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Huang H, Li J, Chen T, Lu M, Zhuoma G, Chen L, Gan Y, Ye H. The correlation between blood lipids and intrahepatic cholestasis syndrome during pregnancy. J OBSTET GYNAECOL 2024; 44:2369929. [PMID: 38963226 DOI: 10.1080/01443615.2024.2369929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND To analyse changes in lipid levels during the development of intrahepatic cholestasis of pregnancy (ICP) and identify new biomarkers for predicting ICP. METHODS A retrospective case-control study was conducted to analyse 473 pregnant women who underwent regular prenatal examinations and delivered at the Women and Children's Hospital, School of Medicine, Xiamen University, between June 2020 and June 2023, including 269 normal pregnancy controls and 204 pregnant women with cholestasis. RESULTS Patients with ICP with gestational diabetes mellitus (GDM) have lower high-density lipoprotein (HDL) levels than in those without GDM. Total bile acid (TBA) levels were significantly higher in pregnant women with GDM than those without. The apolipoprotein A (APOA) level was lower in patients with ICP and hypothyroidism than those without hypothyroidism. TBA levels were significantly higher in pregnant women with hypothyroidism than those without. Triglyceride (TG) levels were significantly higher in patients with preeclampsia (PE) than those without. HDL and APOA levels were lower in women with ICP complicated by preterm delivery than those with normal delivery. The AUC (area under the curve) of the differential diagnosis of cholestasis of pregnancy for the APOA/APOB (apolipoprotein B) ratio was 0.727, with a sensitivity of 85.9% and specificity of 47.5%. CONCLUSIONS The results suggested that dyslipidaemia is associated with an increased risk of ICP and its complications. The timely detection of blood lipid and bile acid levels can assist in the diagnosis of ICP and effectively prevent ICP and other complications.
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Affiliation(s)
- Huibin Huang
- Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
| | - Juan Li
- Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
| | - Tianhua Chen
- Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
| | - Meidan Lu
- Department of obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
| | - Gunsang Zhuoma
- School of Public Health, Xiamen University, Xiamen City, China
| | - Lijin Chen
- Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
| | - Yuebin Gan
- Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
| | - Huiming Ye
- Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen City, China
- Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen City, China
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Bentley BH, Cecil AE, Lippert WC. Atypical Intrahepatic Cholestasis of Pregnancy: A Red Herring. ACG Case Rep J 2024; 11:e01339. [PMID: 38638198 PMCID: PMC11025705 DOI: 10.14309/crj.0000000000001339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Intrahepatic cholestasis of pregnancy is an intrahepatic etiology of acute cholestasis commonly defined by pruritus and increased bile acids, liver transaminases, and, occasionally, bilirubin. Azathioprine is an immunosuppressive agent associated with various forms of hepatoxicity, ranging from transient rises in serum aminotransferase levels, acute cholestatic injury, and chronic hepatic injury. In this report, we present a 20-year-old pregnant woman who presented with cholestatic liver injury due to intrahepatic cholestasis of pregnancy with a clinical picture complicated by increased levels of azathioprine metabolites.
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Affiliation(s)
- Blake H. Bentley
- Department of Internal Medicine. Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alexa E. Cecil
- Department of Internal Medicine. Wake Forest University School of Medicine, Winston-Salem, NC
| | - William C. Lippert
- Department of Internal Medicine. Wake Forest University School of Medicine, Winston-Salem, NC
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Liu W, Chen L, Miao K, You Y, Li J, Lu J, Zhang Y. Identification and validation of diagnostic biomarkers for intrahepatic cholestasis of pregnancy based on untargeted and targeted metabolomics analyses of urine metabolite profiles. BMC Pregnancy Childbirth 2023; 23:828. [PMID: 38036952 PMCID: PMC10691115 DOI: 10.1186/s12884-023-06102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is a prevalent pregnancy-specific complication that presents with maternal itching and elevated serum bile acid levels. ICP is associated with unfavorable pregnancy outcomes, severely decreasing the pregnant woman's quality of life. Timely identification of ICP is crucial for effective management and improved outcomes. METHODS We collected urine samples from 8 patients with ICP and 8 healthy individuals. We used Liquid Chromatography-Mass Spectrometry (LC-MS) to detect metabolite expression levels, then conducted a series of bioinformatic analyses to explore the potential biological meanings of differentially expressed metabolites, and preliminarily discovered several candidate biomarkers. To validate these candidate biomarkers, we performed Gas Chromatography-Mass Spectrometry (GC-MS) detection and analyzed their diagnostic values using receiver operating characteristic (ROC) curve. RESULTS Untargeted metabolomics data showed that 6129 positive peaks and 6218 negative peaks were extracted from each specimen. OPLS-DA analysis and the heat map for cluster analysis showed satisfactory capability in discriminating ICP specimens from controls. Subsequent analysis extracted 64 significantly differentially expressed metabolites, which could be potential biomarkers for diagnosis of ICP. Based on the KEGG enrichment analyses, six candidate biomarkers were preliminarily identified. Two most promising biomarkers (3-hydroxypropionic acid and uracil) were validated by targeted metabolomics analyses with the area under the curve (AUC) of 0.920 and 0.850 respectively. CONCLUSION Based on preliminary screening from untargeted metabolomics and subsequent validation through targeted metabolomics, 3-hydroxypropionic acid and uracil were identified as promising diagnostic biomarkers for ICP.
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Affiliation(s)
- Weici Liu
- Wuxi Maternal and Child Health Hospital, Wuxi Medical Center of Nanjing Medical University, Wuxi, Jiangsu, 214023, China
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Lingyan Chen
- Wuxi Maternal and Child Health Hospital, Wuxi Medical Center of Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Keyan Miao
- Medical College, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Yilan You
- Wuxi Maternal and Child Health Hospital, Wuxi Medical Center of Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Jingyang Li
- Wuxi Maternal and Child Health Hospital, Wuxi Medical Center of Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Jianfeng Lu
- Wuxi Maternal and Child Health Care Hospital, Wuxi, Jiangsu, 214023, China.
| | - Yan Zhang
- Wuxi Maternal and Child Health Hospital, Wuxi Medical Center of Nanjing Medical University, Wuxi, Jiangsu, 214023, China.
- Wuxi Maternal and Child Health Care Hospital, Wuxi, Jiangsu, 214023, China.
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Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol 2023; 20:26-36. [PMID: 36307649 DOI: 10.1038/s41575-022-00687-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/01/2023]
Abstract
Pruritus in cholestatic liver diseases can be a major burden and dramatically impair the quality of life of those affected. Here, we provide an update on the latest insights into the molecular pathogenesis of and novel therapeutic approaches for cholestasis-associated itch. Endogenous and exogenous small-molecule pruritogen candidates bind to their receptors on unmyelinated itch C-fibres in the skin. Candidate pruritogens in cholestasis include certain lysophospholipids and sulfated progesterone metabolites, among others, whereas total bile acid or bilirubin conjugates seem unlikely to have a dominant role in the pathogenesis of cholestasis-associated pruritus. Transmission of itch signals via primary, secondary and tertiary itch neurons to the postcentral gyrus and activation of scratch responses offer various targets for therapeutic intervention. At present, evidence-based treatment options for pruritus in fibrosing cholangiopathies, such as primary biliary cholangitis and primary sclerosing cholangitis, are the peroxisome proliferator-associated receptor (PPAR) agonist bezafibrate and the pregnane X receptor (PXR) agonist rifampicin. In pruritus of intrahepatic cholestasis of pregnancy, ursodeoxycholic acid is recommended and might be supported in the third trimester by rifampicin if needed. Alternatively, non-absorbable anion exchange resins, such as cholestyramine, can be administered, albeit with poor trial evidence. Liver transplantation for intolerable refractory pruritus has become an extremely rare therapeutic strategy.
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Wang P, Yuan P, Lin S, Zhong H, Zhang X, Zhuo Y, Li J, Che L, Feng B, Lin Y, Xu S, Wu D, Burrin DG, Fang Z. Maternal and Fetal Bile Acid Homeostasis Regulated by Sulfated Progesterone Metabolites through FXR Signaling Pathway in a Pregnant Sow Model. Int J Mol Sci 2022; 23:6496. [PMID: 35742938 PMCID: PMC9224516 DOI: 10.3390/ijms23126496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022] Open
Abstract
Abnormally elevated circulating bile acids (BA) during pregnancy endanger fetal survival and offspring health; however, the pathology and underlying mechanisms are poorly understood. A total of nineteen pregnant sows were randomly assigned to day 60 of gestation, day 90 of gestation (G60, G90), and the farrowing day (L0), to investigate the intercorrelation of reproductive hormone, including estradiol, progesterone and sulfated progesterone metabolites (PMSs), and BA in the peripheral blood of mother and fetuses during pregnancy. All data were analyzed by Student's t-test or one-way ANOVA of GraphPad Prism and further compared by using the Student-Newman-Keuls test. Correlation analysis was also carried out using the CORR procedure of SAS to study the relationship between PMSs and BA levels in both maternal and fetal serum at G60, G90, and L0. Allopregnanolone sulphate (PM4S) and epiallopregnanolone sulphate (PM5S) were firstly identified in the maternal and fetal peripheral blood of pregnant sows by using newly developed ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) methods. Correlation analysis showed that pregnancy-associated maternal BA homeostasis was correlated with maternal serum PM4S levels, whereas fetal BA homeostasis was correlated with fetal serum PM5S levels. The antagonist activity role of PM5S on farnesoid X receptor (FXR)-mediated BA homeostasis and fibroblast growth factor 19 (FGF19) were confirmed in the PM5S and FXR activator co-treated pig primary hepatocytes model, and the antagonist role of PM4S on FXR-mediated BA homeostasis and FGF19 were also identified in the PM4S-treated pig primary hepatocytes model. Together with the high relative expression of FGF19 in pig hepatocytes, the pregnant sow is a promising animal model to investigate the pathogenesis of cholestasis during pregnancy.
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Affiliation(s)
- Peng Wang
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
- College of Biology Engineering, Henan University of Technology, Zhengzhou 450000, China
| | - Peiqiang Yuan
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Sen Lin
- Sericultural & Agri-Food Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou 510000, China;
| | - Heju Zhong
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Xiaoling Zhang
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Yong Zhuo
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Jian Li
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Lianqiang Che
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Bin Feng
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
- Key Laboratory for Food Science and Human Health, College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
| | - Yan Lin
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Shengyu Xu
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - De Wu
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
| | - Douglas G Burrin
- USDA/ARS Children’s Nutrition Research Center, Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Zhengfeng Fang
- Key Laboratory for Animal Disease Resistance Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (P.W.); (P.Y.); (H.Z.); (X.Z.); (Y.Z.); (J.L.); (L.C.); (B.F.); (Y.L.); (S.X.); (D.W.)
- Key Laboratory for Food Science and Human Health, College of Food Science, Sichuan Agricultural University, Ya’an 625014, China
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Martínez-García J, Molina A, González-Aseguinolaza G, Weber ND, Smerdou C. Gene Therapy for Acquired and Genetic Cholestasis. Biomedicines 2022; 10:biomedicines10061238. [PMID: 35740260 PMCID: PMC9220166 DOI: 10.3390/biomedicines10061238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cholestatic diseases can be caused by the dysfunction of transporters involved in hepatobiliary circulation. Although pharmacological treatments constitute the current standard of care for these diseases, none are curative, with liver transplantation being the only long-term solution for severe cholestasis, albeit with many disadvantages. Liver-directed gene therapy has shown promising results in clinical trials for genetic diseases, and it could constitute a potential new therapeutic approach for cholestatic diseases. Many preclinical gene therapy studies have shown positive results in animal models of both acquired and genetic cholestasis. The delivery of genes that reduce apoptosis or fibrosis or improve bile flow has shown therapeutic effects in rodents in which cholestasis was induced by drugs or bile duct ligation. Most studies targeting inherited cholestasis, such as progressive familial intrahepatic cholestasis (PFIC), have focused on supplementing a correct version of a mutated gene to the liver using viral or non-viral vectors in order to achieve expression of the therapeutic protein. These strategies have generated promising results in treating PFIC3 in mouse models of the disease. However, important challenges remain in translating this therapy to the clinic, as well as in developing gene therapy strategies for other types of acquired and genetic cholestasis.
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Affiliation(s)
- Javier Martínez-García
- Division of Gene Therapy and Regulation of Gene Expression, Cima Universidad de Navarra, 31008 Pamplona, Spain; (J.M.-G.); (A.M.); (G.G.-A.)
| | - Angie Molina
- Division of Gene Therapy and Regulation of Gene Expression, Cima Universidad de Navarra, 31008 Pamplona, Spain; (J.M.-G.); (A.M.); (G.G.-A.)
| | - Gloria González-Aseguinolaza
- Division of Gene Therapy and Regulation of Gene Expression, Cima Universidad de Navarra, 31008 Pamplona, Spain; (J.M.-G.); (A.M.); (G.G.-A.)
- Instituto de Investigación Sanitaria de Navarra (IdISNA), 31008 Pamplona, Spain
- Vivet Therapeutics S.L., 31008 Pamplona, Spain
| | - Nicholas D. Weber
- Vivet Therapeutics S.L., 31008 Pamplona, Spain
- Correspondence: (N.D.W.); (C.S.); Tel.: +34-948194700 (N.D.W. & C.S.)
| | - Cristian Smerdou
- Division of Gene Therapy and Regulation of Gene Expression, Cima Universidad de Navarra, 31008 Pamplona, Spain; (J.M.-G.); (A.M.); (G.G.-A.)
- Instituto de Investigación Sanitaria de Navarra (IdISNA), 31008 Pamplona, Spain
- Correspondence: (N.D.W.); (C.S.); Tel.: +34-948194700 (N.D.W. & C.S.)
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Zheng Q, Shen L, Zhao D, Zhang H, Liang Y, Zhu Y, Khan NU, Liu X, Zhang J, Lin J, Tang X. Metabolic characteristics of plasma bile acids in patients with intrahepatic cholestasis of pregnancy-mass spectrometric study. Metabolomics 2021; 17:93. [PMID: 34595616 DOI: 10.1007/s11306-021-01844-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/21/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Intrahepatic cholestasis of pregnancy (ICP) is one of the more common complications in the middle and late stages of pregnancy, which requires early detection and intervention. OBJECTIVE The aim of the study is to investigate the changes in the metabolic profile of bile acids (BAs) in plasma of pregnant women with ICP and to look biomarkers for the diagnosis and grading of ICP, and to explore the disease mechanism. METHODS The targeted metabolomics based on high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to analyze plasma BAs. RESULTS Twenty-seven BAs can be quantified in all participants. Among them, 22 BAs were identified as differential BAs between ICP and control groups. Five BAs include 3β-CA, 3β-DCA, CDCA-3Gln, NCA, and Tβ-MCA, were found to be associated with ICP for the first time. Nine BAs include NCA, GCA, GCDCA, GHCA, GUDCA, HCA, TCA, TCDCA and THCA, can be used as possible ICP diagnostic biomarkers. Four BAs, i.e., GLCA, THCA, GHCA and TLCA-3S may be used as potential biomarkers for ICP grading. CONCLUSION There were significant differences in plasma BA profiles between ICP patients and the control. The BA profiles of mild ICP group and severe ICP group partially overlapped. Potential diagnostic and grading BA markers were identified. A significant characteristic of ICP group was the increase of conjugated BAs. A mechanism to sustain the equilibrium of BA metabolism and adaptive response has been developed in ICP patients to accelerate excretion and detoxification.
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Affiliation(s)
- Qihong Zheng
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Liming Shen
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China.
- Brain Disease and Big Data Research Institute, Shenzhen University, Shenzhen, 518071, People's Republic of China.
| | - Danqing Zhao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Huajie Zhang
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Yi Liang
- Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yuhua Zhu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Naseer Ullah Khan
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Xukun Liu
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Jun Zhang
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Jing Lin
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, People's Republic of China
| | - Xiaoxiao Tang
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
- Shenzhen Key Laboratory of Marine Biotechnology and Ecology, Shenzhen, 518071, People's Republic of China
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Jurk SM, Kremer AE, Schleussner E. Intrahepatic Cholestasis of Pregnancy. Geburtshilfe Frauenheilkd 2021; 81:940-947. [PMID: 34393257 PMCID: PMC8354350 DOI: 10.1055/a-1522-5178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/02/2021] [Indexed: 12/29/2022] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a rare but potentially serious complication of pregnancy, the main symptom of which is intense pruritus with elevated serum levels of bile acids. The elevated serum bile acid concentration is regarded as a predictor for poor perinatal outcome including intrauterine death. Ursodeoxycholic acid (UDCA) has become established as the treatment of choice in clinical management to achieve a significant improvement in symptoms and reduce the cholestasis. Pregnant women with severe intrahepatic cholestasis should always be managed in a perinatal centre with close interdisciplinary monitoring and treatment involving perinatologists and hepatologists to minimise the markedly increased perinatal morbidity and mortality as well as maternal symptoms.
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Affiliation(s)
| | - Andreas E Kremer
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Germany.,Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Switzerland
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Shao Y, Chen S, Li H, Tang Q, Xu D. Maternal bile acid profile and subtype analysis of intrahepatic cholestasis of pregnancy. Orphanet J Rare Dis 2021; 16:259. [PMID: 34098996 PMCID: PMC8186144 DOI: 10.1186/s13023-021-01887-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 05/21/2021] [Indexed: 01/17/2023] Open
Abstract
Background ICP pregnant women have a unique profile of serum bile acid metabolism, thus the early and accurate identification of ICP patients is beneficial to early appropriate treatment and improvement of pregnancy outcomes. In this study, ultra-high performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS/MS) was used to analyze the 15 types of serum bile acid profiles among patients with ICP in third trimester, patients with cholelithiasis, and patients with hepatitis B virus. The ICP diagnostic model established by partial least squares-discriminant analysis (PLS-DA) was used to screen the differential bile acids for clinical subtypes of ICP. 144 cases of ICP patients were involved in this study, and divided into four subgroups according to serum level of TBA, DBIL, and ALT. Results (1) The differential serum bile acid profiles of ICP group and normal pregnant women were DCA, TDCA, TCA, GDCA and GLCA. (2) The differential serum bile acid profiles of the ICP1 group (ICP with jaundice) and normal pregnant women were TCDCA, TCA, GCA, GCDCA, TUDCA and GUDCA. (3) The differential serum bile acid profiles of the ICP3 group (Hyperchoicemia of pregnancy) and normal pregnant group was GUDCA, LCA, GLCA, UDCA, TUDCA, CDCA, and TLCA (P < 0.05). (4) The differential serum bile acid profiles of ICP4 group (idiopathic aminotransferase abnormality during pregnancy) and normal pregnant group was UDCA, GUDCA, TUDCA, GCA and GLCA (P < 0.05). (5) The occurrence of meconium-stained amniotic fluid, premature delivery and cesarean section in ICP1 group was significantly higher than normal group, ICP2 group, ICP3 group, and ICP4 group (P < 0.05); The occurrence of meconium-stained amniotic fluid, premature delivery and cesarean section in ICP2 group, ICP3 group, and ICP4 group was significantly higher than normal group (P < 0.05), but no difference was found among ICP2 group, ICP3 group, and ICP4 group (P > 0.05). Conclusion Maternal serum bile acid profiles are useful to differentiate the four subtypes of ICP. ICP with jaundice could be an important predictor of adverse pregnancy outcomes of ICP. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01887-1.
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Affiliation(s)
- Yong Shao
- The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Siyu Chen
- The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huan Li
- The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Tang
- The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Di Xu
- The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Molecular Pathogenesis of Intrahepatic Cholestasis of Pregnancy. Can J Gastroenterol Hepatol 2021; 2021:6679322. [PMID: 34195157 PMCID: PMC8181114 DOI: 10.1155/2021/6679322] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/22/2021] [Indexed: 12/12/2022] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease. The maternal symptoms are characterized by skin pruritus and elevated bile acids, causing several adverse outcomes for fetuses, including an increased risk of preterm birth, meconium-stained amniotic fluid, neonatal depression, respiratory distress syndrome, and stillbirth. Genetic, hormonal, immunological, and environmental factors contribute to the pathogenesis of ICP, and the estrogen-bile acid axis is thought to play a dominant role. The advances in the past 10 years uncover more details of this axis. Moreover, dysregulation of extracellular matrix and oxygen supply, organelle dysfunction, and epigenetic changes are also found to cause ICP, illuminating more potential drug targets for interfering with. Here, we summarize the molecular pathogenesis of ICP with an emphasis on the advancement in the past 10 years, aiming to give an updated full view of this field.
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11
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Langedijk JAGM, Beuers UH, Oude Elferink RPJ. Cholestasis-Associated Pruritus and Its Pruritogens. Front Med (Lausanne) 2021; 8:639674. [PMID: 33791327 PMCID: PMC8006388 DOI: 10.3389/fmed.2021.639674] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/12/2021] [Indexed: 12/17/2022] Open
Abstract
Pruritus is a debilitating symptom of various cholestatic disorders, including primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and inherited progressive familial intrahepatic cholestasis (PFIC). The molecular mechanisms leading to cholestasis-associated pruritus are still unresolved and the involved pruritogens are indecisive. As a consequence of pruritus, patients suffer from sleep deprivation, loss of daytime concentration, auto-mutilation and sometimes even suicidal ideations. Current guideline-approved therapy of cholestasis-associated pruritus includes stepwise administration of several medications, which may alleviate complaints in some, but not all affected patients. Therefore, also experimental therapeutic approaches are required to improve patients' quality of life. This article reviews the current state of research on pruritogens and their receptors, and shortly discusses the most recent experimental therapies.
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Affiliation(s)
- Jacqueline A G M Langedijk
- Amsterdam University Medical Centers, Tytgat Institute for Liver and Intestinal Research, Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), University of Amsterdam, Amsterdam, Netherlands
| | - Ulrich H Beuers
- Amsterdam University Medical Centers, Tytgat Institute for Liver and Intestinal Research, Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), University of Amsterdam, Amsterdam, Netherlands
| | - Ronald P J Oude Elferink
- Amsterdam University Medical Centers, Tytgat Institute for Liver and Intestinal Research, Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), University of Amsterdam, Amsterdam, Netherlands
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12
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Unexplained First Trimester Intrahepatic Cholestasis of Pregnancy: A Case Report and Literature Review. Case Rep Obstet Gynecol 2019; 2019:4980610. [PMID: 32089914 PMCID: PMC7024080 DOI: 10.1155/2019/4980610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/30/2019] [Indexed: 12/27/2022] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a condition that usually affects the 3rd trimester-pregnant women and is associated with adverse pregnancy outcomes. We present a 31-year-old G2P1 patient with symptoms of ICP as early as 10 weeks of gestation (WG). Her pruritis was initially attributed to eczema. Due to the intensity of her discomfort and failure of topical treatment, ICP was suspected, total bile acid salt levels were taken and ursodeoxycholic acid was subsequently started at 18 WG. The patient was followed closely during her pregnancy to adjust the dose of the medication accordingly. Induction of labor was performed at 37 WG without complications. This case demonstrated the importance of clinical suspicion in the setting of such symptomatology in order not to miss or delay treatment of threatening conditions such as ICP.
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Ahmad TR, Haeusler RA. Bile acids in glucose metabolism and insulin signalling - mechanisms and research needs. Nat Rev Endocrinol 2019; 15:701-712. [PMID: 31616073 PMCID: PMC6918475 DOI: 10.1038/s41574-019-0266-7] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
Abstract
Of all the novel glucoregulatory molecules discovered in the past 20 years, bile acids (BAs) are notable for the fact that they were hiding in plain sight. BAs were well known for their requirement in dietary lipid absorption and biliary cholesterol secretion, due to their micelle-forming properties. However, it was not until 1999 that BAs were discovered to be endogenous ligands for the nuclear receptor FXR. Since that time, BAs have been shown to act through multiple receptors (PXR, VDR, TGR5 and S1PR2), as well as to have receptor-independent mechanisms (membrane dynamics, allosteric modulation of N-acyl phosphatidylethanolamine phospholipase D). We now also have an appreciation of the range of physiological, pathophysiological and therapeutic conditions in which endogenous BAs are altered, raising the possibility that BAs contribute to the effects of these conditions on glycaemia. In this Review, we highlight the mechanisms by which BAs regulate glucose homeostasis and the settings in which endogenous BAs are altered, and provide suggestions for future research.
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Affiliation(s)
- Tiara R Ahmad
- Naomi Berrie Diabetes Center, Columbia University Medical Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Rebecca A Haeusler
- Naomi Berrie Diabetes Center, Columbia University Medical Center, New York, NY, USA.
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA.
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Intrahepatic Cholestasis of Pregnancy: A Case Study of the Rare Onset in the First Trimester. ACTA ACUST UNITED AC 2019; 55:medicina55080454. [PMID: 31404990 PMCID: PMC6723234 DOI: 10.3390/medicina55080454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, the patient decided to stop the pregnancy. After a month, the hepatogram was within the reference values. Very rarely an ICP can occur in early pregnancy (first trimester), which calls for close monitoring. The risk of serious adverse fetal outcomes and spontaneous preterm delivery is proportional with increased levels of maternal serum bile acid.
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15
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Manzotti C, Casazza G, Stimac T, Nikolova D, Gluud C. Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev 2019; 7:CD012546. [PMID: 31283001 PMCID: PMC6613619 DOI: 10.1002/14651858.cd012546.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, possibly associated with an increased risk of severe fetal adverse events. Total serum bile acids (TSBA) concentration, alone or in combination with serum aminotransferases, have been the most often used biomarkers for the diagnosis of intrahepatic cholestasis of pregnancy in clinical practice. Serum bile acid profile, composed of primary or secondary, conjugated or non-conjugated bile acids, may provide more specific disease information. OBJECTIVES To assess and compare, independently or in combination, the diagnostic accuracy of total serum bile acids or serum bile acids profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women, presenting with pruritus. To define the optimal cut-off values for components of serum bile acid profile; to investigate possible sources of heterogeneity. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register, the Cochrane Library, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, BIOSIS, CINAHL, two Chinese databases (CKNI, VIP), Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Evidence Search: Health and Social Care by the National Institute for Health and Care Excellence (NICE), the World Health Organization (WHO) Reproductive Health Library (RHL), and the Turning Research into Practice database (TRIP). The most recent date of search was 6 May 2019. We identified additional references by handsearching the references of articles, meta-analyses, and evidence-based guidelines retrieved from the computerised databases, on-line trial registries, and grey literature through OpenSIGLE, National Technical Information Service (NTIS), ProQuest Dissertations & Thesis Database, and Index to Theses in Great Britain and Ireland. SELECTION CRITERIA Prospective or retrospective diagnostic case-control or cross-sectional studies, irrespective of publication date, format, and language, which evaluated the diagnostic accuracy of total serum bile acids (TSBA) or components of serum bile acid profile for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women of any age or ethnicity, in any clinical setting, symptomatic for pruritus. DATA COLLECTION AND ANALYSIS We selected studies by reading titles, abstracts, or full texts, and assessing their fulfilment of our inclusion criteria. We emailed primary authors to request missing data or individual participant data. Having extracted data from each included study, we built the two-by-two tables for each primary study and for all the index tests considered. We estimated sensitivity and specificity with their 95% confidence intervals (CI). We presented data in coupled forest plots, showing sensitivities and specificities of each study, and we plotted the studies in the Receiver Operating Characteristic (ROC) space. We performed meta-analyses adopting the hierarchical summary ROC model (HSROC) or the bivariate model to meta-analyse the data. We made indirect comparisons of the considered index tests by adding the index tests as covariates to the bivariate or HSROC models. We performed heterogeneity analysis and sensitivity analysis on studies assessing TSBA accuracy. We used Review Manager 5 (RevMan 5) and SAS statistical software, release 9.4 (SAS Institute Inc., Cary, NC, USA), to perform all statistical analyses. We used QUADAS-2 domains to assess the risk of bias of the included studies. MAIN RESULTS Our search yielded 5073 references, but at the end of our selection process, only 16 studies fulfilled the review inclusion criteria. Nine of these provided individual participant data. We analysed only data concerning TSBA, cholic acid (CA), glycocholic acid (GCA), chenodeoxycholic acid (CDCA), and CA/CDCA because the remaining planned index tests were assessed in few studies. Only one study had low risk of bias in all four QUADAS-2 domains. The most biased domains were the patient sampling and the reference standard domains. When considering all studies with a cut-off of 10 μmol/L, TSBA overall sensitivity ranged from 0.72 to 0.98 and specificity ranged from 0.81 to 0.97. After a sensitivity analysis excluding case-control studies, TSBA sensitivity ranged from 0.48 to 0.66 and specificity from 0.52 to 0.99. After a sensitivity analysis excluding studies in which TSBA was part of the reference standard, TSBA sensitivity ranged from 0.49 to 0.65 and specificity from 0.53 to 0.99. We found the estimates of the overall accuracy for some serum bile acid components (CA, GCA, CDCA, and CA/CDCA) to be imprecise, with the CI for sensitivity and specificity very wide or impossible to calculate. Indirect comparisons between serum bile acid profile components and TSBA were not statistically significant. None of the heterogeneity analysis performed was statistically significant, except for the timing of assessment of TSBA (onset of symptoms, peak value among multiple assessments, delivery) but without clinically relevant results. We could not analyse the diagnostic accuracy of combinations of index tests because none of the included studies carried them out, and because of the small number of included studies. AUTHORS' CONCLUSIONS The overall high risk of bias, the existing concern regarding applicability of the results in clinical practice, and the great heterogeneity of the results in the included studies prevents us from making recommendations and reaching definitive conclusions at the present time. Thus, we do not find any compelling evidence to recommend or refute the routine use of any of these tests in clinical practice. So far, the diagnostic accuracy of TSBA for intrahepatic cholestasis of pregnancy might have been overestimated. There were too few studies to permit a precise estimate of the accuracy of serum bile acid profile components. Further primary clinical research is mandatory. We need both further phase II and phase III diagnostic studies.
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Affiliation(s)
- Cristina Manzotti
- Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico, Università degli Studi di MilanoObstetrics and Gynecology DepartmentVia Commenda 12 ‐ Clinica Mangiagalli, piano terraMilanMilanItaly20122
- Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
- Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico, Università degli Studi di MilanoGastro‐Intestinal UnitVia Commenda 12 ‐ Clinica Mangiagalli, 1° piano, scala AMilanMilanItaly20122
| | - Giovanni Casazza
- Università degli Studi di MilanoDipartimento di Scienze Biomediche e Cliniche "L. Sacco"via GB Grassi 74MilanItaly20157
| | - Tea Stimac
- Clinical Hospital Centre RijekaObstetrics and GynecologyCambierieva 17RijekaCroatia51000
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Abstract
Dubin-Johnson syndrome is an autosomal recessive condition characterized by recurrent episodes of jaundice and conjugated hyperbilirubinemia. It exacerbates during pregnancy and needs to be differentiated from other causes of jaundice. A 30-year-old patient presented to us with jaundice in her fourth pregnancy. She had intermittent episodes of jaundice earlier, with exacerbation in each pregnancy during the second trimester. The diagnosis of Dubin-Johnson syndrome was made on detailed evaluation along with histopathological confirmation on liver biopsy tissue. The patient was managed conservatively and had a good perinatal outcome.
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Affiliation(s)
- Avantika Gupta
- Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Purnima Tiwari
- Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi, IND
| | - Poonam Sachdeva
- Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi, IND
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17
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Burban A, Sharanek A, Humbert L, Eguether T, Guguen-Guillouzo C, Rainteau D, Guillouzo A. Predictive Value of Cellular Accumulation of Hydrophobic Bile Acids As a Marker of Cholestatic Drug Potential. Toxicol Sci 2019; 168:474-485. [DOI: 10.1093/toxsci/kfz009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Audrey Burban
- INSERM U1241, Numecan, Rennes, France
- University of Rennes 1, Rennes, France
| | - Ahmad Sharanek
- INSERM U1241, Numecan, Rennes, France
- University of Rennes 1, Rennes, France
| | - Lydie Humbert
- ERL INSERM U1157/UMR7203, Faculty of Medicine Pierre et Marie Curie Saint Antoine, Paris, France
| | - Thibaut Eguether
- ERL INSERM U1157/UMR7203, Faculty of Medicine Pierre et Marie Curie Saint Antoine, Paris, France
| | | | - Dominique Rainteau
- ERL INSERM U1157/UMR7203, Faculty of Medicine Pierre et Marie Curie Saint Antoine, Paris, France
| | - André Guillouzo
- INSERM U1241, Numecan, Rennes, France
- University of Rennes 1, Rennes, France
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18
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Diagnostic and therapeutic profiles of serum bile acids in women with intrahepatic cholestasis of pregnancy-a pseudo-targeted metabolomics study. Clin Chim Acta 2018; 483:135-141. [PMID: 29709452 DOI: 10.1016/j.cca.2018.04.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP), as a pregnancy-specific liver disorder, obtains increasing recognition due to a series of adverse outcomes. ICP is generally characterized by pruritus and jaundice, and closely related to abnormalities in the metabolism and disposition of bile acids composition. Because of its elusive pathogenesis, ICP has become an intractable issue to be diagnosed and managed for obstetricians. Analysis of metabolic profile could reveal the state of small-molecule metabolites systematically and provide comprehensively metabolic information for diseases. We developed a pseudo-targeted approach to perform metabolomic analysis of bile acids in serum using an ultra-performance liquid chromatography-triple quadrupole time-of-flight tandem mass spectrometry (UPLC-Triple TOF-MS/MS) method. METHODS We investigated the metabolites of bile acids in 55 healthy pregnant women, 42 women with ICP and 11 women with ICP who persisted to accept ursodeoxycholic acid (UDCA) therapy. RESULTS The metabolic profiles of serum bile acids were significantly altered in ICP group compared with the control group. A screened potential combination biomarker, with a high diagnostic efficiency (area under the curve = 0.996, Youden index = 0.940), was superior to total bile acids for the diagnosis of ICP. CONCLUSIONS The profiles of serum bile acids in women with ICP became more clear under the UDCA therapy, and were fully recovered after the delivery.
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19
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Cholestases intrahepatiques gravidiques (CIG) précoces et tardives : étude des complications materno-fœtales. ACTA ACUST UNITED AC 2018; 46:388-394. [DOI: 10.1016/j.gofs.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Indexed: 12/27/2022]
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20
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Feng C, Li WJ, He RH, Sun XW, Wang G, Wang LQ. Impacts of different methods of conception on the perinatal outcome of intrahepatic cholestasis of pregnancy in twin pregnancies. Sci Rep 2018; 8:3985. [PMID: 29507303 PMCID: PMC5838236 DOI: 10.1038/s41598-018-22387-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 02/22/2018] [Indexed: 12/15/2022] Open
Abstract
Twin pregnancies have a higher prevalence of intrahepatic cholestasis of pregnancy (ICP) than single pregnancies. It is unknown whether in vitro fertilization-embryo transfer (IVF-ET) influences the fetal outcomes in twin pregnancies complicated by ICP. This study aimed to explore the impact of IVF-ET on the perinatal outcomes of ICP in twin pregnancy. Clinical data from 142 twin pregnant women complicated with ICP were retrospectively analyzed, including 51 patients who conceived through IVF-ET (IVF group) and 91 patients with spontaneous conception (SC group). Several biochemical indicators and perinatal outcomes were analyzed. Compared to the SC group, the IVF group had a higher incidence of early-onset ICP (P = 0.015) and more frequent clinical symptoms (P = 0.020), including skin pruritus, skin scratch, and jaundice. Furthermore, the IVF group had higher rates of neonatal asphyxia (IVF vs. SC, 9.80% vs. 1.10%, P = 0.023) and premature delivery (IVF vs. SC, 96.08% vs. 83.52%, P = 0.027) compared to the SC group. The IVF-conceived twin pregnancy group had a higher risk of early-onset ICP and suffered from clinical symptoms and poor perinatal outcomes.
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Affiliation(s)
- Chun Feng
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.,The Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310006, China
| | - Wen-Juan Li
- The Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310006, China
| | - Rong-Huan He
- The Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310006, China
| | - Xi-Wen Sun
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Guirong Wang
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, 13210, USA
| | - Li-Quan Wang
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China. .,The Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310006, China.
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21
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Ma L, Zhang X, Pan F, Cui Y, Yang T, Deng L, Shao Y, Ding M. Urinary metabolomic analysis of intrahepatic cholestasis of pregnancy based on high performance liquid chromatography/mass spectrometry. Clin Chim Acta 2017; 471:292-297. [DOI: 10.1016/j.cca.2017.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 12/11/2022]
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22
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McIlvride S, Dixon PH, Williamson C. Bile acids and gestation. Mol Aspects Med 2017; 56:90-100. [PMID: 28506676 DOI: 10.1016/j.mam.2017.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/27/2017] [Accepted: 05/08/2017] [Indexed: 12/22/2022]
Abstract
There are numerous profound maternal physiological changes that occur from conception onwards and adapt throughout gestation in order to support a healthy pregnancy. By the time of late gestation, when circulating pregnancy hormones are at their highest concentrations, maternal adaptations include relative hyperlipidemia, hypercholanemia and insulin resistance. Bile acids have now been established as key regulators of metabolism, and their role in gestational changes in metabolism is becoming apparent. Bile acid homeostasis is tightly regulated by the nuclear receptor FXR, which has been shown to have reduced activity during pregnancy. This review focuses on the gestational alterations in bile acid homeostasis that occur in normal pregnancy, which in some women can become pathological, leading to the development of intrahepatic cholestasis of pregnancy. As well as their important role in maternal metabolic health, we will review bile acid metabolism in the feto-placental unit.
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Affiliation(s)
- Saraid McIlvride
- Division of Women's Health, King's College London, Guy's Campus, Hodgkin Building, SE1 1UL, London, United Kingdom
| | - Peter H Dixon
- Division of Women's Health, King's College London, Guy's Campus, Hodgkin Building, SE1 1UL, London, United Kingdom
| | - Catherine Williamson
- Division of Women's Health, King's College London, Guy's Campus, Hodgkin Building, SE1 1UL, London, United Kingdom.
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23
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Van Herpe F, Waterham HR, Adams CJ, Mannens M, Bikker H, Vaz FM, Cassiman D. NTCP deficiency and persistently raised bile salts: an adult case. J Inherit Metab Dis 2017; 40:313-315. [PMID: 28283843 DOI: 10.1007/s10545-017-0031-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Filip Van Herpe
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hans R Waterham
- Department of Clinical Chemistry and Pediatrics, Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Christopher J Adams
- Undiagnosed Diseases Program, National Institutes of Health, Bethesda, MD, USA
| | - Marcel Mannens
- Department of Clinical Genetics, Genome Diagnostics Laboratory, Academic Medical Center, Amsterdam, The Netherlands
| | - Hennie Bikker
- Department of Clinical Genetics, Genome Diagnostics Laboratory, Academic Medical Center, Amsterdam, The Netherlands
| | - Frédéric M Vaz
- Department of Clinical Chemistry and Pediatrics, Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - David Cassiman
- Department of Gastroenterology-Hepatology and Metabolic Center, University Hospitals Leuven, Leuven, Belgium.
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24
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Mutlu MF, Aslan K, Guler I, Mutlu I, Erdem M, Bozkurt N, Erdem A. Two cases of first onset intrahepatic cholestasis of pregnancy associated with moderate ovarian hyperstimulation syndrome after IVF treatment and review of the literature. J OBSTET GYNAECOL 2017; 37:547-549. [PMID: 28319428 DOI: 10.1080/01443615.2017.1286302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is an uncommon disorder, which generally occurs in the second and third trimester of pregnancy with symptoms of pruritus. The cause of ICP is unknown but genetic, hormonal and environmental factors contribute to its pathogenesis. The aetiology of ICP is unclear but elevation in oestrogen levels thought to cause ICP is typically seen in the third trimester of pregnancy, and for this reason it is not usually considered in the differential diagnosis of pruritus and liver function disorders in the first trimester of the pregnancy. We present two cases of pregnancy after IVF treatment diagnosed with ICP following the development of OHSS, deteriorating liver function tests and severe pruritus.
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Affiliation(s)
- Mehmet Firat Mutlu
- a Department of Obstetrics & Gynecology , Yuksek Ihtisas University Faculty of Medicine , Ankara , Turkey
| | - Koray Aslan
- b Department of Obstetrics & Gynecology , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Ismail Guler
- b Department of Obstetrics & Gynecology , Gazi University Faculty of Medicine , Ankara , Turkey
| | | | - Mehmet Erdem
- b Department of Obstetrics & Gynecology , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Nuray Bozkurt
- b Department of Obstetrics & Gynecology , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Ahmet Erdem
- b Department of Obstetrics & Gynecology , Gazi University Faculty of Medicine , Ankara , Turkey
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25
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Manzotti C, Casazza G, Stimac T, Nikolova D, Gluud C. Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Cristina Manzotti
- Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano; Obstetrics and Gynecology Department; Via Commenda 12 - Clinica Mangiagalli, piano terra Milan Milan Italy 20122
- Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; Copenhagen Denmark
- Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano; Gastro-Intestinal Unit; Via Commenda 12 - Clinica Mangiagalli, 1° piano, scala A Milan Milan Italy 20122
| | - Giovanni Casazza
- Università degli Studi di Milano; Dipartimento di Scienze Biomediche e Cliniche "L. Sacco"; via GB Grassi 74 Milan Italy 20157
| | - Tea Stimac
- Clinical Hospital Centre Rijeka; Obstetrics and Gynecology; Cambierieva 17 Rijeka Croatia 51000
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
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Abstract
The aim of the present work was to determine maternal and fetal outcomes of intrahepatic cholestasis of pregnancy (ICP) in twin pregnancies. All twin pregnancies delivered above 28 gestational weeks in West China Second University Hospital from January 2013 to May 2015 were included. Data on maternal demographics and obstetric complications together with fetal outcomes were collected. The risk of adverse maternal and fetal outcomes were determined in relation to ICP by crude odds ratios (OR) and adjusted ORs (aOR) with 95% confidence intervals (CI). Subgroup analysis concentrated on the effect of assisted reproductive technology (ART), ICP severity, and onset time. A total of 1,472 twin pregnancies were included, of which 362 were cholestasis patients and 677 were conceived by ART. Higher rates of preeclampsia (aOR 1.96; 95% CI 1.35, 2.85), meconium-stained amniotic fluid (aOR 3.10; 95% CI 2.10, 4.61), and preterm deliveries (aOR 3.20; 95% CI 2.35, 4.37) were observed in ICP patients. Subgroup analysis revealed higher incidences of adverse outcomes in severe and early onset ICP groups. In conclusion, adverse maternal and fetal outcomes were strongly associated with ICP in twin patients. Active management and close antenatal monitoring are needed, especially in the early onset and severe groups.
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Pařízek A, Dušková M, Vítek L, Šrámková M, Hill M, Adamcová K, Šimják P, Černý A, Kordová Z, Vráblíková H, Boudová B, Koucký M, Malíčková K, Stárka L. The role of steroid hormones in the development of intrahepatic cholestasis of pregnancy. Physiol Res 2016; 64:S203-9. [PMID: 26680481 DOI: 10.33549/physiolres.933117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a disorder of liver function, commonly occurring in the third trimester but sometimes also as soon as the end of the second trimester of pregnancy. Symptoms of this disorder include pruritus, plus abnormal values of bile acids and hepatic transaminases. After birth, symptoms disappear and liver function returns to normal. Though ICP is relatively non-complicated and often symptomatically mild from the point-of-view of the mother, it presents a serious risk to the fetus, making this disease the subject of great interest. The etiology and pathogenesis of ICP is multifactorial and as yet not fully elucidated. Hormonal factors likely play a significant role, along with genetic as well as exogenous factors. Here we summarize the knowledge of changes in steroid hormones and their role in the development of intrahepatic cholestasis of pregnancy. In addition, we consider the role of exogenous factors as possible triggers of steroid hormone changes, the relationship between metabolic steroids and bile acids, as well as the combination of these factors in the development of ICP in predisposed pregnant women.
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Affiliation(s)
- A Pařízek
- Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic, Institute of Endocrinology, Prague, Czech Republic.
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Pařízek A, Hill M, Dušková M, Vítek L, Velíková M, Kancheva R, Šimják P, Koucký M, Kokrdová Z, Adamcová K, Černý A, Hájek Z, Stárka L. A Comprehensive Evaluation of Steroid Metabolism in Women with Intrahepatic Cholestasis of Pregnancy. PLoS One 2016; 11:e0159203. [PMID: 27494119 PMCID: PMC4975406 DOI: 10.1371/journal.pone.0159203] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/28/2016] [Indexed: 12/27/2022] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a common liver disorder, mostly occurring in the third trimester. ICP is defined as an elevation of serum bile acids, typically accompanied by pruritus and elevated activities of liver aminotransferases. ICP is caused by impaired biliary lipid secretion, in which endogenous steroids may play a key role. Although ICP is benign for the pregnant woman, it may be harmful for the fetus. We evaluated the differences between maternal circulating steroids measured by RIA (17-hydroxypregnenolone and its sulfate, 17-hydroxyprogesterone, and cortisol) and GC-MS (additional steroids), hepatic aminotransferases and bilirubin in women with ICP (n = 15, total bile acids (TBA) >8 μM) and corresponding controls (n = 17). An age-adjusted linear model, receiver-operating characteristics (ROC), and multivariate regression (a method of orthogonal projections to latent structure, OPLS) were used for data evaluation. While aminotransferases, conjugates of pregnanediols, 17-hydroxypregnenolone and 5β-androstane-3α,17β-diol were higher in ICP patients, 20α-dihydropregnenolone, 16α-hydroxy-steroids, sulfated 17-oxo-C19-steroids, and 5β-reduced steroids were lower. The OPLS model including steroids measured by GC-MS and RIA showed 93.3% sensitivity and 100% specificity, while the model including steroids measured by GC-MS in a single sample aliquot showed 93.3% sensitivity and 94.1% specificity. A composite index including ratios of sulfated 3α/β-hydroxy-5α/β-androstane-17-ones to conjugated 5α/β-pregnane-3α/β, 20α-diols discriminated with 93.3% specificity and 81.3% sensitivity (ROC analysis). These new data demonstrating altered steroidogenesis in ICP patients offer more detailed pathophysiological insights into the role of steroids in the development of ICP.
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Affiliation(s)
- Antonín Pařízek
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Prague, Czech Republic
- * E-mail:
| | | | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics and 4th Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
| | | | | | - Patrik Šimják
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Michal Koucký
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Zuzana Kokrdová
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Karolína Adamcová
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Andrej Černý
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Zdeněk Hájek
- Department of Obstetrics and Gynecology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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29
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Abstract
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease during pregnancy, characterized by otherwise unexplained pruritus in late second and third trimester of pregnancy and elevated bile acids and/or transaminases. ICP is associated with an increased risk of adverse perinatal outcomes for the fetus and the later development of hepatobiliary disease for the mother. Bile acids should be monitored throughout pregnancy since fetal risk is increased at serum bile acids >40 µmol/l. Management of ICP consists of treatment with ursodeoxycholic acid, which reduces pruritus. Early elective delivery is common practice but should be performed on an individualized basis as long as strong evidence supporting this practice is lacking. Mothers should be followed-up for normalization of liver function tests 6-12 weeks after delivery. Future research in large-scale studies is needed to address the impact of ursodeoxycholic acid and early elective delivery on fetal outcome.
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Affiliation(s)
- Hanns-Ulrich Marschall
- a Department of Molecular and Clinical Medicine, University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, S-41345 Gothenburg, Sweden
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30
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Bile acids in drug induced liver injury: Key players and surrogate markers. Clin Res Hepatol Gastroenterol 2016; 40:257-266. [PMID: 26874804 DOI: 10.1016/j.clinre.2015.12.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/21/2015] [Accepted: 12/27/2015] [Indexed: 02/04/2023]
Abstract
Bile acid research has gained great momentum since the role of bile acids as key signaling molecules in the enterohepatic circulation was discovered. Their physiological function in regulating their own homeostasis, as well as energy and lipid metabolism make them interesting targets for the pharmaceutical industry in the context of diseases such as bile acid induced diarrhea, bile acid induced cholestasis or nonalcoholic steatohepatitis. Changes in bile acid homeostasis are also linked to various types of drug-induced liver injury (DILI). However, the key question whether bile acids are surrogate markers for monitoring DILI or key pathogenic players in the onset and progression of DILI is under intense investigation. The purpose of this review is to summarize the different facets of bile acids in the context of normal physiology, hereditary defects of bile acid transport and DILI.
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31
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Abu‐Hayyeh S, Ovadia C, Lieu T, Jensen DD, Chambers J, Dixon PH, Lövgren‐Sandblom A, Bolier R, Tolenaars D, Kremer AE, Syngelaki A, Noori M, Williams D, Marin JJ, Monte MJ, Nicolaides KH, Beuers U, Oude‐Elferink R, Seed PT, Chappell L, Marschall H, Bunnett NW, Williamson C. Prognostic and mechanistic potential of progesterone sulfates in intrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology 2016; 63:1287-98. [PMID: 26426865 PMCID: PMC4869673 DOI: 10.1002/hep.28265] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/28/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED A challenge in obstetrics is to distinguish pathological symptoms from those associated with normal changes of pregnancy, typified by the need to differentiate whether gestational pruritus of the skin is an early symptom of intrahepatic cholestasis of pregnancy (ICP) or due to benign pruritus gravidarum. ICP is characterized by raised serum bile acids and complicated by spontaneous preterm labor and stillbirth. A biomarker for ICP would be invaluable for early diagnosis and treatment and to enable its differentiation from other maternal diseases. Three progesterone sulfate compounds, whose concentrations have not previously been studied, were newly synthesized and assayed in the serum of three groups of ICP patients and found to be significantly higher in ICP at 9-15 weeks of gestation and prior to symptom onset (group 1 cases/samples: ICP n = 35/80, uncomplicated pregnancy = 29/100), demonstrating that all three progesterone sulfates are prognostic for ICP. Concentrations of progesterone sulfates were associated with itch severity and, in combination with autotaxin, distinguished pregnant women with itch that would subsequently develop ICP from pruritus gravidarum (group 2: ICP n = 41, pruritus gravidarum n = 14). In a third group of first-trimester samples all progesterone sulfates were significantly elevated in serum from low-risk asymptomatic women who subsequently developed ICP (ICP/uncomplicated pregnancy n = 54/51). Finally, we show mechanistically that progesterone sulfates mediate itch by evoking a Tgr5-dependent scratch response in mice. CONCLUSION Our discovery that sulfated progesterone metabolites are a prognostic indicator for ICP will help predict onset of ICP and distinguish it from benign pruritus gravidarum, enabling targeted obstetric care to a high-risk population. Delineation of a progesterone sulfate-TGR5 pruritus axis identifies a therapeutic target for itch management in ICP.
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Affiliation(s)
- Shadi Abu‐Hayyeh
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Caroline Ovadia
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - TinaMarie Lieu
- Monash Institute of Pharmaceutical Sciences and Australian Research Council Centre of Excellence in Convergent Bio‐Nano Science and TechnologyMonash UniversityParkvilleVictoriaAustralia
| | - Dane D. Jensen
- Monash Institute of Pharmaceutical Sciences and Australian Research Council Centre of Excellence in Convergent Bio‐Nano Science and TechnologyMonash UniversityParkvilleVictoriaAustralia
| | - Jenny Chambers
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUnited Kingdom
| | - Peter H. Dixon
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUnited Kingdom
| | | | - Ruth Bolier
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CentreAmsterdamThe Netherlands
| | - Dagmar Tolenaars
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CentreAmsterdamThe Netherlands
| | - Andreas E. Kremer
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CentreAmsterdamThe Netherlands
- Department of Medicine 1Friedrich‐Alexander‐University of Erlangen‐NurembergErlangenGermany
| | - Argyro Syngelaki
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUnited Kingdom
| | - Muna Noori
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUnited Kingdom
| | - David Williams
- Institute for Women's HealthUniversity College London HospitalsLondonUnited Kingdom
| | - Jose J.G. Marin
- Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), Biomedical Research Institute of Salamanca (IBSAL)University of Salamanca, National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)SalamancaSpain
| | - Maria J. Monte
- Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), Biomedical Research Institute of Salamanca (IBSAL)University of Salamanca, National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)SalamancaSpain
| | - Kypros H. Nicolaides
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUnited Kingdom
| | - Ulrich Beuers
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CentreAmsterdamThe Netherlands
| | - Ronald Oude‐Elferink
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CentreAmsterdamThe Netherlands
| | - Paul T. Seed
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Lucy Chappell
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Hanns‐Ulrich Marschall
- Institute of Medicine, Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
| | - Nigel W. Bunnett
- Monash Institute of Pharmaceutical Sciences and Australian Research Council Centre of Excellence in Convergent Bio‐Nano Science and TechnologyMonash UniversityParkvilleVictoriaAustralia
- Department of PharmacologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Catherine Williamson
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUnited Kingdom
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32
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Reyes H. Sulfated progesterone metabolites in the pathogenesis of intrahepatic cholestasis of pregnancy: Another loop in the ascending spiral of medical knowledge. Hepatology 2016; 63:1080-2. [PMID: 26599133 DOI: 10.1002/hep.28365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/20/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Humberto Reyes
- Departamento de Medicina Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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33
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Dixon PH, Williamson C. The pathophysiology of intrahepatic cholestasis of pregnancy. Clin Res Hepatol Gastroenterol 2016; 40:141-53. [PMID: 26823041 DOI: 10.1016/j.clinre.2015.12.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/02/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023]
Abstract
A number of liver disorders are specific to pregnancy. Amongst these, intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC), is the commonest, affecting approximately 1 in 140 UK pregnancies. Patients commonly present in the third trimester with severe pruritus and deranged serum liver tests; bile acids are elevated, in severe cases >40 μmol/L. Although the disease is considered relatively benign for the mother, increased rates of adverse fetal outcomes, including stillbirth, are associated with ICP. As our knowledge of the mechanisms underlying bile acid homeostasis has advanced in the last 15 years our understanding of ICP has grown, in particular with respect to genetic influences on susceptibility to the disease, the role of reproductive hormones and their metabolites and the possible identity of the pruritic agents. In this review, we will describe recent advances in the understanding of this condition with a particular emphasis on how aspects of genetic and reproductive hormone involvement in pathophysiology have been elucidated. We also review recent developments regarding our knowledge of placental and fetal pathophysiology and the long-term health consequences for the mother and child.
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Affiliation(s)
- Peter H Dixon
- Division of Women's Health, 2.30W Hodgkin Building, King's College London, Guy's Campus, SE1 1UL London, United Kingdom
| | - Catherine Williamson
- Division of Women's Health, 2.30W Hodgkin Building, King's College London, Guy's Campus, SE1 1UL London, United Kingdom.
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34
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Rodríguez M, Moreno J, Márquez R, Eltit R, Martinez F, Sepúlveda-Martínez A, Parra-Cordero M. Increased PR Interval in Fetuses of Patients with Intrahepatic Cholestasis of Pregnancy. Fetal Diagn Ther 2016; 40:298-302. [DOI: 10.1159/000444297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/26/2016] [Indexed: 11/19/2022]
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35
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Abstract
Intrahepatic cholestasis of pregnancy, also known as obstetric cholestasis, is a pruritic condition of pregnancy characterized by an underlying elevation in circulating bile acids and liver derangement, and associated with adverse fetal outcomes, such as preterm labor and stillbirth. Limited understanding of the underlying pathophysiology and mechanisms involved in adverse outcomes has previously restricted treatment options and pregnancy management. Recent advances in these research fields provide tantalizing targets to improve the care of pregnant women affected by this condition.
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Affiliation(s)
- Caroline Ovadia
- Women's Health Academic Centre, King's College London, London, United Kingdom
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36
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Reyes H. What have we learned about intrahepatic cholestasis of pregnancy? Hepatology 2016; 63:4-8. [PMID: 26473339 DOI: 10.1002/hep.28295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Humberto Reyes
- Department of Medicine, Faculty of Medicine, University of Chile, Santiago de Chile
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37
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Fischer T, Grab D, Grubert T, Hantschmann P, Kainer F, Kästner R, Kentenich C, Klockenbusch W, Lammert F, Louwen F, Mylonas I, Pildner von Steinburg S, Rath W, Schäfer-Graf UM, Schleußner E, Schmitz R, Steitz HO, Verlohren S. Maternale Erkrankungen in der Schwangerschaft. FACHARZTWISSEN GEBURTSMEDIZIN 2016. [PMCID: PMC7158353 DOI: 10.1016/b978-3-437-23752-2.00017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Estiú MC, Monte MJ, Rivas L, Moirón M, Gomez-Rodriguez L, Rodriguez-Bravo T, Marin JJG, Macias RIR. Effect of ursodeoxycholic acid treatment on the altered progesterone and bile acid homeostasis in the mother-placenta-foetus trio during cholestasis of pregnancy. Br J Clin Pharmacol 2015; 79:316-29. [PMID: 25099365 DOI: 10.1111/bcp.12480] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus and elevated bile acid concentrations in maternal serum. This is accompanied by an enhanced risk of intra-uterine and perinatal complications. High concentrations of sulphated progesterone metabolites (PMS) have been suggested to be involved in the multifactorial aetiopathogenesis of ICP. The aim of this study was to investigate further the mechanism accounting for the beneficial effect of oral administration of ursodeoxycholic acid (UDCA), which is the standard treatment, regarding bile acid and PMS homeostasis in the mother-placenta-foetus trio. METHOD Using HPLC-MS/MS bile acids and PMS were determined in maternal and foetal serum and placenta. The expression of ABC proteins in placenta was determined by real time quantitative PCR (RT-QPCR) and immunofluorescence. RESULTS In ICP, markedly increased concentrations of bile acids (tauroconjugates > glycoconjugates >> unconjugated), progesterone and PMS in placenta and maternal serum were accompanied by enhanced concentrations in foetal serum of bile acids, but not of PMS. UDCA treatment reduced bile acid accumulation in the mother-placenta-foetus trio, but had no significant effect on progesterone and PMS concentrations. ABCG2 mRNA abundance was increased in placentas from ICP patients vs. controls and remained stable following UDCA treatment, despite an apparent further increase in ABCG2. CONCLUSION UDCA administration partially reduces ICP-induced bile acid accumulation in mothers and foetuses despite the lack of effect on concentrations of progesterone and PMS in maternal serum. Up-regulation of placental ABCG2 may play an important role in protecting the foetus from high concentrations of bile acids and PMS during ICP.
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Affiliation(s)
- Maria C Estiú
- Ramón Sardá Mother' and Children's Hospital, Buenos Aires, Argentina
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39
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Weinberg A, Allshouse A, Kinzie K, Cho A, Davies JK, Mc Farland EJ. Intrahepatic Cholestasis of Pregnancy and Serum Bile Acids in HIV-Infected Pregnant Women. ACTA ACUST UNITED AC 2015; 6. [PMID: 26236558 PMCID: PMC4519986 DOI: 10.4172/2155-6113.1000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Intra-hepatic cholestasis of pregnancy (ICP) is uncommon, but has severe effects on pregnancy outcomes. ICP is characterized by elevated serum bile acids and liver enzymes and preferentially affects women with liver disorders. We compared bile acids and pregnancy outcomes of HIV-infected pregnant women, who commonly have elevated live enzymes, with uninfected controls. METHODS Twenty-four HIV-infected, including 2 co-infected with hepatitis C virus (HCV), and 25 uninfected women were tested during early and late pregnancy and postpartum. RESULTS After exclusion of the HCV-infected women, serum bile acids were similar in HIV-infected and uninfected participants. -glutamyl transpeptidase was elevated in HIV-infected compared with uninfected women during pregnancy and postpartum. Bilirubin and aspartate transaminase were higher in uninfected compared with HIV-infected women in early pregnancy, but subsequently similar. Bile acids in late pregnancy correlated with bile acids in the baby at birth. An HIV- and HCV-co-infected pregnant woman with active hepatitis developed ICP complicated by fetal distress. Another co-infected participant without active hepatitis had an uneventful pregnancy and delivery. CONCLUSION In the absence of HCV co-infection, bile acid metabolism appeared to be similar in HIV-infected and uninfected pregnant women. Both HIV-infected and uninfected pregnant women had mild liver enzyme elevations.
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Affiliation(s)
- Adriana Weinberg
- Department of Pediatrics, the University of Colorado School of Medicine, USA ; Department of Medicine, the University of Colorado School of Medicine, USA ; Department of Pathology, the University of Colorado School of Medicine, USA ; University of Colorado Hospital, USA ; Childrens Hospital Colorado, Aurora CO, USA
| | - Amanda Allshouse
- Department of Preventative Medicine, the University of Colorado School of Medicine, USA ; Childrens Hospital Colorado, Aurora CO, USA
| | - Kay Kinzie
- Department of Pediatrics, the University of Colorado School of Medicine, USA ; Childrens Hospital Colorado, Aurora CO, USA
| | - Alice Cho
- Department of Pediatrics, the University of Colorado School of Medicine, USA
| | - Jill K Davies
- Departments of Obstetrics and Gynecology, the University of Colorado School of Medicine, USA ; University of Colorado Hospital, USA ; Denver Health Medical Center, Denver CO, USA
| | - Elizabeth J Mc Farland
- Department of Pediatrics, the University of Colorado School of Medicine, USA ; Childrens Hospital Colorado, Aurora CO, USA
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Abstract
Sulfated progesterone metabolites rise 100-fold in the third trimester of human pregnancy and have been shown to be elevated further in the gestational disorder intrahepatic cholestasis of pregnancy (ICP). Typical concentrations of progesterone sulfates range from 1 to 10 µmol/L in an uncomplicated pregnancy and rise to approximately 40 µmol/L in ICP. At this level they can influence bile acid and lipid metabolism. Studies using human and rodent specimens have shown that sulfated metabolites of progesterone competitively inhibit bile acid homeostasis pathways by functioning as partial agonists of farnesoid X receptor (FXR). This explains the loss of induction of FXR target genes in ICP, and may explain susceptibility to hypercholanaemia and dyslipidaemia in the second half of human pregnancy. Furthermore, progesterone sulfates are competitive inhibitors of biliary influx (NTCP) and efflux (BSEP) transport proteins, actions likely to further exacerbate hypercholanaemia and cholestasis.
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Affiliation(s)
- Shadi Abu-Hayyeh
- Women's Health Academic Centre, Kings College London, London, UK
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41
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Bassari R, Koea JB. Jaundice associated pruritis: A review of pathophysiology and treatment. World J Gastroenterol 2015; 21:1404-1413. [PMID: 25663760 PMCID: PMC4316083 DOI: 10.3748/wjg.v21.i5.1404] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/19/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
To review the underlying pathophysiology and currently available treatments for pruritis associated with jaundice. English language literature was reviewed using MEDLINE, PubMed, EMBASE and clinicaltrials.gov for papers and trails addressing the pathophysiology and potential treatments for pruritis associated with jaundice. Recent advances in the understanding of the peripheral anatomy of itch transmission have defined a histamine stimulated pathway and a cowhage stimulated pathway with sensation conveyed centrally via the contralateral spinothalamic tract. Centrally, cowhage and histamine stimulated neurons terminate widely within the thalamus and sensorimotor cortex. The causative factors for itch in jaundice have not been clarified although endogenous opioids, serotonin, steroid and lysophosphatidic acid all play a role. Current guidelines for the treatment of itching in jaundice recommend initial management with biliary drainage where possible and medical management with ursodeoxycholic acid, followed by cholestyramine, rifampicin, naltrexone and sertraline. Other than biliary drainage no single treatment has proved universally effective. Pruritis associated with jaundice is a common but poorly understood condition for which biliary drainage is the most effective therapy. Pharmacological therapy has advanced but remains variably effective.
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42
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Bryan MB, Chung-Davidson YW, Ren J, Bowman S, Scott AP, Huertas M, Connolly MP, Li W. Evidence that progestins play an important role in spermiation and pheromone production in male sea lamprey (Petromyzon marinus). Gen Comp Endocrinol 2015; 212:17-27. [PMID: 25623147 DOI: 10.1016/j.ygcen.2015.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 12/30/2014] [Accepted: 01/14/2015] [Indexed: 11/22/2022]
Abstract
Progestins (progestogens, C21 steroids) have been shown to regulate key physiological activities for reproduction in both sexes in all classes of vertebrates except for Agnathans. Progesterone (P) and 15α-hydroxyprogesterone (15α-P) have been detected in sea lamprey (Petromyzon marinus) plasma, but the expression patterns and functions of putative progestin receptor genes have not yet been investigated. The first objective of this study was to determine the differences in mRNA expression levels of nuclear progestin receptor (nPR) and the membrane receptor adaptor protein 'progesterone receptor membrane component 1' (pgrmc1) in putative target tissues in males at different life stages, with and without lamprey GnRH-I and -III treatment. The second objective was to demonstrate the function of progestins by implanting prespermiating males (PSM) with time-release pellets of P and measuring the latency to the onset of spermiation and plasma concentrations of sex pheromones and steroids. The third objective was to measure the binding affinity of P in the nuclear and membrane fractions of the target tissues. Expression levels of nPR and pgrmc1 differed between life stages and tissues, and in some cases were differentially responsive to lamprey GnRH-I and -III. Increases in nPR and pgrmc1 gene expressions were correlated to the late stages of sexual maturation in males. The highest expression levels of these genes were found in the liver and gill of spermiating males. These organs are, respectively, the site of production and release of the sex pheromone 3 keto-petromyzonol sulfate (3kPZS). The hypothesis that pheromone production may be under hormonal control was tested in vivo by implanting PSM with time-release pellets of P. Concentrations of 3kPZS in plasma after 1week were 50-fold higher than in controls or in males that had been implanted with androstenedione, supporting the hypothesis that P is responsible for regulating the production of the sex pheromone. P treatment also accelerated the onset of spermiation. Saturation and Scatchard analyses of the target tissues showed that both nuclear and membrane fractions bound P with high affinity and low capacity (KD 0.53pmol/g testis and 0.22 pmol/g testis, and Bmax 1.8 and 5.7 nM, respectively), similar to the characteristics of nPR and mPR in other fish. The fact that a high proportion of P was also converted in vivo to 15α-P means that it is not yet possible to determine which of these two steroids is the natural ligand in the sea lamprey.
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Affiliation(s)
- Mara Beth Bryan
- Department of Fisheries and Wildlife, Michigan State University, 13 Natural Resources Building, 480 Wilson Road, East Lansing, MI 48824, USA
| | - Yu-Wen Chung-Davidson
- Department of Fisheries and Wildlife, Michigan State University, 13 Natural Resources Building, 480 Wilson Road, East Lansing, MI 48824, USA
| | - Jianfeng Ren
- College of Fisheries and Life Sciences, Shanghai Ocean University, 999 Huchenghuan Road, Shanghai 201306, China
| | - Stephen Bowman
- Department of Fisheries and Wildlife, Michigan State University, 13 Natural Resources Building, 480 Wilson Road, East Lansing, MI 48824, USA
| | - Alexander P Scott
- The Centre for Environment, Fisheries and Aquaculture Science, Barrack Road, Weymouth, Dorset DT4 8UB, UK
| | - Mar Huertas
- Department of Fisheries and Wildlife, Michigan State University, 13 Natural Resources Building, 480 Wilson Road, East Lansing, MI 48824, USA
| | - Michael Patrick Connolly
- Department of Biochemistry and Molecular Biology, Michigan State University, 212 Biochemistry Building, 603 Wilson Road, East Lansing, MI 48824, USA
| | - Weiming Li
- Department of Fisheries and Wildlife, Michigan State University, 13 Natural Resources Building, 480 Wilson Road, East Lansing, MI 48824, USA.
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Abu-Hayyeh S, Williamson C. Estradiol, farnesoid X receptor, and altered metabolism in pregnancy. Hepatology 2014; 60:1815-7. [PMID: 24975680 DOI: 10.1002/hep.27280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/24/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Shadi Abu-Hayyeh
- Women's Health Academic Centre, Kings College London, Guy's Campus, London, UK
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44
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Receptors, cells and circuits involved in pruritus of systemic disorders. Biochim Biophys Acta Mol Basis Dis 2014; 1842:869-92. [DOI: 10.1016/j.bbadis.2014.02.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/16/2014] [Accepted: 02/18/2014] [Indexed: 12/12/2022]
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45
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Al-Obaidly S, Parrish J, Murphy KE, Maxwell C. Maternal pre-gravid body mass index and obstetric outcomes in twin gestations. J Perinatol 2014; 34:425-8. [PMID: 24603456 DOI: 10.1038/jp.2014.29] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/27/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the impact of maternal pre-gravid and/or first trimester overweight and obesity, and the adverse obstetrics outcome in twin pregnancies. STUDY DESIGN This is a retrospective study of women who delivered viable twins after 23 weeks of gestation with available prepregnancy body mass index (BMI) and/or were at their earliest visit during the first trimester of pregnancy in the period 2007-2011. The patients were divided into four subgroups according to their BMI (underweight, normal weight, overweight and obese) according to the WHO classification and their outcomes were compared. Obstetrical outcomes of interest including gestational diabetes, gestational hypertension, preterm birth, antepartum hemorrhage, intrahepatic cholestasis of pregnancy, method of delivery and neonatal intensive care unit (NICU) admission were all studied and compared. RESULT Electronic records of 1228 pregnant subjects who delivered twins were abstracted. Five hundred and four patients with twin gestations with available BMI were identified (underweight BMI<18.5% (n=22), normal weight BMI 18.5-24.9% (n=260), overweight 25-29.9% (n=114) and obese ⩾30% (n=108)). Obstetric complications occurred more often in the overweight and obese groups as compared with the normal weight group. There was an increased risk of gestational diabetes in overweight and obese women (odds ratio (OR), 3.3; 95% confidence interval (CI) 1.52-7.3; P=0.001) and (OR, 3.2; 95% CI, 1.41-7.1; P=0.002), respectively. There was an increased risk of gestational hypertension in the obese group compared with the normal weight group (OR, 2.29; 95% CI, 1.1-4.7; P=0.02) but not in the overweight group (OR, 1.71; 95% CI, 0.8-3.6; P=0.1). In addition, an increased risk of very preterm delivery (<32 weeks) in the overweight group and obese groups was seen when compared with the normal weight group (OR, 2.2; 95% CI, 1.18-4.20; P=0.014 and OR, 2; 95% CI, 1.024-3.91; P=0.04, respectively). Increased rate of cesarean section in the obese group was seen when compared with the normal weight group (OR, 2; 95% CI, 1.2-3.4; P=0.006). Risks of antepartum hemorrhage, intrahepatic cholestasis and NICU admission were similar between the groups. CONCLUSION In addition to the known obstetrics complications associated with twin gestations, the pregnancy outcomes in twins are further adversely influenced by increased maternal prepregnancy BMI.
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Affiliation(s)
- S Al-Obaidly
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - J Parrish
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - K E Murphy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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46
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Geenes V, Lövgren-Sandblom A, Benthin L, Lawrance D, Chambers J, Gurung V, Thornton J, Chappell L, Khan E, Dixon P, Marschall HU, Williamson C. The reversed feto-maternal bile acid gradient in intrahepatic cholestasis of pregnancy is corrected by ursodeoxycholic acid. PLoS One 2014; 9:e83828. [PMID: 24421907 PMCID: PMC3885440 DOI: 10.1371/journal.pone.0083828] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/08/2013] [Indexed: 12/03/2022] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with an increased risk of adverse fetal outcomes. It is characterised by raised maternal serum bile acids, which are believed to cause the adverse outcomes. ICP is commonly treated with ursodeoxycholic acid (UDCA). This study aimed to determine the fetal and maternal bile acid profiles in normal and ICP pregnancies, and to examine the effect of UDCA treatment. Matched maternal and umbilical cord serum samples were collected from untreated ICP (n = 18), UDCA-treated ICP (n = 46) and uncomplicated pregnancy (n = 15) cases at the time of delivery. Nineteen individual bile acids were measured using HPLC-MS/MS. Maternal and fetal serum bile acids are significantly raised in ICP compared with normal pregnancy (p = <0.0001 and <0.05, respectively), predominantly due to increased levels of conjugated cholic and chenodeoxycholic acid. There are no differences between the umbilical cord artery and cord vein levels of the major bile acid species. The feto-maternal gradient of bile acids is reversed in ICP. Treatment with UDCA significantly reduces serum bile acids in the maternal compartment (p = <0.0001), thereby reducing the feto-maternal transplacental gradient. UDCA-treatment does not cause a clinically important increase in lithocholic acid (LCA) concentrations. ICP is associated with significant quantitative and qualitative changes in the maternal and fetal bile acid pools. Treatment with UDCA reduces the level of bile acids in both compartments and reverses the qualitative changes. We have not found evidence to support the suggestion that UDCA treatment increases fetal LCA concentrations to deleterious levels.
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Affiliation(s)
- Victoria Geenes
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Anita Lövgren-Sandblom
- Departments of Clinical Chemistry and Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lisbet Benthin
- Departments of Clinical Chemistry and Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dominic Lawrance
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Jenny Chambers
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Vinita Gurung
- School of Human Development, University of Nottingham, Nottingham, United Kingdom
| | - Jim Thornton
- School of Human Development, University of Nottingham, Nottingham, United Kingdom
| | - Lucy Chappell
- Women's Health Academic Centre, King's College London and King's Health Partners, London, United Kingdom
| | - Erum Khan
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Peter Dixon
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- Women's Health Academic Centre, King's College London and King's Health Partners, London, United Kingdom
| | | | - Catherine Williamson
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
- Women's Health Academic Centre, King's College London and King's Health Partners, London, United Kingdom
- * E-mail:
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47
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Luo L, Schomaker S, Houle C, Aubrecht J, Colangelo JL. Evaluation of serum bile acid profiles as biomarkers of liver injury in rodents. Toxicol Sci 2013; 137:12-25. [PMID: 24085190 DOI: 10.1093/toxsci/kft221] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Bile acids (BAs) have been studied as potential biomarkers of drug-induced liver injury. However, the relationship between levels of individual BAs and specific forms of liver injury remains to be fully understood. Thus, we set out to evaluate cholic acid (CA), glycocholic acid (GCA), and taurocholic acid (TCA) as potential biomarkers of liver injury in rodent toxicity studies. We have developed a sensitive liquid chromatography-tandem mass spectrometry (LC/MS/MS) assay applicable to rat and mouse serum and evaluated levels of the individual BAs in comparison with the classical biomarkers of hepatotoxicity (alanine aminotransferase [ALT], aspartate aminotransferase [AST], glutamate dehydrogenase (GLDH), alkaline phosphatase, total bilirubin, gamma-glutamyl transferase, and total BAs) and histopathology findings in animals treated with model toxicants. The pattern of changes in the individual BAs varied with different forms of liver injury. Animals with histopathologic signs of hepatocellular necrosis showed increases in all 3 BAs tested, as well as increases in ALT, AST, GLDH, and total BAs. Animals with histopathologic signs of bile duct hyperplasia (BDH) displayed increases in only conjugated BAs (GCA and TCA), a pattern not observed with the other toxicants. Because BDH is detectable only via histopathology, our results indicate the potential diagnostic value of examining individual BAs levels in serum as biomarkers capable of differentiating specific forms of liver injury in rodent toxicity studies.
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Affiliation(s)
- Lina Luo
- * Biomarkers of Drug Safety Research and Development and
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48
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Papacleovoulou G, Abu-Hayyeh S, Nikolopoulou E, Briz O, Owen BM, Nikolova V, Ovadia C, Huang X, Vaarasmaki M, Baumann M, Jansen E, Albrecht C, Jarvelin MR, Marin JJ, Knisely A, Williamson C. Maternal cholestasis during pregnancy programs metabolic disease in offspring. J Clin Invest 2013; 123:3172-81. [PMID: 23934127 PMCID: PMC3696570 DOI: 10.1172/jci68927] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/04/2013] [Indexed: 12/20/2022] Open
Abstract
The intrauterine environment is a major contributor to increased rates of metabolic disease in adults. Intrahepatic cholestasis of pregnancy (ICP) is a liver disease of pregnancy that affects 0.5%-2% of pregnant women and is characterized by increased bile acid levels in the maternal serum. The influence of ICP on the metabolic health of offspring is unknown. We analyzed the Northern Finland birth cohort 1985-1986 database and found that 16-year-old children of mothers with ICP had altered lipid profiles. Males had increased BMI, and females exhibited increased waist and hip girth compared with the offspring of uncomplicated pregnancies. We further investigated the effect of maternal cholestasis on the metabolism of adult offspring in the mouse. Females from cholestatic mothers developed a severe obese, diabetic phenotype with hepatosteatosis following a Western diet, whereas matched mice not exposed to cholestasis in utero did not. Female littermates were susceptible to metabolic disease before dietary challenge. Human and mouse studies showed an accumulation of lipids in the fetoplacental unit and increased transplacental cholesterol transport in cholestatic pregnancy. We believe this is the first report showing that cholestatic pregnancy in the absence of altered maternal BMI or diabetes can program metabolic disease in the offspring.
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Affiliation(s)
- Georgia Papacleovoulou
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Shadi Abu-Hayyeh
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Evanthia Nikolopoulou
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Oscar Briz
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Bryn M. Owen
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Vanya Nikolova
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Caroline Ovadia
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Xiao Huang
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Marja Vaarasmaki
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Marc Baumann
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Eugene Jansen
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Christiane Albrecht
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Marjo-Riitta Jarvelin
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Jose J.G. Marin
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - A.S. Knisely
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Catherine Williamson
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College London, London, United Kingdom.
Division of Women’s Health, Women’s Health Academic Centre, King’s College London, London, United Kingdom.
Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, CIBERehd, University of Salamanca, Salamanca, Spain.
Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute of Biochemistry and Molecular Medicine,
Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, Bern, Switzerland.
Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland.
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Department of Epidemiology and Biostatistics, MRC Health Protection Agency, Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland.
Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland.
Institute of Liver Studies, King’s College Hospital, London, United Kingdom
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Zhu XW, Sedykh A, Liu SS. Hybrid in silico models for drug-induced liver injury using chemical descriptors and in vitro cell-imaging information. J Appl Toxicol 2013; 34:281-8. [PMID: 23640866 DOI: 10.1002/jat.2879] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 02/22/2013] [Accepted: 02/22/2013] [Indexed: 11/08/2022]
Abstract
Drug-induced liver injury (DILI) is a major adverse drug reaction that accounts for one-third of post-marketing drug withdrawals. Several classifiers for human hepatotoxicity using chemical descriptors with limited prediction accuracies have been published. In this study, we developed predictive in silico models based on a set of 156 DILI positive and 136 DILI negative compounds for DILI prediction. First, models based on a chemical descriptor (CDK, Dragon and MOE) and in vitro cell-imaging endpoints [human hepatocyte imaging assay technology (HIAT) descriptors] were built using random forest (RF) and five-fold cross-validation procedure. Then three hybrid models were built using HIAT and a single type of chemical descriptors. Generally, the models based only on chemical descriptors were poor, with a correct classification rate (CCR) around 0.60 when the default threshold value (i.e. threshold = 0.50) was used. The hybrid models afforded a CCR of 0.73 with a specificity of 0.74 and a better true positive rate (sensitivity of 0.71), which is crucial in drug toxicity screening for the purpose of patient safety. The benefit of hybrid models was even more drastic when stricter classification thresholds were employed (e.g. CCR would be 0.83 when double thresholds (non-toxic < 0.40 and toxic > 0.60) were used for the hybrid model). We have developed rigorously validated hybrid models which can be used in virtual screening of lead compounds with potential hepatotoxicity. Our study also showed a chemical structure and in vitro biological data can be complementary in enhancing the prediction accuracy of human hepatotoxicity and can afford rational mechanistic interpretation.
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Affiliation(s)
- Xiang-Wei Zhu
- Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China
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50
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Wu AH, French D. Implementation of liquid chromatography/mass spectrometry into the clinical laboratory. Clin Chim Acta 2013; 420:4-10. [DOI: 10.1016/j.cca.2012.10.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
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