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Alegre F, Martí-Rodrigo A, Polo M, Ortiz-Masiá D, Bañuls C, Pinti M, Álvarez Á, Apostolova N, Esplugues JV, Blas-García A. Macrophages Modulate Hepatic Injury Involving NLRP3 Inflammasome: The Example of Efavirenz. Biomedicines 2022; 10:biomedicines10010109. [PMID: 35052789 PMCID: PMC8772956 DOI: 10.3390/biomedicines10010109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
Drug-induced liver injury (DILI) constitutes a clinical challenge due to the incomplete characterization of the mechanisms involved and potential risk factors. Efavirenz, an anti-HIV drug, induces deleterious actions in hepatocytes that could underlie induction of the NLRP3 inflammasome, an important regulator of inflammatory responses during liver injury. We assessed the potential of efavirenz to modulate the inflammatory and fibrogenic responses of major liver cell types involved in DILI. The effects of efavirenz were evaluated both in vitro and in vivo. Efavirenz triggered inflammation in hepatocytes, in a process that involved NF-κB and the NLRP3 inflammasome, and activated hepatic stellate cells (HSCs), thereby enhancing expression of inflammatory and fibrogenic markers. The NLRP3 inflammasome was not altered in efavirenz-treated macrophages, but these cells polarized towards the anti-inflammatory M2 phenotype and displayed upregulated anti-inflammatory mediators. Conversely, no evidence of damage was observed in efavirenz-treated animals, except when macrophages were depleted, which resulted in the in vivo manifestation of the deleterious effects detected in hepatocytes and HSCs. Efavirenz elicits a cell-specific activation of the NLRP3 inflammasome in hepatocytes and HSCs, but macrophages appear to counteract efavirenz-induced liver injury. Our results highlight the dynamic nature of the interaction among liver cell populations and emphasize the potential of targeting macrophage polarization as a strategy to treat NLRP3 inflammasome-induced liver injury.
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Affiliation(s)
- Fernando Alegre
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Servicio de Endocrinología, FISABIO-Hospital Universitario Dr. Peset, 46017 Valencia, Spain
| | - Alberto Martí-Rodrigo
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Miriam Polo
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Servicio de Endocrinología, FISABIO-Hospital Universitario Dr. Peset, 46017 Valencia, Spain
| | - Dolores Ortiz-Masiá
- Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
| | - Celia Bañuls
- Servicio de Endocrinología, FISABIO-Hospital Universitario Dr. Peset, 46017 Valencia, Spain
| | - Marcello Pinti
- Department of Life Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Ángeles Álvarez
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
| | - Nadezda Apostolova
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Servicio de Endocrinología, FISABIO-Hospital Universitario Dr. Peset, 46017 Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
| | - Juan V Esplugues
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Servicio de Endocrinología, FISABIO-Hospital Universitario Dr. Peset, 46017 Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
| | - Ana Blas-García
- Servicio de Endocrinología, FISABIO-Hospital Universitario Dr. Peset, 46017 Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 46010 Valencia, Spain
- Departamento de Fisiología, Universidad de Valencia, 46010 Valencia, Spain
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Derangement of Liver Enzymes, Hyperglycemia, Anemia, and Associated Factors among HIV-Infected Patients Treated with Tenofovir Disoproxil Fumarate-Based Regimen in Ethiopia: A Prospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6613519. [PMID: 34222476 PMCID: PMC8221861 DOI: 10.1155/2021/6613519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/03/2021] [Accepted: 05/28/2021] [Indexed: 01/17/2023]
Abstract
Hepatotoxicity was found in different case reports and studies in tenofovir disoproxil fumarate- (TDF-) based regimen. However, there was no data regarding liver enzymes, glucose, and hemoglobin in Ethiopian patients receiving TDF-based regimen. The aim of this study was to determine elevated liver enzymes and its associated factors as well as elevated fasting plasma glucose and anemia. A hospital-based observational prospective cohort study was conducted on conveniently selected 63 patients in Tikur Anbessa Specialized Hospital (TASH) from January to September 2019. Laboratory values were determined at pre-TDF-based regimen baseline and six-month follow-up. The data was analyzed by using SPSS version 21.0, and multivariate logistic regression was used to determine associated factors with elevated liver enzymes. The overall elevated liver enzymes were found in 26 (41.3%) participants. From this, elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) comprise 3 (4.8%), 3 (4.8%), and 20 (31.8%), respectively. Elevated fasting plasma glucose (FPG) was found in 9 (14.3%) and 14 (22.2%) of participants at baseline and six-month visit, respectively. At six-month visit, 4 (6.4%) of participants experienced anemia. The mean value of ALP and FPG at six months was significantly higher than their respective baseline mean values (mean difference (MD) = +63.38, 95% CI (39.84, 86.92), p = 0.0001; MD = +6.64, 95% CI (2.63, 10.64), p = 0.002, respectively). The mean value of ALT, AST, and Hg at six months was slightly increased compared to their respective baseline mean values, but the difference was not significant. In multivariate analysis, only female sex was significantly associated with elevated ALP (AOR = 4.5, 95% CI (1.03, 19.6), p = 0.045). Overall mild and moderate hepatotoxicity was found to be high (26, 41.3%) in the present study, and from this, the majority was comprised by elevated ALP (20, 31.8%). The proportion of participants with hyperglycemia was increased at the end of follow-up compared to its baseline value, but anemia was not. Female sex was significantly associated with elevated ALP. This study warrants monitoring of liver enzymes and glucose in TDF-based regimen.
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Naidu ECS, Olojede SO, Lawal SK, Rennie CO, Azu OO. Nanoparticle delivery system, highly active antiretroviral therapy, and testicular morphology: The role of stereology. Pharmacol Res Perspect 2021; 9:e00776. [PMID: 34107163 PMCID: PMC8189564 DOI: 10.1002/prp2.776] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/16/2022] Open
Abstract
The conjugation of nanoparticles (NPs) with antiretroviral drugs is a drug delivery approach with great potential for managing HIV infections. Despite their promise, recent studies have highlighted the toxic effects of nanoparticles on testicular tissue and their impact on sperm morphology. This review explores the role of stereological techniques in assessing the testicular morphology in highly active antiretroviral therapy (HAART) when a nanoparticle drug delivery system is used. Also, NPs penetration and pharmacokinetics concerning the testicular tissue and blood-testis barrier form the vital part of this review. More so, various classes of NPs employed in biomedical and clinical research to deliver antiretroviral drugs were thoroughly discussed. In addition, considerations for minimizing nanoparticle-drugs toxicity, ensuring enhanced permeability of nanoparticles, maximizing drug efficacy, ensuring adequate bioavailability, and formulation of HAART-NPs fabrication are well discussed.
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Affiliation(s)
- Edwin Coleridge S. Naidu
- Discipline of Clinical AnatomySchool of Laboratory Medicine & Medical SciencesNelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Samuel Oluwaseun Olojede
- Discipline of Clinical AnatomySchool of Laboratory Medicine & Medical SciencesNelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Sodiq Kolawole Lawal
- Discipline of Clinical AnatomySchool of Laboratory Medicine & Medical SciencesNelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Carmen Olivia Rennie
- Discipline of Clinical AnatomySchool of Laboratory Medicine & Medical SciencesNelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Onyemaechi Okpara Azu
- Discipline of Clinical AnatomySchool of Laboratory Medicine & Medical SciencesNelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
- Department of AnatomySchool of MedicineUniversity of NamibiaWindhoekNamibia
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Seneviratne HK, Hamlin AN, Heck CJS, Bumpus NN. Spatial Distribution Profiles of Emtricitabine, Tenofovir, Efavirenz, and Rilpivirine in Murine Tissues Following In Vivo Dosing Correlate with Their Safety Profiles in Humans. ACS Pharmacol Transl Sci 2020; 3:655-665. [PMID: 32832868 PMCID: PMC7433710 DOI: 10.1021/acsptsci.0c00015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 02/08/2023]
Abstract
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Emtricitabine (FTC), tenofovir (TFV),
efavirenz (EFV), and rilpivirine
(RPV) are currently used as components of HIV combination therapy.
Although these drugs are widely used in antiretroviral therapy, several
organ toxicities related to TFV and EFV have been observed clinically.
TFV is associated with nephrotoxicity, whereas EFV-related hepatotoxicity
and neurotoxicity have been reported. While the precise molecular
mechanisms related to the above-mentioned clinically observed toxicities
have yet to be elucidated, understanding the local tissue distribution
profiles of these drugs could yield insights into their safety profiles.
To date, the distributions of these drugs in tissue following in vivo exposure are poorly understood. Therefore, in this
study, we employed a matrix-assisted laser desorption/ionization mass
spectrometry imaging method to generate spatial distribution profiles
of FTC, TFV, EFV, and RPV in mouse tissues following in vivo dosing of following drug regimens: TFV–FTC–EFV and
TFV–FTC–RPV. For this study, liver, brain, kidney, spleen,
and heart tissues were obtained from mice (n = 3)
following separate oral administration of the above-mentioned drug
regimens. Interestingly, EFV was detected in liver, brain, and heart
following TFV–FTC–EFV treatment. Additionally, hydroxylated
EFV, which encompasses the cytochrome P450-dependent monooxygenated
metabolites of EFV, was detected in liver, brain, spleen, and heart
tissue sections. Notably, the tissue distribution profiles of RPV
and hydroxylated RPV following in vivo dosing of
TFV–FTC–RPV were different from EFV/hydroxylated EFV
despite RPV belonging to the same drug class as EFV. In conclusion,
the observed spatial distribution profiles of the study drugs are
in agreement with their safety profiles in humans.
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Affiliation(s)
- Herana Kamal Seneviratne
- Department of Medicine, Division of Clinical Pharmacology and Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Allyson N Hamlin
- Department of Medicine, Division of Clinical Pharmacology and Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Carley J S Heck
- Department of Medicine, Division of Clinical Pharmacology and Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Namandjé N Bumpus
- Department of Medicine, Division of Clinical Pharmacology and Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
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Kang MK, Park JG. Tenofovir disoproxil fumarate-induced severe liver injury in a patient with chronic hepatitis B virus infection. Dig Liver Dis 2018; 50:628-630. [PMID: 29625906 DOI: 10.1016/j.dld.2018.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Min Kyu Kang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jung Gil Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
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Kovari H, Sabin CA, Ledergerber B, Ryom L, Reiss P, Law M, Pradier C, Dabis F, d'Arminio Monforte A, Smith C, de Wit S, Kirk O, Lundgren JD, Weber R. Antiretroviral Drugs and Risk of Chronic Alanine Aminotransferase Elevation in Human Immunodeficiency Virus (HIV)-Monoinfected Persons: The Data Collection on Adverse Events of Anti-HIV Drugs Study. Open Forum Infect Dis 2016; 3:ofw009. [PMID: 26925429 PMCID: PMC4767274 DOI: 10.1093/ofid/ofw009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background. Although human immunodeficiency virus (HIV)-positive persons on antiretroviral therapy (ART) frequently have chronic liver enzyme elevation (cLEE), the underlying cause is often unclear. Methods. Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study participants without chronic viral hepatitis were observed to the earliest of cLEE (elevated aminotransferase ≥6 months), death, last follow-up, or January 2, 2014. Antiretroviral treatment exposure was categorized as follows: no exposure and ongoing short- and long-term exposure (<2 or ≥2 years) after initiation. Association between development of cLEE and ART exposure was investigated using Poisson regression. Results. Among 21 485 participants observed for 105 413 person-years (PY), 6368 developed cLEE (incidence 6.04/100 PY; 95% confidence interval [CI], 5.89–6.19). Chronic liver enzyme elevation was associated with short-and long-term exposure to didanosine (<2 years rate ratio [RR] = 1.29, 95% CI, 1.11–1.49; >2 years RR = 1.26, 95% CI, 1.13–1.41); stavudine (<2 years RR = 1.51, 95% CI, 1.26–1.81; >2 years RR = 1.17, 95% CI, 1.03–1.32), and tenofovir disoproxil fumarate (<2 years RR = 1.55, 95% CI, 1.40–1.72; >2 years RR = 1.18, 95% CI, 1.05–1.32), but only short-term exposure to nevirapine (<2 years RR = 1.44, 95% CI, 1.29–1.61), efavirenz (<2 years RR = 1.14, 95% CI, 1.03–1.26), emtricitabine (<2 years RR = 1.18, 95% CI, 1.04–1.33), and atazanavir (<2 years RR = 1.20, 95% CI, 1.04–1.38). Chronic liver enzyme elevation was not associated with use of lamivudine, abacavir, and other protease inhibitors. Mortality did not differ between participants with and without cLEE. Conclusions. Although didanosine, stavudine, nevirapine, and efavirenz have been described to be hepatotoxic, we additionally observed a consistent association between tenofovir and cLEE emerging within the first 2 years after drug initiation. This novel tenofovir-cLEE signal should be further investigated.
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Affiliation(s)
- Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich , Switzerland
| | - Caroline A Sabin
- Research Department of Infection and Population Health , University College London , United Kingdom
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich , Switzerland
| | - Lene Ryom
- CHIP, Department of Infectious Diseases , Rigshospitalet, University of Copenhagen , København , Denmark
| | - Peter Reiss
- Division of Infectious Diseases and Department of Global Health , Academic Medical Center, University of Amsterdam , Netherlands
| | - Matthew Law
- The Kirby Institute for Infection and Immunity in Society , University of New South Wales , Sydney , Australia
| | | | - Francois Dabis
- Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique France
| | | | - Colette Smith
- Research Department of Infection and Population Health , University College London , United Kingdom
| | - Stephane de Wit
- Department of Infectious Diseases , St. Pierre University Hospital , Brussels , Belgium
| | - Ole Kirk
- CHIP, Department of Infectious Diseases , Rigshospitalet, University of Copenhagen , København , Denmark
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases , Rigshospitalet, University of Copenhagen , København , Denmark
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich , Switzerland
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Acute Liver Toxicity due to Efavirenz/Emtricitabine/Tenofovir. Case Reports Hepatol 2015; 2015:280353. [PMID: 26161275 PMCID: PMC4487274 DOI: 10.1155/2015/280353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/09/2015] [Indexed: 11/23/2022] Open
Abstract
The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug. We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.
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