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Pelizzo P, Stebel M, Medic N, Sist P, Vanzo A, Anesi A, Vrhovsek U, Tramer F, Passamonti S. Cyanidin 3-glucoside targets a hepatic bilirubin transporter in rats. Biomed Pharmacother 2023; 157:114044. [PMID: 36463829 DOI: 10.1016/j.biopha.2022.114044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
One of the organ-specific functions of the liver is the excretion of bilirubin into the bile. Membrane transport of bilirubin from the blood to the liver is not only an orphan function, because there is no link to the protein/gene units that perform this function, but also a poorly characterised function. The aim of this study was to investigate the pharmacology of bilirubin uptake in the liver of the female Wistar rat to improve basic knowledge in this neglected area of liver physiology. We treated isolated perfused livers of female rats with repeated single-pass, albumin-free bilirubin boli. We monitored both bilirubin and bilirubin glucuronide in perfusion effluent with a bio-fluorometric assay. We tested the ability of nine molecules known as substrates or inhibitors of sinusoidal membrane transporters to inhibit hepatic uptake of bilirubin. We found that cyanidin 3-glucoside and malvidin 3-glucoside were the only molecules that inhibited bilirubin uptake. These dietary anthocyanins resemble bromosulfophthalein (BSP), a substrate of several sinusoidal membrane transporters. The SLCO-specific substrates estradiol-17 beta-glucuronide, pravastatin, and taurocholate inhibited only bilirubin glucuronide uptake. Cyanidin 3-glucoside and taurocholate acted at physiological concentrations. The SLC22-specific substrates indomethacin and ketoprofen were inactive. We demonstrated the existence of a bilirubin-glucuronide transporter inhibited by bilirubin, a fact reported only once in the literature. The data suggest that bilirubin and bilirubin glucuronide are transported to the liver via pharmacologically distinct membrane transport pathways. Some dietary anthocyanins may physiologically modulate the uptake of bilirubin into the liver.
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Affiliation(s)
- Paola Pelizzo
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Marco Stebel
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Nevenka Medic
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Paola Sist
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Andreja Vanzo
- Department of Fruit Growing, Viticulture and Oenology, Agricultural Institute of Slovenia, Hacquetova ulica 17, SI-1000 Ljubljana, Slovenia
| | - Andrea Anesi
- Food Quality and Nutrition, Research and Innovation Centre, Edmund Mach Foundation, Via E. Mach 1, 38010 San Michele all'Adige, Italy
| | - Urska Vrhovsek
- Food Quality and Nutrition, Research and Innovation Centre, Edmund Mach Foundation, Via E. Mach 1, 38010 San Michele all'Adige, Italy
| | - Federica Tramer
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Sabina Passamonti
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy.
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Hilscher MB, Kamath PS, Eaton JE. Cholestatic Liver Diseases: A Primer for Generalists and Subspecialists. Mayo Clin Proc 2020; 95:2263-2279. [PMID: 33012354 DOI: 10.1016/j.mayocp.2020.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 02/08/2023]
Abstract
Cholestasis describes impairment in bile formation or flow which can manifest clinically with fatigue, pruritus, and jaundice. The differential diagnosis of cholestatic liver diseases is broad, and the etiologies of cholestasis vary in the anatomical location of the defect and acuity of presentation. Cholestasis may occur in a variety of clinical scenarios. Therefore, it is important for a diverse audience with varied clinical practices to have a basic understanding of manifestations of cholestatic liver diseases.
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Affiliation(s)
- Moira B Hilscher
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - John E Eaton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Nehme J, Borghesan M, Mackedenski S, Bird TG, Demaria M. Cellular senescence as a potential mediator of COVID-19 severity in the elderly. Aging Cell 2020; 19:e13237. [PMID: 32955770 PMCID: PMC7576296 DOI: 10.1111/acel.13237] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/10/2023] Open
Abstract
SARS-CoV-2 is a novel betacoronavirus which infects the lower respiratory tract and can cause coronavirus disease 2019 (COVID-19), a complex respiratory distress syndrome. Epidemiological data show that COVID-19 has a rising mortality particularly in individuals with advanced age. Identifying a functional association between SARS-CoV-2 infection and the process of biological aging may provide a tractable avenue for therapy to prevent acute and long-term disease. Here, we discuss how cellular senescence-a state of stable growth arrest characterized by pro-inflammatory and pro-disease functions-can hypothetically be a contributor to COVID-19 pathogenesis, and a potential pharmaceutical target to alleviate disease severity. First, we define why older COVID-19 patients are more likely to accumulate high levels of cellular senescence. Second, we describe how senescent cells can contribute to an uncontrolled SARS-CoV-2-mediated cytokine storm and an excessive inflammatory reaction during the early phase of the disease. Third, we discuss the various mechanisms by which senescent cells promote tissue damage leading to lung failure and multi-tissue dysfunctions. Fourth, we argue that a high senescence burst might negatively impact on vaccine efficacy. Measuring the burst of cellular senescence could hypothetically serve as a predictor of COVID-19 severity, and targeting senescence-associated mechanisms prior and after SARS-CoV-2 infection might have the potential to limit a number of severe damages and to improve the efficacy of vaccinations.
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Affiliation(s)
- Jamil Nehme
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
- Doctoral School of Science and TechnologyLebanese UniversityBeirutLebanon
| | - Michela Borghesan
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
| | - Sebastian Mackedenski
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
| | - Thomas G. Bird
- Cancer Research UK Beatson InstituteGlasgowUK
- Institute of Cancer SciencesUniversity of GlasgowGlasgowUK
- MRC Centre for Inflammation ResearchThe Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | - Marco Demaria
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
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Suliman HM, Osman B, Abdoon IH, Saad AM, Khalid H. Ameliorative activity of Adansonia digitata fruit on high sugar/high fat diet-simulated Metabolic Syndrome model in male Wistar rats. Biomed Pharmacother 2020; 125:109968. [PMID: 32066041 DOI: 10.1016/j.biopha.2020.109968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/11/2022] Open
Abstract
Metabolic syndrome is a complex of metabolic disorders characterized by oxidative stress which compromises cell functions and entails multiple organs pathologies. We investigated the therapeutic and protective potential of Adansonia digitata fruit -a potent antioxidant- in high sugar/high fat diet-simulated metabolic syndrome in Wistar rats. 42 male rats (140-200 g) were randomly divided into 7 groups. G1 was kept on standard laboratory diet (SLD) for all 9 weeks (negative control). 5 groups were fed high Sugar/high fat diet for 6 weeks then switched to SLD for another 3 weeks + oral treatment as follows: G2+ no treatment (positive control), G3-G5 + 200, 400 and 800 mg/kg/day aqueous A. digitata fruit respectively, G6 + 10 mg/kg/day Simvastatin. G7 + HS/HFD + 400 mg/kg/day A. digitata fruit simultaneously and was terminated at W6. Our results showed that G2-G6 develops dyslipidemia, hyperglycaemia, weight gain, elevated hepatic biomarkers, elevated creatinine and urea plus pathological derangements in the heart, liver and kidney tissues compared to negative control at W6. 200 mg/kg/day A. digitata fruit significantly ameliorated the induced dyslipidemia (P ≤ 0.001), hyperglycaemia (P ≤ 0.001) with a significant reduction in the Atherogenic Index of Plasma (P ≤ 0.000) after 3 weeks treatment. The fruit normalized the elevated hepatic biomarkers as well as creatinine and urea. A dose dependent partial reduction in lesion intensity was observed in the hepatic tissue while the heart and kidney showed mostly reversed to normal histology. The inflammatory infiltration was eliminated. Relevant results were observed for the two higher doses. The simultaneous treatment showed significant lower levels in all biomarkers investigated compared to positive control which could be interpreted as protective activity. A reduction of 4-11% in whole body weight was achieved. CONCLUSION: MetS was successfully simulated with a HS/HFD formula in male Wistar rats. Treatment with aqueous A. digitata fruit showed anti-Metabolic Syndrome potential reflected by weight loss, anti-inflammatory, hypolipidemic, hypoglycaemic, renal, hepatic and cardio-protective activities.
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Affiliation(s)
- Hayat Mohamed Suliman
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, 1111 Al Qasr Avenue, P.O.B 1996, Khartoum, Sudan.
| | - Bashier Osman
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, 1111 Al Qasr Avenue, P.O.B 1996, Khartoum, Sudan
| | - Iman H Abdoon
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, 1111 Al Qasr Avenue, P.O.B 1996, Khartoum, Sudan
| | - Amir Mustafa Saad
- Department of Pathology, Faculty of Veterinary Medicine, University of Khartoum, Sudan
| | - Hassan Khalid
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Sudan
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Fielding CL, Rhodes DM, Howard EJ, Mayer JR. Evaluation of potential predictor variables for PCR assay diagnosis of Anaplasma phagocytophilum infection in equids in Northern California. Am J Vet Res 2018; 79:637-642. [PMID: 30085857 DOI: 10.2460/ajvr.79.6.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify clinical or clinicopathologic variables that can be used to predict a positive PCR assay result for Anaplasma phagocytophilum infection in equids. ANIMALS 162 equids. PROCEDURES Medical records were reviewed to identify equids that underwent testing for evidence of A phagocytophilum infection by PCR assay between June 1, 2007, and December 31, 2015. For each equid that tested positive (case equid), 2 time-matched equids that tested negative for the organism (control equids) were identified. Data collected included age, sex, breed, geographic location (residence at the time of testing), physical examination findings, and CBC and plasma biochemical analysis results. Potential predictor variables were analyzed by stepwise logistic regression followed by classification and regression tree analysis. Generalized additive models were used to evaluate identified predictors of a positive test result for A phagocytophilum. RESULTS Total lymphocyte count, plasma total bilirubin concentration, plasma sodium concentration, and geographic latitude were linear predictors of a positive PCR assay result for A phagocytophilum. Plasma creatine kinase activity was a nonlinear predictor of a positive result. CONCLUSIONS AND CLINICAL RELEVANCE Assessment of predictors identified in this study may help veterinarians identify equids that could benefit from early treatment for anaplasmosis while definitive test results are pending. This information may also help to prevent unnecessary administration of oxytetracycline to equids that are unlikely to test positive for the disease.
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Lee WC, Shih SC, Wang HY, Wu CL, Lee SY, Ku HC. Adrenal Insufficiency Associated with Cholestatic Jaundice: A Case Report. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pereira NMD, Shah I. Neonatal cholestasis mimicking biliary atresia: Could it be urinary tract infection? SAGE Open Med Case Rep 2017; 5:2050313X17695998. [PMID: 28321310 PMCID: PMC5347411 DOI: 10.1177/2050313x17695998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/02/2017] [Indexed: 11/16/2022] Open
Abstract
Cholestasis can occur in newborns due to infections. However, the manifestations of the underlying infections usually dominate the presentation. We present a 2-month-old infant who presented with jaundice and no fever or signs of systemic illness. Liver biopsy was suggestive of cholangitis. He was subsequently detected to have urinary tract infection with Klebsiella pneumoniae. The child was treated with appropriate antibiotics for 2 weeks following which the cholestasis resolved. Thus, neonatal cholestasis due to infections can also occur in the post-neonatal period without clinical manifestations of an underlying infection.
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Affiliation(s)
| | - Ira Shah
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
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Hyperbilirubinemia as a predictive factor in acute appendicitis. Eur J Trauma Emerg Surg 2015; 42:471-476. [PMID: 26253886 DOI: 10.1007/s00068-015-0562-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
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Ellis LCJ, Grant MH, Hawksworth GM, Weaver RJ. Quantification of biliary excretion and sinusoidal excretion of 5(6)-carboxy-2',7'-dichlorofluorescein (CDF) in cultured hepatocytes isolated from Sprague Dawley, Wistar and Mrp2-deficient Wistar (TR(-)) rats. Toxicol In Vitro 2014; 28:1165-75. [PMID: 24907646 DOI: 10.1016/j.tiv.2014.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/14/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
Hepatic efflux of drug candidates is an important issue in pre-clinical drug development. Here we utilise a method which quantifies and distinguishes efflux of drugs at the canalicular and sinusoidal membranes in rat hepatocyte cultures. Bi-phasic kinetics of transport of 5(6)-carboxydichlorofluorescein (CDF) at the canalicular membrane was demonstrated in Sprague Dawley (SD) and Wistar (W) rat hepatocytes. The high affinity component (Km=3.2±0.8μM (SD), 9.0±3.1μM (W)) was attributed to Mrp2-mediated transport, the low affinity component (Km=192.1±291.5μM (SD), 69.2±36.2μM (W)) may be attributed to transport involving a separate Mrp2 binding site. Data from membranes (Hill coefficient (h)=2.0±0.5) and vesicles (h=1.6±0.2) expressing Mrp2 and from SD (h=1.6±0.4) and Wistar (h=4.0±0.6) hepatocytes suggests transport involves more than one binding site. In TR(-) hepatocytes, CDF efflux was predominantly over the sinusoidal membrane (Km=100.7±36.0μM), consistent with low abcc2 (Mrp2) expression and compensatory increase in abcc3 (Mrp3) expression. This report shows the potential of using this in vitro method to model changes in biliary excretion due to alterations in transporter expression.
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Affiliation(s)
- L C J Ellis
- Section of Translational Medicine, Division of Applied Medicine, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - M H Grant
- Department of Biomedical Engineering, Bioengineering Unit, University of Strathclyde, Glasgow G4 0NW, UK
| | - G M Hawksworth
- Section of Translational Medicine, Division of Applied Medicine, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - R J Weaver
- Biologie Servier, Drug Safety Research Centre, 905 Route de Saran, 45520 Gidy, France
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10
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Abourazzak S, Bouharrou A, Hida M. [Jaundice and urinary tract infection in neonates: simple coincidence or real consequence?]. Arch Pediatr 2013; 20:974-8. [PMID: 23891551 DOI: 10.1016/j.arcped.2013.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 04/27/2013] [Accepted: 06/11/2013] [Indexed: 11/15/2022]
Abstract
UNLABELLED In neonates, jaundice may be one of the initial symptoms related to urinary tract infection (UTI). The routine testing of the urine in jaundiced neonates is controversial. This study aimed to evaluate the related factors of neonatal infants with the initial presentation of hyperbilirubinemia and the final diagnosis of UTI by evaluating data that help diagnose UTI early in apparently healthy newborns with jaundice. PATIENTS AND METHODS We retrospectively investigated the medical records of neonates who had been admitted for management of jaundice (n=26) and compared with neonates with jaundice but without UTI (n=26). RESULTS There was a significant difference between the two groups in male gender and maternal conditions (prolonged rupture of membranes, maternal UTI). There was also a significant difference between the two groups in their age at the time jaundice started (4 ± 3 days vs 2 ± 1 days) in the UTI and non-UTI groups, respectively (P>0.05). The cases in the UTI group had significantly lower total bilirubin levels (183 ± 71 mg/l) vs (227 ± 40 mg/l) in the non-UTI group, but a higher indirect bilirubin rate than the non-UTI group (P<0.05). Type B blood group was more common in neonates with UTI (P<0.01). In the cases presented herein, none of the jaundiced infants with UTI presented conjugated hyperbilirubinemia. Therefore, urinary tests for UTI should not be absolutely excluded or neglected in neonates in the early stage with unconjugated hyperbilirubinemia. Performing urinary tests to exclude the possibility of coincidental UTI may be necessary for admitted jaundiced infants younger than if they have a high level of indirect bilirubin, especially in male newborns with group B blood and in the presence of maternal urinary infection.
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Affiliation(s)
- S Abourazzak
- Service de pédiatrie, hôpital mère-enfant, CHU Hassan II, Fès, Maroc.
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Magdaleno I, Peña-López Y, Ortega J, Balcells J. Disfunción hepática grave por endotoxemia secundaria a colonización de catéter venoso central. An Pediatr (Barc) 2013; 78:198-9. [DOI: 10.1016/j.anpedi.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/08/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022] Open
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Jäger B, Drolz A, Michl B, Schellongowski P, Bojic A, Nikfardjam M, Zauner C, Heinz G, Trauner M, Fuhrmann V. Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis. Hepatology 2012; 56:2297-304. [PMID: 22706920 DOI: 10.1002/hep.25896] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 05/28/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED Hypoxic hepatitis (HH) is the most frequent cause of acute liver injury in critically ill patients. No clinical data exist about new onset of jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of jaundice in critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of jaundice during the course of HH. Individuals with preexisting jaundice or liver cirrhosis at the time of admission (n = 31) were excluded from analysis. Jaundice was diagnosed in patients with plasma total bilirubin levels >3 mg/dL. One-year-survival, infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of jaundice was 6 days (interquartile range, 3-8). Patients who developed jaundice (group 1) needed vasopressor treatment (P < 0.05), renal replacement therapy (P < 0.05), and mechanical ventilation (P < 0.05) more often and had a higher maximal administered dose of norepinephrine (P < 0.05), compared to patients without jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P < 0.05). Occurrence of jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P < 0.05). In particular, infections as well as renal and GI complications occurred more frequently in group 1 during follow-up. CONCLUSION Jaundice is a common finding during the course of HH. It leads to an increased rate of complications and worse outcome in patients with HH.
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Affiliation(s)
- Bernhard Jäger
- Intensive Care Unit 13h1, Department of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
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EASL recognition awardee 2012: Professor Peter L.M. Jansen. J Hepatol 2012; 57:241-3. [PMID: 22682607 DOI: 10.1016/j.jhep.2012.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/08/2012] [Indexed: 12/04/2022]
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Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl 2011; 93:213-7. [PMID: 21477433 DOI: 10.1308/147870811x566402] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION No reliably specific marker for acute appendicitis has been identified. Although recent studies have shown hyperbilirubinaemia to be a useful predictor of appendiceal perforation, they did not focus on the value of bilirubin as a marker for acute appendicitis. The aim of this study was to determine the value of hyperbilirubinaemia as a marker for acute appendicitis. MATERIALS AND METHODS A retrospective analysis of appendicectomies performed in two hospitals (n=472). Data collected included laboratory and histological results. Patients were grouped according to histology findings and comparisons were made between the groups. RESULTS The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (p<0.001). More patients with simple appendicitis had hyperbilirubinaemia on admission (30% vs 12%) and the odds of these patients having appendicitis were over three times higher (odds ratio: 3.25, p<0.001). Hyperbilirubinaemia had a specificity of 88% and a positive predictive value of 91% for acute appendicitis. Patients with appendicitis who had a perforated or gangrenous appendix had higher mean bilirubin levels (p=0.01) and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 70%. The specificities of white cell count and C-reactive protein were less than hyperbilirubinaemia for simple appendicitis (60% and 72%) and perforated or gangrenous appendicitis (19% and 36%). CONCLUSIONS Hyperbilirubinaemia is a valuable marker for acute appendicitis. Patients with hyperbilirubinaemia are also more likely to have appendiceal perforation or gangrene. Bilirubin should be included in the assessment of patients with suspected appendicitis.
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Affiliation(s)
- Andrew Emmanuel
- Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland.
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Hyperbilirubinemia in infants with Gram-negative sepsis does not affect mortality. Early Hum Dev 2011; 87:515-9. [PMID: 21543167 DOI: 10.1016/j.earlhumdev.2011.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 03/14/2011] [Accepted: 04/09/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sepsis is associated with an increased production of oxidant species and a decrease in endogenous antioxidant defenses. Mortality is high, especially when endotoxins are involved, e.g., in infants with Gram-negative sepsis. Yet, chronic as well as acute unconjugated hyperbilirubinemia has been shown to protect against endotoxin-induced shock in vivo in rats and in mice. We hypothesized that hyperbilirubinemia in infants with Gram-negative sepsis improves survival and/or mitigates the inflammatory response. OBJECTIVE To assess the relationships between serum bilirubin concentrations on the one hand, and leukocyte count, C-reactive protein and survival on the other hand, in infants with Gram-negative sepsis. METHODS Retrospectively, we retrieved clinical and biochemical data from infants less than 90 days of age with a blood culture-proven Gram-negative sepsis between January 1998 and December 2005. RESULTS We identified 92 infants with Gram-negative sepsis in the indicated period. Median gestational age was 29 (24-42) weeks. 22 Patients died. Preceding sepsis, median total serum bilirubin concentrations were below 150 μmol/L. Median concentrations of conjugated bilirubin concentrations increased (+63%, p<0.05), and median concentrations of unconjugated bilirubin decreased (-36%, p<0.05) in infants with Gram-negative sepsis. Median total bilirubin concentrations before and during sepsis were not significantly different between survivors and non-survivors. Changes in bilirubin concentrations were not significantly correlated with changes in either white blood cell count or C-reactive protein. CONCLUSION Present data do not support the concept that bilirubin positively affects survival or the inflammatory response in infants with Gram-negative sepsis.
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Aronsohn A, Jensen D. Hepatobiliary manifestations of critically ill and postoperative patients. Clin Liver Dis 2011; 15:183-97. [PMID: 21112000 DOI: 10.1016/j.cld.2010.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Liver dysfunction is common in both the critically ill and postoperative patient. Metabolic derangements secondary to sepsis, poor hepatic perfusion, total parenteral nutrition, in addition to hemodynamic and anesthetic-induced changes that occur during surgery, can cause liver damage ranging from small self-limited abnormalities in liver chemistries to acute liver failure. Early recognition, supportive care, and effective treatment of the underlying disease process are crucial steps in managing liver disease in a critically ill patient.
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Affiliation(s)
- Andrew Aronsohn
- Center for Liver Disease, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 7120, Chicago, IL 60637, USA
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Endotoxin does not alter the pharmacokinetics of micafungin, but it impairs biliary excretion of micafungin via multidrug resistance-associated protein 2 (ABCC2/Mrp2) in rats. J Infect Chemother 2011; 17:207-13. [DOI: 10.1007/s10156-010-0118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
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Garcea G, Ong SL, Maddern GJ. Predicting liver failure following major hepatectomy. Dig Liver Dis 2009; 41:798-806. [PMID: 19303376 DOI: 10.1016/j.dld.2009.01.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/24/2008] [Accepted: 01/28/2009] [Indexed: 12/11/2022]
Abstract
Pre-operative determination of the risk of liver dysfunction has come under criticism with regards to its usefulness in clinical practice. Opinion is split between centres which use such tests uniformly on all patients and those where clinical judgment alone is used. Published data would not suggest any difference in mortality, morbidity or liver failure rates between these groups. This review outlines and presents the evidence for pre-operative quantification of functional liver remnant volume.
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Affiliation(s)
- G Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia.
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19
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Mulder J, Karpen SJ, Tietge UJF, Kuipers F. Nuclear receptors: mediators and modifiers of inflammation-induced cholestasis. FRONT BIOSCI-LANDMRK 2009; 14:2599-630. [PMID: 19273222 PMCID: PMC4085779 DOI: 10.2741/3400] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Inflammation-induced cholestasis (IIC) is a frequently occurring phenomenon. A central role in its pathogenesis is played by nuclear receptors (NRs). These ligand-activated transcription factors not only regulate basal expression of hepatobiliary transport systems, but also mediate adaptive responses to inflammation and possess anti-inflammatory characteristics. The latter two functions may be exploited in the search for new treatments for IIC as well as for cholestasis in general. Current knowledge of the pathogenesis of IIC and the dual role NRs in this process are reviewed. Special interest is given to the use of NRs as potential targets for intervention.
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Affiliation(s)
- Jaap Mulder
- Department of Pediatrics Center for Liver, Digestive and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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20
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Liver failure after major hepatic resection. ACTA ACUST UNITED AC 2008; 16:145-55. [PMID: 19110651 DOI: 10.1007/s00534-008-0017-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 09/19/2008] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The consequence of excessive liver resection is the inexorable development of progressive liver failure characterised by the typical stigmata associated with this condition, including worsening coagulopathy, hyperbilirubinaemia and encephalopathy. The focus of this review will be to investigate factors contributing to hepatocyte loss and impaired regeneration. METHODS A literature search was undertaken of Pubmed and related search engines, examining for articles relating to hepatic failure following major hepatectomy. RESULTS In spite of improvements in adjuvant chemotherapy and increasing surgical confidence and expertise, the parameters determining how much liver can be resected have remained largely unchanged. A number of preoperative, intraoperative and post-operative factors all contribute to the likelihood of liver failure after surgery. CONCLUSIONS Given the magnitude of the surgery, mortality and morbidity rates are extremely good. Careful patient selection and preservation of an obligate volume of remnant liver is essential. Modifiable causes of hepatic failure include avoidance of sepsis, drainage of cholestasis with restoration of enteric bile salts and judicious use of portal triad inflow occlusion intra-operatively. Avoidance of post-operative sepsis is most likely to be achieved by patient selection, meticulous intra-operative technique and post-operative care. Modulation of portal vein pressures post-operatively may further help reduce the risk of liver failure.
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21
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Na/K-ATPase assay in the intact guinea pig liver submitted to in situ perfusion. Anal Biochem 2008; 385:65-8. [PMID: 19027708 DOI: 10.1016/j.ab.2008.10.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/15/2008] [Accepted: 10/31/2008] [Indexed: 11/22/2022]
Abstract
We describe an assay for the enzyme Na/K-ATPase in intact guinea pig livers perfused through the portal vein with modified Hank's solution. The model uses the measurement of non-radioactive rubidium ion incorporation by liver cells, both in the absence and in the presence of the specific Na/K-ATPase inhibitor ouabain, followed by a rinsing procedure with cold saline. The concentration of Rb+ in acid-digested liver lobes was measured by atomic emission spectrometry and Na/K pump activity was calculated by the difference between the incorporation of Rb+ in the absence and in the presence of ouabain. The optimal conditions for Rb+ incorporation were: perfusion flow rate, 3 ml/min per liver; perfusion time at 37 degrees C, 60 min; rinsing time with cold saline, 5-10 min; and concentration of ouabain, 3 mM. The calculated ouabain IC(50) was 100 microM. The major advantage of this model is the possibility of testing experimental drugs affecting this enzyme in conditions close to those in the intact organ.
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22
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Andrejko KM, Raj NR, Kim PK, Cereda M, Deutschman CS. IL-6 modulates sepsis-induced decreases in transcription of hepatic organic anion and bile acid transporters. Shock 2008; 29:490-6. [PMID: 17724432 PMCID: PMC2667679 DOI: 10.1097/shk.0b013e318150762b] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sepsis, a lethal inflammatory syndrome, is characterized by organ system dysfunction. In the liver, we have observed decreased expression of genes encoding proteins modulating key processes. These include organic anion and bile acid transport. We hypothesized that the inflammatory mediator IL-6 modulates altered expression of several key hepatic genes in sepsis via induction of the intracellular transcription factor signal transducer and activator of transcription (Stat) 3. Sepsis was induced in IL-6 +/+ and IL-6 -/- mice, and expression of the liver-restricted genes encoding the sodium-taurocholate cotransporter (Ntcp), the multidrug resistant protein (MRP) 2 and the organic anion transporter protein (OATP), was determined. As demonstrated previously, cecal ligation and puncture decreases expression of Ntcp, MRP-2, and OATP in IL-6 +/+ mice. Transcription elongation analysis demonstrated that altered expression resulted from decreased transcription. These changes were not observed in IL-6 -/- animals. Cecal ligation and puncture increased the DNA binding activity of Stat-3 in IL-6 +/+ but not IL-6 -/- mice. Because the promoters of Ntcp, MRP-2, and OATP do not contain Stat-3 binding sites, we postulated that altered Ntcp, MRP-2, and OATP expression resulted from activation of hepatocyte nuclear factor (HNF) 1alpha, which is IL-6 dependent. Cecal ligation and puncture decreased HNF-1alpha expression and DNA binding activity in IL-6 +/+ but not IL-6 -/- mice. Recombinant human IL-6 restored the sepsis-induced decrease in Ntcp, MRP-2, OATP, and HNF-1alpha expression in IL-6 -/- mice. We conclude that sepsis decreases the expression of three key hepatic genes via a transcriptional mechanism that is IL-6, Stat-3, and HNF-1alpha dependent.
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MESH Headings
- Animals
- Blotting, Northern
- Chemokines, CC/genetics
- Chemokines, CC/metabolism
- Electrophoretic Mobility Shift Assay
- Hepatocyte Nuclear Factor 1-alpha/genetics
- Hepatocyte Nuclear Factor 1-alpha/metabolism
- Immunoblotting
- Immunoprecipitation
- Interleukin-6/genetics
- Interleukin-6/physiology
- Liver/metabolism
- Macrophage Inflammatory Proteins/genetics
- Macrophage Inflammatory Proteins/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Multidrug Resistance-Associated Protein 2
- Organic Anion Transporters/genetics
- Organic Anion Transporters/metabolism
- Organic Anion Transporters, Sodium-Dependent/genetics
- Organic Anion Transporters, Sodium-Dependent/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- STAT3 Transcription Factor/genetics
- STAT3 Transcription Factor/metabolism
- Sepsis/genetics
- Sepsis/metabolism
- Sepsis/physiopathology
- Symporters/genetics
- Symporters/metabolism
- Transcription, Genetic
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Affiliation(s)
- Kenneth M. Andrejko
- Department of Anesthesiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Nichelle R. Raj
- Department of Anesthesiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Patrick K. Kim
- Department of Critical Care and Surgery, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Maurizio Cereda
- Department of Anesthesiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Clifford S. Deutschman
- Department of Anesthesiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- Department of Critical Care and Surgery, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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23
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Abstract
Cholestasis is a common complication of bacterial infections and sepsis. This article gives a comprehensive overview of the underlying molecular mechanisms of sepsis-associated cholestasis and jaundice, their clinical presentation, and diagnostic and therapeutic management.
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24
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Seehofer D, Stockmann M, Schirmeier A, Nüssler AK, Cho SYR, Rayes N, Koch M, Schiller R, Menger MD, Neuhaus P. Intraabdominal bacterial infections significantly alter regeneration and function of the liver in a rat model of major hepatectomy. Langenbecks Arch Surg 2007; 392:273-84. [PMID: 17380346 DOI: 10.1007/s00423-007-0169-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 02/02/2007] [Indexed: 01/22/2023]
Abstract
BACKGROUND No systematic investigations of interactions of postoperative infections and liver regeneration after resection are available. MATERIALS AND METHODS Male Sprague-Dawley rats underwent sham operation, 70% partial hepatectomy (PH), cecal ligation and puncture (CLP), or synchronous PH + CLP and were killed at regular intervals. Liver regeneration and function were measured by the mitotic index, Bromo-deoxy-uridine labeling, and Ki-67 as well as bilirubin, albumin, and indocyanine green plasma disappearance rate. The inflammatory response was evaluated by determination of IL-1beta and myeloperoxidase (MPO) activity. Bacterial concentrations in different organs were quantified. RESULTS Simultaneous CLP + PH resulted in a significantly delayed regeneration kinetic, which was most pronounced at 24 h. This was preceded by hyperinflammation with increased liberation of pro-inflammatory cytokines in the PH + CLP group at 6 h. After 48 h, the pro-inflammatory response declined, and regeneration proceeded also in the PH + CLP group. Liver function was found impaired in both groups; however, it was significantly worse in the PH + CLP group. Especially after 48 h, when regeneration peaked in this group, liver function significantly declined. At 96 h, only minor differences were seen, but the persistently elevated proliferative activity indicated the delay of regeneration after PH + CLP. CONCLUSION The present analysis shows that infectious conditions delay liver regeneration. Our data suggest a cross-linkage of both conditions via the functional liver capacity. A direct role of microorganisms seems unlikely; however, the inhibitory effect of the pro-inflammatory cytokines may be involved.
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Affiliation(s)
- Daniel Seehofer
- Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany.
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25
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Abstract
Hyperbilirubinemia, or jaundice, is common in the ICU, with incidence up to 40% among critically ill patients. Unfortunately, it is poorly understood in the critically ill, and too often presents a diagnostic dilemma to the ICU physician. Causes of jaundice in the ICU are multiple; the etiology in any given patient, multifactorial. Acute jaundice can be a harbinger or marker of sepsis, multisystem organ failure (MSOF), or a reflection of transient hypotension (shock liver), right-sided heart failure, the metabolic breakdown of red blood cells, or pharmacologic toxicity. Acute ICU jaundice is best divided into obstructive and nonobstructive. This stratification directs subsequent management and therapeutic decisions.
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Affiliation(s)
- Vishal Bansal
- Department of Surgery, University of California at San Diego, San Diego, CA, USA
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26
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Affiliation(s)
- Nisha Chand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0341, USA
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27
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Fretzayas A, Kitsiou S, Tsezou A, Alexaki A, Nicolaidou P. UGT1A1 promoter polymorphism as a predisposing factor of hyperbilirubinaemia in neonates with acute pyelonephritis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2006; 38:537-40. [PMID: 16798708 DOI: 10.1080/00365540500494087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We describe 4 jaundiced neonates with acute pyelonephritis of whom family history was positive for or pointed to Gilbert's syndrome (GS). Uridine diphosphate glucuronosyltransferase 1A1 (UGT-1A1), (TA)7 polymorphism, associated with GS was found in these neonates. We suggest that extended (TA)7 promoter, acting as a predisposing factor, contributes substantially to hyperbilirubinaemia seen in a number of neonates with urinary tract infections (UTIs).
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Affiliation(s)
- Andrew Fretzayas
- Third Department of Paediatrics, Attikon University Hospital, Athens, Greece.
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28
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Abstract
While major liver resections have become increasingly safe due to better understanding of anatomy and refinement of operative techniques, liver failure following partial hepatectomy still occurs from time to time and remains incompletely understood. Observationally, certain high-risk circumstances exist, namely, massive resection with small liver remnants, preexisting liver disease, and advancing age, where liver failure is more likely to happen. Upon review of available clinical and experimental studies, an interplay of factors such as impaired regeneration, oxidative stress, preferential triggering of apoptotic pathways, decreased oxygen availability, heightened energy-dependent metabolic demands, and energy-consuming inflammatory stimuli work to produce failing hepatocellular functions.
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Affiliation(s)
- Thomas S Helling
- Department of Surgery, University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA.
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29
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Wadia Y, Etheridge W, Smart F, Wood RP, Frazier OH. Pathophysiology of hepatic dysfunction and intrahepatic cholestasis in heart failure and after left ventricular assist device support. J Heart Lung Transplant 2005; 24:361-70. [PMID: 15797736 DOI: 10.1016/j.healun.2004.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 09/07/2004] [Accepted: 09/22/2004] [Indexed: 01/12/2023] Open
Affiliation(s)
- Yasmin Wadia
- Department of Cardiovascular Surgery Research, St. Luke's Episcopal Hospital and Texas Heart Institute, Houston, Texas 77225-0345, USA.
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30
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Vidal Company A, Gutiérrez Junquera C, Balmaseda Serrano E, Lillo Lillo M. Ictericia colestásica como complicación de una pielonefritis aguda en una niña de 6 años. An Pediatr (Barc) 2005; 62:596-7. [PMID: 15927132 DOI: 10.1157/13075559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Jones BR, Li W, Cao J, Hoffman TA, Gerk PM, Vore M. The role of protein synthesis and degradation in the post-transcriptional regulation of rat multidrug resistance-associated protein 2 (Mrp2, Abcc2). Mol Pharmacol 2005; 68:701-10. [PMID: 15917434 DOI: 10.1124/mol.105.013144] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Multidrug resistance-associated protein 2 (Mrp2, Abcc2), an organic anion transporter present in the apical membrane of hepatocytes, renal epithelial cells, and enterocytes, is postulated to undergo post-transcriptional regulation. We hypothesized that Mrp2 protein undergoes altered rates of protein synthesis or degradation consistent with different Mrp2 protein expression. We analyzed Mrp2 synthesis, expression, and degradation in control female, 19- and 20-day pregnant, and pregnenolone-16alpha-carbonitrile (PCN)-treated rats using in vivo metabolic-labeling studies with [35S]cysteine/methionine or [14C]NaHCO3, polysomal distribution analyses and ribonuclease protection assays (RPA). Mrp2 protein was significantly increased in rats treated with PCN for 2 days but significantly decreased in 19-day pregnant rats relative to controls; no significant differences were observed in Mrp2 mRNA expression among these groups. The measured half-lives of 14C-labeled Mrp2 in control, pregnant, and PCN-treated rats were 27, 36, and 22 h, respectively, and were not significantly different. The rate of incorporation of 35S into Mrp2 was highest in PCN-treated rats. Polysomal distribution analysis of Mrp2 mRNA was consistent with increased Mrp2 protein synthesis after PCN treatment. The major transcription-initiation site for rat liver determined by RPA was -98 nucleotides (nt), with other start sites observed at -213, -163, -132, and -71 nt; use of transcription sites did not differ among the groups. Differences in the degradation of Mrp2 protein cannot explain the post-transcriptional regulation of Mrp2 in control, pregnant, and PCN-treated rats. Rather, the observed difference in protein synthesis suggests an intrinsic role for the translational regulation of rat Mrp2 protein.
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Affiliation(s)
- B R Jones
- Graduate Center for Toxicology, 306 Health Sciences Research Building, University of Kentucky, Lexington, KY 40536-0305, USA
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32
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Abstract
Sepsis-associated cholestasis should always be considered as part of the differential diagnosis of jaundice in the hospitalized or critically ill patient. The development of a disproportionate elevation of serum bilirubin in comparison with serum alkaline phosphatase and serum aminotransferases should be considered an early warning sign of an underlying infection, even in the absence of fever,leukocytosis, or other signs or symptoms. Prompt recognition and appropriate medical and surgical intervention may reduce morbidity and mortality.
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Affiliation(s)
- Richard H Moseley
- Medical Service, Ann Arbor VA Health Sysytem, and Department of Internal Medicine, University of Michigan Medical Center, USA.
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33
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Geier A, Mertens PR, Gerloff T, Dietrich CG, En-Nia A, Kullak-Ublick GA, Karpen SJ, Matern S, Gartung C. Constitutive rat multidrug-resistance protein 2 gene transcription is down-regulated by Y-box protein 1. Biochem Biophys Res Commun 2003; 309:612-8. [PMID: 12963034 DOI: 10.1016/j.bbrc.2003.08.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIMS Molecular mechanisms underlying transcriptional rat multidrug-resistance protein 2 (Mrp2, Abcc2) gene regulation are mostly unclear. Given the presence of putative binding sites for the Y-box binding protein YB-1 in the regulatory sequence, its trans-regulatory influence was analyzed. METHODS Reporter assays in HepG2 cells with various Mrp2 deletion constructs in the absence and presence of co-transfected YB-1 were performed. DNA binding studies with recombinant YB-1 protein and nuclear extracts obtained from HepG2 cells and rat liver tissue were carried out. RESULTS The minimal promoter sequence was confined to the proximal 186 bp. A YB-1 responsive element, Mrp2 YRE-1, was mapped at -186/-157, which exhibits specific YB-1 binding. YB-1 acts as a potent repressor of Mrp2 promoter activity in vitro. CONCLUSIONS Constitutive Mrp2 gene expression is conferred through the proximal -186 bp. YB-1 acts as a repressor in vitro by specific binding to a defined element in the proximal promoter sequence.
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Affiliation(s)
- A Geier
- Department of Internal Medicine III, University Hospital, Aachen, Germany
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34
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Mesotten D, Van den Berghe G, Liddle C, Coulter S, McDougall F, Baxter RC, Delhanty PJD. Growth hormone modulation of the rat hepatic bile transporter system in endotoxin-induced cholestasis. Endocrinology 2003; 144:4008-17. [PMID: 12933675 DOI: 10.1210/en.2003-0139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Treatment with high dose human GH, although an effective anabolic agent, has been associated with increased incidence of sepsis, inflammation, multiple organ failure, and death in critically ill patients. We hypothesized that GH might increase mortality by exacerbating cholestasis through modulation of bile acid transporter expression. High dose GH was continuously infused over 4 d into rats, and on the final day lipopolysaccharides were injected. Hepatic bile acid transporter expression was measured by Northern analysis and immunoblotting and compared with serum markers of cholestasis and endotoxinemia. Compared with non-GH-treated controls, GH increased endotoxin-induced markers of cholestasis and liver damage as well as augmented IL-6 induction. In endotoxinemia, GH treatment significantly induced multidrug resistance-associated protein 1 mRNA and protein and suppressed organic anion transporting polypeptides, Oatp1 and Oatp4, mRNA, suggesting impaired uptake of bilirubin and bile acids at the basolateral surface of the hepatocyte, which could contribute to the observed worsening of cholestasis by GH. This study of endotoxinemia may thus provide a mechanistic link between GH treatment and exacerbation of cholestasis through modulation of basolateral bile acid transporter expression in the rat hepatocyte.
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Affiliation(s)
- Dieter Mesotten
- Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia.
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35
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Abstract
The relationship between the sepsis syndrome and the development of jaundice is intriguing, with jaundice having been described as the presenting sign of septicaemia in very few cases. We describe a patient who developed a deep jaundice with conjugated hyperbilirubinaemia caused by Staphylococcus aureus during the early course of septicaemia, when no other sign of the sepsis syndrome could be recognised. It is generally accepted that a mild jaundice may complicate the course of the sepsis syndrome, but it is most unusual to observe such a protracted phase of jaundice before the emergence of other specific clinical signs and laboratory abnormalities. Clinicians should be aware of this presentation of the sepsis syndrome in order to avoid a potentially harmful delay in diagnosis and treatment.
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Affiliation(s)
- Giuseppe Famularo
- Department of Internal Medicine, San Camillo Hospital, Circonvallazione Gianicolense, 00152, Rome, Italy
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36
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Hojo M, Sano N, Takikawa H. Effects of lipopolysaccharide on the biliary excretion of bile acids and organic anions in rats. J Gastroenterol Hepatol 2003; 18:815-21. [PMID: 12795754 DOI: 10.1046/j.1440-1746.2003.03053.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Lipopolysaccharide is known to be a cause of cholestasis associated with sepsis. It has also recently been reported to down-regulate the basolateral and canalicular transporters. The aim of the present study was to examine simultaneously the effect of lipopolysaccharide on the biliary excretion of typical substrates of bile salt export pump and multidrug resistance protein 2 in vivo, and the effect of lipopolysaccharide on the amount of these transporters. METHODS After intravenous administration of O127:B8-derived lipopolysaccharide (2.5 mg/kg), the biliary excretion of taurocholate and various organic anions was studied, and the protein levels of bile salt export pump and multidrug resistance protein 2 in the crude liver membrane was determined by western blot analysis. RESULTS Lipopolysaccharide decreased the biliary excretion of tracer amounts of taurocholate, leukotriene C4, taurolithocholate-3-sulfate and temocapril without affecting bile flow. The biliary excretion of high doses of taurocholate and sulfobromophthalein was markedly inhibited by lipopolysaccharide. Lipopolysaccharide decreased bile salt export pump levels in the liver plasma membrane fraction to 48% of control rats, and markedly decreased multidrug resistance protein 2 levels to 17% of control rats. CONCLUSIONS These findings support the hypothesis that down-regulation of the canalicular transporters by lipopolysaccharide causes the impairment of the biliary excretion of bile acids and organic anions in cholestasis of sepsis prior to the decrease of bile flow.
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Affiliation(s)
- Makoto Hojo
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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37
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Patel S, Gaspers LD, Boucherie S, Memin E, Stellato KA, Guillon G, Combettes L, Thomas AP. Inducible nitric-oxide synthase attenuates vasopressin-dependent Ca2+ signaling in rat hepatocytes. J Biol Chem 2002; 277:33776-82. [PMID: 12097323 DOI: 10.1074/jbc.m201904200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Increases in both Ca(2+) and nitric oxide levels are vital for a variety of cellular processes; however, the interaction between these two crucial messengers is not fully understood. Here, we demonstrate that expression of inducible nitric-oxide synthase in hepatocytes, in response to inflammatory mediators, dramatically attenuates Ca(2+) signaling by the inositol 1,4,5-trisphosphate-forming hormone, vasopressin. The inhibitory effects of induction were reversed by nitric oxide inhibitors and mimicked by prolonged cyclic GMP elevation. Induction was without effect on Ca(2+) signals in response to AlF(4)(-) or inositol 1,4,5-trisphosphate, indicating that phospholipase C activation and release of Ca(2+) from inositol 1,4,5-trisphosphate-sensitive Ca(2+) stores were not targets for nitric oxide inhibition. Vasopressin receptor levels, however, were dramatically reduced in induced cultures. Our data provide a possible mechanism for hepatocyte dysfunction during chronic inflammation.
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Affiliation(s)
- Sandip Patel
- Department of Physiology, University College London, Gower Street, London WC1E 6BT, United Kingdom.
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38
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Moazzam FN, Brems JJ, Yong SL, Filkins JP, Fisher SG, Holt DR, Gamelli RL, Ding JW. Endotoxin potentiates hepatocyte apoptosis in cholestasis. J Am Coll Surg 2002; 194:731-9. [PMID: 12081063 DOI: 10.1016/s1072-7515(02)01173-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cholestasis is a component of liver disease of almost any etiology, including septic liver injury. The cellular mechanisms of liver injury in cholestasis and sepsis remain unresolved. We evaluated apoptosis, a well-orchestrated and potentially reversible mechanism of cell death, in bile duct-ligated and endotoxin-injected rats. STUDY DESIGN Male Sprague-Dawley rats were randomly assigned to six groups (n = 6-9): bile duct-ligated+endotoxin (B+E), sham+endotoxin (S+E), bile duct-ligated (B), sham (S), endotoxin (E), and normal (N). On day 1, the bile ducts of B+E and B rats were ligated and severed. S+E and S animals underwent biliary manipulation only. On day 3, B+E, S+E, and E groups received 3 mg/kg endotoxin i.v.. On day 4, livers from all rats were excised, fixed, and stained (hematoxylin and eosin and terminal deoxynucleotidyl transferase dUTP nick-end labeling [TUNEL]). Portions were frozen for DNA fragmentation analysis. Caspase 3 activity was determined using isolated hepatocytes. RESULTS Livers from all groups (B+E, S+E, E, and B) except normal and sham displayed apoptosis by hematoxylin and eosin staining, TUNEL staining, and DNA fragmentation. Histologic evaluation revealed 10% to 20% necrosis in endotoxin-treated animals (B+E, S+E, and E). Caspase 3 activity was significantly higher in endotoxin-treated animals versus animals without endotoxin (treated 0.450 +/- 0.08 versus nontreated 0.135 +/- 0.05, p < 0.0001) (mean +/- SD). CONCLUSIONS Cholestatic livers had apoptosis without progression to necrosis. When exposed to the second insult of endotoxin, cholestatic livers received an acute on chronic apoptotic trigger, and proceeded to necrosis. Endotoxin was a potent hepatotoxic insult because all treated rat livers displayed both apoptosis and necrosis.
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Affiliation(s)
- Farnaz N Moazzam
- Department of Surgery, Burn & Shock Trauma Institute, Loyola University Medical Center, Maywood, IL 60153, USA
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39
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Abstract
OBJECTIVE Urinary tract infections (UTIs) are a common clinical problem in febrile infants younger than 8 weeks old, with a prevalence between 5% and 11%. Previous studies have noted that jaundice may be one of the first signs of a bacterial infection in infants. Our goal was to determine the incidence of UTIs in asymptomatic, jaundiced infants younger than 8 weeks old and to determine which historical and laboratory parameters are associated with UTIs. METHODS We prospectively evaluated asymptomatic, jaundiced infants younger than 8 weeks old for evidence of a UTI (defined as >10 000 colony-forming units per milliliter of a single pathogen, obtained by bladder catheterization). A serum fractionated bilirubin level was obtained on all study patients. Detailed questionnaires were completed, which included demographic information, prenatal, intrapartum, and postnatal events. RESULTS Twelve (7.5%) of 160 infants had a UTI (95% confidence interval: 3.9%-12.7%). Isolated organisms included Escherichia coli, Enterobacter cloacae, Enterococcus, Klebsiella pneumoniae, group B Streptococcus, Streptococcus viridans, and Staphylococcus aureus. Patients with the onset of jaundice after 8 days of age had a higher incidence of UTI, 6 (50%) of 12 infants in the positive culture group, versus 15 (10%) of 148 infants in the negative culture group. Abnormal urinalysis and microscopy results were noted in 5 (42%) of 12 infants with a UTI, and 6 (55%) of 11 infants had abnormal renal ultrasound results. CONCLUSION A UTI was found in 7.5% of asymptomatic, afebrile, jaundiced infants younger than 8 weeks old. In addition, infants with the onset of jaundice after 8 days of age or patients with an elevated conjugated bilirubin fraction were more likely to have a UTI. Therefore, we recommend that testing for a UTI be included as part of the evaluation in asymptomatic, jaundiced infants presenting to the emergency department.
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Affiliation(s)
- Francisco J Garcia
- Division of Emergency and Transport Medicine, Childrens Hospital Los Angeles, Los Angeles, California, USA.
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40
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Bolder U, Schmidt A, Landmann L, Kidder V, Tange S, Jauch KW. Heat stress prevents impairment of bile acid transport in endotoxemic rats by a posttranscriptional mechanism. Gastroenterology 2002; 122:963-73. [PMID: 11910349 DOI: 10.1053/gast.2002.32408] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Endotoxemia leads to reduction of bile acid transporters in the hepatocyte membrane and impaired bile acid transport. Because heat stress ameliorates other sequelae of endotoxemia, studies were performed to determine whether heat stress would correct deficient bile acid transport caused by endotoxin. METHODS Body temperature of rats was elevated to 42 degrees C for 10 minutes. Lipopolysaccharide was injected after different time intervals, and maximal transport for cholyltaurine was measured in perfused rat livers. Sodium-dependent and -independent uptake was studied in isolated hepatocytes. Protein expression, messenger RNA levels, and tissue distribution of the bile acid transporters sodium taurocholate cotransporting protein (ntcp) and bile salt export pump (bsep) were also analyzed. RESULTS In the perfused liver, cholyltaurine transport was reduced by 59% by endotoxin, but transport was not reduced when heat stress was applied 2 hours before injection of lipopolysaccharide. The protective effect coincided with maximal expression of heat shock proteins 70 and 25. Sodium-dependent and -independent transport was preserved by heat stress. Expression of bile acid transporters in plasma membrane fractions was reduced after injection of lipopolysaccharide but not if lipopolysaccharide was preceded by heat stress. In contrast, messenger RNA levels of bile acid transporters were not preserved by heat stress. CONCLUSIONS Heat stress preserves bile acid transporters during endotoxemia by a posttranscriptional mechanism.
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Affiliation(s)
- Ulrich Bolder
- Department of Surgery, University of Regensburg, Regensburg, Germany.
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41
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Janssen H, Lange R, Erhard J, Testa G, Malagó M, Janssen P, Eigler FW, Broelsch CE. Serum bile acids in liver transplantation--early indicator for acute rejection and monitor for antirejection therapy. Transpl Int 2002. [PMID: 11793041 DOI: 10.1111/j.1432-2277.2001.tb00082.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We studied the course of serum bile acids to investigate its reliability in the diagnosis of acute rejection after liver transplantation in relation to pathohistological findings. Serum bile acid concentration, bilirubin and transaminases were measured in 41 patients who underwent liver transplantation. Their course was correlated to liver biopsy. Group I (n = 19) patients were without acute rejection, whereas group II (n = 22) patients showed acute rejection. Bile acid concentrations in group II showed a statistically highly significant (P < or = 0.001) threefold increase 3 days prior to biopsy. Successful antirejection treatment was correlated with a statistically significant (P = 0.008) decrease of serum bile acid 1 day after initiation of therapy. Patients without acute rejection showed a baseline bile acid concentration at the time of biopsy. Bilirubin and transaminases did not show any statistically significant correlation to acute rejection. Infection did not lead to a significant bile acid increase. Our study shows that serum bile acids monitored after liver transplantation can easily be used to detect acute rejection and at the same time they reflect the success of antirejection therapy.
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Affiliation(s)
- H Janssen
- Klinik für Allgemein- und Transplantationschirurgie, Zentrum Chirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45 147 Essen, Germany.
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42
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Abstract
At present, specific evidence regarding the molecular mechanisms of neonatal cholestasis is limited. The recent explosion in the understanding of the molecular physiology of bile formation has been fueled by the discovery of several genes that are involved in familial cholestasis. The ever-growing understanding of the functional immaturity of the neonatal liver is sure to be enhanced by the study of the ontogeny of important hepatobiliary transporters as they are discovered. The understanding of the functional differences between the immature and mature liver is key to the understanding of neonatal cholestasis.
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Affiliation(s)
- Karan McBride Emerick
- Division of Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
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43
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Cullen JJ, Park H, Ephgrave KS, Conklin JL. Lipopolysaccharide temporarily impairs sphincter of Oddi motility. Nitric Oxide 2001; 5:547-54. [PMID: 11730361 DOI: 10.1006/niox.2001.0380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of our study was to determine the effect of lipopolysaccharide (LPS) on sphincter of Oddi (SO) motility. Opossums received saline, Escherichia coli LPS (1.0 mg/kg), or E. coli LPS (1.0 mg/kg) and aminoguanidine (50 mg/kg), and the SO was removed 6-24 h later. At 12 h LPS decreased electrical field stimulation (EFS)-induced relaxation and increased baseline tone. These changes were reversed when the animals were pretreated with aminoguanidine. The dose-dependent decrease in EFS-induced relaxation by N(omega)-nitro-l-arginine was impaired after LPS, but not in animals that received LPS and aminoguanidine. The impaired EFS-induced relaxation after LPS was reversed when l-arginine was added to the tissue bath. Serum levels of NO(-)(2)/NO(-)(3) were increased with LPS as compared to saline or both LPS and aminoguanidine. Inducible nitric oxide synthase mRNA was readily seen in SO segments after LPS. LPS impairs EFS-induced relaxation and increases baseline tone of the SO. The effects of LPS on SO motility appear to be mediated by nitric oxide.
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Affiliation(s)
- J J Cullen
- Department of Surgery, University of Iowa College of Medicine and Veterans Affairs Medical Center, Iowa City, Iowa 52242, USA.
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Nadai M, Zhao YL, Wang L, Nishio Y, Takagi K, Kitaichi K, Takagi K, Yoshizumi H, Hasegawa T. Endotoxin impairs biliary transport of sparfloxacin and its glucuronide in rats. Eur J Pharmacol 2001; 432:99-105. [PMID: 11734193 DOI: 10.1016/s0014-2999(01)01470-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The effect of endotoxin on glucuronidation and hepatobiliary transport of quinolone antimicrobial agents was investigated in rats using sparfloxacin and p-nitrophenyl glucuronide as model drugs. The biliary clearance experiments were performed 24 h after a single intraperitoneal injection of endotoxin (1 mg/kg). Endotoxin significantly delayed the disappearance of sparfloxacin from plasma and increased plasma concentration of its glucuronide after intravenous injection of sparfloxacin (10 mg/kg). Significant decreases in the systemic clearance of sparfloxacin and the biliary clearance of sparfloxacin and the glucuronide were observed. Endotoxin had no effect on in vitro glucuronidation activity using p-nitrophenol as a substrate. When p-nitrophenyl glucuronide (8 mg/kg) was administered in endotoxin-pretreated rats, significant decreases in the systemic clearance, biliary clearance and renal clearance of p-nitrophenyl glucuronide were observed. These findings suggest that endotoxin decreases the biliary excretion of sparfloxacin and its glucuronide probably due to impairment of their hepatobiliary transport systems and renal handling.
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Affiliation(s)
- M Nadai
- Faculty of Pharmacy, Meijo University, 150 Yagotoyama, Tenpaku-ku, 468-8503, Nagoya, Japan
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Narita R, Murata M, Kihara Y, Abe S, Tabaru A, Yoshikawa I, Otsuki M. Sepsis presenting with severe jaundice. Am J Gastroenterol 2001; 96:3214-5. [PMID: 11721785 DOI: 10.1111/j.1572-0241.2001.05292.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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46
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Affiliation(s)
- C Liatsos
- Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, Hampstead, London, UK
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47
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Linden PK, Bompart F, Gray S, Talbot GH. Hyperbilirubinemia during quinupristin-dalfopristin therapy in liver transplant recipients: correlation with available liver biopsy results. Pharmacotherapy 2001; 21:661-8. [PMID: 11401179 DOI: 10.1592/phco.21.7.661.34580] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE To review the liver histopathology in transplant recipients who developed hyperbilirubinemia during therapy with quinupristin-dalfopristin, a new streptogramin antibiotic, and to ascertain whether objective histologic evidence of adverse drug effect could be correlated to serum bilirubin levels. DESIGN Retrospective analysis. SETTING University of Pittsburgh Medical Center. PATIENTS From a database of 34 liver recipients who received quinupristin-dalfopristin for vancomycin-resistant Enterococcus faecium infection who were prospectively enrolled in a multicenter, open-label, emergency-use protocol, the data for a subset of 25 patients who underwent one or more liver biopsies during therapy were reviewed for this study. INTERVENTIONS Quinupristin-dalfopristin was administered intravenously at 7.5 mg/kg every 8 hours. Available serum bilirubin levels from before, during, and 1 week after therapy were tabulated. Liver biopsy results obtained within 1 week before and during therapy were retrospectively reviewed. Histopathologic results were characterized and correlated to bilirubin level. MEASUREMENTS AND MAIN RESULTS Cholestatic changes were already present in 15 of 17 patients who underwent biopsy before therapy. During therapy, the most common findings from 40 biopsies (25 patients) were cholestasis (33 biopsies), acute rejection (10), and periportal inflammation (8). There was no evidence of drug-specific histopathologic injury. CONCLUSION Hyperbilirubinemia in these patients was likely multifactorial and most frequently due to sepsis and prior graft injury.
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Affiliation(s)
- P K Linden
- Division of Critical Care Medicine, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
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Stanca C, Jung D, Meier PJ, Kullak-Ublick GA. Hepatocellular transport proteins and their role in liver disease. World J Gastroenterol 2001; 7:157-69. [PMID: 11819755 PMCID: PMC4723517 DOI: 10.3748/wjg.v7.i2.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- C Stanca
- Division of Clinical Pharmacology and Toxicology, Department of Internal Medicine, University Hospital, CH-8091 Zurich/Switzerland
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Kosuga M, Enosawa S, Li XK, Suzuki S, Matsuo N, Yamada M, Roy-Chowdhury J, Koiwai O, Okuyama T. Strong, long-term transgene expression in rat liver using chicken beta-actin promoter associated with cytomegalovirus immediate-early enhancer (CAG promoter). Cell Transplant 2000; 9:675-80. [PMID: 11144964 DOI: 10.1177/096368970000900513] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For successful gene therapy in hepatic enzyme deficiencies, it is essential to use promoters that can maintain strong transcriptional activity for the long term in the liver. Using Gunn rats, a model animal for Crigler-Najjar syndrome type I, the long-term transcriptional function of the CAG promoter (a combination of chicken beta-actin promoter and cytomegalovirus immediate-early enhancer) was evaluated in the rat liver. We constructed a plasmid pCAGGHUGT, containing expression cassettes of human bilirubin UDP-glucuronosyltransferase (BUGT) and hygromycin phosphotransferase, under the control of the CAG promoter and murine phosphoglycerate kinase promoter, respectively. Conditionally immortalized Gunn rat hepatocytes (IGRH), which had been established using mutant SV40 large T antigen ((TS)T), were transfected with pCAG-GHUGT. A stably transfected clone IGRHUGT, expressing a high level of BUGT, was obtained after selection with hygromycin. At 33 degrees C, the cells doubled in number in approximately 72 h; however, at 37 degrees C, cell proliferation stopped, indicating that the characteristic of temperature-dependent proliferation was retained in this clone. Ten million cells were injected into the spleen of syngeneic Gunn rats five times at 10-day intervals. Serum bilirubin levels were reduced by 45-50% at 70 days after the first transplantation and remained so throughout the duration of the study (120 days). These results suggested that the CAG promoter was able to maintain strong transcriptional activity in rat liver for at least 120 days.
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Affiliation(s)
- M Kosuga
- Department of Genetics, National Children's Medical Research Center, Tokyo, Japan
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50
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Cullen JJ, Maes EB, Aggrawal S, Conklin JL, Ephgrave KS, Mitros FA. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis. Ann Surg 2000; 232:202-7. [PMID: 10903598 PMCID: PMC1421131 DOI: 10.1097/00000658-200008000-00009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether endotoxin causes histologic changes in the gallbladder consistent with acalculous cholecystitis, and to determine the effects of endotoxin on gallbladder motility. SUMMARY BACKGROUND DATA Acute acalculous cholecystitis is frequently seen in critically ill, septic patients, after prolonged fasting and gallbladder stasis. The pathogenesis of acalculous cholecystitis is unknown; however, previous studies have suggested that ischemia may play a role. METHODS Adult opossums received Escherichia coli lipopolysaccharide. The gallbladder was removed for histologic examination or for physiologic studies 4 hours to 2 weeks later. For histologic examination, gallbladder strips underwent standard hematoxylin-and-eosin processing. For physiologic studies, they were mounted in a tissue bath to determine responses to cholecystokinin octapeptide or electrical field stimulation. RESULTS Intravenous endotoxin at a dose of 0.005 mg/kg resulted in disrupted mucosal surfaces and areas of hemorrhage; higher doses of endotoxin resulted in coagulation necrosis, hemorrhage, areas of fibrin deposition, and extensive mucosal loss, consistent with an acute ischemic insult. Endotoxin abolished the contractile response to cholecystokinin octapeptide in gallbladder strips 4 hours after endotoxin administration. The 0.005-mg/kg dose of endotoxin decreased the contractile response to cholecystokinin octapeptide for up to 96 hours after endotoxin administration and decreased the contractile response to electrical field stimulation for 48 hours after administration. Inhibition of nitric oxide synthase reversed the decreased contractile response to cholecystokinin octapeptide. CONCLUSIONS Endotoxin causes an ischemic insult to the gallbladder similar to that seen in acalculous cholecystitis. Also, endotoxin may lead to gallbladder stasis by decreasing gallbladder contractile responses to hormonal and neural stimuli.
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Affiliation(s)
- J J Cullen
- Departments of Surgery and Internal Medicine, University of Iowa College of Medicine and Veterans Affairs Medical Center, Iowa City, Iowa, USA
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