Effect of gomisin A in the prevention of acute hepatic failure induction.

Nearly all rats develop massive hepatic cell necrosis and die upon intravenous administration of heat-killed Propionibacterium acnes followed by a small amount of Gram-negative lipopolysaccharide 7 days later. However, when such an experimental liver disorder is induced in rats raised for 4 or more weeks on food containing 0.06% of gomisin A extracted and purified from Schizandra chinensis, the survival rate rises, histological changes of the liver improve remarkably, and splenocyte reactivity to phytohemagglutinin and pokeweed mitogen as well as splenocyte interleukin 1 productivity are retained. These results suggested the possibility that the development of acute hepatic failure may be prevented with the oral administration of gomisin A.     

Anti-apoptotic and hepatoprotective effects of gomisin A on fulminant hepatic failure induced by D-galactosamine and lipopolysaccharide in mice

This study examined the effects of gomisin A, a lignan compound from Schisandra fructus, on D-galactosamine (GalN) and lipopolysaccharide (LPS)-induced hepatic apoptosis and liver failure. Mice were given an intraperitoneal injection of GalN (700 mg/kg) / LPS (10 microg/kg). Gomisin A (25, 50, 100, and 200 mg/kg) was administered intraperitoneally 1 h before the GalN/LPS injection. The liver injury was assessed biochemically and histologically. GalN/LPS increased the serum aminotransferase levels and lipid peroxidation but decreased the reduced glutathione level. The pretreatment with gomisin A attenuated these changes in a dose-dependent manner. The survival rate of the gomisin A group was significantly higher than that of the control. The mitochondria isolated after the mice had been injected with GalN/LPS were swollen, which was attenuated by the gomisin A pretreatment. The elevation of serum tumor necrosis factor-alpha and activation of caspase-3 were observed in the GalN/LPS group, which was attenuated by gomisin A. The gomisin A-pretreated groups showed significantly fewer apoptotic (TUNEL-positive) cells and DNA fragmentation as compared with the GalN/LPS mice. The liver protection afforded by gomisin A is the result of the reduced oxidative stress and its anti-apoptotic activity.     

Effect of dihydromyricetin on hepatic encephalopathy associated with acute hepatic failure in mice

ContextHepatic encephalopathy (HE) is a complex neuropsychiatric disease caused by liver failure. Dihydromyricetin (DMY) is a traditional medicine used to treat liver injury.ObjectiveTo investigate the effects of dihydromyricetin (DMY) on hepatic encephalopathy associated with acute hepatic failure mice models established by thioacetamide (TAA) exposure.Materials and methodsFemale BALB/c mouse were randomly divided into control, DMY, TAA, and TAA + DMY groups (n = 8). The first two groups were intraperitoneally injected with saline or 5 mg/kg DMY, respectively. The last two groups were injected with 600 mg/kg TAA to establish HE models, and then the mice in the last group were treated with 5 mg/kg DMY. Neurological and cognition functions were evaluated 24 and 48 h after injection. Mice were sacrificed after which livers and brains were obtained for immunoblot and histopathological analysis, while blood was collected for the analysis of liver enzymes.ResultsIn the TAA + DMY group, ALT and AST decreased to 145.31 ± 12.88 U/L and 309.51 ± 25.92 U/L, respectively, whereas ammonia and TBIL decreased to 415.67 ± 41.91 μmol/L and 3.31 ± 0.35 μmol/L, respectively. Moreover, MDA decreased to 10.74 ± 3.97 nmol/g, while SOD and GST increased to 398.69 ± 231.30 U/g and 41.37 ± 21.84 U/g, respectively. The neurological score decreased to 2.87 ± 0.63, and the number of GFAP-positive cells decreased to 41.10 ± 1.66. Furthermore, the protein levels of TNF-α, IL-6, and GABA_A in the cortex decreased.ConclusionsWe speculate that DMY can serve as a novel treatment for HE.     

Effect of acute hepatic failure on epirubicin pharmacokinetics after intrahepatic arterial injection in rats

In the case of cancer chemotherapy for hepatocellular carcinoma, anthracycline anticancer agents such as epirubicin are widely used, and have typically been given by intrahepatic arterial (i.a.) infusion to increase treatment efficacy and to reduce systemic toxicity. The anthracyclines are eliminated primarily by the liver, and the use of these drugs in patients with hepatic failure can be difficult. In this study, we investigated the effect of acute hepatic failure on the pharmacokinetics of epirubicin after i.a. injection in rats. Experimental acute hepatic failure was induced by carbon tetrachloride-treatment. Epirubicin was injected into the hepatic artery or the saphenous vein of the rats at a dose of 2 mg/kg. After both intravenous (i.v.) and i.a. injection, the serum concentration and the AUC 0-24 of epirubicin in hepatic failure rats were significantly higher than the values in control rats. The AUC 0-24 ratio of hepatic failure (i.a.) to control (i.a.) was higher than the ratio of hepatic failure (i.v.) to control (i.v.). These results suggest that the influence of hepatic failure on serum epirubicin concentration is larger with the i.a. route than with the i.v. route. The liver concentration of epirubicin after i.a. administration in hepatic failure rats was significantly lower than that in control rats. This result suggests that the effect of the liver-selective drug targeting after i.a. injection in hepatic failure rats is lower than in normal rats. Therefore, we should be careful when administering epirubicin by the i.a. route in patients with acute hepatic failure.     

Pharmacokinetics of bicyclol in rats with acute hepatic failure

The aim of present study is to evaluate the pharmacokinetics of bicyclol in carbon tetrachloride (CCl(4))-intoxicated rats. The plasma concentration of bicyclol was detected in rats after a single oral or intravenous administration by high-performance liquid chromatography (HPLC) analysis. Rat intestinal and hepatic perfusion models were employed to clarify the respective effect of gut and liver on the pharmacokinetics of bicyclol in acute hepatic failure (AHF) rats. Rat in vitro microsomal incubation was also conducted. The bioavailability of bicyclol was increased 3.1-fold after CCl(4) intoxication in rats. The area under the curve (AUC)((0-infinity)), C(max), and clearance (CL) of bicyclol after intravenous administration were 13.4 mg h l(-1), 18.8 mg l(-1), and 1.8 l h(-1) kg(-1) in control rats, and 130 mg h l(-1), 33.1 mg l(-1), and 0.15 l h(-1) kg(-1) in AHF rats, respectively. In the present study we investigated the pharmacokinetics of bicyclol in CCl(4)-intoxicated rats and differentiated the respective role of intestine and liver by using in situ intestinal and hepatic perfusion in rats, and in vitro rat microsomes incubation. The studies are expected to provide a better understanding related to the alteration of pharmacokinetics of bicyclol in pathological situation.     

Pharmacokinetics of bicyclol in rats with acute hepatic failure

The aim of present study is to evaluate the pharmacokinetics of bicyclol in carbon tetrachloride (CCl₄)-intoxicated rats. The plasma concentration of bicyclol was detected in rats after a single oral or intravenous administration by high-performance liquid chromatography (HPLC) analysis. Rat intestinal and hepatic perfusion models were employed to clarify the respective effect of gut and liver on the pharmacokinetics of bicyclol in acute hepatic failure (AHF) rats. Rat in vitro microsomal incubation was also conducted. The bioavailability of bicyclol was increased 3.1-fold after CCl₄ intoxication in rats. The area under the curve (AUC)_(0–∞), C_max, and clearance (CL) of bicyclol after intravenous administration were 13.4 mg h l^?1, 18.8 mg l^?1, and 1.8 l h^?1 kg^?1 in control rats, and 130 mg h l^?1, 33.1 mg l^?1, and 0.15 l h^?1 kg^?1 in AHF rats, respectively. In the present study we investigated the pharmacokinetics of bicyclol in CCl₄-intoxicated rats and differentiated the respective role of intestine and liver by using in situ intestinal and hepatic perfusion in rats, and in vitro rat microsomes incubation. The studies are expected to provide a better understanding related to the alteration of pharmacokinetics of bicyclol in pathological situation.     

Effects of calcitriol and alfacalcidol on an osteoporosis model in rats with hepatic failure

To predict the potential utility of calcitriol in human osteoporosis with hepatic dysfunction, we examined the effects of calcitriol and alfacalcidol in ovariectomized (OVX) aged-rats with CCl4-induced hepatic failure. In OVX+CCl4 rats, GOT, GTP, alkaline phosphatase and total bilirubin increased and hepatic enzyme activity (cytochrome b5 and P450) decreased. Repeated oral doses of calcitriol (0.1 and 0.2 microgram/kg) for 51 days inhibited a decrease in serum calcium concentration. This effect was more potent than that of alfacalcidol at the same dose. Both drugs tended to inhibit a decrease in femoral calcium contents. Calcitriol (0.2 microgram/kg) prevented a decrease in femoral bone density (dry and ash weight per volume), unlike alfacalcidol. Soft X-ray imaging analysis revealed that both drugs tended to inhibit the decrease in femoral bone density. There were no differences in the femoral bone strength between OVX+CCl4 and sham-operated rats. The serum calcitriol concentrations increased after the last doses of calcitriol, while they did not increase after the last dose of alfacalcidol. All these effects of calcitriol were related to the serum calcitriol levels. These results suggest that calcitriol, unlike alfacalcidol, may have a clinical therapeutic effect in osteoporosis with hepatic dysfunction.     

Effect of experimental acute renal and hepatic failure on absorption of tacrolimus in rat small intestine

The objective of this study is to evaluate the effect of acute renal or hepatic failure on the intestinal absorption of tacrolimus. Simultaneous perfusion study in rat small intestine revealed that the extent of absorption into blood vessels was decreased in the jejunum and the ileum of rat of acute renal failure due to the decrease in the uptake of tacrolimus into enterocytes. In contrast, there observed no significant changes in tacrolimus absorption in rat of acute hepatic failure. Since it has been reported that tacrolimus absorption is regulated mainly by Cytochrome P-450 (CYP) mediated metabolism in the jejunum, but by P-glycoprotein (P-gp) mediated efflux in the ileum, these factors might contribute to the changes in intestinal absorption of tacrolimus in rat of acute renal failure. Enzyme inhibitor, ketoconazole, was co-perfused with tacrolimus to specify the effect of CYP and P-gp. However, since ketoconazole failed to recover the permeability in the jejunum and ileum of rat of acute renal failure, it is considered that the changes in CYP or P-gp functions might not be involved in the decreased uptake of tacrolimus. This type of kinetic study in rats should be valuable to identify the precise mechanisms of drug absorption and the effects of various diseases on it, such as acute renal or hepatic failure.     

Cisplatin (CDDP)-induced acute toxicity in an experimental model of hepatic fibrosis

Cisplatin (CDDP)-induced acute toxicity was investigated in an experimental model of liver fibrosis produced through repeated intraperitoneal injections of swine serum in rats. A significant increase in level of hepatic markers, such as plasma ASAT, LDH, glucose, total cholesterol and bile acid levels, and a significant decrease in the plasma triacylglycerol level were observed. Slight histological changes, such as necrosis, vacuolar degeneration, and the proliferation of bile ducts were observed as compared with the control fibrotic rats. On the other hand, a significant increase in levels of renal markers, such as plasma BUN and creatinine levels as well as more remarkable tubular degeneration were observed. From these results, CDDP's hepatotoxicity was slight while its nephrotoxicity was more extensive in fibrotic rats.     

Effect of acute hepatic failure on the hepatic first‐pass effect of 5‐fluorouracil in rats

Objectives In cancer chemotherapy for hepatocellular carcinoma, 5‐fluorouracil is widely used and has typically been given by intrahepatic arterial (i.a.) infusion to increase treatment efficacy and reduce systemic toxicity. 5‐Fluorouracil is eliminated primarily by the liver and so the hepatic first‐pass effect after intrahepatic arterial administration of 5‐fluorouracil may be lower in patients with hepatic failure, and systemic toxicity may not be reduced. In this study, we have investigated the effect of acute hepatic failure on the first‐pass effect of 5‐fluorouracil in rats. Methods Experimental acute hepatic failure was induced by treatment with carbon tetrachloride (CCl₄). 5‐Fluorouracil was infused for 15 min into the hepatic artery or the saphenous vein of rats at a dose of 1.25 mg/kg. Key findings Hepatic availability in 50% CCl₄‐treated (severe hepatic failure) rats was higher than in controls. Conclusions The hepatic first‐pass effect after intrahepatic arterial administration of 5‐fluorouracil was lower in severe hepatic failure. Therefore, the reducing effect of the systemic toxicity after intrahepatic arterial administration may be lower in severe hepatic failure.     

阿德福韦停用后致急性肝功能衰竭死亡

1例35岁男性，因慢性乙型肝炎口服阿德福韦10mg／d治疗。3个月后肝功能恢复正常，15个月后HBVDNA〈1×10^3拷贝／ml，但HBeAg仍呈阳性。治疗2年，患者自行停药。停药40d后，出现乏力和食欲不振，实验室检查显示ALT1884．9U／L，AST1135．4U／L，TBil42．8μmol／L，DBil16．8μmol／L，HBVDNA1．27×10。拷贝／ml。考虑为阿德福韦停药所致的病毒学反弹。入院后给予恩替卡韦1mg／d及保肝对症治疗。但患者的症状逐渐加重，黄疸加深。实验室检查显示TBil428μmol／L，PTA13．8％，INR5．8。诊断为肝衰竭。尽管给予非生物型人工肝治疗及血浆置换，但患者病情进一步恶化，出现肝性脑病，终因肝衰竭死亡。     

Review article: liver support systems in acute hepatic failure

The treatment of acute hepatic failure has developed rapidly over the last 40 years, reducing morbidity and mortality from this syndrome. Whilst this has been partly attributed to significant improvements in the specialist medical management of these patients, advances in surgical techniques and pharmaceutical developments have led to the establishment of successful liver transplantation programmes, which have improved mortality significantly. This review will examine the clinical impact of alternative methods that have been used to provide extra-corporeal hepatic support. Non-biological, bio- logical and hybrid hepatic extra-corporeal support will be explored, offering a comprehensive historical overview and an appraisal of present and future advances.     

Effect of gomisin A (TJN-101) on the arachidonic acid cascade in macrophages

It has been reported that leukotrienes (LTs) may play a role in inflammatory liver diseases, and several inhibitors of LTs show an inhibitory effect on experimental liver injuries. In this study, the effect of Gomisin A (TJN-101), which is a lignan component of schisandra fruits, on the arachidonic acid cascade in macrophages was examined to explain the mechanisms of the inhibitory effect of TJN-101 on liver injuries. The production of leukotriene B4 was suppressed by treatment with TJN-101, while the activity of 5-lipoxygenase was not affected. The release of arachidonic acid from macrophages stimulated with fMet-Leu-Phe or the Ca++ ionophore A23187 was suppressed by treatment with TJN-101. The activity of phospholipase A2 was not affected by treatment with TJN-101. These results suggested that TJN-101 produces an inhibitory effect on the biosynthesis of LTs by preventing the release of arachidonic acid, and it was thought that the preventive effect on the arachidonic acid cascade may be partially associated with the inhibitory effect of TJN-101 on liver injuries.     

Reduced hepatic uptake of propranolol in rats with acute renal failure

The effect of acute renal failure (ARF) on the hepatic uptake and metabolism of propranolol was investigated in relation to the hepatic clearance of the drug. ARF was induced by the subcutaneous injection of uranyl nitrate to rats. The uptake rate of propranolol in the isolated perfused liver was determined by the multiple-indicator dilution method and was found to decrease from 43.6 +/- 2.0 min-1 (mean +/- S.E.) in control to 29.4 +/- 1.7 min-1 in ARF (P less than 0.001). The recovery fraction of propranolol in effluent venous blood increased about twofold in ARF compared to control (P less than 0.05). The metabolic activity for propranolol was examined using the hepatic microsomal fraction prepared from control and ARF rats. There was no significant difference in the kinetics of oxidative metabolism of propranolol between two groups. These results suggest that the previously reported decrease in the hepatic clearance of propranolol in ARF is due to decreased hepatic uptake of the drug from the blood into the liver cells.     

Function of multidrug resistance-associated protein 2 in acute hepatic failure rats

The function of multidrug resistance-associated protein 2 (Mrp2) in the intestine and liver, as well as intestinal Mrp2 expression, was analyzed in CCl(4)-induced acute hepatic failure rats with hyperbilirubinemia. The plasma level of bilirubin glucuronides, endogenous Mrp2-substrates, was 26 microM at 24 h after CCl(4) treatment. Mrp2 protein levels in jejunum decreased to 41% of control level. Mrp2-mediated efflux of 2,4-dinitrophenyl-S-glutathione (DNP-GSH), an Mrp2-substrate, in jejunum decreased to 31% of control in vitro, and was almost completely suppressed in vivo to the same level as that in the presence of probenecid, an Mrp2-inhibitor. Biliary excretion of DNP-GSH was suppressed to the same level as that inhibited by intravenous probenecid. The suppression of Mrp2 and the increased plasma bilirubin glucuronides recovered within 24 h thereafter. These results suggest that hyperbilirubinemia in disease states may be related to the systemic suppression of Mrp2 function.     

丙酮酸乙酯对大鼠急性肝损伤的保护作用

目的探讨丙酮酸乙酯(EP)对D-氨基半乳糖所致的大鼠急性肝损伤的保护作用及其可能机制。方法采用D-氨基半乳糖复制急性肝损伤(ALI)模型,Wistar大鼠随机分为正常对照组、ALI组、EP干预组。用Westernblot方法测定肝组织高迁移率族蛋白B1(HMGB1),鲎实验法检测血清中内毒素水平,全自动生化分析仪测定肝功能指标。结果与正常对照组相比,ALI后24～72hHMGB1表达显著升高(P<0.01);血清内毒素水平逐渐升高,24h达到高峰;血清丙氨酸转氨酶(ALT)6h和24h有两个峰值,且24h峰值高于6h。与ALI组相比,EP干预组24～72hHMGB1蛋白表达均显著抑制(P<0.01),内毒素和ALT在24、48、72h也均有不同程度下降(P<0.05)。结论EP可减轻D-氨基半乳糖所致的ALI。其机制可能是EP下调了肝组织中HMGB1蛋白表达和降低血清中的肠源性内毒素水平。     

Pharmacokinetic behavior of micafungin in rats with carbon tetrachloride-induced acute hepatic failure

We examined the pharmacokinetic behavior of micafungin, a novel antifungal agent, in rats receiving carbon tetrachloride (CCl4) at a single dose of 2.5 ml/kg. There was no significant change in the total clearance (CL(tot)) in CCl4-treated rats, while the steady-state volume of distribution (Vd(ss)) was significantly increased by CCl4 treatment. Alteration in the serum unbound fraction of micafungin after CCl4 treatment was unlikely in light of the serum albumin, bilirubin, creatinine, and urea nitrogen. The increased Vd(ss) was attributable to augmentation in the accessibility of micafungin to peripheral tissue without impairment of the intrinsic clearance, because slight enhancement of the tissue distribution of micafungin was confirmed following CCl4 treatment.