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Hou W, Huo KG, Guo X, Xu M, Yang Y, Shi Z, Xu W, Tu J, Gao T, Ma Z, Han S. KLF15-Cyp3a11 Axis Regulates Rifampicin-Induced Liver Injury. Drug Metab Dispos 2024; 52:606-613. [PMID: 38670799 DOI: 10.1124/dmd.123.001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Rifampicin (RFP) has demonstrated potent antibacterial effects in the treatment of pulmonary tuberculosis. However, the serious adverse effects on the liver intensively limit the clinical usage of the drug. Deacetylation greatly reduces the toxicity of RFP but also retains its curative activity. Here, we found that Krüppel-like factor 15 (KLF15) repressed the expression of the major RFP detoxification enzyme Cyp3a11 in mice via both direct and indirect mechanisms. Knockout of hepatocyte KLF15 induced the expression of Cyp3a11 and robustly attenuated the hepatotoxicity of RFP in mice. In contrast, overexpression of hepatic KLF15 exacerbated RFP-induced liver injury as well as mortality. More importantly, the suppression of hepatic KLF15 expression strikingly restored liver functions in mice even after being pretreated with overdosed RFP. Therefore, this study identified the KLF15-Cyp3a11 axis as a novel regulatory pathway that may play an essential role in the detoxification of RFP and associated liver injury. SIGNIFICANCE STATEMENT: Rifampicin has demonstrated antibacterial effects in the treatment of pulmonary tuberculosis. However, the serious adverse effects on the liver limit the clinical usage of the drug. Permanent depletion and transient inhibition of hepatic KLF15 expression significantly induced the expression of Cyp3a11 and robustly attenuated mouse hepatotoxicity induced by RFP. Overall, our studies show the KLF15-Cyp3a11 axis was identified as a novel regulatory pathway that may play an essential role in the detoxification of RFP and associated liver injury.
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Affiliation(s)
- Wanqing Hou
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Ku-Geng Huo
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Xiaohua Guo
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Mengtong Xu
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Yongting Yang
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Zhuangqi Shi
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Weixiong Xu
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Jinqi Tu
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Tangxin Gao
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Zhenghai Ma
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
| | - Shuxin Han
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (W.H., X.G.); Cyagen Biosciences (Guangzhou) Inc. Guangzhou, Guangdong, China (K.-G.H.); Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, China (M.X., Y.Y., Z.S., J.T., Z.M., S.H.); Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio (W.X.); and Lantu Biopharma, Guangzhou, China (T.G.)
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Perumal Kannabiran B, Palaniappan NA, Manoharan T, Paramasivam PK, Saini JK, Ansari MS, Jayabal L, Aggarwal AN, Garg R, Subramanyam B, Thakur D, Pantula S, P M R, GS V, Natarajan S, Ammayappan RK, Manpreet B, Ganesan M, Angamuthu D, Chinnaiyan P, Singh M, Chandrasekaran P, Swaminathan S. Safety and Efficacy of 25 mg/kg and 35 mg/kg vs 10 mg/kg Rifampicin in Pulmonary TB: A Phase IIb Randomized Controlled Trial. Open Forum Infect Dis 2024; 11:ofae034. [PMID: 38444824 PMCID: PMC10914527 DOI: 10.1093/ofid/ofae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
Background Globally, no trial data are available on head-to-head comparison between 10 mg/kg and 25/35 mg/kg rifampicin in treating pulmonary tuberculosis during study initiation. Methods A multicentric, phase IIb randomized trial recruited 333 new culture-positive, drug-sensitive adult patients with pulmonary tuberculosis to compare safety and efficacy of high-dose rifampicin (R25/R35), against conventional dose (R10) given daily for 8 weeks followed by standard doses for 16 weeks. Main outcomes were treatment-emergent grade 3/4 adverse events (AEs) and time-to-culture conversion in liquid media, assessed by division of AIDS system for grading the severity of adverse events division of AIDS criteria and Kaplan-Meier methods. Results In a modified intention-to-treat population of 323 patients (R10: 105/R25: 112/R35: 106), grade 3/4 AEs were reported in 34 patients (R10: 9.5% [10/105], R25: 9.8% [11/112], R35: 12.3% [13/106]) during the intensive phase. Among 23 patients (R10: 3.8% [4/105], R25: 6.3% [7/112], R35: 11.3% [12/106]) with grade 3/4 hepatotoxicity, 15 (R10: 1.9% [2/105], R25: 3.6% [4/112], R35: 8.5% [9/106]) had grade 3/4 hyperbilirubinemia and 9 patients (R10: 1.0% [1/105], R25: 0.9% [1/112], R35: 6.6% [7/106]) developed clinical jaundice. Significant differences observed only between R10 and R35 with hepatotoxicity (P = .039), hyperbilirubinemia (P = .031), clinical jaundice (P = .032), and treatment interruption (P = .039). Eighteen serious AEs and 6 deaths (R10: 3/R25: 1/R35: 2) occurred during study period. Time to stable culture conversion in liquid media was faster in R25 (adjusted hazard ratio, 1.71; 95% confidence interval [CI], 1.26-2.31 [solid: 1.97; 95% CI, 1.46-2.67]) and R35 (1.81; 95% CI, 1.33-2.48 [solid: 2.24; 95% CI, 1.64-3.06]), than R10 (34 vs 44 days). R25 had no failure/relapse. Conclusions Hepatotoxicity, clinical jaundice, and treatment interruptions occurred significantly higher with R35 than R10. Because R25 was comparably safe as R10 and also highly efficacious than R10, it may be considered for implementation. Clinical Trials Registration. CTRI/2017/12/010951.
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Affiliation(s)
| | | | - Tamizhselvan Manoharan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Paul Kumaran Paramasivam
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Jitendra Kumar Saini
- Department of Pulmonary Oncology, National Institute for Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Mohammed Soheb Ansari
- Department of Respiratory Medicine, Bhagwan Mahavir Medical Hospital and Research Centre, Hyderabad, India
| | - Lavanya Jayabal
- District TB office, Greater Chennai Corporation, Chennai, India
| | - Ashutosh N Aggarwal
- Department of Respiratory Medicine, Post Graduate Institute of Medical Research, Chandigarh, India
| | - Rajiv Garg
- Department of Respiratory Medicine, King George's Medical University, Lucknow, India
| | - Balaji Subramanyam
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Deepika Thakur
- Department of Respiratory Medicine, Post Graduate Institute of Medical Research, Chandigarh, India
| | - Shilpa Pantula
- Department of Respiratory Medicine, Bhagwan Mahavir Medical Hospital and Research Centre, Hyderabad, India
| | - Ramesh P M
- Department of Respiratory Medicine, Government Thiruvotteeswarar Hospital of Thoracic Medicine, Chennai, India
| | - Vijayachandar GS
- Department of Respiratory Medicine, Institute of Thoracic Medicine, Chennai, India
| | - Saravanan Natarajan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Radha Krishnan Ammayappan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Bhalla Manpreet
- Department of Pulmonary Oncology, National Institute for Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Mangalambal Ganesan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Dhanalakshmi Angamuthu
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Ponnuraja Chinnaiyan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Manjula Singh
- Division of Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Bakshi S, Kaur M, Verma A, Sharma S. Molecular and cellular remodeling of HepG2 cells upon treatment with antitubercular drugs. J Biochem Mol Toxicol 2023; 37:e23386. [PMID: 37254945 DOI: 10.1002/jbt.23386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/20/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
Drug-induced liver injury (DILI) is an adverse outcome of the currently used tuberculosis treatment regimen, which results in patient noncompliance, poor treatment outcomes, and the emergence of drug-resistant tuberculosis. DILI is primarily caused by the toxicity of the drugs and their metabolites, which affect liver cells, biliary epithelial cells, and liver vasculature. However, the precise mechanism behind the cellular damage attributable to first-line antitubercular drugs (ATDs), as well as the effect of toxicity on the cell survival strategies, is yet to be elucidated. In the current study, HepG2 cells upon treatment with a high concentration of ATDs showed increased perforation within the cell, cuboidal shape, and membrane blebbing as compared with control/untreated cells. It was observed that ATD-induced toxicity in HepG2 cells leads to altered mitochondrial membrane permeability, which was depicted by the decreased fluorescence intensity of the MitoRed tracker dye at higher drug concentrations. In addition, high doses of ATDs caused cell damage through an increase in reactive oxygen species production in HepG2 cells and a simultaneous reduction in glutathione levels. Further, high dose of isoniazid (50-200 mM), pyrazinamide (50-200 mM), and rifampicin (20-100 µM) causes cell apoptosis and affects cell survival during toxic conditions by decreasing the expression of potent autophagy markers Atg5, Atg7, and LC3B. Thus, ATD-mediated toxicity contributes to the reduced ability of hepatocytes to tolerate cellular damage caused by altered mitochondrial membrane permeability, increased apoptosis, and decreased autophagy. These findings further emphasize the need to develop adjuvant therapies that can mitigate ATD-induced toxicity for the effective treatment of tuberculosis.
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Affiliation(s)
- Shikha Bakshi
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Maninder Kaur
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpana Verma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhna Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Ahmadi Ghezeldasht S, Soleimanpour S, Hedayati-Moghaddam MR, Farshchian M, Rezaee SA, Mosavat A. Rate of occult hepatitis B virus infection among individuals with tuberculosis in northeastern Iran: A molecular epidemiological study. J Virus Erad 2023; 9:100333. [PMID: 37408699 PMCID: PMC10319180 DOI: 10.1016/j.jve.2023.100333] [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: 03/01/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
One third of the world population has a history of exposure to the hepatitis B virus (HBV), and two billion people are infected with latent tuberculosis (TB). Occult hepatitis B infection (OBI) is defined as the presence of replicative-competent HBV DNA in the liver with detectable or undetectable HBV DNA in the serum of individuals testing negative for the HBV surface antigen (HBsAg). Screening with HBV DNA could identify OBI and significantly reduce carriers and complications of chronic hepatitis B (CHB). This study aims to assess HBV serological markers and OBI molecular diagnosis among people with TB in Mashhad, northeastern Iran. We have performed HBV serological markers (HBsAg, HBc antibodies (Ab) and HBs Ab) in 175 participants. Fourteen HBsAg+ sera were excluded for further analysis. The presence of HBV DNA (C, S, and X gene regions) was assessed by the qualitative real-time PCR (qPCR) method. Frequencies of HBsAg, HBc, and HBs Ab were 8% (14/175), 36.6% (64/175), and 49.1% (86/175), respectively. Among these 42.9% (69/161) were negative for all HBV serological markers. The S, C, and X gene regions were positive in 10.3% (16/156), 15.4% (24/156), and 22.4% (35/156) of participants, respectively. The total OBI frequency was estimated at 33.3% (52/156) when based on detecting one HBV genomic region. Twenty-two and 30 participants had a seronegative and seropositive OBI, respectively. Thorough screening of high-risk groups with reliable and sensitive molecular methods could lead to OBI identification and decrease CHB long-term complications. Mass immunization remains critical in preventing, reducing, and potentially eliminating HBV complications.
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Affiliation(s)
- Sanaz Ahmadi Ghezeldasht
- Blood Borne Infections Research Center, Academic Center for Education, Culture, and Research (ACECR), Razavi Khorasan, Mashhad, Iran
| | - Saman Soleimanpour
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Hedayati-Moghaddam
- Blood Borne Infections Research Center, Academic Center for Education, Culture, and Research (ACECR), Razavi Khorasan, Mashhad, Iran
| | - Moein Farshchian
- Division of Oncology, Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Seyed Abdolrahim Rezaee
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arman Mosavat
- Blood Borne Infections Research Center, Academic Center for Education, Culture, and Research (ACECR), Razavi Khorasan, Mashhad, Iran
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Zhou J, Tan Y, Hu L, Fu J, Li D, Chen J, Long Y. Inhibition of HSPA8 by rifampicin contributes to ferroptosis via enhancing autophagy. Liver Int 2022; 42:2889-2899. [PMID: 36254713 DOI: 10.1111/liv.15459] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Rifampicin is the most common pathogenic factor in anti-tuberculosis drug-induced liver injury (AT-DILI), the mechanisms that it promotes hepatocyte damage in AT-DILI are not yet to be thoroughly elucidated. In this study, we investigated the potential molecular mechanisms for ferroptosis involving rifampicin hepatotoxicity. METHODS Animal and cell injury models of rifampicin were constructed, and the toxicity of rifampicin was assessed by physicochemical staining and cell viability assay. Next, flow cytometry was employed to detect changes in ferroptosis-related markers, and Western blotting was used to detect protein expression. Then, the important role of autophagy and ferroptosis was verified with small molecule compound intervention. RESULTS We found that ferritinophagy-induced ferroptosis participates in the toxicity of rifampicin, and the mechanism is that rifampicin precisely activates high-throughput autophagy, which leads to the massive degradation of ferritin and the increase of free iron. Moreover, rifampicin exhibited conspicuous inhibition of Human 71 kDa heat shock cognate protein (HSPA8) that is intimately associated with Microtubule-associated protein light chain 3 isoform B (LC3B) expression, in turn, HSPA8 inducer attenuated intracellular autophagy flux. Of note, inducing HSPA8 or inhibition of autophagy and ferroptosis considerably relieved the hepatotoxicity of rifampicin in mouse model. CONCLUSIONS The present study highlights the crucial roles of the HSPA8 and autophagy in ferroptotic cell death driving by rifampicin, particularly illumines multiple promising regulatory nodes for therapeutic interventions in diseases involving AT-DILI.
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Affiliation(s)
- Juan Zhou
- Department of Infectious Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Yingzheng Tan
- Department of Infectious Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Lingli Hu
- Department of Infectious Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Jingli Fu
- Department of Infectious Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Dan Li
- Department of Infectious Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Jun Chen
- Department of Liver Diseases, Third Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yunzhu Long
- Department of Infectious Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
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Hou W, Nsengimana B, Yan C, Nashan B, Han S. Involvement of endoplasmic reticulum stress in rifampicin-induced liver injury. Front Pharmacol 2022; 13:1022809. [PMCID: PMC9630567 DOI: 10.3389/fphar.2022.1022809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Rifampicin is a first-line antituberculosis drug. Hepatocyte toxicity caused by rifampicin is a significant clinical problem. However, the specific mechanism by which rifampicin causes liver injury is still poorly understood. Endoplasmic reticulum (ER) stress can have both protective and proapoptotic effects on an organism, depending on the environmental state of the organism. While causing cholestasis and oxidative stress in the liver, rifampicin also activates ER stress in different ways, including bile acid accumulation and cytochrome p450 (CYP) enzyme-induced toxic drug metabolites via pregnane X receptor (PXR). The short-term stress response helps the organism resist toxicity, but when persisting, the response aggravates liver damage. Therefore, ER stress may be closely related to the “adaptive” mechanism and the apoptotic toxicity of rifampicin. This article reviews the functional characteristics of ER stress and its potentially pathogenic role in liver injury caused by rifampicin.
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Affiliation(s)
- Wanqing Hou
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bernard Nsengimana
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chuyun Yan
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bjorn Nashan
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Shuxin Han
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Shuxin Han,
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Bogale L, Tenaw D, Tsegaye T, Abdulkadir M, Akalu TY. A Score to Predict the Risk of Major Adverse Drug Reactions Among Multi-Drug Resistant Tuberculosis Patients in Southern Ethiopia, 2014–2019. Infect Drug Resist 2022; 15:2055-2065. [PMID: 35480059 PMCID: PMC9037729 DOI: 10.2147/idr.s351076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adverse events (AE) contribute to poor drug adherence and withdrawal, which contribute to a low treatment success rate. AE are commonly reported among multi-drug resistance tuberculosis (MDR-TB) patients in Ethiopia. However, predictors of AE among MDR-TB patients were limited in Ethiopia. Thus, the current study aimed to develop and validate a score to predict the risks of major AE among MDR-TB patients in Southern Ethiopia. Methods A retrospective follow-up study design was employed among MDR-TB patients from 2014–2019 in southern Ethiopia at selected hospitals. A least absolute shrinkage and selection operator algorithm was used to select the most potent predictors of the outcome. The adverse event risk score was built based on the multivariable logistic regression analysis. Discriminatory power and calibration were checked to evaluate the performance of the model. Bootstrapping method with 100 repetitions was used for internal model validation. Results History of baseline khat use, long-term drug regimen use, and having coexisting disorders (co-morbidity) were predictors of AEs. The score has a satisfactory discriminatory power (AUC = 0.77, 95% CI: 0.68, 0.82) and a modest calibration (Prob > chi2 = 0.2043). It was found to have the same c-statistics after validation by bootstrapping method of 100 repetitions with replacement. Conclusion A history of baseline khat use, co-morbidity, and long-term drug regimen use are helpful to predict individual risk of major adverse events in MDR-TB patients with a satisfactory degree of accuracy (AUC = 0.77).
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Affiliation(s)
- Lemlem Bogale
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Denekew Tenaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Temesgen Yihunie Akalu, Tel +251929390709, Email
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8
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Chen J, Wu H, Tang X, Chen L. 4-Phenylbutyrate protects against rifampin-induced liver injury via regulating MRP2 ubiquitination through inhibiting endoplasmic reticulum stress. Bioengineered 2022; 13:2866-2877. [PMID: 35045794 PMCID: PMC8974152 DOI: 10.1080/21655979.2021.2024970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rifampin (RFP), a first-line anti-tuberculosis drug, often induces cholestatic liver injury and hyperbilirubinemia which limits its clinical use. Multidrug resistance-associated protein 2 (MRP2) localizes to the hepatocyte apical membrane and plays a pivotal role in the biliary excretion of bilirubin glucuronides. RFP is discovered to reduce MRP2 expression in liver cells. 4-Phenylbutyrate (4-PBA), a drug used to treat ornithine transcarbamylase deficiency (DILI), is reported to alleviate RFP-induced liver cell injury. However, the underlying mechanism still remains unclear. In the current study, we discovered that RFP induced HepG2 cell viability reduction, apoptosis and MRP2 ubiquitination degradation. Administration of 4-PBA alleviated the effect of RFP on HepG2 cell viability reduction, apoptosis and MRP2 ubiquitination degradation. In mechanism, 4-PBA suppressed RPF-caused intracellular Ca2+ disorder and endoplasmic reticulum (ER) stress, as well as the increases of Clathrin and adapter protein 2 (AP2). ER stress marker protein C/EBP homologous protein took part in the modulation of AP2 and clathrin. Besides, 4-PBA reduced the serum bilirubin level in RFP-induced cholestasis mouse model, along with raised the MRP2 expression in liver tissues. These findings indicated that 4-PBA could alleviate RFP-induced cholestatic liver injury and thereby decreased serum total bilirubin concentration via inhibiting ER stress and ubiquitination degradation of MRP2, which provides new insights into the mechanism of 4-PBA in the treatment of RFP-induced cholestasis and liver damage.
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Affiliation(s)
- Jing Chen
- Institute of Gastroenterology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P.R. China
| | - Hongbo Wu
- Institute of Gastroenterology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P.R. China
| | - Xudong Tang
- Institute of Gastroenterology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P.R. China
| | - Lei Chen
- Institute of Gastroenterology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P.R. China
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9
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Perwitasari DA, Setiawan D, Nguyen T, Pratiwi A, Rahma Fauziah L, Saebrinah E, Safaria T, Nurulita NA, Arfianti Wiraagni I. Investigating the Relationship between Knowledge and Hepatotoxic Effects with Medication Adherence of TB Patients in Banyumas Regency, Indonesia. Int J Clin Pract 2022; 2022:4044530. [PMID: 36110263 PMCID: PMC9448620 DOI: 10.1155/2022/4044530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Tuberculosis (TB) still remains the burden in Indonesia. One of the factors that may influence the treatment success of TB is patient's adherence. However, the hepatotoxicity of the TB medicine may decrease the patient's adherence. Our study's aim is to investigate the relationship between the patient's knowledge and the hepatotoxicity with medication adherence of TB patients in Banyumas Regency. This study was conducted at one Community Lung Health Center and two hospitals in Banyumas Regency, Purwokerto, Center of Java, Indonesia. The respondents were 91 TB patients with hepatotoxicity characterized by an increased aspartate transaminase (AST) and alanine aminotransferase (ALT). The level of the patients' knowledge about the hepatotoxicity effect was determined using a questionnaire. The patients' adherence was determined using the Medication Adherence Rating Scale -5 (MARS) questionnaire and pill count methods. Most of the patients were male (53.8%), the age was in the range of 18-29 years old (3.5%), they have no smoking history (59.3%), and their last education majorly was senior high school (46.2%). Most TB patients had poor knowledge (47.3%) and the hepatotoxic effect often appeared in grade 1 (61.5%). The TB patients with a good and moderate level of knowledge were 17.6% and 35.2%, respectively. The TB patients with moderate and severe hepatotoxicity were 39.4% and 1.1%, respectively. The measurement of the level of respondents' adherence using MARS-5 showed that 51.6% of patients had good adherence. We determined the rest of the drug-using pill count method, which resulted in 62.6% of patients adhering to taking antituberculosis drugs. TB patients with a sufficient knowledge and those with mild hepatotoxicity show the higher adherence (p < 0.001). There is a significant relationship between a high level of the patient's knowledge about hepatotoxicity effect, less severity of the hepatotoxic effect, and increased patient adherence in taking the medication.
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Affiliation(s)
| | - Didik Setiawan
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Yogyakarta 53182, Indonesia
| | - Thang Nguyen
- Department of Pharmacology and Clincal Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Arum Pratiwi
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Yogyakarta 53182, Indonesia
| | - Laila Rahma Fauziah
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Yogyakarta 53182, Indonesia
| | - Erin Saebrinah
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Yogyakarta 53182, Indonesia
| | - Triantoro Safaria
- Faculty of Psychology, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
| | - Nunuk Aries Nurulita
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Yogyakarta 53182, Indonesia
| | - Idha Arfianti Wiraagni
- Faculty of Medicine, Nursing and Public Health, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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10
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Zhong T, Zhuang Z, Dong X, Wong KH, Wong WT, Wang J, He D, Liu S. Predicting Antituberculosis Drug-Induced Liver Injury Using an Interpretable Machine Learning Method: Model Development and Validation Study. JMIR Med Inform 2021; 9:e29226. [PMID: 34283036 PMCID: PMC8335604 DOI: 10.2196/29226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 01/18/2023] Open
Abstract
Background Tuberculosis (TB) is a pandemic, being one of the top 10 causes of death and the main cause of death from a single source of infection. Drug-induced liver injury (DILI) is the most common and serious side effect during the treatment of TB. Objective We aim to predict the status of liver injury in patients with TB at the clinical treatment stage. Methods We designed an interpretable prediction model based on the XGBoost algorithm and identified the most robust and meaningful predictors of the risk of TB-DILI on the basis of clinical data extracted from the Hospital Information System of Shenzhen Nanshan Center for Chronic Disease Control from 2014 to 2019. Results In total, 757 patients were included, and 287 (38%) had developed TB-DILI. Based on values of relative importance and area under the receiver operating characteristic curve, machine learning tools selected patients’ most recent alanine transaminase levels, average rate of change of patients’ last 2 measures of alanine transaminase levels, cumulative dose of pyrazinamide, and cumulative dose of ethambutol as the best predictors for assessing the risk of TB-DILI. In the validation data set, the model had a precision of 90%, recall of 74%, classification accuracy of 76%, and balanced error rate of 77% in predicting cases of TB-DILI. The area under the receiver operating characteristic curve score upon 10-fold cross-validation was 0.912 (95% CI 0.890-0.935). In addition, the model provided warnings of high risk for patients in advance of DILI onset for a median of 15 (IQR 7.3-27.5) days. Conclusions Our model shows high accuracy and interpretability in predicting cases of TB-DILI, which can provide useful information to clinicians to adjust the medication regimen and avoid more serious liver injury in patients.
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Affiliation(s)
- Tao Zhong
- Department of Tuberculosis Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zian Zhuang
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, Hong Kong.,Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States.,Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Xiaoli Dong
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Ka Hing Wong
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Wing Tak Wong
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Jian Wang
- Department of Tuberculosis Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, Hong Kong.,Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Shengyuan Liu
- Department of Tuberculosis Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
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11
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Nataprawira HM, Aliyannissa A, Febrianti SA. Unusual Recurrence of Antituberculosis Drug-Induced Hepatotoxicity in Children: A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930828. [PMID: 34267172 PMCID: PMC8295927 DOI: 10.12659/ajcr.930828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Case series Patients: Male, 4-year-old • Female, 18-month-old • Male, 2-year-and-6-month-old • Female, 13-year-old • Female, 8-year-old • Male, 7-year-old Final Diagnosis: Recurrent ADIH Symptoms: Nausea • vomiting • yellowish skin Medication: — Clinical Procedure: Liver function test examination Specialty: Infectious Diseases • Pulmonology
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Affiliation(s)
| | - Almira Aliyannissa
- Department of Child Health, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Sindy A Febrianti
- Department of Child Health, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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12
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Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Answers. Pediatr Nephrol 2021; 36:2131-2135. [PMID: 33768327 DOI: 10.1007/s00467-021-05006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
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13
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Wang J, Zhou F, Jiang MB, Xu ZH, Ni YH, Wu QS. Epidemiological characteristics and trends of Bacillus Calmette-Guérin lymphadenitis in Shanghai, China from 2010 to 2019. Hum Vaccin Immunother 2021; 18:1938922. [PMID: 34156902 PMCID: PMC8920159 DOI: 10.1080/21645515.2021.1938922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the administration of the Bacillus Calmette–Guérin (BCG) vaccine is generally safe, lymphadenitis, the most common complication of BCG vaccination, can occur. Here, we describe the epidemiological characteristics and incidence trends of BCG lymphadenitis in Shanghai, China, among a population with a high burden of tuberculosis. A total of 56 cases of adverse events following immunization (AEFI) after BCG vaccination were reported in Shanghai, including 51 cases of BCG lymphadenitis (91.07%), from 2010 to 2019. The general incidence of BCG lymphadenitis was 173 per 1,000,000 doses in Shanghai from 2010 to 2019. A nonsignificant increase of 58.81% per year was observed between 2010 and 2012 (t = 0.93; p = .40), followed by a significant decline of 28.00% per year from 2012 to 2019 (t = −4.27; p < .01). Seven batches of BCG vaccines triggered three or more BCG lymphadenitis cases, for 27 (52.94%) cases in total. We identified two patients with immunodeficiency of chronic granulomatous disease, one of whom died four years later after BCG vaccination and another of whom was still being treated after two transplants. The average total care cost of the 47 recovered cases was 11,336 RMB (range: 2,637–33,861 RMB). Due to the high burden of BCG lymphadenitis, especially in children with immunodeficiency, it is suggested that government departments should strengthen healthcare provider training, assign specific nurses to perform BCG vaccination, monitor vaccinated individuals actively and timely detect abnormal signals so as to reduce the incidence of BCG lymphadenitis.
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Affiliation(s)
- Jing Wang
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Feng Zhou
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Ming-Bo Jiang
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Zhen-Hui Xu
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Yi-Hong Ni
- Department of Immunization, Huangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Qiang-Song Wu
- Department of Immunization, Xuhui District Center for Disease Control and Prevention, Shanghai, China
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14
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Konduri S, Pogaku V, Prashanth J, Siva Krishna V, Sriram D, Basavoju S, Behera JN, Prabhakara Rao K. Sacubitril‐Based Urea and Thiourea Derivatives as Novel Inhibitors for Anti‐Tubercular against Dormant
Tuberculosis. ChemistrySelect 2021. [DOI: 10.1002/slct.202004724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Srihari Konduri
- New Generation Materials Lab (NGML), Department of Science and Humanities Vignan's Foundation for Science Technology and Research (VFSTR)(Deemed to be University), Vadlamudi Guntur 522 213, Andhra Pradesh India
| | - Vinay Pogaku
- Department of Chemistry National Institute of Technology Warangal 506 004 Telangana India
| | - Jyothi Prashanth
- Department of Physics Kakatiya University, Warangal- 506009 Telangana India
| | - Vagolu Siva Krishna
- Department of Pharmacy Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Shameerpet, Jawaharnagar Hyderabad 500 078 India
| | - Dharmarajan Sriram
- Department of Pharmacy Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Shameerpet, Jawaharnagar Hyderabad 500 078 India
| | - Srinivas Basavoju
- Department of Chemistry National Institute of Technology Warangal 506 004 Telangana India
| | - J. N. Behera
- School of Chemical Sciences National Institute of Science Education and Research (NISER) Bhubaneswar 752050, Odisha India
- HomiBhabha National Institute Anushakti Nagar Mumbai 400 094 India
| | - Koya Prabhakara Rao
- New Generation Materials Lab (NGML), Department of Science and Humanities Vignan's Foundation for Science Technology and Research (VFSTR)(Deemed to be University), Vadlamudi Guntur 522 213, Andhra Pradesh India
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15
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Lisanwork Arage L, Deybasso HA, Yilma Gebremichael D, Gintamo Nuramo B, Negash Mekuria Z. Determinants of Drug-Induced Hepatotoxicity Among Patients with Human Immunodeficiency Virus Taking a High Dose of Rifapentine Plus Isoniazid Drugs at the All Africa Leprosy Tuberculosis Rehabilitation and Training Center in Addis Ababa, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:307-314. [PMID: 33758553 PMCID: PMC7981156 DOI: 10.2147/hiv.s300135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022]
Abstract
Purpose The drugs for the treatment of latent Tuberculosis are potentially hepatotoxic and can lead to drug-induced hepatotoxicity. The current study aimed at identifying the determinants of anti-tuberculosis drug-induced hepatotoxicity among patients living with Human Immunodeficiency Virus taking Isoniazid and rifapentine at All Africa Leprosy Tuberculosis Rehabilitation and Training Center in Addis Ababa, Ethiopia. Methods An unmatched case-control study was conducted from March, 21, to April 21, 2020, at All Africa Leprosy Tuberculosis Rehabilitation and Training Center. A total of 65 cases and 130 controls were interviewed. Data were collected using a data extraction tool from clinical reporting forms, follow-up charts, and patients' logbooks. Binary and multiple logistic regressions were conducted to check the association between independent and dependent variables. Adjusted odds ratios and the corresponding 95% confidence intervals were estimated to assess the strength of association. P-values <0.05 were used to declare statistical significance. Results The prevalence of anti-TB drug-induced hepatotoxicity was 8%. Body mass index <18.5 Kg/m2 (AOR = 5.8 [95% CI: 2.2-8.9]), low CD4 count (AOR = 4.9 [95% CI: 1.6-15.8]), and the presence of comorbid illnesses (AOR = 3.9 [95% CI: 1.7-8.9]) were identified as independent predictors of drugs-induced hepatotoxicity among Human Immunodeficiency Virus positive patients taking Isoniazid and rifapentine. Conclusion The prevalence of anti-TB drug-induced hepatotoxicity was higher compared to standard references. BMI<18 kg/m2, low CD4 count, and comorbid illness were positively associated with anti-tuberculosis drug-induced hepatotoxicity among patients with HIV.
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Affiliation(s)
| | | | | | - Binyam Gintamo Nuramo
- Addis Ababa Medical and Business College, Department of Research and Community Service, Addis Ababa, Ethiopia
| | - Zelalem Negash Mekuria
- Addis Ababa Medical and Business College, Department of Research and Community Service, Addis Ababa, Ethiopia
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16
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Bakshi S, Kaur M, Saini N, Mir AA, Duseja A, Sinha SK, Sharma S. Altered expressions of circulating microRNAs 122 and 192 during antitubercular drug induced liver injury indicating their role as potential biomarkers. Hum Exp Toxicol 2021; 40:1474-1484. [PMID: 33729026 DOI: 10.1177/0960327121997975] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Drug induced liver toxicity is a serious health complication leading to high mortality rates and post marketing withdrawal of drugs. Although considered to be the gold standard biomarkers; aspartate aminotransferase, alanine aminotransferase, total bilirubin and alkaline phosphatase have been found to have specificities beyond liver, therefore more specific and predictive markers for the detection of antitubercular drug mediated liver damage are required. Unfortunately, the effectiveness of currently used first line antitubercular drugs namely isoniazid, rifampicin, pyrazinamide is often accompanied with liver injury, impeding the cure of patients. Keeping in view, the prognostic and diagnostic applications of microRNAs in various diseases, we tried to assess the importance of microRNAs 122 and 192 in antitubercular drug associated liver injuries. The study included subjects having tuberculosis of any type with antitubercular drug induced liver injury; naïve or newly diagnosed tuberculosis patients, tuberculosis patients on drugs not having toxicity and healthy controls. Observations from this study revealed that expression levels of miR-122 and miR-192 were significantly decreased in the serum of antitubercular drug induced liver injury patients only. Therefore, these microRNAs or the pathways associated with them can be used as a tool to predict or cure antitubercular drug associated liver injury in future.
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Affiliation(s)
- S Bakshi
- Department of Biochemistry, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Kaur
- Department of Biochemistry, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Saini
- Department of Biochemistry, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A A Mir
- Department of Biochemistry, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Biochemistry, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - A Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Sinha
- Department of Gasteroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Sharma
- Department of Biochemistry, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Molla Y, Wubetu M, Dessie B. Anti-Tuberculosis Drug Induced Hepatotoxicity and Associated Factors among Tuberculosis Patients at Selected Hospitals, Ethiopia. Hepat Med 2021; 13:1-8. [PMID: 33536799 PMCID: PMC7850419 DOI: 10.2147/hmer.s290542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Background Tuberculosis caused by susceptible mycobacterium tuberculosis strains is effectively treated by the first-line anti-tuberculosis drugs. However, most antibacterial drugs are known to induce hepatotoxicity which may limit their adherence and hence lead to the development of mycobacterial drug resistance. Objective The aim of this study was to assess the incidence of anti-tuberculosis drug induced hepatotoxicity and associated factors among tuberculosis patients of Debre Markos, Mota, and Bichena Hospitals. Methods The prospective cross sectional-study was conducted in three hospitals of East Gojjam zone by taking blood samples of new tuberculosis patients every 2 weeks for 2 months to measure the elevation of liver proteins indicating liver toxicity from the onset of starting therapy. A semi-structured questionnaire was also used to collect the socio-demographic data and factors of anti-tubeculosis drug induced liver toxicity. To identify factors associated with drug induced hepatotoxicity, binary logistic regression followed by multivariate analysis was applied at a statistically significant level of P<0.05. Results The incidence of hepatotoxicity among tuberculosis patients is 7.9%. Diagnosis of extrapulmonary tuberculosis, having comorbid disease, and old age are significantly associated (P<0.05) with first-line antituberculosis drugs induced hepatotoxicity. Conclusion The incidence of hepatotoxicity is relatively high among tuberculosis patients taking first-line anti-tuberculosis drugs. Therefore, the liver function of patients with old age, comorbid diseases, and extrapulmonary tuberculosis should be regularly monitored to reduce the severity of drug-induced hepatotoxicity.
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Affiliation(s)
- Yalew Molla
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Muluken Wubetu
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Dessie
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
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18
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Kesenogile B, Godman B, Rwegerera GM. Alanine transaminase and hemoglobin appear to predict the occurrence of antituberculosis medication hepatotoxicity; findings and implications in Botswana. Expert Rev Anti Infect Ther 2020; 19:379-391. [PMID: 32909487 DOI: 10.1080/14787210.2020.1822735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Tuberculosis (TB) remains a global health problem, with medications having adverse effects including drug-induced hepatotoxicity. We determined the prevalence of anti-tuberculosis drug-induced hepatotoxicity and associated risk factors. METHODS Retrospective cross-sectional study in Botswana including TB patients admitted from 1 June 2017 to 30 June 2018. Anti-TB drug-induced hepatotoxicity was categorized according to WHO criteria whereas causality assessment was made according to the updated Roussel Uclaf Causality Assessment Method (RUCAM) scale. The association between hepatotoxicity and included variables was undertaken by binary logistic regression. RESULTS Out of 112 patient files, 15 (13.4%) developed hepatotoxicity after an average of 20.4 days from the start of treatment. Grade 3 and 4 hepatotoxicity was found in 66.7% of the cases. According to the updated RUCAM tool, 86.7% of patients were categorized as having possible anti-TB-associated hepatotoxicity. Patients with elevated baseline alanine transaminase (ALT) were more likely to develop hepatotoxicity (OR = 3.484, 95% CI = 1.02-11.90). Patients with normal hemoglobin (Hb ≥ 12 g/dl) were also more likely to develop hepatotoxicity (OR = 4.413, 95% CI = 1.160-14.8). CONCLUSION Overall, normal hemoglobin and elevated baseline ALT levels were significantly associated with anti-TB drug-induced hepatotoxicity. Additional research is needed to explore this association further.
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Affiliation(s)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Godfrey Mutashambara Rwegerera
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana.,Department of Internal Medicine, University of Botswana, Gaborone, Botswana
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19
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Gezahegn LK, Argaw E, Assefa B, Geberesilassie A, Hagazi M. Magnitude, outcome, and associated factors of anti-tuberculosis drug-induced hepatitis among tuberculosis patients in a tertiary hospital in North Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0241346. [PMID: 33170847 PMCID: PMC7654771 DOI: 10.1371/journal.pone.0241346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Short-course chemotherapy comprising isoniazid, rifampicin, ethambutol, and pyrazinamide has proved to be highly effective in the treatment of tuberculosis (TB). However, the most common adverse effect of this regimen leading to interruption of therapy is hepatotoxicity. There is a paucity of evidence in Tigray region on anti-tuberculosis drug-induced hepatitis. Therefore, this study aims to determine the magnitude, outcomes, and associated factors of drug-induced hepatitis in Ayder specialized comprehensive hospital tuberculosis clinic. METHODS An institution-based cross-sectional study was done on 188 cases of patients who took anti-tuberculosis drugs from August 4, 2015 to June 30, 2018 in tuberculosis clinic, Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Data on socio-demography, clinical characteristics and magnitude of the incidence and outcome of anti-tuberculosis drugs-induced hepatitis were collected using structured checklist from patients' records using census method. Then, we entered and analyzed the data using statistical packages for social sciences (SPSS) statistical software version 21. Descriptive statistics were done in tables, counts, proportions, median and range. Bivariate and multivariable regression analyses were done to identify factors that are associated with drug-induced hepatitis. Confidence interval was taken at 95% and p-value of less than 0.05 was used to denote significance. RESULTS We approached a total of 226 patients' records, and we collected data from188 records (83.2%response rate). Anti-tuberculosis drug-induced hepatitis was found in 26 (13.8%) of the patients, of which 3 (11.54%) have died. Using multivariable logistic regression analyses, preexisting liver disease (AOR: 42.01, 95% CI: 4.22-417.49), taking other hepatotoxic drugs (AOR: 23.66, 95% CI: 1.77-314.79), and having lower serum albumin (AOR: 10.55, 95% CI: 2.57-43.32) were found to be significantly associated with the development of anti-tuberculosis drug-induced hepatitis. CONCLUSION AND RECOMMENDATION The incidence of anti-tuberculosis drug-induced hepatitis was high. Patients with low baseline serum albumin, taking other hepatotoxic drugs and having preexisting liver disease should be followed with serial liver enzymes after initiation of anti-tuberculosis medications. These patients should be followed with frequent measurement of liver enzymes to assess for the development of drug-induced hepatitis.
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Affiliation(s)
- Liwam Kidane Gezahegn
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Ermias Argaw
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Belete Assefa
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Azeb Geberesilassie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mengistu Hagazi
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Xu N, Yang JX, Yang J. Incidence and associated risk factors of antituberculosis drug-induced hepatotoxicity among hospitalised patients in Wuhan, China. Eur J Hosp Pharm 2020; 29:217-221. [DOI: 10.1136/ejhpharm-2020-002433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/20/2020] [Accepted: 09/01/2020] [Indexed: 02/01/2023] Open
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Feleke BE, Feleke TE, Adane WG, Girma A. Impacts of hepatitis B and hepatitis C co-infection with tuberculosis, a prospective cohort study. Virol J 2020; 17:113. [PMID: 32703225 PMCID: PMC7376700 DOI: 10.1186/s12985-020-01385-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study was conducted to estimate the prevalence, determinants of hepatitis B, hepatitis C and the survival of tuberculosis patients until drug-induced hepatitis. METHODS Prospective cohort study design was implemented. The data were collected from September 2016 - May 2019. Systematic random sampling was used to select the study participants. Baseline data were collected before the patient starts DOTS, the sign of liver toxicity was assessed every week. Tuberculosis treatment outcomes and WHO clinical stage was recorded at the end of 6th months. Descriptive statistics were used to estimate the prevalence of hepatitis B, hepatitis C viral infections and their effect on tuberculosis treatment outcomes. Binary logistic regression was used to identify the determinants of hepatitis B and C infections. The Kaplan Meier survival curve was used to estimate the survival of tuberculosis patient and Cox regression was used to identify the predictors of drug-induced hepatitis. RESULTS A total of 3537 tuberculosis patients were followed. The prevalence of hepatitis B and C viral infection among tuberculosis patients were 15.1 and 17.3% respectively. Hepatitis B viral infection among tuberculosis patients was associated with alcohol, sex, HIV, chronic illness. Hepatitis C viral infection among tuberculosis patients was associated with alcohol, sex, HIV, chronic illness. The incidence density for liver toxicity among tuberculosis patients was 843/15707 person-months and liver toxicity was determined by HIV, Hepatitis B, Hepatitis C, the severity of tuberculosis and chronic illnesses. CONCLUSION Decision-makers should consider incorporating screening for hepatitis B and C viral infection during tuberculosis treatment.
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Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, University of Bahir Dar, Bahir Dar, Ethiopia.
| | | | | | - Abel Girma
- Department of Internal Medicine, University of Bahir Dar, Bahir Dar, Ethiopia
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Abnormal Levels of Liver Enzymes and Hepatotoxicity in HIV-Positive, TB, and HIV/TB-Coinfected Patients on Treatment in Fako Division, Southwest Region of Cameroon. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9631731. [PMID: 32462039 PMCID: PMC7243024 DOI: 10.1155/2020/9631731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/04/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
Hepatotoxicity is historically the 3rd most common reason for drug withdrawal and toxicity-related discontinuation of treatment. This study was aimed at determining the incidence and the onset of hepatotoxicity and at evaluating the relationship of some risk factors for hepatotoxicity among Human Immunodeficiency Virus- (HIV-) positive, tuberculosis (TB), and HIV/TB patients on treatment. This was a prospective follow-up study involving 125 participants from the HIV/AIDS and TB treatment centres in three hospitals in Fako Division of Cameroon. These TB and HIV patients were initiated on RHEZ (R = Rifampicin, H = Isoniazid, E = Ethambutol, and P = Pyrazinamide) and TELE (efavirenz/tenofovir/lamivudine), respectively, and followed up for 12 weeks between September 2018 and November 2019. The levels of liver enzymes (transaminases, gamma-glutamyltransferase, alkaline phosphatase, and unconjugated/total bilirubin) were measured spectrophotometrically using serum. The Chi-squared (χ2) test was used to assess the association between risk factors and hepatotoxicity, while the Kaplan-Meier survival analysis with the log-rank test was used to determine the occurrence of hepatotoxicity in the different groups. We followed the general study population for a total person time of 6580 person-days, with an incidence rate and cumulative incidence of 8 cases per 1000 person-days (53/6580 person-days) and 42.4% (53/125), respectively (95% confidence interval), recorded after 12 weeks of follow-up of all the participants. The onset of hepatotoxicity in the total study population was statistically significant (χ2 = 9.5334; p = 0.022979; CI = 95%), with the majority observed at week eight of follow-up. Also, the incidence rate and cumulative incidence of hepatotoxicity with respect to HIV/AIDS, TB, and HIV/TB patients, respectively, at 95% confidence interval were: 8 cases per 1000 person-days (32/3843 person-days) and 32/76 (42.1%), 6 cases per 1000 person-days (12/1932 person-days) and 12/32 (37.5%), and 11 cases per 1000 person-days (9/805 person-days) and 9/17 (52.9%). This study shows that the incidence rate and cumulative incidence of hepatotoxicity in HIV/AIDS, TB, and HIV/TB patients on treatment were high in Fako Division, Cameroon. Also, it is very important to check these patients' liver function especially within the first 12 weeks of treatment.
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N-Acetyl Cysteine as an Adjunct in the Treatment of Tuberculosis. Tuberc Res Treat 2020; 2020:5907839. [PMID: 32411461 PMCID: PMC7210531 DOI: 10.1155/2020/5907839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/04/2020] [Accepted: 04/22/2020] [Indexed: 01/19/2023] Open
Abstract
Oxidative stress is a common feature of tuberculosis (TB), and persons with reduced antioxidants are at more risk of TB. TB patients with relatively severe oxidative stress had also more advanced disease as measured by the Karnofsky performance index. Since adverse effects from anti-TB drugs are also mediated by free radicals, TB patients are prone to side effects, such as hearing loss. In previous articles, researchers appealed for clinical trials aiming at evaluating N-acetyl cysteine (NAC) in attenuating the dreaded hearing loss during multidrug-resistant TB (MDR-TB) treatment. However, before embarking on such trials, considerations of NAC's overall impact on TB treatment are crucial. Unfortunately, such a comprehensive report on NAC is missing in the literature and this manuscript reviews the broader effect of NAC on TB treatment. This paper discusses NAC's effect on mycobacterial clearance, hearing loss, drug-induced liver injury, and its interaction with anti-TB drugs. Based on the evidence accrued to date, NAC appears to have various beneficial effects on TB treatment. However, despite the favorable interaction between NAC and first-line anti-TB drugs, the interaction between the antioxidant and some of the second-line anti-TB drugs needs further investigations.
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Targeted ultra-deep sequencing of a South African Bantu-speaking cohort to comprehensively map and characterize common and novel variants in 65 pharmacologically-related genes. Pharmacogenet Genomics 2020; 29:167-178. [PMID: 31162291 PMCID: PMC6675649 DOI: 10.1097/fpc.0000000000000380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Supplemental Digital Content is available in the text. Background African populations are characterised by high genetic diversity, which provides opportunities for discovering and elucidating novel variants of clinical importance, especially those affecting therapeutic outcome. Significantly more knowledge is however needed before such populations can take full advantage of the advances in precision medicine. Coupled with the need to concisely map and better understand the pharmacological implications of genetic diversity in populations of sub-Sharan African ancestry, the aim of this study was to identify and characterize known and novel variants present within 65 important absorption, distribution, metabolism and excretion genes. Patients and methods Targeted ultra-deep next-generation sequencing was used to screen a cohort of 40 South African individuals of Bantu ancestry. Results We identified a total of 1662 variants of which 129 are novel. Moreover, out of the 1662 variants 22 represent potential loss-of-function variants. A high level of allele frequency differentiation was observed for variants identified in this study when compared with other populations. Notably, on the basis of prior studies, many appear to be pharmacologically important in the pharmacokinetics of a broad range of drugs, including antiretrovirals, chemotherapeutic drugs, antiepileptics, antidepressants, and anticoagulants. An in-depth analysis was undertaken to interrogate the pharmacogenetic implications of this genetic diversity. Conclusion Despite the new insights gained from this study, the work illustrates that a more comprehensive understanding of population-specific differences is needed to facilitate the development of pharmacogenetic-based interventions for optimal drug therapy in patients of African ancestry.
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Complicated Urinary Tract Tuberculosis in a 13-Year-Old Adolescent with Chronic Kidney Disease and Antituberculous Drug-Induced Hepatotoxicity. Case Rep Infect Dis 2019; 2019:7370150. [PMID: 31781434 PMCID: PMC6855035 DOI: 10.1155/2019/7370150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/29/2019] [Indexed: 11/17/2022] Open
Abstract
Urinary tract tuberculosis (TB) is a rare extrapulmonary manifestation of TB in children. The disease is potentially underdiagnosed because it clinically resembles other urinary tract infections. A 13-year-old adolescent girl presented with pain, difficulty in micturition, and gross hematuria for almost two years before admission, and she had left flank pain since one year ago and significant loss of body weight during the illness. The close TB contact was her grandmother who was on TB treatment. Acid-fast bacilli yielded positive result, Mantoux test was positive (17 mm), urine GeneXpert MTB/Rif was positive; tuberculoma was identified on kidney histopathology, and a diuretic renogram revealed an uncorrected glomerular filtration rate (GFR) of the right and left kidney to be 32.5 mL/min/1.73 m2 and 5 mL/min/1.73 m2, respectively. During the treatment, oral anti-TB drug-induced hepatotoxicity (ADIH) occurred to the patient. This problem was solved with management according to the British Thoracic Society (BTS) guidelines. Screening TB in children is very important for a better outcome. If children complain of some complicated urinary tract infection, TB should be suspected. Optimaly treating children with urinary tract TB exagerrated with ADIH and CKD is very challenging.
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Abdel-Ghaf O, Hegab AM, Rayan EI. Evaluation of Antioxidative Effect of Green Tea Catechins Against Isoniazid-induced Biochemical Alterations in Rats. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.777.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wahid B. Hepatotoxicity and virological breakthrough of HCV following treatment with sofosbuvir, daclatasvir, and ribavirin in patients previously treated for tuberculosis. J Med Virol 2019; 91:2195-2197. [PMID: 31347729 DOI: 10.1002/jmv.25557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022]
Abstract
The prevalence of hepatitis C virus/tuberculosis (HCV/TB) coinfection has not been estimated globally but few studies highlight the risk of hepatotoxicity following TB treatment or HCV treatment. Previously reported data highlights the risk of drug-induced hepatotoxicity associated with three of the first-line anti-TB agents: rifampin, isoniazid, and pyrazinamide specifically in patients coinfected with HIV and HCV. Thus far, direct-acting antiviral (DAA) drug-induced hepatotoxicity has not been reported in the literature but herein, we observed an unusual case of HCV virological breakthrough and hepatoxicity during treatment with DAA drugs in a patient who has previously been successfully treated for TB.
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Affiliation(s)
- Braira Wahid
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Punjab, Pakistan
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Laoveeravat P, Wongjarupong N, Phathong C, Hurst C, Treeprasertsuk S, Rerknimitr R, Chaiteerakij R. Characteristics and risk factors for antituberculosis drug-induced liver injury in a cohort of patients with cirrhosis in a tertiary referral university teaching hospital in Thailand. ASIAN BIOMED 2019; 12:65-74. [DOI: 10.1515/abm-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Background
Cirrhotic patients are susceptible to drug toxicity, which presents frequently with antituberculosis drug (ATD) treatment. Previous studies of ATD-induced liver injury (ATDILI) in cirrhotics have been limited to patients with early-stage cirrhosis.
Objectives
To describe characteristics and determine risk factors for ATDILI in cirrhotic patients.
Methods
We included 64 cirrhotic patients treated with ATDs between 2006 and 2016 in a tertiary referral university teaching hospital in Bangkok, Thailand. Cirrhosis was diagnosed by radiological features, including small-sized nodular liver and/or caudate lobe hypertrophy or evidence of portal hypertension (collateral vessels, varices, and/or splenomegaly). Clinical information was retrospectively abstracted. Characteristics of patients with ATDILI vs. those without ATDILI were compared.
Results
Six (9.4%) patients developed ATDILI with the median duration from ATD initiation of 14 days (range: 6–66). All the 6 patients who developed ATDILI received 3 hepatotoxic ATDs (isoniazid, rifampin, and pyrazinamide) and had Child–Turcotte–Pugh class B cirrhosis. The patients with ATDILI were found to have a higher percentage of human immunodeficiency virus (HIV) infection than patients without ATDILI (50% vs. 8.6%; P = 0.02).
Conclusions
Cirrhotic patients, particularly those with underlying HIV infection, are at risk of developing ATDILI. Pyrazinamide should be used cautiously in cirrhotic patients due to the significantly increased risk of ATIDLI. This study supports the current recommendation for the use of ATD in patients with cirrhosis; however, the ATD regimen should be carefully selected, particularly for cirrhotic patients with HIV infection.
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Affiliation(s)
- Passisd Laoveeravat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
| | - Nicha Wongjarupong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
- Department of Physiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
| | - Chonlada Phathong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
| | - Cameron Hurst
- Biostatistics Center, Faculty of Medicine, Chulalongkorn University , Bangkok 10330, Thailand
| | - Sombat Treeprasertsuk
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
| | - Rungsun Rerknimitr
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
| | - Roongruedee Chaiteerakij
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok 10330, Thailand
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Merid MW, Gezie LD, Kassa GM, Muluneh AG, Akalu TY, Yenit MK. Incidence and predictors of major adverse drug events among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara regional state public hospitals; Ethiopia: a retrospective cohort study. BMC Infect Dis 2019; 19:286. [PMID: 30917788 PMCID: PMC6437856 DOI: 10.1186/s12879-019-3919-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/19/2019] [Indexed: 11/22/2022] Open
Abstract
Background Second line anti-tuberculosis drugs are substantially complex, long term, more costly, and more toxic than first line anti-tuberculosis drugs. In Ethiopia, evidence on the incidence and predictors of adverse drug events has been limited. Thus, this study aimed at assessing incidence and predictors of major adverse drug events among drug resistant tuberculosis patients on second line tuberculosis treatment in Amhara Regional State public hospitals, Ethiopia. Methods A multi-center retrospective cohort study was conducted on 570 drug resistant tuberculosis Patients. Data were entered in to EPI-Data version 4.2.0.0 and exported to Stata version 14 for analysis. Proportional hazard assumption was checked. The univariate Weibull regression gamma frailty model was fitted. Cox-Snell residual was used to test goodness of fit and Akaike Information Criteria (AIC) for model selection. Hazard ratio with 95% CI was computed and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors for adverse drug event. Results A total of 570 patients were followed for 5045.09 person-month (PM) observation with a median follow-uptime of 8.23 months (Inter Quartile Range (IQR) =2.66–23.33). The overall incidence rate of major adverse drug events was 5.79 per 100 PM (95% CI: 5.16, 6.49). Incidence rate at the end of 2nd, 4th, and 6th months was 13.73, 9.25, 5.97 events per 100 PM observations, respectively. Age at 25–49 (Adjusted Hazard Ratio (AHR) = 3.36, 95% CI: 1.36, 8.28), and above 50 years (AHR = 5.60, 95% CI: 1.65, 19.05), co-morbid conditions (AHR = 2.74 CI: 1.12, 6.68), and anemia (AHR = 3.25 CI: 1.40, 7.53) were significant predictors of major adverse drug events. Conclusion The incidence rate of major adverse drug events in the early 6 months of treatment was higher than that of the subsequent months. Age above 25 years, base line anemia, and co-morbid conditions were independent predictors of adverse drug events. Thus, addressing significant predictors and strengthening continuous follow-ups are highly recommended in the study setting.
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Affiliation(s)
- Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia.
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Soedarsono S, Mandayani S, Prayuni K, Yuliwulandari R. THE RISK FACTORS FOR DRUG INDUCED HEPATITIS IN PULMONARY TUBERCULOSIS PATIENTS IN DR. SOETOMO HOSPITAL. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2018. [DOI: 10.20473/ijtid.v7i3.8689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Tuberculosis (TB) is still a major public health problem in Indonesia. Anti-tuberculosis drug-induced hepatotoxicity (DIH) is common side effect leading to changes in treatment regimens, and the less effective second-line treatments. Several risk factors such as age, sex, body mass index (BMI) and acetylization status for hepatotoxicity were suggested in previous studies but in the fact, those are often not related to DIH incidence after receiving standard TB treatment regimen. The aim of this study was to asses the role of risk factors in the DIH incidence in pulmonary TB patients receiving standard TB treatment regimen in Dr. Soetomo Hospital, Surabaya. Study design was analytic observational with case control. The subjects were 30 TB DIH patients and 31 TB non-DIH patients receiving standard national TB program therapy. DIH severity was divided based on International DIH Expert Working Group. Demographic data and BMI status were taken from medical records. The age classification are ≥35 years old and <35 years old as one of the risk factors studied. DNA sequencing was used to assess single-nucleotide polymorphisms in NAT2 coding region to evaluate acetylator status from blood samples. The risk factors were evaluated using chi-square test and Mantel-Haenszel test. Significant association between low BMI and DIH in general was identified (OR=3.017; 95% CI=1.029-8.845) and more significant association between low BMI and moderate DIH (OR=15.833; 95% CI=1.792-139.922). Age, sex, and acetylization status has no significant correlation with DIH incidence in general. Significant association between slow acetylator phenotype and incidence of moderate DIH was identified (OR=7.125; 95% CI= 1.309-38.711). In conclusion, some risk factors were correlated to DIH incidence in pulmonary TB patientsreceiving standart TB treatment regimen.
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de Martino RB, Abdala E, Villegas FC, D’Albuquerque LAC, Song ATW. Liver transplantation for acute liver failure due to antitubercular drugs - a single-center experience. Clinics (Sao Paulo) 2018; 73:e344. [PMID: 30020340 PMCID: PMC6015261 DOI: 10.6061/clinics/2018/e344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/22/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation. METHODS We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database. RESULTS Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given. CONCLUSION Patients arrived very sick and displayed poor survival after deceased donor transplantation.
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Affiliation(s)
- Rodrigo Bronze de Martino
- Disciplina de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edson Abdala
- Laboratorio de Hepatite Virais – LIM-47, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Doencas Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Felipe Castro Villegas
- Disciplina de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Augusto Carneiro D’Albuquerque
- Disciplina de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Transplante e Cirurgia de Figado - LIM-37, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alice Tung Wan Song
- Disciplina de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Transplante e Cirurgia de Figado - LIM-37, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Jing J, Teschke R. Traditional Chinese Medicine and Herb-induced Liver Injury: Comparison with Drug-induced Liver Injury. J Clin Transl Hepatol 2018; 6:57-68. [PMID: 29577033 PMCID: PMC5863000 DOI: 10.14218/jcth.2017.00033] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 12/16/2022] Open
Abstract
Cases of suspected herb-induced liver injury (HILI) caused by herbal Traditional Chinese Medicines (TCMs) and of drug-induced liver injury (DILI) are commonly published in the scientific literature worldwide. As opposed to the multiplicity of botanical chemicals in herbal TCM products, which are often mixtures of several herbs, conventional Western drugs contain only a single synthetic chemical. It is therefore of interest to study how HILI by TCM and DILI compare with each other, and to what extent results from each liver injury type can be transferred to the other. China is among the few countries with a large population using synthetic Western drugs as well as herbal TCM. Therefore, China is well suited to studies of liver injury comparing drugs with TCM herbs. Despite some concordance, recent analyses of liver injury cases with verified causality, using the Roussel Uclaf Causality Assessment Method, revealed major differences in HILI caused by TCMs as compared to DILI with respect to the following features: HILI cases are less frequently observed as compared to DILI, have a smaller proportion of females and less unintentional rechallenge events, and present a higher rate of hepatocellular injury features. Since many results were obtained among Chinese residents who had access to and had used Western drugs and TCM herbs, such ethnic homogeneity supports the contention that the observed differences of HILI and DILI in the assessed population are well founded.
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Affiliation(s)
- Jing Jing
- Medical School of Chinese PLA, Beijing, China
- Integrative Medical Center, 302 Military Hospital, Beijing, China
| | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University, Frankfurt/Main, Germany
- *Correspondence to: Rolf Teschke, Department of Internal Medicine II, Klinikum Hanau, Teaching Hospital of the Goethe University of Frankfurt/Main, Leimenstrasse 20, Hanau D-63450, Germany. Tel: +49-6181-21859, Fax: +49-6181-2964211, E-mail:
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Categorization and association analysis of risk factors for adverse drug events. Eur J Clin Pharmacol 2017; 74:389-404. [PMID: 29222712 DOI: 10.1007/s00228-017-2373-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Adverse drug events (ADE) are among the leading causes of morbidity and hospitalization. This review analyzes risk factors for ADE, particularly their categorizations and association patterns, the prevalence, severity, and preventability of ADE, and method characteristics of reviewed studies. METHODS Literature search was conducted via PubMed, Science Direct, CINAHL, and MEDLINE. A review was conducted of research articles that reported original data about specific risk factors for ADE since 2000. Data analyses were performed using Excel and R. RESULTS We summarized 211 risk factors for ADE, and grouped them into five main categories: patient-, disease-, medication-, health service-, and genetics-related. Among them, medication- and disease-related risk factors were most frequently studied. We further classified risk factors within each main category into subtypes. Among them, polypharmacy, age, gender, central nervous system agents, comorbidity, service utilization, inappropriate use/change use of drugs, cardiovascular agents, and anti-infectives were most studied subtypes. An association analysis of risk factors uncovered many interesting patterns. The median prevalence, preventability, and severity rate of reported ADE was 19.5% (0.29%~86.2%), 36.2% (2.63%~91%), and 16% (0.01%~47.4%), respectively. CONCLUSIONS This review introduced new categories and subtypes of risk factors for ADE. The broad and in-depth coverage of risk factors and their association patterns elucidate the complexity of risk factor analysis. Managing risk factors for ADE is crucial for improving patient safety, particularly for the elderly, comorbid, and polypharmacy patients. Some under-explored risk factors such as genetics, mental health and wellness, education, lifestyle, and physical environment invite future research.
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Zhang W, Chen L, Feng H, Wang W, Cai Y, Qi F, Tao X, Liu J, Shen Y, Ren X, Chen X, Xu J, Shen Y. Rifampicin-induced injury in HepG2 cells is alleviated by TUDCA via increasing bile acid transporters expression and enhancing the Nrf2-mediated adaptive response. Free Radic Biol Med 2017; 112:24-35. [PMID: 28688954 DOI: 10.1016/j.freeradbiomed.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
Bile acid transporters and the nuclear factor erythroid 2-related factor (Nrf-2)-mediated adaptive response play important roles in the development of drug-induced liver injury (DILI). However, little is known about the contribution of the adaptive response to rifampicin (RFP)-induced cell injury. In this study, we found RFP decreased the survival rate of HepG2 cells and increased the levels of lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), γ-glutamyl-transferase (γ-GT), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total bile acid (TBA) and adenosine triphosphate (ATP) in the cell culture supernatants in both a concentration- and a time-dependent manner. RFP increased the expression levels of bile acid transporter proteins and mRNAs, such as bile salt export pump (BSEP), multidrug resistance protein 1 (MDR1), multidrug resistance-associated protein 2 (MRP2), Na+/taurocholate cotransporter (NTCP), organic anion transporting protein 2 (OATP2), organic solute transporter β (OSTβ) and Nrf2. Following the transient knockdown of Nrf2 and treatment with RFP, the expression levels of the BSEP, MDR1, MRP2, NTCP, OATP2 and OSTβ proteins and mRNAs were decreased to different degrees. Moreover, the cell survival was decreased, whereas the LDH level in the cell culture supernatant was increased. Overexpression of the Nrf2 gene produced the opposite effects. Treatment with tauroursodeoxycholic acid (TUDCA) increased the expression levels of the bile acid transporters and Nrf2, decreased the expression levels of glucose-regulated protein 78 (GRP78), PKR-like ER kinase (PERK), activating transcription factor 4 (ATF4), and C/EBP-homologous protein (CHOP), and inhibited RFP-induced oxidative stress. Moreover, TUDCA reduced cell apoptosis, increased cell survival and decreased the levels of LDH, ALT, AST, AKP, γ-GT, TBIL, DBIL, IBIL, TBA and ATP in the cell culture supernatant. Therefore, TUDCA alleviates RFP-induced injury in HepG2 cells by enhancing bile acid transporters expression and the Nrf2-mediated adaptive response.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/agonists
- ATP Binding Cassette Transporter, Subfamily B/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- ATP Binding Cassette Transporter, Subfamily B, Member 11/agonists
- ATP Binding Cassette Transporter, Subfamily B, Member 11/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B, Member 11/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 11/metabolism
- Adaptation, Physiological
- Adenosine Triphosphate
- Alanine Transaminase/genetics
- Alanine Transaminase/metabolism
- Alkaline Phosphatase/genetics
- Alkaline Phosphatase/metabolism
- Antibiotics, Antitubercular/pharmacology
- Aspartate Aminotransferases/genetics
- Aspartate Aminotransferases/metabolism
- Bilirubin
- Endoplasmic Reticulum Chaperone BiP
- Gene Expression Regulation
- Hep G2 Cells
- Humans
- L-Lactate Dehydrogenase/genetics
- L-Lactate Dehydrogenase/metabolism
- Liver-Specific Organic Anion Transporter 1/genetics
- Liver-Specific Organic Anion Transporter 1/metabolism
- Membrane Transport Proteins/genetics
- Membrane Transport Proteins/metabolism
- Multidrug Resistance-Associated Protein 2
- Multidrug Resistance-Associated Proteins/agonists
- Multidrug Resistance-Associated Proteins/antagonists & inhibitors
- Multidrug Resistance-Associated Proteins/genetics
- Multidrug Resistance-Associated Proteins/metabolism
- NF-E2-Related Factor 2/agonists
- NF-E2-Related Factor 2/genetics
- NF-E2-Related Factor 2/metabolism
- Organic Anion Transporters, Sodium-Dependent/genetics
- Organic Anion Transporters, Sodium-Dependent/metabolism
- RNA, Small Interfering/genetics
- RNA, Small Interfering/metabolism
- Rifampin/antagonists & inhibitors
- Rifampin/pharmacology
- Signal Transduction
- Stress, Physiological
- Symporters/genetics
- Symporters/metabolism
- Taurochenodeoxycholic Acid/pharmacology
- gamma-Glutamyltransferase/genetics
- gamma-Glutamyltransferase/metabolism
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Affiliation(s)
- Weiping Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China; The First Affliated Hospital of AUTCM, 117 Meishan Road, Hefei 230031, People's Republic of China
| | - Lihong Chen
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Hui Feng
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Wei Wang
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Yi Cai
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Fen Qi
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Xiaofang Tao
- School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China; Biopharmaceutical Institute, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China
| | - Jun Liu
- School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China; Biopharmaceutical Institute, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China
| | - Yujun Shen
- School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China; Biopharmaceutical Institute, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China
| | - Xiaofei Ren
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Xi Chen
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China
| | - Jianming Xu
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei 230022, People's Republic of China.
| | - Yuxian Shen
- School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China; Biopharmaceutical Institute, Anhui Medical University, 81 Meishan Road, Hefei 230032, People's Republic of China.
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Abstract
Tuberculosis of the liver, biliary tract, and pancreas is discussed. In addition, tuberculosis in the setting of HIV-AIDS and liver transplantation is explored. Drug-induced liver injury secondary to antituberculosis medication and monitoring and prophylactic treatment for such injury is also considered.
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Live donor liver transplantation for antitubercular drug-induced acute liver failure. Indian J Gastroenterol 2017; 36:56-61. [PMID: 28066854 DOI: 10.1007/s12664-016-0725-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/07/2016] [Indexed: 02/04/2023]
Abstract
Antitubercular therapy (ATT)-induced hepatotoxicity is often over looked and active tuberculosis is considered a contraindication for liver transplantation, however it might be the only lifesaving option to certain patients of acute liver failure (ALF) due to ATT. We have assessed the outcome of live donor liver transplantation in ATT-induced ALF. A retrospective analysis of all the cases of ALF that underwent liver transplantation from 2006 to 2014 at the Amrita Institute of Medical Sciences was done. A total of seven (7.7%) patients with ATT-induced ALF who had underwent live donor liver transplantation were included in the study. Out of seven patients, three (42.8%) had established diagnosis of tuberculosis and the remaining (58.2%) patients were started on ATT empirically. The median duration of ATT intake was 2 months. All the patients underwent live donor liver transplant as they met King's College criteria, and their model for end-stage liver disease score was above 35 on admission, receiving graft from first degree relatives. Histopathology of explant liver showed pan acinar necrosis. Restarting of ATT after transplant was individualized. It was restarted only in two (28%) patients with prior sputum-positive pulmonary tuberculosis after a median time of 27 days after transplant. ATT was not restarted in rest of the (72%) patients. Postoperative mortality was seen in two (28%) patients due to conditions that masquerade the ATT-induced acute liver failure. The overall survival rate was 71.4% with a median follow up of 22 months. Live donor-related transplantation is feasible option in ATT-induced acute liver failure. Restarting of ATT post liver transplant is feasible and should be individualized along with frequent monitoring of immunosuppressant levels; however, if the primary diagnosis of tuberculosis was empirical, reintroduction of ATT can be omitted.
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Bouazzi OE, Hammi S, Bourkadi JE, Tebaa A, Tanani DS, Soulaymani-Bencheikh R, Badrane N, Bengueddour R. First line anti-tuberculosis induced hepatotoxicity: incidence and risk factors. Pan Afr Med J 2016; 25:167. [PMID: 28292129 PMCID: PMC5326068 DOI: 10.11604/pamj.2016.25.167.10060] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/04/2016] [Indexed: 11/11/2022] Open
Abstract
In our days, tuberculosis, whet ever its localization, became a curable disease. The cornerstone is a 6 month course of isoniazid, rifampicine and pyrazinamide. All of the three first line antituberculosis drugs may induce hepatic damage which may have negative consequences for treatment outcome. Several risk factors were associated with the development of antituberculosis- drug-induced hepatotoxicity (ATDH). A retrospective study was conducted from July 2014 to March 2015 regarding all therapeutic drug-monitoring requests sent to the Laboratory of Poison Control and Pharmacovigilance Centre of Morocco. 142 patients diagnosed with active tuberculosis were included in study. Plasma peak levels of isoniazid, rifampicin and pyrazinamide were analyzed in plasma samples after 2 to 3 hours of administration of anti-tuberculosis treatment. Logistic regression was used to identify the ATDH risk factors. The incidence of ATDH was found 24.6% (35 patients out of 142). Intergroup differences in the plasma levels were statistically significant for isoniazid (p=0.036). ATDH was found to be associated with combined form of anti-TB drugs (p=0.002, COR=13.1, AOR= 13.5) and plasma concentration of INH superior to 2mg/l (p=0.045, COR=1.3, AOR= 1.4).age, gender, alcohol intake and smoking status were not significantly associated with ATDH. The finding of 24.6% incidence of hepatotoxicity is extremely high. Many factors can be associated with the development of ATDH such as genetic factors, combined forms of treatment and plasma peak levels.
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Affiliation(s)
- Omaima El Bouazzi
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté des Sciences, Universités Ibn Tofail, Kénitra, Maroc
| | - Sanaa Hammi
- Faculté de Médecine et de Pharmacie, Université Abd El Malek Essadi, Tanger, Maroc; Hôpital Moulay Youssef, Rabat, Maroc
| | - Jamal Eddine Bourkadi
- Hôpital Moulay Youssef, Rabat, Maroc; Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Amina Tebaa
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc
| | - Driss Soussi Tanani
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté de Médecine et de Pharmacie, Université Abd El Malek Essadi, Tanger, Maroc
| | - Rachida Soulaymani-Bencheikh
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Narjis Badrane
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté des Sciences, Universités Ibn Tofail, Kénitra, Maroc
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