Bilirubin as a Biomarker in Liver Disease

Hepatoprotective effect of ethanolic extract of sugarcane (Saccharum officinarum Linn.) leaves

OBJECTIVES

The sugarcane leaf is rich inphytochemical content. It is rarely used because it is a waste although it has potential activity as antimutation, anti inflammation, and antioxidation. There is no study about its hepatoprotective activity yet. This study was conducted to determine the hepatoprotection of sugarcane leaves in tested animals with liver acute injury induced by carbon tetrachloride (CCl₄).

METHODS

Twenty-four Wistar strain rats were divided into three groups of experimental animals (dose 300, 400, and 500 mg/kg) and three control groups (normal, positive, and negative). The ethanol extract of sugarcane leaves obtained from Panti, Jember, was made using the maceration method. The animals were treated for 14 days by giving the extract to the treatment group. One hour after treatment on the last day, the test animals were given CCl₄ intraperitoneally except for the normal group. On the 15th day, the blood of the test animal was taken to be tested for the biochemical value of the liver (aspartate transaminase (AST), alanine aminotransferase (ALT), alanine phosphatase (ALP), and bilirubin) and examined for its liver to be made histological preparations.

RESULTS

The results showed that the treatment with a dose of 500 mg/kg was able to decrease AST, ALT, ALP, and bilirubin parameters compared to the negative control. The extract also provided improvements in liver tissue histology compared to the negative control.

CONCLUSIONS

Sugarcane leaf ethanol extract (SCLE) has a potential hepatoprotective effect.

When special populations intersect with drug-drug interactions: Application of physiologically-based pharmacokinetic modeling in pregnant populations

Pregnancy results in significant physiological changes that vary across trimesters and into the postpartum period, and may result in altered disposition of endogenous substances and drug pharmacokinetics. Pregnancy represents a unique special population where physiologically-based pharmacokinetic modeling (PBPK) is well suited to mechanistically explore pharmacokinetics and dosing paradigms without subjecting pregnant women or their fetuses to extensive clinical studies. A critical review of applications of pregnancy PBPK models (pPBPK) was conducted to understand its current status for prediction of drug exposure in pregnant populations and to identify areas of further expansion. Evaluation of existing pPBPK modeling efforts highlighted improved understanding of cytochrome P450 (CYP)-mediated changes during pregnancy and identified knowledge gaps for non-CYP enzymes and the physiological changes of the postpartum period. Examples of the application of pPBPK beyond simple dose regimen recommendations are limited, particularly for prediction of drug-drug interactions (DDI) or differences between genotypes for polymorphic drug metabolizing enzymes. A raltegravir pPBPK model implementing UGT1A1 induction during the second and third trimesters of pregnancy was developed in the current work and verified against clinical data. Subsequently, the model was used to explore UGT1A1-related DDI risk with atazanavir and rifampicin along with the effect of enzyme genotype on raltegravir apparent clearance. Simulations of pregnancy-related induction of UGT1A1 either exacerbated UGT1A1 induction by rifampicin or negated atazanavir UGT1A1 inhibition. This example illustrated the advantages of pPBPK modeling for mechanistic evaluation of complex interplays of pregnancy- and drug-related effects in support of model-informed approaches in drug development.