Impaired Bile Secretion Promotes Hepatobiliary Injury in Sickle Cell Disease

BACKGROUND AND AIMS

Hepatic crisis is an emergent complication affecting patients with sickle cell disease (SCD); however, the molecular mechanism of sickle cell hepatobiliary injury remains poorly understood. Using the knock-in humanized mouse model of SCD and SCD patient blood, we sought to mechanistically characterize SCD-associated hepato-pathophysiology applying our recently developed quantitative liver intravital imaging, RNA sequence analysis, and biochemical approaches.

APPROACH AND RESULTS

SCD mice manifested sinusoidal ischemia, progressive hepatomegaly, liver injury, hyperbilirubinemia, and increased ductular reaction under basal conditions. Nuclear factor kappa B (NF-κB) activation in the liver of SCD mice inhibited farnesoid X receptor (FXR) signaling and its downstream targets, leading to loss of canalicular bile transport and altered bile acid pool. Intravital imaging revealed impaired bile secretion into the bile canaliculi, which was secondary to loss of canalicular bile transport and bile acid metabolism, leading to intrahepatic bile accumulation in SCD mouse liver. Blocking NF-κB activation rescued FXR signaling and partially ameliorated liver injury and sinusoidal ischemia in SCD mice.

CONCLUSIONS

These findings identify that NF-κB/FXR-dependent impaired bile secretion promotes intrahepatic bile accumulation, which contributes to hepatobiliary injury of SCD. Improved understanding of these processes could potentially benefit the development of therapies to treat sickle cell hepatic crisis.

Lipid emulsions in the treatment and prevention of parenteral nutrition-associated liver disease in infants and children

Long-term parenteral nutrition (PN) carries the risk of progressive liver disease in infants with intestinal failure. Although PN-associated liver disease (PNALD) is multifactorial in etiology, components of soybean oil lipid emulsions have been implicated in the disease's pathogenesis. Historically, infants with PNALD who were unable to wean from PN to full enteral feeding developed cirrhosis and end-stage liver disease, which require liver transplantation to survive. Over the past 2 decades, novel strategies for the management of parenteral lipids have improved morbidity and mortality from PNALD in infants with intestinal failure. Current strategies for the treatment of PNALD include restricting the dose of parenteral soybean oil lipid emulsion and/or replacing the soybean oil with a parenteral fish-oil lipid emulsion or emulsions of mixed-lipid sources. The purpose of this report is to review published data that evaluate these strategies in parenteral lipid management for the treatment and prevention of PNALD.

[CONSERVATIVE THERAPY IN THE COMPLEX TREATMENT OF ACUTE NECROTIZING PANCREATITIS]

Developed and implemented a phased differentiated treatment tactics in acute necrotizing pancreatitis, based on the theory of phase course of acute pancreatitis. Treatment started with conservative measures. Applications developed set of measures allowed us to achieve recovery of 39.53% patients without any instrumental interventions performans, including diapevtycal. Laparotomy reduced frequency performance of 57.14%--in the control group to 33.07%--in the main. Mortality in the main group was 6.72%; complication rate decreased 2.26 times; postoperative mortality was 9.83%.

[Combination of in-situ hepatic split and portal ligation in patients with colorectal cancer and metastatic hepatic spread]

In up to 50% of patients, suffering colorectal cancer (CRC), a hepatic metastatic affection was revealed, in 20-34% of them the metastases have occurred synchroniously with primary tumor. The main problem in estimation of resectability of metastatic CRC (mCRC) is a possibility to preserve a sufficient volume of the organ parenchyma, because an acute hepatic insufficiency (AHI) constitute one of the main risk factors for occurrence of complications and mortality in early postoperative period after extended hemihepatectomy. The expediency of application in National Cancer Institute of the insitu hepatic split in conjunction with a portal ligation (ISHS-PL), elaborated by surgical group in Regensburg, was studied up. The results of treatment of mCRC, using ISHS-PL--in 3 patients and of a standard two-staged hepatic resection--in 3, were analyzed. Duration of a gap period between the ISHS-PL stages have constituted on average (10 +/- 1) days, and for a standard two-staged hepatic resection--(56 +/- 11.3) days (p = 0.001). The investigation results witness a safety of performance of the ISHS-PL in patients, suffering mCRC. Application of such a surgical tactics have permitted to reduce the risk of an AHI occurrence after performance of the extended hepatic resection in patients, suffering bilobar metastatic hepatic affection.

Benefits of exenatide on obesity and non-alcoholic fatty liver disease with elevated liver enzymes in patients with type 2 diabetes

BACKGROUND

The purpose of this study was to evaluate the advantages of exenatide treatment on obesity and non-alcoholic fatty liver disease (NAFLD) with elevated liver enzymes in patients with type 2 diabetes (T2D).

METHODS

A total of 60 newly diagnosed patients with obesity, NAFLD with elevated liver enzymes and T2D were included in the study. The patients were randomly divided into two groups. The exenatide treatment group (n = 30) were treated with exenatide and insulin glargine, and the intensive insulin therapy group (n = 30) were treated with insulin aspart and insulin glargine for 12 weeks. Selected clinical characteristics were determined, and ultrasonography was performed at both baseline and 12 weeks following treatment.

RESULTS

At baseline, the clinical characteristics were matched between the two groups. After 12 weeks, fasting blood glucose (FBG), postprandial blood glucose (PBG), glycosylated haemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG) and total bilirubin levels were significantly decreased in the two groups (p < 0.001). Body weight and waist circumference were significantly decreased in the exenatide group but increased in the intensive insulin group (p < 0.001). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transpeptidase (γGGT) in the exenatide group were significantly lower than in the intensive insulin group (p < 0.001). The mean body weight change correlated with the levels of ALT, AST and γGGT change (ALT, r = 0.761; AST, r = 0.733; γGGT, r = 0.752; p < 0.001). Moreover, the reversal rate of fatty liver was significantly higher in the exenatide group (93.3%) than the intensive insulin group (66.7%) (p < 0.01).

CONCLUSIONS

Exenatide has a better hepatic-protective effect than intensive insulin therapy and perhaps represents a unique option for adjunctive therapy for patients with obesity, non-alcoholic fatty liver disease with elevated liver enzymes and T2D.

[Prophylaxis of hepatic insufficiency after major hepatic resections]

The article deals with a problem of prophylaxis of hepatic insufficiency in oncological patients after liver resections.

MATERIALS AND METHODS

We analyzed data of effectiveness and safety of the use of Remaxol in oncological patients with hepatic metastasis of colorectal cancer--dynamics of indicators of cytolysis and cholestasis, hepatic protein synthesis, exchange of pigments, pro- and antioxidant system and the level of endogen intoxication in postoperative period.

RESULTS

Use of Remaxol allows decreasing the duration of postoperative rehabilitation and intensive care unit staying.

Soya phospholipid complex of mangiferin enhances its hepatoprotectivity by improving its bioavailability and pharmacokinetics

BACKGROUND

Mangiferin is a xanthonoid present in Mangifera indica. It has been reported for a variety of pharmacological activities, including hepatoprotection. However, the major disadvantage of mangiferin is its reduced biological activity due to poor absorption, low bioavailability and rapid elimination from the body after administration. The aim of this study was to prepare a phospholipid complex of mangiferin to overcome these limitations and to investigate the impact of the complex on hepatoprotective activity and bioavailability.

RESULTS

The results showed that the complex has an enhanced hepatoprotective and in vivo antioxidant activity as compared to pure mangiferin at the same dose level (30 and 60 mg kg⁻¹). The complex restored the levels of serum hepatic marker enzymes and liver antioxidant enzymes with respect to carbon tetrachloride-treated animals. The complex also increased the bioavailability of mangiferin in rat serum by 9.75-fold compared to pure mangiferin at the same dose level and enhanced the elimination half-life (t(1/2 el)) from 1.71 ± 0.12 h⁻¹ to 3.52 ± 0.27 h⁻¹.

CONCLUSION

The results suggested that the complexation of mangiferin with soya phospholipid enhanced the hepatoprotection and in vivo antioxidant activity, which may be due to the improved bioavailability and pharmacokinetics of mangiferin in rat serum.

Protective effects of ginsenoside Rb1 on septic rats and its mechanism

This study aims to observe the protective effects of ginsenoside Rb1 on liver and lung in rats with septic shock and reveal its mechanism. Rats were randomly divided into three groups: sham, cecal ligation and puncture (CLP), and CLP with ginsenoside Rb1. Then, the survival rate, arterial blood pressure, TLR4 mRNA, and TNF-α levels were determined. The liver and lung tissues were stained with hematoxylin-eosin (HE). The overall survival rate of the Rb1 group was significantly higher than that of the CLP group. Mean arterial blood pressure went down in both the CLP and Rb1 groups after CLP, and there was a significant difference both in the sham and Rb1 groups when compared with the CLP group. The Rb1 treatment group had markedly lower TLR4 mRNA expression and TNF-α levels than the CLP group. In the CLP group, pathology showed swelling, degeneration, necrosis, and neutrophil infiltration in the liver and alveolar epithelial cells. However, in the Rb1 group, there was mild degeneration and slight neutrophil infiltration, but no obvious necrosis. Rb1 may improve the survival rate, ameliorate arterial blood pressure, and protect the liver and lung in septic shock rats by downregulating the expression of TLR4 mRNA and inhibiting the production of TNF-α.

Docosahexaenoic acid for the treatment of fatty liver: randomised controlled trial in children

BACKGROUND AND AIM

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in children. We tested whether dietary supplementation with docosahexaenoic acid (DHA) can decrease liver fat content in children with NAFLD.

METHODS AND RESULTS

We performed a randomized controlled trial of DHA supplementation (250 mg/day and 500 mg/day) vs. placebo in 60 children with NAFLD (20 children per group). The main outcome was the change in liver fat as detected by ultrasonography after 6, 12, 18 and 24 months of treatment. Secondary outcomes were changes in triglycerides, alanine transaminase (ALT), body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA). The odds of more severe versus less severe liver steatosis decreased to the same degree at 6 months in children treated with DHA 250 mg/day and DHA 500 mg/day vs. placebo and persisted virtually unmodified for 24 months (OR ≤ 0.02, p ≤ 0.05 for all time points). Triglycerides were lower in the DHA groups than in the placebo group at any time point and ALT was lower in these groups from month 12 onwards. HOMA was lower in the DHA 250 mg group vs. placebo at months 6 and 12.

CONCLUSION

DHA supplementation improves liver steatosis in children with NAFLD. Doses of 250 mg/day and 500 mg/day of DHA appear to be equally effective in reducing liver fat content.

Theacrine, a purine alkaloid obtained from Camellia assamica var. kucha, attenuates restraint stress-provoked liver damage in mice

Theacrine (1,3,7,9-tetramethyluric acid), a purine alkaloid, has proven to be beneficial in maintaining several brain functions and is being studied for potential medicinal uses in recent years. In this study, we isolated theacrine from Camellia assamica var. kucha and investigated its protective effects on liver damage induced by restraint stress in mice. Results showed that 18 h of restraint stress could induce liver damage, with an obvious increase in levels of plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). This finding was further confirmed by hepatic pathological examination, which showed inflammatory cell infiltration and focal necrosis of hepatocytes. However, oral administration of theacrine (10, 20, 30 mg/kg for 7 consecutive days) was found to decrease plasma ALT and AST levels, reduce hepatic mRNA levels of inflammatory mediators (IL-1β, TNF-α, IL-6, and IFN-γ), and reverse the histologic damages in stressed mice. Simultaneously, theacrine also significantly decreased the content of malondialdehyde and increased oxygen radical absorbance capacity (ORAC) level in the plasma and liver of stressed mice. These results suggested that the protective effects of theacrine on stress-induced liver damage might be correlated with its antioxidative activity. The antioxidative capacity of theacrine was further evaluated by in vitro ORAC and cellular antioxidant activity assay. The results suggested that the antioxidative capacity of theacrine was not due to the direct action on free radical clearance. Moreover, the elevated activities and gene expressions of superoxide dismutase, catalase, and glutathione peroxidase, as well as the reduced activity of xanthine oxidase by theacrine treatment in stressed mice suggested that the antioxidative activity might be due to the strengthening of the antioxidant system in vivo. On the basis of the above results, theacrine is possibly a good candidate for protecting against or treating lifestyle diseases and might contribute to the study of natural products.

[Hepatic dysfunction correction in patients with obturation jaundice]

Comparative analysis of results of examination and treatment of 54 patients, suffering obturation jaundice syndrome, is presented. The presence and severity of hepatic dysfunction was determined in accordance to indices of cytolysis and cholestasis syndromes, and its severity--in accordance to V. P. Zinevich criteria (1986). There was established, that timely elimination of obturation jaundice, using miniinvasive interventions and subsequent conduction of complex hepatotropic therapy, using L-ornitin L-aspartate, permits to correct hepatic dysfunction effectively.

Endometrial, breast and liver safety of soy isoflavones plus Lactobacillus sporogenes in post-menopausal women

OBJECTIVE

To assess the safety of a nutraceutical compound containing soy isoflavones and Lactobacillus sporogenes on endometrium, breast and liver function.

SETTING

Outpatient Menopausal Clinic.

STUDY DESIGN

130 healthy postmenopausal women suffering from menopausal symptoms were randomized to receive soy isoflavones 60 mg and Lactobacillus sporogenes 1 billion spores (group E: 65 women) or calcium and vitamin D₃ (group C: 65 women). Safety of the treatment was assessed at baseline and after 1 year taking into account endometrial thickness, mammographic density, serum levels of transaminases, γ-GT and bilirubin. Efficacy of the treatment was evaluated rating the score of menopausal symptoms at baseline and every 3 months. The statistical analysis was carried out with χ², Fisher exact's test and ANOVA.

RESULTS

After 12 months of treatment mammographic density, endometrial thickness and hepatic function did not show significant differences between groups, while menopausal symptoms were progressively and significantly reduced in severity and frequency during treatment with soy isoflavones plus Lactobacillus sporogenes versus calcium plus vitamin D₃.

CONCLUSION

A 12 months treatment with a nutraceutical compound based on isoflavones and Lactobacillus sporogenes at the recommended doses is safe for endometrium, mammary glands and liver function in postmenopausal women.

Hypoglycaemic effect of Melothria heterophylla in streptozotocin-induced diabetic rats

CONTEXT

In the Indian traditional system of medicine, Melothria heterophylla (Lour.) Cogn., (Cucurbitaceae) is prescribed for the treatment of diabetes mellitus.

OBJECTIVE

In the present study, the antidiabetic effect of ethanol extract of Melothria heterophylla (EEMH), and its active isolated constituents were investigated in streptozotocin (STZ)-induced diabetic Swiss albino rats.

METHOD

Successive Soxhlet extraction of the dried total aerial parts with petroleum ether for defatting and then with ethanol (95%) to obtain ethanol extract, which was concentrated under reduced pressure. Hyperglycemia was induced in rats by STZ (50 mg/kg, body weight). Twenty-four hours after STZ induction, respective groups of diabetic rats received EEMH (200 and 400 mg/kg, body weight), gallic acid (GA) (2 and 4 mg/kg, body weight), and rutin (RU) (2 and 4 mg/kg, body weight), respectively, orally daily for 15 days. Glibenclamide (0.5 mg/kg, orally) served as reference. Blood glucose levels and change in body weight were measured on every 5(th) day during 15 days of treatment. Biochemical parameters, viz., serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase (ALP) and serum insulin, were measured.

RESULTS

EEMH and its active constituents significantly (p < 0.01) normalized blood glucose levels and serum biochemical parameters as compared to those of STZ controls. Both GA (4 mg/kg) and RU (4 mg/kg) exhibited maximum glucose lowering effect (69.1 and 66.7%, respectively) in diabetic rats compared to the other dose (2 mg/kg) at the end of the study. EEMH, gallic acid and RU also showed significant increase in serum insulin, and body weight of STZ-induced diabetic rats.

CONCLUSION

Therefore, ethanol extract of Melothria heterophylla, GA and RU demonstrated remarkable antidiabetic activity in STZ-induced diabetic rats.

[Clinical signs of endothelial disorders in patients with severe sepsis]

A clinical-experimental study was carried out. The objective was to find some regularities in endothelial disorder progression in patients with severe sepsis and to evaluate clinical efficacy of some methods of hepatic protection. Experimental part of work was carried out on 59 mice with induced peritonitis. Obtained data shows early emergence of lung disorders that precede changes in hepatic tissue. Clinical part of work included 181 patient with severe sepsis. It was noted that acute respiratory distress syndrome symptoms occurred earlier than hepatic dysfunction, if the latter joints, it aggravates the patients status and worsens the prognosis. Use of Heptral (Ademetionine) and Ketamine in order to protect liver is a clinically effective method which makes possible to decrease the lethality.

[Modern tendencies in surgical treatment of patients with obturation jaundice complicated by hepatic insufficiency]

The article is devoted to the problem of efficacy of the hepatic insufficiency (HI) prophylaxis and treatment methods in obturation jaundice. The role of energy-depending processes and the oxygen deficiency in tissues in the HI occurrence and progressing, the possibilities of medicinal correction of such disorders were studied up. The authors follow the concept of expediency of the oxygen-bearing preparations, which improve the erythrocytes function and oxygen delivery to the tissues in combination with miniinvasive decompression of bilioefferent ways, incorporation into the treatment complex of HI of mechanic genesis.

[Effectiveness of nutritional support for the liver-cell deficiency in the liver cirrhosis]

THE AIM

To study the efficiency of enteral nutritional support and its impact on clinical-laboratorial markers of hepatocellular failure of the patients with Child-Pue's hepatic cirrhosis type B suffering from trafologic impairment. MATERIAL AND RESEARCH METHODS: 61 patients with Child-Pue's hepatic cirrhosis type B suffering from trafologic impairment took part in the randomized prospective study. The control group (31 patients) got the conventional treatment with lactulose, beta-blocker, spironolactone on the basis of 1.2 g/kg protein weight and 30 kcal/kg body weight per day. There were 30 patients in the second group (the principal one) and in addition to conventional treatment they got the multisubstrate nutritional cocktail of dietary fibers on the basis of 0.3 g/kg protein weight, 7.5 g fibers per day and 10 kcal/kg body weight during 30 days. To evaluate the efficiency of the treatment we analyzed the clinical presentation and the intensity of blood cholinesterase. The stage of hepatic encephalopathy was defined with the affinity numbers test of Retainer. The parameters under study were checked before the treatment, 30 days and 60 days later after the treatment began.

RESULTS

It was found out during the prospective randomized study that the patients under nutritional support showed the positive clinical dynamics (asthenia and hepatic encephalopathy retrogression and the accurate increase of blood cholinesterase from 4365.4 +/- 1028.6 ME up to 5502.7 +/- 1142.6 ME (p < 0.05).

CONCLUSION

Nutritional support of the patients with Child-Pue's hepatic cirrhosis type B suffering from trafologic impairment is effective and has an accurate impact upon clinical-laboratorial markers of hepatocellular failure.

[Portal vein embolization preparation for major hepatic resection: a new standard in liver surgery]

Preoperative portal vein embolization (PVE) is increasingly used for operative treatment of patients scheduled to undergo liver resection when the volume of the future remnant liver appears to be insufficient. Portal vein embolization should be considered when the prospective postoperative liver volume is less than 20 % or less than 40 % in patients with known liver cirrhosis. Our own results (n = 28) demonstrated an average volume increase in segments II and III of 280 +/- 95 ml to 420 +/- 98 ml within 6 weeks after selective percutaneous- transhepatic embolization of the portal vein branches (IV)-V-VIII. Thus, an expanded right resection of the liver could be performed in all patients without major complications. None of the patients suffered from clinically relevant liver insufficiency within the first few postoperative months.

[Clinical study on severe acute pancreatitis complicated by hepatic insufficiency]

OBJECTIVE

To investigate the pathogenic factors of severe acute pancreatitis (SAP) complicated by hepatic insufficiency, the prognosis and the effective preventive and therapeutic interventions.

METHODS

One hundred and fifty-two patients with SAP (from January 2003 to June 2004) were divided into 2 groups, SAP with hepatic insufficiency group and SAP without hepatic insufficiency group. The related factors such as causes of disease, serum biochemical criteria, complications, mortality and course of disease were observed.

RESULTS

The concentrations of serum amylase, creatinine and lactate dehydrogenase were all much higher in the SAP with hepatic insufficiency group than those in the SAP without hepatic insufficiency group (P<0.05). The incidences of complications such as acute renal failure, heart failure, gastrointestinal hemorrhage and infection were also higher in the SAP with hepatic insufficiency group than those in the SAP without hepatic insufficiency group (P<0.05). There was no significant difference in mortality between these two groups, but the course of disease in SAP with hepatic insufficiency group was longer than that in the other group (P<0.05).

CONCLUSION

The causes of SAP complicated by hepatic insufficiency are related to the imbalance of internal environment and the characteristics of the liver function. To control the biliary tract diseases, intervene with traditional Chinese medicine, recover the intestinal function in time, reduce the damage of pancreatic enzyme, maintain the stability of internal environment and avoid using drugs that can induce liver injury are all important aspects of reducing the incidence of hepatic insufficiency.

Activation of the liver X receptor protects against hepatic injury in endotoxemia by suppressing Kupffer cell activation

Recent reports have demonstrated that liver X receptors (LXRs) of the nuclear receptor family have anti-inflammatory effects on macrophages. Here we examine whether activation of LXR by the synthetic agonist GW3965 can ameliorate the liver injury/dysfunction caused by endotoxins in the rat. Male Wistar rats received GW3965 (0.3 mg/kg) or vehicle (50% dimethyl sulfoxide) 30 min before coadministration of lipopolysaccharide (LPS, 5 mg/kg i.v.) and peptidoglycan (1 mg/kg i.v.). Treatment with GW3965 attenuated the increase in the plasma levels of alanine aminotransferase and bilirubin (markers of liver injury/dysfunction) as well as the focal hepatocyte necrosis (histology) caused by coadministration of LPS and peptidoglycan. This protective effect of GW3965 treatment was associated with reduced infiltration of mast cells in the liver (histopathology) and reduced gene expression of the chemokines eotaxins 1 and 2, whereas MIP-2 mRNA levels were not affected. Plasma levels of tumor necrosis factor alpha and prostaglandin E2 were significantly attenuated by GW3965, whereas plasma interleukins 6 and 10 were not altered. High expression of LXRalpha mRNA was observed in Kupffer cell cultures, suggesting that Kupffer cells are targets of GW3965. Subsequent in vitro studies in Kupffer cells demonstrated that exposure to GW3965 attenuated the LPS-induced release of tumor necrosis factor alpha and prostaglandin E2 in a dose-dependent manner. In conclusion, this study demonstrates that activation of LXR by GW3965 protects against liver injury and dysfunction in a rat model of endotoxemia, in part by exerting an anti-inflammatory effect on Kupffer cells.