Drug metabolism and hepatotoxicity

Effect of the human therapeutic drug diltiazem on the haematological parameters, histology and selected enzymatic activities of rainbow trout Oncorhynchus mykiss

Diltiazem is a pharmaceutical belonging to a group of calcium channel blockers (CCB) that is widely used in the treatment of angina pectoris and hypertension. The objective of the present study was to assess the effect of diltiazem on rainbow trout (Oncorhynchus mykiss). Juvenile trout were exposed for 21 and 42 days to three nominal concentrations of diltiazem: 0.03 μg L(-1) (environmentally relevant concentration), 3 μg L(-1), and 30 μg L(-1) (sub-lethal concentrations). The number of mature neutrophilic granulocytes was significantly increased by 450 and 400% in fish exposed to 3 μg L(-1) and 30 μg L(-1) diltiazem compared to the control, respectively. Antioxidant enzyme activity was affected in liver and gills of fish exposed to all tested concentrations of diltiazem but the changes were mostly transient and not concentration dependent. Creatine kinase activity was markedly increased (ranging from 520 to 845%) at all tested diltiazem concentrations at the end of the exposure indicating muscle and/or kidney damage. The highest concentration was associated with histological changes in heart, liver, and kidney. These alterations can be attributed to the effects of diltiazem on the cardiovascular system, similar to those observed in the human body, as well as to its metabolism. At the environmentally relevant concentration, diltiazem was found to induce some alterations in the blood, gills, and liver of fish, indicating its potential for adverse effects on non-target organisms in the aquatic environment.

Non-parenchymal cell responses in paracetamol (acetaminophen)-induced liver injury

We have analysed Kupffer cell and 'activated' perisinusoidal cell populations in liver biopsies from patients with paracetamol (acetaminophen)-induced hepatic necrosis of varying degrees of severity. Kupffer cells were identified immunohistochemically using the monoclonal antibody KPJ and perisinusoidal cells by identification of alpha-smooth muscle actin expression. Material was available from four groups of individuals: (i) 11 cases with mild (grade I) injury; (ii) six cases with moderate (grade II) injury; (iii) six cases with severe (grade III) injury; and (iv) controls with normal liver histology (n = 23). Biopsies in groups (i)-(iii) were obtained within 5 days of drug ingestion. All patients in this study survived and follow-up biopsies were obtained at 4 months, by which time the histological abnormalities had fully resolved. Kupffer cells and perisinusoidal cell numbers were assessed in immunostained preparations of acute and recovery phase biopsies and in control specimens. In acute phase biopsies from patients with grade II and III injury there was expansion of the Kupffer cell and perisinusoidal cell populations within areas of injury. There was a strong correlation between the size of these two cell populations (r = 0.886). No significant difference in cell numbers was found between those with grade I injury and controls. In recovery phase biopsies from patients with paracetamol-induced injury, perisinusoidal cell numbers did not differ significantly from normal controls. Kupffer cells numbers also decreased in recovery phase biopsies compared with the acute phase, although there was persistent expansion of the Kupffer cells population in those who originally had grade III injury.(ABSTRACT TRUNCATED AT 250 WORDS)

The establishment and continuous subculturing of normal human adult hepatocytes: expression of differentiated liver functions

The use of normal adult liver hepatocytes in cell culture for biochemical, toxicological and pharmacological studies has been greatly limited owing to the loss of replicative capacity and differentiated liver function. This is contrary to the ability of the liver to regenerate following injury in vivo. This suggests that liver "stem" or "transitional" hepatocytes exist that upon proper stimulus divide and differentiate into mature hepatocytes. In this study we report the establishment and culture of hepatocytes from normal human adult liver, which: (1) possess replicative capacity sufficient to subpassage 12-15 times (27-37 cumulative population doublings); (2) can be cryopreserved for subsequent use without loss of replicative capacity; and (3) upon differentiation in culture synthesize albumin and keratin 18 and metabolize benzo[a]pyrene. The ability of these cells to divide or express differentiated functions appears to be due to a number of cellular, biochemical and physical characteristics that are present during the primary establishment and subsequent growth phases of the cell cultures. Disassociation of cells from excess liver tissue was best achieved by combining the mechanical action of the Stomacher with very low amounts of proteolytic enzymes and EGTA. The cell lines appeared to grow best when established and subpassaged in an mALPHA medium supplemented with insulin, hydrocortisone, transferrin, epithelial growth factor and fetal bovine serum (prescreened for human hepatocyte cell growth). The seeding density and cell-cell contact in culture appeared to be important for both cell division and expression of liver function. When cells were seeded at a low density and subpassaged before confluency, the cells continued to divide. Albumin and keratin 18 synthesis occurred primarily in tightly packed cell clusters. When cells were seeded at a high density, near confluency, albumin and keratin 18 synthesis occurred uniformly in all of the cells of the culture and the culture metabolized benzo[a]pyrene to water-soluble metabolites, which covalently bound to cellular DNA. This appearance of liver functions was consistent with the "transition" of hepatocytes to a terminally differentiated state. Nonhepatic markers, i.e., alpha-fetoprotein, factor VIII and gamma-glutamyl transpeptidase activity were not expressed in cells cultured at either low or high density. Thus, the data presented here indicate that normal human adult liver hepatocytes, once established in culture, can be subpassaged to a high number of population doublings, cryopreserved for later use, and modulated to express differentiated liver functions.

Does hypothermia protect against the development of hepatitis in paracetamol overdose?

A 24-year-old female presented in hospital following self-poisoning with a dose of greater than 30 g of paracetamol (acetaminophen), taken both as co-proxamol (dextropropoxyphene and paracetamol) and paracetamol. She arrived in hospital more than 18 h after ingestion of the drug. On admission, she was profoundly hypothermic, with a rectal temperature of 19 degrees C. Her paracetamol level was 943 mumol.l-1 which, when related to the time of ingestion, implied a very high risk of hepatocellular damage as well as fulminant liver failure, even if she was treated with the antioxidant n-acetylcysteine. The patient's condition was stabilised by initial resuscitation with fluids, vasoactive drugs, and active rewarming. N-acetylcysteine therapy was begun promptly. This patient's liver function tests remained entirely normal in spite of the delay in presentation and she made a rapid and complete recovery. This remarkable clinical course indicates a possible role for therapeutically induced hypothermia in the management of severe paracetamol overdose, particularly in the group of patients who seek medical attention some hours after ingestion of the drug and who therefore remain at high risk, despite treatment with n-acetylcysteine.