Quantitative analysis of intrahepatic bile duct component in normal adult human liver and in primary biliary cirrhosis

Overcoming the shortcomings of the extended-clearance concept: a framework for developing a physiologically-based pharmacokinetic (PBPK) model to select drug candidates involving transporter-mediated clearance

Introduction:Human pharmacokinetic (PK) prediction can be a significant challenge to drug candidates undergoing transporter-mediated clearance, when only animal data and in vitro human parameters are available in the drug discovery stage.Areas covered:The extended clearance concept (ECC) that incorporates the processes of hepatic uptake, passive diffusion, metabolism and biliary secretion has been adapted to determine the rate-determining process of hepatic clearance and drug-drug interactions (DDIs). However, since the ECC is derived from the well-stirred model and does not consider the liver as a drug distribution organ to reflect the time-dependent variation of drug concentrations between the liver and plasma, it can be misused for compound selection in drug discovery.Expert opinion:The PBPK model consists of a set of differential equations of drug mass balance, and can overcome the shortcomings of the ECC in predicting human PK. The predictability, relevance and reliability of the model and the scaling factors for IVIVE must be validated using either the measured liver concentrations or DDI data with known transporter inhibitors, or both, in monkeys. A human PBPK model that incorporates in vitro human data and SFs obtained from the validated monkey PBPK model can be used for compound selection in the drug discovery phase.

Novel Method to Predict In Vivo Liver-to-Plasma Kpuu for OATP Substrates Using Suspension Hepatocytes

The ability to predict human liver-to-plasma unbound partition coefficient (Kpuu) is of great importance to estimate unbound liver concentration, develop PK/PD relationships, predict efficacy and toxicity in the liver, and model the drug-drug interaction potential for drugs that are asymmetrically distributed into the liver. A novel in vitro method has been developed to predict in vivo Kpuu with good accuracy using cryopreserved suspension hepatocytes in InVitroGRO HI media with 4% BSA. Validation was performed using six OATP substrates with rat in vivo Kpuu data from i.v. infusion studies where a steady state was achieved. Good in vitro-in vivo correlation (IVIVE) was observed as the in vitro Kpuu values were mostly within 2-fold of in vivo Kpuu Good Kpuu IVIVE in human was also observed with in vivo Kpuu data of dehydropravastatin from positron emission tomography and in vivo Kpuu data from PK/PD modeling for pravastatin and rosuvastatin. Under the specific Kpuu assay conditions, the drug-metabolizing enzymes and influx/efflux transporters appear to function at physiologic levels. No scaling factors are necessary to predict in vivo Kpuu from in vitro data. The novel in vitro Kpuu method provides a useful tool in drug discovery to project in vivo Kpuu.

Hepatobiliary Secretion Kinetics of Conjugated Bile Acids Measured in Pigs by 11C-Cholylsarcosine PET

The aim of this study was to develop a method for the quantification of hepatobiliary uptake and secretion of conjugated bile acids with PET and the (11)C-labeled conjugated bile acid analog [N-methyl-(11)C]cholylsarcosine ((11)C-CSar).

METHODS

Six pigs (13 experiments) underwent dynamic (11)C-CSar PET of the liver with simultaneous measurements of hepatic blood perfusion and (11)C-CSar concentrations in arterial, portal, and hepatic venous blood. In 3 pigs (7 experiments), bile was collected from a catheter in the common hepatic duct. PET data were analyzed with a 2-tissue compartmental model with calculation of rate constants for the transport of (11)C-CSar among blood, hepatocytes, and intra- and extrahepatic bile ducts. PET results were validated against invasive blood and bile measurements.

RESULTS

The directly measured rate of secretion of (11)C-CSar into bile was equal to the rate of removal from blood at steady state. Accordingly, hepatocytes did not accumulate bile acids but simply facilitated the transport of bile acids from blood to bile against a measured concentration gradient of 4,000. The rate constant for the secretion of (11)C-CSar from hepatocytes into bile in experiments with a catheter in the common hepatic duct was 25% of that in experiments without a catheter (P < 0.05); we interpreted this result to be mild cholestasis caused by the catheter. The catheter caused an increased backflux of (11)C-CSar from hepatocytes to blood, and hepatic blood flow was 25% higher than in experiments without the catheter. The capacity for the overall transport of (11)C-CSar from blood to bile, as quantified by intrinsic clearance, was significantly lower in experiments with the catheter than in those without the catheter (P < 0.001). PET and blood measurements correlated significantly (P < 0.05).

CONCLUSION

The in vivo kinetics of hepatobiliary secretion of conjugated bile acids can now be determined by dynamic (11)C-CSar PET.

Toward Prospective Prediction of Pharmacokinetics in OATP1B1 Genetic Variant Populations

Physiologically based pharmacokinetic (PBPK) models are increasingly being used to provide human pharmacokinetic (PK) predictions for organic anion-transporting polypeptide (OATP) substrates based on in vitro assay data. As a natural extension in the application of these models, in this study, we incorporated in vitro information of three major OATP1B1 genetic variants into a previously reported PBPK model to predict the impact of OATP1B1 polymorphisms on human PK. Using pravastatin and rosuvastatin as examples, we showed that the predicted plasma concentration-time profiles in groups carrying different OATP1B1 genetic variants reasonably matched the clinical observations from multiple studies. This modeling and simulation approach may aid decision making in early pharmaceutical research and development as well as patient-specific dose adjustment in clinical practice.

Physiologically based pharmacokinetic prediction of telmisartan in human

A previously developed physiologically based pharmacokinetic model for hepatic transporter substrates was extended to an organic anion transporting polypeptide substrate, telmisartan. Predictions used in vitro data from sandwich culture human hepatocyte and human liver microsome assays. We have developed a novel method to calibrate partition coefficients (Kps) between nonliver tissues and plasma on the basis of published human positron emission tomography (PET) data to decrease the uncertainty in tissue distribution introduced by in silico-predicted Kps. With in vitro data-predicted hepatic clearances, published empirical scaling factors, and PET-calibrated Kps, the model could accurately recapitulate telmisartan pharmacokinetic (PK) behavior before 2.5 hours. Reasonable predictions also depend on having a model structure that can adequately describe the drug disposition pathways. We showed that the elimination phase (2.5-12 hours) of telmisartan PK could be more accurately recapitulated when enterohepatic recirculation of parent compound derived from intestinal deconjugation of glucuronide metabolite was incorporated into the model. This study demonstrated the usefulness of the previously proposed physiologically based modeling approach for purely predictive intravenous PK simulation and identified additional biologic processes that can be important in prediction.

A bio-impedance probe to assess liver steatosis during transplant surgery

This work addresses the design of a bioimpedance probe to assess steatosis on the exposed liver in the donor during liver transplant surgery. Whereas typically bioimpedance uses needle probes to avoid surface effects, for clinical reasons a non-penetrative probe is required. In addition the need to ensure that the measurement is representative of the bulk tissue suggests a larger probe than is normally used to ensure a sufficiently large measurement volume. Using a simple model, simulations and tests on bovine liver, this paper investigates the relationship between probe dimensions and depth of measurement penetration and investigates the accuracy which might be expected in a configuration suitable for use in the operating theatre on intact but exposed livers. A probe using ECG electrodes is proposed and investigated.

A case of cholestatic hepatitis associated with histologic features of acute cholangitis

This report describes a case showing histologic features of acute cholangitis with an over-the-counter drug. A 48-year-old woman was diagnosed with general malaise and progressive jaundice. A thorough review of her medical history revealed that the patient had taken an over-the-counter drug, Pabron Gold^®, which she had used previously, that may have caused liver injury. Laboratory investigations revealed jaundice and liver dysfunction. Endoscopic retrograde cholangiography detected no extrahepatic biliary duct dilatation or stones. Liver biopsy indicated acute cholangitis involving neutrophils and eosinophils. Electron microscopy revealed fragmented nuclei, indicating that the degenerative bile duct-related epithelial cells were in an apoptotic process.

Stereology of the liver in three species of Leontopithecus (Lesson, 1840) Callitrichidae--primates

Studies on liver morphology and stereology are relevant to the comparative anatomical and pathological research. They also facilitate the use of non-human primates in basic research, which has substantially supported studies in human medicine. Quantitative studies of liver structures have also been more extensive in Old World primates and other vertebrates. Twenty-three livers of adult lion tamarins were studied (six Leontopithecus rosalia, seven Leontopithecus chrysomelas, and 10 Leontopithecus chrysopygus), dissected, and fixed in 10% neutral buffered formalin solution. For stereological quantification, the liver was regarded as consisting of parenchyma (hepatocytes) and stroma (non-hepatocytes). The volume density (V(v)) was determined by point counting, and the disector method was used to obtain the numerical density of hepatocytes (N(v)). Hepatic stereological differences among the three species of lion tamarins were not statistically significant. Therefore, the pooled V(v[hepatocyte]) and V(v[stroma]) could be determined as 96.2 and 7.4%, respectively, and N(v[hepatocyte]) as 500.33 x 10(6) cm(-3). Significantly different, the values found for V(v[hepatocyte]) and N(v[hepatocyte]) in lion tamarins were, respectively, 0.09 and 2.8 times greater than those in baboons, and 0.17 and 3.8 times greater than those in man. However, the V(v[stroma]) was 1.04 times smaller than that in baboons and 1.79 times smaller than that in man.

Intrahepatic bile duct loss in primary sclerosing cholangitis: a quantitative study

AIMS

Intrahepatic bile duct volume density has been evaluated in four cases of primary sclerosing cholangitis (PSC) by applying a semiautomatic image analysis system to histological sections of surgical biopsies. Comparison was made between normal livers and cases of primary biliary cirrhosis.

METHODS AND RESULTS

A marked decrease in both bile duct volume density in liver (up to 50% of normal value) and bile duct volume density in portal tracts (up to 21% of normal value) was found. The analysis of correlations between the portal tract size and the portal tract volume fraction constituted by bile ducts confirms that the destruction mainly affects small and medium-sized ducts. The ratio of bile duct to arterial component volume fractions in portal tracts turned out to be inverted with respect to that determined in normal liver, showing a decrease of up to 30% of normal value.

CONCLUSIONS

The features observed in primary sclerosing cholangitis, as well as the extent of bile duct loss proved to be quite similar to what we had previously described in primary biliary cirrhosis. Thus, regardless of the causes and mechanisms leading to the bile duct loss, the quantification of ductopenia produced results which are alike for the two distinct cholestatic diseases.

Anatomy of the human biliary system studied by quantitative computer-aided three-dimensional imaging techniques

The branching geometry of the normal, cholangiographically identifiable human biliary tree was studied with an innovative computer-aided three-dimensional (3D) imaging technique. In addition, a serially sectioned conventional paraffin block from a normal donor liver was used to create and quantitatively study a microscopic 3D image. Finally, a geometric model was developed to estimate the enlargement of biliary surfaces imparted by microvilli. The images created by these techniques could be viewed in stationary modes or rotating around any preselected axis. Approximately 7 (+/-3) intrahepatic duct orders were cholangiographically identified. Computerized measurements of the images from three normal livers suggested that the mean total volume of duct orders 1 to 7 shown in the cholangiograms was 16.6 cm3. The volume of the entire macroscopic duct system was estimated to be between 14 and 24 cm3 (mean, 20.4 cm3), with an internal surface of 336 to 575 cm2 (mean, 398 cm2). A geometric model based on electron micrographs suggested that this surface is magnified approximately 5.5-fold by the presence of microvilli. Volume and surface area (SA) measurements of all ducts in the same orders increased nearly exponentially from the first toward the seventh branching order (i.e., from the hilus toward the periphery of the liver), and probably beyond. The microscopic computerized reconstruction of a septal bile duct with its tributaries also allowed volume measurements; the imaged duct system represented 2.7% of the portal tract volume. The data presented herein may help to better evaluate branching patterns of the biliary tree and, eventually, the quantitative aspects of site-restricted cholangiocyte function and their role in the development of biliary diseases.

Liver of the brown trout, Salmo trutta (Teleostei, Salmonidae): a stereological study at light and electron microscopic levels

BACKGROUND

A quantitative study was undertaken for the first time on the normal liver of male and female 2-year-old brown trout, Salmo trutta.

METHODS

Liver was fixed by controlled perfusion. Organ-level morphometry provided weight and volume. A two-stage stereological approach was performed at light and electron microscopy levels. Systematic sampling and point-counting morphometry were used for estimating the relative volumes of the structural compartments. Total absolute volumes of these components were obtained by multiplying each volume density by the volume of its reference space.

RESULTS

Liver volume was 3,423.6 mm3 for males and 3,657.4 mm3 for females. Parenchyma accounted for 95% of hepatic volume. Veins and bile ducts occupied, respectively, 76% and 17% of the stroma, whereas arteries, connective tissue, and melanomacrophages together composed only 6%. Hepatocytes occupied 88% of the parenchyma. Nonhepatocytic cells (endothelium, biliary epithelial cells, Ito cells, and macrophages) composed 4% of the parenchyma, the capillary lumen 6%, and other spaces (Disse space, canaliculi, and lumina of preductules and ductules) composed 2%. Significant sexual differences were found: (1) Females showed a greater parenchymal volume density (0.85% vs. 0.35%) and absolute volume (29.5 mm2 vs. 11.7 mm3) of Ito cells; (2) macrophages of females also presented a greater parenchymal volume density (0.94% vs. 0.46%), but not absolute volume.

CONCLUSIONS

The need to analyze both relative and absolute stereological data was stressed. Similarities and differences were detected between brown trout and other species (fishes and mammals); the findings suggest that, despite architectural differences, some quantitative parameters of liver microanatomy were retained during phylogeny. Factors mediating sexual differences in Ito cells and macrophages were discussed and the need for further studies was highlighted.