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Jimenez-Cauhe J, Vaño-Galvan S, Mehta N, Hermosa-Gelbard A, Ortega-Quijano D, Buendia-Castaño D, Fernández-Nieto D, Porriño-Bustamante M, Saceda-Corralo D, Pindado-Ortega C, Moreno-Arrones OM, Wambier C, Dhura R, Lotti T, Goren A. Hair follicle sulfotransferase activity and effectiveness of oral minoxidil in androgenetic alopecia. J Cosmet Dermatol 2024. [PMID: 39034734 DOI: 10.1111/jocd.16473] [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: 02/02/2024] [Revised: 04/29/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is common. While topical minoxidil remains the only FDA-approved therapeutic for AGA, its efficacy is limited in stimulating clinically significant hair regrowth over the longer term. Oral minoxidil, which is used off-label, is a promising alternative; however, its effectiveness and underlying mechanisms warrant further investigation. AIMS To elucidate the site of action and infer the physiological mechanisms underlying therapeutic responses to oral minoxidil in patients with AGA. METHODS Forty-one patients with AGA underwent 6 months of low-dose oral minoxidil treatment. Minoxidil sulfotransferase (SULT) activity was assayed in plucked scalp hair follicles. The primary outcome was hair growth after low-dose oral minoxidil treatment for a minimum of 6 months, and the secondary outcome was SULT activity in hair follicles. RESULTS After 6 months of treatment, 26 (63.4%) patients experienced a clinical improvement in alopecia symptoms. The response rate was higher in men (19/26 [73.1%]) than in women (6/15 [40.0%]). Patients with low hair follicle SULT activity demonstrated a higher minoxidil response rate than those with high enzyme activity (85% vs. 43%, p = 0.009). CONCLUSIONS Our findings indicate that low SULT activity within the hair follicles is associated with a favorable response to oral minoxidil therapy in patients with AGA. Further elucidation of the underlying mechanisms could significantly improve personalized therapeutic approaches through improved patient selection and the rational design of adjuvant treatments.
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Affiliation(s)
- Juan Jimenez-Cauhe
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Sergio Vaño-Galvan
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Nina Mehta
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Angela Hermosa-Gelbard
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Daniel Ortega-Quijano
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Diego Buendia-Castaño
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Diego Fernández-Nieto
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | | | - David Saceda-Corralo
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Cristina Pindado-Ortega
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Oscar M Moreno-Arrones
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain; Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
| | - Carlos Wambier
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachita Dhura
- Department of Dermatology, LTM Medical College and Hospital Sion, Mumbai, India
| | | | - Andy Goren
- University of Rome ("G. Marconi"), Rome, Italy
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Catumbela CSG, Morales R. Elderly mice with history of acetaminophen intoxication display worsened cognitive impairment and persistent elevation of astrocyte and microglia burden. Sci Rep 2024; 14:14205. [PMID: 38902507 PMCID: PMC11190293 DOI: 10.1038/s41598-024-65185-z] [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: 03/16/2024] [Accepted: 06/18/2024] [Indexed: 06/22/2024] Open
Abstract
Acetaminophen (APAP) is a leading cause of acute liver failure. The effect of APAP metabolite's effects in the periphery are well characterized; however, associated consequences in the brain remain poorly understood. Animal studies on this subject are few and reveal that frequent APAP intake can trigger cerebral abnormalities that vary depending on the subject's age. Alarmingly, experimental efforts have yet to examine associated consequences in elderly hosts, who correspond to the highest risk of medication overload, impaired drug clearance, and cognitive deficits. Here, we interrogated the cerebral and peripheral pathology of elderly mice submitted to monthly episodes of APAP intoxication since a young adult age. We found that weeks after the final episode of recurrent APAP exposure, mice exhibited worsened non-spatial memory deficit whereas spatial memory performance was unaltered. Interestingly, one month after the period of APAP intoxication, these mice showed increased glial burden without associated drivers, namely, blood-brain barrier disruption, cholesterol accumulation, and elevation of inflammatory molecules in the brain and/or periphery. Our experimental study reveals how recurrent APAP exposure affects the cognitive performance and cellular events in elderly brains. These data suggest that APAP-containing pharmacological interventions may foreshadow the elevated risk of neuropsychiatric disorders that afflict elderly populations.
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Affiliation(s)
- Celso S G Catumbela
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Rodrigo Morales
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Centro Integrativo de Biologia y Quimica Aplicada (CIBQA), Universidad Bernardo O'Higgins, Santiago, Chile.
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3
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Prescott LF. Paracetamol (acetaminophen) poisoning: The early years. Br J Clin Pharmacol 2024; 90:127-134. [PMID: 37683599 DOI: 10.1111/bcp.15903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023] Open
Abstract
Paracetamol (acetaminophen) was marketed in the 1950s as a nonprescription analgesic/antipyretic without any preclinical toxicity studies. It became used increasingly for self-poisoning, particularly in the UK and was belatedly found to cause acute liver damage, which could be fatal. Management of poisoned patients was difficult as maximum abnormalities of liver function were delayed for 3 days or more after an overdose. There was no treatment and the mechanism of hepatotoxicity was not known. The paracetamol half-life was prolonged with liver damage occurring when it exceeded 4 h and the Rumack-Matthew nomogram was an important advance that allowed stratification of patients into separate zones of risk. It is used to guide prognosis and treatment and its predictive value could be increased by combining it with the paracetamol half-life. The problems of a sheep farmer in Australia in the early 1970s led to the discovery of the mechanism of paracetamol hepatotoxicity, and the first effective treatment of overdosage with intravenous (IV) cysteamine. This had unpleasant side effects and administration was difficult. N-acetylcysteine soon became the treatment of choice for paracetamol overdose and given early it was very effective when administered either IV or orally. N-acetylcysteine could cause anaphylactoid reactions, particularly early during IV administration when the concentrations were highest. Simpler and shorter regimes with slower initial rates of infusion have now been introduced with a reduced incidence of these adverse effects. In addition, there has been a move to use larger doses of N-acetylcysteine given over longer periods for patients who are more severely poisoned and those with risk factors. There has been much interest recently in the search for novel biomarkers such as microRNAs, procalcitonin and cyclophilin that promise to have greater specificity and sensitivity than transaminases. Paracetamol-protein adducts predict hepatotoxicity and are specific biomarkers of toxic paracetamol metabolite exposure. Another approach would be measurement of the plasma levels of cysteine and inorganic sulfate. It is 50 years since the first effective treatment for paracetamol poisoning and, apart from liver transplantation, there is still no effective treatment for patients who present late.
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Affiliation(s)
- Laurie F Prescott
- Emeritus Professor of Clinical Pharmacology, University of Edinburgh, Edinburgh, UK
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Chiew AL, Isbister GK. Advances in the understanding of acetaminophen toxicity mechanisms: a clinical toxicology perspective. Expert Opin Drug Metab Toxicol 2023; 19:601-616. [PMID: 37714812 DOI: 10.1080/17425255.2023.2259787] [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: 05/15/2023] [Revised: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Acetaminophen (paracetamol) is a commonly used analgesic and antipyretic agent, which is safe in therapeutic doses. Acetaminophen poisoning due to self-harm or repeated supratherapeutic ingestion is a common cause of acute liver injury. Acetylcysteine has been a mainstay of treatment for acetaminophen poisoning for decades and is efficacious if administered early. However, treatment failures occur if administered late, in 'massive' overdoses or in high-risk patients. AREAS COVERED This review provides an overview of the mechanisms of toxicity of acetaminophen poisoning (metabolic and oxidative phase) and how this relates to the assessment and treatment of the acetaminophen poisoned patient. The review focuses on how these advances offer further insight into the utility of novel biomarkers and the role of proposed adjunct treatments. EXPERT OPINION Advances in our understanding of acetaminophen toxicity have allowed the development of novel biomarkers and a better understanding of how adjunct treatments may prevent acetaminophen toxicity. Newly proposed adjunct treatments like fomepizole are being increasingly used without robust clinical trials. Novel biomarkers (not yet clinically available) may provide better assessment of these newly proposed adjunct treatments, particularly in clinical trials. These advances in our understanding of acetaminophen toxicity and liver injury hold promise for improved diagnosis and treatment.
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Affiliation(s)
- Angela L Chiew
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Geoffrey K Isbister
- New South Wales Poisons Information Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Clinical Toxicology Research Group, University of Newcastle, Callaghan, NSW, Australia
- Department of Clinical Toxicology, Calvary Mater Newcastle, Waratah, NSW, Australia
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Wu Y, Völler S, Krekels EHJ, Roofthooft DWE, Simons SHP, Tibboel D, Flint RB, Knibbe CAJ. Maturation of Paracetamol Elimination Routes in Preterm Neonates Born Below 32 Weeks of Gestation. Pharm Res 2023; 40:2155-2166. [PMID: 37603141 PMCID: PMC10547636 DOI: 10.1007/s11095-023-03580-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Despite being off-label, intravenous paracetamol (PCM) is increasingly used to control mild-to-moderate pain in preterm neonates. Here we aim to quantify the maturation of paracetamol elimination pathways in preterm neonates born below 32 weeks of gestation. METHODS Datasets after single dose (rich data) or multiple doses (sparse data) of intravenous PCM dose (median (range)) 9 (3-25) mg/kg were pooled, containing 534 plasma and 44 urine samples of PCM and metabolites (PCM-glucuronide, PCM-sulfate, PCM-cysteine, and PCM-mercapturate) from 143 preterm neonates (gestational age 27.7 (24.0-31.9) weeks, birthweight 985 (462-1,925) g, postnatal age (PNA) 5 (0-30) days, current weight 1,012 (462-1,959) g. Population pharmacokinetic analysis was performed using NONMEM® 7.4. RESULTS For a typical preterm neonate (birthweight 985 g; PNA 5 days), PCM clearance was 0.137 L/h, with glucuronidation, sulfation, oxidation and unchanged renal clearance accounting for 5.3%, 73.7%, 16.3% and 4.6%, respectively. Maturational changes in total PCM clearance and its elimination pathways were best described by birthweight and PNA. Between 500-1,500 g birthweight, total PCM clearance increases by 169%, with glucuronidation, sulfation and oxidation clearance increasing by 347%, 164% and 164%. From 1-30 days PNA for 985 g birthweight neonate, total PCM clearance increases by 167%, with clearance via glucuronidation and oxidation increasing by 551%, and sulfation by 69%. CONCLUSION Birthweight and PNA are the most important predictors for maturational changes in paracetamol clearance and its glucuronidation, sulfation and oxidation. As a result, dosing based on bodyweight alone will not lead to consistent paracetamol concentrations among preterm neonates.
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Affiliation(s)
- Yunjiao Wu
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Swantje Völler
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Elke H J Krekels
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Daniëlla W E Roofthooft
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery, Erasmus University MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert B Flint
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Catherijne A J Knibbe
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
- Department of Clinical Pharmacy, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.
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Chiew AL, Isbister GK, Stathakis P, Isoardi KZ, Page C, Ress K, Chan BS, Buckley NA. Acetaminophen Metabolites on Presentation Following an Acute Acetaminophen Overdose (ATOM-7). Clin Pharmacol Ther 2023; 113:1304-1314. [PMID: 36919638 PMCID: PMC10952325 DOI: 10.1002/cpt.2888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
Acetaminophen (APAP) is commonly taken in overdose and can cause acute liver injury via the toxic metabolite NAPQI formed by cytochrome (CYP) P450 pathway. We aimed to evaluate the concentrations of APAP metabolites on presentation following an acute APAP poisoning and whether these predicted the subsequent onset of hepatotoxicity (peak alanine aminotransferase > 1,000 U/L). The Australian Toxicology Monitoring (ATOM) study is a prospective observational study, recruiting via two poison information centers and four toxicology units. Patients following an acute APAP ingestion presenting < 24 hours post-ingestion were recruited. Initial samples were analyzed for APAP metabolites, those measured were the nontoxic glucuronide (APAP-Glu) and sulfate (APAP-Sul) conjugates and NAPQI (toxic metabolite) conjugates APAP-cysteine (APAP-Cys) and APAP-mercapturate (APAP-Mer). The primary outcome was hepatotoxicity. In this study, 200 patients were included, with a median ingested dose of 20 g, 191 received acetylcysteine at median time of 5.8 hours post-ingestion. Twenty-six patients developed hepatotoxicity, one had hepatotoxicity on arrival (excluded from analysis). Those who developed hepatotoxicity had significantly higher total CYP metabolite concentrations: (36.8 μmol/L interquartile range (IQR): 27.8-51.7 vs. 10.8 μmol/L IQR: 6.9-19.5) and these were a greater proportion of total metabolites (5.4%, IQR: 3.8-7.7) vs. 1.7%, IQR: 1.3-2.6, P < 0.001)]. Furthermore, those who developed hepatotoxicity had lower APAP-Sul concentrations (49.1 μmol/L, IQR: 24.7-72.2 vs. 78.7 μmol/L, IQR: 53.6-116.4) and lower percentage of APAP-Sul (6.3%, IQR: 4.6-10.9 vs. 13.1%, IQR, 9.1-20.8, P < 0.001)]. This study found that those who developed hepatotoxicity had higher APAP metabolites derived from CYP pathway and lower sulfation metabolite on presentation. APAP metabolites may be utilized in the future to identify patients who could benefit from increased acetylcysteine or newer adjunct or research therapies.
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Affiliation(s)
- Angela L. Chiew
- Department of Clinical ToxicologyPrince of Wales HospitalRandwickNew South WalesAustralia
- Faculty of MedicineThe University of New South WalesSydneyNew South WalesAustralia
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Geoffrey K. Isbister
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle and School of Medical PracticeUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Paul Stathakis
- NSW Health PathologyPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Katherine Z. Isoardi
- Clinical Toxicology UnitPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Queensland Poisons Information CentreQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Colin Page
- Clinical Toxicology UnitPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Queensland Poisons Information CentreQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Kirsty Ress
- NSW Health PathologyPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Betty S.H. Chan
- Department of Clinical ToxicologyPrince of Wales HospitalRandwickNew South WalesAustralia
- Faculty of MedicineThe University of New South WalesSydneyNew South WalesAustralia
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Nicholas A. Buckley
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital HealthThe University of SydneySydneyNew South WalesAustralia
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Zempsky W, Bell J, Mossali VM, Kachroo P, Siddiqui K. Common Selfcare Indications of Pain Medications in Children. Paediatr Drugs 2023; 25:321-341. [PMID: 36928608 PMCID: PMC10019440 DOI: 10.1007/s40272-023-00562-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Pain has a multifaceted impact on individuals worldwide, affecting their physical functioning, emotional well-being, and quality of life. Children (age < 18 years) have a high prevalence of conditions associated with pain, such as toothache, headache, earache, sore throat, and respiratory tract infections, many of which may be accompanied by fever. Globally, the pharmacologic treatment of pain in pediatric patients is limited largely to nonopioid analgesics, and dosing must account for differences in age, weight, metabolism, and risk of adverse effects. This narrative review summarizes the findings of a literature search on the pediatric indications, dosing approaches, dosing guidelines, and pharmacokinetics of paracetamol and ibuprofen, which are common pain medications available globally for self-care use in children. The review also discusses the risks and benefits associated with these agents. The current roles of paracetamol and ibuprofen in the symptomatic management of coronavirus disease 2019 (COVID-19) infection and in the management of post-COVID-19 immunization symptoms in children are also discussed. Therefore, while a very large amount of data over several decades is available for paracetamol and ibuprofen, an urgent need exists for well-designed studies of these medications for the management of pain and fever in pediatric patients with COVID-19 to ensure optimal relief with minimal toxicity.
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Affiliation(s)
- William Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, 06106, USA. .,University of Connecticut School of Medicine, Farmington, CT, USA.
| | - John Bell
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Sridharan K, Qader AM, Hammad M, Jassim A, Diab DE, Abraham B, Hasan HMSN, Pasha SAA, Shah S. Evaluation of the Association between Single Nucleotide Polymorphisms of Metabolizing Enzymes with the Serum Concentration of Paracetamol and Its Metabolites. Metabolites 2022; 12:metabo12121235. [PMID: 36557273 PMCID: PMC9785892 DOI: 10.3390/metabo12121235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Intravenous paracetamol is a commonly administered analgesic and antipyretic in inpatient settings. Paracetamol is metabolized by cytochrome P450 (CYP) enzymes followed by conjugating enzymes to mainly glucuronide but to a lesser extent, sulphate metabolites, and oxidative metabolites. Single nucleotide polymorphisms (SNPs) in the CYP enzymes result in modified enzymatic activity. The present study was carried out to evaluate the prevalence of SNPs related to paracetamol metabolism and principal metabolites in critically ill patients, and those with chronic kidney disease. The present study is a cross-sectional study carried out in adults (>21 years) requiring intravenous paracetamol as part of their standard of care. Details regarding their demographics, and renal and liver function tests were collected. Blood was withdrawn for the analysis of paracetamol and their metabolites, and the SNPs of key CYP enzymes. Paracetamol/paracetamol glucuronide (P/PG), paracetamol/paracetamol sulphate (P/PS) and PG/PS were estimated. Acute liver injury (ALI) and renal dysfunction were defined using standard definitions. We observed a significant prevalence of SNPs in CYP1A2*1C, CYP3A4*3, CYP1A2*1K, CYP1A2*6, CYP2D6*10, and CYP2E1*2 amongst the 150 study participants. Those with CYP1A2*6 (CC genotype) were observed with significantly lower PG and PS concentrations, and a higher P/PS ratio; CYP2D6*10 (1/1 genotype) with a significantly lower PG concentration and a higher P/PG ratio; and CYP1A2*1K (CC genotype) was observed with a significantly higher PG/PS ratio. Good predictive accuracies were observed for determining the SNPs with the cut-off concentration of 0.29 μM for PS in determining CYP1A2*1K, 0.39 μM for PG and 0.32 μM for PS in determining CYP1A2*6 genotype, and 0.29 μM for PG in determining the CYP2D6*10 genotype. Patients with renal dysfunction were observed with significantly greater concentrations of paracetamol, PG and P/PS, and PG/PS ratios, with a lower concentration of PS. No significant differences were observed in any of the metabolites or metabolite ratios in patients with ALI. We have elucidated the prevalence of key CYP enzymes involved in acetaminophen metabolism in our population. Alterations in the metabolite concentrations and metabolic ratios were observed with SNPs, and in patients with renal dysfunction. Population toxicokinetic studies elucidating the dose-response relationship are essential to understand the optimized dose in this sub-population.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
- Correspondence: ; Tel.: +973-17239794
| | | | - Mustafa Hammad
- Salmaniya Medical Complex, Manama P.O. Box 26671, Bahrain
| | - Anfal Jassim
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Al-Jawhara Center, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
| | - Diab Eltayeb Diab
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Al-Jawhara Center, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
| | - Betsy Abraham
- Intensive Care Unit, Salmaniya Medical Complex, Manama P.O. Box 26671, Bahrain
| | | | | | - Shamik Shah
- Department of Nephrology, Salmaniya Medical Complex, Manama P.O. Box 26671, Bahrain
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Monte AA, Mackenzie IA, Pattee J, Kaiser S, Willems E, Rumack B, Reynolds KM, Dart RC, Heard KJ. Genetic variants associated with ALT elevation from therapeutic acetaminophen. Clin Toxicol (Phila) 2022; 60:1198-1204. [PMID: 36102175 PMCID: PMC9701448 DOI: 10.1080/15563650.2022.2117053] [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: 06/07/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several studies have suggested genetic variants associated with acetaminophen induced liver injury (DILI) following overdose. Genetic variation associated with acetaminophen-induced alanine aminotransferase elevation during therapeutic dosing has not been examined. METHODS We performed genetic analyses on patients that ingested therapeutic doses of 4 grams of acetaminophen for up to 16 days. We examined 20 genes previously implicated in the metabolism of acetaminophen or the development of immune-mediated DILI using the Illumina Multi-Ethnic Global Array 2. Autosomes were aligned and imputed using TOPMed. A candidate gene region analysis was performed by testing each gene individually using linkage disequilibrium (LD) pruned variants with the adaptive sum of powered scores (aSPU) test from the aSPU R package. The highest measured ALT during therapy, the maximum ALT, was used as the outcome. RESULTS 192 subjects taking therapeutic APAP were included in the genetic analysis. 136 (70.8%) were female, 133 (69.2%) were Caucasian race, and the median age was 34 years (IQR: 26, 46). Age > 50 years was the only clinical factor associated with maximum ALT increase. Variants in SULT1E1, the gene responsible for Sulfotransferase Family 1E Member 1 enzyme production, were associated with maximum ALT. No single variant drove this association, but rather the association was due to the additive effects of numerous variants within the gene. No other genes were associated with maximum ALT increase in this cohort. CONCLUSION Acetaminophen induced ALT elevation at therapeutic doses was not associated with variation in most genes associated with acetaminophen metabolism or immune-induced DILI in this cohort. The role of SULT1E1 polymorphism in acetaminophen-induced elevated ALT needs further examination.
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Affiliation(s)
- Andrew A. Monte
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO
- University of Colorado School of Medicine, Center for Bioinformatics & Personalized Medicine, Aurora, CO
- University of Colorado, Skaggs School of Pharmacy, Aurora, CO
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Ian Arriaga Mackenzie
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO
| | - Jack Pattee
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO
| | - Sasha Kaiser
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Emileigh Willems
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO
| | - Barry Rumack
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Kate M. Reynolds
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Richard C. Dart
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Kennon J. Heard
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authority, Denver, CO
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Chen Y, Song W, Ge W, Yan R. Metabolic competency of larval zebrafish in drug-induced liver injury: a case study of acetaminophen poisoning. Toxicol Sci 2022; 189:175-185. [PMID: 35944217 DOI: 10.1093/toxsci/kfac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Larval zebrafish is emerging as a new model organism for studying drug-induced liver injury (DILI) with superiorities in visual assessment, genetic engineering as well as high throughput. Metabolic bioactivation to form reactive intermediates is a common event that triggers DILI. This study first addressed the correlation between acetaminophen metabolism and hepatotoxicity in zebrafish larvae (3 days post-fertilization) and demonstrated the occurrence of cytochrome P450 enzymes-mediated APAP bioactivation at early developmental stage through characterizing the dose-effect (0-1.6 mg/mL) and the time-course (0-72 h) of liver injury and metabolism in the AB strain and LiPan transgenic line Tg(lfabp10a: DsRed; elaA: egfp) expressing liver-specific fluorescent protein. APAP caused multi-organ developmental retardation and elicited dose- and time-dependent hepatotoxicity. Liver imaging revealed significant changes earlier than histological and biochemical measurements. APAP bioactivation in larval zebrafish was first confirmed by the detection of the glutathione conjugate of the reactive intermediate NAPQI (NAPQI-GSH) and subsequent mercapturate derivatives NAPQI-cysteine and NAPQI-N-acetylcysteine after even short (0.5-hour post exposure) or low (0.2 mg/mL) APAP exposure. APAP overdose impaired metabolic function, in particular sulfation, while facilitated GSH depletion and APAP sulfate excretion. Meanwhile, APAP displayed triphasic accumulation in the larvae, agreeing with fluctuating metabolic capabilities with sulfation dominating the early larval developmental stage. Most importantly, the dose-response effects and time-course of APAP accumulation and metabolism agree well with those of the liver injury development. Overall, larval zebrafish has developed mammalian-like metabolic function, enabling it an ideal model organism for high throughput screening hepatotoxicity and mechanistic study of bioactivation-based DILI.
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Affiliation(s)
- Yijia Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao, China
| | - Weiyi Song
- Center of Reproduction, Development and Aging (CRDA), Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Wei Ge
- Center of Reproduction, Development and Aging (CRDA), Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Ru Yan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao, China.,Zhuhai UM Science & Technology Research Institute, Zhuhai, 519080, China
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11
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Liu J, Tan Y, Cheng H, Zhang D, Feng W, Peng C. Functions of Gut Microbiota Metabolites, Current Status and Future Perspectives. Aging Dis 2022; 13:1106-1126. [PMID: 35855347 PMCID: PMC9286904 DOI: 10.14336/ad.2022.0104] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 12/12/2022] Open
Abstract
Gut microbiota, a collection of microorganisms that live within gastrointestinal tract, provides crucial signaling metabolites for the physiological of hosts. In healthy state, gut microbiota metabolites are helpful for maintaining the basic functions of hosts, whereas disturbed production of these metabolites can lead to numerous diseases such as metabolic diseases, cardiovascular diseases, gastrointestinal diseases, neurodegenerative diseases, and cancer. Although there are many reviews about the specific mechanisms of gut microbiota metabolites on specific diseases, there is no comprehensive summarization of the functions of these metabolites. In this Opinion, we discuss the knowledge of gut microbiota metabolites including the types of gut microbiota metabolites and their ways acting on targets. In addition, we summarize their physiological and pathologic functions in health and diseases, such as shaping the composition of gut microbiota and acting as nutrition. This paper can be helpful for understanding the roles of gut microbiota metabolites and thus provide guidance for developing suitable therapeutic strategies to combat microbial-driven diseases and improve health.
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Affiliation(s)
- Juan Liu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Yuzhu Tan
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Hao Cheng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
- Key Laboratory of the Ministry of Education for Standardization of Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Dandan Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
- Key Laboratory of the Ministry of Education for Standardization of Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Wuwen Feng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
- Key Laboratory of the Ministry of Education for Standardization of Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Cheng Peng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
- Key Laboratory of the Ministry of Education for Standardization of Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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12
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Delayed Acetaminophen Absorption Resulting in Acute Liver Failure. Case Rep Crit Care 2022; 2022:3672248. [PMID: 35578608 PMCID: PMC9107358 DOI: 10.1155/2022/3672248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction. Acetaminophen is a common medication involved in deliberate and accidental self-poisoning. The acetaminophen treatment nomogram is used to guide acetylcysteine treatment. It is rare to develop hepatotoxicity with an initial acetaminophen concentration below the nomogram line. We present a case of acetaminophen ingestion with an initial concentration below the nomogram line that developed hepatic failure, due to a delayed peak acetaminophen concentration secondary to coingesting medications that slow gastric emptying. Case Report. A 43-year-old (55 kg) female presented after ingesting an unknown quantity of acetaminophen, clonidine, and alcohol. Her acetaminophen level was 41 mg/L (256 μmol/L) at 4.5 h post-ingestion, well below the nomogram line, and ALT was 25 U/L. Hence, acetylcysteine was not commenced. She was intubated for decreased level of conscious. A repeat acetaminophen level 4 h later was 39 mg/L (242 μmol/L), still below the nomogram line. She was extubated 24 h later.At 38 h post-ingestion she developed abdominal pain, the repeat acetaminophen level was 85 mg/L (560 μmol/L), ALT was 489 U/L, and acetylcysteine was commenced. The patient developed hepatic failure with a peak ALT of 7009 U/L and INR of 7.5 but made a full recovery. It was discovered that she had ingested a combination acetaminophen product containing dextromethorphan and chlorphenamine. Acetaminophen metabolites were measured, including nontoxic glucuronide and sulfate conjugates and toxic cytochrome P450 (CYP) metabolites. The metabolite data demonstrated increasing CYP metabolites in occurrence with the delayed acetaminophen peak concentration. Discussion. Opioids and antimuscarinic agents are known to delay gastric emptying and clonidine may also have contributed. These coingested medications resulted in delayed acetaminophen absorption. This case highlights the issue of altered pharmacokinetics when patients coingest gut slowing agents.
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13
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Bauer AZ, Swan SH, Kriebel D, Liew Z, Taylor HS, Bornehag CG, Andrade AM, Olsen J, Jensen RH, Mitchell RT, Skakkebaek NE, Jégou B, Kristensen DM. Paracetamol use during pregnancy - a call for precautionary action. Nat Rev Endocrinol 2021; 17:757-766. [PMID: 34556849 PMCID: PMC8580820 DOI: 10.1038/s41574-021-00553-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever. APAP is widely used by pregnant women as governmental agencies, including the FDA and EMA, have long considered APAP appropriate for use during pregnancy when used as directed. However, increasing experimental and epidemiological research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Here we summarize this evidence and call for precautionary action through a focused research effort and by increasing awareness among health professionals and pregnant women. APAP is an important medication and alternatives for treatment of high fever and severe pain are limited. We recommend that pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimize exposure by using the lowest effective dose for the shortest possible time. We suggest specific actions to implement these recommendations. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.
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Affiliation(s)
- Ann Z Bauer
- Department of Public Health, University of Massachusetts School of Health Sciences, Lowell, MA, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - David Kriebel
- Department of Public Health, University of Massachusetts School of Health Sciences, Lowell, MA, USA
| | - Zeyan Liew
- Yale Center for Perinatal, Paediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - Carl-Gustaf Bornehag
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Anderson M Andrade
- Departamento de Fisiologia, Setor de Ciências Biológicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Jørn Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh, Scotland
| | - Niels E Skakkebaek
- Department of Growth & Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bernard Jégou
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S, 1085, Rennes, France
| | - David M Kristensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S, 1085, Rennes, France.
- Department of Biology, University of Copenhagen, Copenhagen, Denmark.
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14
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Ahmad S, Zeb A, Khan S. Effects of aqueous extract of Medicago denticulata against paracetamol-induced hepatotoxicity in rabbits. J Food Biochem 2021; 45:e13985. [PMID: 34713456 DOI: 10.1111/jfbc.13985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
Medicago denticulata is commonly used as a leafy vegetable, salad, and food ingredient. In this study, different doses of leaves aqueous extract of M. denticulata (MD) were fed to intoxicated rabbits with paracetamol (100, 200, and 300 mg/kg) for regular 21 days. The aqueous extract was evaluated for phenolic composition using HPLC-DAD. Serum biochemical and hematological parameters were studied to check its activity. The liver was examined histologically and for antioxidant status. Results revealed that paracetamol led to a significant alteration in all the hematological (RBC, WBC, Hb, PLT, and HCT), and serum lipid parameters (TC, HDL, LDL, and TG) while MD at the dose rate of 300 mg/kg had a curative effect on the stabilization of the affected parameters. The high dose of MD ameliorated different antioxidant parameters such as reduced glutathione (GSH), DPPH radical scavenging activity (RSA), and thiobarbituric acid reactive substances (TBARS) of the liver on day 21st of the treatment. Histological studies revealed significant paracetamol-induced toxicity of the liver, whereas the MD had positive effects on induced toxicity. Improvement in all these alterations confirms the curative potential of Medicago denticulata extract. PRACTICAL APPLICATIONS: Paracetamol is a well-known antipyretic and analgesic medicine. However, it has been found to cause toxicity including hepatotoxicity. Synthetic drugs such as statins, antibiotics, and anti-viral are used for curing hepatic diseases also cause severe side effects. Thus, nutraceuticals from plant foods are used to reduce the side effects of different hepatotoxic medicine are continuously researched. This study reported for the first time that aqueous extract of the plant leaves was protective against the hepatotoxicity induced by paracetamol.
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Affiliation(s)
- Saeed Ahmad
- Department of Zoology, University of Peshawar, Peshawar, Pakistan
| | - Alam Zeb
- Department of Biochemistry, University of Malakand, Chakdara, Pakistan
| | - Sanaullah Khan
- Department of Zoology, University of Peshawar, Peshawar, Pakistan
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15
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Li J, Chiew AL, Isbister GK, Duffull SB. Population pharmacokinetics of immediate-release and modified-release paracetamol and its major metabolites in a supratherapeutic dosing study. Clin Toxicol (Phila) 2021; 60:25-32. [PMID: 34080498 DOI: 10.1080/15563650.2021.1928163] [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: 10/21/2022]
Abstract
OBJECTIVES Overdose with paracetamol modified-release (MR) formulation, a bilayer tablet containing 69% slow-release component, has been increasing since its introduction to the market. However, little evidence exists for the management of MR paracetamol overdose. We aimed to develop a population pharmacokinetic (PK) model for immediate-release (IR) and MR paracetamol and its major metabolism, and quantitatively understand the formulation difference in toxicity assessment based on the nomogram line. METHODS Data from a cross-over study design in nine healthy volunteers administered a single supratherapeutic oral dose (80 mg/kg) of either IR and MR paracetamol were available from a published study. Plasma concentrations for paracetamol and its metabolites glucuronide (APAPG) and sulfate conjugate (APAPS) for both formulations were measured and analysed with population pharmacokinetic (PK) method using NONMEM. Toxicity in both formulations was assessed by comparing the simulated paracetamol concentrations under different paracetamol dose levels with the 150 mg/L nomograms. The difference in the assessment was compared between the two formulations. RESULTS Paracetamol concentrations for the IR formulation were described with a two-compartment model with first-order input and a lag time. The delayed time-course of MR paracetamol concentrations was best captured by a parallel absorption model in which the slow-release component was a serial zero-order then the first-order process. The formation of APAPG was linear, while APAPS concentrations were best fitted by a Michaelis-Menten process. The relative bioavailability of MR paracetamol compared to IR (FMR/IR) was estimated as 0.81. The simulated probability of making different toxicity assessments based on nomogram line was increased with dose levels and was as high as 14.6% after 22 g IR or MR paracetamol ingested. CONCLUSIONS A joint parent-metabolite model to describe time-course profiles of both IR and MR paracetamol and its metabolites APAPG and APAPS concentrations was developed. Simulations from the model showed that toxicity assessment based on the 150 mg/L nomograms is not suitable in MR paracetamol overdoses.
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Affiliation(s)
- Jingyun Li
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Angela L Chiew
- Emergency Department and Clinical Toxicology, Prince of Wales Hospital and Community Health Services, Randwick, Australia.,NSW Poisons Information Centre, Children's Hospital at Westmead, Westmead, Australia
| | - Geoffrey K Isbister
- NSW Poisons Information Centre, Children's Hospital at Westmead, Westmead, Australia.,Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia
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16
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Sonn BJ, Heard KJ, Heard SM, D'Alessandro A, Reynolds KM, Dart RC, Rumack BH, Monte AA. Metabolomic markers predictive of hepatic adaptation to therapeutic dosing of acetaminophen. Clin Toxicol (Phila) 2021; 60:221-230. [PMID: 34047639 DOI: 10.1080/15563650.2021.1925686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Drug induced liver injury (DILI) remains a prominent global issue and acetaminophen (APAP) overdose represents a common cause of hepatic injury and DILI. Transient alanine aminotransferase (ALT) elevations have been documented while adhering to recommended daily dosing. However, no metabolites have been identified in pre-treatment samples predicting which patients will develop these transient increases. METHODS This was a secondary analysis of samples collected from a parent study describing the course of ALT levels in subjects receiving therapeutic APAP dosing. Two hundred and four subjects recruited from Denver, Colorado received 4 g APAP/daily for at least 16 days. Subjects were grouped by ALT at any monitored time point above 60 units/L (n = 25) vs. no increase (n = 179). Serum samples from days 0, 7, 16, and 31 were run on ultra-high performance liquid chromatography mass spectrometry. We report the metabolomic results of samples analyzed prior to APAP administration and over time. Significant changes in metabolite and demographic variable expressions were explored using t-tests with false discovery rate correction, chi square, and partial least squares discriminant analyses. RESULTS Within pre-treatment day 0 samples, allantoate and ornithine were significantly elevated in subjects of the ALT elevation group (p = .032). Baseline ALT (p = .011) and alkaline phosphatase (p = .006) were also significant. These metabolites were significant independent of race, ethnicity, gender, or BMI. CONCLUSIONS Allantoate and ornithine are directly involved in pathways related to nitrogen release and urea production. Further investigation into alterations in the glutathione metabolism and urea cycle pathways may lead to a greater understanding of the mechanisms associated with hepatic adaptation for a variety of pharmaceuticals.
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Affiliation(s)
- Brandon J Sonn
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Center for Bioinformatics & Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Kennon J Heard
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Susan M Heard
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Angelo D'Alessandro
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,Department of Structural Biology and Biochemistry, Metabolomics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kate M Reynolds
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Richard C Dart
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Barry H Rumack
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Andrew A Monte
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Center for Bioinformatics & Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
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