1
|
Gouju J, Legeay S. Pharmacokinetics of obese adults: Not only an increase in weight. Biomed Pharmacother 2023; 166:115281. [PMID: 37573660 DOI: 10.1016/j.biopha.2023.115281] [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: 06/30/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023] Open
Abstract
Obesity is a pathophysiological state defined by a body mass index > 30 kg/m2 and characterized by an adipose tissue accumulation leading to an important weight increased. Several pathologies named comorbidities such as cardiovascular disease, type 2 diabetes and cancer make obesity the fifth cause of death in the world. Physiological changes impact the four main phases of pharmacokinetics of some drugs and leads to an inappropriate drug-dose. For absorption, the gastrointestinal transit is accelerated, and the gastric empty time is shortened, that can reduce the solubilization and absorption of some oral drugs. The drug distribution is probably the most impacted by the obesity-related changes because the fat mass (FM) increases at the expense of the lean body weight (LBW), leading to an important increase of the volume of distribution for lipophilic drugs and a low or moderately increase of this parameter for hydrophilic drugs. This modification of the distribution may require drug-dose adjustments. By various mechanisms, the metabolism and elimination of drugs are impacted by obesity and should be considered as similar or lower than that non-obese patients. To better understand the necessary drug-dose adjustments in obese patients, a narrative review of the literature was conducted to highlight the main elements to consider in the therapeutic management of adult obese patients.
Collapse
Affiliation(s)
- Julien Gouju
- MINT, INSERM U1066, CNRS 6021, UNIV Angers, SFR-ICAT 4208, IBS-CHU Angers, 4 rue Larrey, Angers 49933 Cedex 9, France; CHU Angers, 4 rue Larrey, Angers 49933 Cedex 9, France.
| | - Samuel Legeay
- MINT, INSERM U1066, CNRS 6021, UNIV Angers, SFR-ICAT 4208, IBS-CHU Angers, 4 rue Larrey, Angers 49933 Cedex 9, France
| |
Collapse
|
2
|
Nakajima T, Wang H, Yuan Y, Ito Y, Naito H, Kawamoto Y, Takeda K, Sakai K, Zhao N, Li H, Qiu X, Xia L, Chen J, Wu Q, Li L, Huang H, Yanagiba Y, Yatsuya H, Kamijima M. Increased serum anti-CYP2E1 IgG autoantibody levels may be involved in the pathogenesis of occupational trichloroethylene hypersensitivity syndrome: a case-control study. Arch Toxicol 2022; 96:2785-2797. [PMID: 35763063 PMCID: PMC9352743 DOI: 10.1007/s00204-022-03326-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/01/2022] [Indexed: 01/23/2023]
Abstract
Occupational exposure to trichloroethylene (TCE) causes a systemic skin disorder with hepatitis known as TCE hypersensitivity syndrome (TCE-HS). Human Leukocyte Antigen (HLA)-B*13:01 is its susceptibility factor; however, the immunological pathogenesis of TCE-HS remains unknown. We herein examined the hypothesis that autoantibodies to CYP2E1 are primarily involved in TCE-HS. A case–control study of 80 TCE-HS patients, 186 TCE-tolerant controls (TCE-TC), and 71 TCE-nonexposed controls (TCE-nonEC) was conducted to measure their serum anti-CYP2E1 antibody (IgG) levels. The effects of TCE exposure indices, such as 8-h time-weighted-average (TWA) airborne concentrations, urinary metabolite concentrations, and TCE usage duration; sex; smoking and drinking habits; and alanine aminotransferase (ALT) levels on the antibody levels were also analyzed in the two control groups. There were significant differences in anti-CYP2E1 antibody levels among the three groups: TCE-TC > TCE-HS patients > TCE-nonEC. Antibody levels were not different between HLA-B*13:01 carriers and noncarriers in TCE-HS patients and TCE-TC. The serum CYP2E1 measurement suggested increased immunocomplex levels only in patients with TCE-HS. Multiple regression analysis for the two control groups showed that the antibody levels were significantly higher by the TCE exposure. Women had higher antibody levels than men; however, smoking, drinking, and ALT levels did not affect the anti-CYP2E1 antibody levels. Anti-CYP2E1 antibodies were elevated at concentrations lower than the TWA concentration of 2.5 ppm for TCE exposure. Since HLA-B*13:01 polymorphism was not involved in the autoantibody levels, the possible mechanism underlying the pathogenesis of TCE-HS is that TCE exposure induces anti-CYP2E1 autoantibody production, and HLA-B*13:01 is involved in the development of TCE-HS.
Collapse
Affiliation(s)
- Tamie Nakajima
- Research Institute of Life and Health Sciences, Chubu University, Kasugai, Aichi, 487-8501, Japan.
| | - Hailan Wang
- Laboratory of Key Technology Research, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Yuan Yuan
- Research Institute of Life and Health Sciences, Chubu University, Kasugai, Aichi, 487-8501, Japan
| | - Yuki Ito
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hisao Naito
- College of Human Life and Environment, Kinjo Gakuin University, Nagoya, Aichi, Japan
| | - Yoshiyuki Kawamoto
- College of Life and Health Sciences, Chubu University, Kasugai, Aichi, Japan
| | - Kozue Takeda
- College of Life and Health Sciences, Chubu University, Kasugai, Aichi, Japan
| | - Kiyoshi Sakai
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Na Zhao
- Laboratory of Key Technology Research, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Hongling Li
- Laboratory of Key Technology Research, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Xinxiang Qiu
- Poison Control Center Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Lihua Xia
- Poison Control Center Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Jiabin Chen
- Poison Control Center Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Qifeng Wu
- Poison Control Center Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Laiyu Li
- Laboratory of Key Technology Research, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, People's Republic of China
| | - Hanlin Huang
- Guangdong Province Hospital for Women and Children Healthcare, Guangdong, People's Republic of China
| | - Yukie Yanagiba
- Division of Industrial Toxicology and Biological Monitoring, National Institute of Occupational Safety and Health, Kawasaki, Kanagawa, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michihiro Kamijima
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| |
Collapse
|
3
|
Ozawa S, Miura T, Terashima J, Habano W, Ishida S. Recent Progress in Prediction Systems for Drug-induced Liver Injury Using in vitro Cell Culture. Drug Metab Lett 2020; 14:25-40. [PMID: 33267768 DOI: 10.2174/1872312814666201202112610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/26/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In order to avoid drug-induced liver injury (DILI), in vitro assays, which enable the assessment of both metabolic activation and immune reaction processes that ultimately result in DILI, are needed. OBJECTIVE In this study, the recent progress in the application of in vitro assays using cell culture systems is reviewed for potential DILI-causing drugs/xenobiotics and a mechanistic study on DILI, as well as for the limitations of in vitro cell culture systems for DILI research. METHODS Information related to DILI was collected through a literature search of the PubMed database. RESULTS The initial biological event for the onset of DILI is the formation of cellular protein adducts after drugs have been metabolically activated by drug metabolizing enzymes. The damaged peptides derived from protein adducts lead to the activation of CD4+ helper T lymphocytes and recognition by CD8+ cytotoxic T lymphocytes, which destroy hepatocytes through immunological reactions. Because DILI is a major cause of drug attrition and drug withdrawal, numerous in vitro systems consisting of hepatocytes and immune/inflammatory cells, or spheroids of human primary hepatocytes containing non-parenchymal cells have been developed. These cellular-based systems have identified DILIinducing drugs with approximately 50% sensitivity and 90% specificity. CONCLUSION Different co-culture systems consisting of human hepatocyte-derived cells and other immune/inflammatory cells have enabled the identification of DILI-causing drugs and of the actual mechanisms of action.
Collapse
Affiliation(s)
- Shogo Ozawa
- Department of Clinical Pharmaceutical Sciences, Division of Pharmacodynamics and Molecular Genetics, School of Pharmacy, Iwate Medical University, Yahaba. Japan
| | - Toshitaka Miura
- Department of Clinical Pharmaceutical Sciences, Division of Pharmacodynamics and Molecular Genetics, School of Pharmacy, Iwate Medical University, Yahaba. Japan
| | - Jun Terashima
- Department of Clinical Pharmaceutical Sciences, Division of Pharmacodynamics and Molecular Genetics, School of Pharmacy, Iwate Medical University, Yahaba. Japan
| | - Wataru Habano
- Department of Clinical Pharmaceutical Sciences, Division of Pharmacodynamics and Molecular Genetics, School of Pharmacy, Iwate Medical University, Yahaba. Japan
| | - Seiichi Ishida
- Department of Pharmacology, National Institute of Health Sciences, Kawasaki. Japan
| |
Collapse
|
4
|
Bessone F, Dirchwolf M, Rodil MA, Razori MV, Roma MG. Review article: drug-induced liver injury in the context of nonalcoholic fatty liver disease - a physiopathological and clinical integrated view. Aliment Pharmacol Ther 2018; 48:892-913. [PMID: 30194708 DOI: 10.1111/apt.14952] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/25/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nonalcoholic fatty disease (NAFLD) is the most common liver disease, since it is strongly associated with obesity and metabolic syndrome pandemics. NAFLD may affect drug disposal and has common pathophysiological mechanisms with drug-induced liver injury (DILI); this may predispose to hepatoxicity induced by certain drugs that share these pathophysiological mechanisms. In addition, drugs may trigger fatty liver and inflammation per se by mimicking NAFLD pathophysiological mechanisms. AIMS To provide a comprehensive update on (a) potential mechanisms whereby certain drugs can be more hepatotoxic in NAFLD patients, (b) the steatogenic effects of drugs, and (c) the mechanism involved in drug-induced steatohepatitis (DISH). METHODS A language- and date-unrestricted Medline literature search was conducted to identify pertinent basic and clinical studies on the topic. RESULTS Drugs can induce macrovesicular steatosis by mimicking NAFLD pathogenic factors, including insulin resistance and imbalance between fat gain and loss. Other forms of hepatic fat accumulation exist, such as microvesicular steatosis and phospholipidosis, and are mostly associated with acute mitochondrial dysfunction and defective lipophagy, respectively. Drug-induced mitochondrial dysfunction is also commonly involved in DISH. Patients with pre-existing NAFLD may be at higher risk of DILI induced by certain drugs, and polypharmacy in obese individuals to treat their comorbidities may be a contributing factor. CONCLUSIONS The relationship between DILI and NAFLD may be reciprocal: drugs can cause NAFLD by acting as steatogenic factors, and pre-existing NAFLD could be a predisposing condition for certain drugs to cause DILI. Polypharmacy associated with obesity might potentiate the association between this condition and DILI.
Collapse
Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, Facultad de Ciencias Médicas, Servicio de Gastroenterología y Hepatología, Universidad Nacional de Rosario, Rosario, Argentina
| | - Melisa Dirchwolf
- Unidad de Transplante Hepático, Servicio de Hepatología, Hospital Privado de Rosario, Rosario, Argentina
| | - María Agustina Rodil
- Hospital Provincial del Centenario, Facultad de Ciencias Médicas, Servicio de Gastroenterología y Hepatología, Universidad Nacional de Rosario, Rosario, Argentina
| | - María Valeria Razori
- Instituto de Fisiología Experimental (IFISE-CONICET), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Marcelo G Roma
- Instituto de Fisiología Experimental (IFISE-CONICET), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| |
Collapse
|
5
|
Dundee JW, McIlroy PD, Fee JP, Black GW. Prospective Study of Liver Function following Repeat Halothane and Enflurane. J R Soc Med 2018; 74:286-9. [PMID: 6112275 PMCID: PMC1438394 DOI: 10.1177/014107688107400410] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a prospective study of liver function following repeat anaesthesia, patients who received repeat halothane had a higher frequency of abnormal liver enzyme results than a similar group who received repeat enflurane. Obesity and short intervals between administrations increased the likelihood of abnormal liver enzyme activity in the halothane group. Enflurane would seem to be the volatile agent of choice for repeat anaesthesia in such circumstances.
Collapse
|
6
|
|
7
|
|
8
|
Abstract
Patients with chronic liver disease face greater risk of perioperative morbidity and mortality, with the greatest risk among patients with cirrhosis. Both the Child-Pugh score and the Model for End-Stage Liver Disease have been evaluated as predictors of postoperative mortality. Other comorbidities, age, and American Society of Anesthesiologists physical status classification are also important predictors of these outcomes. In patients with liver disease, elective surgeries should be delayed to allow complete evaluation of the severity of liver disease, including the role of transplantation in the event of hepatic decompensation postoperatively.
Collapse
Affiliation(s)
- Andrew J Muir
- Division of Gastroenterology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA.
| |
Collapse
|
9
|
Begriche K, Massart J, Robin MA, Borgne-Sanchez A, Fromenty B. Drug-induced toxicity on mitochondria and lipid metabolism: mechanistic diversity and deleterious consequences for the liver. J Hepatol 2011; 54:773-94. [PMID: 21145849 DOI: 10.1016/j.jhep.2010.11.006] [Citation(s) in RCA: 365] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/05/2010] [Accepted: 11/09/2010] [Indexed: 02/08/2023]
Abstract
Numerous investigations have shown that mitochondrial dysfunction is a major mechanism of drug-induced liver injury, which involves the parent drug or a reactive metabolite generated through cytochromes P450. Depending of their nature and their severity, the mitochondrial alterations are able to induce mild to fulminant hepatic cytolysis and steatosis (lipid accumulation), which can have different clinical and pathological features. Microvesicular steatosis, a potentially severe liver lesion usually associated with liver failure and profound hypoglycemia, is due to a major inhibition of mitochondrial fatty acid oxidation (FAO). Macrovacuolar steatosis, a relatively benign liver lesion in the short term, can be induced not only by a moderate reduction of mitochondrial FAO but also by an increased hepatic de novo lipid synthesis and a decreased secretion of VLDL-associated triglycerides. Moreover, recent investigations suggest that some drugs could favor lipid deposition in the liver through primary alterations of white adipose tissue (WAT) homeostasis. If the treatment is not interrupted, steatosis can evolve toward steatohepatitis, which is characterized not only by lipid accumulation but also by necroinflammation and fibrosis. Although the mechanisms involved in this aggravation are not fully characterized, it appears that overproduction of reactive oxygen species by the damaged mitochondria could play a salient role. Numerous factors could favor drug-induced mitochondrial and metabolic toxicity, such as the structure of the parent molecule, genetic predispositions (in particular those involving mitochondrial enzymes), alcohol intoxication, hepatitis virus C infection, and obesity. In obese and diabetic patients, some drugs may induce acute liver injury more frequently while others may worsen the pre-existent steatosis (or steatohepatitis).
Collapse
Affiliation(s)
- Karima Begriche
- Department of Metabolism and Aging, The Scripps Research Institute, Jupiter, FL 33458, USA
| | | | | | | | | |
Collapse
|
10
|
Aronsohn A, Jensen D. Hepatobiliary manifestations of critically ill and postoperative patients. Clin Liver Dis 2011; 15:183-97. [PMID: 21112000 DOI: 10.1016/j.cld.2010.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Liver dysfunction is common in both the critically ill and postoperative patient. Metabolic derangements secondary to sepsis, poor hepatic perfusion, total parenteral nutrition, in addition to hemodynamic and anesthetic-induced changes that occur during surgery, can cause liver damage ranging from small self-limited abnormalities in liver chemistries to acute liver failure. Early recognition, supportive care, and effective treatment of the underlying disease process are crucial steps in managing liver disease in a critically ill patient.
Collapse
Affiliation(s)
- Andrew Aronsohn
- Center for Liver Disease, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 7120, Chicago, IL 60637, USA
| | | |
Collapse
|
11
|
Habibollahi P, Mahboobi N, Esmaeili S, Safari S, Dabbagh A, Alavian SM. Halothane-induced hepatitis: A forgotten issue in developing countries: Halothane-induced hepatitis. HEPATITIS MONTHLY 2011; 11:3-6. [PMID: 22087107 PMCID: PMC3206652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/01/2010] [Accepted: 08/11/2010] [Indexed: 11/25/2022]
Abstract
Halothane was introduced as an anesthetic in the 1950s and was considered a revolutionary agent in the field of anesthesia. Soon after, halothane-induced hepatitis became a concern, leading to the development of less toxic gases that induced a lower incidence of side effects. Two types of halothane-related hepatotoxicity have been described: type 1, or mild hepatitis, is associated with elevated transaminase levels and self-limiting symptoms, and type 2, or severe hepatotoxicity, is associated with acute fatal liver failure and is fatal in most cases. Hepatotoxicity is most likely to be immune-related, based on much evidence. Free radicals that are produced by the metabolism of halothane in the liver can modify cellular proteins and introduce neo-antigens to the immune system. Sensitization to these neo-antigens induces a more severe response after multiple exposures; most cases of type 2 hepatitis occur after repeated contact. New halogenated anesthetics such as enflurane, sevoflurane, and desflurane, are not metabolized in the liver, causing few cases of sensitization. Compared with halothane, these anesthetics are expensive. As a result, replacement of halothane with new halogenated anesthetics requires a precise cost-benefit analysis, especially in developing countries that have low health care budgets.
Collapse
Affiliation(s)
- Peiman Habibollahi
- Department of Gastroenterology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nastaran Mahboobi
- Department of Gastroenterology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Sara Esmaeili
- School of Medicine, School of Public Health, Tehran university of Medical sciences, Tehran, IR Iran
| | - Saeid Safari
- Department of Anesthesiology, Tehran University of Medical sciences, Tehran, IR Iran
| | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences and Tehran Hepatitis Center, Tehran, IR Iran,* Corresponding author at: Seyed Moayed Alavian, Baghiyatallah Research Center for Gastroenterology and Liver Diseases, Baghiyatallah University of Medical Sciences & Tehran Hepatitis Center, Tehran, IR Iran. Tel.: +98-81262072, Fax: +98-81262072, E-mail:
| |
Collapse
|
12
|
You Q, Cheng L, Ju C. Generation of T cell responses targeting the reactive metabolite of halothane in mice. Toxicol Lett 2010; 194:79-85. [PMID: 20156533 DOI: 10.1016/j.toxlet.2010.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 02/04/2010] [Accepted: 02/05/2010] [Indexed: 01/05/2023]
Abstract
Immune-mediated adverse drug reactions (IADRs) represent a significant problem in clinical practice and drug development. Studies of the underlying mechanisms of IADRs have been hampered by the lack of animal models. Halothane causes severe allergic hepatitis with clinical features consistent with an IADR. Our ultimate goal is to develop a mouse model of halothane hepatitis. Evidence suggests that adaptive immune responses targeting liver protein adducts of the reactive metabolite (trifluoroacetyl (TFA)) play an important role in the pathogenesis. The present study demonstrated that the combination of an anti-CD40 antibody (Ab) and a Toll-like receptor (TLR) agonist served as a potent adjuvant in generating TFA-specific T cell responses in mice. Both CD4(+) and CD8(+) subsets of T cells were activated and the TFA-specific responses were detected not only in the spleen but also in the liver of mice immunized with mouse serum albumin adducts of TFA (TFA-MSA) plus the combined CD40/TLR agonist. Whereas all three TLR agonists examined were effective in eliciting TFA-specific immune responses in BALB/cByJ mice, only polyI:C was effective in DBA/1 mice and none of the TLR agonists could aid the generation of TFA-specific T cells in C57BL/6J mice. This result, combined with our previous finding that BALB/cByJ mice were the most susceptible to halothane-induced acute liver injury, provides the basis for employing this strain in future studies. Collectively, our data demonstrated the successful completion of a crucial first step in the development of a murine model of halothane hepatitis.
Collapse
Affiliation(s)
- Qiang You
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Colorado Denver, Aurora, CO 80045, United States.
| | | | | |
Collapse
|
13
|
Dugan CM, MacDonald AE, Roth RA, Ganey PE. A mouse model of severe halothane hepatitis based on human risk factors. J Pharmacol Exp Ther 2010; 333:364-72. [PMID: 20124411 DOI: 10.1124/jpet.109.164541] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Halothane (2-bromo-2-chloro-1,1,1-trifluoro-ethane) is an inhaled anesthetic that induces severe, idiosyncratic liver injury, i.e., "halothane hepatitis," in approximately 1 in 20,000 human patients. We used known human risk factors (female sex, adult age, and genetics) as well as probable risk factors (fasting and inflammatory stress) to develop a murine model with characteristics of human halothane hepatitis. Female and male BALB/cJ mice treated with halothane developed dose-dependent liver injury within 24 h; however, the liver injury was severe only in females. Livers had extensive centrilobular necrosis, inflammatory cell infiltrate, and steatosis. Fasting rendered mice more sensitive to halothane hepatotoxicity, and 8-week-old female mice were more sensitive than males of the same age or than younger (4-week-old) females. C57BL/6 mice were insensitive to halothane, suggesting a strong genetic predisposition. In halothane-treated females, plasma concentration of tumor necrosis factor-alpha was greater than in males, and neutrophils were recruited to liver more rapidly and to a greater extent. Anti-CD18 serum attenuated halothane-induced liver injury in female mice, suggesting that neutrophil migration, activation, or both are required for injury. Coexposure of halothane-treated male mice to lipopolysaccharide to induce modest inflammatory stress converted their mild hepatotoxic response to a pronounced, female-like response. This is the first animal model of an idiosyncratic adverse drug reaction that is based on human risk factors and produces reproducible, severe hepatitis from halothane exposure with lesions characteristic of human halothane hepatitis. Moreover, these results suggest that a more robust innate immune response underlies the predisposition of female mice to halothane hepatitis.
Collapse
Affiliation(s)
- Christine M Dugan
- Cellular and Molecular Biology Program, Michigan State University, East Lansing, Michigan 48824, USA
| | | | | | | |
Collapse
|
14
|
Uetrecht J. Evaluation of Which Reactive Metabolite, If Any, Is Responsible for a Specific Idiosyncratic Reaction. Drug Metab Rev 2008; 38:745-53. [PMID: 17145699 DOI: 10.1080/03602530600959615] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reactive metabolites are believed to be responsible for most idiosyncratic drug reactions. It is often assumed that if a reactive metabolite is found, it must be responsible for the idiosyncratic reactions associated with that drug. However, the evidence linking reactive metabolites and idiosyncratic reactions is circumstantial at best, and in many cases we have virtually no evidence. Furthermore, it is common for a drug to form several reactive metabolites, so it can be difficult to determine which, if any, is responsible for a given idiosyncratic reaction. Although the reactive metabolite hypothesis is logical, it has important implications for drug development, and we need to develop ways to test the hypothesis for specific drugs rigorously. Valid animal models are a powerful tool for testing whether a specific reactive metabolite is responsible for a specific adverse reaction and for studying further the mechanism by which it may induce such reactions; however, such models are rare.
Collapse
Affiliation(s)
- Jack Uetrecht
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
| |
Collapse
|
15
|
Eghtesadi-Araghi P, Sohrabpour AA, Vahedi H, Saberi-Firoozi M. Halothane hepatitis in Iran: A review of 59 cases. World J Gastroenterol 2008; 14:5322-6. [PMID: 18785286 PMCID: PMC2744064 DOI: 10.3748/wjg.14.5322] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study halothane hepatitis (HH) in Iran and its associated risk factors.
METHODS: We retrospectively studied files of all cases diagnosed with HH referred to three referral hospitals and four private centers in Iran from April 1994 to September 2006. Information on age at surgery, gender, medications history, obesity, history of previous exposure, previous reaction to halothane, familial history, type of surgery, perioperative hypoxia or sepsis, morbidity and mortality were recorded and analyzed.
RESULTS: A total of 59 cases were identified. Forty-eight (81%) were women. The median age at the time of surgery was 44 years (range, 18 to 80 years). Sixty percent of patients were above 40-year-old. Obesity was observed in 22.2%. Previous history of exposures to halothane was noted in 61% of which 50% had history of post-exposure reaction. Coronary artery bypass graft (CABG), cholecystectomy, and cosmetic surgeries (mainly weight reduction) were the most frequent surgeries. The mortality rate was 12.2%. In patients developing encephalopathy, it was as high as 50%.
CONCLUSION: HH remains an important cause of morbidity and mortality in centers still using this anesthetic. However, a large percentage of these cases could have been avoided. To lessen occurrence of further cases of HH, the authors suggest that in female patients having a history of surgery (or delivery) with general anesthesia, the use of halothane should be absolutely avoided. Utilization of proper substitutes in adults’ anesthesia is advocated.
Collapse
|
16
|
Hoteit MA, Ghazale AH, Bain AJ, Rosenberg ES, Easley KA, Anania FA, Rutherford RE. Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis. World J Gastroenterol 2008; 14:1774-80. [PMID: 18350609 PMCID: PMC2695918 DOI: 10.3748/wjg.14.1774] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome.
METHODS: We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint.
RESULTS: Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 ± 3.9 vs 12.6 ± 4.7, P = 0.9) or in the mean CTP (7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP: 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3).
CONCLUSION: The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.
Collapse
|
17
|
Abstract
Clinical characteristics and circumstantial evidence suggest that idiosyncratic drug reactions are caused by reactive metabolites and are immune-mediated; however, there are few definitive data and there are likely exceptions. There are three principal hypotheses for how reactive metabolites might induce an immune-mediated idiosyncratic reaction: the hapten hypothesis, the danger hypothesis, and the PI hypothesis. It has been proposed that some idiosyncratic reactions, especially those involving the liver, represent metabolic idiosyncrasy; however, there are even less data to support this hypothesis. The unpredictable nature of these reactions makes mechanistic studies difficult. There is a very strong association with specific human leukocyte antigen (HLA) genes for certain reactions, but this has only been demonstrated for very few drugs. Animal models represent a very powerful tool for mechanistic studies, but the number of valid models is also limited. There may be biomarkers of risk; however, much more work needs to be done.
Collapse
Affiliation(s)
- Jack Uetrecht
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S 2S2, Canada.
| |
Collapse
|
18
|
Uetrecht J. Role of drug metabolism for breaking tolerance and the localization of drug hypersensitivity. Toxicology 2005; 209:113-8. [PMID: 15767022 DOI: 10.1016/j.tox.2004.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are three major working hypotheses for the mechanism of drug hypersensitivity reactions: the hapten hypotheses, the danger hypothesis and the PI hypothesis. These hypotheses are difficult to test because of the idiosyncratic nature of hypersensitivity reactions. There is evidence that reactive metabolites are involved in many hypersensitivity reactions, and the reactive metabolite is often formed in the target organ of toxicity, presumably because the half-life of most reactive metabolites is too short to allow them to reach distant sites. In the case of less reactive species that freely circulate the pattern of hypersensitivity usually fits that expected of an extracellular antigen, specifically, an antibody-mediated reaction. We have used two animal models: penicillamine-induced autoimmunity and nevirapine-induced skin rash in Brown Norway rats to test hypotheses. We have found that tolerance is readily induced with a lower dose of the drug, although the nature of tolerance is different in the two models. In the penicillamine model, tolerance is immune-mediated and can be overcome by agents that act as a danger signal. Reactive metabolites may also act as a danger signal. The models can also be used to test the role of reactive species in the mechanism of hypersensitivity reactions.
Collapse
Affiliation(s)
- Jack Uetrecht
- University of Toronto, Faculty of Pharmacy, 19 Russell St., Toronto, Canada M5S 2S2.
| |
Collapse
|
19
|
Abstract
Idiosyncratic drug reactions represent a major problem. In most cases the mechanisms of these reactions are unknown, but circumstantial evidence points to the involvement of reactive metabolites and the characteristics of the reactions suggest involvement of the immune system. If progress is to be made in dealing with these adverse reactions it is essential that we have a better understanding of their mechanisms, and it is hard to imagine testing mechanistic hypotheses without good animal models. Unfortunately, idiosyncratic reactions are also idiosyncratic in animals so few good models exist. The best models, in which a rodent develops a clinical syndrome similar to that which occurs in humans, appear to be penicillamine-induced autoimmunity in Brown Norway rats and nevirapine-induced skin rash in rats. Sulfamethoxazole-induced hypersensitivity in dogs and propylthiouracil-induced autoimmunity in cats are also similar to adverse reactions that occur in people, but they have practical limitations. Halothane-induced liver toxicity in guinea pigs and amodiaquine-induced bone marrow and liver toxicity in rats represent models in which there is an immune response and mild, reversible toxicity. It is possible that the development of immune tolerance is what limits the toxicity in these models, and if this is true, interventions that prevent tolerance might lead to good models. Although the history of developing animal models of idiosyncratic drug reactions is mostly one of failure, such models are essential. A better understanding of immune tolerance may greatly facilitate the development of better models; transgenic technology may also provide an important tool.
Collapse
Affiliation(s)
- Jacintha M Shenton
- Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, Ont., Canada M5S 2S2
| | | | | |
Collapse
|
20
|
La Scala GC, Rice SB, Clarke HM. Complications of microsurgical reconstruction of obstetrical brachial plexus palsy. Plast Reconstr Surg 2003; 111:1383-8; discussion 1389-90. [PMID: 12618596 DOI: 10.1097/01.prs.0000049110.65510.10] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The charts of the 173 consecutive patients who underwent microsurgical reconstruction for obstetrical brachial plexus palsy from 1988 to 1999 (inclusive) in the Division of Plastic Surgery at the Hospital for Sick Children were analyzed. The overall complication rate was 33.5 percent, and there was no mortality in this series. The most significant intraoperative complication was accidental extubation, which occurred five times in the first 84 patients (6 percent of this early group; 2.9 percent of the whole series). This complication was addressed by suturing the endotracheal tube to the membranous septum and by using a transparent drape to allow direct visualization of the tube in all 89 subsequent patients. There have been no further accidental extubations. Postoperative fluid overload occurred in 14 patients (8.1 percent), three (1.7 percent) of whom developed pulmonary edema. Intensive care unit admission was required in two of those patients. Diuretic treatment was required in seven patients. No patient receiving less than or equal to 4 ml/kg/hour developed fluid overload, whereas 50 percent of the patients receiving greater than or equal to 10 ml/kg/hour did. Currently, the authors' policy is to strictly limit intravenous maintenance fluids to 4 ml/kg/hour or less. Despite the long and complex procedure required to reconstruct obstetrical brachial plexus palsy, the incidence of significant complications can be minimized with simple precautions, such as suturing the endotracheal tube to the septum or reducing the amount of fluids administered during the operation.
Collapse
Affiliation(s)
- Giorgio C La Scala
- Division of Plastic Surgery, The Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
21
|
Daggan RN, Zafeiridis A, Dipla K, Puglia CD, Gratz I, Catalano E, Kendrick ZV. The effects of chronic exercise on anesthesia induced hepatotoxicity. Med Sci Sports Exerc 2000; 32:2024-8. [PMID: 11128846 DOI: 10.1097/00005768-200012000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED A hypoxic rat model of halothane-induced hepatotoxicity, which is known to produce liver damage, was used to determine the effects of chronic exercise on halothane-induced hepatotoxicity and on reduced hepatic glutathione (GSH) levels. Metabolism of volatile anesthetics may generate metabolites that can cause mild and transient hepatotoxicity. METHODS Six male Sprague-Dawley rats completed a 10-wk (5 d x wk(-1)) treadmill running protocol. Twelve age-matched animals were used as sedentary controls. After the completion of exercise training, rats were exposed for 2 h to 1% halothane in 14% O2. Twenty-four hours later, animals were anesthetized with sodium pentobarbital and sacrificed. Livers were excised, stained, and evaluated for hepatotoxicity using a histopathological 0 (normal) to 5 (severe damage) point categorical scale and for the determination of GSH levels. RESULTS Median histopathologic scores revealed significantly lower indications of hepatotoxicity in exercise animals as compared with control animals (score = 0.25 vs 1.50; P < 0.05). Liver damages scores between 1 and 5 were observed in 75% (9 of 12) of the control animals, whereas only 1 of 6 exercise animals had a score greater than 1 (P < 0.05). No significant difference was observed in reduced GSH levels. CONCLUSIONS Chronic exercise improves the detoxicant ability of the liver for halothane anesthesia as noted by the ameliorated liver damage and reduced incidence of halothane-induced hepatotoxicity in the exercise animals.
Collapse
Affiliation(s)
- R N Daggan
- Department of Anesthesiology and Department of Pathology, Cooper Hospital/UMC, Camden, NJ 08103, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Postoperative jaundice is often multifactorial (Fig. 2). A precipitating or causative factor may be identified but seldom can a specific therapy be offered. A systematic approach will help eliminate a hepatotoxic drug or identify a biliary tract problem. Treatment involves discontinuation of an offending drug; however, the drug, such as an anesthetic agent, may not be in use when the jaundice is detected. Recognition of an anesthetic-induced injury would certainly warn the physician not to repeat its use in future surgery for that patient. Hyperalimentation may contribute to jaundice, but patients developing postoperative jaundice are generally very ill and require nutrition. Extrahepatic biliary tract disease should be readily recognized and treated. The physician should be alert to the possibility of acalculous cholecystitis so that it can be appropriately diagnosed and treated.
Collapse
Affiliation(s)
- E G Molina
- Center for Liver Diseases, University of Miami School of Medicine, Miami, Florida, USA
| | | |
Collapse
|
23
|
Eliasson E, Gardner I, Hume-Smith H, de Waziers I, Beaune P, Kenna JG. Interindividual variability in P450-dependent generation of neoantigens in halothane hepatitis. Chem Biol Interact 1998; 116:123-41. [PMID: 9877205 DOI: 10.1016/s0009-2797(98)00081-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Halothane hepatitis occurs because susceptible patients mount immune responses to trifluoroacetylated protein antigens, formed following cytochrome P450-mediated bioactivation of halothane to trifluoroacetyl chloride. In the present study, an in vitro approach has been used to investigate the cytochrome P450 isozyme(s) which catalyze neoantigen formation and to explore the protective role of non-protein thiols (cysteine and reduced glutathione). Significant levels of trifluoroacetyl protein antigens were generated when human liver microsomes, and also microsomes from livers of rats pre-treated with isoniazid, phenobarbital or beta-naphtoflavone, were incubated with halothane plus a nicotinamide adenine dinucleotidephosphate (NADPH) generating system. Immunoblotting studies revealed that the major trifluoroacetyl antigens expressed in vitro exhibited molecular masses of 50-55 kDa and included 60 and 80 kDa neoantigens recognized by antibodies from patients with halothane hepatitis. Much lower concentrations of halothane were required to produce maximal antigen generation in isoniazid-induced rat microsomes, as compared with phenobarbital or isosafrole-induced microsomes (0.5 vs 12.5 microl/ml). In isoniazid-induced microsomes, antigen generation was inhibited > 90% by the nucleophiles cysteine and glutathione and by the CYP2E1-selective inhibitors diallylsulfide and p-nitrophenol, but was unaffected by inhibitors of other P450 isozymes (furafylline, sulfaphenazole or triacetyloleandomycin). Neoantigen formation in six human liver microsomal preparations was inhibited in the presence of diallylsulfide, but not by furafylline, sulfaphenazole or triacetyloleandomycin, and exhibited marked variability which correlated with CYP2E1 levels. These results suggest that the balance between metabolic bioactivation by CYP2E1 and detoxication of reactive metabolites by cellular nucleophiles could be an important metabolic risk factor in halothane hepatitis.
Collapse
Affiliation(s)
- E Eliasson
- Department of Molecular Toxicology, Imperial College School of Medicine at St Mary's, London, UK.
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
Improved understanding of the structure/activity relationship of inhaled anaesthetics has resulted in the synthesis of fluorinated compounds which are more potent and less toxic than their unfluorinated antecedents. The toxic effects of inhaled anaesthetics on the liver and kidney are complex but, in general, are related to the extent to which individual inhaled agents are metabolised. Halothane hepatotoxicity is a rare, idiosyncratic reaction which typically occurs in obese women having more than one exposure to the drug within a short time interval. All currently available volatile anaesthetic drugs have depressant effects on the cardiovascular and respiratory systems; arrhythmias are more likely with halothane than with the fluorinated ethers. Cerebral blood flow tends to increase during inhalation anaesthesia, especially with halothane and in the presence of hypercarbia; isoflurane may be given sparingly during neurosurgical procedures whilst monitoring its end-tidal concentration. Although the volatile agents tend to cause uterine relaxation they may be given safely in low concentration to avoid awareness during Caesarean section. In general, young children require rather higher concentrations of volatile agents than adults and seem to be less susceptible to organ toxicity. Two relatively new volatile agents, sevoflurane and desflurane, offer some advantages over isoflurane but neither is an "ideal drug'. Sevoflurane interacts with soda-lime to produce a series of degradation products, the most important of which is compound A. Production is greatest during low-flow, closed circuit anaesthesia using high inspired concentrations of the drug. Compound A has nephrotoxic potential in rats but the clinical significance of the interaction between sevoflurane and soda-lime is unclear. Nitrous oxide when given for prolonged periods may cause irreversible bone marrow depression.
Collapse
Affiliation(s)
- J P Fee
- Queen's University of Belfast, Northern Ireland
| | | |
Collapse
|
25
|
Affiliation(s)
- J G Kenna
- Imperial College School of Medicine at St Mary's, London, UK.
| |
Collapse
|
26
|
Obermayer-Straub P, Manns MP. Cytochromes P450 and UDP-glucuronosyl-transferases as hepatocellular autoantigens. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1996; 10:501-32. [PMID: 8905121 DOI: 10.1016/s0950-3528(96)90055-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Autoantibodies directed against cytochromes P450 or UDP-glucuronosyl-transferases (UGTs) are detected in hepatitis of different aetiology: drug-induced hepatitis autoimmune hepatitis type 2, hepatitis associated with the autoimmune polyglandular syndrome type 1 (APS1) and virus-induced autoimmunity. Autoantibodies directed against cytochrome P450 2C9 are induced by tienilic acid, and anti-P450 1A2 autoantibodies by dihydralazine. Potential mechanisms involved may be metabolic activation of the drugs by cytochromes P450, adduct formation and circumvention of T cell tolerance. In contrast, little is known about the aetiology of autoimmune hepatitis type 2. This disease is characterized by marked female predominance, hypergammaglobulinaemia, circulating autoantibodies and benefit from immunosuppression. Patients with HLA B8, DR3 or DR4 are over-represented. The major target of autoimmunity in this disease is cytochrome P450 2D6. The autoantibodies were shown to be directed against at four short linear epitopes. In addition, about 10% of the patient sera form an additional autoantibody that detects a conformational epitope on UGTs of family 1. The phenomenon of virus-associated autoimmunity is found in chronic infections with hepatitis C and D. In chronic hepatitis C the major target of the autoantibodies again is cytochrome P450 2D6. Some linear and a high proportion of conformational epitopes are recognized. The LKM3 autoantibody is found in 13% of patients with chronic hepatitis D. The target proteins are UGTs of family 1 and, in some sera also, low titres of anto-antibodies directed against UGTs of family 2 are found. The epitopes detected are conformational. In contrast to the patients suffering from autoimmune hepatitis, patients with hepatitis as part of the autoimmune polyglandular syndrome type 1 recognize cytochrome P450 1A2. Interestingly, in APS1 patients also, autoantibodies directed against cytochromes P450 c21, P450 scc and P450 c17a may be detected; these autoantibodies are associated with adrenal and ovarian failure.
Collapse
Affiliation(s)
- P Obermayer-Straub
- Division of Gastroenterology and Hepatology, Medical School of Hannover, Germany
| | | |
Collapse
|
27
|
Affiliation(s)
- B Oberg
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | | |
Collapse
|
28
|
Affiliation(s)
- J G Kenna
- Department of Pharmacology and Toxicology, St. Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | | |
Collapse
|
29
|
Martin JL, Meinwald J, Radford P, Liu Z, Graf ML, Pohl LR. Stereoselective metabolism of halothane enantiomers to trifluoroacetylated liver proteins. Drug Metab Rev 1995; 27:179-89. [PMID: 7641575 DOI: 10.3109/03602539509029822] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J L Martin
- Laboratory of Chemical Pharmacology, NHLBI, NIH, Bethesda, Maryland 20892, USA
| | | | | | | | | | | |
Collapse
|
30
|
Effects of saikosaponins on hepatic damage induced by halothane and hypoxia in phenobarbital-pretreated rats. J Anesth 1994; 8:87-92. [DOI: 10.1007/bf02482762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/1992] [Accepted: 05/18/1993] [Indexed: 10/24/2022]
|
31
|
Beaune P, Pessayre D, Dansette P, Mansuy D, Manns M. Autoantibodies against cytochromes P450: role in human diseases. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 1994; 30:199-245. [PMID: 7833293 DOI: 10.1016/s1054-3589(08)60175-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P Beaune
- INSERM U75, Université René Descartes, Paris, France
| | | | | | | | | |
Collapse
|
32
|
Kenna JG, Knight TL, van Pelt FN. Immunity to halothane metabolite-modified proteins in halothane hepatitis. Ann N Y Acad Sci 1993; 685:646-61. [PMID: 8363272 DOI: 10.1111/j.1749-6632.1993.tb35930.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- J G Kenna
- Department of Pharmacology and Toxicology, St. Mary's Hospital Medical School (Imperial College), London, England
| | | | | |
Collapse
|
33
|
Heijink E, De Matteis F, Gibbs AH, Davies A, White IN. Metabolic activation of halothane to neoantigens in C57Bl/10 mice: immunochemical studies. Eur J Pharmacol 1993; 248:15-25. [PMID: 8339751 DOI: 10.1016/0926-6917(93)90020-q] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
C57Bl/10 mice were given halothane (10 mmol/kg, intraperitoneally) and microsomal proteins were analysed for the presence of trifluoroacetylated (TFA) neoantigens by SDS-gel electrophoresis followed by immunoblotting using a polyclonal anti-TFA antibody. In microsomal preparations from liver, lung and olfactory tissues, a 54 kDa TFA adduct was detectable 1 h after dosing. After 3-48 h, multiple bands were detected in liver (45-100 kDa) and in the lung (26-57 kDa) and in one experiment in which [14C]halothane was given, several immunoreactive bands from liver microsomes were shown to contain a covalently bound metabolite of the drug. In olfactory tissue, initially (1 h), a major band of 54 kDa and a less prominent component of about 50 kDa were seen. The number of bands increased at later times but the additional bands were far fewer than in liver. The rate of decay of the 54 kDa adduct was also measured in both liver and olfactory microsomes and found to be compatible with the reported turnover of total liver cytochrome P-450. 24 h after treating mice with halothane (10 mmol/kg), no TFA neoantigens could be detected on the outer cell surface of isolated viable hepatocytes when analysed by fluorescence activated flow cytometry. In contrast, non-viable cells, or those fixed in acetone were all positive. Using immunohistochemistry, TFA neoantigens were demonstrated in the centrilobular area of the liver, the non-ciliated bronchiolar epithelial (Clara) cells of the lung, proximal tubular cells of the kidney and the respiratory and olfactory epithelium of nasal tissues.
Collapse
Affiliation(s)
- E Heijink
- MRC Toxicology Unit, Carshalton, Surrey, UK
| | | | | | | | | |
Collapse
|
34
|
Abstract
This review deals with the adverse reactions associated with general anaesthetic agents in current use. These reactions fall into 2 categories; those which are more common, predictable and often closely related, and those which are rare, unpredictable and carry a high mortality. Both inhalational and intravenous anaesthetic agents affect the central nervous and cardio-respiratory systems in a dose-related manner. Neuronal inhibition results in decreasing levels of consciousness and depression of the medullary vital centres which can lead to cardiorespiratory failure. Both groups of agents have some depressant effect on the myocardium and vascular smooth muscle leading to a fall in cardiac output and hypotension. Centrally-mediated respiratory depression is common to both groups and the inhalational agents have a direct effect on lung physiology. The most important idiosyncratic reactions to the volatile agents are malignant hyperpyrexia and 'halothane hepatitis'. Malignant hyperpyrexia has an incidence of 1:12,000 with a mortality of about 24%. It is triggered most often by halothane together with suxamethonium. Post halothane hepatic necrosis is rare. Evidence points to 2 distinct syndromes; direct toxicity from the products of reductive metabolism, and a more serious illness, immunologically mediated via haptens formed by liver proteins and the products of oxidative metabolism. Prolonged nitrous oxide exposure can cause bone marrow depression and life-threatening pressure effects by expansion of air-filled spaces within the body. The idiosyncratic reactions to the intravenous agents include anaphylactoid reactions (which are rare) and triggering of acute porphyria. Etomidate is immunologically 'clean', but it inhibits cortisol synthesis.
Collapse
Affiliation(s)
- M C Berthoud
- Department of Anaesthesia, University of Sheffield, Medical School, England
| | | |
Collapse
|
35
|
Lunel F, Abuaf N, Frangeul L, Grippon P, Perrin M, Le Coz Y, Valla D, Borotto E, Yamamoto AM, Huraux JM. Liver/kidney microsome antibody type 1 and hepatitis C virus infection. Hepatology 1992; 16:630-6. [PMID: 1380479 DOI: 10.1002/hep.1840160304] [Citation(s) in RCA: 169] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Recent studies have shown that hepatitis C virus antibodies are present in a large proportion of patients with autoimmune hepatitis type 2. We have studied 83 patients with liver/kidney microsome antibody-positive type 1 hepatitis. Hepatitis C virus antibodies were sought in every case by second-generation tests (hepatitis C virus enzyme-linked immunosorbent assay and recombinant immunoblot assay). Hepatitis C virus RNA sequences were sought in 22 patients (12 with recombinant immunoblot assay-positive results and 10 with recombinant immunoblot assay-negative results) by means of polymerase chain reaction and by use of primers located in the 5' noncoding region. Sixty-four patients (77%) had positive results for hepatitis C virus antibodies in the enzyme-linked immunosorbent assay test, and 41 (49.3%) were confirmed by recombinant immunoblot assay. Hepatitis C virus RNA sequences were found in all the recombinant immunoblot assay-positive patients but in none of the 10 who were recombinant immunoblot assay-negative. The recombinant immunoblot assay-negative patients were younger than those who were positive (13 +/- 11 vs. 50 +/- 11 years) and had higher gamma-globulin levels and liver/kidney microsome antibody-positive type 1 titers (61% had a titer of 1:1,000 or more, vs. only 17% of the recombinant immunoblot assay-positive patients).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- F Lunel
- Service de Bactério-virologie, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Kenna JG, Martin JL, Pohl LR. The topography of trifluoroacetylated protein antigens in liver microsomal fractions from halothane treated rats. Biochem Pharmacol 1992; 44:621-9. [PMID: 1510711 DOI: 10.1016/0006-2952(92)90395-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sera from patients with halothane hepatitis contain immunoglobulin G (IgG) antibodies to trifluoroacetylated liver microsomal proteins of 100, 76, 59, 57 and 54 kDa, which are produced as a consequence of metabolism of halothane to trifluoroacetyl halide by cytochrome(s) P450. In the present study, the membrane topographies of the various antigens in rat liver microsomal fractions were investigated. Liver microsomal fractions from rats treated with halothane in vivo, and rat liver microsomal fractions which had been incubated with halothane in vitro, were used as the source of trifluoroacetyl antigens. The antigens were detected by immunoblotting. Whereas the 100, 76, 59 and 57 kDa antigens were solubilized from the microsomal membrane by either 0.1 M sodium carbonate or 0.1% (w/v) sodium deoxycholate, the 54 kDa antigen was not solubilized by 0.1% (w/v) sodium deoxycholate. In intact microsomal fractions, the 100, 76, 59 and 57 kDa antigens were not degraded appreciably by trypsin unless detergent was added to permeabilize the microsomal membrane. These results indicate that the 54 kDa antigen is an integral membrane protein, whereas the 100, 76, 59 and 57 kDa antigens are peripheral membrane proteins situated within the lumen of microsomal vesicles, and hence presumably located within the lumen of the endoplasmic reticulum in vivo.
Collapse
Affiliation(s)
- J G Kenna
- Department of Pharmacology and Toxicology, St Mary's Hospital Medical School (Imperial College), London, U.K
| | | | | |
Collapse
|
37
|
Affiliation(s)
- J M Tredger
- Institute of Liver Studies, King's College School of Medicine and Dentistry, London
| | | |
Collapse
|
38
|
Abstract
Exacerbation of pre-existing liver disease after halothane anaesthesia has been reported in adult patients. A prospective study was performed in 38 children with biopsy-proven liver disease to assess the effect of surgery and halothane anaesthesia on liver function. Plasma liver enzyme levels were measured immediately preoperatively and again four to eight days after surgery and halothane anaesthesia. Minor elevations of both AST and ALT occurred in four patients but this was not associated with a clinical deterioration in the patients' postoperative recovery. In the children studied pre-existing liver disease did not predispose to a deterioration of liver function following surgery and halothane anaesthesia.
Collapse
Affiliation(s)
- H Wark
- Department of Anaesthesia, Royal Alexandra Hospital for Children, Sydney, NSW, Australia
| | | | | | | |
Collapse
|
39
|
Bird GL, Williams R. Detection of antibodies to a halothane metabolite hapten in sera from patients with halothane-associated hepatitis. J Hepatol 1989; 9:366-73. [PMID: 2607125 DOI: 10.1016/0168-8278(89)90147-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sera from 40 patients with a clinical diagnosis of halothane-associated hepatitis were tested for the presence of antibodies to the trifluoroacetate (TFA) halothane metabolite hapten using an ELISA assay, with TFA-albumin as the antigen. Positive results were obtained in 30% of cases of which 3/4 with encephalopathy were positive and 9/36 non-fulminant cases were positive. Antibody specificity to the TFA hapten was confirmed in each positive result by a 'hapten inhibition' experiment in which TFA albumin binding was blocked by preincubation of serum with TFA-lysine. Most probably this assay detects a relatively low affinity cross-reaction with the TFA hapten of antibodies in the patients' sera which are directed against specific TFA-labelled liver proteins. Anti-TFA-albumin antibodies were not detected in 28 normal subjects, 5 subjects with fulminant hepatic failure secondary to other causes, 6 subjects with a history of 2 or more exposures to halothane but with no evidence of liver disease and 28 patients with a variety of chronic liver diseases. It is concluded that ELISA testing using trifluoroacetylated rabbit serum albumin (TFA-RSA) as antigen is a quick and convenient assay for the confirmation of halothane-associated hepatitis in fulminant hepatic failure secondary to halothane, but is less sensitive when the illness follows a milder course.
Collapse
Affiliation(s)
- G L Bird
- Liver Unit, King's College Hospital School of Medicine and Denistry, Denmark Hill, London, UK
| | | |
Collapse
|
40
|
Affiliation(s)
- D Rosenak
- Department of Surgery A, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | | | | |
Collapse
|
41
|
|
42
|
Cousins MJ, Plummer JL, Hall PD. Risk factors for halothane hepatitis. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1989; 59:5-14. [PMID: 2643940 DOI: 10.1111/j.1445-2197.1989.tb01457.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Helothane hepatitis is a rare but sometimes fatal complication of halothane anaesthesia. Examination of case reports has pointed to a number of risk factors. Studies in animals and humans in the laboratory have provided evidence of a complex multifactorial basis for halothane hepatotoxicity, with the following factors playing a part: genetic predisposition; metabolism of halothane; repeated halothane anaesthetics; female sex; age of patient; intrahepatic hypoxia; and enzyme induction. Immunologic changes can be detected in a high percentage of cases of halothane hepatitis; however, studies establishing a cause-effect relationship are not available to determine if these changes cause, or result from, hepatic damage.
Collapse
Affiliation(s)
- M J Cousins
- Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, South Australia
| | | | | |
Collapse
|
43
|
Salazar DE, Sorge CL, Corcoran GB. Obesity as a risk factor for drug-induced organ injury. VI. Increased hepatic P450 concentration and microsomal ethanol oxidizing activity in the obese overfed rat. Biochem Biophys Res Commun 1988; 157:315-20. [PMID: 3196341 DOI: 10.1016/s0006-291x(88)80049-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The obese overfed rat effectively models many of the pharmacological changes in human obesity. Recent data show that the obese rat is unusually susceptible to liver damage by several metabolically activated drugs that may be more toxic in obese humans. Results of the present study suggest a specific molecular locus for this interaction. In obese rats, P450 content of liver and the microsomal concentration of P450 were elevated 88% and 31%, respectively, over nonobese controls. Increases in microsomal ethanol oxidation were of identical magnitude. The ethanol-inducible form of P450 that is responsible for microsomal ethanol oxidation, P450IIE1, bioactivates several drugs that are shown to cause increased injury in obese rats. Collectively, these findings indicate that specific forms of P450 may become up-regulated in obesity, increasing the risk of a biochemically defined spectrum of drug-induced organ injuries.
Collapse
Affiliation(s)
- D E Salazar
- Department of Pharmaceutics, School of Pharmacy, State University of New York, Buffalo 14260
| | | | | |
Collapse
|
44
|
Kenna JG, Neuberger J, Williams R. Evidence for expression in human liver of halothane-induced neoantigens recognized by antibodies in sera from patients with halothane hepatitis. Hepatology 1988; 8:1635-41. [PMID: 3192177 DOI: 10.1002/hep.1840080627] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous investigations have shown that antibodies in sera from patients with halothane hepatitis recognize neoantigens, expressed in livers of halothane-exposed rabbits and rats, which consist of a halothane metabolite bound covalently to specific microsomal proteins. These studies have suggested that the patients' antibodies may play a role in the pathogenesis of the hepatitis. In the present investigation, human liver biopsy samples were analyzed using an immunoblotting method to seek evidence for expression of halothane-induced neoantigens in humans. Sera from four patients with halothane hepatitis, which recognized halothane-induced rabbit liver neoantigens of 100, 76 and 57 kD, reacted strongly with antigens of very similar molecular weights that were expressed in livers from two patients who had died of cardiac failure following recent anesthesia with halothane. The antigens were not expressed in normal human liver or in livers from three patients who died of cardiac failure following anesthesia with agents other than halothane. The human antigens were not recognized by antibodies present in various control sera. Recognition of the 100- and 76-kD human antigens by the patients' antibodies was greatly reduced by absorption of sera with liver microsomes from halothane-exposed rabbits, but not by absorption of sera with control rabbit microsomes. These results indicate that humans exposed to halothane express liver neoantigens which are analogous to the halothane metabolite-protein neoantigens characterized previously in halothane-exposed animals.
Collapse
Affiliation(s)
- J G Kenna
- Liver Unit, King's College Hospital and School of Medicine and Dentistry, London, United Kingdom
| | | | | |
Collapse
|
45
|
|
46
|
Blanc F, Monnin E, Brunin JL. [Drug-induced chronic active hepatitis]. Rev Med Interne 1987; 8:402-6. [PMID: 3423479 DOI: 10.1016/s0248-8663(87)80013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- F Blanc
- Service de médecine E. hôpital Saint-Eloi, Montpellier
| | | | | |
Collapse
|
47
|
Kenna JG, Neuberger J, Mieli-Vergani G, Mowat AP, Williams R. Halothane hepatitis in children. BRITISH MEDICAL JOURNAL 1987; 294:1209-11. [PMID: 3109584 PMCID: PMC1246366 DOI: 10.1136/bmj.294.6581.1209] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is often stated that halothane hepatitis in children is nonexistent or extremely rare. This syndrome occurred in seven children aged between 11 months and 15 years, one of whom, a 3 1/2 year old boy, died with fulminant hepatic failure. All the children had received multiple halothane anaesthetics (range 2-6, median 3). In all cases other causes of liver diseases were excluded, and in all but one the diagnosis was confirmed serologically by antibodies to halothane altered liver cell membrane antigens. These findings suggest that halothane hepatitis occurs in children, and the risk of halothane hepatitis should therefore be considered when choosing which agents to use in children who require multiple anaesthetics.
Collapse
|
48
|
Beaune P, Dansette PM, Mansuy D, Kiffel L, Finck M, Amar C, Leroux JP, Homberg JC. Human anti-endoplasmic reticulum autoantibodies appearing in a drug-induced hepatitis are directed against a human liver cytochrome P-450 that hydroxylates the drug. Proc Natl Acad Sci U S A 1987; 84:551-5. [PMID: 3540968 PMCID: PMC304247 DOI: 10.1073/pnas.84.2.551] [Citation(s) in RCA: 235] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
"Anti-liver/kidney microsome" (anti-LKM) autoantibodies have been found in the serum of patients with cryptogenic chronic hepatitis and with immunoallergic drug-induced hepatitis, such as those induced by halothane or by tienilic acid (called anti-LKM2 in this case). So far the nature of the human microsomal macromolecules recognized by these antibodies has not been determined. Here we show, by using immunoblot techniques, that among the macromolecules present in human adult liver microsomes, one protein called cytochrome P-450-8 is specifically recognized by most sera of patients containing anti-LKM2 antibodies but not by control serum. Human fetal liver microsomes that do not contain cytochrome P-450-8 are not recognized by the anti-LKM2 antibodies. It is also shown that anti-cytochrome P-450-8 antibodies as well as human serum containing anti-LKM2 antibodies specifically inhibit the hydroxylation of tienilic acid by human liver microsomes. These results indicate that anti-LKM2 antibodies appearing in patients with hepatitis and concomitant administration of tienilic acid are directed against a cytochrome P-450 isoenzyme that catalyzes the metabolic oxidation of this drug. This suggests a possible mechanism for the appearance of anti-organelle antibodies in a drug-induced hepatitis.
Collapse
|
49
|
Adams AP, Campbell D, Clarke RS, Downing JW, Healy TE, Hull CJ, Hutton P, Jones JG, Norman J, Payne JP. Halothane and the liver. BMJ : BRITISH MEDICAL JOURNAL 1986; 293:1023. [PMID: 3094742 PMCID: PMC1341800 DOI: 10.1136/bmj.293.6553.1023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
50
|
Zaric D, Larsen SF, Jacobsen E, Olesen KH, Ranek L. Halothane hepatitis in a prospective study of postoperative complications. Acta Anaesthesiol Scand 1986; 30:529-32. [PMID: 3811796 DOI: 10.1111/j.1399-6576.1986.tb02469.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In a prospective study comprising 2609 consecutive surgical patients, of whom 1166 were anesthetized with halothane, four cases of hepatitis were encountered. The incidence of hepatitis among those who received halothane was 1:292 in our material. The high incidence may be explained by the recognition of milder forms of hepatitis and by the selection of the series (over 40 years). Serum alanine aminotransferase should be investigated in all patients with postoperative pyrexia of unknown origin if mild forms of halothane hepatitis are to be discovered. The patient's history should be carefully examined for previous postoperative pyrexia of unknown origin following halothane anesthesia, in which case other anesthetics should be chosen.
Collapse
|