Influência do consumo do café (com e sem cafeína) ou da cafeína isolada sobre a fibrose e a promoção da hepatocarcinogênese química em ratos Wistar machos

Pós-graduação em Patologia - FMB

Adsorvente de micotoxinas em dietas de frangos de corte contendo aflatoxina e fumonisina

Pós-graduação em Ciência e Tecnologia Animal - FEIS

Spontaneous poisoning by Hovenia dulcis in dairy cattle in Southwest Parana, Brazil

Livestock poisoning by plants is a frequent occurrence which determines severe losses, such as the fall in the milk and meat production, the cost of expensive treatments, the state of immunosuppression, or even the animal's death. Cattle ingest toxic plants only when there is food shortage, when they cannot select what they eat, or when they ingest food for preference, which is the case of Hovenia dulcis fruits, very rich in sucrose. This plant is widely distributed in the southern and southeastern Brazilian regions. In literature, there are some cases of severe human liver injury associated with a long-term of H. dulcis leaf and fruit tea intake, and only one report regarding spontaneous poisoning of goats caused by this plant ingestion. However, its toxic effects associated with spontaneous ingestion by cattle have never been reported. This paper reports the first case of spontaneous poisoning in cattle by H. dulcis, which occurred in a dairy farm in southwest Paraná, Brazil. Three cattle individuals showed anorexia, ruminal atony, severe diarrhea and neurological tournament, head pressing, blindness, ataxia, and circling. The necropsy of the animals was done, and the remaining alterations were restricted to the digestive system and brain. The clinical signs presented by the animals are characteristic of polioencephalomalacia (PEM), caused by changes in the thiamine metabolism. Furthermore, clinical signs, gross, and microscopic lesions as well as the large amount of the plant throughout the digestive segment led to a diagnosis.

In vivo and in vitro antioxidant activity and hepatoprotective properties of polyphenols from Halimeda opuntia (Linnaeus) Lamouroux

Antioxidant activity and hepatoprotective properties of the aqueous extract and tetrahydrofuran-extracted phenolic fractions of Halimeda opuntia (Linnaeus) Lamouroux were investigated in rats with chemically induced liver injury. Total polyphenols were determined by using the Folin-Ciocalteau reagent. Liver damage was induced by CCl4 and assessed by a histological technique. Reverse transcription/polymerase chain reaction (RT/PCR) analysis showed increased superoxide dismutase (SOD) and catalase (CAT) gene expression and activities in the group treated with free phenolic acid (FPA) fractions of H. opuntia, suggesting inducing effects on both enzymes. In addition, rats treated with FPA fractions displayed lower liver thiobarbituric acid reactive substance (TBARS) levels than those observed for rats in the CCl4-treated group. These data suggest that the phenolic fractions from H. opuntia may protect the liver against oxidative stress-inducing effects of chemicals by modulating its antioxidant enzymes and oxidative status.

Safety and efficacy of sitaxsentan 50 and 100 mg in patients with pulmonary arterial hypertension

Objective: To assess safety and efficacy of sitaxsentan 50 and 100 mg in patients with pulmonary arterial hypertension (PAH). Background: Sitaxsentan is a highly selective endothelin-A receptor antagonist that was recently withdrawn by the manufacturer because of a pattern of idiosyncratic liver injury. Methods: Before sitaxsentan withdrawal, this 18-week double-blind, placebo-controlled study randomized patients with PAH to receive placebo or sitaxsentan 50 or 100 mg once daily. The primary efficacy endpoint was change from baseline in 6-min walk distance (6MWD) at week 18. Changes in World Health Organization (WHO) functional class and time to clinical worsening (TTCW) were secondary endpoints. The primary efficacy analysis was powered for sitaxsentan 100 mg versus placebo. Results: Of 98 randomized patients, 61% were WHO functional class II at baseline. Improvement from baseline to week 18 in 6MWD occurred with sitaxsentan 100 but not 50 mg; a strong placebo effect was observed. At week 18, WHO functional class was improved or maintained in more patients receiving sitaxsentan 100 mg than placebo (P = 0.038); 0% versus 12% of patients deteriorated, respectively. TTCW was not significantly different for 100-mg sitaxsentan patients than placebo (P = 0.090). Adverse events (AEs) occurring more frequently with sitaxsentan (50 or 100 mg) included headache, peripheral edema, dizziness, nausea, extremity pain, and fatigue; most AEs were of mild or moderate severity. Conclusion: Sitaxsentan 100 mg improved functional class but not 6MWD in PAH patients who were mostly WHO functional class II at baseline. No patient receiving sitaxsentan 100 mg experienced clinical worsening; sitaxsentan was well tolerated. (C) 2011 Elsevier Ltd. All rights reserved.

Mechanismen der Aktivierung und Detoxifizierung von Aflatoxin B 1 in verschiedenen Leberzelltypen von Ratten, Mäusen und Waldmurmeltieren

Zusammenfassung: Die Applikation des Mykotoxins Aflatoxin B1 (AFB1) führt in der Ratte zu Lebertumoren hepatozellulären Ursprungs, während bisher keine transformierende Wirkung dieses Mykotoxins auf Kupffer- und Endothelzellen (Nichtparenchymzellen, NPC) nachgewiesen werden konnte. Diese Resistenzmechanismen der NPC gegenüber AFB1 wurden im ersten Teil dieser Arbeit untersucht. AFB1 ist per se inaktiv, wird jedoch durch Verstoffwechselung in den chemisch reaktiven, an DNA bindenden Metaboliten AFB1-8,9-Epoxid überführt. Daneben stellt die enzymatische Hydroxylierung von AFB1 am Kohlenstoff-9a zum Aflatoxin M1 eine Detoxifizierung dar. Durch HPLC-Analyse der AFB1-Metabolite konnte gezeigt werden, daß in Nichtparenchymzellen (NPC) das Verhältnis von 9a-Hydroxylierung zu 8,9-Epoxidierung höher als in Parenchymzellen (PC) ist. Die AFB1-9a-hydroxylase fördert insbesondere in den NPC der Leber die Bildung des weniger gentoxischen Metaboliten AFM1 und konkurriert daher um die Aktivierung von AFB1 zum mutagenen und kanzerogenen 8,9-Epoxid. Dieser metabolische Unterschied scheint also einen Beitrag zur Resistenz der NPC der Leber gegenüber der hepatokanzerogenen Wirkung von AFB1 zu leisten. Da ein Synergismus zwischen der AFB1-Exposition und einer Infektion mit dem Hepatitis B-Virus (HBV) beim Menschen bezüglich des Auftretens von hepatozellulären Karzinomen zu bestehen scheint, wurde im zweiten Teil dieser Arbeit untersucht, ob die metabolische Aktivierung von AFB1 durch eine HBV-Infektion verstärkt wird. In einem Vergleich der Biotransformation von AFB1 mit mikrosomalen Leberfraktionen von transgenen HBV-Mäusen und Kontrollmäusen wurde keine signifikanten Unterschiede festgestellt. Dagegen wurde bei Virus-infizierten Waldmurmeltieren eine deutlich reduzierte Bildung des AFB1-8,9-Epoxids beobachtet. Es konnte z.T. ein Zusammenhang zwischen den verschiedenen Stadien der Leberschädigung und den Metabolismusraten festgestellt werden, wobei die metabolische Aktivierung mit zunehmender Leberschädigung abzunehmen scheint. Auch hinsichtlich der Aktivitäten verschiedener Cytochrom P450 abhängiger Monooxygenasen wurde eine weitgehende Übereinstimmung mit den durch HPLC ermittelten Metabolitenprofilen des AFB1 beobachtet. Diese Studien mit subzellulären Leberfraktion der transgenen HBV-Mäusen und der Waldmurmeltieren zeigen, daß die Interaktion zwischen Hepatitis und AFB1 nicht mit der verstärkten metabolischer Aktivierung von AFB1 zu erklären ist. TGF-ß1, aus der Gruppe der Cytokine, wird als Mediator bei Entzündungsprozessen in der Leber so z.B. im Verlauf einer Virushepatitis freigesetzt. Aufgrund der besonderen Bedeutung des murinen CYP2A5 (ortholog zum humanen CYP2A6) bei der Aktivierung von AFB1 wurde der Einfluß von TGF-ß1 auf CYP2A5 in Primärkulturen von Maushepatozyten untersucht. Durch Messung der Aktivität der Cumarin-7-hydroxylase sowie durch Bestimmung der Proteinmenge von CYP2A5 mittels Western Blotting konnte zunächst die Induzierbarkeit des CYP2A5-Isoenzyms durch Phenobarbital in kultivierten Hepatozyten der Maus gezeigt werden. Nur bei einer niedrigen TGF-ß1-Konzentration wurde eine leicht erhöhte Expression von CYP2A5 festgestellt, ansonsten führte die Behandlung der kultivierten Maushepatozyten mit TGF-ß1 zu einer dosisabhängigen Verminderung der Expression von CYP2A5.

Dati preliminari dello studio multicentrico caso-controllo "Grave danno epatico acuto indotto da farmaci"

Il danno epatico indotto dall'assunzione di farmaci viene comunemente indicato con il termine inglese DILI (Drug-Induced Liver Injury). Il paracetamolo rappresenta la causa più comune di DILI, seguito da antibiotici, FANS e farmaci antitubercolari. In particolare, i FANS sono una delle classi di farmaci maggiormente impiegate in terapia. Numerosi case report descrivono pazienti che hanno sviluppato danno epatico fatale durante il trattamento con FANS; molti di questi farmaci sono stati ritirati dal commercio in seguito a gravi reazioni avverse a carico del fegato. L'ultimo segnale di epatotossicità indotto da FANS è associato alla nimesulide; in alcuni paesi europei come la Finlandia, la Spagna e l'Irlanda, la nimesulide è stata sospesa dalla commercializzazione perché associata ad un'alta frequenza di epatotossicità. Sulla base dei dati disponibili fino a questo momento, l'Agenzia Europea dei Medicinali (EMA) ha recentemente concluso che i benefici del farmaco superano i rischi; un possibile aumento del rischio di epatotossicità associato a nimesulide rimane tuttavia una discussione aperta di cui ancora molto si dibatte. Tra le altre classi di farmaci che possono causare danno epatico acuto la cui incidenza tuttavia non è sempre ben definita sono gli antibiotici, quali amoxicillina e macrolidi, le statine e gli antidepressivi.Obiettivo dello studio è stato quello di determinare il rischio relativo di danno epatico indotto da farmaci con una prevalenza d'uso nella popolazione italiana maggiore o uguale al 6%. E’ stato disegnato uno studio caso controllo sviluppato intervistando pazienti ricoverati in reparti di diversi ospedali d’Italia. Il nostro studio ha messo in evidenza che il danno epatico da farmaci riguarda numerose classi farmacologiche e che la segnalazione di tali reazioni risulta essere statisticamente significativa per numerosi principi attivi. I dati preliminari hanno mostrato un valore di odds ratio significativo statisticamente per la nimesulide, i FANS, alcuni antibiotici come i macrolidi e il paracetamolo.

Gewebeprotektive und antiinflammatorische Wirkung von humanem Choriogonadotropin in Mausmodellen mit autoimmunem Leberschaden

Während der Schwangerschaft kommt es häufig zu einer spontanen Verbesserung von klinischen Symptomen der autoimmunen Hepatitis und anderen Th1-vermittelten Autoimmunerkrankungen. Die Gründe hierfür sind bis heute noch nicht vollständig aufgeklärt. Eines der wichtigsten Hormone in der Schwangerschaft ist das humane Choriogonadotropin (hCG), welches schon in der frühen Schwangerschaft eine entscheidende Rolle spielt. Es sorgt für die Stimulation des Corpus luteums, wodurch es zur Ausschüttung von Progesteron kommt und somit die Einnistung der Blastozyte gewährleistet und die Abstoßung des Embryos verhindert wird. In dieser Arbeit wurden Effekt und Signalweg von hCG in primären murinen und humanen Hepatozyten sowie in Mausmodellen mit T-Zell-abhängigem Leberschaden untersucht. hCG führte sowohl bei akuten als auch bei chronischen Leberschäden zu einer drastischen Senkung der Aspartat-Aminotransferase, einem Indikator für Lebererkrankungen. Die Histologie der Leber hCG-behandelter Tiere wies außerdem signifikant weniger apoptotische Zellen und eine deutliche Reduktion infiltrierender CD4+ T-Zellen auf. Die Analyse des hCG-Signalweges zeigte, dass hCG die Langlebigkeitsproteine Foxo3a und Sirt1 reguliert. Die Aktivierung des PI3-Kinase/Akt-Signalweges durch hCG führte zu einem Transport des Transkriptionsfaktors Foxo3a aus dem Zellkern, wodurch die proapoptotischen Zielgene Bim und Puma nicht mehr transkribiert werden können. Eine zusätzliche Hemmung von Foxo3a erfolgte durch die Aktivierung der Deacetylase Sirt1, indem diese phosphoryliert wird und in den Zellkern transloziert. In weiteren Untersuchungen wurde der immunsuppressive Effekt von hCG näher betrachtet. Dabei stellte sich heraus, dass hCG effektiv die proteolytische Aktivität der Caspase-3 in Hepatozyten hemmt, wodurch die Ausschüttung der biologisch aktiven Form von Interleukin-16, einem chemotaktischen Faktor für CD4+ Zellen, herabgesetzt wird. Dadurch wird die Leber erfolgreich vor der Infiltration durch autoaggressive CD4+ Zellen geschützt. IL-16 spielt bei vielen inflammatorischen Krankheiten eine Rolle, was auch in dieser Arbeit durch den Nachweis hoher IL-16-Konzentrationen in Seren von Patienten mit autoimmuner Hepatitis bestätigt werden konnte. Die in dieser Studie beschriebene Wirkung von hCG und die Tatsache, dass hCG ein bereits bewährtes und auf Nebenwirkungen getestetes Medikament bei Infertilität ist, macht es zu einem idealen Kandidaten für immunsuppressive Therapieansätze bei akuten und chronisch entzündlichen Lebererkrankungen.

Atorvastatin attenuates hepatic fibrosis in rats after bile duct ligation via decreased turnover of hepatic stellate cells

Activation of hepatic stellate cells (HSC) and transdifferentiation to myofibroblasts following liver injury is the main culprit for hepatic fibrosis. Myofibroblasts show increased proliferation, migration, contraction, and production of extracellular matrix (ECM). In vitro, HMG-CoA reductase inhibitors (statins) inhibit proliferation and induce apoptosis of myofibroblastic HSC. To investigate the antifibrotic effects of atorvastatin in vivo we used bile duct ligated rats (BDL).

A new model of interactive effects of alcohol and high-fat diet on hepatic fibrosis

Alcoholic steatohepatitis (ASH) and nonalcoholic steatohepatitis (NASH) are the most frequent conditions leading to elevated liver enzymes and liver cirrhosis, respectively, in the Western world. However, despite strong epidemiological evidence for combined effects on the progression of liver injury, the mutual interaction of the pathophysiological mechanisms is incompletely understood. The aim of this study was to establish and analyze an experimental murine model, where we combined chronic alcohol administration with a NASH-inducing high-fat (HF) diet.

[Pharmacotherapy of hyperthyreosis--adverse drug reactions]

The antithyroid drugs mainly include thioimidazole (carbimazole, methimazole=thiamazole) and propylthiouracil. After absorption, carbimazole is rapidly metabolized to methimazole and thus switching between these two drugs should not be considered in case of side effects. Furthermore, in case of side effects, sometimes even cross reactions between thioimidazoles and propylthiouracil occur. Common and typical adverse reactions of antithyroid drugs include dose dependent hypothyroidism and thus thyroid function should be repeatedly checked while the patient is on antithyroid drugs. Furthermore, pruritus and rash may develop. In this case, one might try to switch from thioimidazoles to propylthiouracil or vice versa. Antithyroid drugs may cause mild dose dependent neutropenia or severe allergy-mediated agranulocytosis, which typically occurs during the first three months of treatment, has an incidence of 3 per 10,000 patients and cross reactivity between thioimidazoles to propylthiouracil may occur. Rarely, antithyroid drugs can cause aplastic anemia. Mainly propylthiouracil, but sometimes also methimazole may lead to an asymptomatic transient increase in liver enzymes or to severe, even lethal liver injury of cholestatic or hepatocellular pattern. Since propylthiouracil associated liver injury was observed increasingly among children and adolescent, it has been suggested to prefer thioimidazoles for these patients. Because of these potential serious adverse effects, physicians should advise patients to immediately seek medical help if they get a fever or sore throat or malaise, abdominal complaints or jaundice, respectively. Furthermore, arthralgias may develop in 1-5% of patients under both antithyroid drugs. Since arthralgias may be the first symptom of more serious immunologic side effects, it is recommended to stop the antithyroid drug in this case. Drug induced polyarthritis mainly develops during the first month of therapy, whereas ANCA-positive vasculitis is generally observed only after long term exposure to propylthiouracil or very rarely with the thioimidazoles. The teratogenic risk of the thioimidazoles is somewhat higher (Aplasia cutis congenita), that is why one generally recommends preferring propylthiouracil during pregnancy. During breast feeding both, thioimidazoles or propylthiouracil, may be administered. Nowadays, perchlorate is only used short term in case of latent hyperthyroidism before administering iodine-containing contrast agents. Therefore, the known side effects, which usually are only observed after long term treatment, are not an issue any more.

Mechanisms of hepatocellular toxicity associated with dronedarone--a comparison to amiodarone

Dronedarone is a new antiarrhythmic drug with an amiodarone-like benzofuran structure. Shortly after its introduction, dronedarone became implicated in causing severe liver injury. Amiodarone is a well-known mitochondrial toxicant. The aim of our study was to investigate mechanisms of hepatotoxicity of dronedarone in vitro and to compare them with amiodarone. We used isolated rat liver mitochondria, primary human hepatocytes, and the human hepatoma cell line HepG2, which were exposed acutely or up to 24h. After exposure of primary hepatocytes or HepG2 cells for 24h, dronedarone and amiodarone caused cytotoxicity and apoptosis starting at 20 and 50 µM, respectively. The cellular ATP content started to decrease at 20 µM for both drugs, suggesting mitochondrial toxicity. Inhibition of the respiratory chain required concentrations of ~10 µM and was caused by an impairment of complexes I and II for both drugs. In parallel, mitochondrial accumulation of reactive oxygen species (ROS) was observed. In isolated rat liver mitochondria, acute treatment with dronedarone decreased the mitochondrial membrane potential, inhibited complex I, and uncoupled the respiratory chain. Furthermore, in acutely treated rat liver mitochondria and in HepG2 cells exposed for 24h, dronedarone started to inhibit mitochondrial β-oxidation at 10 µM and amiodarone at 20 µM. Similar to amiodarone, dronedarone is an uncoupler and an inhibitor of the mitochondrial respiratory chain and of β-oxidation both acutely and after exposure for 24h. Inhibition of mitochondrial function leads to accumulation of ROS and fatty acids, eventually leading to apoptosis and/or necrosis of hepatocytes. Mitochondrial toxicity may be an explanation for hepatotoxicity of dronedarone in vivo.

HLA haplotype determines hapten or p-i T cell reactivity to flucloxacillin

Drug-induced liver injury (DILI) is a main cause of drug withdrawal. A particularly interesting example is flucloxacillin (FLUX)-DILI, which is associated with the HLA-B*57:01 allele. At present, the mechanism of FLUX-DILI is not understood, but the HLA association suggests a role for activated T cells in the pathomechanism of liver damage. To understand the interaction among FLUX, HLA molecules, and T cells, we generated FLUX-reacting T cells from FLUX-naive HLA-B*57:01(+) and HLA-B*57:01(-) healthy donors and investigated the mechanism of T cell stimulation. We found that FLUX stimulates CD8(+) T cells in two distinct manners. On one hand, FLUX was stably presented on various HLA molecules, resistant to extensive washing and dependent on proteasomal processing, suggesting a hapten mechanism. On the other hand, in HLA-B*57:01(+) individuals, we observed a pharmacological interaction with immune receptors (p-i)-based T cell reactivity. FLUX was presented in a labile manner that was further characterized by independence of proteasomal processing and immediate T cell clone activation upon stimulation with FLUX in solution. This p-i-based T cell stimulation was restricted to the HLA-B*57:01 allele. We conclude that the presence of HLA-B*57:01 drives CD8(+) T cell responses to the penicillin-derivative FLUX toward nonhapten mechanism.

Oral imatinib treatment reduces early fibrogenesis but does not prevent progression in the long term

BACKGROUND/AIMS: Transactivated hepatic stellate cells (HSCs) represent the key source of extra cellular matrix (ECM) in fibrotic liver. Imatinib, a potent inhibitor of the PDGF receptor tyrosine kinase, reduces HSC proliferation and fibrogenesis when treatment is initiated before fibrosis has developed. We tested the antifibrotic potential of imatinib in ongoing liver injury and in established fibrosis. METHODS: BDL-rats were gavage fed with 20 mg/kg/d imatinib either early (days 0-21) or late (days 22-35) after BDL. Untreated BDL-rats served as controls. ECM and activated HSCs were quantified by morphometry. Tissue activity of MMP-2 was determined by gelatin zymography. mRNA expression of TIMP-1 and procollagen alpha1(I) were measured by RT-PCR. Liver tissue concentration of imatinib was measured by tandem mass spectrometry. RESULTS: Early imatinib reduced ECM formation by 30% (P=0.0455) but left numbers of activated HSCs and procollagen I expression unchanged. MMP-2 activity and TIMP-1 expression were reduced by 50%. Late imatinib treatment did not alter histological or molecular markers of fibrogenesis despite high imatinib tissue levels. CONCLUSIONS: The antifibrotic effectiveness of imatinib is limited to the early phase of fibrogenesis. In ongoing liver injury other mediators most likely compensate for the inhibited PDGF effect.

Hepatitis C coinfection is independently associated with decreased adherence to antiretroviral therapy in a population-based HIV cohort

OBJECTIVE: To characterize the impact of hepatitis C (HCV) serostatus on adherence to antiretroviral treatment (ART) among HIV-infected adults initiating ART. METHODS: The British Columbia HIV/AIDS Drug Treatment Program distributes, at no cost, all ART in this Canadian province. Eligible individuals used triple combination ART as their first HIV therapy and had documented HCV serology. Statistical analyses used parametric and non-parametric methods, including multivariate logistic regression. The primary outcome was > or = 95% adherence, defined as receiving > or = 95% of prescription refills during the first year of antiretroviral therapy. RESULTS: There were 1186 patients eligible for analysis, including 606 (51%) positive for HCV antibody and 580 (49%) who were negative. In adjusted analyses, adherence was independently associated with HCV seropositivity [adjusted odds ratio (AOR), 0.48; 95% confidence interval (CI), 0.23-0.97; P = 0.003], higher plasma albumin levels (AOR, 1.07; 95% CI, 1.01-1.12; P = 0.002) and male gender (AOR, 2.53; 95% CI, 1.04-6.15; P = 0.017), but not with injection drug use (IDU), age or other markers of liver injury. There was no evidence of an interaction between HCV and liver injury in adjusted analyses; comparing different strata of HCV and IDU confirmed that HCV was associated with poor adherence independent of IDU. CONCLUSIONS: HCV-coinfected individuals and those with lower albumin are less likely to be adherent to their ART.