The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis

Background/Aims

Accurate diagnosis of drug-induced liver injury (DILI) is difficult without considering the possibility of underlying diseases, especially autoimmune hepatitis (AIH). We investigated the clinical patterns in patients with a history of medication, liver-function abnormalities, and in whom liver biopsy was conducted, focusing on accompaniment by AIH.

Methods

The clinical, serologic, and histologic findings of 29 patients were compared and analyzed. The patients were aged 46.2±12.8 years (mean±SD), and 72.4% of patient were female. The most common symptom and causal drug were jaundice (58.6%) and herbal medications (55.2%), respectively.

Results

Aspartate aminotransferase (AST), alanine aminotransferase, total bilirubin, alkaline phosphatase, and γ-glutamyl transpeptidase levels were 662.2±574.8 U/L, 905.4±794.9 U/L, 12.9±10.8 mg/dL, 195.8±123.3 U/L, and 255.3±280.8 U/L, respectively. According to serologic and histologic findings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited significantly higher AST levels (537.1±519.1 vs. 1043.3±600.5 U/L), globulin levels (2.7±0.4 vs. 3.3±0.5 g/dL), and prothrombin time (12.9±2.4 vs. 15.2±3.9 s; P<0.05). Antinuclear antibody was positive in 7 of 21 cases of DILI and all 8 cases of AIH (P=0.002). The simplified AIH score was 3.7±0.9 in the DILI group and 6.5±0.9 in the AIH group (P<0.001).

Conclusions

Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of AIH should be considered.     

A severe case of mandibuloacral dysplasia in a girl

We report on a 16-year-old girl with mandibuloacral dysplasia, a rare progeroid syndrome. She presented at age 2 years with thin skin on the limbs, characteristic face with prominent eyes, a pinched nose, micrognathia, and small mouth. Hair was sparse and brittle. The terminal phalanges were hypoplastic and showed acroosteolysis. On follow-up, hands and feet showed progressive camptodactyly of fingers and toes with total loss of subcutaneous tissue. The clavicles were hypoplastic. Intelligence was normal. We review the literature on the subject and discuss differential diagnosis. © 1992 Wiley-Liss, Inc.     

Method for simultaneous determination of red cell and plasma flow velocityin vitro andin vivo

A method is described which can be used to simultaneously determine the flow velocity of plasma and of red blood cells in small glass tubesin vitro or in living microvessels of the microcirculation. The principle of dual slit photometry is applied to the measurement of plasma flow by determining the passage time of a dye bolus across two photodetectors separated by a variable distance. Measurements performed bothin vitro andin vivo indicate a significant difference (up to 85%) between cellular and plasmatic flow velocity.     

Channeling phage DNA through membranes: from in vivo to in vitro

We discuss current models of phage DNA transport through membranes. We present results that attempt to answer the following questions: is there a single mechanism of transport for all types of phage? is DNA transported as a free molecule or in association with proteins? what is the driving force for transport?     

In vivo and in vitro assessment of mitogen activated protein kinase involvement during quail secondary palate formation

Spatiotemporally regulated cell proliferation and differentiation are crucial for the successful completion of morphogenesis of the vertebrate secondary palate. An understanding of the mechanisms by which these cellular phenomena are regulated during palate development involves the identification of the various signal transduction pathways. In the present study, the presence and activation of mitogen-activated protein (MAP) kinases were investigated during the development of quail secondary palate. The palatal shelves were dissected on days 5–9 of incubation, homogenized, and centrifuged, after which the samples were separated by anion exchange fast protein liquid chromatography. The fractions were analyzed for myelin basic protein (MBP) phosphorylation. In addition, primary cultures of quail palate mesenchymal cells (QPMCs) were treated with epidermal growth factor (EGF) and prepared for MBP phosphorylation assays. A temporally regulated pattern of phosphotransferase activity, characterized by a three-fold increase in phosphotransferase activity toward MBP between days 5 and 8 of incubation, was observed during quail palate development. Western blotting, using MAP kinase antibodies, demonstrated the presence of a 42-kDa isoform between days 5 and 9 of incubation, during which the level of protein remained constant. Antityrosine immunoblotting with 4G10 also detected a 42-kDa protein. Phosphotransferase assays, using either a MAP kinase-specific substrate peptide (S5) or a protein kinase C inhibitor (R3), further confirmed the presence of a MAP kinase in the developing palate of quail. Because diverse biological processes occur concurrently during in vivo palate morphogenesis, the involvement of MAP kinase was explored further in primary cell culture. The data showed that EGF stimulated proliferation and activated 42-kDa MAP kinase in QPMCs. It is suggested that MAP kinase cascade may be involved in growth factor-regulated cell proliferation during morphogenesis of quail secondary palate. Anat. Rec. 252:194–204, 1998. © 1998 Wiley-Liss, Inc.     

Characteristics of anti-Cob in vitro and in vivo: a case study

Serologic and biologic properties of an example of anti-Cob were investigated. The antibody was of the IgG class, and it bound small amounts of complement. It reacted optimally in the albumin-antiglobulin test with little or no enhancement of its reactivity in tests using enzymes. Additional experiments indicated that the Cob antigen is resistant to treatment with chemicals known to destroy other antigens. The antibody caused shortened survival of radiolabeled Co(b+) donor red cells in our patient. At 24 hours, nearly 50 percent of the red cells were no longer detectable in the circulation. It is concluded that anti-Cob is a clinically relevant antibody, a fact that must be taken into account when transfusing patients with anti-Cob.     

Genetic variations of KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2 in drug-induced long QT syndrome patients

Administration of specific drugs may occasionally induce acquired long QT syndrome (aLQTS), a disorder that predisposes to ventricular arrhythmias, typically of the torsade de pointes (TdP) type, and sudden cardiac death. Forme fruste mutations in congenital LQTS (cLQTS) genes have been reported repeatedly as the underlying cause of aLQTS, and are therefore considered as an important risk factor. We evaluated the impact of genetic susceptibility for aLQTS through mutations in cLQTS genes. Five cLQTS genes (KCNH2, KCNQ1, SCN5A, KCNE1, KCNE2) were thoroughly screened for genetic variations in 32 drug-induced aLQTS patients with confirmed TdP and 32 healthy individuals. Missense forme frust mutations were identified in four aLQTS patients: D85N in KCNE1 (two cases), T8A in KCNE2, and P347S in KCNH2. Three other missense variations were found both in patients and controls, and are thus unlikely to significantly influence aLQTS susceptibility. In addition, 13 silent and six intronic variations were detected, four of which were found in a single aLQTS patient but not in the controls. We conclude that missense mutations in the examined cLQTS genes explain only a minority of aLQTS cases.Abbreviations cLQTS Congenital long QT syndrome - aLQTS Acquired long QT syndrome - TdP Torsade de pointes - ECG Electrocardiogram - QTc Corrected QT - PCR Polymerase chain reaction - LD Linkage disequilibrium     

A combined approach to early detect in vitro drug-induced hemostatic changes in preclinical safety

Early detection of drug-induced alterations of hemostasis is challenging. Drugs can affect different components of the Virchow’s triad and measurement of plasmatic coagulation times lacks sensitivity. New techniques for a more global assessment of the hemostasis are now available: the impedance platelet aggregometry, the thromboelastography and the thrombin generation measurement. The aim of this study was to evaluate three techniques (i.e.: Multiplate^®, TEG^® and CAT) for the in vitro detection of the effect of a drug known to induce hemostatic alterations in a preclinical safety environment. Cyclosporine A was chosen and tested at 4 concentrations after solubilization in DMSO in Wistar rats and Beagle dogs. The results obtained were comparable between both species except for the thrombin generation in platelet rich plasma. Enhanced platelet aggregability was observed after ADP stimulation and alterations of the thromboelastograms consisted in decreased maximum amplitude and increased LY30. A dual effect on thrombin generation was observed and suggested that CsA may interact with platelets in rat platelet rich plasma and speed up thrombin generation. The results of this study indicate that using a combined approach on hemostasis testing in preclinical safety it is possible to detect in vitro drug-induced alterations of hemostasis.     

A short review on cell-based biosensing: challenges and breakthroughs in biomedical analysis

Current cell-based biosensors have progressed substantially from mere alternatives to molecular bioreceptors into enabling tools for interfacing molecular machineries and gene circuits with microelectronics and for developing groundbreaking sensing and theragnostic platforms. The recent literature concerning whole-cell biosensors is reviewed with an emphasis on mammalian cells, and the challenges and breakthroughs brought along in biomedical analyses through novel biosensing concepts and the synthetic biology toolbox. These recent innovations allow development of cell-based biosensing platforms having tailored performances and capable to reach the levels of sensitivity, dynamic range, and stability suitable for high analytic/medical relevance. They also pave the way for the construction of flexible biosensing platforms with utility across biological research and clinical applications. The work is intended to stimulate interest in generation of cell-based biosensors and improve their acceptance and exploitation.     

A case of congenital Echovirus 11 infection acquired early in pregnancy

Enterovirus (EV) maternal infection during pregnancy and its relation to fetal developmental pathology are seldomly described. When reported, the main manifestations of EV congenital infections are myocarditis or intra-uterine fetal demise (IUFD). No information on intrauterine Echovirus 11 infection or the effect of transplacental Echovirus 11 infection on development of the fetus has been described in literature up to date (excluding late-pregnancy infections).We report here a case of an extreme form of pulmonary hypoplasia in a neonate, characterized by total failure of development of terminal respiratory units. This pregnancy was marked by spontaneous demise of a co-twin at 14 weeks of gestation (WG), as well as by positive PCR for EV (Echovirus 11 serotype) in the amniotic fluid, performed for moderate pericardial effusion at 22 WG. No signs of cardiac disease were further observed, but at 32 WG a bilateral abnormal lung development was noticed After spontaneous delivery at 38 WG, the child could not be resuscitated, and died at one hour after birth.Pulmonary hypoplasia is usually described following decrease intrapulmonary pressure due to oligohydramnios or compression due to intrathoracic mass of variable cause. However, rare cases of primary pulmonary hypoplasia are also described and usually of unknown etiology. The coexistence in our case of a congenital EV infection and a severe primary pulmonary hypoplasia with congenital acinar aplasia, challenges our understanding of the pathogenesis of this severe pulmonary growth arrest.     

Fibrin-based model for cartilage regeneration: tissue maturation from in vitro to in vivo

One of the crucial points for a successful tissue-engineering approach for cartilage repair is represented by the level of in vitro maturation of the engineered tissue before implantation. The purpose of this work was to evaluate the effect of the level of in vitro maturation of engineered cartilaginous samples on the tissue quality after in vivo implantation. Samples were obtained from isolated swine articular chondrocytes embedded in fibrin glue. The cell-fibrin composites were either cultured in vitro or directly implanted in vivo for 1, 5, and 9 weeks. Other experimental samples were precultured for either 1 or 5 weeks in vitro and then implanted in vivo for 4 additional weeks. All the samples were analyzed by histology, immunohistochemistry, biochemistry, and gene expression. The results strongly suggest that the in vivo culture in this model promoted a better tissue maturation than that obtained in the in vitro condition, and that 1 week in vitro preculture resulted in the primary structuring of the engineered composites and their subsequent maturation in vivo, without affecting the cell viability and activity, while a prolonged in vitro preculture caused a cell and matrix degeneration that could not be rescued in vivo.     

In vitro and in vivo assessment of bone-implant interface: a comparative study.

The present in vitro and in vivo comparison of three bioactive (HA, AP40, RKKP) and three bioinert (Ti6-Al4-V, Al2O3, ZrO2) materials was undertaken to identify which of them provide(s) the most suitable coating for prostheses implanted in patients with altered metabolic status. The experimental design included in vitro tests with human osteoblasts and morphological observations by scanning electron microscopy. For the in vivo evaluation, the materials were implanted in the femoral condyle of ovariectomised and intact female rats, and two months after surgery an X-ray microanalytical study was performed. The in vitro study showed good biocompatibility with all materials. Microanalysis evidenced a similar behaviour with all materials except the two biological glasses. The differences in Ca and P content observed between intact and ovariectomised rats can be explained by the intrinsic capability of biological glasses to undergo surface modifications in the presence of alterations of the bone metabolism. Thus, their use seems to be indicated in recipients with osteoporotic pathologies.     

Rationale for the selection and use of in vitro assays to screen for chemopreventive agents

This issue reports the methods of twelve in vitro assays currently being used to screen potential chemopreventive agents for activity. These assays provide quantitative data to help determine the efficacy and prioritize agents for further development in whole animal screening. It is essential that such in vitro assays provide accurate, consistent, and relevant data to identify and prioritize agents with the most promise to prevent human cancer. The twelve assays presented in this volume are currently providing such data to the National Cancer Institute's Chemoprevention Program.     

Expanding the phenotype of anauxetic dysplasia caused by biallelic NEPRO mutations: A case report

The cartilage hair hypoplasia and anauxetic dysplasia (CHH-AD) spectrum encompasses a group of rare skeletal disorders, with anauxetic dysplasia (ANXD) at the most severe end of the spectrum. Biallelic variants in RMRP, POP1, and NEPRO (C3orf17) have previously been associated with the three currently recognized ANXD types. Generally, all types are characterized by severe short stature, brachydactyly, skin laxity, joint hypermobility and dislocations, and extensive skeletal abnormalities visible on radiological evaluation. Thus far, only five patients with type 3 anauxetic dysplasia (ANXD3) have been reported. Here, we describe one additional ANXD3 patient. We provide a detailed physical and radiological evaluation of this patient, in whom we identified a homozygous variant, c.280C > T, p.(Arg94Cys), in NEPRO. Our patient presented with clinically relevant features not previously described in ANXD3: atlantoaxial subluxation, extensive dental anomalies, and a sagittal suture craniosynostosis resulting in scaphocephaly. We provide an overview of the literature on ANXD3 and discuss our patient's characteristics in the context of previously described patients. This study expands the phenotypic spectrum of ANXD, particularly ANXD3. Greater awareness of the possibility of atlantoaxial subluxation, dental anomalies, and craniosynostosis may lead to more timely diagnosis and treatment.     

Quantitative analysis of thrombomodulin-mediated conversion of protein C to APC: Translation from in vitro to in vivo

Thrombomodulin-bound thrombin cleaves protein C (PC) zymogen in blood plasma producing activated protein C (APC), which exerts anti-coagulant, anti-inflammatory, anti-apoptotic and CNS-protective effects. Recombinant APC and thrombomodulin (TM) are both in clinical studies for management of acute conditions including sepsis. Methods that permit accurate measurement of APC in plasma are needed for clinical monitoring and mechanistic studies in animal models. However, the two existing methods require either long incubation periods with substrate, resulting in high background or they also recognize protein C inhibitor (PCI) complexed with APC (APC:PCI), which convolutes analysis of the amount of APC generated. Here we describe a robust quantitative in vivo assay that measures APC generation at both low levels of human protein C seen in chronic inflammatory disease and at physiological levels that shows a >99% fit with in vitro data.     

抗CD4单抗-表阿霉素在体外和体内对T源性淋巴瘤的作用

目的：探讨抗CD4单克隆抗体免疫结合物对T源性淋巴瘤细胞的特异性杀伤效应。方法：采用低分子右旋糖苷（DextranTl0）作联接桥，将表阿霉素分子偶联到抗CD4单抗上，制备成抗CD4单抗免疫结合物，在体外和体内，经补体非依赖性细胞毒试验、免疫组化试验、CFU-GM集落形成试验．^125I-单抗结合物裸鼠体内示踪等方法测定抗CD4免疫结合物对T-源性淋巴瘤细胞的亲合力和特异性杀伤效应。结果：抗CD4-表阿霉素免疫结合物对T源性淋巴瘤细胞（CEM）有较强亲合力和特异性杀伤力（79％），ECT扫描发现^125I-抗CD4结合物主要富集在含CEM细胞的实体瘤内。结论：^125I-抗CD4单抗标志物和抗CD4-表阿霉素结合物可用于诊断和治疗T-源性淋巴瘤。     

人骨髓间充质干细胞在体内外分化为心血管组织

目的验证人骨髓间充质干细胞(MSC)分化为心血管组织的潜能。方法用5-氮胞杂苷诱导MSC向心肌细胞分化,用VEGF-B诱导向血管内皮细胞分化。异丙肾上腺素法制成NOD/SCID小鼠心肌损伤模型,经尾静脉注入标记的MSC。免疫荧光法检测MSC的体内、外分化。结果在体外,经诱导的MSC表达肌凝蛋白重链和肌钙蛋白I,表达Ⅷ因子相关抗原和CD31。在体内,标记的MSC表达阳性的肌凝蛋白重链和Ⅷ因子相关抗原。结论MSC可分化为心肌和血管内皮细胞,是再生医学的理想种子细胞。     

Methods to measure blood flow velocity of red blood cells in vivo at the microscopic level

Several methods to measure red blood cell velocity in microvessels by electronic means are discussed. Signals are generated by the red blood cells present in the microscopic image of the microvessels. These signals can be converted to obtain an output signal proportional to the actual red blood cell velocity. The method of spatial filtering by interlacing gratings is discussed in terms of a filter with an input signal. Adaptation of optical factors that might improve the velocity measurement is obtained by a mathematical analysis. Different methods of correlation are presented. The temporal correlation (dual slit and video window) and spatial correlation methods are discussed in relation to factors influencing the quality of the correlogram, the peak of which is proportional to red blood cell velocity. The conversion of red blood cell velocity to volume flow is put in perspective.     

Indium-labelled human gut-derived T cells from healthy subjects with strong in vitro adhesion to MAdCAM-1 show no detectable homing to the gut in vivo

Integrin alpha4beta 7 is the principal gut-homing receptor, and it is assumed that expression of this specific integrin directs lymphocytes to the gut in vivo. Adoptive cellular immunotherapy against inflammatory bowel disease (IBD) may depend on the expression of integrin alpha4beta 7 to accomplish local delivery of intravenously injected regulatory T cells in inflamed gut mucosa. The present study aimed to investigate whether in vitro expanded human T cells from the colonic mucosa maintain integrin expression, show in vitro adhesion and retain in vivo gut-homing properties during cultivation. Whole colonic biopsies from healthy subjects were cultured in the presence of interleukin-2 (IL-2) and IL-4. The integrin expression of the cultured T cells was determined by flow cytometry and in vitro adhesion was assessed in a mucosal addressin cell adhesion molecule 1 (MAdCAM-1) adhesion assay. We studied the homing pattern after autologous infusion of 3 x 10(8 111)Indium ((111)In)-labelled T cells in five healthy subjects using scintigraphic imaging. The cultured CD4(+)CD45RO(+) gut-derived T cells express higher levels of integrin alpha4beta 7 than peripheral blood lymphocytes (PBLs) and show strong adhesion to MAdCAM-1 in vitro, even after (111)In-labelling. Scintigraphic imaging, however, showed no gut-homing in vivo. After prolonged transit through the lungs, the T cells migrated preferentially to the spleen, liver and bone marrow. In conclusion, it is feasible to infuse autologous T cells cultured from the gut mucosa, which may be of interest in adoptive immunotherapy. Despite high expression of the gut-homing integrin alpha4beta 7 and adhesion to MAdCAM-1 in vitro, evaluation by (111)In-scintigraphy demonstrated no gut-homing in healthy individuals.