Postpartum supplementation with fermented ammoniated condensed whey altered nutrient partitioning to support hepatic metabolism

Our previously published paper demonstrated that fermented ammoniated condensed whey (FACW) supplementation improved feed efficiency and metabolic profile in postpartum dairy cows. The objective of this study was to further explore the effects of FACW supplementation on liver triglyceride content, hepatic gene expression and protein abundance, and plasma biomarkers related to liver function, inflammation, and damage. Individually fed multiparous Holstein cows were blocked by calving date and randomly assigned to postpartum (1 to 45 d in milk, DIM) isonitrogenous treatments: control diet (n = 20) or diet supplemented with FACW (2.9% dry matter of diet as GlucoBoost; Fermented Nutrition, Luxemburg, WI, replacing soybean meal; n = 19). Liver biopsies were performed at 14 and 28 DIM for analysis of mRNA expression, protein abundance, and liver triglyceride content. There was marginal evidence for a reduction in liver triglyceride content at 14 DIM in FACW-supplemented cows compared with the control group. Cows supplemented with FACW had greater mRNA expression of glucose-6-phosphatase at 14 DIM relative to control. Supplementation with FACW increased mRNA expression of pyruvate carboxylase (PC), but did not alter cytosolic phosphoenolpyruvate carboxykinase (PCK1), resulting in a 2.4-fold greater PC:PCK1 ratio for FACW-supplemented cows compared with control. There was no evidence for a FACW effect on mRNA expression of propionyl-CoA carboxylase nor on mRNA expression or protein abundance of lactate dehydrogenase A or B. Cows supplemented with FACW had lower plasma urea nitrogen compared with control. Plasma l-lactate was greater for FACW-supplemented cows compared with control at 2 h before feeding time at 21 DIM. There was no evidence for altered expression of IL1B or IL10, or blood biomarkers related to liver function and damage. Greater glucose-6-phosphatase and PC gene expression, together with greater blood glucose and similar milk lactose output, suggests that FACW increased the supply of glucose precursors, resulting in greater gluconeogenesis between 3 and 14 DIM. Greater hepatic PC:PCK1 ratio, together with previously reported decreased plasma β-hydroxybutyrate and the marginal evidence for lower liver triglyceride content at 14 DIM, suggests greater hepatic capacity for complete oxidation of fatty acids in FACW-supplemented cows compared with control. Overall, improvements in metabolite profile and feed efficiency observed with postpartum supplementation of FACW may be attributed to increased gluconeogenic and anaplerotic precursors, most likely propionate, due to modulated rumen fermentation.

Role of antioxidant supplementation in oxidant/antioxidant status and hepatotoxic effects due to aflatoxin B1 in wheat miller workers

Background

Aflatoxin B1 (AFB1) is classified as a Group I carcinogen. A Previous study found that oxidative stress from the metabolism of AFB1 induced hepatotoxic effects in wheat miller workers. Zinc and vitamin C may play a significant role in the activation of detoxification and overcoming the oxidative stress of AFB1.

Objectives

A prospective clinical trial was designed to evaluate the role of zinc and vitamin C oral supplementation on the oxidant-antioxidant status and the hepatotoxic effects of AFB1 in wheat miller workers.

Methods

Liver enzymes (ALT, AST, ALP, and GGT), P53 protein, malondialdehyde (MDA), glutathione S transferase (GST), Superoxide dismutase (SOD), zinc and vitamin C were estimated in 35 wheat miller workers before and after zinc and vitamin C supplementation for 1 month.

Results

The results revealed that zinc and vitamin C were significantly increased after the one-month supplementation, while liver enzymes (AST, ALP, and GGT), MDA, and GST of the workers were significantly decreased. SOD and P53 were also decreased but not to a significant level; SOD was decreased in 56% and P53 was decreased in 58% of the total workers.

Conclusions

Zinc and vitamin C oral supplementation for 1 month had an ameliorative effect on the hepatotoxicity of AFB1 in wheat miller workers, through decreasing MDA, SOD, and GST levels that in turn led to an improvement in their liver enzymes. Further study on a larger scale is needed to confirm these results.

Measurement of Creatine kinase and Aspartate aminotransferase in saliva of dogs: a pilot study

Background

Muscle enzymes in saliva have been reported to be possible markers of heart and muscle damage in humans. The aim of this study was to assess if Creatine kinase (CK) and Aspartate aminotransferase (AST) activities could be measured in canine saliva, and to evaluate their possible changes in situations of muscle damage.

Results

The spectrophotometric assays for CK and AST measurement in saliva of dogs showed intra- and inter-assay imprecision lower than 1 and 16% and coefficients of correlation close to 1 in linearity under dilution tests. Healthy dogs showed activities in saliva of CK between 27 and 121 U/L and AST between 46 and 144 U/L, whereas in saliva of dogs with muscle damage CK ranged between 132 and 3862 U/L and AST between 154 and 4340 U/L. Positive moderate correlations were found between saliva and serum activities of the two enzymes (CK, r = 0.579; P = 0.001; AST, r = 0.674; P = 0.001).

Conclusions

CK and AST activities can be measured in canine saliva with commercially available spectrophotometric assays. In addition these enzymes show higher values in saliva of dogs with muscle damage and their values are moderately correlated with those of serum.

Oxidative Role of Aflatoxin B1 on the Liver of Wheat Milling Workers

Aim: The study aimed to estimate oxidative role of aflatoxin B1 (AFB1) on the liver in wheat milling workers. Materials and Methods: Case-control study was conducted to compare between the levels of AFB1/albumin (AFB1/alb), liver enzymes (ALT, AST, GGT, and ALP), P53, MDA, GST, SOD, zinc and vitamin C in 35 wheat milling workers and 40 control subjects. Results: Statistical analysis revealed that ALT, AST, GGT, ALP, P53, MDA, GST and SOD in workers were significantly elevated compared to their controls. In the milling workers, there were significant correlations between MDA levels and the levels of AST, GGT, and P53, while, P53 was inversely correlated with GST and SOD activities. There were significant correlations between Zn levels and GGT, GST and SOD activities, between vitamin C and GST activities, and vitamin C inversely correlated with MDA. Conclusion: The present study concluded that the oxidative stress of AFB1 elevated the MDA and the liver enzymes in wheat milling workers. GST has a crucial role in the detoxification of aflatoxin and SOD as a scavenger antioxidant increased in the workers to overcome the oxidative toxic effects of AFB1 on the liver of the workers, and roles of Zn and vitamin C were significant in activation of these processes.

On the performance of trimetazidine and vitamin e as pharmacoprotection agents in cyclosporin a-induced toxicity

The immunosuppressant drug cyclosporin A (CyA) has been used in diseases with immunological basis and in transplant patients. Nephrotoxicity and hepatotoxicity are the main adverse effects of this drug. To find a protective drug against those effects we assayed the cardioprotector Trimetazidine (TMZ) and vitamin E, used as nutritional supplements to alleviate oxidative stress. Six groups of eight male Wistar rats each were prepared (groups A-F): A, control; B, vitamin E (10 mg/Kg/day); C, TMZ (20 mg/Kg/day); D, 25 mg/Kg/day CyA; E, CyA and vitamin E (25 mg/Kg/day CyA + 10 mg/Kg/day Vit E); F, TMZ for 20 days (20 mg/kg/day); and then CyA (25 mg/kg/day) and TMZ (20 mg/Kg/day). The experiment lasted 120 days. The exposure of rats to CyA promoted nephrotoxicity and hepatotoxicity with an increase in serum urea, creatinine, and glutamate dehydrogenase (GLDH). Structural and ultrastructural studies of liver and kidney were performed. Group D showed adverse effects induced by CyA since statistically significant differences were found with respect to the control group (A). Vitamin E (E) showed no protective effect. Pretreatment with TMZ (F) attenuated the adverse effects of CyA. We conclude that CyA-induced nephrotoxicity and hepatotoxicity are attenuated by the cytoprotective effect of TMZ. TMZ inhibits the reabsorption and, consequently, the accumulation of CyA in the cell. The antioxidant capacity of vitamin E did not improve the effect of CyA.

Subchronic administration of Catha edulis F. (khat) extract is marked by elevation of cardiac biomarkers and subendocardial necrosis besides blood pressure alteration in rats

ETHNPHARMACOLOGICAL RELEVANCE: Khat is a widely chewed herb for its stimulant effect, however, its effects on the cardiovascular system are a source of growing concern, as prevalence of chewing is increasing and susceptible individuals may experience cardiovascular episodes. This study attempted to evaluate cardiovascular substrates that predispose individuals to these episodes by using both biochemical and morphologic-pathologic studies.

MATERIALS AND METHODS

Rats were treated with either Tween 80 (2% in distilled water) (CON), or khat extract (100mg/kg, K100; 200mg/kg, K200; or 400mg/kg, K400 doses) orally for 6 weeks. Blood pressure (BP) in each group was measured before dosing and 1, 2 and 3h after-dose as well as weekly for 6 weeks using Tail cuff method. On day 45, blood was drawn for assessment of cardiac biomarkers and animals were sacrificed, and histological examination was undertaken for any overt damage on the myocardium.

RESULTS

K400 was the only dose that significantly increased BP at 2 (p<0.05) and 3h (p<0.001) postdose compared to predose level. Likewise, the 3h postdose BP of each week was significantly greater (p<0.001) than baseline BP only at 400mg/kg. However, when the weekly values were compared among themselves, the difference was not statistically significant and a progressive change in postdose BP had not been observed. On the other hand, predose systolic BP of K400 rats tended to decline at week 3 and significantly decreased (p<0.05) beyond week 4 compared to baseline values, but the decline was not significant for the rest of the doses. Biomarker assessments revealed that whereas levels of total creatine kinase were found to be elevated significantly for K100 (p<0.05), K200 and K400 (p<0.001 in both cases); aspartate aminotransferease was increased in K200 (p<0.01) and K400 (p<0.001) compared to CON rats. By contrast, levels of cardiac troponin T was significantly increased (p<0.001) only in K400 rats. Heart tissues of CON and K100 rats were normal, while those from K200 showed signs of focal lesions but normal architecture of the myocardium was maintained. K400 rats, however, displayed fragmentation and segmentation of fibers, edema and mottled staining.

CONCLUSIONS

These findings collectively indicate that the high dose of crude khat extract modulated most of the hemodynamic, biochemical and histopathological parameters in rats and hence chronic use of khat at higher dose and for longer sessions bear a significant risk for cardiovascular morbidities.

Analysis of Aspartate Aminotransferase and Alkaline Phosphatase in Crevicular Fluid From Implants With and Without Peri-implantitis

PURPOSE

The aim of this investigation was to determine the presence of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in crevicular fluid collected from implants with and without clinical and radiographic signs of peri-implantitis.

MATERIALS AND METHODS

There were 17 implants with symptoms of peri-implantitis in 12 subjects, including 4 females and 8 males, compared to 17 implants in 13 subjects, including 5 females and 8 males, with healthy peri-implant tissues. Filter paper strips were used to collect peri-implant crevicular fluid for 30 seconds in the base of the crevice/pocket. SPSS statistical software (SPSS, Inc., Chicago, IL) was used to determine AST and ALP activity.

RESULTS

The results showed that there was a significant difference in the activity of AST and ALP between the 2 study groups (P < 0.0001). AST activity was significantly associated with the amount of bleeding on probing (P = 0.02), but no statistical correlation was found between ALP activity and increased amount of bleeding on probing (P = 0.05).

CONCLUSIONS

Within the limits of this study, our results may suggest that peri-implant crevicular fluid analysis could be further investigated in longitudinal studies as a suitable diagnostic strategy in the evaluation of dental implants.

Effect of antihypertensive drugs on cardiac enzymes in hypertension with myocardial infarction in NIDDM

Enzymology is a diagnostic indicator for myocardial infarction and diabetes in hypertension patients. Therefore the selection of methods for measurement of cardiac enzyme, Aspartate transaminase (AST), Creatine kinase(CK), and isoenzyme of creatine kinase (MB form), determine the effectiveness of antihypertension drug would provide the physician with diagnostic and prognostic clinical evidence.

Evaluation of efficacy, safety, and reversibility of combination regimen of cyproterone acetate and testosterone buciclate in bonnet monkey

A combination regimen of cyproterone acetate (CPA) and testosterone buciclate (TB) was evaluated for its contraceptive efficacy, safety, and reversibility in bonnet monkeys. Cyproterone acetate (5 mg in 0.2 mL of olive oil) injected daily for 180 days, in combination with 40 mg testosterone buciclate given i.m. on days 0, 60, and 120 in the monkeys of group II (n = 6) induced azoospermia in all animals by 120 days, which was maintained until day 210. By day 240 sperm concentration increased gradually and reached baseline values by day 330. When 5mg of cyproterone acetate was injected daily for a similar duration in combination with a higher dose (80 mg) of testosterone buciclate in the monkeys of group III (n = 6) on days 0, 60, and 120, uniform and consistent azoospermia could not be achieved and two animals remained oligozoospermic even after 180 days of treatment. Mean sperm concentration did not return to baseline values until the day that the study ended, i.e. day 330. In groups II and III serum testosterone levels were elevated (p <0.05) from days 9-120 except on day 150 and returned to near baseline values by day 330. Serum testosterone levels were higher in group III compared to group II. The sperm concentration and testosterone levels in control animals (group I; n = 6) showed fluctuations. Lipid profile and liver function parameters did not show significant changes in any group. The present data clearly indicate that administration of CPA and TB in proper dosage combination can provide an effective, safe, and reversible method of male contraception.

Effects of long-term use of testosterone enanthate. II. Effects on lipids, high and low density lipoprotein cholesterol and liver function parameters

The present study was designed to evaluate the effects of long-term administration of testosterone enanthate (TE) on lipid and liver function parameters in rhesus monkeys (n = 9) maintained under controlled dietary conditions. Bimonthly administration of 50 mg of TE increased serum testosterone into the supraphysiological range one day after injection and peak levels were seen on day 3, followed by a decrease to above baseline values by day 14. High density lipoprotein cholesterol (HDL-C) levels decreased gradually; compared to baseline values, the decline was significant from the 19th month of injection until the first month of recovery. The increase in low density lipoprotein cholesterol (LDL-C) levels and the LDL-C/HDL-C ratio during the treatment period was not significant compared to baseline values; however, when compared to control animals, HDL-C and LDL-C levels and the LDL-C/HDL-C ratio were significantly elevated from the 12th month until the end of the treatment period. All lipid parameters recovered by the end of the treatment period. Control animals (n = 9) did not show significant changes in HDL-C and LDL-C levels and the LDL-C/HDL-C ratio during the study period. Total cholesterol levels decreased in control (n = 9) and treated animals from 6 to 15th months of the treatment period, coinciding with the feeding of sprouted grams to animals. TE injections did not change the levels of triglycerides, alkaline phosphatase or bilirubin in control and treated animals. However, transaminase (SGOT and SGPT) levels increased following TE injections and remained elevated until the end of injections followed by a return to baseline values or below during the recovery period. These effects could be due to the pharmacokinetic profile of TE in which testosterone levels were elevated to supraphysiological values after injections. The recovery of the TE-induced changes in lipid parameters and liver transminases is reassuring but the changes in these parameters during TE injections indicate the need for long-acting androgens with better pharmacokinetic properties.

Serum biochemical and histopathological changes related to the hepatic function in pigs following atrazine treatment

Biochemical and histopathological parameters of the hepatic function were used to quantify the hepatotoxic effects of atrazine in female pigs (gilts) undergoing intensive breeding. Female pigs (cross-bred Swedish and German landrace) received 2 mg atrazine kg-1 body wt. in feed daily during 19 days of the oestrous cycle. The last treatment day corresponded to day -3 of the onset of the next expected oestrus. Blood samples were collected three times daily at 3-h intervals on the first four post-treatment days. Serum activities of gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (AP) were determined. Serum activity of GGT was significantly increased throughout the four post-treatment days. In comparison with the control values, a slight but not significant decrease was observed in the serum activities of ALT, AST and AP. Histopathological examination of the liver of exposed pigs showed mild centrolobular parenchymatous degeneration. Interstitial connective tissue proliferation resulted in narrow and irregular bile canaliculi.

Experimental production of hypocalcemia by EDTA infusion in calves: a critical appraisal assessed from the profile of blood chemicals and enzymes

Physiological studies of the effects of Ca2+ withdrawal using Na2EDTA have been conducted with the prior basic assumption that Na2EDTA-specific direct or indirect effects on the functions under study were negligible. The present study aimed at providing unequivocal confirmation of such assumption by establishing the pattern of response of blood constituents to intravenous infusions of Na2EDTA in calves. Na2EDTA infusion in calves allowed effective chelation of blood Ca2+, leading to a progressive hypocalcemia. Magnesium levels remained constant and concentrations of other ions (Na+, K+, Pi, H+, HCO3-), although significantly altered (P < or = 0.0001), remained within the normal range. Comparison of enzymes, urea, and creatinine changes precluded renal, hepatic, or muscular parenchymatous damages as being the cause of dysfunctions in the context of Na2EDTA-induced hypocalcemia. It was not possible, however, to standardize the Na2EDTA infusion characteristics (flow, volume) to obtain previsible Ca2+ decay in different animals. Conversely, monitoring of systemic arterial pressure (SAP) offered a precious tool to estimate the degree of hypocalcemia reached. Infusion rate must, therefore, be manipulated using careful on-line monitoring of SAP to obtain an experimental range of Ca2+ as large as possible. It was concluded that physiological data collected during Na2EDTA perfusions can be reliably discussed in terms of Ca2+ dependence rather than in terms of either Na2EDTA toxicity, electrolytes maladjustment, acid-base imbalance, impaired blood oxygenation, or hepatic, renal, myocardic, or skeletal muscle damages.

Biochemical features in patients with their first acute inferior myocardial infarction

Sixty eight patients with their first acute inferior myocardial infarction were studied within 24 h of the onset of chest pain by vectorcardiography and biochemical indicators. Patients were divided into three groups according to the vectorcardiographic findings: Group 1 (31 patients with inferior myocardial infarction); Group 2 (26 patients with inferior myocardial infarction and right ventricular involvement); and Group 3 (11 patients with inferior-posterior infarction). Biochemical studies showed that the tendency for the magnitude of enzyme release varied with the site inferior-posterior > inferior+right ventricular > inferior groups. However, the differences between inferior and inferior plus right-ventricular groups were not significant. This suggests that the left ventricle dominates enzyme release regardless, with or without right ventricular involvement in patients with acute inferior myocardial infarction. When the enzyme levels in inferior and inferior-posterior myocardial infarction are compared, the HBDH and CK-MB were significantly higher (2P < 0.02 and 2P < 0.05 respectively). This confirms that when the vectorcardiographic QRS loop changes are large, more enzyme is released during acute myocardial infarction.

Evaluation of hepatocyte-specific paramagnetic contrast media for MR imaging of hepatitis

The hepatocyte-specific paramagnetic magnetic resonance (MR) contrast agents manganese-DPDP [N,N'-dipyridoxylethylenediamine-N,N'-diacetate 5,5'bis-(phosphate)] and gadobenate dimeglumine were used for diagnosing chemically induced hepatitis in rats. Ex vivo liver tissue relaxation times and in vivo MR image signal-to-noise ratios were compared before and after contrast agent administration. Ex vivo relaxometry and in vivo MR imaging showed that Mn-DPDP enhanced normal and diseased livers to the same degree at all time points from 5 to 120 minutes. Gadobenate dimeglumine showed reduced T1 and T2 enhancements in hepatitis relative to those of normal liver, in the early phase (5-30 minutes). However, these effects are offsetting, and as a result, MR imaging failed to allow distinction of diseased from normal livers. This surprising result observed in vivo was in fact predicted by applying the Bloch equation to our ex vivo data. Our results show that detection and quantitation of hepatitis with MR imaging enhanced with paramagnetic cell-specific contrast agents will be more difficult than anticipated.

Diagnosis of fatty liver with MR imaging

The diagnosis of fatty liver with magnetic resonance (MR) imaging was evaluated in experimental rat models of simple fatty infiltration and fatty liver with hepatocellular injury. T1 and T2 were measured ex vivo and correlated with the histologic degree of fatty infiltration. Enhancement of fatty liver with four different cells-specific contrast agents was studied with ex vivo relaxometry and in vivo MR imaging. Quantitative analysis of conventional and chemical shift MR images was correlated with biochemically determined fat content of the liver. Diet-induced simple fatty infiltration of the liver caused a decrease in T1 of 15%, whereas the T1 of L-ethionine-induced fatty liver with hepatocellular injury increased by 12%. T2 showed a positive correlation with the degree of fatty infiltration in both models. Cell-specific hepatobiliary contrast agents showed the same liver uptake and relaxation enhancement in fatty livers as in normal livers. Conventional T1-weighted images and chemical shift images showed good correlation (r = .83 and .80, respectively) between signal intensity and the degree of fatty infiltration. However, only chemical shift imaging was reliable in the diagnosis of fatty liver.

The development of computer programs to predict and minimise the effect of sample pyruvate on aspartate aminotransferase assays

Some NADH-linked aspartate aminotransferase (AST) assay systems may produce significant errors due to endogenous pyruvate because the pre-incubation time employed is too short and/or because the reagent lactate dehydrogenase (LD) activity is inadequate. Such errors in patient specimens may go unnoticed if quality control materials themselves contain a low pyruvate concentration. A theory of pyruvate interference in AST assay is formulated and calculation programs are described which will allow a laboratory to assess whether their particular AST methods are likely to be subject to such interference and also to predict a way of removing any error thus identified.

Optimal conditions for protease use in the assay of serum mitochondrial aspartate aminotransferase

The optimal conditions for selective proteolytic inactivation of cytosolic aspartate aminotransferase (c-AST) to determine mitochondrial aspartate aminotransferase (m-AST) in serum were studied. Protease 401 was found to be effective over a pH range of 6.0-10.0. A pH of 9.5 with 0.5% albumin in the reagent mixture was determined to be optimal for inactivation of c-AST and preservation of m-AST, lactic dehydrogenase (LDH), and malic dehydrogenase (MDH) in the assay procedure. The presence of serum endogenous protein inhibitors such as alpha 1-antitrypsin and alpha 2-macroglobin did not inhibit protease 401.

A computer program to determine diagnostic decision thresholds and likelihood ratios illustrated with aspartate aminotransferase activities after a myocardial infarction

We describe an enhancement of our earlier computer program which allows calculation of decision thresholds, sensitivity and specificity, and likelihood ratios of negative and positive test results for any chosen value of sensitivity or specificity. The program will also plot continuous receiver operating characteristic and decision level curves which permit examination of the contours created by using all the available data. We illustrate the value of these routines by showing that the sensitivity and specificity of serum aspartate aminotransferase changes during the course of a myocardial infarction.

Evaluation of commercially formulated aspartate aminotransferase and alanine aminotransferase activity determinations by the Scandinavian Committee on Enzymes and IFCC methods as modified for use with automated enzyme analysers

The performance characteristics of the Scandinavian Committee on Enzymes (SCE) methods for the assay of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined using six automated enzyme analysers. The reagent formulation did not include pyridoxal phosphate (PLP). An optimal operating mode was defined for each instrument and precision was assessed in greater detail on four instruments. A points rating system was devised to place the instruments in the following order of proficiency: IL Multistat III, LKB-8600, Gilford 3500, ABA 100. In contrast to AST, the ALT activity of patient samples was unstable at -20 degrees C over periods as short as seven days. The performance characteristics of the IFCC methods for assay of AST and ALT activities were determined by using three automated enzyme analyzers in order to assess the effect of PLP upon precision and activity of four quality control sera, and to compare the SCE and IFCC methods. Precision of AST assays did not alter on omission of PLP from the IFCC formulation, while that of ALT assays showed slight deterioration. The decrease in activity on omitting PLP was variable with each instrument. A points-rating system was devised to place the methods in the following order of precision: AST: IFCC (-PLP) 118, IFCC 109, SCE 61; ALT: IFCC 125, IFCC (-PLP) 97, SCE 66. The IFCC methods offer better precision, and the overall change on omitting PLP is minimal.

Cyclosporine nephrotoxicity is minimized by adjusting dosage on the basis of drug concentration in blood

Two immunosuppressive regimens-cyclosporine plus prednisone and azathioprine plus prednisone-were compared in 78 renal transplantation patients (39 in each treatment group) who were successfully managed for more than 15 months. In patients who received cyclosporine, the dosage was adjusted to achieve trough whole blood concentrations of 100 to 250 ng/ml measured by liquid chromatography. A greater number of haplotypes matched in the azathioprine-treated group than in the cyclosporine-treated group (P less than 0.026). Graft survival was similar in patients who received azathioprine (95%) and those given cyclosporine (94%). The azathioprine group had a higher mortality (7%) than the cyclosporine group (2%). In a comparison of the two treatment groups, no statistically significant difference was found in posttransplant renal function, based on either serum creatinine or iothalamate clearance. We conclude that renal toxicity due to cyclosporine can be minimized to statistical nonsignificance by using cyclosporine dosages that provide trough whole blood concentrations in the range of 150 to 250 ng/ml during the first 4 months of therapy and 80 to 200 ng/ml thereafter.

Macroenzyme as a cause of unexplained elevation of aspartate aminotransferase

Aspartate aminotransferase (AST) can exist as a macroenzyme by forming a complex with an immunoglobulin. This immunoglobulin-complexed macromolecule can cause an elevation in serum AST activity, which may be detected on routine blood chemistry analysis and erroneously considered to indicate the presence of liver disease. Clinicians should be aware of this phenomenon so patients are not subjected to unnecessary procedures. In patients with unexplained AST elevation, liver and muscle disease can be biochemically excluded by the finding of normal serum levels of alanine aminotransferase and creatine kinase. The presence of macro-AST can be determined by exclusion chromatography, electrophoresis, and activation assays with pyridoxal 5-phosphate. The elevated AST values can persist for many years.

Changes in activation of aspartate aminotransferase by pyridoxal 5'-phosphate after experimental liver damage in rabbits

The aspartate aminotransferase activity with and without pyridoxal 5'-phosphate supplementation was examined in mitochondrial and cytoplasmic preparations from fresh human heart and liver samples. The apoenzyme was fully saturated in all cases. Liver cell damage was produced by ischaemia and carbon tetrachloride poisoning in two groups of rabbits. The activity of aspartate aminotransferase with and without pyridoxal 5'-phosphate was measured in the plasma and in cytoplasmic and mitochondrial preparations from both groups. After carbon tetrachloride poisoning the enzyme activity in the plasma increased within 2 h but was not enhanced by pyridoxal 5'-phosphate. Following ischaemia, plasma enzyme activity only increased between 4 and 8 h and was progressively stimulated by pyridoxal 5'-phosphate. Up to 15 h after carbon tetrachloride poisoning the liver cytoplasmic and mitochondrial apo-enzyme remained fully saturated with co-enzyme. In contrast, a pronounced loss of co-enzyme occurred in both fractions of the ischaemic group. These result suggest that the type of injury and not necessarily the organ affected could determine the degree of activation of aspartate aminotransferase by pyridoxal 5'-phosphate observed in human myocardial infarction and liver disease.

The changes in activation of intracellular aspartate aminotransferase by pyridoxal 5-phosphate after cell death

Aspartate aminotransferase activity was measured in plasma, in liver and in heart mitochondrial and cytoplasmic preparations from rats immediately after death and after a post-mortem interval of 15 h. No significant stimulation of activity on addition of pyridoxal 5-phosphate to the assay medium could be demonstrated in any preparations obtained immediately after death. Significant stimulation occurred in both cytoplasmic and mitochondrial preparations of liver and myocardium after a 15-h post-mortem interval, but not in plasma stored for the same period. It appears, therefore, that variations in the intracellular saturation of apoenzyme with coenzyme cannot account for the observed differences in activation of aspartate aminotransferase by pyridoxal 5-phosphate in sera from patients with myocardial infarction and liver disease. Changes in degree of saturation of apoenzyme seem to occur intracellularly after cell death or injury and before release into the circulation.