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Critical appraisal of 13C breath tests for microsomal liver function: aminopyrine revisited
Authors:Kirsten E. Pijls  Hanne de Vries  Suzan Nikkessen  Aalt Bast  Will K. W. H. Wodzig  Ger H. Koek
Affiliation:1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, , Maastricht, the Netherlands;2. Department of Toxicology, Maastricht University, , Maastricht, the Netherlands;3. Department of Clinical Chemistry and Stable Isotope Research Center (SIRC), Maastricht University Medical Center, , Maastricht, the Netherlands
Abstract:As liver diseases are a major health problem and especially the incidence of metabolic liver diseases like non‐alcoholic fatty liver disease (NAFLD) is rising, the demand for non‐invasive tests is growing to replace liver biopsy. Non‐invasive tests such as carbon‐labelled breath tests can provide a valuable contribution to the evaluation of metabolic liver function. This review aims to critically appraise the value of the 13C‐labelled microsomal breath tests for the evaluation of metabolic liver function, and to discuss the role of cytochrome P450 enzymes in the metabolism of the different probe drugs, especially of aminopyrine. Although a number of different probe drugs have been used in breath tests, the perfect drug to assess the functional metabolic capacity of the liver has not been found. Data suggest that both the 13C2‐aminopyrine and the 13C‐methacetin breath test can play a role in assessing the capacity of the microsomal liver function and may be useful in the follow‐up of patients with chronic liver diseases. Furthermore, CYP2C19 seems to be an important enzyme in the N‐demethylation of aminopyrine, and polymorphisms in this gene may influence breath test values, which should be kept in mind when performing the 13C2‐aminopyrine breath test in clinical practice.
Keywords:aminopyrine  breath tests  caffeine  cytochrome P450 enzymes  genetic polymorphisms  liver function  methacetin  microsomal  phenacetin
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