Isoflurane hepatitis-induced liver failure: a case report

A comparison of the effect of isoflurane and propofol on liver enzymes

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Isoflurane induces liver injury by modulating the expression of miR-125a-5p

BACKGROUND

Isoflurane can cause hepatotoxicity, and microRNAs (miRNAs) are involved in the regulation of liver injury. Therefore, this study aimed to explore the effect of miR-125a-5p on isoflurane-induced liver injury.

BASIC PROCEDURES

Sprague-Dawley (SD) male rats and BRL-3A cells were exposed to isoflurane to construct animal and cell models. Serum alanine transaminase (ALT) and aspartate transaminase (AST) levels of rats were detected. RT-qPCR was performed for the measurement of miR-125a-5p levels. Cell proliferation and apoptosis were also detected.

MAIN FINDINGS

After isoflurane treatment, serum ALT and AST levels of rats increased in a time-dependent manner, and the differences reached significant levels from 3 days after isoflurane treatment. MiR-125a-5p levels increased significantly in the liver tissues of isoflurane-treated rats. MiR-125a-5p downregulation significantly attenuated isoflurane-induced increasing trend of serum ALT and AST levels in rats. In BRL-3A cells, isoflurane treatment significantly inhibited cell proliferation and promoted cell apoptosis, which was reversed by miR-125a-5p downregulation.

PRINCIPAL CONCLUSIONS

Isoflurane exposure significantly elevates the level of miR-125a-5p in the liver tissues of rats. Downregulation of miR-125a-5p may protect against isoflurane-induced liver injury through regulating liver cell proliferation and apoptosis. Dysregulation of miR-125a-5p might be a possible mechanism of isoflurane-induced liver injury.

Fulminant hepatic failure after simultaneous kidney-pancreas transplantation: a case report

We describe an unusual case of hyperacute hepatic failure following general anesthesia in a patient receiving a simultaneous kidney-pancreas transplant. Despite an aggressive evaluation of structural, immunological, viral, and toxicological causes, a definitive cause could not be elucidated. The patient required a liver transplant and suffered a protracted hospital course. We discuss the potential causes of fulminant hepatic failure and the perioperative anesthesia management of her subsequent liver transplantation.

Traditional Chinese Medicine and Herb-induced Liver Injury: Comparison with Drug-induced Liver Injury

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.