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Zhang P, Tan Z, Li C, Han Z, Zhou J, Yin Y. The correlation between serum total bile acid and adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and non-ICP hypercholanemia of pregnancy. Ann Med 2024; 56:2331059. [PMID: 38515230 PMCID: PMC10962286 DOI: 10.1080/07853890.2024.2331059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. OBJECTIVE To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. METHODS From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n = 160), liver disease (n = 164), and AHP (n = 650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. RESULTS The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p = 0.03). CONCLUSIONS If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered.
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Affiliation(s)
- Peizhen Zhang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhangmin Tan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chuo Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhenyan Han
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Zhou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuzhu Yin
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Li W, Gong X, Niu X, Zhou Y, Ren L, Man Z, Tu P, Xiong X, Liu W, Song Y. Quantitative comparison of bile acid glucuronides sub-metabolome between intrahepatic cholestasis and healthy pregnant women. Anal Bioanal Chem 2024:10.1007/s00216-024-05430-6. [PMID: 38990360 DOI: 10.1007/s00216-024-05430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/15/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
Because of the pathological indication and the physiological functions, bile acids (BAs) have occupied the research hotspot in recent decades. Although extensive efforts have been paid onto BAs sub-metabolome characterization, as the subfamily, BA glucuronides (gluA-BAs) profile is seldom concerned. Here, we made efforts to develop a LC-MS/MS program enabling quantitative gluA-BAs sub-metabolome characterization and to explore the differential species in serum between intrahepatic cholestasis of pregnancy (ICP) patients and healthy subjects. To gain as many authentic gluA-BAs as possible, liver microsomes from humans, rats, and mice were deployed to conjugate glucuronyl group to authentic BAs through in vitro incubation. Eighty gluA-BAs were captured and subsequently served as authentic compounds to correlate MS/MS spectral behaviors to structural features using squared energy-resolved MS program. Optimal collision energy (OCE) of [M-H]->[M-H-176.1]- was jointly administrated by [M-H]- mass and glucuronidation site, and identical exciting energies corresponding to 50% survival rate of 1st-generation fragment ion (EE50) were observed merely when the aglycone of a gluA-BA was consistent with the suspected structure. Through integrating high-resolution m/z, OCE, and EE50 information to identify gluA-BAs in a BAs pool, 97 ones were found and identified, and further, quantitative program was built for all annotated gluA-BAs by assigning OCEs to [M-H]->[M-H-176.1]- ion transitions. Quantitative gluA-BAs sub-metabolome of ICP was different from that of the healthy group. More GCDCA-3-G, GDCA-3-G, TCDCA-7-G, TDCA-3-G, and T-β-MCA-3-G were distributed in the ICP group. Above all, this study not only offered a promising analytical tool for in-depth gluA-BAs sub-metabolome characterization, but also clarified gluA-BAs allowing the differentiation of ICP and healthy subjects.
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Affiliation(s)
- Wei Li
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Xingcheng Gong
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Xiaoya Niu
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Yuxuan Zhou
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Luyao Ren
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Zhuo Man
- SCIEX China, Beijing, 100015, China
| | - Pengfei Tu
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Xin Xiong
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China.
| | - Wenjing Liu
- School of Pharmacy, Henan University of Chinese Medicine, Jinshui East Road, Zhengdong New District, Zhengzhou, 450046, China.
| | - Yuelin Song
- Modern Research Center for Traditional Chinese Medicine, Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102401, China.
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Wang M, Chen L, Li J, You Y, Qian Z, Liu J, Jiang Y, Zhou T, Gu Y, Zhang Y. An omics review and perspective of researches on intrahepatic cholestasis of pregnancy. Front Endocrinol (Lausanne) 2024; 14:1267195. [PMID: 38260124 PMCID: PMC10801044 DOI: 10.3389/fendo.2023.1267195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is one of the common pregnancy complications that may threaten the health of both pregnant women and their fetuses. Hence, it is of vital importance to identify key moleculars and the associated functional pathways of ICP, which will help us to better understand the pathological mechanisms as well as to develop precise clinical biomarkers. The emerging and developing of multiple omics approaches enable comprehensive studies of the genome, transcriptome, proteome and metabolome of clinical samples. The present review collected and summarized the omics based studies of ICP, aiming to provide an overview of the current progress, limitations and future directions. Briefly, these studies covered a broad range of research contents by the comparing of different experimental groups including ICP patients, ICP subtypes, ICP fetuses, ICP models and other complications. Correspondingly, the studied samples contain various types of clinical samples, in vitro cultured tissues, cell lines and the samples from animal models. According to the main research objectives, we further categorized these studies into two groups: pathogenesis and diagnosis analyses. The pathogenesis studies identified tens of functional pathways that may represent the key regulatory events for the occurrence, progression, treatment and fetal effects of ICP. On the other hand, the diagnosis studies tested more than 40 potential models for the early-prediction, diagnosis, grading, prognosis or differential diagnosis of ICP. Apart from these achievements, we also evaluated the limitations of current studies, and emphasized that many aspects of clinical characteristics, sample processing, and analytical method can greatly affect the reliability and repeatability of omics results. Finally, we also pointed out several new directions for the omics based analyses of ICP and other perinatal associated conditions in the future.
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Affiliation(s)
- Min Wang
- Center for Reproductive Medicine, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Lingyan Chen
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Jingyang Li
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Yilan You
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Zhiwen Qian
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Jiayu Liu
- Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Ying Jiang
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Tao Zhou
- Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Ying Gu
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yan Zhang
- Department of Gynaecology and Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, China
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Obiegbusi CN, Dong XJ, Obiegbusi SC. Pregnancy outcomes following antenatal screening for intrahepatic cholestasis of pregnancy (ICP). Taiwan J Obstet Gynecol 2023; 62:809-816. [PMID: 38008498 DOI: 10.1016/j.tjog.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To evaluate the maternal and perinatal outcomes following antenatal screening for ICP using a retrospective approach. MATERIALS AND METHODS A retrospective study was conducted at the second affiliated hospital of Chongqing Medical University, Chongqing, China, from 2012 to 2017. Pregnant women registered for antenatal in our hospital were screened for ICP. The pregnant women with detailed delivery record and presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. METHOD The pregnant women with detailed delivery records presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. 1410 pregnant women were enrolled in this study. We selected 940 pregnant women without the diagnosis of ICP as our control and 470 pregnant women diagnosed with ICP as our case study. Data collection and sampling in the control group was done using microsoft excel (version 16.61) random number generator. RESULTS The mean age of the pregnant women and the gestational age at the time of diagnosis of ICP were 29.01 ± 4.3 years and 31.90 ± 8.83 weeks, respectively. It was found that a significant number of patients with ICP had a preterm birth and low birth weight (LBW), n = 151 (32.5%) P < 0.001 and n = 70 (14.9%) P < 0.001, respectively. A significant number of patients in the case group had a history of liver disease and gall bladder disease, p < 0.001 and p = 0.005, respectively, and a higher rate of GDM p < 0.001. Despite treatment, high TBA titer among ICP patients was associated with preterm delivery. CONCLUSION ICP in pregnancy leads to complications and poor perinatal outcomes. Fetal outcomes depend on the TBA levels; therefore, early diagnosis of ICP through routine screening followed by treatment is recommended in high-risk persons/areas.
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Affiliation(s)
- Chidera Nneji Obiegbusi
- The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Jiangnan Xincheng, Zone B, Chayuan, Nan'an District, Chongqing, China.
| | - Xiao Jing Dong
- The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Jiangnan Xincheng, Zone B, Chayuan, Nan'an District, Chongqing, China; The Second Affiliated Hospital of Chongqing Medical University, No.76 LinJiang Road, YuZhong District, Chongqing, China.
| | - Samuel Chigbo Obiegbusi
- The Second Affiliated Hospital of Chongqing Medical University, 288 Tianwen Avenue, Jiangnan Xincheng, Zone B, Chayuan, Nan'an District, Chongqing, China.
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Czuba LC, Malhotra K, Enthoven L, Fay EE, Moreni SL, Mao J, Shi Y, Huang W, Totah RA, Isoherranen N, Hebert MF. CYP2D6 Activity Is Correlated with Changes in Plasma Concentrations of Taurocholic Acid during Pregnancy and Postpartum in CYP2D6 Extensive Metabolizers. Drug Metab Dispos 2023; 51:1474-1482. [PMID: 37550070 PMCID: PMC10586507 DOI: 10.1124/dmd.123.001358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/23/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
Cytochrome P450 2D6 (CYP2D6) is involved in the metabolism of >20% of marketed drugs. CYP2D6 expression and activity exhibit high interindividual variability and is induced during pregnancy. The farnesoid X receptor (FXR) is a transcriptional regulator of CYP2D6 that is activated by bile acids. In pregnancy, elevated plasma bile acid concentrations are associated with maternal and fetal risks. However, modest changes in bile acid concentrations may occur during healthy pregnancy, thereby altering FXR signaling. A previous study demonstrated that hepatic tissue concentrations of bile acids positively correlated with the hepatic mRNA expression of CYP2D6. This study sought to characterize the plasma bile acid metabolome in healthy women (n = 47) during midpregnancy (25-28 weeks gestation) and ≥3 months postpartum and to determine if plasma bile acids correlate with CYP2D6 activity. It is hypothesized that during pregnancy, plasma bile acids would favor less hydrophobic bile acids (cholic acid vs. chenodeoxycholic acid) and that plasma concentrations of cholic acid and its conjugates would positively correlate with the urinary ratio of dextrorphan/dextromethorphan. At 25-28 weeks gestation, taurine-conjugated bile acids comprised 23% of the quantified serum bile acids compared with 7% ≥3 months postpartum. Taurocholic acid positively associated with the urinary ratio of dextrorphan/dextromethorphan, a biomarker of CYP2D6 activity. Collectively, these results confirm that the bile acid plasma metabolome differs between pregnancy and postpartum and provide evidence that taurocholic acid may impact CYP2D6 activity during pregnancy. SIGNIFICANCE STATEMENT: Bile acid homeostasis is altered in pregnancy, and plasma concentrations of taurocholic acid positively correlate with CYP2D6 activity. Differences between plasma and/or tissue concentrations of farnesoid X receptor ligands such as bile acids may contribute to the high interindividual variability in CYP2D6 expression and activity.
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Affiliation(s)
- Lindsay C Czuba
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Karan Malhotra
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Luke Enthoven
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Emily E Fay
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Sue L Moreni
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Jennie Mao
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Yuanyuan Shi
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Weize Huang
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Rheem A Totah
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Nina Isoherranen
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
| | - Mary F Hebert
- Department of Pharmaceutics, School of Pharmacy (L.C.C., W.H., N.I.), Department of Pharmacy, School of Pharmacy (K.M., L.E., M.F.H.), Department of Obstetrics and Gynecology, School of Medicine (E.E.F., S.L.M., J.M., M.F.H.), and Department of Medicinal Chemistry, School of Pharmacy (Y.S., R.A.T.), University of Washington, Seattle, Washington
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