostino Estense (NOCSAE), Baggiovara, Modena, Italy
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182
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Eğin S, Açıksarı K, Ercan G, Aydın AF, Üstyol EA, Eser M, Tanrıverdi G, Yanar HT. Effects of pentoxifylline on oxidative stress in rats with abdominal compartment syndrome model. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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183
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Hu X, Cheng S, Liu X, Li J, Zheng W, Lu G, Zhang J, Zheng J, Zhang J. Development of monoclonal antibodies and immunochromatographic lateral flow device for rapid test of alanine aminotransferase isoenzyme 1. Protein Expr Purif 2015; 119:94-101. [PMID: 26611609 DOI: 10.1016/j.pep.2015.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/22/2015] [Accepted: 11/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alanine aminotransferase (ALT) has been used as a sensitive marker for liver injury in people and in preclinical toxicity studies. But measurement of ALT isoenzymes, ALT1 and ALT2, was reported to be of more diagnostic value. The aim of this study is to develop an ideal pair of anti-ALT1 monoclonal antibodies (MAbs) of high specificity and affinity, and subsequently prepare a Immunochromatographic lateral flow device (LFD) for rapid test of ALT1 in human serums. METHODS The complete coding sequence of ALT1 gene (1500 bp) was cloned from human hepatoma G2 cells (HepG2) and inserted into the expression vector pET-32a(+). ALT1 recombinant protein was routinely prepared by E. coli BL21 (DE3) expression and Ni(2+) affinity purification. Balb/c mice were immunized with purified ALT1 and the splenocytes were fused with Sp2/0 myeloma cells. The positive clones, verified by indirect enzyme-linked immunosorbent assay (ELISA) using purified ALT1, were subcloned to single clones by limiting dilution process. A MAb pair was selected from the obtained MAbs according the sandwich ELISA pairing results and then used for lateral flow device (LFD) production. After evaluation of the sensitivity and specificity, the LFD strips were employed to test human serum samples with known ALT activity levels. RESULTS ALT1 recombinant protein was expectedly prepared by expression and purification. A total of 8 stable clones that produced antibodies specifically recognizing ALT1 protein were developed. After sandwich ELISA pairing, an ideal pair of anti-ALT1 MAbs, designated as BD7 and DG3, were selected and proved to be of high specificity, titer and affinity. Based on the MAb pair, LFD strips specifically for ALT1 rapid test were subsequently prepared. The detection threshold of the LFD strips was 12 U/L. No cross reaction was found. CONCLUSIONS The ALT1 LFD with high sensitivity and specificity was successfully developed. It is valuable for testing ALT1 protein in human sera and can be a beneficial complement for traditional ALT test.
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Affiliation(s)
- Xiaomei Hu
- The Blood Transfusion Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Shiliang Cheng
- Clinical Laboratory, Shandong Jiaotong Hospital, No.11 Wuyinshan Road, Tianqiao District, Ji'nan, Shandong Province, PR China
| | - Xinfeng Liu
- Clinical Laboratory, Shandong Jiaotong Hospital, No.11 Wuyinshan Road, Tianqiao District, Ji'nan, Shandong Province, PR China
| | - Jie Li
- The Blood Transfusion Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Wen Zheng
- Clinical Laboratory, Shandong Jiaotong Hospital, No.11 Wuyinshan Road, Tianqiao District, Ji'nan, Shandong Province, PR China
| | - Gang Lu
- Artron BioResearch Inc., 3938 North Fraser Way, Burnaby, British Columbia, V5J 5H6, Canada
| | - Jun Zhang
- Artron BioResearch Inc., 3938 North Fraser Way, Burnaby, British Columbia, V5J 5H6, Canada
| | - Jian Zheng
- Key Laboratory of Molecular Biology on Infectious Diseases, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing 400016, PR China
| | - Juan Zhang
- The Blood Transfusion Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
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184
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Ali SO, Darwish HA, Ismail NA. Curcumin, Silybin Phytosome(®) and α-R-Lipoic Acid Mitigate Chronic Hepatitis in Rat by Inhibiting Oxidative Stress and Inflammatory Cytokines Production. Basic Clin Pharmacol Toxicol 2015; 118:369-80. [PMID: 26457982 DOI: 10.1111/bcpt.12502] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/06/2015] [Indexed: 12/28/2022]
Abstract
Chronic hepatitis is recognized as a worldwide health problem that gradually progresses towards cirrhosis and hepatocellular carcinoma. Despite the large number of experiments using animal models for allergic hepatitis, it is still difficult to produce a picture of chronic hepatitis. Therefore, this study was conducted to introduce an animal model approximating to the mechanism of chronicity in human hepatitis. The study also aimed to examine the hepatoprotective effects of curcumin, silybin phytosome(®) and α-R-lipoic acid against thioacetamide (TAA)-induced chronic hepatitis in rat model. TAA was administered intraperitoneally at a dose of 200 mg/kg three times weekly for 4 weeks. At the end of this period, a group of rats was killed to assess the development of chronic hepatitis in comparison with their respective control group. TAA administration was then discontinued, and the remaining animals were subsequently allocated into four groups. Group 1 was left untreated, whereas groups 2-4 were allowed to receive daily oral doses of curcumin, silybin phytosome(®) or α-R-lipoic acid, respectively, for 7 weeks. Increases in hepatic levels of malondialdehyde associated with TAA administration were inhibited in groups receiving supplements. Furthermore, glutathione depletion, collagen deposition, macrophage activation and nuclear factor κappa-B expression as well as tumour necrosis factor-α and interleukin-6 levels were significantly decreased in response to supplements administration. Serological analysis of liver function and liver histopathological examination reinforced the results. The above evidence collectively indicates that the antioxidant and anti-inflammatory activities of curcumin, silybin phytosome(®) and α-R-lipoic acid may confer therapeutic efficacy against chronic hepatitis.
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Affiliation(s)
- Shimaa O Ali
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | - Nabila A Ismail
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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185
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Xu CF, Johnson T, Wang X, Carpenter C, Graves AP, Warren L, Xue Z, King KS, Fraser DJ, Stinnett S, Briley LP, Mitrica I, Spraggs CF, Nelson MR, Tada H, du Bois A, Powles T, Kaplowitz N, Pandite LN. HLA-B*57:01 Confers Susceptibility to Pazopanib-Associated Liver Injury in Patients with Cancer. Clin Cancer Res 2015; 22:1371-7. [PMID: 26546620 DOI: 10.1158/1078-0432.ccr-15-2044] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/23/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Pazopanib is an effective treatment for advanced renal cell carcinoma and soft-tissue sarcoma. Transaminase elevations have been commonly observed in pazopanib-treated patients. We conducted pharmacogenetic analyses to explore mechanistic insight into pazopanib-induced liver injury. EXPERIMENTAL DESIGN The discovery analysis tested association between four-digit HLA alleles and alanine aminotransferase (ALT) elevation in pazopanib-treated patients with cancer from eight clinical trials (N = 1,188). We conducted confirmatory analysis using an independent dataset of pazopanib-treated patients from 23 additional trials (N = 1,002). Genome-wide association study (GWAS) for transaminase elevations was also conducted. RESULTS The discovery study identified an association between HLA-B*57:01 carriage and ALT elevation [P = 5.0 × 10(-5) for maximum on-treatment ALT (MaxALT); P = 4.8 × 10(-4) for time to ALT > 3× upper limit of normal (ULN) event; P = 4.1 × 10(-5) for time to ALT > 5× ULN event] that is significant after adjustment for number of HLA alleles tested. We confirmed these associations with time to ALT elevation event (P = 8.1 × 10(-4) for ALT > 3× ULN, P = 9.8 × 10(-3) for ALT > 5× ULN) in an independent dataset. In the combined data, HLA-B*57:01 carriage was associated with ALT elevation (P = 4.3 × 10(-5) for MaxALT, P = 5.1 × 10(-6) for time to ALT > 3×ULN event, P = 5.8 × 10(-6) for time to ALT > 5× ULN event). In HLA-B*57:01 carriers and noncarriers, frequency of ALT > 3× ULN was 31% and 19%, respectively, and frequency of ALT > 5× ULN was 18% and 10%, respectively. GWAS revealed a possible borderline association, which requires further evaluation. CONCLUSIONS These data indicate that HLA-B*57:01 carriage confers higher risk of ALT elevation in patients receiving pazopanib and provide novel insight implicating an immune-mediated mechanism for pazopanib-associated hepatotoxicity in some patients.
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Affiliation(s)
- Chun-Fang Xu
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania.
| | - Toby Johnson
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Xiaojing Wang
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Chris Carpenter
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Alan P Graves
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Liling Warren
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Zhengyu Xue
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Karen S King
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Dana J Fraser
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Sandy Stinnett
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Linda P Briley
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Ionel Mitrica
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Colin F Spraggs
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Matthew R Nelson
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Hiroomi Tada
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
| | - Andreas du Bois
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Thomas Powles
- Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Neil Kaplowitz
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lini N Pandite
- GlaxoSmithKline Research and Development, Stevenage, UK, Research Triangle Park, North Carolina and King of Prussia, Pennsylvania
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186
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Zelber-Sagi S, Ben-Assuli O, Rabinowich L, Goldstein A, Magid A, Shalev V, Shibolet O, Chodick G. The association between the serum levels of uric acid and alanine aminotransferase in a population-based cohort. Liver Int 2015; 35:2408-15. [PMID: 25845417 DOI: 10.1111/liv.12842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/29/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Elevated serum uric acid levels reflect and also cause both oxidative stress and insulin resistance and are frequently observed in patients with the metabolic syndrome. A strong association exists between the metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Therefore, we aimed to test the association between uric acid and elevated alanine aminotransferase (ALT), as a surrogate for NAFLD, using real-world data. METHODS Data used for the cross-sectional study were obtained from Maccabi Healthcare System, a 2-million member health maintenance organization in Israel. The population consisted of individuals aged 20-60 years who underwent blood tests for ALT and uric acid between 1997 and 2012. Individuals with secondary liver disease, celiac, and inflammatory bowel-disease were excluded. Subgroup analysis was performed in subjects who were given the diagnosis of fatty liver in their medical records (n = 2628). RESULTS The study population included 82,608 people (32.5% men, mean age 43.91 ± 10.15 years). There was a significant positive dose-response association between serum uric acid levels and the rate of elevated serum ALT (P for trend <0.001). In multivariable model, controlling for potential confounders, the association between uric acid and elevated ALT persisted (OR = 2.10, 95% CI 1.93-2.29, for the fourth quartile vs. the first). This association was maintained in all categories of gender and BMI. Similar results were observed among patients diagnosed with fatty liver (OR = 1.77, 1.22-2.57). CONCLUSIONS Serum uric acid is independently associated with elevated ALT, as a surrogate for NAFLD, and thus may serve as a serum marker for liver damage and should be further investigated as a risk factor for NAFLD.
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Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa, Israel.,The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
| | - Liane Rabinowich
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Alex Goldstein
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Avi Magid
- School of Public Health, University of Haifa, Haifa, Israel
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Oren Shibolet
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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187
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Cho YJ, Park YJ, Min SH, Ryu HG. The Effect of General Anesthesia on Aminotransferase Levels in Patients with Elevated Aminotransferase Levels: A Single-Center 5-Year Retrospective Study. Anesth Analg 2015; 121:1529-33. [PMID: 26496369 DOI: 10.1213/ane.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The effect of commonly used anesthetics on postoperative aminotransferase levels in patients with preoperatively elevated values is unclear. METHODS The medical records of 25,567 adult patients undergoing elective general anesthesia were retrospectively reviewed. Patients were classified into normal (≤ 40 IU/L), mild (41-119 IU/L), moderate (120-199 IU/L), and marked elevation (200+ IU/L) groups according to their preoperative alanine aminotransferase levels. Changes in these levels before and after general anesthesia were compared according to the anesthetics used. RESULTS Among the patients with preoperative mild or moderate elevation, 97.8% (2589/2647) did not show a higher alanine aminotransferase level after surgery. Compared with total IV anesthesia (TIVA), sevoflurane showed adjusted odds ratios (95% confidence interval) of 1.27 (1.10-1.46) for mild, 1.33 (0.86-2.05) for moderate, and 3.35 (1.58-7.04) for marked postoperatively elevated levels of alanine aminotransferase versus normal levels. Similarly, compared with TIVA, desflurane showed adjusted odds ratios (95% confidence interval) of 1.21 (0.96-1.53) for mild, 1.44 (0.70-2.94) for moderate, and 3.18 (1.14-8.89) for marked postoperatively elevated levels of alanine aminotransferase versus normal levels (P = 0.05). CONCLUSIONS In most cases, postoperative alanine aminotransferase levels did not worsen even in patients with preoperatively elevated levels. Sevoflurane was associated with increased odds for postoperative elevation of these levels after general surgery compared with TIVA.
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Affiliation(s)
- Youn Joung Cho
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
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188
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Children's liver chemistries vary with age and gender and require customized pediatric reference ranges. Regul Toxicol Pharmacol 2015; 73:349-55. [DOI: 10.1016/j.yrtph.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/22/2022]
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189
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Xu Q, Higgins T, Cembrowski GS. Limiting the testing of AST: a diagnostically nonspecific enzyme. Am J Clin Pathol 2015; 144:423-6. [PMID: 26276772 DOI: 10.1309/ajcpo47vawyridhg] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Annually, millions of pairs of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) tests are ordered. These enzymes are highly correlated, and ALT is far more specific diagnostically than AST. To reduce AST testing, we suggest measuring AST only when ALT exceeds a predetermined limit. METHODS We derived the proportions of elevated ASTs that would not be measured based on 15 months of paired inpatient and outpatient ALT and AST data. RESULTS For inpatients, a 35 U/L ALT limit for initiating AST testing would reduce AST testing by 51%, missing only 3% and 7.5% of ASTs exceeding 50 U/L and 35 U/L, respectively. In outpatients, AST testing can be reduced by more than 65%, with fewer missed elevated ASTs (0.5% and 2% of the ASTs exceeding 50 U/L and 35 U/L, respectively). CONCLUSIONS Conservatively, $100 million could be saved annually in the US health care budget by selectively limiting AST testing in just the US outpatient environment.
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Affiliation(s)
- Qian Xu
- University of Alberta Hospital, Edmonton, Canada
| | | | - George S. Cembrowski
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Canada
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190
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Castillo NE, Vanga RR, Theethira TG, Rubio-Tapia A, Murray JA, Villafuerte J, Bonder A, Mukherjee R, Hansen J, Dennis M, Kelly CP, Leffler DA. Prevalence of abnormal liver function tests in celiac disease and the effect of a gluten-free diet in the US population. Am J Gastroenterol 2015; 110:1216-22. [PMID: 26150087 DOI: 10.1038/ajg.2015.192] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/24/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Guidelines recommend routine screening of liver function tests (LFTs) in patients diagnosed with celiac disease (CD). However, little is known about the prevalence of liver disorders in CD outside of Europe. Our aims were to estimate the prevalence of LFT abnormalities in CD and to evaluate the effect of a gluten-free diet (GFD) on LFTs. METHODS Adult patients with biopsy-proven CD were identified from a prospectively maintained database and matched with healthy controls. LFT levels for women and men were defined as abnormal based on the Third National Health and Nutrition Examination Survey (NHANES III) criteria. Data on demographics, coexisting liver diseases, and laboratory work-ups including aspartate transaminase (AST) and alanine transaminase (ALT) values at the time of diagnosis and on a GFD were recorded. Subsequently, data from this cohort were compared with data from 7,789 individuals participating in the National Health and Nutrition Examination Survey, 2009-2010. Univariate logistic regression, Wilcoxon signed-ranks, Student's t-test, χ(2), and Fischer's exact test were used for statistical analysis. RESULTS In 463 CD patients with ALT or AST levels at the time of CD diagnosis, 40.6% had elevated LFTs compared with 24.2% of treated CD patients (P<0.001) and 16.6% of matched controls (P<0.001). Similarly, 36.7% of CD patients on the NHANES database had abnormal ALT values compared with 19.3% of non-celiac patients (P=0.03). Approximately, 78.6% of CD patients with elevated LFTs at diagnosis normalized LFTs on a GFD after a mean duration of 1.5±1.5 years. CONCLUSIONS Forty percent of individuals will have elevated LFTs at CD diagnosis; however, the majority will normalize with standard CD therapy. LFTs should be checked in all patients with CD and coexisting liver disorder should be considered in patients whose LFTs have not improved within a year on a GFD.
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Affiliation(s)
- Natalia E Castillo
- 1] Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA [2] Joint first authors
| | - Rohini R Vanga
- 1] Department of Medicine and Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA [2] Joint first authors
| | - Thimmaiah G Theethira
- Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alberto Rubio-Tapia
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Javier Villafuerte
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan Bonder
- Liver Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rupa Mukherjee
- Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Hansen
- Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Melinda Dennis
- Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ciaran P Kelly
- Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Leffler
- Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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191
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Kobkitjaroen J, Pongprasobchai S, Tientadakul P. γ-Glutamyl Transferase Testing, Change of Its Designation on the Laboratory Request Form, and Resulting Ratio of Inappropriate to Appropriate Use. Lab Med 2015. [DOI: 10.1309/lm7e5lg6pwjyefuj] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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192
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Xu L, Jiang CQ, Schooling CM, Zhang WS, Cheng KK, Lam TH. Liver enzymes and incident diabetes in China: a prospective analysis of 10 764 participants in the Guangzhou Biobank Cohort Study. J Epidemiol Community Health 2015; 69:1040-4. [PMID: 26139641 DOI: 10.1136/jech-2015-205518] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/08/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Impaired liver function has been shown to be associated with incident diabetes. The independent role of the different liver enzymes, including γ-glutamyltransferase (GGT), alanine transaminase (ALT) and aspartate transaminase (AST), has not been addressed properly, taking into account their high collinearity. We used partial least squares (PLS) regression to identify the contribution of ALT, AST and GGT, which appears causally associated with diabetes as a validation factor, to incident diabetes in a South China population where liver impairment and diabetes are common. METHODS Participants were from the Guangzhou Biobank Cohort Study recruited in 2003-2008, with follow-up re-examination up to the end of 2012. Multivariable generalised linear models and PLS were used to examine the adjusted associations of ALT, AST and GGT with diabetes. Incident diabetes was defined as self-reported diabetes, and/or initiation of hypoglycaemia medication or insulin during follow-up, or fasting glucose ≥7.0 mmol/L, or 2 h oral glucose tolerance test, glucose ≥11.1 mmol/L at follow-up examination. RESULTS In 10 764 Chinese participants aged ≥50 years with no diabetes at baseline, 1228 (11.4%) developed diabetes during the median 4 years of follow-up. Using PLS, the risk for incident diabetes was higher by 18% (95% CI 8% to 27%) per 1 SD increment in log-ALT, and expectedly higher by 36% (95% CI 26% to 52%) for log-GGT, adjusted for age, sex, education, smoking, alcohol, physical activity, waist circumference and body mass index. Similarly adjusted, no association for log-AST (relative risk 0.92, 95% CI 0.85 to 1.01) was found. CONCLUSIONS ALT but not AST was associated with incident diabetes. Further experimental studies are needed to confirm the causal association and clarify the underlying mechanisms.
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Affiliation(s)
- L Xu
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - C Q Jiang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - C M Schooling
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong CUNY School of Public Health and Hunter College, New York, USA
| | - W S Zhang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - K K Cheng
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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193
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Kullak-Ublick GA, Merz M, Griffel L, Kaplowitz N, Watkins PB. Liver safety assessment in special populations (hepatitis B, C, and oncology trials). Drug Saf 2015; 37 Suppl 1:S57-62. [PMID: 25352328 PMCID: PMC4212149 DOI: 10.1007/s40264-014-0186-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The FDA guidance for industry in the premarketing clinical evaluation of drug-induced liver injury (DILI) is the most specific regulatory guidance currently available and has been useful in setting standards for the great majority of clinical indications involving subjects with a low risk of liver disorders. However, liver safety assessment faces challenges in populations with underlying liver disease, such as viral hepatitis or metastatic cancer. This is an important issue because there are currently many promising anti-viral and oncologic therapies in clinical development, with a trend toward oral therapies with reduced side effects. Without clearer guidelines, questions regarding liver safety may become a major factor in regulatory approval and ultimately physician uptake of the new treatments. The lack of consensus in defining stopping rules based on serum alanine aminotransferase (ALT) levels underscores the need for precompetitive data sharing to improve our understanding of DILI in these populations and to allow evidence-based rather than empirical definition of stopping rules. A workshop was convened to discuss best practices for the assessment of drug-induced liver injury (DILI) in clinical trials.
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Affiliation(s)
- Gerd A Kullak-Ublick
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland,
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194
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Froud T, Venkat SR, Barbery KJ, Gunjan A, Narayanan G. Liver Function Tests Following Irreversible Electroporation of Liver Tumors: Experience in 174 Procedures. Tech Vasc Interv Radiol 2015; 18:140-6. [PMID: 26365543 DOI: 10.1053/j.tvir.2015.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Irreversible electroporation (IRE) is a relatively new ablation modality that uses electric currents to cause cell death. It is commonly used to treat primary and secondary liver tumors in patients with normal liver function and preexisting cirrhosis. Retrospective analysis of 205 procedures sought to evaluate changes in liver function after IRE. Liver function tests (LFTs) results before and after IRE were evaluated from 174 procedures in 124 patients. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (ALKP), and total bilirubin levels were analyzed. The study was Health Insurance Portability and Accountability Act compliant and institutional review board approved. Informed consent was waived. Changes in LFT results after IRE were compared with baseline and were followed up over time to see if they resolved. Changes were compared with volume of ablation. The greatest perturbations were in transaminase levels. The levels increased sharply within 24 hours after IRE in 129 (74.1%) procedures to extreme levels (more than 20 times the upper limit of normal in one-third of cases). Resolution occurred in 95% and was demonstrated to have occurred by a mean of approximately 10 weeks, many documented as early as 7 days after procedure. ALKP levels elevated in 10% procedures, was slower to increase, and was less likely to resolve. Total bilirubin level demonstrated 2 different patterns of elevation--early and late--and similar to ALKP, it was more likely to remain elevated. There was no increased risk in patients with cirrhosis or cholangiocarcinoma. There was no correlation of levels with volume of ablation. IRE results in significant abnormalities in LFT results, but in most of the cases, these are self-limiting, do not preclude treatment, and are similar to the changes seen after radiofrequency and cryoablation in the liver.
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Affiliation(s)
- Tatiana Froud
- Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
| | - Shree R Venkat
- Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Katuzka J Barbery
- Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Arora Gunjan
- Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Govindarajan Narayanan
- Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL
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195
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Rey JW, Jahn-Eimermacher A, Doernberger V, Barreiros AP, Krupp M, Hoffman A, Kiesslich R, Müller-Schilling M, Galle PR, Teufel A. To biopsy or not to biopsy: evaluation of a large German cohort of patients with abnormal liver tests of unknown etiology. Digestion 2015; 89:310-8. [PMID: 25074257 DOI: 10.1159/000362404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/21/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Despite increasingly sensitive and accurate blood tests to detect liver disease, liver biopsy remains very useful in patients with atypical clinical features and abnormal liver tests of unknown etiology. The aim was to determine those elevated laboratory liver parameters that cause the clinician to order a biopsy, and whether laboratory tests are associated with pathological findings on histology. METHODS 504 patients with unclear hepatopathy, admitted to the outpatient clinic of a university hospital between 2007 and 2010, were analyzed with respect to laboratory results, clinical data, and the results of liver biopsies. RESULTS Aspartate aminotransferase (AST) and glutamate dehydrogenase (GLDH) levels above the normal range significantly increased the likelihood of recommending a liver biopsy by 81% [OR with 95% CI 1.81 (1.21-2.71), p = 0.004] and 159% [OR with 95% CI 2.59 (1.70-3.93), p < 0.001], respectively. AST values above normal were associated with fibrosis (63 vs. 40% for normal AST, p = 0.010). Elevated ferritin levels pointed to a higher incidence of steatosis (48 vs. 10% for normal ferritin, p < 0.001) and inflammation (87 vs. 62% for normal ferritin, p = 0.004). CONCLUSIONS Our results indicate that elevated AST and GLDH were associated with a greater likelihood of recommending liver biopsy. Elevated AST and ferritin levels were associated with steatosis, inflammation and fibrosis on liver biopsies. Thus, AST and ferritin may be useful non-invasive predictors of liver pathology in patients with unclear hepatopathy.
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Affiliation(s)
- Johannes Wilhelm Rey
- First Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
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196
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Badrick T, Turner P. Review and Recommendations for the Component Tests in the Liver Function Test Profile. Indian J Clin Biochem 2015; 31:21-9. [PMID: 26855484 DOI: 10.1007/s12291-015-0493-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/21/2015] [Indexed: 01/01/2023]
Abstract
Pathology laboratories group some tests that they perform on their high throughput biochemistry analysers into profiles of tests that are associated with different organs (e.g. liver function tests-LFT). The components of these profiles are historic and often vary between different laboratories. This can lead to confusion and begs the question of what should be in a particular profile. In community medicine profiles may be used as screening tests but some of the components of the profiles may have low sensitivity and specificity and may produce both false positives and negatives. The LFT may include components which are poor liver function tests but are sensitive to fatty liver and hence elevations may cause unnecessary concern. Harmonisation of clinical chemistry reference intervals and units is occurring now so it is time to consider a similar process for components of a profile. A proposed list of analytes to be performed in the LFT profile is given.
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Affiliation(s)
- Tony Badrick
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia ; Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards, Sydney, Australia
| | - Peter Turner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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197
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Brancheau D, Patel B, Zughaib M. Do cinnamon supplements cause acute hepatitis? AMERICAN JOURNAL OF CASE REPORTS 2015; 16:250-4. [PMID: 25923145 PMCID: PMC4423171 DOI: 10.12659/ajcr.892804] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Female, 73 Final Diagnosis: Drug induced acute hepatitis Symptoms: Abdominal pain • diarrhea • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Daniel Brancheau
- Section of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA
| | - Brijesh Patel
- Section of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA
| | - Marcel Zughaib
- Department of Internal Medicine, Providence Hospital and Medical Center, Southfield, MI, USA
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198
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Powles T, Bracarda S, Chen M, Norry E, Compton N, Heise M, Hutson T, Harter P, Carpenter C, Pandite L, Kaplowitz N. Characterisation of liver chemistry abnormalities associated with pazopanib monotherapy: a systematic review and meta-analysis of clinical trials in advanced cancer patients. Eur J Cancer 2015; 51:1293-302. [PMID: 25899987 DOI: 10.1016/j.ejca.2015.03.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/23/2015] [Indexed: 12/19/2022]
Abstract
Drug-induced liver chemistry abnormalities, primarily transaminase elevations, are commonly observed in pazopanib-treated patients. This meta-analysis characterises liver chemistry abnormalities associated with pazopanib. Data of pazopanib-treated patients from nine prospective trials were integrated (N=2080). Laboratory datasets were used to characterise the incidence, timing, recovery and patterns of liver events, and subsequent rechallenge with pazopanib. Severe cases of liver chemistry abnormalities were clinically reviewed. Multivariate analyses identified predisposing factors. Twenty percent of patients developed elevated alanine aminotransferase (ALT) >3×ULN. Incidence of peak ALT >3-5×ULN, >5-8×ULN, >8-20×ULN and >20×ULN was 8%, 5%, 5% and 1%, respectively. Median time to onset for all events was 42days; 91% of events were observed within 18weeks. Recovery rates based on peak ALT >3-5×ULN, >5-8×ULN, >8-20×ULN and >20×ULN were 91%, 90%, 90% and 64%, respectively. Median time from onset to recovery was 30days, but longer in patients without dose interruption. Based on clinical review, no deaths were associated with drug-induced liver injury. Overall, 38% of rechallenged patients had ALT elevation recurrence, with 9-day median time to recurrence. Multivariate analysis showed that older age was associated with development of ALT >8×ULN. There was no correlation between hypertension and transaminitis. Our data support the current guidelines on regular liver chemistry tests after initiation of pazopanib, especially during the first 9 or 10weeks, and also demonstrate the safety of rechallenge with pazopanib.
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Affiliation(s)
- Thomas Powles
- Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London EC1A 7BE, UK.
| | - Sergio Bracarda
- Medical Oncology Unit, San Donato Hospital, Arezzo 52100, Italy
| | - Mei Chen
- GlaxoSmithKline, Collegeville, Pennsylvania 17426-0989, USA
| | - Elliot Norry
- GlaxoSmithKline, Collegeville, Pennsylvania 17426-0989, USA
| | | | - Mark Heise
- GlaxoSmithKline, Collegeville, Pennsylvania 17426-0989, USA
| | - Thomas Hutson
- Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX 75246, USA
| | - Philipp Harter
- Departments of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen 45136, Germany
| | | | - Lini Pandite
- GlaxoSmithKline, Research Triangle Park, North Carolina 27709, USA
| | - Neil Kaplowitz
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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199
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Dey T, Gogoi K, Unni B, Bharadwaz M, Kalita M, Ozah D, Kalita M, Kalita J, Baruah PK, Bora T. Role of environmental pollutants in liver physiology: special references to peoples living in the oil drilling sites of Assam. PLoS One 2015; 10:e0123370. [PMID: 25874634 PMCID: PMC4395329 DOI: 10.1371/journal.pone.0123370] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
The populations residing near polluted sites are more prone to various types of diseases. The important causes of air pollution are the suspended particulate matter, respirable suspended particulate matter, sulfur dioxide and nitrogen dioxide. As limited information is available enumerating the effect of these pollutants on liver physiology of the population living near the polluted sites; in the present study, we tried to investigate their effect on liver of the population residing near the oil drilling sites since birth. In this study, a randomly selected 105 subjects (46 subjects from oil drilling site and 61 subjects from control site) aged above 30 years were taken under consideration. The particulate matter as well as the gaseous pollutants, sulfur dioxide and nitrogen dioxide, were analyzed through a respirable dust sampler. The level of alkaline phosphatase, alanine transaminase and aspartate transaminase enzymes in serum were measured by spectrophotometer. The generalized regression model studies suggests a higher concentration of respirable suspended particulate matter, suspended particulate matter and nitrogen dioxide lowers the alkaline phosphatase level (p<0.0001) by 3.5 times (95% CI 3.1-3.9), 1.5 times (95% CI 1.4 - 1.6) and 12 times (95% CI 10.74 -13.804), respectively in the exposed group. The higher concentration of respirable suspended particulate matter and nitrogen dioxide in air was associated with increase in alanine transaminase level (p<0.0001) by 0.8 times (95% CI 0.589-1.049) and by 2.8 times (95% CI 2.067-3.681) respectively in the exposed group. The increase in nitrogen dioxide level was also associated with increase in aspartate transaminase level (p<0.0001) by 2.5 times (95% CI 1.862 – 3.313) in the exposed group as compared to control group. Thus, the study reveals that long-term exposure to the environmental pollutants may lead to liver abnormality or injury of populations living in polluted sites.
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Affiliation(s)
- Tapan Dey
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Kabita Gogoi
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Balagopalan Unni
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
- * E-mail:
| | - Moonmee Bharadwaz
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Munmi Kalita
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Dibyajyoti Ozah
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Manoj Kalita
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Jatin Kalita
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Pranab Kumar Baruah
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
| | - Thaneswar Bora
- Biotechnology Division, Council of Scientific & Industrial Research—North-East Institute of Science and Technology, Jorhat, Assam, India
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200
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Kang H, Zhao Y, Li C, Chen Y, Tang K, Yang L, Ma C, Peng J, Zhu R, Liu Q, Hu Y, Cao Z. Integrating clinical indexes into four-diagnostic information contributes to the Traditional Chinese Medicine (TCM) syndrome diagnosis of chronic hepatitis B. Sci Rep 2015; 5:9395. [PMID: 25797918 PMCID: PMC4369723 DOI: 10.1038/srep09395] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 03/03/2015] [Indexed: 12/20/2022] Open
Abstract
Traditional Chinese Medicine (TCM) treatment has been commonly used to treat Chronic Hepatitis B (CHB) in Asian countries based on TCM syndrome diagnosis, also called "ZHENG". The syndrome is identified through the four-diagnostic methods, with certain degree of subjectivity and ambiguity from individual doctors. Normally those CHB patients also receive series of parameters from modern clinical examination, while they are routinely believed to be unrelated with the TCM syndrome diagnosis. In this study, we investigated whether these biomedical indexes in modern medicine could be beneficial to TCM syndrome diagnostics in an integrative way. Based on 634 patient samples from health controls and three subtypes of CHB syndromes, a two-view based hierarchical classification model was tested for TCM syndromes prediction based on totally 222 parameters integrated from both TCM practice and modern clinical tests. The results indicated that the performance of syndrome classification based on a proper integration of TCM and modern clinical indexes was significantly higher than those based on one view of parameters only. Furthermore, those indexes correlated with CHB syndrome diagnosis were successfully identified for CM indexes and biochemical indexes respectively, where potential associations between them were hinted to the MAPK signaling pathway.
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Affiliation(s)
- Hong Kang
- 1] School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China [2] School of Biomedical Informatics, University of Texas Health Science Center, Houston. TX 77030, USA
| | - Yu Zhao
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R.China
| | - Chao Li
- School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China
| | - Yujia Chen
- School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China
| | - Kailin Tang
- School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China
| | - Linlin Yang
- School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China
| | - Chao Ma
- Key Lab of Systems Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, P.R.China
| | - Jinghua Peng
- Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R.China
| | - Ruixin Zhu
- School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China
| | - Qi Liu
- School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China
| | - Yiyang Hu
- 1] Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R.China [2] E-Institute of TCM Internal Medicine, Shanghai Municipal Education Commission, Shanghai 200003, P.R.China
| | - Zhiwei Cao
- 1] School of Life Sciences and Technology, Tongji University, Shanghai 200092, P.R.China [2] Key Lab of Systems Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, P.R.China
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