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Luo X, Lu LG. Progress in the Management of Patients with Cholestatic Liver Disease: Where Are We and Where Are We Going? J Clin Transl Hepatol 2024; 12:581-588. [PMID: 38974958 PMCID: PMC11224908 DOI: 10.14218/jcth.2023.00519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 07/09/2024] Open
Abstract
Cholestatic liver disease is a group of diseases in which bile acid accumulates in the liver for various reasons, resulting in abnormal liver biochemical indicators and histological damage. Cholestasis can be divided into intrahepatic cholestasis and extrahepatic cholestasis, which will contribute to liver damage and progress to liver fibrosis and cirrhosis. Primary biliary cholangitis (PBC) and primary sclerosing cholangitis are the two most typical cholestatic liver diseases. Ursodeoxycholic acid is currently the first-line treatment for PBC, while obeticholic acid, budesonide and fibrates have also shown good potential in the treatment of PBC. There are currently no official drugs approved to treat primary sclerosing cholangitis, and the use of ursodeoxycholic acid may have certain clinical benefits. At present, progress has been made in new treatment directions for cholestatic liver disease, including fibroblast growth factor 19, cholestyramine, S-adenosyl-L-methionine, steroid drugs, farnesoid X receptor agonists, and more. Considerable progress has been made in the management of cholestatic liver disease but there are still many opportunities and challenges. In this review, we summarized the recommended guidelines for the management of cholestatic disease and the progress of new drug research and development, in order to provide an important reference for the clinical practice of cholestatic liver disease.
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Affiliation(s)
- Xin Luo
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lun-Gen Lu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sauerbruch T, Hennenberg M, Trebicka J, Beuers U. Bile Acids, Liver Cirrhosis, and Extrahepatic Vascular Dysfunction. Front Physiol 2021; 12:718783. [PMID: 34393832 PMCID: PMC8358446 DOI: 10.3389/fphys.2021.718783] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
The bile acid pool with its individual bile acids (BA) is modulated in the enterohepatic circulation by the liver as the primary site of synthesis, the motility of the gallbladder and of the intestinal tract, as well as by bacterial enzymes in the intestine. The nuclear receptor farnesoid X receptor (FXR) and Gpbar1 (TGR5) are important set screws in this process. Bile acids have a vasodilatory effect, at least according to in vitro studies. The present review examines the question of the extent to which the increase in bile acids in plasma could be responsible for the hyperdynamic circulatory disturbance of liver cirrhosis and whether modulation of the bile acid pool, for example, via administration of ursodeoxycholic acid (UDCA) or via modulation of the dysbiosis present in liver cirrhosis could influence the hemodynamic disorder of liver cirrhosis. According to our analysis, the evidence for this is limited. Long-term studies on this question are lacking.
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Affiliation(s)
- Tilman Sauerbruch
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Martin Hennenberg
- Department of Urology I, University Hospital, LMU Munich, Munich, Germany
| | - Jonel Trebicka
- Translational Hepatology, Medical Department, University of Frankfurt, Frankfurt, Germany
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam, Netherlands
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JUŘICA J, DOVRTĚLOVÁ G, NOSKOVÁ K, ZENDULKA O. Bile Acids, Nuclear Receptors and Cytochrome P450. Physiol Res 2016; 65:S427-S440. [DOI: 10.33549/physiolres.933512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This review summarizes the importance of bile acids (BA) as important regulators of various homeostatic mechanisms with detailed focus on cytochrome P450 (CYP) enzymes. In the first part, synthesis, metabolism and circulation of BA is summarized and BA are reviewed as physiological ligands of nuclear receptors which regulate transcription of genes involved in their metabolism, transport and excretion. Notably, PXR, FXR and VDR are the most important nuclear receptors through which BA regulate transcription of CYP genes involved in the metabolism of both BA and xenobiotics. Therapeutic use of BA and their derivatives is also briefly reviewed. The physiological role of BA interaction with nuclear receptors is basically to decrease production of toxic non-polar BA and increase their metabolic turnover towards polar BA and thus decrease their toxicity. By this, the activity of some drug-metabolizing CYPs is also influenced what could have clinically relevant consequences in cholestatic diseases or during the treatment with BA or their derivatives.
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Affiliation(s)
| | | | | | - O. ZENDULKA
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno. Czech Republic
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Ma H, Zeng M, Han Y, Yan H, Tang H, Sheng J, Hu H, Cheng L, Xie Q, Zhu Y, Chen G, Gao Z, Xie W, Wang J, Wu S, Wang G, Miao X, Fu X, Duan L, Xu J, Wei L, Shi G, Chen C, Chen M, Ning Q, Yao C, Jia J. A multicenter, randomized, double-blind trial comparing the efficacy and safety of TUDCA and UDCA in Chinese patients with primary biliary cholangitis. Medicine (Baltimore) 2016; 95:e5391. [PMID: 27893675 PMCID: PMC5134868 DOI: 10.1097/md.0000000000005391] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/09/2016] [Accepted: 10/21/2016] [Indexed: 11/26/2022] Open
Abstract
AIM Tauroursodeoxycholic acid (TUDCA) is a taurine conjugated form of ursodeoxycholic acid (UDCA) with higher hydrophility. To further evaluate the efficacy and safety of TUDCA for primary biliary cholangitis (PBC), we performed this study on Chinese patients. METHODS 199 PBC patients were randomly assigned to either 250 mg TUDCA plus UDCA placebo or 250 mg UDCA plus TUDCA placebo, 3 times per day for 24 weeks. The primary endpoint was defined as percentage of patients achieving serum alkaline phosphatase (ALP) reduction of more than 25% from baseline. RESULTS At week 24, 75.97% of patients in the TUDCA group and 80.88% of patients in the UDCA group achieved a serum ALP reduction of more than 25% from baseline (P = 0.453). The percentage of patients with serum ALP levels declined more than 40% following 24 weeks of treatment was 55.81% in the TUDCA group and 52.94% in the UDCA group (P = 0.699). Both groups showed similar improvement in serum levels of ALP, aspartate aminotransferase, and total bilirubin (P > 0.05). The proportion of patients with pruritus/scratch increased from 1.43% to 10.00% in UDCA group, while there's no change in TUDCA group (P = 0.023). Both drugs were well tolerated, with comparable adverse event rates between the 2 groups. CONCLUSIONS TUDCA is safe and as efficacious as UDCA for the treatment of PBC, and may be better to relieve symptoms than UDCA.
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Affiliation(s)
- Hong Ma
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing
| | - Minde Zeng
- Gastroenterology Department, Renji Hospital, Shanghai Jiao Tong University, Shanghai
| | - Ying Han
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi’an
| | - Huiping Yan
- Clinical Research Center for Autoimmune Liver Disease, Beijing You-an Hospital Capital Medical University, Beijing
| | - Hong Tang
- Department of Infectious Diseases, Huaxi Hospital, Chengdu
| | - Jifang Sheng
- Department of Infectious Diseases, Zhejiang University 1st Affiliated Hospital, Hangzhou
| | - Heping Hu
- Department of Comprehensive Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai
| | - Liufang Cheng
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai
| | - Youfu Zhu
- Hepatology Department, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Guofeng Chen
- Liver Fibrosis Noninvasive Diagnosis and Treatment Center, 302 Military Hospital, Beijing
| | - Zhiliang Gao
- Department of Infectious Diseases, Sun Yat-Sen University 3rd Affiliated Hospital, Guangzhou
| | - Wen Xie
- Liver Disease Center, Beijing Ditan Hospital, Capital Medial University, Beijing
| | - Jiyao Wang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University
| | | | - Guiqiang Wang
- Department of Infectious Disease, Peking University First Hospital, Beijing
| | - Xiaohui Miao
- Department of Infectious Diseases, Changzheng Hospital, Second Military Medical University, Shanghai
| | - Xiaoqing Fu
- Department of Infectious Diseases, Hangzhou Sixth People's Hospital, Hangzhou
| | - Liping Duan
- Department of Gastroenterology, The 1st Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jie Xu
- Department of Infectious Diseases, The Third People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Lai Wei
- Hepatology Unit, Peking University People's Hospital, Beijing
| | - Guangfeng Shi
- Department of Infectious Diseases, Shanghai Huashan Hospital
| | - Chengwei Chen
- Department of Infectious Diseases, 85th PLA Hospital, Shanghai
| | - Minhu Chen
- Department of Gastroenterology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Qin Ning
- Institute and Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chen Yao
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing
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Abstract
Primary biliary cholangitis (PBC, primary biliary cirrhosis) is an autoimmune cholestatic liver disease characterized by chronic nonsuppurative destructive cholangitis and the presence of serum antimitochondrial antibodies. Ursodeoxycholic acid is the only drug approved by the US Food and Drug Administration to treat PBC. However, one-third of patients show incomplete responses to ursodeoxycholic acid and a poor prognosis. A number of old and new medications have been used in these patients, such as fibrates, glucocorticoids, immunosuppressants, obeticholic acid, mesenchymal stem cells, biological agents (anti-interleukin-12, cytotoxic T-lymphocyte antigen 4 immunoglobulin, anti-CD20), and antifibrotic drugs. This article reviews the therapeutic advances of these old and new medications in patients with PBC.
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Pu Y, Yang JH, Yang J. Progress in treatment of primary biliary cirrhosis. Shijie Huaren Xiaohua Zazhi 2014; 22:5273-5278. [DOI: 10.11569/wcjd.v22.i34.5273] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
Primary biliary cirrhosis (PBC) is a chronic autoimmune cholestatic liver disease characterized by cholestasis, and it often eventually develops into cirrhosis, portal hypertension and liver failure. Asymptomatic patients typically are diagnosed by the elevation of alkaline phosphatase (ALP) and the presence of anti-mitochondrial antibody (AMA) titers of 1:40 or greater. Ursodeoxycholic acid (UDCA) is the only Food and Drug Administration approved treatment for PBC, but it is not universally effective. In patients with UDCA-refractory PBC, additional therapies should be considered, including budesonide, fibrates, obeticholic acid, immunosuppressants and liver transplantation.
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